One Nut Wonder

I received a call from the Surgical Oncologist's office much quicker than I did when I had been referred for my hernia surgery, I guess expediency is important when it comes to cancer treatments. They had me scheduled for the consult for the end of March, which would have been about a month and a half past the date of my Radiation Oncology appointment at the Cross Cancer. I was anxious to get it over with and apparently the universe agreed because I received a call on Tuesday, March 7th to tell me they had a cancellation and could get me in the following day. I agreed and took part of the day off work, because I had yet another sperm analysis that day as well and it just made sense.

I was about an hour early for my appointment, had paid for parking, and decided to hang out in the lobby. The building was two or three stories and was occupied pretty much all by health care practitioners except for the daycare on the main floor. I took a seat on a small leather couch and scrolled through my emails feeling guilty for missing work yet again for another appointment. I sat there casually looking up at what seemed like a parade of pregnant women walking by who must have been visiting their OBGYNs for their pregnancy follow-ups - reminding me how much I wanted what they had. I listened to the screams and laughs of the daycare beside me, and watched the day-care workers walk by with kids in little groups singing songs I remembered from when I was a kid. Now that we had sorted out our fertility issues I at least felt like fatherhood was within my grasp so I smiled while I sat there...until I realized I was sitting by myself, next to a daycare, smiling at little children, and felt like a total creeper and decided to go search out my doctor's office.

I found my doctor's name in the directory and climbed the stairs to the second floor before meandering around the halls searching for the right door. I found it at the end of what seemed like a totally deserted hall and pushed it open. I was surprised when the waiting room was so busy and realized that the office was home to a large number of specialists. The waiting room was surrounded by six or seven reception windows and reminded me of a scene from the Ministry of Magic in Harry Potter. Each window had the names of two or three different doctors posted above them and I found the one with my doctor and approached the window. The clerk took my info and handed me a clipboard to fill out with the same standard information as usual; why you're here, medications, past health, family health, surgeries, etc. I completed it fairly quickly and then sat down to wait for my name to be called.

The nurse came and got me and escorted me to an exam room down a back hallway. The surgical resident came in and did her exam before running off to give her report. Shortly after that both the resident and the surgeon walked through the door. My surgeon shook my hand and mentioned that she thought I had been through a lot in the last few months. I nodded and thanked her. I'm not really sure why I thanked her, I guess I appreciated her empathy. It's not that I haven't received any, because the support I've received from people has been overwhelming. I think it was because I didn't get the feeling that she felt sorry for me, like she understood what I was going through better than most; understood, but didn't pity me. I appreciated that.

She started by explaining that although I had been referred to her by the oncologist at the Cross Cancer, I did have options. She asked me about my fertility issues and expressed that she understood that we had been trying to get pregnant for a while. It was at this point that something in the back of my mind started nagging at me. You see, K does a lot of research (on everything, especially things that scare her, which is a lot of things) and me getting cancer scares the shit out of her, so she researches the hell out of it. Then she makes sure she tells me so I can be as thoroughly informed as possible, even though I'd rather stick my head in the sand until the doctors confirm my fears. And of course as it turns out, K had to be right - again - when she told me that the precautionary surgery my oncologist would want to do would require total removal of my left testicle.

They found the tumour on my spermatic cord, which means that it would have to be removed in order to ensure all the cells around the tumour had been removed. Unfortunately, without a spermatic cord, my testicle would no longer have a blood supply and would die, meaning it was coming out too. The surgeon explained my options to me; this type of tumour is very rare and although it is not cancerous, it can act like cancer and spread. Of course there is no way to tell if it will spread until it does, and it could end up anywhere in my body. She said that with the surgery there is a 99% chance I would be cured and never have another problem. Without it, there is a very good chance I could still never have another problem, but we couldn't be sure. So the options are to wait and monitor it and hope for the best, or lefty was getting a new home. Is it weird that I kind of want to keep it? Ya, that’s weird, never mind.

I never really appreciated my balls until I needed them. I mean...I never wanted to get rid of them or anything, but for the majority of my life they were somewhat of an annoyance. When you're a kid, you have to worry about them getting kicked, or your buddy nutting you with the back of his hand; they're a bit of a weakness. As you get older, they become the reason you have to practice safe sex (when you're monogamous anyway, there's so many more when you're not). Then all too quickly, a third of your life is gone and suddenly you need them? If you ask me, irony is a cruel joke, I've never needed my testicle more than I need it right now, while at the same time I have never needed to be rid of my testicle more than I do right now.

Maybe the thoughts circling in my head are just pride, the ones telling me I'd be less of a man after the loss of my testicle. Or maybe I'll be more of a man, with balls of steel...literally; honestly though, that sounds like more of a hassle at the airport than its worth.

Knee-High Socks

Hi Mom! Hi Dad! Hello readers! I’m so happy all 5 of you made it down to read my very first guest post! I’m Kay, Lefty’s more fertile half.  Since our most recent fertility news has more to do with me than Lefty, he asked me to do a super special edition guest post on the blog, to give you some insight from my perspective. Buckle Up!

On March 7, Lefty and I went for our follow-up consult at PCRM to discuss the results of the repeat semen analysis. We were told since the doctor we were initially seeing was gone (mat leave of all things, oh the irony!) we would be seeing someone new.

After providing reception with our IDs and healthcare cards, we were led into one of the cubicle rooms overlooking Jasper Ave, and spent a few minutes trying to decide if this had been THE room in which we had received the news about Lefty’s Highlander swimmer (there can be only one!). After deciding that this was most definitely not the same room and relaxing a bit, Lefty – who is an inherently fidgety person –started leafing through the helpful little info-graphic books they have in each room.

“Sooo, what’s the difference between this one and that one?” he asked, referring to the different types of cycles they run based on your individual fertility issues. Since I’m really into researching (What? You don’t say!), I had a basic idea of what was involved in an IVF cycle, so I did my best to give Lefty a quick run-through of the basics. “Sweet! So do I get to help you with your injections? I want to be as much a part of this process as I can.”

Bless his heart, but between you and I, Lefty has a kind of a…tremor sometimes when he’s trying to do delicate tasks. The thought of him coming at me with various (and numerous) sharp objects over the course of several weeks is on my list of ‘favorite activities’ right between number 776: watching non-stop reruns of my dads old fishing shows and number 778: letting moths swarm me in the dark. I have a completely irrational and uncontrollable fear of moths and butterflies, so this is a real issue for me.

Our new doctor came in shortly after and introduced himself. I immediately liked him; he was totally approachable and easy to talk to. He answered ALL the questions I had written down in my handy-dandy notebook. ALLLLL 47 of them. We talked about timing of IVF and how I had to go on birth control before going into the stimulation phase (Right? Opposite day!). Why you ask? Well apparently they want to quiet the ovaries in order to give the follicles (where the eggs grow) a chance to all grow together, so none get ahead and become over-ripe, so to speak. We also talked about the different drugs I would be on, and the dreaded Progesterone shot I would have to take after the retrieval. “No, we actually don’t use the Progesterone in oil shot,” (Yessss!) “We use the vaginal suppositories.” (Ohhhh…)

He also informed us that Lefty’s latest semen analysis - lucky number 3 - produced a count of 300,000 sperm with a motility of 32% and we were able to freeze 5 more straws! I asked the doctor if 300,000 was enough to just dump the sperm in with some eggs and say “go for it boys!” (Which he got a chuckle out of; apparently the embryologists would not find it as funny. I guess it takes a bit more finesse than that. Who knew?) The doc shook his head, “No sorry, we’ll still have to do the ICSI”.  ICSI - intracytoplasmic sperm injection (say that 10 times fast!) - is the process of injecting a single sperm directly into an egg to pretty much ensure fertilization.

We then talked about how many eggs we would transfer back into me after all the magic happened. Lefty, the doc and I all agreed we would do 1 egg at a time, to decrease the chance of multiples and extend the amount of tries we might have, by not putting in 2 at once and potentially having neither ‘stick’. Given my age (27), he doesn’t foresee any issues with that part, so he wants to be as conservative as possible.

At the end of the consult the doctor asked me if I had done my ‘internal ultrasound’ yet. “Hmmm, that sounds ominous” I thought. Well, let me tell you. I was not wrong. I was led to a change room by a nurse and instructed to remove everything from the waist down, and grab a ‘sheet’ from the cupboard. HAHA, I think they meant giant napkin, because I ripped that thing about 4 times just walking across the room. I sat on the table with the super nifty stirrups and waited. It was about this time that I realized I hadn’t shaved my legs in GOD knows how long (it’s winter!) and immediately regretted my decision not to wear knee-high socks. Buuuut, then that would have been a whole different level of weird and awkward so I decided to suck it up and assume that no one would care because they were doctors after all. Weeeeee! A super invasive and slightly uncomfortable ultrasound was then performed and I got to see my very own uterus and ovaries on live ultrasound TV!

“So you have an retroverted uterus,” the doc said. “Not a big deal, about 1/3 of the population has it. It shouldn’t cause any problems.” So basically my uterus points towards my spine, instead of my belly-button. WEIRD. Apparently this should correct itself when we get a bun in that oven. 

It took him a little while to find my right ovary, but it’s definitely in there (Go me! Matching set!). I was then informed that I had 16 Antral follicles, which is one of the values they use to base how successful they expect to be during retrieval. Evidently, 16 is pretty decent, so we are hoping to get lots of healthy eggs!

Goodbye to the napkin sheet, hello to my own pants, out into reception to get our consent forms, and Lefty and I were 1 step closer to being parents!

Testing Our Resolve

Apart from wanting to be a dad, there are a few other reasons that I'm putting myself through all of this. The biggest is K, she wants to carry a baby and to be a mom, and seeing as she agreed to marry me on the condition of the vows I made to her, it's my responsibility to do the best I can for her and for our family. Additionally, since I'm the reason she has to endure all of this, I figure the least I can do is everything I possibly can to keep that promise. However, until now, I haven't really explained what "everything I possibly can" means, mostly because I'm figuring this out as I go along.

So I'll give it to you straight, and I promise you, it's not pretty. There are a lot of different treatments that can be done to assist an infertile couple get pregnant and they are recommended on an escalatory basis:

To start off with, there's Intrauterine Insemination (IUI) where the doctor would take my sperm sample, wash it, and place it in K's uterus during ovulation, hoping that one of my swimmers would make a break for it and fertilize the egg. This relatively simple procedure costs $400. Unfortunately, this procedure would be recommended in a situation where my sperm was 6 million, not 6. So that's out and we move on to the next.

With oligospermia (low sperm count) the recommendation is to complete a sperm retrieval procedure to go in and get the sperm needed, which can be done in two ways:

The first is an aspiration with a needle, which yes, is exactly how it sounds: a big-ass needle would be inserted into my nut to suck out my soldiers. This procedure, at the time of this post, costs $2000; and would not likely be recommended due to the severity of the absenteeism in my testicles.

The second possible recommendation for sperm retrieval is called MicroTESE. This fun little operation requires "removing the testicle from the scrotum and opening it widely while the patient is under general anesthesia", a direct quote from Calgary's Regional Fertility Program website. I'm probably just being dramatic but a broken can-opener comes to mind when I think of this procedure. What makes it even better, is that the fertility clinic charges $5500 to open this can of oysters and with my count, this is the recommended form of retrieval. Unfortunately, when I called the clinic, I discovered that the clinic in Edmonton doesn't yet offer this surgery, so they would have to refer us to B.C., requiring quite a bit of travel. In addition, the sperm retrieved during MicroTESE is not as mature as the sperm that is collected naturally, so it doesn't freeze nearly as well and K's eggs would have to be harvested the same day the sperm is collected, so we would both have to undergo procedures, on the same day, in another province.

The consult room can crush your dreams,
make them come true, or in my case both.

I'm not going to go into details about the In Vitro Fertilization (IVF) procedures K will have to undergo, but I can tell you it's no picnic. It's a lot of self administered (or administered by me) injections, a lot of invasive examinations, tests, hormones, time spent in appointments, and emotions. So if K has to go through all of this just because of me, you're damn right I can pull up my socks and do what needs doing. To top all of this off, this procedure comes out to $9000 on top of my surgery, and medications, and teaching fees, and sperm tests, and ultrasounds. So basically, $15,000 to $20,000 for a 59% chance at pregnancy...but like I said, with cancer out of the way, we can do anything.

Since all of this would have to be completed at the Burnaby, B.C. clinic, the Edmonton clinic referred our file there, and we were booked for a telephone consult on Thursday, March 2, 2017 with their IVF doctor. Although the added procedural costs and the complications of travelling were weighing heavily on our minds and ramping up our stress levels, we were eager, even excited for our phone consult. The last time we spoke with an IVF doctor, we were so caught off guard we didn't even know what questions to ask. Now, we were ready, and we could have all of our questions answered and get some movement towards our actual goal.

On the day of the phone consult the clinic in Burnaby called me half an hour early. I was a little concerned because K wasn't there yet and I didn't want to start without her. I picked up the phone and it turned out it was the IVF doctor's assistant who was calling me. She said she was calling because the lab in Edmonton contacted their lab and recommended that our file be referred back to Edmonton. I was getting a little annoyed at this point because it felt like I was getting the run around and I had enough of that when dealing with my tumour. I asked "why?" in the most polite voice I could muster and what she told me next shocked me so much that I'm only half certain I didn't utter the words "Shut the fuck up!". She explained that my second semen sample was not only viable for freezing, they had enough to freeze two whole straws of semen! I must have asked her three or four times if she was sure before I actually accepted she was telling me the truth. She followed it up by telling me I wouldn't need the expensive and painful sperm retrieval surgery and all of our procedures could be completed at the Edmonton clinic! I was ecstatic! She said they would be recommending another sperm freeze to get some more and that the Edmonton clinic would be contacting me to book the appointment.

When the call was over I immediately called K and told her the news, she was in complete disbelief. I have no idea if it was the Snowballs, the healthy diet, or the Chinese medicine, but something I did worked. Although IVF would still be required, I had managed to bolster my army from a measly militia of six unwilling fighters, to a force of 100,000 sperm with a motility rate of 29%!

Are You Jerking My Chain?

My second sperm analysis took place the day before my ultrasound. I like to refer to this one as my "deposit" because the idea is that if they were able to get a viable number and quality of sperm, they would freeze it and put it in the sperm bank for use at a later time. This nifty little procedure came at a cool (see what I did there?) cost of $425. Given the extremely low count from my first analysis, we made sure if there was not enough viable sperm to freeze, we could get a refund for the cost of the freezing.

**Something I learned while writing this post is that apparently there isn't a formal synonym in the thesaurus for the word "masturbate", however there is a wealth of options in the Urban Dictionary, that I'll share with you.**

This time around was actually closer to what I had expected when going into my first analysis. This one didn't take place at a hospital's masturbatorium (apparently these nasty little rooms have a name, I swear I didn't make it up); this one was at the private clinic. The last time I was at this clinic was when I found out I was infertile, so I wasn't really looking forward to going to the appointment by myself. Plus there was something about leaving work for an hour to "buff your banana" into a cup only to go back to work and go on about your day like nothing happened that just didn't sit well with me.

Or maybe it's just the whole procedure, I mean, literally every person you come into contact with knows you're there to "yank the crank". The two ladies at reception, the grumpy looking one who comes out of the hallway door to escort you to the lab, and then there's the lab tech; every single one of them knows that behind that door, you're "pumping the python". The only thing I could think of that could be more awkward would be sex in a mattress store...unless that's something you're into (no judgement).

Private masturbatorium

The other differences between the hospital and the private clinic is that your "willy whipping" material is provided in a couple different forms. After confirming my name and birthdate the lab tech handed me a clipboard with a questionnaire, a sterile cup, and offered me an iPad in a waterproof case. She informed me the WiFi password was on the back of the iPad but I declined the iPad for two reasons:

1) I don't know where that iPad has been.
2) I can deal with people knowing what I'm doing, but what kind of porn I watch is a personal decision that I prefer to keep to myself. Not that I'm into "footjob" videos or anything weird like that, it's just personal, like when you have company and you close your bedroom door to keep them from seeing the dirty laundry strewn all over your floor.

The little room at the new clinic was very similar and the chair was almost identical except it was a shade of grey instead of black.  It still had the blinding fluorescent lights which was intensified by the bright white floor, wall, sink, and cupboard. If I was to make any suggestion, I would seriously recommend they add some LED bulbs and a dimmer switch to that room; the brightness makes you feel like you're being watched. Sitting on the cupboard in this room was a stack of old porno magazines that were exactly what I had expected at my first analysis appointment; they were dusty, and looked to be somewhat water damaged, I thought it best not to touch them, but it was at that moment that I became genuinely grateful that I am alive during the time of smartphones and WiFi.

The directions on this wall were also a little different, they didn't include rubber gloves or sanitary wipes to clean the chair, so I did the best I could with paper towels and water, placing a lot of trust in my assumption that they sterilize the room and chair after every use. They did, however, provide lube but made sure to insist that only the provided lube be used for its sperm-safe properties.

Sperm-safe lube

Following completion of my business I filled out the obligatory questionnaire which basically asks you two things: if you abstained from "polishing your rifle" for 2-5 days like they instructed you to, and how your aim was, more specifically; what percentage of your swimmers made it into the cup. I proudly marked down 100% because my rifle is dead accurate, it just apparently shoots a lot of blanks.

I deposited my sample with the andrologist and returned to the front desk to talk to the receptionist. We had been told that the wait to see the urologist may be a while because he basically flies out to Edmonton from Vancouver specifically for appointments here, so I wanted to ask if I could be referred to the clinic in B.C. for a quicker consult. I figured there was no point in waiting any longer than we had to, who knows how long this would take. They gave me the number for my doctor's assistant and my receipt for the sperm deposit and sent me on my way, somewhat lighter than when I entered.

Balltrasound

Since getting the news that I don't have cancer, my life has become substantially easier to deal with. At the risk of using a cliche, it's like the weight of the world has been taken off my shoulders. If I take into account my belief that everything happens for a reason, I think the purpose of the cancer investigation was to put our fertility issues into perspective for us. Somehow, big issues like infertility don't seem as big when you're not battling cancer. K and I are ready now for whatever they can throw at us...at least I hope we are.

 

My last test before following up with the fertility clinic again was a scrotal ultrasound, or as K likes to refer to it, my "balltrasound". This isn't the first time I've had to undergo a procedure like this. As I indicated previously, I was referred for a scrotal ultrasound to confirm my nut infection about ten years previous so I'm not entirely new to the procedure.

 

Straight jacket pose

I drove over to the Hys Centre about 15 minutes from work and made my way to the second floor. Reception checked me in and I sat down in the waiting room which was busy and much larger than I was used to. I did some more waiting, but realized waiting doesn't really bother me as much anymore. The staff member called my name from the corner of the waiting room along with another patient and she ushered us both into a back hallway lined with change rooms. She handed me a blue gown, pointed to a change room and told me to take off everything from the waist down, put on the gown, and wait for the tech to come get me. I was so close to asking for pajama pants but decided against it; I was pretty sure I wouldn't need them given the reason for my visit. I struggled, however, with the gown. I tried this straight jacket on probably six different ways before tying what looked to be the matching strings together and sitting down feeling defeated. I'm positive I didn't put it on properly because it looked like one of my togas the morning after a high school party. I was pretty sure it wouldn't matter though, as long as I was able to flash the tech sufficiently.
 



Can't see into the future, just into my balls

The tech called my name in the hall and I exited to find a middle aged woman with librarian glasses smiling at me. She led me to a room at the end of the hall, closed the door behind us and handed me a towel. The next part was totally different than my prior experience. Her instructions were clear; I was to hike up my gown, lay down on the bed, pull my penis up onto my abdomen and cover it with the towel. I was halfway there when she got startled and said "wait! wait!". I stopped dead, afraid I had messed something up, apparently she was used to much more shy men than myself because what she wanted was to unfold and hold up the sheet she was holding in front of her to give me some privacy. I waited till she was ready and then followed her instructions. What followed, though, really made me wonder why she was being so discreet in the first place because her next instruction was to reach down and hike up my scrotum so she could tuck the sheet under it. I was thinking to myself, "my dignity is as intact as its going to get, lets just get this over with".

 

Since my last ultrasound one thing for sure has changed, they now use a heated jelly, which gave me an instant flashback to the original American Pie movie. I mean, had it not been for the awkward lady holding a camera to my junk, it might have actually been pleasant. She took her time, which I actually appreciated because I wanted this done right the first time. Check one side, then the other, I heard her snap a handful of pictures on each side and she made sure to check with the doctor before sending me on my way. I cleaned myself up with the towel she gave me, made my way back to my change room, put my clothes back on and was released with a severe craving for some apple pie.