Diagnosing: Jason’s Infertility Factors

What if I told you that 95 percent of infertility issues are female-related and that the male is almost never to blame? Would you believe it?

If you did, then please know that I am lying. It was a trick question, but I used it only to highlight the misunderstanding that prevails among those who mean well. Did you know that the statistics for infertility are split equally? In other words, if you were to place blame you would find that roughly one third of infertility cases are due to female factor (a disease or impairment on the female side), one third male factor (Yep, that’s right), and one third are unexplained (My heart goes out to these people. Can you imagine how hard it would be not even knowing WHY you can’t have a baby?)

In fact, here are some quick facts for you. Thanks to the American Society for Reproductive Medicine for this data.

  • Infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body’s ability to perform the basic function of reproduction.
  • Infertility affects men and women equally.
  • Twenty-five percent of infertile couples have more than one factor that contributes to their infertility.
  • In approximately 40 percent of infertile couples, the male partner is either the sole cause or a contributing cause of infertility.

Okay, now that you know this, you may be wondering what I contribute to this mix. Well, let’s start where Katie left off.

Dr. Drewes had suggested we get me tested since the Clomid wasn’t working. We went to see a Uroliogist and he referred us to the fertility clinic for a Semenalysis.

I’m going to make a little plug here for Dr. Foulk and the Utah Fertility Clinic. These guys are the best in the nation. Seriously! Dr. Foulk has one of the highest success ratings for IVF in the country. Add to this the fact that he is kind, empathetic, caring and just a nice guy. His staff is professional and SUPER helpful, and you never once feel awkward or nervous or mistreated while in their care. Honestly, they are simply the best, and we are so extremely grateful to be their patients.

At this point, I wasn’t very nervous. I mean, why would I be? It was clear that there was something holding us back from being pregnant, but it couldn’t be all that bad right? I turned in the sample and sat down in the lobby for a few moments. Not two minutes later, the nurse called me in and I was given good news and bad news. The bad news was that my sample was about 180 million sperm short. Now, that may not sound so bad, but when you realize that the average number of sperm per sample is 180 million… well, you get the picture. So, the good news was they didn’t charge me for the analysis. This was only because there was literally NOTHING to analyse. They ordered a second analysis in order to confirm the results, and it was official. When there are 0 sperm, this is called Azoospermia, and was my first diagnosis.

So, when you are diagnosed with Azoospermia, there are several possibilities and explanations. Either I am sterile and I have never produced sperm at all, I was injured enough that I am more or less sterile, there is a blockage of some sort in my piping, or I am just not producing enough sperm for them to show up in my semen. Of course, in my mind, the only possible causes were: You’re not a man, you’re not a man, you’re not a man, or (my favorite) you’re not a man.

So, what’s the next step? Well my friends, let me introduce you to a wonderful little procedure called the PESA/TESE (you can look up the acronym, I’m too lazy right now.) This is the next step in the diagnosis. Using this procedure, they can usually tell whether you are producing sperm or not. Depending on this outcome, the doctor is then able to determine whether or not IVF is even an option.

So, they take you in and give you a small dose of Valium and some painkiller. They could have knocked me out for this, but I figured, “Meh, what’s the worst it could hurt, right?” and it would have cost an extra 500 bucks. Yeah, next time, I’m forking over the half a grand.

The doctor takes a looooong needle (For the men who are squeamish, there may be some leg-crossing involved while reading this. You have been warned.) and inserts is directly into your epididymis. This part was actually not bad at all since they had given me some lidocaine shots and I was pretty much all numb “down there”. They “fish around” for a few minutes, attempting to extract semen from your epididymis. This is the PESA portion. If they find sperm at this point then, good news! It’s over. I was not so lucky.

The next step, TESE (Testicular sperm extraction–look at that, I did some googling for you), is, let’s say… unpleasant. The doctor takes what I can only describe as “one of those ear-piercing guns they use in the mall” and places it against one of your testicles. It basically “reaches in”, takes a sample and pulls it out. I was not expecting the very sudden and loud punching sound, but I barely even heard it as I had probably jumped about five feet into the air above the doctor at this point. It hurt. A lot. ‘Nuff said.

He then did it to the other side. Yeah.

While the patient, i.e. Me, is struggling to breathe, they take the “sample” to the lab. Here is where I received the first good news I had been given in a while. Certainly not the best outcome, but definitely not the worst. Long story short, I wasn’t sterile. Out of the millions of sperm that would normally be present, they found 2. Not two million, mind you. Two sperm. Hey, this was honestly better news than I was hoping for.


Click on the picture to enlarge.

The answer to my diagnosis is that, where the seminiferous tubules (where the sperm are created and transferred to the testes) should be, there is simply fibrous tissue. In other words, I have scarring where my sperm are made. This means that either I had an injury which led to most of my tubules being scarred over, or (the more likely option, says Dr. Foulk) I wasn’t developed correctly at birth and my tubules never grew in as they should have.

What this DOES mean is that I AM producing them. Just at such low amounts as to make natural conception next to impossible. It only takes one, but we’re looking at about a 1 in 90 million chance. Anyway, it’s good news because this means that IVF is likely an option.

So, now that we had found Klaus and Fritz (apparently they have names), we just had to find a way for me to make LOTS more of them. About 10 million or so would be ideal for IVF. The lowest count to date for successful IVF was about 45,000.

This leads us to the shots. Long story short, it took us a while to get the money together and get ourselves ready to start this journey. Once you start IVF, you can’t stop the ball rolling. So, once we pulled the trigger, I started taking daily shots. I take a medication called Novarel once every Mon, Wed and Fri. I also take a shot called Bravelle on Tues and Thurs. The idea here is to jump-start my hormones and release testosterone naturally into my system. The hope is that I will begin creating unimaginable amounts of sperm. Three months later, which will be August, will tell us the results. If I have enough (I think a few million would be enough to continue) then we go for IVF. if there are only a few more, then I continue the shots for three more months. If there is no improvement, then that’s that. At this point, adoption would be our only choice.

So, we’re sitting at one month on the shots. The added benefits of the medication could potentially be higher amounts of testosterone, which make me happier, healthier, and all sorts of other things. It’s also possible that I could become aggressive, irritable or depressed. So far though, I’m feeling really good. I’m taking advantage of this added testosterone by lifting weights daily, growing a beard, eating like a teenager and so on. Who knows what the near future holds? I don’t, but we are optimistic at this point and we know that, no matter what, everything is going to work out.