Conference moira::parenting

    
The following note is being entered for a member of the PARENTING
notesfile community who prefers to remain anonymous at this time.

Carol Stolicny, PARENTING co-mod

-----------------------------------------------------

It is so frustrating.  My wife and I have been trying to conceive a child
for about a year.  We have really been trying to think of what we may be
doing wrong during the last 6-9 months.  This time, my wife was over 2 weeks
late for her period.  She is never late - not even during our wedding and
trying to buy a house.  Just yesterday (Sunday) she had her period.  We
have made an appointment to see the doctor about what to try next.  But,
it is hard not to wonder if I am the problem.  We have tried ovulation
testing, and other things.

I know the doctor is going to check for low sperm count.  I am also not
looking forward to the process.

Why is it that so many people who don't want children don't even have to
try, while those that want them badly can't seem to have them?  My wife
said that we were made to be so worried when we are young and given the
impression that it is so easy to get pregnant.  But when we are older and
it is acceptable, we just can't.

It isn't any easier that my brothers, my wife's sister, and my wife's best
friend have all had, or are having, children recently or soon.

I know.  Don't try so hard.  Just have fun.  Practice, practice, practice.
These are the things that everyone has told us many times.  Heck, we have
told ourselves these same things.  That doesn't make it any easier.  We
have to fight so hard not to get our hopes up.  This is the second time
that we have been wrong.  If I try not to get excited, my wife thinks I
am not being supportive.  If I try to be excited and supportive, I get
crushed when it turns out negative.

We are going to ask the doctor why she had her period this time so late.
This is the first time since I have known her (over 3 years) that she has
EVER been late.  I am wondering if this means anything.  Also, she has
been sore and cramped alot lately.

Well, thanks for listening.  I know there is nothing you all can do.  But
at least I can talk about it without feeling that I am causing anyone any
further pain.

-------------------------------------------------------------------------

This reply is posted anonymously from the same author as .1


Well folks.  I posted a reply a little while ago noting that my wife was not
pregnant when we thought she might be.  It seems we may have found one
reason.  As the start of the workup, we did a sperm count.  It seems that it
turned out with zero (0) for a count.  This did not seem right,so we all
agreed to do another test.  Well, guess what.  The exact same results.

The doctor has sent to Boston for some further tests (I don't know exactly
what tests).  The results won't be in until Monday or Tuesday.  Then we will
know where to go next.

Amazing.  All the while both my wife and I had been thinking that the problem
was her.  My two brothers have had no problem having children.  My father had
5 children.  To find out I am the problem (and not just a low sperm count but
zero) is a bit of a shock.  We will work through it.  We talked about it last
night and agreed to do whatever is necessary.  I know there are things to be
done to find out where the problem lies.

I am working with my mother to find out if anything unusual happened over my
childhood that could have contributed to this.

It is just a bit disturbing thinking that I may never be able to father any
children.  Also, thinking that we spent money on birth control pills when we
did not have to (trying to look at positive on things).

I know that then we speak with the doctor next week, I am going to demand
that we go to the best route immediately.  In my mind this means someplace
like Brigham and Women's (is there an equivalent for men?).  I am 34 years
old and not getting any younger.

What experiences have people had?  I know there is less they can do for a man
than for a woman, but what are they?

Also a question - if there were ANY sperm, but they were dead, would they
show up?  What happens when a sperm dies?  Does it disappear or can it be
seen?

It is time to start getting as much information as we can.

Thanks,

disappointed & shocked

It's possible that sperm are being produced but not making it into the semen.
There's a congenital condition where some of the plumbing is configured wrong
(so to speak).  In the last few years a technique has been developed to
"harvest" the sperm.  Sherman Silber ("How to Get Pregnant") pioneered
this technique.  He's in St. Louis.  I believe that there's at least one
urologist in Boston who learned it from him, and I know of a couple who
travelled from Canada to California to have it done.

The following note is entered anonymously by the author of .1 and .2.

--------------------

I spoke with the doctor's nurse yesterday to try to better understand what
was meant by a count of zero.  It seems that the lab could not see any
sperm in the semen.  They sent the slides to Boston to a pathologist there.
It seems the lab in Boston is going to look for such things as immature
sperm, and other signs.

In the meantime, the doctor has referred me to an endocrinologist.  I assume
this is to find out if the sperm are being generated at all.  I assume that
if they find this to be positive, then I would see a urologist to find out
why they are not making it out.

Are there other things that we should be checking or trying?  The last
time we spoke with the endocrinologist, it was about my wife's thyroid.  She
was slightly high.  The guy was somewhat noncommittal.  He seemed to know
what he was talking about, but this seems to be a fuzzy area (at least in
my own mind).

What kinds of things can be done?  My uncle had this problem about 10 years
ago.  They didn't do anything because his wife also had some problem as a
result of not having had a child until late in life (there also were not
the techniques that exist today - like GIFT).

I know that if there are any sperm at all, they can "harvest" them and then
artificially perform what needs to be done.

I assume that if there is anything that is blocking the sperm, there may be
something they can do about that.  I checked my medical history and there
was nothing beyond the normal chicken pox, measles, mumps, etc.  The only
thing special was that I had a strangled hernia when I was a baby (actuall
a double hernia - both sides).  The doctors had to operate, or I could have
died (or so they told my mother).  I am wondering if this could have something
to do with this.  As far as I know, I am the only one in the family that had
this problem.

It is so hard.  We see other children, and want our own so badly.  And yet,
what am I able to say?  I am sorry?  It is hard to appreciate the pain that
my wife is going through.  I think to myself - why are you upset?  I am the
one with the problem.  But then, I remember that without my sperm, she cannot
have my child (which is what we both want).

We have discussed things like using a sperm bank, adopting, etc.  We would
probably try the sperm bank first, so that at least one person would have
a blood tie to the child.  But that will be hard for me, because I will know
that it is not my blood child (although I will love it just the same).

The waiting is probably the hardest part.  We can't do anything until the
test results come back.  As I said, I have the referral appointment set up
(just before Thanksgiving - great time huh?).

We don't want to wait too long, but at the same time, we don't want to be
a pain to the doctors.  Like they keep telling us, this is not life threatening.
It may not be, but it is no less painful.

I am sorry for bending your ears so long.  I am just trying to find things to
do so that I feel like I am not just sitting around.

My husband and i went thru alot of testing as well and we both had a problem.
His sperm count was very low and the motility was poor.  I had a luteal phase
defect (a short cycle which prevented my uterine lining to mature by the time I
ovulated).  My husband had a varicoceleectomy (sp?) - as he was found to have a
varicocele (a varicose vein) (the doctor thought this might have been in 
connection to a hernia operation he had as an infant).  I had lots of testing as
well.  We both also had brothers and sisters on each side of us that had 
absolutely no problem getting pregnant and we were very discouraged.  

My husband and I know what you are feeling but Id just like to say please don't
give up - the testing is worth it - just be there for each other and dont lose
your hope.  After a year and a half of trying, testing, and surgery for both of
us, as well as one cycle on Clomid, we finally got pregnant and I am now in my
6th month. I understand your frustration - Im 32 and felt that I was losing time
especially if we wanted to plan for more than one.  My husband is younger but
he too went through alot of frustration and agony as he assumed the problem to
be mine.  

please take care and keep trying.  I wish you well.

Maureen

    A friend of ours had a varicose vein too.  The blood was 
    killing the semen off.  One month after the operation they 
    got pregnant.
    
    Good luck.
    
 

This note is being entered anonymously  by the author of .1, .2, and .4

--------------


Well, an update.  I received a letter in the mail from my doctor last night.
It told me that a part of the lab work results were available.  The
urinalysis was negative, and the semen did not have any sperm (which I 
already knew).  However, he also mentioned that an FSH test, which checks
a pituitary hormone, was quite elevated (did not say how elevated).  He
mentioned that this is suggestive of a primary testicular failure.  As
most doctors are, he was not willing to be solid without further tests.

Also, the LH level, which is another pituitary hormone, was within normal
limits.

My question is what does this mean?  I have a call into the doctor, but 
thought I would ask here, also.

Also, he suggested that it might be advisable to check both endocrinology
and urology until some specific direction is found.  What are the thoughts
on this?  Is this how others tackled this problem?

    Re: .7 
    
    I can suggest a very good book:
    
    "Overcoming Infertility" by Robert Nachtigall, M.D. and Elizabeth
    Mehren.
    
    I think you need to meet with your doctor, in person if possible, to
    discuss the results of your tests. There are so many tests that can be
    performed, such as testing whether there is sperm in the urine after
    ejaculation. "Primary testicular failure" is a sort of male menopause,
    similar to premature ovarian failure. I would highly suggest contacting
    a good fertility clinic, like Boston IVF, if you are in the area, (I
    can recommend Dr. Berger) to check on the latest treatments. Every
    year new discoveries are found in treating infertility, and you will
    have the best chance at the special clinics. 
    
    Cyn

re .6:

Since it takes 3 months for sperm to be generated, it's highly unlikely that
the varicocelectomy had anything to do with the pregnancy.

This note is being posted anonymously for the basenoter.

      Carol duBois, PARENTING Co-moderator

*******************************************************

Well, I saw the endocrinologist before Thanksgiving.  He confirmed my
worst fears.  He put everything in typical doctor-ese (we can't be positive
without more tests), but only discussed one possible problem.

It appears that I have what is known as Klein-Felter's Syndrome.  This
is where both an X and Y sperm attached to a X egg.  Apparently when
an egg is fertilized, the egg (which is always a type X) can be fertilized
by either a X sperm (which gives a girl) or a Y sperm (which gives a boy).
When conception occurred for me, both sperm somehow attached to the egg.
This has the effect of causing primary testicular failure.  Apparently
the body is trying to get the testicles to work harder, but it doesn't
help.  The testicles work as hard as they can and still don't generate
any sperm and not enough testosterone.

My testosterone level in in the low end of normal and fading.  This means
that if I did nothing I would lose body mass, and be at risk of Osteoporosis.

The doctor said this happens in 1 in 400 (or thereabouts) men.  It is not
cureable or fixable - it is permanent.  I can never have children because
I don't generate any sperm.  Also, my testicles are smaller than they should be.

The doctor had blood taken and sent to a lab for a detailed chromosome
analysis.  This is hoped to confirm the diagnosis.  If it is not conclusive,
then they will have to do a testicle biopsy (which the doctor said is
painful).

So, the end of my story has about been reached - no children fathered by
myself.  My wife can still have children, so I should look on this with
a favorable light.  But, it only makes it slightly easier since my own
special characteristics will never be passed on.

Great holiday present - huh?

If I hear any more that I think everyone would be interested in, I will
post updates.  But, I don't expect much more to happen on my side of
things.  At least we know now.

    RE:  .10
    
    Dear Noter,
    
    I am so sorry to hear this sad news.  What a disappointment for you. 
    Whatever path you take enroute to parenthood, I wish you the best of
    luck and peace of mind.
    
    Laura
    

I, too, am very sorry for the basenoter.  I can hear in your words how sad and
painful this is for you.  I hope that as you consider your situation and
come to terms with your problems, that you will be able to find a resolution
that will satisfy you and your family.

You say that you can't pass on that special part that is "you".  Maybe you can
not father a child but you can still pass on the very special you.  What we
give to our children in loving care, in time, in culture, in our own very
special personality is as much a part of "you" as 23 chromosomes.  In my own
very humble opinion, you sound like a man who would have a lot to offer a child
and for this, I hope that you are able to find satisfaction and love for a 
little one.

ccb

    Maybe you could get a male relative to donate sperm. That way you could
    still have a child which is related to you. I know that I really have
    strong feelings for my niece.

     Just to be perfectly clear, .10 was entered on behalf of .1, not the
base noter.
     The subject of having a male relative donate sperm for an artificial
insemination is also being discussed in note 24.
     My reaction to the "special characteristics" statement was very similar
to Cheryl's.  Your feelings are very understandable, and we are not trying to
invalidate them, but I very firmly believe that the most important things
that I am passing on to my children are passed through time, effort,
discussion, and example, not by my gene contribution.  This country is today,
unfortunately, filled with kids whose fathers have contributed nothing more
than their genes.
     I strongly recommend support groups that include non-biological fathers,
whether they be by adoption or artificial insemination.  I'm sure that they
have had feelings much like yours, and how they have coped with them might be
of help to you.

Clay  
      

    re: .10
    
    I can certainly relate to your situation, since I have the female
    counterpart of the problem you have; no eggs. And I understand very
    much what you are feeling now, the frustrations, the guilt, the grief
    for the child you cannot have, the anger. Be sure that you will have
    real grief for this child you have pictured. 
    
    Your options are better than mine, however, since it appears you can
    be a father to a child that your wife can carry. I wish my husband
    could do the same! But it will take time to get over your grief and
    think about your options. I urge you to take some time to let your
    feelings work through before you pursue your options. I think it's
    important to express your grief and other feelings so you won't be
    dealing with the intensity of your emotions while trying to deal with
    some complicated options like donor sperm or adoption. 
    
    Yes, it's a crummy time to get this news. But getting this news is
    crummy no matter when it is. I hope you can find some peace during
    this holiday season to work out your feelings. 
    
    Cyn

    
    
    	I have a curious question - If a man has a vacitomy(sp), does
    he still create sperm?  Where does the sperm go when it's been cut?
    
    	Say this person remarry's can he have sperm removed without
    having to undo his vacitomy?
    
    	Thanks
    	Donna

A new topic, on the subject of the influences of genetics vs. environment on a 
child's behavior has been opened up in topic 403.  Please use topic 377 to 
discuss male infertility issues.

Entries suggesting separating the topic out have been deleted.

re: .16

Vasectomies can be reversed, but it's not universally successful, and 
generally, the longer the period between the vasectomy and the attempted 
reversal, the less likely the chance of success.

I'm sure other noters are more informed on this than I am.

Clay Satow
co-moderator

re .16:

>    	I have a curious question - If a man has a vacitomy(sp), does
>    he still create sperm?  Where does the sperm go when it's been cut?

A vasectomy simply prevents the sperm from entering the semen.  It's still
produced, but takes an alternate route: it's pushed out of the epididymus
and is reabsorbed in the body.  That's pretty much what happens to sperm
that get into the fallopian tubes but don't fertilize an egg.

>    	Say this person remarry's can he have sperm removed without
>    having to undo his vacitomy?

Such an operation is considerably more complicated than a vasectomy
reversal.

    'can a person have sperm removed if he remarries'.  Unless the reversal
    of the vasectomy is successful, the answer is no.
    
    Jeff

re .19:

There are men who are born without a vas deferens.  There are also men whose
vas is damaged by injury or disease.  It's possible for sperm to be removed
from their testicles surgically.  The sperm can then be used for IVF.
This is a much more complicated procedure than vasectomy reversal, and 
it has to be done again for each IVF attempt.

    Re: vasectomy reversal
    
    One of the complications of this procedure is that the man does
    not cease producing sperm after a vasectomy.  The sperm simply
    have nowhere to go, and die inside the man.  In many cases, the
    man's body responds by treating the dead sperm as foreign objects,
    and develops an antibody to the dead sperm.  Unfortunately, this
    antibody will also attack live sperm and frequently continues to
    be produced even after a vasectomy reversal.  
    
    If this happens, the sperm may be extremely short-lived -- 4-6 hours
    instead of 48-72.  The man may be effectively infertile despite
    a high sperm count and normally healthy sperm.  My understanding
    is that washing the sperm does not counteract this antibody, as it
    infests the sperm itself, not just the seminal fluid.
    
    This antibody may also be produced as result of any "naturally
    occurring" blockage, such as an acute temporary injury to the scrotum.

A workaround for sperm antibodies is IVF or GIFT.

Some of the things mentioned here have confused me.  If a person is told
he has no sperm, can they tell from blood tests that the sperm are really
being created?

I am confused about the antibodies and washing (how do you wash millions
of tiny little sperm?).  I was following this discussion to then.  I really
feel bad for anyone who is trying to have children and can't for whatever
reason.

Ed..

I don't believe they can tell from a blood test whether sperm are being
created.  I think they have to do a testicular biopsy.

Semen contains all kinds of nasty stuff that's actually harmful to sperm
once it's helped it get through the vagina.  Normally, the cervical mucus
filters the sperm from the semen.  Sperm washing effectively separates
the sperm from the semen.  The semen is mixed with a culture medium in
a test tube.  The test tube is then centrifuged, leaving all the sperm
in a "button" at the bottom of the test tube.  The fluid is drained off,
leaving sperm, white blood cells, and bacteria.  Sometimes this is used
as-is, but often the good sperm are separated from the not-so-good sperm
and foreign cells by allowing them to "swim up."  This simply means
that more culture medium is added to the test tube, and the good sperm
break out of the pack and swim into the medium, leaving the button to
be discarded.

This note is being entered for the wife of the "basenoter" (.1).

      Carol duBois, PARENTING co-moderator

****************************************************

	My husband has been TFSOed from Digital but, he and I wanted
	to share what we have been through to find out why he has
	no sperm count.

	The first doctor said he had Klien Felters syndrome (sp)?, 
	which means you have extra chromosomes, so we had a
	series of tests and found out that he didn't have Klien 
	Felters but had something wrong with his eleventh chromosome.
	They couldn't say that this was the problem of why he had
	no sperm, though.

	So.. 

	We went to endocrinologist - 

	He said that my husband had small testicles and that no
	sperm was going to be generated.. - He could do a testicular
	biopsy to confirm it but, he felt that would be a wasted 
	effort - but some people need to see the pictures.

	This problem happens to 1 in one million men.

	We decided against it since it would put him on his back
	for 5 days.

	We are now looking into adoption and AI.. (I am scared of
	both). - but I am working through it.. 


	What my husband and I want to pass on is - DON'T WAIT to find
	out that it's your husband - we waited for over a year assuming
	the problem was me.  It wasn't and we both feel we have wasted
	a whole year.   

	Good luck to everyone...

This note is being entered for a member of our community who wishes to
remain anonymous.

        Carol duBois, PARENTING co-moderator

*******************************************************************

Has anyone gone through the process of collecting sperm after having
a vasectomy?

Would you explain the procedure? Is it a major task? Is it done in the
doctor's office? Were you under anesthesia? Would you do it again?

My understanding is that they make a minor incision on the testicle and 
somehow withdraw the sperm from the testicle.

Any insight would be GREATLY appreciated!

Thanks!

Try Dr. Silber's book "How to Get Pregnant with the New Technology."  I'm
pretty sure he covers fertility after vasectomy in some detail (he's the
doctor who pioneered a method of aspirating sperm from men who congenitally
lack a vas deferens).

An associate of mine, who is a micro-surgeon, has a 90%+ hit rate on
re-connecting vas deferens. The other 10% are done by "Butchers" to use his own
words. When I get around to needing one, I'm definitely going to him...

q