mTESE Surgery Day

7:40am: Well, today is the day! My mom, our designated driver, spent the night last night because we had to leave at 4am to get to the hospital on time. They just took Mr.E back. Dr. Hotaling said the mTESE surgery would be anywhere from 1-3.5 hours. Obviously I want it to be just 1 hour because that means they found sperm right away.

9:30am: Fortunately my egg retrieval is only 1 mile away. I just woke up from the procedure. I’m having a little cramping. They found 14 eggs, still waiting to hear how many were mature.

These crackers and juice they gave me really hit the spot. I was starving! Now I’m just ready to get the heck out of here and get back up to the hospital to check on Mr.E.

10:40am: Dr. Hotaling came out to tell me that Mr.E is in recovery and they didn’t find any sperm during surgery. Now it is up to Dr. Carrell to finish looking in the lab to see if they can find some there.

12:36 pm: Dr. Carrell called with the bad news. No sperm. He said they couldn’t even find any precursor sperm cells. In all his years he’s never seen a case so black and white.

We are so devastated.

Sperm: Fresh vs. Frozen

I have a fertility app on my phone called iPeriod. Before we found out Mr.E had zero sperm I was using it to track LH surges, morning basal body temperature, pregnancy tests, etc. Now I mostly just use it to track my period.

Anyway, I was looking at it several weeks ago and realized that Mr.E’s mTESE is scheduled for exactly 6 weeks after my next period is supposed to start. Six weeks is exactly the minimum for how long it takes to do an egg retrieval cycle. So I thought, “Is this a sign? Should we try to do a fresh-fresh cycle?”

What do I mean by “fresh-fresh”? I mean fresh (not frozen-then-thawed) eggs and fresh (not frozen-then-thawed) sperm. What difference does it make?

First we have to define what “success” means. For most, if not all, infertility patients, success would be considered taking home a healthy baby while success in the laboratory might be considered making lots of grade A embryos or simply surviving the freeze-thaw procedure. For this post, “success” means taking home a baby.

I think all studies agree that fresh eggs are always better than frozen eggs. So if possible, you always want to use fresh eggs.

Some studies show that fresh sperm is better than frozen sperm. Other studies show that fresh and frozen sperm have the same chance of success. I think there’s even one that shows frozen is better than fresh (think survival of the fittest).

For us, I think fresh-fresh is going to be the best option. Why?

– not 100% guaranteed that all/any sperm will survive the freeze-thaw
– only 80% of subsequent mTESE procedures are successful (meaning sperm found on the 2nd mTESE)

By doing fresh-fresh, we’ll have the same number of sperm frozen (minus the 8-12 used to fertilize any eggs retrieved), plus we get to do the fresh-fresh. It’s like a two-for-one deal.

Continue reading

Azoospermia and the Andrology Lab

As you may know, Mr.E has NOA (non-obstructive azoospermia) which means he has no sperm in his semen. The only way to get sperm is with a surgical procedure. We’ve chosen to do mTESE (microdissection testicular sperm extraction). Depending on who you talk to, mTESE has between 50-70% chance of success (finding sperm).

Mr.E’s mTESE is scheduled for January with Dr. Hotaling at the University of Utah. Dr. Hotaling just finished his fellowship with Dr. Neiderberger in Chicago (who is one of the top 3 surgeons who perform mTESE).

We chose Dr. Hotaling for a few reasons:
– U of U is closer to us than Dr. Schlegel in NYC
– the surgery is less expensive in Utah (though truth be told I don’t care how much any of it costs, I just want my miracle babies)
– the U of U has an amazing take-home-baby rate at their reproductive clinic (almost 70% success rate in the under 35 male factor category)
– Dr. Schlegel doesn’t have Dr. Doug Carrell

Who is Dr. Carrell you ask? Dr. Carrell is not an MD, he’s a PhD. He’s the director of the Andrology Lab at the U of U.

I let you in on a little secret: the real stars of the show when it comes to IVF are the people in the lab. If you’ve got seriously low egg reserve, then maybe the star of the show is the Reproductive Endocrinologist that gets your body to produce good quality eggs. But otherwise, the star of the show is the lab.

Continue reading

A Different Kind of 2WW

Usually 2WW refers to the dreaded 2 week wait between ovulation and the start of your period, or in the case of people trying to conceive, your lack of period so you can take a home pregnancy test. Its a time period full of hopes and dreams where part of you is certain that you timed your baby dancing just right this month so surely this is it, and the other part cautions you not to get too hopeful. We had a few of those before we had the infamous semen analysis. Mr.E and I have a long way to go before we even get to that kind of 2ww again.

Currently we’re stuck in another kind of 2ww: the 2ww for the TESE biopsy (testicular sperm extraction). On 11/29 we scheduled it for 12/14, 15 days later. I was so anxious, literally pacing for days, unable to concentrate on almost anything at work, crying at the slightest things, exclaiming, “How am I going to do this?! We still have x more days to go!” and wondering internally how I could survive this 2ww without driving myself and everyone around me absolutely nuts.

Somehow I made it 8 days (I think scheduling the sonohyst and the IVF calendar planning right in the middle helped a lot because it gave me something to look forward to).

And then on that 8th day, 12/7, the hospital told us about the scheduling error and moved the surgery to 12/21. Another freaking 14 days away: the beginning of another 2ww.

This time I don’t have any other appointments to distract me. I have no idea what to do with myself. I think the anxiety from the previous 2ww which would be coming to an end in 2 days *sigh* sort of wore my mind out, if that’s even possible. I’m exhausted from the anxiety. But I still feel it inside. 9 more days to go.

So far, TV and books have been my best friends for distraction. Actually, people at work have been unknowingly wonderful for me, too. They come ask me questions and make me think about work stuff which helps to pass the time. Worst thing you could possibly do: take time off from work. I’m pretty sure staying busy is the best thing for mental health.

If anyone out there has suggestions for me on how to stay busy, please comment with them. Hopefully, one day, they’ll also come in handy for the real 2ww!

TESE Emotional Rollercoaster Update

IVF#1, CD7, Friday 12/7/12

Wow, this roller coaster doesn’t know when to end. Just last night I was on cloud nine thinking how lucky we were that the hospital scheduling error actually got us in a day early for Mr.E’s TESE biopsy.

Today we were told that the TESE wasn’t scheduled for 12/13 but for 2/13, three months from now! They might as well have told me it was 3 years from now. It was so outrageous that I didn’t even get upset because I knew it would get fixed or I would take Mr.E somewhere else.

After clearing that up, now we are tentatively set for 12/21. Ugh. 2 more weeks again.

I just want to know if we even have a chance at having babies! The suspense is killing me.

Cycle Day 6 – Emotional Rollercoaster

So far there are 4 people who know our situation: Mr.E, my mom, my BFF, and me. Why are we keeping it so secret? Well, you can’t unring a bell. Once people know there’s no going backwards and you can’t stop the flow of information from them to others. I don’t want people feeling sorry for me or constantly asking if I feel ok or how I’m doing with a pitiful look on their faces. First of all I can’t stand that. But second of all my “game face” is pretty fragile and sometimes the slightest thing can make it crumble!

Here’s a snippet of an email I sent today to my BFF who recently got married and wants a gazillion kids 🙂

When you wrote earlier today the surgery was next Friday 12/14. It’s been an emotional roller coaster of a day with fears we would have to wait until Jan 4 or even a week after that because the hospital notified us of a scheduling problem this morning. But they just moved it to Thursday, a week from today, thank goodness! So actually it’s a day before the original appt. Its 90% set for Thursday, anyway, just need a note from Mr.E’s doctor for his professor so that he can take his final exam early.

We will find out right away if they found any sperm. I mean, I think it’s within minutes of cutting because if they find some they freeze them right then. So a week from today I’ll know if I get to have kids.
Continue reading