April 24, 2013 -- Raul Rodriguez of Camarillo, Calif., has been paralyzed since a 1997 car accident when he tried to pass a truck on a canyon road. His car spun out of control, slammed into a large tree and landed upside down in a creek.
An athlete before he became wheelchair-bound, Rodriguez, then 24, bounced back quickly. Six months out of the hospital, he was water skiing, and in 2004, he found love and got married.
Because the injury in his spine was low, on the T-5 vertebra, Rodriguez can get an erection but cannot ejaculate. So his doctor told the couple they could never have children.
Rodriguez said he was told, "Sorry, your best bet is to look into adoption or a donor -- that's it."
That doctor was wrong. Today, at 39, Rodriguez and his wife, Maria Angelica Rodriguez, or "Angie," are expecting twin girls. It's all because of a procedure called testicular sperm extraction, or TESE.
Rodriguez said he feels as if he has been "reborn."
"They are having twins -- It's a miracle," said Dr. Philip Werthman, director of the Center for Male Reproductive Medicine and Vasectomy Reversal in Los Angeles, who performed the procedure.
"Here is a guy who lost everything, and for whatever reason, he was told the wrong thing," he said. "They took away all his hope."
During this week of National Infertility Awareness, Rodriguez's story should bring hope to many couples who may have thought they could never have children.
"I have spent my career dedicated to ... countering misinformation and rumors and old wives' tales about fertility," said Werthman. "Many people are denied the hope of reproduction, even though it's technically feasible."
Rodriguez was diagnosed with anejaculation, meaning he wasn't producing enough ejaculate because of nerve damage, and nonobstructive azoospermia, meaning he had no measurable levels of sperm.
"He had sperm, they just weren't very good," said Werthman.
In a 30-minute office procedure, Werthman removed a piece of testicular tissue through a 2-inch skin incision, which requires nothing more than a small Band-Aid afterward.
The tissue is placed in culture and morseled into tiny pieces, which liberates the sperm so that it can be extracted. The sperm can be used for insemination right away or frozen for later use.
Despite Rodriguez's paralysis, erection is still possible because it is controlled by a separate division of the central nervous system than his leg movement.
"No one is exactly sure why in many men who have a spinal cord injury the sperm quality deteriorates after the injury," said Werthman.
"It may well be, sitting in a wheelchair, the heat builds up -- that's one theory," he said. "Many also develop chronic urinary tract infections, and that affects their reproductive tissues."
For three years, Rodriguez and his wife tried to get pregnant, even spending $800 on a lab stimulator. Then they consulted that first Los Angeles doctor, who did some cursory lab tests and took their hope for children away.
"It was a long drive home, and Angie said she was OK with getting donor sperm," said Rodriguez. "We tried that three or four times, and it never took.
"Angie became depressed, and we decided it was taking an emotional toll, so we decided to take a break," he said.
Costs had been adding up, but by 2012 they explored insurance coverage and learned that in vitro fertilization was covered.
In June, the couple found a nearby fertility clinic and Dr. Richard Buylos, who was instrumental in the pregnancy.
Rodriguez said Buylos was stunned by the advice Rodriguez and his wife had previously received and referred the couple to Werthman.
"[Werthman] did a physical exam and felt normal testicle size and didn't think it would be a problem. We were already off to a good start," said Rodriguez.
Rodriguez's sperm production was also deemed normal. "I just wanted to cry," he said. "I couldn't believe it. My wife was even happier than me."
The sperm extraction was set for a Thursday, and the first step in the IVF was scheduled for Saturday.
Biopsy results showed Rodriguez had a good number of sperm, but on Friday, the lab called to say the quality of the sperm was not good enough and the number was decreasing.
With the clock ticking, Werthman recommended the couple try extraction a second time, on Saturday, the same day as Angie Rodriguez's egg retrieval.
"Dr. Werthman showed up whistling and singing and all happy," said Rodriguez. "He said, 'We're going to get some more babies out -- don't worry.'"
As soon as Werthman looked under the microscope he grew optimistic. The sperm were stronger and better-looking than the first batch.
Of the 12 eggs retrieved, eight formed into blastocysts, embryos that had advanced to the five-day stage. Two were implanted and both took. The couple has frozen the rest for future use.
Eleven days after the implantation, Angie Rodriguez had a blood test that revealed she was pregnant.
And now, with the twins due in May, "She's pretty big," said Rodriguez. "I am buying things like double strollers and infant seats and looking into cribs.
"I just want other guys in my situation to be informed," he said. "I wish I had known sooner, to find that your sperm can be good.
"It has already changed my life, and I feel like I've got more life in me," said Rodriguez, who hasn't ruled out siblings for the twins "It's just made me whole again."