Urological Update

Today was E's urological consult with what turned out to be the director of the department. He was an excellent doctor, really down to earth and honest without being overly optimistic or depressing. E's physical exam was normal, as we had all expected, and the doctor ordered blood work and semen analysis number 3. We're waiting on the results of the blood work now and semen analysis number 3 will be on Monday.

More importantly, he advised us to manage our expectations. Don't get too high or too low. He said he has seen so many couples spend hundreds of thousands of dollars trying to get pregnant without success. That more often than not, people were not the exception to the rule and that he defined success as a baby in your arms, while most clinics define it as a positive test. That we shouldn't tie our self worth in with our ability to have biological children.

On the downside, he seemed to be laying the ground work for what sounded like inevitable bad news. He talked about friends who have wonderful adopted children. How the most important thing is E and I together as a couple, that we're here because we love each other and to not lose sight of that. I know that it's easy to do, that the stress of treatment, the hormones and failures can take its toll on your body and mind. That having a child can come to mean two different things to each partner and that even a strong relationship can be sorely tried.

The doctor said that if E's FSH results come back with a level like 40, we have no hope of having E's biological babies. Right now we're hoping for normal blood work to indicate a mechanical problem somewhere in the factory. Mechanical problems might be fixable, while high FSH, like my high FSH, can't really be fixed.  He said that if a mechanical problem is indicated, that a biopsy would be the next step. Since he agrees IVF is our only shot right now, if he found viable sperm while E was opened up, he would collect and preserve them for IVF.  I think this would save E a procedure, and potentially lots of money, since I don't think E can product viable sperm via ejaculate.

Overall, we were happy with E's new urologist. Now we just have more waiting, for lab work, for the SA, for some indication of what our next step is. We also need to determine whether we want to continue treatment with Kaiser and pursue their IVF clinic, out of pocket of course, or stick with the clinic we had our initial consult with. The urologist spoke highly of one of the IVF doctors in particular, and said he would introduce us, but I'm not sure they'd even be willing to treat me with my FSH as high as it is.

Another Blow

Yesterday the RE called and said that E's second semen analysis came back at 0. As in not One.Single.Sperm present, he might as well have poured water in the cup. This was after a one day hold, versus E's previous SA which was after a three day hold. 

While the RE had previously said he thought E's poor quality sperm was the result of genetics, he has now referred us to a urologist to rule out things like hormone imbalances and physical problems. I had asked about this during our initial consultation but he had tentatively ruled it out since E's first SA did show sperm present. It makes me really glad that we did another SA to confirm, since I was sure there had to be something more going on than just shitty genetics.

This morning, I called and set up an appointment with a urology specialist at Kaiser on the 10th. I'm not sure they are going to be able to do anything since we have no infertility coverage, but I figured it would pay to start with them before going directly to the outside specialist. The RE referred us to an excellent urologist who is one of the top in the country for male infertility problems, but he would be very pricey. Just in case, we called as got some info about him as well and he has an opening on the 17th if Kaiser is no help.  

We also have an appointment with a genetic counselor set up with Kaiser that I think they're going to cover, though the testing will likely be out of pocket. It will probably be a moot point anyway if we have to use a donor, but I am still proceeding with the intent of using E's sperm. I want to have our babies, not just a baby and I'm not ready to give up on that. 

Bad News and (Not So) Easy Choices

This morning, or more accurately this afternoon, E and I went in for our infertility consultation. Even though I tried to be optimistic, it was disheartening to have our challenges laid out so plainly. The RE went over all our test results and all our options, which are extremely limited. Because E has such severe male factor infertility, we can only go with IVF. Because I have so few eggs, we can only go with IVF. So basically, even if we were only dealing with one form of infertility, we'd still need to do IVF to get pregnant.

Right now E is a bit of a wild card. We're not sure whether his sperm are non motile because they're dead, or because they're just lazy fuckers. Our doctor ran another SA on E and we should have those results tomorrow, but considering the poor quality of his boys overall, the doctor is suggesting that we split the eggs.

Lets say we retrieve 13 eggs, and 10 are mature enough to use. Our RE is suggesting that we use E's sperm for 5 of the eggs and donor sperm for the other 5. That way, if none of E's swimmers are able to produce viable embryos, we still have those 5 other hopefully good quality embryos to implant. If we didn't do this and none of E's swimmers were able to produce embryos, the cycle would be cancelled and we would be out all the money we had spent.

I am not in much better shape than E. I had my AFC and while my uterus looked just fine, my ovaries only had 7 antral follicles between them. That's a pretty awful number for a 26 year old, the RE was hoping to see more like 20, making my high FSH a fluke. Unfortunately, that wasn't the case, my awful numbers are accurate and I really am running out of eggs. Yay :(

Now we get to wait for a phone call tomorrow. If E's results are improved, we can proceed with IVF. If they're still awful, we need to seriously consider whether we're okay with using donor sperm.  E was really against it when we discussed it before, but it might be the only way we can achieve a viable pregnancy. It's a lot to deal with and we're going to have to do some real thinking.