Episode 160: Male-Factor Infertility: IVF & the Unexpected

Lizzy Colas: We actually started with IVF right off the bat, my husband was super open with me about the fact that we would face infertility challenges from the beginning. So, we always knew that we would need medical intervention, but I don’t think either of us realized how challenging it would actually be.

Dan Bulger: He was born without a vas deferens. And this brings us to our second special guest of the episode, Dr. Joseph Alukal from Columbia University Irving Medical Center.

Dr. Joseph Alukal: The vas deferens is a tube that colloquially, people are going to know best because it’s what gets snipped when a person has a vasectomy. It carries sperm from the testicles deep into the pelvis to the base of the penis and the prostate. So now instead, imagine a patient who was born without that tubing. And actually, the most common medical condition that this is associated with is cystic fibrosis or cystic fibrosis mutation carriers.

The next question is, “what are we going to do about it?” Couples can be really disheartened to find out that the male partner doesn’t have any sperm. But I’ve tried to be encouraging to these people because almost always there are numerous sperm to be found. They just have to be taken out of the testicle with surgery. We can actually do less invasive procedures to try and find sperm for the reproductive endocrinologist to work with. Sometimes those procedures can be as quick and easily accomplished as a couple of needle sticks to numb the patient up in the office, and then a third needle stick to actually take sperm out of the out of the testes. So hopefully, when that works like that the patient only needs to have this procedure one.

IVF is the only way forward, IUI is not an option. What I think people need to plan on having happen is they’ll do an IVF cycle with ICSI, where a technician takes individual sperm and injects them into an egg one at a time. And so, with that, you know the success rates are really high.

Lizzy Colas: We did three egg retrievals with the clinic. And we got one embryo of fair quality. So, at that point, they basically told us, we couldn’t have kids. We had coverage under my employer. And their benefit was that they covered $15,000 for infertility, which was a max lifetime value. And after that we had to pay out of pocket. We ended up getting like 50 eggs per egg retrieval. And then by the time we got to genetic testing our embryos we’d usually have two left and usually those would, you know, they would call us, and they would say neither of them were genetically viable.

And after the first year, and after we had gone through this once or twice, we realized that it was just too much of a burden to bear on our own. So, we came out about it on Facebook. And I remember just writing the post, and sitting on it for about five minutes before I actually posted our story. And then I didn’t check Facebook for a while. And my husband was reading it and came to me and said, “Oh, my goodness, you cannot imagine the most amazing things people are commenting.” So, we got so much support from our friends and family through that. And it was just such a surprise, I think especially because IVF is so controversial, I wasn’t sure what people were going to say to us. But we just couldn’t bear the burden on our own anymore. We were able to find a wonderful support network through our friends and our families, and also, our colleagues once we came out about it that work as well.

Lizzy Colas: We switched clinics for two reasons. One was because my husband got a job at Facebook, which uses Progyny for fertility benefits, the clinic we were using at the time was not covered under Progyny

Dan Bulger: Quality differs depending where you go, and Progyny only partners with doctors and clinics that reach our standards of care. If you are at a Progyny clinic, then you can be confident that you’re at a modern clinic that’s practicing today’s best practices. So, whether you have the benefit or not, you can take advantage of this fact by using our finding provider tool. Lindsay found out that her doctor wasn’t in network, well, as she said, that was actually a blessing. It led to more research where she discovered that this clinic was below average and stats and was not recommended upon review.

Lizzy Colas: I think the fact that Progyny has clearly done their due diligence on who should be in their network and who shouldn’t be was a huge win for us. We’ve been super happy with our clinic, we’ve had six embryo transfers with them, one of which resulted in our daughter. The doctors, embryologists, nurses, and even the front desk staff just celebrated with us when things go well, and cry with us when things don’t go well. They’re like family to us. So, I think we made the right decision. Have a conversation with the doctors before you go and just make sure that you feel like you can trust them that you feel like you’re getting the explanations that you need. And that they’re going to be your partner and work with you through this entire process. Because you’re going to see them a lot. And you want to feel like a human as much as you can throughout this entire process.

I was able to remain optimistic for every transfer, surprisingly. But I think for me, for every transfer, part of that process is getting myself into the right mental state and emotional state and just being optimistic and trying to give each embryo the best chance they can have.