[Tangent Thoughts] A club we will never be part of.....

May 7th, 2013.......Mother's day.

Today is a day when motherhood is celebrated.  While celebrating mother's day with my mom and dad, we observe all the families and children around. It certainly is a celebratory day for moms, and their thankful families. During our dinner, unexpectedly, my brother and his wife shared unbelievably exciting and happy news with us today while eating dinner with my mom and dad: he and his wife are expecting twins.  My mother's face lit up like I've seen few times in my life, and for good reason - she was going to be a grandmother, twice over. I've seen this same face in my mother-in-law's face when my wife's sister gave birth to their first child. I also saw the smile and pride which my wife's father gave to my brother-in-law when they announced she was pregnant. The same look I saw on my father today. Looks I so desperately desire to obtain. Words I whole-heartedly wish to hear. And I could see my parents giving those looks to my brother, cautious not to be overly excited as my wife and I were present. I was elated for my brother, but could feel a bit of sadness loom. Let me explain.

Imagine going to a very large celebration, a prom or formal perhaps, and forgetting to wear dress shoes.   Like most nice venues, there is a strict dress code. Those whom dont have the right attire can't be apart of the celebration and, if their lucky, their date stands by their side. Two people paying the price for the mishaps of one of them. In life, there is such a celebration in which nearly everyone is invited and few are left out of: pregnancy and birth. It seems in this life event, I've showed up with sandals while my wife dressed up like she belongs on the red carpet. Imagine how horrible you would feel if you know you kept your wife from having the time of her life at such an event. Imagine how infinitely worse it would be if that event lasted a lifetime. 

How can I ever repay my wife for robbing her of such an important life event?  I work tirelessly with adoption agencies, social workers, lawyers, etc. to make our hopes of becoming parents come true.  And  as hard as I try, and as positive as I try to be, the truth of the matter is this: I fall short. My BEST efforts remain a very distant and lackluster second to becoming a family through pregnancy and birth.  The self-pity and realization with which I find myself feeling at this moment is a cocktail of guilt, depression, and sorrow. My wife, a women whom has such a motherly touch, may never become a biological mother simply because she was unlucky enough to marry a man whom was born infertile. Just yesterday I saw her walking and talking gently, happily, and selflessly with my nephew.  In another life, perhaps that would be our kid she was taking care of so gingerly. But in this life, her husband has primary testicular failure and a piece of him dies each time he thinks of how hard their life has become because of him.

The ephiphanies of an azoospermic.....and the emotions.....

June 6th, 2012. 5:30pm.

My cell phone rings and I recognize the phone number as the doctor's office that performed the FNA mapping one week prior. I have been somewhat bed-ridden, and in a bit of physical discomfort for several days. That said, this is the day that I have been waiting for. I was so nervous picking up the phone call I felt like puking. This is how the phone call went:

"Hello?" I said as I picked up the phone.
"Hi Brian, how are you feeling?" said the doctor.
"I'm doing well, and feeling better."
"Is there anything bothering you?" he continued.
"No, nothing other than a little lingering discomfort when I run or sit down too quickly."
"That's normal, that should subside in a week or so. I'm sure you are anxious to find out the results, but I'm afraid I dont have any good news to share" he stated with a cautious tone.
My heart sank, I could barely breath, and I couldn't get a word out.
He paused and then continued "there was no sperm found at any of the mapped sites in your testes. The  results show that you have less than a 2% chance to retrieve sperm using even the most aggressive micro TESE procedure."
I paused, mustering the little courage I had and finally squeezed out the words "Okay, doctor, thank you for the call and for your help."
"Please let me know if you have any questions, and if you need any counseling. The results and impact of your diagnosis is truly on par with those that have suffered a loss of a very close loved one, or have been given the results of a cancer diagnosis. You don't have to face this alone" he said.
"Thanks for the information, I'll let you know if I need anything."
I never called him, never got counseling, and sunk into the deepest of depressions I have ever felt. It was like I died all over again, and when I told my wife - she died with me, and with it any dreams of our envisioned path to parenthood. That was one of the darkest days of our married life, and I held her a little tighter that night as we fell asleep with swollen eyes and heavy hearts. And when I could hear her breathing slow and knew she had fallen asleep......my tears rolled down my cheeks in a way they haven't in a very, very long time.

The next few days were very blurry, and we were somewhat disoriented. We tried to do normal things: laundry, clean the house, find places to eat. But it was like someone took our tastes buds away, and the color out of the sky and trees. I remember when we first moved into our house, I put up photos of our wedding in nearly every room, so we could each remember that day. Not because our wedding was so unforgettable, but because it was OUR day, and our friends and family shared it with us, our promise to be together. Those same pictures now mocked us. The smiles, the promises, the gifts, the happiness. It was all a faded memory. The things we envisioned while we were at the alter looking at each other: achieving goals, having children, raising children, becoming a family, getting old and seeing grandchildren......were all changed so suddenly. We simply didn't have time to adjust, and maybe we never will.

For my wife and I, the next days, weeks, and months were extremely difficult as we tried to move on with our lives. We tried to stay as strong as possible, but the fact was simple: our life and the path we envisioned towards becoming parents and raising a child had been changed forever.  The depression and fatigue we both felt was unbearable at times, and I could find my wife quietly crying on occasions. I felt like we were paralyzed, and we couldn't talk to people about it and, therefore, there was no one really there to help.


After about a month had gone by and we started to adjust to life again, I (for some random reason) decided to look into adoption. For anyone reading this that is going through or dealing with azoospermia, they have undoubtedly been presented with the idea and option of adoption. It is one that is unfathomable at first, and one that is extremely hard to think about. Raising someone else's child is a tall order. The funny thing is, once I started going to the adoption websites, I could feel a sense of possibility. And for the first time in wait seem like ages, I felt something positive about our future. And so I decided to call an adoption agency which specialized in international adoptions with Korea (since my wife and I are of Korean descent, we wanted a child that our parents could easily communicate with).

When I called the adoption agency, I asked about Korean adoptions and she replied: "The cost will likely be somewhere between $30,000-40,000 and the time to bring a child home will be 18-24 months." The small bit of excitement which had coursed through me had flickered out, and I felt like my heart imploded all over again. After my voice changed to a saddened tone and she replied "I know this is not what you wanted to hear, but unfortunately this is the way the Korean government has decided to implement the adoption process." And with that, I thanked her and we hung up.

It wasn't until a week later that I called again, and this time, I asked for more information. It was daunting. Full medical exams for both my wife and I. Blood tests, urine analysis, vital statistics. 6 letters of recommendations each. Official birth and marriage certificates. Proof of citizenship. 6 hours worth of visits from social workers. Mounds of paperwork describing our childhood, parents, siblings, education.  transcripts from our universities attended. Proof of insurance, proof of employment, proof of salaries, proof of taxes paid, proof of coverage in case of accidental death, proof of tetanus vaccination, proof of hepatitis vaccinations, proof of polio vaccinations. FBI database clearances for legal records. Background checks. Credit score reports. Even proof of our BMI (body mass index). Notarizations on 100+ documents. Let me stress that this is only a partial list. This was a very hard and unconventional way to becoming a parent. But when you have few choices and your life has thrown you into the darkest predicaments, you have little else to do than make the best of your shitty situation. It was our chance to take our infertility combine it with a child's loss of parents with the possibility of making all of our lives a little better. At least that's what I hoped for as I clung to a thread of hope for my wife and I as we looked to our future.

When I went home to speak about things with my wife, I realized one fact. My infertility had robbed us of becoming parents biologically, but it didn't mean we couldn't become parents and have a family in another way. This path, while far from the path we envisioned to parenthood when we got married, was nonetheless a real option towards raising a child together, as a family. I can not even begin to tell you or express the amount of uncertainty and hesitation we felt as we started preparing all the documents and appointments necessary to just qualify to adopt from Korea (let alone all the money we had to prepare to invest in this endeavor). But, for the first time since feeling that infertility had choked the life out of us, we gasped a few breaths of optimism.


“I thought about all the people I knew who spent many of their waking hours feeling sorry for themselves. How useful it would be to put a daily limit on self-pity. Just a few tearful minutes, then on with the day.” 
― Mitch Albom, Tuesdays With Morrie

Sometimes, the little things get you

Here's a short poem that I'd like to share to start the blog. It's not always the monumental things events in our lives that make us break down. Sometimes it's the little things that happen during times of massive stress that solidify out state and make us melt in the spot. They catch us off guard and already worn thin.

Shoelace

it’s not the large things that 
send a man to the 
madhouse. death he’s ready for, or 
murder, incest, robbery, fire, flood… 
no, it’s the continuing series of small tragedies 
that send a man to the 
madhouse… 
not the death of his love 
but a shoelace that snaps 
with no time left … 
The dread of life 
is that swarm of trivialities 
that can kill quicker than cancer 
and which are always there - 
license plates or taxes 
or expired driver’s license....

As my wife and I waited for the test results of the various exams I took in the weeks before, we started to plan the "next steps" of assisted conception through what is known as ICSI-IVF. ICSI-IVF stands for intracytoplasmic sperm injection-in vitro fertilization. What ICSI-IVF essentially amounts to is the extraction of sperm from a male which gets "injected" into harvested eggs from a female. Its a very expensive and complicated procedure which is an amazing process, but one that is also incredibly prone to failure (success rates can be as high as ~50%, but typically are a lot lower and multiple attempts are usually necessary).

So what is ICSI-IVF exactly? To me, it sounded a lot like the doctors were simply impregnating my wife's eggs with the sperm they would extract from me and then implanting them back into her. The physical cost: my wife would have to take large, muscular injections near the back of the pelvis for the better part of 3-4 weeks, as well as hormones and other light injections. My wife, God bless her, was scared as all hell over the idea of taking so many shots and having to go through all the bodily changes that comes with such hormones. But she was a trooper, and I was so proud of how she kept herself composed and positive as we embarked on an endearing and torturous journey.  Even now, as I hear her watching TV in the bedroom as I type, I can see my sweet, playful girl prepping herself like a soldier that is readying to go to battle - telling herself to be strong, be brave. And she was so, throughout this entire debacle. I was and am still so very proud of her.

For me? Testicular sperm exploration and, hopefully, extraction. One such process is Fine Needle Aspiration (FNA) Mapping.  In fine needle aspiration (FNA) mapping, there are roughly 18 aspirations with a needle, surgically pierced into EACH testicle (for a total of 36 "punctures") with an extraction of some intra-testicular medium. Each sample will be examined by two independent labs to determine if there is any sperm being produced in the testes. Then, assuming sperm is found, there are TESE and mTESE procedures. TESE is also known as Testicular Sperm Extraction, where the scrotum is sliced open, and one or both testicles are further sliced "opened" to reveal the inner "tubings" where samples are taken which may or may not yield sperm. mTESE is a variant of TESE were a microscope to aid in the extraction of testicular tissue is done so that less testicular tissue can be taken with a better chance of finding sperm. In other words, both will hurt like shit, and the "balls" are gonna be swollen.

Let's talk about the money. ICSI-IVF would cost about $30k, for 2 attempts. FNA-mapping costs about $6-7k (since we chose to go with one of the best FNA-mapping specialists in the world, who happens to practice in SF). TESE/mTESE would be another $5-10k depending on how little sperm there was (i.e. how hard it would be for them to find the swimmers).  Before subjecting my wife to anything, I decided to get FNA-mapping done on myself to determine if there was even any sperm worth betting ICSI-IVF on. My appointment in San Francisco was on May 31, 2012. That was one day after my wife and my 3-year anniversary.

On the day of my surgery, my friend C picked me up. I was happy that someone could accompany me and that my wife could be spared from having to wait in the waiting room thinking about my surgical discomfort. She would be working until later that day, and my appointment was at 3pm. I arrived at 2:30p, by 2:45p I was a little loopy from the valium they gave me. She really wanted to come, but I thought it was better if she didn't and I would see her at home immediately afterwards. I remember as I was getting prepped for surgery, the thought of most my friends not knowing anything about my surgery nor about my condition made me feel isolated. The nurse left the room for a moment, and I remember how alone I felt - and for a while, I wished I could hear my friends tell me everything was going to be okay, and that they would be there when I got home. Even till this day, most of my friends, even the ones that know of my azoospermic condition and surgery can barely remember the feelings I had, or could care less. But they are still very real to me. Even nearly a year later, I can still feel emotions put a strangle hold on my thoughts when I recollect.

As I lay back on the surgery table, bare naked, the nurse completely shaved my scrotum (rather quickly which was horrifying even with the valium), it became very real that my testicles were about to have a major "attack" happen to them. And then, she applied what felt like really hot water on my scrotum. It was a topical analgesic, and it made my balls feel like they were on fire. Then the real fun began: 6 inch needles filled with local anesthesia. They were injected about 2-3 inches into my groin area and it was very uncomfortable but I didn't budge, I was too scared of what might happen if I did. I barely breathed.  All said, the doctor gave me 4 shots on my left groin, 3 on my right. He was about to delay the surgery as I was not getting fully numb, but I asked him to just proceed. I hadn't come out here and go through all this just to go back home with partially numb testicles. And so with a little discomfort he proceeded. 36 aspirations where he stuck a needle about 1/4-1/2 inch into each testicle, 18 times. When everything was done, I was still a little loopy from the valium, but very happy that the procedure was over.

My friend C was waiting for me in the waiting room and it was great to see him, and thankfully he was able to drive me home. Amongst all the friends that tried to say the right thing, that were absent from it all, that were too busy to come by, and to those that just didn't make an effort to call after not hearing from me for a year.....it was C that came thru the most. He just came by to, well, come by. To watch TV, to eat some food. Not because he felt sorry for me, or because he thought I needed it - but because he just wanted to hang out. To me, that was the sign of a great friend. Even people that don't like you will be there when you are really down (say when a parent passes away), but the ones that come by just because they like being around you and just like seeing you......well, those are the ones worth keeping the most.

One thing I learned from all this was that there are only a handful of times in your life that allow you to define who you are and what you're willing to do.  I think, amongst many things, friendships intersect at such junctures. It's the people that shine in those moments, without necessarily intending to rise to an  occasion,...... those are the ones that define friendships for other people. Other people, like me, that were on the receiving end of an unintended but generous gift. Thanks C, and, of course - thanks to my wife.