Out of a Struggle With Infertility, Success

Fourteen years ago, when Robert Johnson, now 31, donned his navy blue trumpet jacket, he never thought that getting outfitted like a “screaming” nerd would attract anything other than an acceptance to the college of his choice, let alone a wife. The circle of young instrumentalists was small and exclusive, so meeting someone new was rare: Everyone just knew one another.

And everyone knew of Ariella Perlman, also now 31, because of her famous violinist father, Itzhak Perlman.

It was surprising that having attended various band camps in her teens, Ms. Perlman had never met Mr. Johnson until fate brought them together at an audition for Rice University’s music program. There, on a whim, she decided to make a bee line for the music man cradling the French horn.

She gave him a hug that he never expected, and a compliment: “Hey, nice jacket.” She had an appreciation for men in uniform because brass players, she declared, were “more laid-back.”

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It was a flash meeting that did not seem as if it could ever lead to a happily-ever-after arrangement. Against all odds, parental concerns and some rabbis’ concerns, they were married in June 2009.

Mr. Johnson, now the associate principal horn at the Houston Symphony, revealed early into dating that he had a medical condition that would prevent him from fathering children.

“I said, ‘This is what’s wrong with me,' ” Mr. Johnson recalled telling Ms. Perlman of his diagnosis of Kallmann syndrome, a hormonal disorder that caused delayed puberty and infertility. “When I was a teenager, I was on testosterone therapy, every day, 365 days a year. The doctor had told me at age 13: ‘You’re sterile. Forget about it.’ ”

Ms. Perlman, who still plays the flute as a freelancer but is now a certified teacher in a Jewish Montessori school in Houston, was just fine with that because she was eventually going to marry a Jew, and Mr. Johnson wasn’t one. So with full disclosures, they decided to carry on with the romance anyway because at 17, marriage and parenthood seemed too distant to be concerned with.

“We connected on many levels, and on the levels that we didn’t connect on, we didn’t need to,” he said. “We didn’t need to connect our lips at the beginning.”

Seven years later, when marriage seemed imminent, the decision to convert to Judaism was an easy one for Mr. Johnson, who admits that the process itself wasn’t. “That was a whale of a conversion,” he said. It turned out that accepting pushbacks from the local rabbi and finally getting permission to become a Jew — and to marry Ms. Perlman — was the easy part.

A week before their wedding, the couple had already met with a fertility specialist, who has since retired, Dr. Wylie Hembree, a neighbor of Ms. Perlman’s father. Ms. Perlman, who comes from a large family with four older siblings, had always wanted the same, but having understood the condition that afflicted Mr. Johnson for much of his life, she fully accepted the idea that a large family might never happen.

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“Whether it’s a donor or a surrogate or adoption or whatever form it was going to take,” she said. “That never mattered.” Still their goal from the day their marriage began was to have a family of their own, and they were determined to do everything to make it happen.

The doctors instructed the pair to stay sexually active while Mr. Johnson began testosterone replacement therapy. “We were in training for, like, the sexual Olympics,” he said. “We really had to, like, work it.”

According to the Mayo Clinic, the average man with a diagnosis of a low sperm count may produce fewer than 15 million sperm per millimeter of semen. Mr. Johnson’s lab results were coming back at zero. Consistently. And it became a waiting game filled with hope and then disappointment. “We were basically restarting an engine that had been dead for 25 years,” he said.

By 2010, the couple had settled in Virginia, where Mr. Johnson was the principal horn with the Richmond Symphony. Since Dr. Hembree was in New York, the process to receive treatment became a marathon for the couple, who flew to New York four times a month for lab work only to return home the same day for Mr. Johnson to play the evening concert.

“The really heartbreaking thing was that time after time of going to labs, it’s embarrassing, it’s expensive, it breaks your spirit kind of thing,” Mr. Johnson said of the treatment.

Feelings of isolation and inadequacy began to creep into their marriage. Ms. Perlman, whose role up until this point was to be on standby for sperm, did her best to be supportive.

“There’s a whole community out there of women trying to get pregnant and going through IVF and sharing their stories and all of this type of thing,” she said. “And I think for men, it’s really not the same. It’s much more hush-hush, and it’s a different type of thing.”

Ms. Perlman recalls a particularly hurtful incident in which one doctor told her that there was no hope. She was told to get a sperm donor. She was furious and defiant: “I remember feeling really heartbroken, and feeling really angry, and sort of being like: ‘You don’t know anything. Why would you say that? We’re going to keep working and we’re going to make this happen. We’ll show you!’ ”

But soon, she too found herself in despair.

“And I think this probably happens in marriages with all different types of things but this feeling of: ‘I’m really upset. I’m really sad, but I’m not mad at you,’ ” she said. “I was just sad, because I wanted a family and it was hard. So I remember sort of crying and just getting in a really dark place, and being like: ‘I still totally love you, I don’t want to give up. It’s sort of hard to be happy right now.' ”

Year 3 came and went. Year 4 rolled round, and there was still no visible improvement. With Mr. Johnson having been on medication levels that hadn’t changed in years, the idea to throw in the towel crossed his mind more than once.

“We made a beautiful life together,” he said. “We travel all over the place. The one thing that was out of my control was the one thing we wanted the most.” And patience, which had been their M.O., was running out as well. “It doesn’t matter how many times you push the elevator button, and the elevator is not going to get there sooner,” he said. “You push it once, it’s going to get here the same time as if you pushed it 100 times. And I was pushing that elevator button like a crazy person.”

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During those dark moments, the couple who had been so close as teenage lovers suddenly found themselves suffering alone and in silence. Both said they felt helpless and hopeless.

“I think there was always this feeling of, the sort of catchphrase was, ‘Please wait for me,' ” recalled Ms. Perlman, who could sense her husband’s frustration but did not know how to help him, or herself.

“Don’t give up on me,” Mr. Johnson remembered telling his wife.

By 2013, they had settled in Texas, where Mr. Johnson had an offer to play with the Houston Symphony. It was during one of these concert performances that a message came from Dr. Hembree: “Good news. You have two sperm in your last count. It’s not a lot, but the evidence is there that you’re on.”

Mr. Johnson was elated.

When his sperm count reached 22, his Houston-based fertility team decided that this was the magic number to begin IVF treatment, almost five years to the day that the couple had sought medical intervention. “I just was happy to be sort of more contributing and part of the process,” Ms. Perlman said.

Their twin boys, Ezra and Reuben, were born in January.

Ms. Perlman can now reflect warmly on their journey to parenthood. She recalled advice she received from a dear friend who became pregnant immediately after marriage. Her advice to Ms. Perlman, who was depressed at the time, was to take advantage of this time when “it’s just the two of you.”

“I think we’re the closest now than we’ve ever been,” Mr. Johnson said. “It’s the sort of thing where had we just been handed a child nine months in, it’s a very different situation.”

Ms. Perlman said: “We’ve both been so proactive in the creation of these children. We did this together, and it’s amazing.”

A version of this article appears in print on March 8, 2015, on page ST18 of the New York edition with the headline: Out of a Struggle With Infertility, Success. Order Reprints| Today's Paper|Subscribe