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Ejaculatory dysfunction and impairment of semen quality are commonly found in men after spinal cord injury (SCI). Each condition alone and in combination has the potential to interfere with the ability of the individual and his partner to have children. Over the past several decades, clinical treatments and techniques have been developed and advances in assisted reproductive techniques have taken place that now allow spinal cord-injured men to father children. This review will focus on the current understanding of ejaculatory dysfunction, semen characteristics, and clinical treatments and techniques to enhance fertility in men with SCI.