TMI

Talk about information overload.  After our 3 hour 2nd opinion consult this morning, my mind is a whirlwind of big words, tests, and thoeries.  This infertility cyclone involves genetic testing, chromosones, smoking, semen analysis and SCSA, karyotype test, and clomid challenge test.

I put together on a one page document our entire infertility history.  This list starts in late 2006 with going off of birth control, includes 2 HSGs, multiple day 3 blood tests, too many SA's to count, working with an OB and an RE, a visit to a uroligist, 6 clomid IUIs, 3 injectible IUIs, and 2 IVFs with ICSI.  This little document was a lifesaver since we not only spoke to the doctor, but 2 nurses and a genetic counselor individually.  They all asked most of the same questions and it was nice to hand over this one-page sheet of paper to give them most of the answers they needed without having to repeat myself or forget something.  I did most of the talking as DH gets pretty quiet during these meetings.

We arrived 30 minutes prior to our appointment.  Yes, too early, but I wasn't sure what to expect in terms of traffic, parking, or paperwork.  Fortunately, I had already done most of the paperwork and had mailed it in prior to the appointment.  I asked if they had received my records from my other doctor(s).  The receptionist specifically remembered my records because they summed up to the size of a large novel! 

I think we peaked the doctor's curiosity about us, though.  That's a good thing.  Give him something to think about.  To say the least, we have been on a very LONG road in the way of infertility with no BFPs.  The ultimate question is why?  It doesn't make sense.  Based upon our individual history and tests, something should have worked at some point in the last 4 years.  Particularly disconcerting is that the embryos during IVF w/ ICSI are arresting on Day 3.  The doctor was going to have an embryologist look at my records, but he mostly wants to take a closer look at DH.  He even mentioned referring us to some doctor friends in Boston/New Jersey if we end up doing ICSI again.  Apparently they are the best in the nation at ICSI.  Oh boy.

Like my previous RE had said, day 3 is crucial because the embryo is trying to survive on its own.  How I understood it, is that up to that point the embryo is thriving on the woman's chromosomes and then trying to "mix" with the man's chromosomes on Day 3.  The embryo may be arresting at Day 3 during this process because there may be sperm DNA fragmentation. DNA fragmentation could be causing the embryo arrest on Day 3 and could cause miscarriage if we did get pregnant.  You can't SEE DNA fragmentation or a chromosomal issue during ICSI, so even if they pick out the perfect looking sperm, there could be issues on the inside of the sperm or with the egg itself.  The only way to prove that it may be a chromosomal issue is to do a karyotype test.  The cost is nearly $1,400 per person, not covered by insurance, and according to the doctor and the genetic counselor the chance of this being 'the problem' for us or the reason for DNA fragmentation is very low (less than 15% in those with male factor infertility and less than 5% in those with general infertility). 

In all likelihood, if the problem is from DNA fragmentation of the sperm, it is probably due to smoking.  My husband has smoked since he was 18 years old (at least he waited until it was legal) and he currently smokes about a pack a day.  That's 15 years of smoking.  I don't see how that wouldn't have an impact on his swimmers and I've told him that from day one.  Smoking may not affect the count or the shape of the sperm, but the insides of it.  Kind of like in humans.  You might not be able to see the immediate affects of smoking from the outside, but it sure is doing a number on your insides. 

Now, I'm sure you all are rolling your eyes at us, because why hasn't this been called to our attention before?  Why didn't we do something about this habit before 9 IUIs and 2 rounds of ICSI?  All I can say is that we all know that smoking is bad for us, but people do it anyway.  It is addictive and it is hard to quit.  Your brain tells you one thing - that you should quit and that it is bad, bad, bad - but your body craves more and overtakes your brain.  Smart people can get sucked into this addictive spiral.  DH (and myself) are no different.  He knows its bad, but by now it is an addictive habit and denial of its negative affect kicks in. 

We're thinking chantix is in order.  DH already has a prescription for it, but has been reluctant to fill it.  He really doesn't want to quit and the drug is not covered by our insurance either.  I can't make him do it.  His own doctor has urged him to quit due to his high blood pressure and cholesterol.  Still he hasn't quit.  Now, our infertility doctor is saying that this could be "the big reason", and I'm not sure what he'll do. 

Bottom line: I don't think we should try any more major infertility treatments until he has quit.  And he has to quit soon because it will take 3 months to get all of the affected sperm out before the unaffected sperm will hit the surface (so to speak!).  The doctor mentioned that they could take unaffected baby sperm directly out of the testes for ICSI, but that in most cases a man would rather quit smoking than have a big needle shoved into their balls!  He mentioned that we could bypass all of the questions and costs by considering donor sperm.  We've thought about it, but haven't decided on it.  Not sure if we're ready for that yet.  We've come so far already.

If and when we get to the point of ICSI again, the doctor did say they would look at a different drug protocol for me.  I didn't press as to what that might be because he seemed more concerned with getting the answer of why this is happening first.  We'll cross that bridge when we get there.

Lastly, there is a genetic test we can take that costs around $300 per person that can test for over 100 different genetic diseases.  It's a spit test and is pretty easy to do.  It's just another cost that we can decide to incur.  It is up to us, but the office wants to let us know our options.  Our previous doctor never even mentioned genetic testing to us.  I think we'll consider it before we go into ICSI again.  The genetic counselor also mentioned our mental/emotional health and wanted to make sure that we get what we need in that area, too.  Again, more than the previous RE ever offered in that department.

So, where do we go from here?  First, DH had an SA today with SCSA testing.  This is to determine if DNA fragmentation is an issue.  If it is, quitting the smoking is a top priority. Secondary would be to consider the karyotype test for DH even if the risk is small.  I could take the test, too.  I'm not sure if we want to incur those costs or not.  I had some bloodwork drawn and so did DH.  They're going to do a panel of a variety of things, among them testosterone for him and prolactin for me.  Then, I'll be doing a clomid challenge test during my next cycle.  This is to test my ovaries.  I've done 6 IUIs with clomid, but they never took blood on day 10 to check how my ovaries had responded.  I don't think there's an issue with my ovaries, but ya never know.  Why not?

So, like I said, this appointment was information overload.  I feel like we're starting over.  I am 26-27 years old again and trying to figure out what to do about this not-being-able-to-have-a-baby thing.  I'm pretty numb to it all at this point.  Overall, the entire office was very nice, as was the doctor.  In my mind though, actions speak louder than words.  I'm thinking we'll stick with this guy until we can get some more definite answers.