(Warning: Long post)
As they say, we all have our own crosses to bear. I have accepted that this is ours, and I just pray for divine guidance and protection to ensure that everything will be okay in the end.
OK, to recap, my husband and I went to Taiwan last February, mainly for a vacation with his parents, but while we were there, I felt it prudent to visit the IVF clinic there and get some tests done. We were there already, after all, and it will only take one morning to get everything done. One thing I heard is that the clinic there has a 100X better magnification for their semen analysis and hopefully it sheds more light on why we have been unsuccessful in our attempts so far at natural conception.
So off we went to Mackay Memorial Hospital. It's a much smaller place than I imagined, and not exactly looking top-of-the-line, if you get my drift. Makati Med and St Lukes look so much better and much more 'high tech', but this place has the highest success rate in Asia, so maybe looks can be deceiving. We had our consult with the famous Dr Robert Lee, and had our blood tests done. Dennis also had his semen analysis done and then off we went to enjoy the rest of our trip.
Fast forward to two weeks later and I get an email on the results. The Taipei diagnosis for me is that I have fair ovarian reserve, which means I have egg quality and quantity that matches my age. That's good news. However, Dennis has oligoasthenoteratozoospermia. A mouthful to say, I know, but an even bigger mouthful to swallow and accept. Basically, it means sub-par sperm on all 3 counts (or 3 factors by which sperm is judged -- count, motility and morphology or the level of normal-form sperm VS abnormally-shaped).
His count was an 11, when the healthy minimum is 40 and the average fertile man has hundreds. Motility is 36% when the average is 40%. What really worried me was the morphology result -- he only got a 2% as per Kruger's criteria (a stringent criteria by which 'normal' sperm is judged. It's a highly strict criteria, so high that a result of 14% is treated as extremely good). I worry because morphology can be linked to chromosomal abnormalities, and I am fearful of what that may mean to our future child. Given his results, the Taipei clinic recommended IVF-ICSI to our case. This is a more aggressive form of IVF (yes, IVF has yet another MORE aggressive version than the test-tube one people are more familiar with, believe it or not) that has to do with injecting one single sperm into the egg. Essentially the clinic is recommending this because they feel the sperm is of a weak composition that it will likely not be able to penetrate the egg at all. So a form of additional 'manual help' is administered, with an embryologist picking out a sperm that to his eye, looks healthy and injects that into the egg. Poof! Off goes natural selection. No more 'may the strongest sperm win'. If we do this, our future child will not be the 'sperm that won' but the 'sperm that the embryologist chose'. There are a lot of risks here and a lot of choices to be made -- some I'm still trying to navigate through. I do not want to make a mistake. This is our baby we're talking about. Few other choices compare to this one in terms of significance.
Like any warm-blooded man, Dennis took the news quite badly. Seeing him so sad and dejected was enough to make me cry, but I resolved to stay strong because he couldn't and that's what marriage is all about. I resolved at the start of this journey that in no way will I allow infertility to hurt our marriage, and this was probably the toughest test yet. I told him, "how would you want me to feel if it was me that had the problem? Would you want me to be ashamed? Would you want me to feel undeserving of you and your love? Would you want me to be afraid that you will leave me because I am the reason we can't have a child? Would you want me to feel less of a person, less of a woman, less of a wife, just because of a physical weakness that I had nothing to do with? Take all your answers to those questions and apply them to yourself, because that's how I want you to feel." Deep inside, my heart was breaking, but I couldn't let him see that. I feel all the 'normal' emotions that someone in my shoes would, but I couldn't allow myself to show weakness, when he already felt the heavy brunt of it. It all feels so unfair, presenting options that I feel are risky in one way or another, and making choices that I know I will forever second-guess. It felt that way when the news hit and it still does, until now. I know that staying positive is key, but the reality is staying positive feels impossible sometimes, especially when you don't know the reason why this unfair thing happened to choose you and not someone else. Why bad things happen to good people. Why children are elusive to people who would make good parents yet are born all the time to people who are unready for them.
After some time, my husband, God bless his heart, came around and told me he is ready to support whatever choice I wanted to make. This is where another tough part lies. There are many options to consider and many research to wade through. People who know me well know how much of a nerd I am and how studious I am at knowing about things I want to know about. Obviously, this ranks at the top, and despite the amount of stuff I have read, most especially about the incremental risks of ICSI, I am still unsure of where to stand. On one hand, I want to choose the procedure that will work, but on the other hand, I know it's not just about the procedure that will get me pregnant, but the procedure that will likely yield us a healthy baby. I am so uneasy about the risks on the child, because my conscience keeps telling me it's unfair to expose a baby to additional risks that his peers are not subjected to, when it is me and his dad that are making the choices, not him. Yet, the price of these choices will be borne by him, not us. Does that make sense? It's one thing to toy around with my body, injecting hormones that may increase my risk for ovarian cancer, or taxing my ovaries to the point that they may explode (which is fatal, by the way). But all that is on me. It's another thing to expose a hapless, innocent child to risks that he may have to bear his whole life, to satisfy a maternal need in my heart.
So essentially these are the questions to be answered:
1. How do I want to ovulate?
Option A: Ovulate naturally. The clinic I'm looking to go to has an option of natural ovulation. They will not give me medicine to induce ovulation and will instead just monitor my normal cycle and aspirate (suck out, in short) the lone egg in my ovary once it has matured.
Option B: Ovulate with stimulation. This is close to the conventional IVF whereby I will be injected with medicine that will stimulate my ovaries to produce more than 1 egg. The conventional IVF done in St Lukes and Taiwan inject an irregularly huge amount of hormones. The clinic in Enterprise I'm considering only do it 'minimally', which means their aim is to yield about 2-3 eggs whereas the conventional method aims to get 10-20 or sometimes even 25 eggs. This is huge given that nature's version is only 1 per cycle.
2. How do I want to fertilize?
Option A: Conventional test-tube fertilization whereby the egg is placed on a dish then a concentrated solution of sperm is poured over it. This has less success rate than Option B below but is closer to nature, because the method still allows the best sperm to enter the egg. However, with Dennis' condition, the indication is that this method will likely fail.
Option B: ICSI or the injection of one lone sperm, which was selected by the human eye of an embryologist (tao lang, pwedeng magkamali) but carries a higher success rate. This is quite expected, because you eliminate issues about weak sperm and/or an egg with a covering layer that is thicker than normal, making it hard for a sperm (much less a weak sperm) to penetrate. While this has a higher rate of pregnancy, it has also shown higher (50% more!) risk of congenital defects, like vascular defect, cleft palate, and even learning disabilities. Scientists suspect that this higher level of risks (which are still considered small in relation to the total universe, like a 2% chance) is due to the fact that the weak sperm that otherwise would not be allowed by nature to fertilize an egg, managed to because of a syringe and manual intervention. Hence, a weaker sperm may carry defective genes that were allowed to perpetuate. Oh and there's also evidence that if the procedure yields a baby boy, that boy also carries the risk of being infertile. Yes, infertility can be genetic.
So there. Two options for two questions. Risks every way I turn. Risk of failure. Risk of something wrong. Risk everywhere.
I wish I can tell you (and myself) that there's a way to avoid risks completely. But unfortunately, in the world of IVF, risk is a necessary evil. There's always risk when you use science to deal with something that, once upon a time, only Mother Nature had jurisdiction over. Risk is part and parcel of the game -- it's the nature of the beast. The only thing I can do is to try to choose the route that gets us the result we want, at the least possible risk for my baby.
So where is that line?
Where shall I draw the line on the sand?
You may say, so why even try IVF? Why not try naturally forever and see how that goes? My answer to that is because time is possibly the single, most valuable factor in fertility. Time affects egg quality. Time affects endometrium quality. Time affects many other fertility aspects. I don't want to wait and wait, only to find out there's nothing waiting for me at the end of this line. Also, while there are risks to IVF, especially IVF-ICSI, it's still minimal compared to the odds of having a perfectly normal, perfectly healthy baby. So while the risk is there, the reward is also very much there.
As I said, infertility is such a gray area, there's no use looking for the black and white. There are no guarantees in this.
So far, we've told ourselves we'll start the process in May. I have until then to decide what particular method to choose.
In other news, I informed my boss yesterday about my intention to do IVF and what that may mean for my work schedule. Specifically, I told him this means for sure that I will need to be on leave for two weeks in May. This also raises the possibility that the leave may be extended, depending on our outcome, or shortened, also depending on the outcome. There's really nothing definite I can commit to, because I am not in control of how this plays out. And I hoped with all my heart that he will stand with me as I faced this part of my personal life.
Sadly, I was disappointed. For a man I held in such high regard and for whom I made quite a number of sacrifices, I was left wanting. When I expected kindness, empathy and understanding, what I got was a reluctant okay, a mild threat and an order to 'think deeply about my career aspirations.' I was so surprised, and my innocence lost, because I thought he would come through for me the way I felt I always came through for him. To have the audacity to do otherwise was probably the biggest professional slap in the face (okay, not that dramatic, so maybe just a symbolic 'cold water splashed on my face') I have ever received. And if there was any ideas being entertained in my head before of "maybe I can try to manage this pregnancy quest with helping him push his corporate agenda, maybe I can make it work somehow, with some days I go to the office and some other days I stay home", that's now out the window. If you are not looking out for me, then there's no reason for me to do the same for you. In a way, it was liberating -- I now know there's nothing else I could have done. How dare he try to make me choose between him and my personal life -- and how dare he even think he can win in such a choice. Such arrogance.
So there. So much heartache, I tell you. So much more than I thought I could ever bear in my life. I have more questions than answers, more sources of disappointment than sources of hope, more fears than when I started walking this path. I just pray and hold on to my faith... and to my belief that after all this is done, in the end,
good things will happen to good people.
Please pray for us.
