The Politics Of “Fertility Fog” Ctd

Andrew Sullivan —  Jan 16 2015 @ 4:00pm

A reader from the other side of the reproductive struggle broadens the discussion:

I’m not sure if you’ve received many responses from male readers on this issue, but I’d like to add a male’s perspective. Oftentimes the discussion about having a child and fertility usually revolve around the woman’s reproductive health, and more often than not the male partners either don’t think about their own health, get tested to see if they’re producing healthy sperm, or consider their own health as an essential part of the equation.

I’m 42 years old, my wife is 31. We’re in the process of trying to start a family. She got off birth control over a year ago because her sister, who’s an obstetrician, recommended at least six months to a year of being off birth control before really trying to get pregnant. Of course none of our family knows about these things and yet I’ll share my perspective here anonymously to further the discussion.

I scheduled a check up with my urologist and reproductive specialist last September, which meant a full checkup and measurement of my testicles, a full history of my sex life, prior conceptions (there was with my first wife that ended in a miscarriage) and then providing the requisite sperm sample there in the office. There is nothing more romantic than locking yourself in an exam room with clinic-provided skin-mags from the early ’90s and trying to provide a sample while clinicians wander the hall outside. Thank God for smartphones, an unlimited data plan and online porn to ease my situation.

I subsequently found out that I had a low sperm count that was impacted by a high white blood cell count that resulted from trying to heal from a massive leg contusion. My initial response was despair at being nearly infertile.

But my doctor encouraged me that they would try a few things before making any decisions. A heavy round of antibiotics, 60-day supply of motility vitamins, and more frequency between ejaculations. At the follow-up exam and sample in hand, I was on the road to healthier motility and sperm count but still a cause of mild concern for my doctor. He said to keep trying and come back in 8 months. If we weren’t pregnant, he’d give me a shot of testosterone to boost my system as another step in fixing my sperm count issues.

What most doctors don’t tell you is that there are many aspects that affect a man’s reproductive health even on a day-to-day basis. My wife and I are both architects and have stressful project loads. Couple that with running our lighting business, everyday life and the stress factor can wear on you. Most doctors recommend 6 months of really trying before seeking out fertility help.

Tracking that narrow window of opportunity when your wife’s ovulation cycle is at its peak and hoping that your both feeling “in the mood”, the very act of trying to conceive becomes yet another layer of stress in trying to do everything correct. Hoping the stars align, you’ve had a healthy few days prior to the main event, you haven’t waited too long between efforts to maximize motility, factoring in the natural chances of getting pregnant on any one try, adding in that conception is very difficult to begin with all adds to the stress of trying to conceive. And while most couples we know have tried for longer than a year or two, we’re seeing many younger couples with fertility issues leap in with IVF or other treatments and getting pregnant quickly.

And while my wife and I continue to make the effort to chart her temperatures, map the moon cycles, keeping my junk primed but not backed-up, getting each other in the mood, generating the energy to do it when we don’t feel in the mood, and then her getting depressed, then my getting depressed at each month we miss an opportunity, and these all feed back into a temporary loop of despair about thinking that we will never get pregnant. We have to gently remind ourselves that it will take time and effort every month and we’ve barely just begun trying.

We get questions from friends and family about when we’re having kids or if we’re having kids. We euphemistically say we’re “working on it” and tell ourselves that it will happen when it happens.
For most men the pressure of having children is less of a burden than it is for women. Of course we’re told that men can keep reproducing into their 70s ala Charlie Chaplin. But I know this is unrealistic and unfair to burden my future children with a geriatric father. As a guy fast approaching 43, my own urge to have children increases and my desire to not be in a wheelchair and being mistaken for my kids’ grandparent at their college graduation adds a level of urgency to the equation too.

As a guy, wandering in the “fertility fog” now, I’d just like to say it’s not just a woman’s issue and it shouldn’t be a burden that just women should have to carry. I hope more men are open and honest about their own reproductive health with their doctor, spouse and especially themselves. For many men who want to start a family, the mere thought of being infertile or having low sperm count, the initial response to hearing that news can be depressing and create the idea of being “less of a man” because you might be incapable or have difficulties conceiving. I know I did when I first found out my predicament. But I also found out that it’s easier to fix my issues first. Fertility is complicated for both sexes and having that frank discussion is relevant to women and men.

Another man:

I was diagnosed with testicular cancer, seminoma, when I was 36 (quite old for seminoma), when my wife and I married less than one year.  It’s really a great cancer, from one point of view – very high cure rates of approximately 99+% from either radiation or chemo, so presumably >99.9% from either one followed by the other if necessary.  Given this choice, and despite being an expert in the chemo treatment (which he had devised; this was a world-renowned expert in the field), my urologist urged radiation because “the side effects of nausea and vomiting were fewer and milder”.

But as my wife and I were talking to the radiation oncologist prior to my first treatment, we mentioned to her that we planned to start a family one day, asking her advice on how long to wait after the radiation.  She got a horrified look on her face, and said: “Oh, no.  After the treatments you’ll certainly be sterile.”

The urologist also knew that we planned to start a family; upon further discussion I came to the conclusion (possibly incorrect and unfair) that to him sterility wasn’t a side effect worth mentioning or even considering. So it’s not just women who miss physician education on fertility.

Well, I had the chemotherapy, the cancer was cured, we later had two GREAT kids before getting a vasectomy. My wife and I are approaching our 29th anniversary.  Sounds like a happy ending.  However, I also got “chemo-brain” which is yet ANOTHER side effect that wasn’t mentioned – a permanent diminution of intelligence, concentration, etc, that has profoundly affected my entire life from that day forward (I’m a scientist).  I love my children beyond measure, but if I had known about chemo-brain in advance, and not knowing in advance the great kids I would later have, I would have chosen sterility and we would have adopted.