Becoming a Parent Despite a SCI

Dr. Ibrahim consults SCI patient about fertility

(January, 2023) After growing up in a big family in Long Island, Eric Rosemary knew from an early age that he wanted a family of his own, that he wanted to be a dad.

Then came Memorial Day weekend of 2009. While boating with friends off Peanut Island, he fell into shallow water and shattered his C-4 and C-5 vertebrae, immediately turning Rosemary into a quadriplegic.

“(The doctors) were blunt in the beginning,” he said. “They said, ‘You’ll never do this, you’ll never do that.’ A lot of never going to do things.”

But Rosemary, now living in Boca Raton, kept pushing to fulfill his dream of fatherhood.

After agonizing through two years of physical therapy, he regained the use of both his arms and one hand. It was enough to get back to his job as a mortgage company branch manager and to move out of his parent’s house back into his.

He kept pushing. He gave online dating a try and matched with a woman named Christina. They met, hit it off, and moved in together within three months. The couple married three years later, unleashing a secret, choreographed dance number at the reception that left their 150 guests in a pool of tears.

He kept pushing. It was time to try for a baby and Rosemary had his doubts.

But then he went to The Miami Project to Cure Paralysis. Working with Emad Ibrahim, M.D., the director of the Male Fertility Research Program, they sorted through the options, chose the best one for his condition, and started trying to conceive.

Finally, on September 1, 2019, Christina played a game that forced Eric to wear noise-canceling headphones and guess what she was saying. After a few failed attempts, he finally got it: “I’m going to be a dad.”

“I couldn’t believe it actually all worked out and happened,” said Eric Rosemary, who’s now the father of 2-year-old Grayson Rosemary. “It was just surreal.”

About 90% of men who suffer a spinal cord injury (SCI) cannot conceive through sexual intercourse, so they must use other methods to extract sperm. That’s where the Male Fertility Research Program comes in.

Founded by the Miami Project’s late Scientific Director, Dr. Richard Bunge, and expanded by SCI fertility pioneer Dr. Nancy Brackett and her colleague Dr. Charles Lynne, the program has established itself as the preeminent research site for SCI fertility.

Now led by Dr. Ibrahim, the program has helped more than 300 men father children, including the Rosemary’s.

Dr. Ibrahim says he can’t help but form a bond with each couple he helps.

He works with each of the men to find the right treatment for their injury and helps the women track their ovulation cycles. When the day comes that they successfully conceive, Dr. Ibrahim struggles to contain his emotions.

“When they send you the ultrasound picture, I’m like the dad who jumps for joy,” he said. “They have a lot of tough times, but when it’s successful and you reach the ultimate goal, that’s all you need as a reward. You’re starting a whole new life, a family, that were told many years ago, ‘Forget about it. Just have somebody for companionship.’”

Getting there has taken decades of intense, exhausting research.

Men who suffer an SCI experience infertility because of disruptions to the nerves supplying their reproductive system. Those disruptions can lead to impairments in erection, ejaculation and semen quality.

When the Miami Project’s team members started their research, little was known about the fertility in men with SCI.

There was so little research in the field that they had limited data and few procedures to learn from.

When Dr. Ibrahim joined the team in 2004, he was also starting from scratch. Born and educated in Egypt, he was trained as a urologist and spent years studying tuberculosis. That research brought him to South Florida, where he started collaborating with researchers at Nicklaus Children’s Hospital. He later moved on to the University of Miami after completing his fellowship and was invited to join the fertility team.

“I had no clue what they were doing when I started,” he said. “When you graduate from urology, you have zero exposure to people with spinal cord injury in most programs.”

Ever since, he’s not only carried on the work of his predecessors but taken the research to new levels.

In recent years, Dr. Ibrahim’s team has performed multiple procedures to overcome ejaculatory dysfunction so common in men with SCI. That includes a range of penile vibratory stimulation, electronic ejaculation, prostate massages and, the most expensive form, surgical sperm retrieval.

Dr. Ibrahim has also tested ways to overcome another major hurdle: the quality of sperm.

For men without an SCI, on average, about 40% of their sperm is mobile. The sperm motility score for men with SCI can drop as low as 2%.

But extensive research revealed it’s not the sperm that’s damaged. Instead, the problem is the fluid that’s mixed in when men are about to ejaculate, known as seminal plasma. That fluid is filled with chemicals produced to protect the body from injury. But in men with SCI, the fluid mistakenly attacks sperm, causing irreparable harm.

“The sperm touches this fluid, and it automatically starts to slow down and eventually die,” Dr. Ibrahim said.

Dr. Ibrahim is testing medications that men with SCI can take to lower the harmful chemicals in their seminal plasma. He’s already seen progress and is applying for grants to provide medication to more men for longer periods of time.

The program had to shutter its doors during the COVID-19 pandemic, but as the nation eases out of quarantines and closures, he’s hoping to recruit more patients to his program. The sessions and treatments are free, since the men’s experiences become part of the research that Dr. Ibrahim and his team are conducting.

Dr. Ibrahim is also trying to spread the message of their work.

He was awarded a grant to lead workshops to teach doctors from across the country about the breakthroughs they’ve made.

“We’re trying to spread the knowledge so that people from all over the country and all over the world will be able to do these procedures,” Dr. Ibrahim said.

Eric Rosemary was so overwhelmed by his results that he has continued to volunteer for anything Dr. Ibrahim needs. If a team of doctors need to observe the stimulation processes used by Dr. Ibrahim’s team, Rosemary will drive the hour down from Boca Raton and show them. If Dr. Ibrahim needs patients for new studies, he jumps in.

“Whenever they call me for clinical trials or whatever they need, I’m there because I want other people to know about them because they’re amazing.” –   Eric Rosemary

Christina Rosemary sums up her feelings about the project another way: “They gave me the best thing in the world.” Grayson is now a thriving, energetic, chatty 2-year-old.

He loves riding on his father’s lap as he zooms around the house in his power-assisted wheelchair. They go to baseball games together and play around the house. And every morning, when a nurse comes to help Eric Rosemary out of bed and prepares him by saying, “One, two, three,” Grayson runs into the room, grabs his father’s legs and screams, “One, two, three.”

The Rosemarys are now hoping to continue building the family that Eric always dreamed of. They are returning to Dr. Ibrahim’s office to try for another baby.

“I think it would be nice to have a girl,” he said.

Alan Gomez is a contributing writer for UHealth’s news service.