Stephen and Brenda MacDonald had been married five years, but they wanted to wait until they had their own home before starting a family.
On May 21, 1981, three months after they moved into a house in Laurel, the 24-year-old machinist crashed his motorcycle into a guardrail.
He was riding "too fast" on a one-lane bridge, he remembers. When he hit the rail, his motorcycle stopped. But his body kept going, zooming into space before plummeting onto the railroad tracks 25 feet below.
Almost 11 years later, Mr. MacDonald blames "partly alcohol and partly speed" for the accident that left him paralyzed from the chest down. He and his wife were sure they would never have a child of their own.
But they were wrong.
On Jan. 2, the MacDonalds became the parents of Sarah Elizabeth, the first baby conceived and born in Maryland with the help of electroejaculation, a new technique also known as electrically-assisted recovery of sperm.
Today, Stephen and Brenda MacDonald are celebrating at the Greater Baltimore Medical Center in Towson where their 19-day old baby was conceived after her father's sperm was artificially inseminated into her mother's uterus.
Electroejaculation is increasingly being used across the country to enable men with spinal-cord injuries to become fathers. Victims of severe spinal injuries usually suffer secondary infertility. About 10,000 men in this country suffer such injuries each year.
The procedure involves using electrodes to stimulate specific nerves in the male reproductive tract to induce ejaculation. It requires inserting a probe in the rectum. In most cases, local anesthesia is not required because patients have no sensation where the stimulation would be felt, experts say.
The procedure has shown a 75 percent to 85 percent success rate in obtaining sperm needed for reproduction, said Dr. Brad Lerner. He and his partner, Dr. Joseph Murphy, are the only specialists in Maryland offering the therapy. The Towson urologists work in conjunction with the GBMC male and female infertility program, which is headed by Dr. Jairo Garcia.
Brenda MacDonald, 33, learned she was pregnant last April after her second try with artificial insemination. Sarah was born at Holy Cross Hospital in Silver Spring.
"Those were ecstatic moments for both of us," said Mrs. MacDonald, assistant manager of a Laurel finance company, referring to the pregnancy and the birth of 7-pound, 7-ounce Sarah. "Every minute of this experience was worth it -- the strain, the money, everything."
"Our wildest dream has come true," said Mr. MacDonald, 35. "We now have what we've always wanted -- a child of our own -- not just Brenda's or someone else's.
"Sarah has a full head of black hair, my mouth, her mom's nose, and she's very cute," said the beaming father.
Dr. Lerner shares the MacDonalds' joy. "I have two children of my own and I know what that means. I believe the ultimate gift I can give to somebody is to help them have a child of their own."
The therapy is now available in a dozen medical institutions in Washington, D.C., Virginia, California, Illinois, Connecticut, Texas and Michigan. The early work was done at Baylor College of Medicine in Texas and the University of Michigan.
In four years there have been 87 reported births worldwide using this technique -- most of them in the United States, according to Dr. Stephen W.J. Seagar, of the National Rehabilitation Center in Washington.
A veterinarian, Dr. Seagar developed the electroejaculation equipment that urologists now use for human patients. He was instrumental in getting electroejaculation studies under way at Baylor and Michigan.
Without the electroejaculation procedure, men with spinal-cord injuries have no chance of fathering a child, Dr. Lerner stressed. "These men are producing sperm and the other fluid that makes up the semen but, because of their injury, there is no stimulation for those fluids to be released into the penis as an ejaculate," he explained.
"With the electrical stimulation, we are actually stimulating all those structures to contract and release their fluids. We collect and process the fluids and then use them in the insemination."
While uncommon in the general population, ejaculatory failure is a harsh reality for the majority of patients who have spinal cord injuries.
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.
Research published recently in the Journal of Urology has stressed that sexuality in patients who have spinal-cord injuries is an important concept.
"While the nature of sexual response may be altered, sexual activity persists and is enjoyed by a large segment of the spinal cord injury population," said the report from the University of Michigan and Texas A&M; University.
Ejaculation may also be impaired in young, fertile men who have undergone testicular cancer surgery or colon surgery and men with nerve diseases, like multiple sclerosis and diabetes. However, they would require general anesthesia before undergoing electroejaculation, according to Dr. Lerner.
The MacDonalds began their quest for parenthood by seeking the help of of Dr. Allan Levine, a University of Maryland Medical Center orthopedist. Dr. Levine had followed Mr. MacDonald's case all the way from the Maryland Shock Trauma Center, where Mr. MacDonald was treated after his accident.
"Brenda had clipped an article on electroejaculation therapy that was being offered in Chicago. So we knew that it was possible," said Mr. MacDonald. "Levine led me to Lerner. I was his second patient, but the first to become a father."
Since Dr. Lerner has been doing electroejaculation therapy, he has had 12 patients. The wives of two of these patients are expected to be artificially inseminated soon, he said.
His patients undergo electroejaculation once a month for up to six months. It usually takes at least four stimulations to get the healthy sperm needed for fertilization. Since sperm in spinal-cord injury patients lies dormant for a number of years due to ejaculatory failure, the sperm initially released may be infected and inadequate in number.
Dr. Lerner charges about $575 for each stimulation, so the bill for the electroejaculation alone could cost more than $3,400. In addition, a couple would have to pay separate artificial insemination costs and any laboratory fees, which could add up to another $2,000.
"I'm not interested in getting wealthy by doing this procedure," said Dr. Lerner. "I'm interested in helping people have families. Since this is a new procedure and since perhaps only one or two insurance carriers are reimbursing for it, we are willing to work things out with our patients.
"We are not about to put a financial burden on these families who already are fiscally strained," he said.
As of Jan. 1, Blue Cross-Blue Shield of Maryland has said it will cover electroejaculation, Dr. Lerner said, but the extent of the coverage will probably depend on an individual's policy.