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.
• • • • • • • • •
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.