The Seamen Analysis

SA





One of the first things my Reproductive Endocrinologist (RE) suggested is that we get Joe tested first since a seamen analysis (SA) is the least invasive test. For those of you who are wondering if you live really close to the Dr’s office you can collect the sample at home other wise you need to do in the office. For the actual collection they give you cup and put you in a room, your wife can stay or wait outside, whatever you’re more comfortable with. From what I’ve read and seen the rooms very greatly as does the paraphernalia available to assist in the collection. Most have at least a selection of magazines, but I’ve heard that others also have videos. The rooms at Joe’s urologist (UR) were the same rooms they used to examine or consult with patients. The room he used at the RE’s where we had our first IUI was about the size of a porta-potty. don’t you know that’s conductive to having a pleasant experience. After dealing with infertility for a while you begin to wonder what pleasure has to do with it, but it’s a proven fact that the better it is for the man the better the quality and quantity of the SA produced.

Since one of Joe’s ex-wives had a miscarriage while they were married and a girl friend once told him she had an abortion we figured he would pass with flying colors. We were shocked when he didn’t. Azoospermia ~ the complete absence of sperm. None! Nada! Zero! Zip! The Urologist (UR) asked if he’d had a vasectomy; like that’s something he might have forgotten. After that he mentioned that the testosterone replacement that Joe had been taking for a couple of years since he had been diagnosed with very low testosterone; could effect sperm production. I did have some inkling that it could lower his counts, but no idea that it could completely stop it. Besides I thought it was only when testosterone was being abused and the level got too high that it was a problem and Joe’s level was slap dab in the middle range of normal.

The options the UR gave us were for Joe to quit taking the supplements for 3 months and see if that worked or to do a biopsy of his testicles to see if he had any sperm or sperm producing cells. He also suggested an US of his testicles to check for blockages, since Joe’s exam showed no signs of Varicocele. (enlarged veins that can cause lower sperm counts) The US came back clear and after 3 months off the testosterone Joe felt awful because his hormone level was so low and his sperm count was still zero. We were told our only option’s now were for him to have the biopsy and if they found sperm then we could try IVF with ICSI (they inject a single sperm into each harvested egg) or we could use donor sperm. If they found no sperm with the biopsy then without donor sperm neither of us would have a biological child.

We decided that we would try the biopsy and have donor sperm as a backup just in case they didn’t find any. But Joe had been having a lot of hip pain and we wanted to find out what was wrong with that first. After having x-rays and an MRI we were told that he had a disease called Avascular Necrosis (AVN) and that the bone at the top of his femur had lost it’s blood supply and was dying. There were early changes in his other hip that indicated that it was also on borrowed time. We were given more options: Hip replacement or a core decompression where they would drill holes in the bone and pack it with bone graft material in the hopes that it would reestablish blood flow. Since Joe is still young and a hip replacement was unlikely to last a lifetime he chose to try the core decompression. It required that he spend 6 weeks on crutches before he was allowed to put any weight on his leg. Anyone who’s ever been on crutches knows that it’s hard on your back. It was hard enough on his that by the time he was off the crutches his back was giving him problems. But the good news was that the hip looked good and continued to show signs of improvement for the next 8 months.

Now if we could just get that back fixed. Off to another Dr. we went, and after several months of injections with no improvement we decided that surgery to trim the herniated disk was the only option. Joe had the same surgery 9 years earlier on the disk just below the one that was bulging now and it was a breeze so we expected the same of this surgery. The first week things seemed good, but by the second he was having more pain then expected. Joe asked about it when the Dr. removed his staples and he told Joe not to over do things. Two days later Joe developed a boil that broke open when I touched the skin near it, so we called the Dr. and went back for him to look at it. The Dr. declared it a superficial infection and prescribed oral antibiotics. The open wound healed, but Joe’s pain increased daily. For over a month we called and visited and basically begged the Dr. to do some tests and figure out what was wrong. The Dr. just treated us like children and insisted that Joe just needed to wean himself off of the pain medication. (The reason I’ve told this part of the story in such detail is to warn people that if you think something is wrong, get a second opinion, don’t let your Dr. make you feel like he knows better) About 8 weeks after Joe’s surgery we ended up in the emergency room because his pain had gotten so bad. (Did I mention that this was two days after we got married?) They "suggested" that we cancel our honeymoon and sent us to a neurosurgeon; Joe had developed an infection that was now effecting the bone and disk in his back. It took another surgery to clean out the infected tissue, 6 weeks IV antibiotics and leaving the wound open until it healed on it’s own for them to tell us that they could never guarantee that the infection was gone. Once the bone gets infected it’s like playing Russian roulette when you have surgery or any other medical problem. The infection can hide and hibernate in those little bitty holes you have in your bones and it’s kind of like a seed that you plant after it’s been sitting in a shed somewhere for years; something triggers it and boom the infection comes back and attacks the weakened part of your body. Remember Joe’s AVN? Well the core decompression began to fail shortly after the back surgery for the infection. The bone was collapsing and crumbling and the only thing they could do was a hip replacement, but it would many months before the doctors would feel that it wasn’t too dangerous, that the chance of the infection attacking the damaged bone wasn’t too great, to attempt it.

As you can see by now we had been on hold in our trying to conceive efforts for around a year and I was no spring chicken to start with. The Dr. had told us it would between 6 months and 1 year before they would even consider the hip replacement so we had to decide what to do. After discussing all our options again, we decided to move ahead and talk to the UR about the biopsy. But we both mentioned that we didn’t really click with the UR he’d seen and that maybe we could find someone else that we liked better. I searched the internet and found Dr Larry Lipshultz . Joe was lucky to get an appointment pretty quickly. After discussing what the first UR had told us and what tests he had preformed, Dr Lipshultz wanted his own SA just in case things had changed in the last year and to insure that his lab couldn’t find a few strays that the other lab had missed. No such luck. I was pretty skeptical when the Dr. suggested that he still thought that the testosterone might be the culprit, but Joe was willing to try almost anything to keep that needle away from his boys. At least he didn’t want to play wait and see for three months again while Joe testosterone plummeted, he suggested a combination of a pill (Nolvadex) that would tell Joe’s body to produce testosterone and a shot (Novarel) that would tell it to produce sperm. One month later Joe was back in the office leaving a deposit, that night they called us with the results. Joe had 9 sperm. I think the guy who called couldn’t figure out why we were so happy. It was enough to try IVF without the biopsy; but even better it meant we had a chance of having our child. We knew that sperm take months to develop and that the real test of how the medications were working would take a little while longer but now we thought we could relax; after all the biggest hurdle was behind us. Little did we know that more hurdles were in store, and as Joe’s sperm count improved over the next several months, I would discover that I had problems of my own.