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OT - Fertility Updates from Anti-Canada

lieutenant_dad's picture

Quick recap: DH had a vasectomy reversal May 2019. Surgery went well, and by December, he had noticeable improvement in sperm quality/quantity. Win for us.

While things were improving, they weren't getting out of the "unassisted pregnancy" category. DH was supposed to have follow-up testing in March, but COVID. I still wasn't getting pregnant, and I was tracking my side hardcore. Lose for us.

In June, I reached out to a fertility specialist who helped friends of ours conceive their daughter. I expected it to take a few months for an appointment (again, COVID), but we managed to get scheduled right away. She looked at DH's sperm analysis from December and said we were good candidates for IUI, which is covered by my insurance, so they did some testing for any immediate concerns on my end (nothing major found) and redo his sperm analysis. Big win for us because it could mean summer pregnancy!

Sperm analysis comes back and DH is worse than before and all of a sudden we only qualify for IVF. I was devastated because it's expensive and really limits our ability to grow our family. DH was also equally devastated, and he started making lifestyle changes right away and getting back in touch with his doc that did the reversal. We were told to wait a few months to see if DH could bump up quality, but be prepared for IVF. Major lose to us.

Well, within the last few weeks, DH has done two additional SAs with his doc, and both show him with everything being fine except his mobility is on the low end (but better than December). DH's bloodwork shows his testosterone is on the low end of normal, so he is now on Clomid to see if he can get a boost. I now need to send this information to my fertility doc so that we can plan next steps and see what she has to say since the SA her office did is VASTLY (and I mean VASTLY) different than his most recent ones, which were all done within the last three months.

I'm all over the place with this. I don't feel like we're getting super clear guidance on what we should be doing, when we should be doing it, etc. Unfortunately, fertility specialists aren't overly abundant here, so we're a little "stuck" with the options we have. It's not that they have been bad. I guess I just expected more than "let's give it a few months and see what happens" with no real end date of when to follow back up (at least from my doc; DH's has done a better job on that front once he was able to see him again).

I dunno if I am looking for advice, just to vent, just to share, etc. I'm all over the place with this, and it's happening at the same time as OSS leaving, YSS is struggling with school, etc. I had honestly thought, when we started this in early summer, that we'd be pushed off for a consultation until the fall. I mostly just wanted to get our "spot in line", but then it ended up just being able to happen. Amd after a whirlwind few weeks of "let's get everything figured out and started right away", we're back to "let's give it time". It's like being in a car with someone constantly speeding up and then slamming on the brakes.

Comments

strugglingSM's picture

This isn't necessarily advice, but I'll share my own experience. We had to use fertility treatments due to male factor infertility. What we learned is that the fertility industry has very little understanding about male fertility or how to treat male infertility. Most of the treatment is targeted at the female in the situation. In fact, DH was an afterthought at the second clinic we went to, even though, his condition was presenting the only challenge for us. 

We went to one specialist, who claimed to be a male fertility expert, who was going to "cure" DH and "publish research" after she'd cured him. Needless to say, his low count went to zero after she prescribed some treatment for him. 

One warning about drugs like Clomid. While they increase testosterone, they can also increase female hormones (including estrogren and FSH), which can impact sperm count. DH also had low testosterone and our first specialist prescribed  medication that shot his testosterone through the roof, but drove his count to zero. I had done my own research online and begged the specialist to put him on a medication that would counter the rise in female hormones that he also saw. She dismissed me saying, "I'm the doctor", but finally gave in and a little over two months after starting that medication, his sperm returned, although his count was still at the same low level. After that experience, we moved to a new specialist and despite all the treatment, DH's sperm count roughly stayed the same, so we still had to rely on IVF. 

SSs were also born via IVF, but DH says they never said anything to him about his sperm count being an issue. I think this was because BM had multiple fertility issues herself, so again, DH's low sperm count was one factor, but not the only one. We pulled his medical records from that time, thought, and his counts were bascially the same at that time. 

One other thing I learned is that in the fertility industry, there seem to be providers who are in it for the "business" side of things (i.e. the money) and those who are in it for the science. Some will fall somewhere in the middle. If you end up with someone who is more on the business side of things, it can be a frustrating experience. In my analysis, those on the business side are cold, try to rush you to decisions, will not always be honest with you about what your choices really are, and basically ignore how emotional this entire process can be. I think sometimes, even those on the science side are not always honest about choices or try to dissuade you from doing things that could see a positive benefit. For example, we opted for some procedure that our second specialist said didn't help around 80% of people, so she didn't recommend it. I pushed for it anyway and we ended up being part of the 20% for whom it had a positive impact. 

I've also learned that you need to advocate heavily for yourself throughout this process, because there are a lot of unknowns in fertility medicine and some doctors use that to their advantage. I'm speaking from experience both for myself and for some friends. 

And to comment on your last point, there is a lot of "hurry up and wait" involved in this process. That said, DH and I have had a positive result (we have a little more than a month to go before our baby will join our family), so it all seems worth it, but there were times when I thought about giving up. I will also admit that I would have been more likely to walk away after our first bad experience, if I was not a SM. Having to be an SM and being tied in the parenting role to someone else's children, made me even more intent on having my own child. 

Good luck to you and your DH!

 

lieutenant_dad's picture

Thanks so much for this!

DH's specialist laid out three options on the testosterone side of things and explained it could drop his count, so anything they try is going to start at a very low dose and they'll monitor in a month. Clomid was the cheaper, mostly-likely-to-work option, so we decided to try that route first. If it doesn't work, then it's a combo of meds (I forget what) to boost testosterone and maintain his count. 

DH, in theory, had both his kids without assistance. I say "in theory" because ET has a history of cheating and DH never got the boys paternity tested. But, he had a vasectomy over a decade ago and the reversal last year, and his specialist told him that IF he had a return of sperm, it could take a year to 18 months for it to be back "to normal". We're not at normal, but his specialist is very pleased with how much quality and quantity has come back. Technically, the reversal worked because he has a return of good sperm that should allow me to get pregnant, though not naturally.

It's good to hear that my feelings of wondering if my specialist is in it for the money aren't necessarily unjustified, and that the rhythm of "hurry up and wait" mixed with having to heavily advocate for myself is "normal". I feel like most of the boards/blogs I read talk about how "wonderful" their process was, but that's all post-baby where there may be those rose-colored glasses since it was a success.

There is a part of me that is almost willing to sign off on IVF just to get this done. But, it's a lot of money. We can afford it, but I just think "that's a new car, or a semester of college, or five years of house payments". I haven't been "desperate" enough yet (hope springs eternal?) to hand over that kind of money, I suppose.

strugglingSM's picture

It's definitley costly, especially since I live in a state where insurance is not required to cover anything towards these treatments, so 99% of employers provide no coverage. 

DH was the one who really pushed to start the process and then when I thought about it, I felt that I would be forever resentful of being a stepmother if I didn't try to have my own child. Not that I won't ever be resentful, but as a stepmom, you don't get to experience the benefits of being childfree, so I'd be stuck with not be able to have my own child, while also having to live the parent lifestyle on behalf of someone else's children. Also, I know DH and BM spent far more than we would, so admittedly, I would have been annoyed with DH if he has pushed back on the cost issue, especially since we're better off financially than he and BM ever were and since he always wants to spend so much on extras for SSs. 

ndc's picture

I am another person who questions the competence/motivations of some fertility "specialists." I saw two; their opinions were in direct conflict. We had DD with the assistance of Clomid. I had a few cycles of taking it at the times during my cycle recommended by my doctor - nothing. I read in multiple places on the internet that different timing worked better. Tried that - bam, pregnant that month. Maybe coincidence, but my faith in the fertility industry is gone. Our next step would have been IVF, but fortunately my insurance will cover two rounds.

lieutenant_dad's picture

The reason I went with my specialist is because our friends used her and were successful. However, I wasn't super thrilled that we went from "IUI will work" to "nope IVF only" after one SA, and that SA is in conflict with the others.

DH's specialist has been awesome. Cheap and effective. Did the more extensive surgery that DH needed. Has laid out multiple options for DH to do better. He has glowing reviews from others. He has done everything he can to keep costs down. I really like him, and I do think he wants DH to be successful (even if it's for his own egotistical reasons as a surgeon, too). 

I have to call my specialist here soon because I need a refill on a high-dose Vitamin D supplement I needed (my Vit D was super low), and I think I may say "here's what is happening, I want to try IUI next cycle, schedule it".

thiscantbenormal's picture

Good luck on your journey.  

I finally got pregnant after having my tubes cleared out. And now I'm missing part of one so if I did want another kid it might be difficult to conceive again.

I'm happy to hear your DH is a supportive partner on this journey.  My DH had to get a SA too and honestly I'm shocked he agreed to do it b/c he was convinced he had super sperm "b/c he made twins".  I wasn't sure I could get him on board with lifestyle changes and supplements if his SA had poor results.