The Male Factor

If you’ve ever tried to get pregnant and it didn’t work right away, you’ve likely come across this statistic: when couples have trouble conceiving, 30% of the time the problem is linked exclusively to the female, in another 30% it’s exclusively with the male, and the rest of the time it’s a combination of both. When you begin the infertility journey, one of the first things your OBGYN will ask for is a semen analysis, which makes sense. Sperm are pretty crucial when it comes to making a baby. And compared to the invasive and sometimes painful diagnostic procedures the woman has to endure, this part seems relatively easy – hell, even fun! But as with everything else in our endeavor to try to conceive, ruling out the male factor proved in reality to be a lot more complicated than I thought it would be.

Five years ago, when we first began to dip our toes in the infertility pool, we stopped short of having my husband’s sperm tested. I’d been through months of blood tests and ultrasounds, two rounds of Clomid, and so many Ovulation Predictor Kits that I’d developed a deep and personal relationship with that little happy face that appears when you’re having your LH surge (I named him Guy Smiley… what?) Frustrated, I was ready to give up and resume the benign neglect that had characterized my relationship with my fertility up until that point. I was only 34 and I guess I felt like we still had plenty of time. HA!

And there is another reason.

I don’t know how to put this delicately so I’ll just say it: my husband has a lot of complex feelings about masturbation. While it’s not something that has ever presented a concern in our marriage, his embarrassment is perhaps the real reason we drug our feet for so long on the semen analysis. But this past year, as we began to get more serious about pursuing IUI and, failing that, IVF, I knew we had to get a full picture of what exactly we were dealing with, and that would mean Jeff would just have to get over his discomfort. So one day I came home from the clinic with a little plastic cup and a list of instructions and we put it on our calendars. Friday, Sept. 14th: collect sample.

The good news: we could take care of it at home! No drab little lab annex with poor lighting and questionable pornography for Jeffrey; we could do this in the comfort of our own bedroom.

More good news: though the instructions prohibited the use of any sort of lubricant, they didn’t say we couldn’t collaborate. So that’s what we did.

It wasn’t until I was about to leave for the andrology lab that I read the fine print on that instruction sheet. We’d fucked up. In an effort to make the experience as comfortable for him as possible, we’d, um. Well, that is, we… The manner in which we collected the sample was not a medically sanctioned one. Turns out, it was possible we’d tainted it right out of the gates with residue from my toxic vagina.

Side note, during one of my OBGYN appointments that Jeff attended with me, my doctor, in explaining why it can be difficult to conceive, characterized the vagina as “a horribly toxic environment for sperm” and I have never forgiven him.

So there I was, driving to the lab with a brown paper take-out bag containing a little cup of my husband’s semen on the passenger seat, already freaking out that we’d killed the poor bastards before they’d even had a chance to show what they were made of. But I had an appointment to keep and needed my wits about me to navigate peak Minneapolis traffic to the largest hospital in the Twin Cities.

The thing about getting sperm tested is that time is very much of the essence. That’s why you have to make an appointment for a specific time and woe betide the poor fool who misses the window. Let’s say your appointment is at 2:30. You have to make plans to ejaculate no earlier than 1:30 but no later than 2:00 because the semen has to rest at room temperature for an hour to – well I don’t know, exactly. To prove or set or something. But once you reach the hour deadline, those boys need to get in the incubator STAT or they’ll start dying and the test results won’t be accurate. They’re quite temperamental, when you think about it.

All this is to say that for me, a person who is perpetually anxious about being late for anything, threading the needle of this narrow sperm window was stressful enough without having to worry that we’d already compromised the sample by exposing them to my (all together now) TOXIC VAGINA.

Right about now you might be wondering why Jeff didn’t drive his own damn semen to the lab but as every married person can tell you, there are certain things in a marriage that, if they’re going to get done, you just have to do them yourself. It’s not a source of simmering resentment; it’s just reality, and you get on with it. I didn’t give a single, liberated fuck that this task fell on me. I just wanted to get it done.

I arrived at the hospital in good time and didn’t even have to make too many switchbacks before finding a space in the parking ramp. For a fleeting second I may have thought: wait, am I sure this is the ramp specified by the instructions? But I still had a full 16 minutes before my scheduled lab time; I was feeling calm, cool, collected, and ready to celebrate the accomplishment of another important chore completed. The sliding doors whooshed open to welcome me and I stepped forward in the grand lobby of… the cardiology wing? Where the hell was I?

The sense of peace I’d achieved by getting there on time quickly evaporated and my heart began to pound, my breath became shallow and fast, as I wandered aimlessly down hallways that all looked the same, searching for some sign that I was in the right place. I don’t know what I was expecting – big neon letters flashing “JIZZ LAB THIS WAY”? It became clear to me that just speed-walking through one sunlit atrium after another (seriously, this place is huge) was not going to lead me anywhere, so I stopped at a station staffed by a few young people who didn’t seem to be particularly busy and looked like they might take pity on me. At this point, my comfortable time padding had shrunk to about 9 minutes.

“Um hi,” I stammered. “Can you help me? I’m supposed to get this to the lab and I don’t know where to go and I have these instructions and they say to come here but I don’t know where to go and I -” I held up the sheet and the brown paper take-out bag, my eyes brimming with panic-tears.

“Okay,” the man replied, overly-calm. “Which lab are you trying to get to? What is this?” He eyed the bag askance.

“I have an appointment for 2:30,” I sniffled, “to get this sample tested, and it’s -“

“I’m sorry ma’am, what IS it?” He was less patient now.

“It’s um -” I looked at the other attendant, willing her to just read my mind so I could spare them all the embarrassment, but she was silent.

“It’s semen. My husband’s semen.”

“Oh you need to go to the andrology lab,” he said. “Yeah, you’re definitely in the wrong place. Hold on, lemme see that,” and he took the sheet of instructions, now crumpled and slightly damp from my sweaty hands, and began typing an address into his computer.

“Okay, so the building you’re going to is actually out these doors here, down the block and on your right – “

“Thank you!” I breezed, taking the sheet back from him, on which he’d drawn a little map and circled the clearly marked address of the andrology lab (if only I’d plugged THAT into my GPS in the first place instead of just the name of the hospital, god I am a moron). But it was okay, I still had a few minutes and it was a gorgeous sunny day and I could make that block in under a minute if I caught the stoplight…

It was about this time that I realized I didn’t have my wallet with me. In fact, I had no memory of ever having had a wallet, ever. I couldn’t remember whether I’d left it at home and I couldn’t contemplate the possibility that I’d lost it somewhere. My anxiety had now reached a threshold that would not allow one more thing for me to worry about. I had my phone and the all-important (now rapidly-cooling) sperm sample and no way to prove my identity or that I had insurance or pay for the test. I couldn’t even pay for my parking.

You know that scene toward the end of The Shining when Wendy is kind of shuffle-jogging through the hotel, holding that butcher knife you KNOW she doesn’t have the strength to actually use and whimpering to herself? That was me in that moment, except instead of a knife I had a brown paper take-out bag containing a little cup of semen. I knelt down in one of those curb-bordered triangles of grass in the parking lot and just fell apart.

“What am I going to do?” I kept repeating to myself. Looking back, I know exactly what I would have done. We’d just schedule another lab time, get another plastic cup, and do it again. It would have been fine. It certainly wasn’t the end of the world, but in that moment it felt like all the stress and uncertainty of infertility, all the fear that there was something really wrong with us, we just hadn’t discovered it yet, and our own window to become parents was shrinking every day, and that we’d never have children, all of that combined into a swirling tornado of dread that brought me to my knees.

When I’d called to confirm the appointment the day before, the woman who answered the phone had explained to me that, due to a billing change, I’d have to pay for the test up front and then file a claim through our insurance company to be reimbursed. “It’s $120,” she’d told me. “Check or Credit Card, just be sure you have payment ready”. It was so like me to forget the one thing I knew I needed most. Disgusted with myself and half convinced they’d turn me away before I could even open my mouth to explain, I stood up, took a few breaths, and walked the short block to the lab. The right lab. Where I should have just gone in the first place.

After some confusion in the elevator (because it wasn’t enough that I was finally in the right building, now I had to find the right goddamned floor), I walked into the andrology lab looking I am sure an absolute fright – pale, stricken, tear-streaked – to be greeted by the brilliant smile of an actual princess in a white coat.

“Good afternoon!” she enthused in a voice that made me feel like her entire day had been building to this moment. “You must be Lora!”

She must have been the one I’d spoken to on the phone. I managed a half-hearted smile and a “yeah” and was all ready to explain why I’d probably need to reschedule when she nodded at the bag.

“Well let’s get those guys in the incubator first and then we can take care of the paperwork!”

I reached into the bag and unwrapped the kitchen towel we’d used to try to keep the semen warm during transport. I handed her the little plastic cup and she accepted it like it was a chalice of liquid gold, not some strange dude’s come, her raven hair falling down her back in waves as she opened a drawer behind her chair and placed the sample gently inside.

As I began to explain that I didn’t have any way to pay for the test, she interrupted me with a quick flap of her wrist. “We decided not to start that until next month anyway, you’re good. All I need is this – ” she picked up the sorry instructions sheet, which also contained the official orders from my OBGYN to conduct the analysis. “Alright Lora, you’re all set!”

Another brilliant smile. I felt something inside my chest begin to loosen a bit, like I’d wound ropes around my ribs to keep everything intact, and now I’d allowed them a little slack. My legs felt lighter as I walked back to the main entrance of the hospital and explained my situation to the parking attendant. He just smiled and gave me a validation ticket. “No worries,” he assured me. “Have a good weekend.”

When I look back on this ordeal, my heart still quickens at the memory. I don’t know why, of all the trials I’ve faced on this path, this would be the bridge too far, the one that pushed me closest to the brink of a breakdown. But I also feel the warmth of that lab worker’s smile and am comforted all over again when I remember how one minute of kindness was enough to make me feel like everything would be alright. That’s another thing I’ve learned about infertility. It certainly has its bad days, when your isolation and hopelessness feel so complete that you can’t imagine any way out from under this shadow hanging over your life. And then from out of the blue you’ll get a text from a friend saying “I’m here for you” or someone else will say simply, “I’m thinking of you”, and you realize you have this whole army of good folk who care about you and love you and are out there every day wishing you the very best. It’s nice to remember that. It makes me feel like maybe I can keep fighting and maybe I can even beat this.

And at least now we know that Jeff’s sperm is in top fighting form. The semen analysis checks for three main functions: count (the number of sperm/mL), motility (speed, quality, and direction of movement) and morphology (shape). Happily, Jeff’s sperm (like all my blood tests) were found to be “within normal range”. Which means that after everything, we still don’t know why we can’t conceive and I have a decision to make: I can go on feeling hopeless and dejected, like nothing is ever going to work for us because no one is ever going to figure out what the hell is wrong –

OR

I can, as my doctor insists, look on the bright side. They’ve found no reason to think that our next option, IUI, won’t work, and in fact, I should assume that it will. So I’m trying to stay optimistic. I’m not always successful and I still have tough days but at the end of them, I know that’s all they are – just a day. There’ll be another one tomorrow. And one of these days, I’m going to wake up pregnant.

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