The Urologist

As a reminder, not only do I have DOR (Diminished Ovarian Reserve) but Mr. R has a 14 year old vasectomy that is beyond the recommended cut off age for effective reversal.  We were referred to this Urologist by our RE.  Their offices are in the same building, and they work together often.  We'll call him Dr. B.  Dr. B studied at Harvard and Duke University and specializes in male fertility so I figured he was well qualified to handle my man's nuts ;).  He is a large, soft spoken, African American man - think Mike Tyson.  Mr. R was not amused... "Really?  No pressure or anything!" haha

 We met him at a location closer to our home, he sees patients there every Monday in a shared office set-up that is common around here. (i.e. today it's a Urologist, tomorrow a Foot and Ankle doctor and on Wed it's an Ear, Nose, Throat doctor.)  The place was not exactly super sparkly clean- note the yellowed seat of the examination bench BLEURGH!- , and we were greeted by the receptionist with "Sign in here." No time wasted on pleasantries at all! We were finally ushered through to the back a full 30 minutes after our scheduled appointment, and waited there an additional 30 minutes before Dr. B breezed into the room dragging his laptop table behind him.  Mr. R was grumpy, I mean REALLY grumpy! He grumbled several times that this was ridiculous and that he already didn't like this doctor, and he wasn't sure he wanted him anywhere near his "bits".  By the time Dr. B walked in I was sure Mr. R was ready to walk out. But 2 minutes after meeting the good doctor Mr. R softened and joked, and relaxed and all was well again.  I had all my questions answered.  He was not at all condescending (as some of the doctors we've met on our journey have been).  He really put my mind at ease and I am very happy we are working with him.

Some notable notes from this consult:

-  We will not freeze any sperm and will do the aspiration on the morning of my egg retrieval.  This unfortunately means that they will most likely be wheeling Mr. R out of the room and wheeling me in.  No hand holding.  No calming talks while all the "science" part of this is going on.  Cold sterile rooms, on our own, separately.  I was bummed about this, but I trust that Dr. B knows  his stuff when he says they have MUCH better success with fresh over frozen.  Dr. B is therefore ready to go at a moment's notice whenever I am ready for retrieval -- which I thought was really quite remarkable!  Down side is that we will have to have a fresh extraction with every IVF attempt.  Upside is we cannot afford more than one IVF attempt (aside from the trial) and because they are able to work from same room at same time per Dr. B the cost of doing a fresh extraction every time is very, very reasonable... around $1,000.  Anyone else had experience with this sort of procedure and can chime in on costs?

-  He will not be doing an extraction through the vas, but will rather take a section of the testes and extract sperm from there.  Strangely Mr. R finds the idea of him cutting away a piece of his testes less painful sounding than them threading a tube through there and sucking up some swimmers.  Men!  Go figure.  He described the pain relief, anesthesia which Mr. R found to be agreeable.  This was the area he was most concerned with.  He will have a valium cocktail before entering the surgery, he will then receive shots in his lower abdomen and only then will they move to the more area-specific anesthetic.

-  Dr. B thinks Mr. R is perfectly fertile and doesn't suspect any issues with count or quality of his sperm. He ran through a number of questions designed to "guesstimate" Mr. Rs fertility.  I like to call it the Man Test.  The questions were as you'd expect:  How often do you have intercourse, do you have other children, etc.  My favorite part was when he asked, "How often do you shave?" and Mr. R who is meticulous about his grooming replied, "You mean my face?" I nearly fainted. Anyway, based on his answers and the physical examination Mr. R is guessed to be perfectly fertile behind the vasectomy, but we won't really know until the day of, which of course is going to drive me crazy with worry.  For now Dr. B has prescribed clomid.  (I know right? Wierded me out too, but apparently it boosts testosterone production and will create what Dr. B describes as "super sperm" and while we're not too concerned about sperm count or quality, we need all the help we can get).

Lastly... We have been talking about our plan C.  Our final attempt, our last hope.  We are not going to be able to afford to keep trying with IVF and donor eggs and other measures.  Adoption is also out of our price range.  After the trial we have one IVF cycle and then ??  Mr. R has a 14 year old vasectomy and doctors we have spoken to advise against a reversal saying it's a complete waste of time, with million-to-one odds.  I have read enough on these blogs and forums to know that any shot is better than none.  Right now, every cycle goes by with a zero percent chance.  I am so happy for, (but secretly quite envious of), those of you with DOR and no male factor issues because the supplement cocktail has been working all kinds of miracles in the IF blogosphere... but no amount of wonder supps will ever help me as long as we have the vasectomy to deal with.  I asked Dr. B to be honest about his feelings about a reversal being our last ditch effort.  He was supportive!  He said he has seen people overcome amazing odds and he sees nothing wrong with a reversal up to 15 years.  After that there really is no hope because of the "sludge" that accumulates in the tubes.  So IF we fail at these two cycles, that is what we're going to do.  The cost is about half of a full IVF cycle, which is still a LOT of money, but it's an amount which secures us multiple months of possibilities instead of one single shot at success.  Mr. R has some concerns about our age.  He is 41 and doesn't really want to be successful for too much longer.  He has issues with the idea of being an "older parent" and we're talking about this... bottom line is, with me being pre-menopausal already at 35 we really won't have too much longer anyway!

So that in a nutshell is our visit to the Urologist.  Now we pick up the clomid script and get him going on those in addition to the Fertility Blend supps for men and I continue with my fitness, supps, acupuncture and TCM and we wait to hear back from the Dr. C about the start date for the trial.