Receiving the news that you or your partner have Azoospermia is a tough pill to swallow. I know because I have been there with my husband. After learning what we were up against, we spent months trying to learn as much as we could about this form of male factor infertility (MFI), only to come up short. The complete and utter lack of information and hope was unbearable, and a driving factor in starting this blog in the first place: to offer a relatable resource – and our azoospermia success story – with other couples experiencing similarly difficult times.
Infertility is not something you ever believe you will have to deal with until you’re dealing with it.
While one in eight couples live through some type of fertility problem, you don’t hear a whole lot about male factor infertility. Why is that? This serious lack of discussion is unusual because of all infertility cases, a staggering 40-50% are male-factor. And yet still, when one thinks of fertility, the first speculation is that it is the woman.
We tried to conceive for three years before we sought the help of a fertility specialist, and even when we did, I went through all of the standard tests before they asked for a semen sample.
How Our Azoospermia Success Story Started
When we got the call that my husband’s semen analysis came back showing no sperm, we didn’t know how to react.
We were shocked, of course, but we weren’t overly upset straight out of the gate – more caught off guard. We were quiet, naturally a bit concerned, and curious more than anything. What does this mean? Is this normal? Does this happen sometimes? Should we provide another sample? What’s next? While up to this point, my own fertility tests had come back normal, this still wasn’t what we expected to hear.
The conversation with my Reproductive Endocrinologist wasn’t informative. He simply told us there wasn’t any sperm in the semen sample provided, and that he would be referring us to an excellent Urologist in the area. Thinking back, I wonder if our emotions weren’t super heightened because his tone didn’t seem very concerned himself. In fact, it felt like just another phone call on his agenda. I would later recall him saying to us in our next meeting, “you guys took that news really well actually.” Well, you didn’t tell us much, now did ya?
I remember that after we hung up with him, we sort of avoided talking about it. After all the time that had passed trying to get pregnant, it wasn’t what we were expecting to hear. But, at the same time, when you start a fertility journey of any kind, you don’t really know what to expect.
We both went back to our computers, both working from home. But it was obvious that neither of us was fully engaged in our work. I know I had about a hundred tabs open, trying to google what “no sperm” could mean (since we hadn’t actually been given an official diagnosis), and whether I could find other couples who had been told the same. What was their diagnosis? Their outcome? I imagine my husband’s computer looked pretty similar.
My husband is admittedly more positive than I am. He doesn’t like to assume the worst or focus on the negative until all the cards are on the table. Once the cards are on the table, he goes into solution mode. I am often a “what if” thinker, which was particularly hard for me in this scenario because if I was feeling anxious and imagining the worst possible outcome… imagine how he must have been feeling.
I didn’t feel like it was fair for me to even bring it up or express my fears, because I know he was trying to process the news himself.
We let the conversation go until he went to his physical exam with his Urologist.
Diagnosed with Non-Obstructive Azoospermia (NOA)
When my husband was diagnosed with Non-Obstructive Azoospermia (NOA), our world was turned upside down.
After an incredibly brief physical exam with his Urologist (and when I say brief, I mean he looked at his goods for about half a second), he was sent down to the lab for some bloodwork and he was on his way.
Later, the doctor called to give his diagnosis of non-obstructive azoospermia, which, after our aforementioned research, was exactly what we didn’t want to hear. By this point, we’d already heard about azoospermia, even speculating that this could be the problem. Most would argue that if you’re going to be diagnosed with azoospermia, it’s better that it’s obstructive over non-obstructive because then you’re more likely to be able to remedy the situation by clearing out any blockages
But we were told non-obstructive, which meant that it wouldn’t as “simple.” He was also told that he had high FSH (the only hormone test that came back at an unusual level), which was just about the only additional information we had to work with in terms of understanding the why.
The Urologist advised that our only option was for him to have a MicroTESE procedure, which is a microsurgical testicular sperm extraction, used to retrieve sperm from a male’s testes. This surgery is often recommended when a hormone test indicates that a man has an acceptable level of testosterone in his blood, coupled with other exams suggesting that he is not producing normal amounts of sperm. While 60 percent of surgeries result in finding sperm, the extraction is just the start.
When we finally had the diagnosis and a tentative plan of action, we, of course, had a repeat of our multi-tab scenario as we searched high and low for more information on this diagnosis – both studies and forums. I was in a tizzy searching for anything – any sign that it was possible to see a success story come out of this. I didn’t find a whole lot. In fact, not only was information on NOA incredibly lacking (and what was available wasn’t exactly consumable) but what I COULD find from other couples was limited to just a sprinkling of hope and a whole lot of other women looking for the same thing I was.
I would comment on years-old discussions asking what their outcome was, knowing the odds of hearing back were slim. I would look for any variation of related search terms to find more details that could help me understand what we were facing. And I scoured the internet to see what kind of reviews I could find about our specific Urologist. Is he the best in the area? What is his success rate? Should we find someone else to do the surgery?
After all, a micro-TESE is incredibly invasive and not something that you want to have done more than once if you can avoid it.
The surgery was scheduled a little over a month after the diagnosis, which gave me plenty of time (way too much time) to scour. Many of the stories I found online were disheartening, while others were open-ended and without news of what happened.
Fertility Treatment Plan
We had one follow up call with my reproductive endocrinologist after the diagnosis and before surgery day to discuss the next steps in my treatment plan. Because we knew that a microTESE was our only option for collecting any sperm, IVF was my recommended course of action.
If the Urologist was able to find and sperm in the semen, it would be collected and put on ice to be used for a fresh embryo transfer.
What I wasn’t prepared to be asked (though kind of expected it in the back of my mind) was if we would be interested in using donor sperm if nothing was found. We were pretty thrown by that question; not only because it reinforced what we already knew – that there was a good chance that either a) no sperm would be found, or b) the sperm found wouldn’t be viable enough for use – but also because it felt way too soon.
Here we were, hiding out in our car in a Best Buy parking lot so the family we were visiting wouldn’t overhear our phone call, just a few weeks before our surgery, and my husband was being asked if he couldn’t have biological children, would he mind using a donor. Talk about a punch in the gut.
While we obviously knew that worst-case scenario, a donor and adoption would be our only options, we weren’t ready for that discussion. And I can only imagine the hurt and fear it placed on my husband’s heart.
We stayed positive, we prayed, we were gentle with each other, and we headed into surgery day full of fear and hope.
MicroTESE day was nerve-wracking, to say the least. I won’t sugarcoat it.
We thought receiving the news was rough, and that our five weeks of waiting took an eternity. Nope. Waiting for his surgery to be conducted and for the results to come in the same day – THAT was an eternity.
The microTESE took about an hour and a half. My job was to collect the sperm from the Urologist post-surgery and hurry it over to my fertility clinic for analysis, before coming back to get my poor, recovering husband.
Up to this point, as nervous as I was, I held it together. But the moment I dropped the sperm off at my clinic and headed back to my car, I lost it in the parking lot. I don’t know if it was the relief that we were one step closer in knowing if we could or couldn’t have a biological child together, overwhelm, exhaustion, or a combination of all of the above. But I let it go.
When I got back to the hospital, my husband was wheeled out in a chair and he side-stepped his way into the car with a giant, bulgy jockstrap filled with gauze holding him together. He wasn’t in pain yet as he was still feeling the magic of the surgery drugs.
We drove home, slowly waddled our way up to the apartment, and settled him on the couch for the start of what was going to be a very long and painful few days.
News & Recovery
The fertility clinic was tasked with looking at the semen samples under a microscope to determine if what the Urologist was able to collect had any viable sperm. Now, it isn’t just a matter of whether the lab technician is able to see anything; the Urologist needs to be good… really good… at this procedure. Capable of visually identifying small pockets in the testes that are most likely to actually contain sperm. It isn’t a matter of just scraping and closing up.
Not only do you have to worry about whether there are, in fact, any swimmers at all, but also the concentration, motility, and whether there is abnormal morphology. These factors will indicate whether your reproductive endocrinologist will be able to use what is found to fertilize your eggs.
To say the wait was stressful is an understatement.
I busied myself with treating my patient and work, and the patient did his best to sleep off the pain. To anyone who may need to have this surgery, again, I won’t sugarcoat it… it isn’t easy.
The drugs wore off a few hours after getting home and the pain set in. He described standing up as his balls dropping from Outerspace each time he got fully upright. I would have to gently pull him up off the couch so he wouldn’t have to work too hard. He would have to hold onto my shoulders for support in order to get to the bathroom (and when I say get to the bathroom, I mean more of a crab walk). I’d pull down his pants, he would do his best to aim, but those first few days, pee just didn’t land in the toilet. Soup was just about the only thing he was interested in. He opted for taking his prescribed oxycodone, despite not having an interest in anything but Ibuprofen throughout his life. It was virtually impossible to get comfortable. Until it got better.
By early afternoon, the Urologist called to say that they found “plenty, more than enough” sperm in the sample. He didn’t get into the quality of the sperm, but I suppose if there were any issues, that would have been the time to mention it.
Success! Relief. Tears. Happiness. We had a chance.
Do you have an azoospermia success story? I would love, love, love to hear it! Feel free to share in the comments!
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