As the number of women with Spinal Cord Injury (SCI) has increased over the years, a much-needed focus on fertility of these women has emerged. The changes that a woman undergoes neurologically may have an influence on her sexual function, reproductive health, pregnancy and psychosocial health. Furthermore, acute and long-term neural responses to traumatic SCI are affected by the female reproductive neuro-endocrine system.
The evolution of a female’s fertile life covers about 30 years in which a woman can become pregnant. These years can be divided into stages consisting of Stage 1: Early Reproductive, Stage 2: Peak Reproductive, Stage 3: Late Reproductive, Stage 4: Early Perimenopausal, and Stage 5: Late Perimenopausal. All stages may be impacted by the changes that an SCI has on a woman. Depending on the age of the woman and the time in her life that she sustained an SCI, providers should be prepared to offer advice on pre- and post-conception. This instructional course will review the state-of-the art research of the impact of SCI on the female’s continuum of becoming pregnant and having children.
I. Sexual Function: (25 minutes) Marcalee Alexander, MD
SCI has a significant impact on sexual behavior and function in women. Participation in sexual intercourse decreases after SCI. Reasons for this are multifactorial and related to SCI dependent physiological and psychological issues.

II. Pregnancy, Labor and Delivery: (25 minutes) Amie (Jackson) McLain, MD
Reproductive health and disability affect each other in such a way that the conditions of pregnancy and SCI must be managed together. A woman’s fertility may not be directly affected after SCI but other age-related issues are relevant as women with SCI are at later fertility stages than ablebody women when the decision is made to become pregnant. Obstetrical conditions including labor and delivery, can have unique challenges due to the sequela of SCI.

III. Fertility, Having Children, and Lactation: (25 minutes) Nora Sandholdt and Erika Nilsson
These experts will discuss Sweden’s SCI-parenting project and their efforts to gather and spread knowledge about fertility, pregnancy and parenting with SCI. Since 2007 a wealth of information has contributed to the creation of networks online and IRL across Sweden. They have advocated the necessity of being an expert on your own body when living with a SCI and having health care issues. The goal has been to strengthen and support women with SCI and offer a platform as a model for the exchange of experiences.

IV. Questions/answers with panel.

Learning Objectives:
1. Describe how changes in sexual function after SCI may directly or indirectly affect a woman’s ability to conceive.
2. Explain the way an SCI interferes with normal pregnancy and how pregnancy may exacerbate the secondary conditions from SCI.
3. List 4 ways mothers with SCI face challenges with parenting.
4. Give preconception information to women with SCI who are considering becoming pregnant and having children.