Tuesday, June 30, 2009

Fertility Updates - Part 1 - The results

We finally have answers. I'm still not sure if that is a good thing or a not so good thing. Only time will tell I suppose. This is actually the 4th time I started writing an update but each time couldn't figure out what exactly to write or got interrupted. For what it's worth I really don't have much time at work anymore to write blogs...which is a good thing but not for my blog life. :)

Ok...so since the last update we've had a series of appointments. First, we met with my OB/GYN for a consult and she verified my understanding of the first set of tests...it did not appear I was having ovulation problems but assured me that this was abnormal. I tried to excuse our situation as having been busy and stressed with full-time school again and she said "yeah, but you've done that before right?"...she wasn't convinced that the stress was a factor. J and I sat together as she explained basically everything I explained in the previous post. We left really having wasted an hour of our life, but at least we were making progress in the infertility testing process.

The next steps were two-fold. An HSG (Histerosalpingogram) for me and an SA (Semen Analysis) for J. Due to the timing of it all, we were able to get the SA done first during the 1st or 2nd week in May. It was a few days before we got those results and they shocked us. I actually got the call from the nurse at my OB/GYN, and afterward I bawled my eyes out. At my desk. With my direct reports and peers listening in. My boss walked by about two minutes later and told me that if I needed to go take care of something then go do it (I have an incredibly supportive boss...she really meant it). I had stopped crying by then, but apparently she knew something was wrong. And I knew that going home wasn't going to help me...there wasn't anything I could "take care of".

At first the nurse simply told me that the results were abnormal. This was my favorite nurse from the first time when I was pregnant with Logan. NOT. I'll follow the Bible's advice and pray for her. Anyway...I didn't accept her first answer and asked for more details. The next piece I got from her was this:

  • Decreased Density
  • Decreased Motility
  • Abrnormal Morphology

Basically, an SA takes a look at three main factors and a few other subfactors. The worst case scenario would be "Azoospermia", meaning 0 sperm in the seminal fluid. Next to worst would be what we had...bad on all 3 factors. Decreased Density: Low sperm count. Decreased Motility: Low # of sperm actually moving and low # of sperm moving forward. Abnormal Morphology: refers to the shape of the sperm cell itself...apparently ours was abnormal. Essentially this appointment confirmed that there was a problem with J. Beyond what I've written here we had no details. No understanding of the problem, how severe it might be, or what cause might be involved. No knowledge of really what was next. I had to break the news to J and had him come "eat" lunch with me. On the way out I ran into my boss's boss...the head of HR for 7-Eleven, who also asked how I was clearly seeing I was not well.

This was devastating. The recommendation was to continue with the HSG the following Tuesday to see what that showed, just for fun or maybe to get an understanding of the situation for the future, and then followup with the recommended Urologist specialist. Apparently he is the best in North Texas at this.

If you've never had an HSG you are missing out! Seriously fun stuff. Or, seriously awkward and eventually painful. But, the good thing is that you get the results immediately and the actual procedure itself wasn't that bad until afterward. The procedure is done at the hospital in the radiology department. Basically a dr. takes a long tube with a balloon on the end, inserts it through the cervix, then fills the balloon with a dye and shoots it into the uterus, all while laying under an x-ray machine that is recording the process of the dye as it moves through the system. Ideally the dye flows through the fallopian tubes and pours out into the uterus and eventually into the abdominal cavity. The doctor is able to see the tubes, any blockage, any structural issues, and any scarring or endometriosis. That's it!

In my case, the results were perfect. He saw exactly what he needed to see apparently and all was well. I cleaned up, had J drive me home, and then started feeling the discomfort and eventually pain. It felt to me like the first few days after having Logan...particularly while nursing. Nothing equals that. I slept for a while and laid on the couch then had a wonderful friend visit and bring dinner (Thanks Mandi!!!). J stayed home with me that night and we enjoyed a nice family day. And, my sister cleaned the carpet on the stairs so overall it was a good day.

This left us back needing to investigate male infertility and all evidence pointed to that being the largest culprit in our infertility. Our doctor though didn't have an appointment to see us for another 6 weeks, so we waited, me largely in a fog of agony, crying a lot, etc., and then realizing that living day to day was much better than trying to plan too much for the future. Then I was ok. I'll get to the reaction to our appointments and how we're handling it all in Part 3, I think. In the meantime I did a little research but couldn't find anything to clarify our results before the appointment. I really had no idea what the problem was, only that there was abnormal results in all factors of the SA.

On 6/29 we had our appointment. We were nervous and excited, ready to move forward. We had no idea what to expect. It poured rain as we got there and then the whole time we were there. It seemed appropriate. We met our dr. (Jeffrey Buch) and liked him from the start. He has a quirky humor, which is probably pretty good for someone who does what he does. Apparently he is highly respected for what he does, particularly in vasectomy reversal and infertility work. We laughed a lot, even while he gave us the results. He was somewhat upset that we received the results as we did. I told him that we knew about the decreased density. And he went from there. I tried to mention the other abnormalities and he shut me down and said "with these results we don't even worry about those factors". I figured he meant statistically low density meant the other pieces weren't statistically reliable or something, but once he talked more I realized that wasn't what he meant.

Literally with our density results what he meant was that the other factors weren't relevant. He went on to tell us our density number, but I'll wait to reveal that until a bit only because at this point WE didn't know what normal was and it meant relatively nothing to us. He started to say that he wanted to do a basic exam expecting that he would find a varicocele, a varicose veins of the testes an easy problem to fix that causes 60% of low sperm count results. As soon as we started the exam he noticed a scar J had. J explained he'd had a surgery when he was 7 for a hernia repair but didn't know much about it. The doctor continued with his short exam and noted a few other things I'll leave private for now but essentially the idea that there might be a varicocele was no longer a consideration. We moved to his office where he showed us all the actual test results and talked us through them. This is where it started to hit us.

Our sperm density count was 10,000. He explained how they got that count to a painful detail. I then said..."what is normal? About a million?"...he said "about 20 million". and ours is 10,000? Holy cow. He showed us the other numbers that weren't nearly as abnormal as this, but again, didn't matter. He told us that we have 0% chance to conceive on our own and that the only chance to conceive a biological child would be IVF-ICSI...which he explained. In order for us to qualify for IUI, we'd have to get sperm density up to 5,000,000 motile (moving) sperm. He wrote down that IVF-ICSI would run about $14K and that we'd try to get the density up, maybe, with hormones, maybe. He seemed to acknolwedge that this was extremely optimistic. You probably have quite a miracle on your hands in your son. Based on the exam he was fairly confident that either the problem that led to J's surgery, or the surgery itself, or a procedure they may have done while doing the surgery, likely caused him to have this challenge. And since it was so long ago, there was nothing that could be done. Except maybe hormones. Maybe. We have to do another SA to verify the results (normal proticol but he doesn't expect anything to change...we need a baseline). And we had some genetic testing done, and some hormonal testing done to check certain levels. So that in itself was bad and we both left in a strange mood...happy from the dr and just shocked. This is real infertility. Again, I'll get more into that later.

I've been able to do more research since we left the doctor. Low sperm count is technically called "Oligoospermia". In order to be diagnosed with that condition you would have 2-3 results with less than 20 million. 20 million is not "normal"...it is the line to be considered "low". Normal is actually 60-120 million. Severe Oligospermia is diagnosed when there is less than 10 million. This is the level the dr said we'd need to get to for IUI...10 million with 40% motility (which is the line for average/abnormal) = 5 million motile. I found a website that reference the World Health Organization's standard for a successful vasectomy at <100,000.>

We're at 10,000.


amelia said...

Oh my Marie, my heart aches with yours. Thank you for being so vulnerable with what is going on in your life. I am praying for you.

Raina said...

Goodness. What a rough time you've been going through! I'm so sorry for the bad news. I think of all babies as miracles, but this makes Logan especially miraculous! I'll definitely pray for your family and for peace with whatever God's plan is for you.

Mandi said...

:( Thank you for being so willing to share your emotions. Please call me when/if there's something I can do!