We’re Going on a Sperm Hunt

We’re going on a sperm hunt.
We’re going to catch a big one.
What a beautiful day!
We’re not VERY scared.”

If I’d ever imagined a caricature of conception, then the egg would have been cool and mysterious, aloof even. Perhaps wearing a headscarf and sunglasses and looking more than a little disdainfully at the sperm rushing towards her, falling over one another like over enthusiastic puppies, unable to contain themselves and certainly with no lack of energy and focus to get to their goal.

It turns out in our case the egg could have been wearing a high-vis jacket and neon flashing sign and attempting to fall under the feet of the incoming sperm. For all the good it would have done. Because at some point in the last three years we went from falling pregnant with relatively little effort to a sperm count of virtually zero.

It’s a position that even has our fertility consultant a little baffled, as there is simply no logical explanation for such a dramatic change in our fortunes in the absence of an abnormal hormonal profile and any illness or trauma. Even from a lifestyle perspective, Ian is, if anything, in a better place now than he was three years ago. In fact the favoured explanation at the moment is that we were simply very, very lucky to have ever fallen pregnant before. 

It’s taken a while for me to write about this because it is obviously not just my story to tell. And whilst Ian is not silly enough to believe that a sperm count is any kind of reflection on his masculinity, or worth as a father, other people are not always so sensible. And somehow it’s still more “acceptable”, or at least expected, in this day and age for a woman to have fertility issues than for the problem to lie with the male. Of course, in reality, all fertility problems belong to a couple – there is no fault, or blame or responsibility. It may be Ian’s body which is the predominant problem, but it’s an issue for both of us as a couple. 

I want to write about it, though, because it seems that no one else is. It seems like severe oligozoospermia (low sperm count) and azoospermia (total lack of sperm) are not common causes of secondary infertility (infertility occurring after a previous successful pregnancy). I can believe it’s not that common. And I also wonder if dropping sperm counts do perhaps happen, but go unnoticed, since the only indicator is reduced fertility. If we had only wanted one child, or if Thomas had been our second instead of our first, there is a good chance we would never have known. But I also think that perhaps it doesn’t seem that common simply because no one is talking about it. I want to stand up and say that this happens.

Secondary infertility can be hard enough and lonely enough without shrouding it in further secrecy. People are fond of telling us that we have one child, of course we’ll be able to have another. We’re living proof of the existence of physiological changes that can actually render that impossible. And already having one child doesn’t make it any less painful when your heart and your arms ache for another.

Where we are very fortunate is that we live in a day and age where diagnosis and treatment are possible. Less than half a century ago we would simply have become “that couple” who longed for another child but just couldn’t have one. We’d probably have blundered on with “trying” for the next five years or more, perhaps never truly coming to terms with it. But now we have sensitive techniques for testing fertility problems. We have In Vitro Fertilisation and Intra-Cytoplasmic Sperm Injection (ICSI) techniques, which require just a single sperm for each egg collected during an IVF cycle, which is then injected directly in to the egg.

We even have surgical sperm retrieval procedures.

And that’s our golden ticket.

After discovering Ian’s very low sperm count at the end of last year, we had a consultation with a private fertility specialist. (No NHS options for us, given that we already have Thomas.) The plan was to proceed with ICSI, but to be sure we’d have plenty of sperm, especially if the first cycle failed, or we decide on a couple of years that we’d like to try for number three, we decided to freeze some sperm.

Here the real problems began. The diagnosis officially became azoospermia when all efforts yielded zero sperm.

Our only options for another child that is a full biological child to both of us and a full biological sibling to Thomas was to go in and hunt the sperm down surgically. So last Tuesday, we did just that.

Ian was scared for obvious reasons. I was scared for more subtle reasons. Because this was our last chance and finding no sperm would mean the end of the line. (We’ve already discounted donor sperm as I don’t want Thomas to have half siblings. Who knows if this decision would be different if we were trying for our first child.) Although I’ve now had more time to get used to the possibility of an only child, it’s still not my preference. I felt like everything rested on the short twenty minute sperm hunt and the skill of the consultant.

The news is good. Not brilliant, but good. He found sperm, and enough to freeze. The less good news is that we only have enough for a single IVF/ICSI cycle, which has immediately upped the pressure I feel for it to work. So if you’re reading this, I’d like to ask you to keep everything crossed for us.

I’ve said before that I’m trying to avoid asking “why us?”, when the question could just as easily be “why not us?”. 

Because yes, secondary infertility exists. Even secondary azoospermia exists. And it’s heartbreakingly hard. But no matter what happens now, at least we can’t say that we haven’t given it our very best shot.

The Stages of Trying (and Failing) to Conceive

The title of this post gave me some difficulty. It turns out that I’m still somewhat hesitant to use the word “infertility”. It’s not simply about wanting to deny the situation that we’re in, or that the definition fits. It’s more about a fear that by applying that word to our current situation I might somehow be belittling those whose situations are far more complex, more difficult and have gone on for much longer. I’m very definitely a newbie at this.

That said, I’ve already learned a awful lot about struggling to conceive. And I can already identify several distinct phases in the trying-and-failing-to-conceive journey. So here’s my round up of the six stages that those of us in for the long haul seem to pass through on our journey to conceiving a child. (And here’s hoping that anyone reading this never gets beyond stage 1 or 2 before they see that second pink line!)

 

Impatience

It starts with impatience, almost universally. You make the decision to start trying for a baby and it’s pretty natural that you want it to happen straight away. So you start off by wondering how long this is going to take and wishing the weeks away. This is the stage in which you happily pee on a stick a couple of days before your period is even due and watch the test with a rising sense of excitement. Because although you’re impatient, you’re also expectant. We all know people have trouble conceiving, but yet often manage to convince ourselves that it won’t happen to us and we’ll soon get the longed for positive. After all, we also know plenty of people who got pregnant on their honeymoon, and we’ve all attended secondary school sex-ed classes that taught us the “dangers” of “un-protected” sex.

 

Frustration

So, when it doesn’t happen after the first few months, the frustration creeps in. We’re doing everything right, tracking ovulation, plenty of sex so why hasn’t it happened yet? This is also the point at which all the stops are pulled out. You find yourself researching supplements and scouring eBay for the best deals on bulk buys of ovulation predictor kits, cross that you need to buy them at all because you definitely should be pregnant by now.

 

Optimism

But that gives way to optimism, when you realise that you’ve been at this for several months and so probability dictates that you must be getting closer to success. “This month” is definitely going to be “the month”. After all, statistics suggest that around 60% of couples will be pregnant after six months of trying.

 

Disbelief

Of course, that leaves 40% of us still waiting, but, given that you’re doing everything right, it’s pretty hard to believe that you’re not in the other 60%. In fact, it becomes pretty hard to believe a lot when you’ve been trying for nine months or more. It’s hard to believe that the egg you’re certain you’re releasing (after peeing on so many sticks that catching your wee in a cup is now a conditioned reflex) is not getting fertilised by the plentiful supply of sperm that you (or your partner, to be more specific) are providing. How is it possible that so much “unprotected” sex can result in nothing when high school biology, and the problem pages of teenage magazines, would have you believe the briefest of fumbles behind the bike sheds would get you up the duff?

 

Anger

After disbelief comes anger, jealousy, bitterness and the “it’s not fair” syndrome. All the negative and slightly destructive emotions come tumbling in one after another. It’s hard to maintain sight of the fact that this is actually quite common when you are surrounded by pregnancies, some unplanned, others achieved lightening fast. It’s hard not be at least a little bit jealous when other people have something you desire so strongly and have worked so hard to get but without success. It’s natural to question why this is happening to you, and to feel it’s not particularly fair. It’s all too easy to forget that you never really know any body else’s story, or how hard their road to pregnancy really was.

 

Resignation

When the anger burns out, you land somewhere between depression and resignation, depending partly on your character and personality, and partly on the particular day. It’s hard to turn practical to solve the problem, because that is what all the charting, testing and frequent bedroom antics have been about. Once you start down the road of fertility investigations, it feels, in many ways, even more out of your control. The desperate longing for a baby doesn’t go away, but it becomes equally balanced by the fear and belief that it won’t ever happen forcing you in to an odd neutrality and an awkward acceptance of the situation. Well, on a good day at least.

 

Which is exactly where I found myself just prior to receiving a definitive verdict on our situation. Funnily enough, that diagnosis has sent me right back to square one. We have the answers now, and so I want to get on and do something about it. I’m impatient to start down the assisted conception road that we now know we need to take, and I’m cursing Christmas, and the popularity of our chosen fertility clinic, for slowing things down. I’m back to anxiously counting out the days of my cycle, working out when we might actually be able to start the treatment we need.

I can foresee that the stages above could easily transform in to the “Six Stages of Fertility Treatment”, but right now I’m bypassing frustration and heading straight to optimism – optimism that we won’t get as far as disbelief, anger or resignation in the IVF process.

Here’s hoping.

Where Did It All Go Wrong?: A Secondary Infertility Diagnosis

Observant readers of this blog may have noticed that I’ve rarely, if ever, used the words “infertile” or “infertility” up to this point. I’ve preferred to refer instead to”difficulty conceiving”. Since we conceived the first one without any difficulty at all, it seemed natural to assume that “difficulty” was all we were having. It seemed unthinkable that things could change that dramatically. However, it appears that not only is it entirely possible to become almost completely infertile in the three years after conceiving one child, but that it has also happened to us.

I don’t particularly want to discuss specifics here, because they relate to us personally and have little relevance to anyone else. Suffice it to say, however, that even my husband, who has no interest in, and little understanding of, medical matters, it’s fairly clear from our results that our chances of conceiving and carrying a baby on our own are extremely tiny.

In a way, this is a massive positive. It seems that IVF does have a reasonably good prognosis and to be honest, I’m happy about the definite-ness of the fact that this is what we need to do. Like, I suppose, many people struggling to conceive, I was dreading getting no answers. Being told just to be more patient and “keep trying”. I was worried that I’d be forced in to making a decision to undertake expensive fertility treatment just to satisfy my own impatience all whilst wondering whether it was truly necessary.

Now, I know exactly what we need to do.

And do it we will. Obviously and rightly we won’t qualify for any treatment on the NHS, so it seems that rainy day that we’ve been saving for has arrived, because I can’t put a price on having another child. Even the unobservant blog readers amongst you have probably picked that one up by now! I feel fortunate that we have the money available to do this and give it our very best shot.

I’m daunted, too. Naturally. I’ve just begun dipping my toe in the waters of infertility forums online and I’m overwhelmed by things I don’t yet understand, and by the many ways this could end up going. Surely no one would choose assisted reproduction if they had a true choice. It isn’t where I want to be, but I know that it is where I have to go.

Something – call it women’s intuition if you want – has been telling me for over six months that something wasn’t right. And so it turns out I was correct to have so many concenrs about our fertility. Even so, I’m still confused about just exactly where it all went so wrong in such a short space of time. But whilst we have answers for why we can’t conceive now, we don’t know exactly how we managed it before. Perhaps we had the same problems back then too. We will probably never know, but I can admit to having hugged my son just a little bit tighter when we arrived home from our appointment.

Never mind IVF, perhaps he, too, is a miracle baby.

On the Flip Side…

A couple of days on, I’m concerned that my last post may have come across as unnecessarily negative or self indulgent, and that perhaps it requires some balance.

For starters, I’m acutely aware of how many alternative scenarios I could be facing that are infinitely worse than anything I’ve ever experienced or am facing now. It may be a big deal to me in this moment, but in the grand scheme of things, it’s a minor blip.

I’ve spent my entire life refusing to be someone who says “It’s not fair”, because, frankly, that is only stating the obvious. Life is intrinsically unfair.

Perhaps the most difficult part for me is the lack of control. I’m used to working to get what I want and holding no one accountable but myself if I don’t get to where I want to go. And whilst I’ve made changes to my lifestyle and devoted hours to monitoring and recording my “fertile signs”, doing everything in my power to optimise our chances of successful conception, ultimately there is only so much that I can do. At the end of the day, much of it is out of my hands and comes down to chance, or to good old-fashioned luck. It’s hard for me to get my head around that.

I feel sometimes like my body is saying “no” to me, which is not something I find easy to accept. As someone who has met a lot of narrow minded prejudice in my life, I’ve learned always to be clear with people that they shouldn’t tell me not to do something that I really want to do. Not to tell me “no” based on their own assumptions of what they could, or would, do if they were me or in my position. The greater the barriers people raise, the higher I will jump, or the further I will go, to get around them. I  generally set a limit on my limitations rather than letting my limitations set a limit on what I can achieve. I can assure you that without this attitude I wouldn’t be where I am now, doing the job that I do, living, and having lived, the life that I do.

But none of this works when then problem lies in the way that your body works. Or doesn’t. I can’t go any further or work any harder, and my passivity is translating in to negativity.

On the flip side, at least I’m used to things not really working how they should. I’m used to unexpected twists to the journey and I’m used to getting bad news about my health. Even a commonplace broken leg for me had to be complicated by the simultaneous rupture of my achilles tendon which led to three surgeries and a total of more than six months in plaster. I never do things by halves, and perhaps my biggest mistake is allowing myself to be surprised that this isn’t going smoothly.

The positive side of all of this is that I’m built to cope. If I can’t direct my strength and determination into actually making it happen myself, at least I can direct it into re-setting my expectations and coping with the journey.

And not giving up.

Flowers on the piano

Broken

I’ve been a bit quiet lately, both online and off. It’s not for a lack of things to write about or share. It’s not even as simple as a lack of time, although things have been exceptionally busy. It’s more down to a lack of motivation and a slide in to reversed philosophy of not doing today what can be put off until tomorrow. That, and every time my thoughts turn to my blog, or to other parenting blogs – and hence Twitter too – with so many sibling tales and happy pregnancy announcements throughout, they can’t help but turn to the baby we keep failing to conceive.

I never meant for this blog to turn in to a “trying to conceive” blog. And I certainly never dreamed it would become an infertility blog. When I first wrote about trying for a second child back in February, we’d already been trying for a number of months and I made the decision to share because I wanted to touch on the subject of the extra stresses that are associated with the experience when you have diabetes. I honestly thought at that time that we wouldn’t have too much longer to wait, so it seemed like the best time to cover the topic.

But here we are, eight months down the line, no nearer to having another child but with the newly acquired diagnosis of “secondary infertility”. The cause, if any, is as yet unknown. And I’m starting to really feel the strain. Even Ian’s attitude of calm, relaxed patience is starting to falter. Time and again he’s been the one to remind me that it’s “normal” for this to take up to a year. But just this week he has conceded that though this statistic is often bandied about, we know very few people who have waited that long and then suddenly conceived without fertility treatment. In fact, we know far more people who have experienced accidental surprises, or fallen pregnant on their first try.

Somewhere along the line this has stopped being about a desire for a nice tight age gap – although the number of Phil & Ted’s pushchairs at the local park is still a stark reminder of what we now won’t have. But these days it’s about desperation to complete the family I aspire to, whilst slowly losing hope that it will happen at all. I feel as though I’m surrounded by pregnancies, or families with more than one child. I know it’s partly because I’m focused on it, but it’s hard to do anything else when you want something so badly. It’s hard not to wonder why it seems to be working out for everyone around me.

I’ve tried to be positive about this. I’ve tried standing the typical questions on their head and asking not, “why us?” but instead, “why NOT us?”

I think it’s probably selfish to believe that we’re somehow more deserving of an easy ride than any other couple and I know just how lucky we are to have one fantastic child. But yet I can’t help but think that I’ve already dealt with enough crap and, in particular, enough of my body’s failings. Whilst no one else may deserve to be in this position either, I think I’m justified in wishing for a break.

My entire medical history, not mention life story, is too long and too boring to share here. Besides, I don’t care for the medical one-upmanship that abounds across the internet – there is no competition or prize for the longest list of bodily ailments. I prefer to focus on living well despite limitations. But here are some of the important facts of the matter: Diabetes pre-dates my earliest memories. I literally do not know what it feels like to live with a body in full working order, to not be reliant on an external supply of an essential substance that most people barely even know about, never mind take for granted. Then, following a run in with meningitis as a teenager, I’ve dealt with a life altering diagnosis which severely limited my freedoms and opportunities at precisely the time of my life I should have been seizing them. Instead, I was seizing in an entirely different way. To this day I live with brain circuitry that is dependent on medication for its proper function. And whereas many people couldn’t tell you where their pituitary gland is located, I’m intimately familiar with each of the hormones it produces and what can happen when their function goes haywire too.

I live with a broken body. Bloody hell, I live well – a good life – with a broken body. But I think it’s understandable that just sometimes I wish my body would do what it is supposed to do, without the need for medical assistance, without any hiccups. I’d like for things to simply work.

I’m not normally one for reading horoscopes (I mean, come on, can those little paragraphs really each be so applicable to one twelfth of the population?) But at the hairdressers earlier, the page in the back of a magazine caught my eye. Under my own sign, it included the statement “eventually life runs out of ways to torture us”.

Today, feeling down as I do, I couldn’t help but wonder when that time might come for me.

Why I Believe Fertility Support for Women With Diabetes Needs a Rethink

Like a lot of women with diabetes, I spend a lot of time ensuring that people see that it doesn’t have to interfere with life and that there aren’t very many things that I can’t do. We don’t want or need special treatment in most ordinary circumstances in life. That said, it certainly complicates life at times, and many things need a little more thought and planning. Pregnancy is an obvious example. Women with diabetes can, and frequently do, have happy healthy pregnancies with happy healthy babies at the end. But it does take a lot more planning and effort to achieve than for many women without diabetes.

Pregnancy prep, for a diabetic, begins many months before “trying to conceive”. Current available evidence suggests that the risk complications is reduced if blood glucose control is at optimal pregnancy levels for some months prior to conception. Most experts seem to recommend a minimum of three months of good control. And this has benefits for the mother-to-be too, as very rapidly tightening control after learning about an (unplanned) pregnancy is associated with a greater risk of worsening any pre-existing eye complications, or bringing new ones on, as well as a much greater risk of hypoglycaemic unawareness and severe low blood sugars – potentially dangerous for both mum and baby.

Pregnancy standard of control achieved for the requisite time, you get the green light to start “trying” in the normal way in the hope that a positive pregnancy test will soon follow. Except, obviously, sometimes it doesn’t. In the presence of good control and regular cycles, there is nothing to suggest that this might be related to diabetes. But all the while that tight control needs to be maintained.

Unless you live with it, it’s impossible to truly understand what that means, but here is a small flavour: Testing blood sugars frequently (up to ten times per day) day-in, day-out. Counting every carb that passes your lips and calculating the corresponding insulin dose. Restricting dietary choices in pursuits of better post-meal blood glucose levels. Aggressively correcting high blood sugars whilst trying to avoid too many lows. Dealing as best as possible with the hormonal ups and downs of each cycle and their effects on your carefully calculated control. And doing that over and over as each month your period arrives and your pregnancy hopes fade.

Vibe CGM Graph

Trying to conceive can be trying for everyone, but trying to conceive with diabetes is a double whammy of struggle.

If you’re under 35, like other women in the UK, women with diabetes are expected to endure 12 months of this roller coaster of trying and waiting until basic fertility investigations are carried out on the NHS. By this stage the obsession over blood sugars has already been going for at least 15 solid months. You then spend month 13 of “trying to conceive” getting blood tests done on appropriate days. And possibly month 14 having these repeated in the hope of a different result. Then you might wait anything between six and eighteen weeks to be seen by a fertility specialist (unless you opt to pay privately, of course). All of which adds up to over 18 months of super tight diabetes control. Two pregnancies worth, before you’re even pregnant.

It’s easy for outsiders to dismiss, to tell you to take a break and that it won’t hurt. Even my GP suggested to me that I stop trying quite so hard to keep my control so good, and if I did happen to fall pregnant I could quickly “sort things out” then. It’s easy to say if you won’t be the one unable to move on should that pregnancy end in miscarriage, forever wondering if those weeks of slacking were the cause. It’s also easy to say when you don’t understand that “sorting it out” isn’t always as easy as it sounds. Because where blood sugars are concerned, stability breeds stability and chaos breeds, well, chaos. Keeping on the level is hard work, but comparatively easier than creating good control out of a mess.

I’m well aware, as someone who wants to minimise the impact of diabetes on my life and health, that we should all be striving for tight control for our own sakes, not just our unborn children. But there is a difference in the level of control required long term to reduce the risks of complications and the extra level required to really minimise the risks to a growing baby. The difference is that just two weeks of terrible control in a forty week pregnancy is a relatively long term. Two weeks in the three decades of diabetes behind me and the many, many years still stretching ahead of me is comparatively tiny. I can slip up for a few weeks, slack off and only test a few times each day. I can take a break between CGM sensors if I so choose and I can be lazy and let my pump infusion site run on for four days because I don’t feel like changing it. In the grand scheme of things it won’t make much difference, unless you throw a potential pregnancy in to the mix. A baby is the biggest motivation for good control ever. But it’s also the biggest fear factor.

I can’t say it often enough that people with diabetes on the whole don’t want to be treated any differently than those without. For the most part there is no need. But sometimes it’s essential. Our pregnancies aren’t managed in the same way as pregnancies which aren’t complicated by diabetes, and I don’t believe that the assessment of our fertility should be either.

I wouldn’t for a moment suggest that women with diabetes should somehow jump the queue for fertility treatment and I fully understand and support the general need to wait a while before testing fertility, as most often all that is required is time. But for some people all that time will turn out to be a waste, because pregnancy could never have been achieved without some form of intervention. That is sad, and hard enough to bear for any couple. But for a woman with diabetes who has driven herself to burnout in all the months of obsessive control, it’s even harder.

The basic fertility tests offered to women who’ve been trying for a year are relatively inexpensive in health service terms and I believe that they should be offered sooner to women in this position. Even if it’s just reassurance that all the effort is worth while because there is nothing obvious going on and pregnancy is as likely as for every other couple. If the news is less good, then at least it’s possible to make informed decisions about diabetes management moving forwards. Because what is the comparative cost to the health service of managing pregnancies in women who have tired of all the hard of work of diabetes and burned out long before the successful conclusion of a pregnancy? These women are at increased risk of miscarriage, need even closer monitoring in pregnancy, have increased risk of needing a caesarean delivery, and increased risk of birth defects or still birth.

Obviously this is something about which I’m very biased, impatient as I am to have another child and as burned out as I am by controlling diabetes right now. I know that every women who is trying and failing to conceive is desperate for answers and wants them as soon as possible. What I’m trying to illustrate is how dealing with an all-consuming chronic medical condition makes this process harder. I’m constantly baffled by how we are left to struggle yet the moment the second line appears on a pregnancy test, there couldn’t be more help on offer.

I could certainly have done with a bit more support on this journey. It’s amazing how much better I’m beginning to feel now that we’re finally getting it.