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Paralyzed man hopes for a family New procedure may help with pregnancy

THE BALTIMORE EVENING SUN

For Charles Lamoreaux and his wife, Maureen, wanting to have a child is a natural outgrowth of their loving relationship.

Both were raised in families that had five children each, so they're accustomed to sharing, affection and working things out. And they really like kids. They work with youths at the Reisterstown Baptist Church.

But male infertility -- triggered by a shattering highway tragedy that left Charles paralyzed -- has kept the Baltimore County couple from realizing the dream of having their own child.

At 16, Chuck, as he prefers to be called, was a strapping 6 feet and 180 pounds. His life changed one winter night on a Pennsylvania mountain road. He lost control of a Volkswagen Squareback, rolled over 1 1/2 times and rammed into a tree.

He escaped death, and although he was paralyzed from the chest down, his arms and hands miraculously were spared. He has normal function in his arms. His hands are only minimally limited.

"I can write and I can eat without braces on my hands," said Chuck, 31, in an interview this week. "What saved my life was the size of my 16 1/2 -inch neck. Otherwise, I would have died."

Due to a reawakening interest in infertility among spinal cord injury patients, Chuck and Maureen, 29, have new hope.

Next month, a procedure that has yielded at least 50 babies for similar couples across the country, will be available for the first time in Maryland, at Greater Baltimore Medical Center. Chuck and Maureen plan to be among the first couples to sign up for it.

Because of his spinal cord injury, Chuck cannot impregnate his wife. He has ejaculatory failure, but he is not impotent. He and his wife can have sex but he cannot eject semen which contains sperm that penetrates the female egg to fertilize it.

While uncommon in the general population, ejaculatory failure is a devastating reality for the majority of the 10,000 new spinal cord injury patients in this country each year.

Only 7 percent of these patients are able to ejaculate, according to the scientific literature. Almost one-third of these patients, aged 25 and under, are married or subsequently marry and want to become natural parents.

For the past three years, the procedure, known as electroejaculation, has been tested at the Baylor College of Medicine in Houston, Texas, and the University of Michigan at Ann Arbor. Electroejaculation induces ejaculation with electro-stimulation by way of a rectal probe. It has shown a 75 percent to 85 percent success rate in obtaining sperm needed for reproduction, according to Journal of Urology reports.

At Baylor and at Michigan, sperm produced by electro-stimulation has provided an opportunity for the artificial insemination of spouses and for the couples to become natural parents.

"We underwent this therapy a year ago in California, but ran out of time and money," Chuck said. He took a leave of absence from his job as a personnel specialist at the federal Health Care Financing Administration to give the therapy a try. His wife, a Sinai Hospital nurse, joined him.

"The electroejaculation worked for me, but Maureen's two attempts at artificial insemination failed," he said. "Her ovulation timing might have been off. But, we haven't given up. We still have the same dream."

Through the efforts of Dr. Brad Lerner, a urologist with a special interest in male reproductive medicine, GBMC will be one of 13 medical centers in the country doing further studies on the efficacy and safety of the therapy.

Lerner, who is a clinical instructor in urology at the University of Maryland, spent four months last year learning how to do electroejaculation under experts at Texas A&M; University at College Station, and at the National Rehabilitation Institute in Washington, D.C.

At GBMC, the therapy will be offered on an outpatient basis by urologists in a group practice, who will work closely with Dr. Jairo Garcia, who heads GBMC's male and female infertility service.

"To date, we have reports of at least 50 take-home babies in the last three years, using electroejaculation," Lerner said. "There may even be more. At the first World Congress on Electroejaculation next February in California, we hope to set up a registry, just like the in vitro fertilization registry, to keep an accurate record of births."

As a physician interested in infertility and fertility, Lerner said, "I believe the ultimate thing I can do for a couple is to help them conceive a child. I feel strongly about that. I have two young children of my own."

As early as 1922, it was noted that electrocution used for corporal punishment in human beings caused seminal emissions. Over the years, veterinarians have compiled a vast amount of experimental knowledge in this field. Dr. Stephen W. J. Seager, a veterinarian, was instrumental in getting the recent electroejaculation studies under way at Baylor and the University of Michigan, Lerner said.

The first human pregnancy resulting from the procedure was not achieved until 1975. Since then, a variety of devices have been used with varying results, according to the literature.

Recent research in the Journal of Urology has stressed that sexuality in spinal cord injury patients is an important concept, which until recently was neglected by health care professionals.

"While the nature of sexual response may be altered, sexual activity persists and is enjoyed by a large segment of spinal cord injury population," said the report from the University of Michigan and Texas A&M.;

In the electroejaculation process, specific nerves in the male reproductive tract are stimulated with electrodes in the rectum, Lerner explained. The majority of the patients would not even require local anesthesia because they do not have any sensation in the area where the stimulation would be felt. No significant injuries have been tied to the procedure, Lerner said.

Young, fertile men who have undergone testicular cancer surgery or colon surgery and men with nerve diseases, like multiple sclerosis and diabetes, also have ejaculatory dysfunction. They, however, would require general anesthesia before undergoing electroejaculation, Lerner said.

A patient would get about six months of therapy. The procedure, which would be done once a month, probably would require several stimulations to get the healthy sperm needed for fertilization.

The cost for each monthly procedure would be $450. Lerner said. The bill for the electroejaculation alone could cost as much as $2,700, or possibly more, if additional therapy was deemed necessary. Over and above that, the couple would have to pay separate artificial insemination costs and any laboratory fees.

Insurance coverage of new techniques, which some may perceive as still experimental, is spotty, Lerner said. For example, some insurance policies still do not cover artificial insemination.

Lerner said he plans to write to the State Insurance Division, urging the agency to take action to soften the financial blow for couples who seek electroejaculation to help them have children.

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