Many couples are eager to have children but have to work hard to overcome unexpected obstacles to parenthood. Then there are couples like Bill and Julie Botten.
Bill Botten is paralyzed from the chest down from an auto accident 17 years ago and unable to impregnate his wife naturally. Yet Bill and Julie Botten, who met in their native Kansas after his accident and married in 1994, have shared a deep desire for a family and children of their own.
Until fairly recently, there was no hope of fatherhood for men like Bill. But today, surprising medical advances are providing new options for a growing number of couples that include disabled men.
Four years ago, the Gaithersburg couple learned about a program at Washington's National Rehabilitation Hospital that helps disabled men produce and release sperm. They signed up eagerly, but went through more than two years of difficult and disappointing attempts before the treatment worked.
Today, the Bottens are the delighted, though exhausted, parents of 2-year-old triplets--Stephenson, Elisa and Jude (named for the patron saint of lost causes).
"When a person becomes disabled, it's easy to lose hope that good things will happen to you. But very good things have happened to me--so much more than I ever expected," said Bill Botten, 40, who is director of accessible seating and services at the MCI Center.
"Whenever I go out with the kids and see people watching us, I think this is very good for disabled people," he said. "The more we're seen as regular people who want to work and have families like everyone else, the better it will be for everyone."
The process that enabled the Bottens to conceive is not easy. The technology that allows sperm to be collected from men with spinal cord injuries comes from veterinary science, and is called "electro-ejaculation." It involves stimulating damaged nerves with a 10- to 15-volt electrical impulse to allow an ejaculation.
The semen collected after ejaculation is used for artificial insemination or in-vitro fertilization. Both techniques were used with the Bottens, who succeeded after an in-vitro fertilization--which may account for the Bottens' multiple birth.
The process sometimes felt "more than a little embarrassing," Bill Botten said. "Basically, we had a team of doctors in two different rooms working to allow us to 'have sex.' It was a difficult experience, but the result certainly made it all worthwhile."
The team working with Bill Botten was led by Stephen W.J. Seager, a medical pioneer in the fields of both human and endangered animal species reproduction, and spinal cord specialist Lauro Halstead. Seager is based at the National Rehabilitation Hospital, but he travels the world to work with disabled men and with animals from cheetahs and leopards to rhinos and pandas. He recently returned from a trip to Bosnia, where he said he worked with 18 war-injured men in three days. Another 700 disabled men in Bosnia, he said, are on a waiting list, hoping to become fathers soon.
"There seems to be a fundamental desire for people to have their own biological children," said Seager. "Many of the men we work with very much wanted to have their own children, but never thought it would be possible. But our success rate now in terms of producing fertile sperm is about 90 percent."
Seager, a veterinarian by training, said that rate is much higher than when he started in 1986. The men tend to be healthier now, he pointed out, with fewer of the urinary tract infections that can undermine fertility. In addition, the technology for collecting and handling the sperm has improved greatly and is generally covered by insurance.
There is a large and growing population of men who might use Seager's services. According to the National Spinal Cord Statistical Center, 10,000 Americans suffer from spinal cord injuries every year, and more than 80 percent of them are men.
Seager said that an estimated 250 babies have been conceived through electro-ejaculation, including the child of a Texas couple who are both wheelchair-bound. That's enough babies to make the procedure fairly routine medically. But for the general public, it is little known and so people like Bill and Julie Botten remain pioneers.
"When I was pregnant, a lot of people just assumed the father wasn't Bill, that it wasn't possible for him," said Julie Botten, 35, a sales representative for the pharmaceutical company Biogen. "It kind of bothered me that people thought they knew something that they didn't. But that was a small thing compared to the miracle that allowed all this to happen."
"Basically, we just feel lucky that we're alive today," she said, noting that her husband is a very involved, hands-on father. "Not very long ago, there was no way we could possibly have kids."
CAPTION: Elisa Botten and her father, Bill, top, were among those who gathered in June to celebrate a program that helps disabled men become fathers. Rachel Harrison, above left, holds her father's wheelchair. Stephenson Botten, above right, makes a playful face.