Читать книгу IVF: An Emotional Companion - Brigid Moss - Страница 7

My partner had no sperm

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When a man finds out that he’s subfertile, it can be a huge knock. Thinking he might not be a father can change how he feels about himself,’ says fertility coach, Anya Sizer.

A low or even a zero sperm count doesn’t mean a man can’t be a father, though. ‘There is a range of sperm counts in men, some have lots, some very few,’ says Dr Allan Pacey, Senior Lecturer in Andrology at the University of Sheffield. ‘And the definition of healthy sperm count recently went down from 20 million per millilitre to 15 million. At that level, a man should be able to become a father within a year. But you can be “abnormal” by that definition and manage it in, for example, two years.’

Male fertility treatment has seen the biggest technological advances in the past 10 years. ‘We don’t have any magic pills to stimulate men to produce more sperm. What we do have are ways of extracting sperm or doing the best we can with the sperm that we can get,’ says Dr Pacey. By using‘ intracytoplasmic sperm injection, or ICSI, embryologists can now fertilise an egg with a single sperm.

Even if tests show zero sperm in a man’s ejaculate, there are several surgical techniques that can extract sperm, when previously a man would have had to use a donor to have a family. ‘Finding nothing in ejaculate is unfortunate,’ says Dr Pacey, ‘but it doesn’t necessarily mean that a man’s testicles aren’t producing any sperm, just that they’re not making it out in the ejaculate or they haven’t been seen in the lab. When we look at ejaculate, usually several millilitres of fluid, it’s impossible to look in every single bit of it. Theoretically, there could still be several thousand sperm in there, when we see nothing.’

The major factors that affect sperm count and/or quality are genetics (including having undescended testicles at birth), trauma, chemotherapy and vasectomy. The surgery of choice if there’s a blockage, for example after vasectomy, is aspiration via a needle, usually taken out of the tube which carries sperm from the testes to the penis (PESA — percutaneous epididymal sperm aspiration), but sometimes from the testicle itself (TESA — testicular sperm aspiration). These are procedures that are performed every day.

My dad had a vasectomy over 20 years ago, which meant he couldn’t have it reversed when he wanted to have a child in his 60s. So he had PESA to help conceive his now toddler daughter: ‘I had a full anaesthetic but I was only out for thirty minutes. There was no pain or bruising afterwards; the only slightly embarrassing part was that the nurse who helped with the op was so chatty!’

‘After a vasectomy, there’s usually a hundred per cent success rate at getting sperm surgically. These men were obviously fertile in the first place,’ says Dr Pacey. But, he explains, ‘With a man whose fertility has been affected by chemotherapy, the success rate is perhaps about forty per cent.’ These men, or those who had undescended testicles at birth, may need to have an operation called TESE (testicular sperm extraction), where tissue is removed from the testicles, then dissected to find any sperm.

There are a lot of other factors affecting sperm quality and quantity too. These include sexually transmitted infections (‘In my lab’s last study, thirteen per cent of men referred by their GP for fertility tests had chlamydia and didn’t know it,’ says Dr Pacey), flu or any illness with a temperature, prescription medicines including some SSRI antidepressants and anabolic steroids, sitting down a lot (for example, men who drive a car for more than two hours a day), smoking, over-drinking, working with various chemicals (glycol ethers, in paint, glues, dry cleaning fluids) and long exposure to lead in petrol or exhaust fumes.

Of course, even once you have the sperm, pregnancy isn’t guaranteed, as Ella, whose story is below, found out, because to do ICSI, you’re relying on the success of IVF.

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Ella, 37, a marketing manager from Bristol, and her husband Nick were told that he had a zero sperm count.

Nick was at the airport with a group of his friends, about to go away on a boys’ weekend to Berlin, when he got the call to say he wasn’t producing any sperm. He’d had the test done at our local hospital, and when the nurse called him to give him the results, he was sitting in the bar, drinking with his mates. To be in that testosterone-fuelled environment, then be told you have no sperm count and, therefore, no chance of fathering a baby seemed the ultimate irony. He had half expected it, but it was still a shock. His very worst fears had turned out to be true.

Nick had been concerned about his fertility ever since his early teens. That’s when he’d found out that when he was born, his testes were still inside his body — ‘undescended’. He did have an operation to correct it, but not until he was six years old. Nowadays, doctors think it’s best to do that operation as early as possible, as it’s thought that high temperatures inside the body may affect sperm production later in life. The actual operation may do so too.

Nick told me about the operation within a couple of weeks of us starting to get serious, so I knew it was important to him. Without him telling me, I’d never have known he’d had it; as an adult, the only sign was a tiny scar on each side of his testes.

Once we’d got the news he was producing zero sperm, my first thought was to find a solution. We asked to be referred to a urologist (a specialist who deals with male parts), but he told us the same thing as our GP: that our options were now sperm donation or adoption. He also did some blood tests, which confirmed that Nick wasn’t producing any sperm, despite the appearance that things were working normally. It was our first encounter with a specialist, and I was shocked at how, for him, it was an everyday job. Considering he was telling us our future, he seemed quite offhand — he even answered the phone in the middle of our consultation and chatted for 10 minutes. He was so used to dealing with fertility issues, it wasn’t a big deal to him, but it was our life.

Because Nick had worried about not being fertile for so long, then had had his worst nightmare confirmed, it was pretty hard to find the right way to help him. It felt as if I was treading on eggshells. The hardest part was that it had happened to him when he was little, and so he had had no control over it. It wasn’t as if he’d taken steroids or even that he’d had cancer or an accident. I know he was thinking: why me?

I was devastated too. We’d just got married but, potentially, I was facing not being able to have his child. That was a really sad prospect. Part of getting married was wanting to create a family together. When I looked at him, he was the person whose biological children I wanted. I wanted a mini Nick running around, not to have to think about using somebody else’s sperm. So while I was trying to be strong for him, I was trying to deal with my own emotions too.

But I’m a very persistent person, so we went back for a second appointment to ask if there were any other tests we could do. The specialist said there was one option — an operation called TESE, where incisions are made in the testes, at the top and bottom, some of the sperm-producing tissue is removed, then whatever sperm is found in it is retrieved and frozen. I’d have to have IVF to produce eggs, then Nick’s sperm would be thawed and injected into my eggs, using the ICSI technique.

The specialist told us that some clinics and hospitals are more experienced and better than others at TESE, so I asked him the very best place to have the operation. He mentioned a clinic in Brussels, where ICSI was actually pioneered.

Nick and I discussed whether or not to go ahead and decided that we didn’t have much to lose. If the operation didn’t work, at least we would have done everything we could to have our own biological child. We didn’t feel we could move on to thinking about donor sperm or adoption until we knew that.

So, a few weeks later, we booked our flights to Brussels. The clinic there was quite a culture shock after what we’d seen of British hospitals. It was modern in its design and high-tech. The staff were very welcoming and professional. There was no language problem because we were assigned an English-speaking counsellor, and she arranged and attended all our appointments and was our point of contact throughout the whole process.

When we met with our consultant, he made us feel comfortable too. He assured us that a lot of couples were in our situation, and said that Nick was a suitable candidate for the operation. He explained that there would be an embryologist in the operating theatre with a microscope, and as soon as the tissue was removed, he or she would check the sample for sperm immediately, and freeze whatever was found. He also said that if they didn’t find any sperm during the operation, the clinic would help us to move on to other options.

That night, we went out for dinner in Brussels. We’d decided to spend some of the money we’d saved for treatment on dinner, a nice hotel and some sightseeing. It was April, and it was warm, so we ate outside in Brussels’ famous and very beautiful historic square, Grand-Place. Being away from home together felt very special. Some of the usual stresses disappeared and it gave us time to talk — I think Nick was the most open he’s ever been.

We were put on the waiting list at the Brussels clinic, but amazingly the counsellor called the next day to say they’d had a cancellation for two weeks later. So we booked in.

Once we got home, however, we began to get nervous. It’s obviously not great for a guy to have his bits sliced up, and we had also been warned there was a small risk his testosterone levels could drop after the operation, so he’d have to be on hormone replacement therapy, and the drop would put him at risk of osteoporosis too.

The more I read up, the more I worried. I lost my dad when I was fifteen and since then I’ve had a phobia of hospitals. I got completely carried away, thinking: Nick and I have only been married six months; will I lose him too?

That’s where the counsellor came into her own. She told us on the phone that the clinic did the same operation every single day. And she explained that some men do have a tiny drop in hormones after surgery, but that it usually only lasts for around a year. I was vocal about my fears to Nick, but he stayed level-headed. He said the operation didn’t scare him, and that it was very important for him to know if he could father a child or not.

Two weeks later, we were back in Brussels. The night before the operation, I had to help Nick remove the hair from his bits using cream. I know a lot of men do shave or wax now, but I’m not sure many of them use Immac! It was a really girly scented one too, and that made it even funnier. Nick made me swear never to tell his mates.

On the morning of the operation, I was so nervous that I hurried us too much, and we arrived at the hospital an hour early, at 6.30 a.m. I didn’t want to be teary in front of Nick, but I was feeling very emotional. I was terrified he wouldn’t come round from the operation. He, of course, was absolutely fine, being his usual self and joking around when they gave him some unattractive paper pants to put on.

We waited in a room with a Dutch couple who were having the same operation. Luckily, we were going first. Nick was put on the bed to go to theatre at 8 a.m. He’s quite a big muscular guy, and when he lay down, the trolley started to collapse. I couldn’t help but laugh.

As soon as they took Nick off to theatre, I started crying. I was so worried. I kept thinking that making a baby is supposed to be a special experience, not a medical one. I felt lonely, knowing he was under anaesthetic, and that the outcome would decide if we could have children or not. I thought he was so brave to have the operation. A tiny bit of me was hopeful, but I kept talking myself out of it because I didn’t want to be let down if it didn’t work.

It only took a couple of hours for Nick to come round after surgery, but it felt like for ever. When he was wheeled into the recovery room, he was still high, so he was joking around a bit, telling me how pretty the nurses were. I was pleased he was positive, but he was also quite groggy and it was unnerving to see him not being himself.

A nurse came in and said, ‘I hear it’s good news.’ I said, ‘Oh no, I don’t think so.’ I was so convinced it wouldn’t be. But the nurse went on, ‘No, they looked at the tissue in theatre and they found sperm.’

Nick went to sleep at that point, and I was sure she had confused our results with the Dutch couple’s. But an hour or so later, our specialist came in and gave us both a massive hug. He said they’d found plenty of sperm; on one side, they hadn’t found anything (the original operation to bring down the testicles had, apparently, been botched), but on the other, they’d managed to extract twelve straws. Each straw is a vial the size of a match, and you only need one to have ICSI. We still had quite a lot to do before we could have a baby, but we were on our way.

While we were hugging and laughing with relief, the Dutch couple had found out they had a negative result. We could hear the woman crying through the curtains around her partner’s bed, and we really felt for them. It so easily could have been us.

As we left the clinic later that afternoon, Nick wasn’t in any pain, but he was walking like John Wayne, as if he’d just got off a horse, which made us laugh. Amazingly, the swelling went down fast after the first day, and after a week or so, the stitches had dissolved; after two weeks the wounds were completely healed. The surgeon had gone in through the same incisions that had been made when Nick was a child, so there were no new scars. We were so impressed and grateful; I even called the surgeon to say what a great job he’d done.

I wanted to crack on with my part of the treatment to keep the momentum going. Scans and blood tests at the clinic showed that I was ovulating and producing lots of eggs, so I could start the injections to stimulate my ovaries a few weeks later. The counsellor showed me how to do the injections on an orange, and I soon got over my needle phobia.

It was quite complicated to be treated abroad: I was being monitored at a clinic near home, who would fax my results to work, then I’d fax them on to Brussels. Then Brussels would call me to say if I should change my drug dosage. Once the follicles were a certain size, I did the injection to make me ovulate, and we got on the Eurostar the next morning. It was scary, knowing I was about to release all my eggs, and I spent the whole journey hoping we’d get to Brussels on time.

I was nervous about the egg-collection procedure, but it helped that Nick had already had an operation. He was very supportive, though I could tell he hated that I was having to go through so much.

In the morning — roughly 36 hours after my final injection — I was wheeled into the same operating theatre where Nick had had his surgery a few weeks before. Egg collection is done under local anaesthetic at that clinic, so I had an injection in my bottom. But I don’t think it worked, as once they started doing the actual egg retrieval, via a needle through my vagina, I felt everything. I’m normally quite good with pain, but I was in agony. The only way I can describe it is like someone pushing a red-hot needle into your lower tummy, then feeling something being sucked out. Because I’d never had it done before, I assumed this was how it was meant to be, so when the nurse asked me if I was ok, I kept saying I was fine. For the first four or five eggs, I thought I could cope, but then the pain got too much and the anaesthetist put something in my drip, which helped a bit.

In all, they collected 18 eggs, and the whole process took half an hour. When I was wheeled into recovery, I told Nick how horrific it had been. I couldn’t move as I was in so much pain. But we had good news almost straight away: 16 out of the 18 eggs were viable.

Then we were on to the next worry: would Nick’s sperm survive defrosting? It did, but the clinic don’t give out any more information about fertilisation, so we had to endure three days without news of the embryos. We were staying in a nice hotel which helped take our minds off what was happening at the clinic, but it was a nerve-wracking time.

On day three, we were having breakfast, when the counsellor called to say they’d like to do the transfer in two hours. We were very excited and phoned our families to say that it was finally going ahead. I felt much happier about going into the theatre with Nick holding my hand this time.

But once we got to the clinic, there was bad news. Of the 18 eggs, only three had actually fertilised and only one was still alive at day three. We told each other that we only needed one, that it could still work, but the quality of the embryo wasn’t that great, and we were disappointed. All that effort and stress, all those injections, and we were left with a single, solitary hope.

After transfer, I rested in bed at the hotel for three days, as I felt that would give it the best chance of working, then we took the Eurostar home. The two-week wait was hard; with every tweak and sensation, I couldn’t help questioning if I was pregnant or not. Then, the day before the end of the two-week wait, I was about to go out to my sister’s birthday party, when I got my period. Even when you’re trying to get pregnant naturally and you get your period, it feels as if you’re losing something. But this time, that feeling was much more brutal. Somewhere, I knew there was a little embryo that hadn’t taken. We’d had mainly good news until this point, so it took us a while to realise that, this time, it really was bad news.

I wanted to try again straight away, but when I rang the clinic, they advised us to wait three months, to give my body time to settle down. They were really encouraging; they said we should think of our first go as a trial, and that we had loads of sperm left.

I think taking that break was sensible, even though it felt as if we were back to square one. That was our lowest point. I needed to keep talking about it, but Nick was happy to talk about it just once or twice, then move on.

We hadn’t lived a normal life for ages, so we tried to spend time together, and see friends and family. There were a lot of weddings that summer. It was hard because we hadn’t told anyone we were having treatment, and people kept asking us when we were starting a family. At home afterwards, I’d always end up in tears.

The second treatment cycle was pretty much the same as the first: 16 eggs but, in the end, only one embryo was viable. It was easier, as I knew about the injections and all the procedures. In the end, we were unlucky again. I found out I wasn’t pregnant when I went to the loo at a friend’s wedding and I’d got my period. I went out and had a glass of champagne, because I could. I felt awful.

The next morning, lying in bed, I was idly Googling IVF, and I put in ‘best results’. The ARGC in London came up. Nick had wanted to wait for few months for our next treatment, but I was impatient. I managed to get an appointment for a few weeks later, and took the train to London.

I was expecting a grand Harley Street set-up, but the ARGC is pretty well worn. The doctor we saw was very helpful and easy to talk to. Pricewise, I knew it was more expensive than some other UK clinics, as there are a lot of extras (for example, daily blood tests), but then travelling to Brussels hadn’t been cheap either.

The doctor recommended I have a hysteroscopy — an operation where the doctors look inside your womb using a camera inserted via your vagina — which, he said, may help increase the chances of success. I had to be monitored for a month too, so we couldn’t start the actual treatment for a couple of months.

In the meantime, I went part-time at work, as working full-time and doing IVF had become too stressful. I borrowed a flat in London, as I had to have daily blood tests and go into the clinic for scans and drugs too. The nurses and staff were very kind and, through talking to the other women I met there, I learned that everyone seemed to be on different drugs and dosages, so I was confident that I was getting treatment personalised to me.

The day of egg collection and fertilisation was nail-biting. We had arranged for Nick’s sperm to come over by courier from Brussels, but the flight was delayed. Nick had to be in the clinic early, ready to have another operation, just in case the sperm didn’t arrive or hadn’t survived.

To my huge relief, egg collection at the ARGC is done under general anaesthetic, so I didn’t feel a thing. When I woke up, the nurses were laughing. I asked if everything was ok, and they said, ‘Yes — we’re now calling you the eighty-egg girl!’ Apparently, in my half-awake state, I’d asked a nurse how many eggs they’d collected, and, though she’d said 18, I’d thought she said 80, and repeated it.

It took the embryologists an hour to find viable sperm in the straws. In the end, they found enough and did ICSI on my eggs. Out of the 18 eggs, this time 16 fertilised. By day three, we still had eight good embryos, so they said we should hold off until day five, when the embryos would reach blastocyst stage (an advanced stage of development); this would allow them to choose those that had the best chance of implantation. On day five, they called us and said, ‘Actually, we still can’t choose between them, as they’re all looking good, so we’re going to wait until day six.’ We had two good-quality blastocysts to put in that day. Sadly, the others had started to die away, so we had none to freeze.

I was really churned up. It felt like we’d reached the end of a big journey and I couldn’t work out what we’d do next if I didn’t get pregnant. Before embryo transfer, I asked if I could see the embryos, but the doctor, Mr Taranissi, said that too much movement can be traumatic for them, and that he preferred to put them straight in. After transfer, he left us alone for half an hour, saying, ‘This is your moment to be together.’

I felt so full of emotion. I said to Nick that I could feel it working. He told me not to be silly, that it was far too early, but I really did feel positive. When it was time to stand up, I was scared. But the embryologist reassured me with a really clever image. He described the womb lining as being like the bread of a jam sandwich, so the embryos couldn’t fall out. I still spent the journey back home the next day with my feet up on the dashboard, though. I must have looked like Lady Muck, the back seat crammed with bags from my month spent shopping in London, and the seat pushed back as far as it would go.

The next 10 days of waiting were hard. But I was disciplined, and didn’t do a home pregnancy test. I took the blood test at the clinic at 7 a.m., then Nick and I went for breakfast at a lovely café nearby called Patisserie Valerie. We both ordered scrambled eggs and bacon, but I was too nervous to eat. The call came and it was positive. I couldn’t process the enormity of it. If we hadn’t pushed to have the operation, if we hadn’t kept going with treatment, we never would have had this incredible news.

A few weeks later, we discovered that we were having twins, and Mia and Milly were born by Caesarean section at 38 weeks. It was a surprise, as we had thought we were having at least one boy, but it was an incredibly good one. We both feel so privileged to be parents, when we’d been so close to it never happening.

Q: WHAT’S YOUR ADVICE TO ANYONE DIAGNOSED WITH A LOW OR ZERO SPERM COUNT?

See a specialist and find out all the possible options. We went to our GP to discuss the first set of sperm-test results. He’s a great GP, but not a fertility specialist. He just said, ‘You must be devastated,’ and that there was no way Nick could father his own children. I’m really pushy until I’m completely convinced; I thought: that can’t be it – there must be some new technology that can help us. It was only when I asked to be referred to a urologist that we got a more detailed picture.

Q: WHAT DID YOU TELL FRIENDS ABOUT WHY YOU HAD TO HAVE IVF?

At first, we didn’t tell anyone anything. Once we decided to tell a few close friends we were having treatment, after our first failure, everything became a lot easier. Before, I’d felt as if I was lying all the time. Everyone in our group was so supportive and it was amazing how many people knew people who’d been through it. We didn’t tell them why we had to have IVF though – people naturally assumed the problem was on my side, and we let them.

Q: HOW DO YOU THINK A ZERO SPERM COUNT DIAGNOSIS AFFECTED YOUR HUSBAND?

I suppose all men who want children worry, to some extent, about their fertility and whether they’re going to be able to father a baby. After Nick’s diagnosis, but before anyone else knew we were trying, I remember a guy at a wedding telling us his wife was pregnant, joking he had ‘ace swimmers’. Even though it was in jest, it hurt. Nick is very down to earth and practical, so he doesn’t talk very much about his emotions, but I know he found it hard to take. His reaction was to shut down and not want to talk. I didn’t push him: I read some good advice that said men can talk about fertility for a maximum of three days, and then they want to move on. I’m lucky because, when I needed to talk, I could go to my mum, sister and friends.

Q: WHAT WOULD YOU HAVE DONE IF YOU HADN’T GOT PREGNANT?

The idea of sperm donation seemed very alien to me, whereas adoption seemed more natural. At the time, I also thought it would be easier, though I’ve since found out it can take a lot longer.

Q: WHAT’S YOUR BEST ADVICE FOR ANYONE HAVING IVF?

Make sure you rest properly after embryo transfer. Your body has been through a lot, and so have you. And you want to give yourself the best chance. For the first week after the third transfer, I went to stay with my mum. Not that Nick didn’t look after me, but I knew that if I was at home, I’d end up doing housework. Mum made me lie down and did everything for me.

The other piece of advice is, don’t test early, as you can get the wrong result. I met a girl at the clinic who’d done a home test that showed up positive, but her blood test showed very low levels of pregnancy hormones, and it turned out to be a negative in the end.

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Looking for people to speak to for the book, I tried to find a man to interview whose child had been conceived using donor sperm and whose partner had had IVF. Even though there are thousands of children conceived using donor sperm every year, I couldn’t find one. Perhaps ICSI has meant a drop in the numbers of male—female couples using donor sperm. Or perhaps men just don’t want to talk. It’s interesting that of the couples I spoke to whose infertility was partly or wholly ‘male factor’, all of them allowed friends and family to think that the issue was the woman’s.

Fertility coach, Anya Sizer, says she always recommends the website mensfe.net, which is dedicated to male fertility issues, as a good source of information and support. It appears (as a generalisation) that men prefer not to share in the same way that women do on fertility websites; there are a lot fewer posts on the forums, but each one has been viewed hundreds, sometimes thousands, of times. Mensfe.net is an excellent website and includes personal stories, as well as information on vasectomy reversal, sperm donation and nutrition, plus questions answered by doctors and a section on the emotional effects of fertility problems.

As regards nutrition, the latest research shows that it may be worth men whose partners are having fertility treatment taking antioxidant supplements, such as vitamin E, L-carnitine, zinc and magnesium, although it’s not proven which particular supplements are most effective. That’s the conclusion of a 2011 Cochrane Review of 34 randomised controlled trials involving 2876 couples.⁴

The Donor Conception Network (donor-conceptionnetwork.org) has a section aimed at men that includes personal stories. If you’ve been told that your best option is donor insemination, it’s recommended you have counselling first. And be clear about your legal situation: in law, if you are married, you (the ‘intended’ father) are automatically the legal father if your child has been conceived by donated sperm, but that’s not always the case if you’re unmarried. (See www.nataliegambleassociates.com for more information.)

Infertility Network UK have a very useful factsheet on exactly how ICSI works, one on male infertility generally and one on the emotional side of male infertility (www.infertilitynetworkuk.com). For a full-length account of IVF from a male point of view, read Test Tubes and Testosterone: A Man’s Journey Into Infertility and IVF by Michael Saunders (Nell James Publishers). ‘The idea behind my story was just to get men talking about fertility. I imagine it will be bought by women and hopefully read by men,’ says Saunders.