THE COMPUTER PROJECT. The desktop computer at home (where we have all our trip photos) is having major issues. The month-old two terrabyte hard drive began loading sluggishly, and audible clicks could be heard as it spun, looking for data. The concensus is that the hard drive is on the verge of crashing. Mr. W backed up the data and we went to a computer store to look into returning the old one and/or buying a new one. Since he didn’t have the receipt, he bought a new hard drive and for the first time, purchased the extended warranty. While there, he discussed the symptoms with a store techie, and learned that his particular motherboard causes problems on high density hard drives (hence clicking), so the only way to cure this is to buy a new updated motherboard ($$), which means he’ll have to update his processor chip to support the new motherboard ($$), and that means his memory should be updated, too ($$). And of course he has to replace the crashing hard drive ($). Meanwhile, he’s installed the new hard drive and is in the process of transferring data from the old to the new, to buy a little time. For me, it means I have to wait a bit until I can finish my French Polynesia vacation posts since I have one more island port, Moorea, to cover and the day we came home from the island of Tahiti.

THE INSANITY PROJECT. The makers of the P90X workout, Beachbody, listened to people complain about not having the pull-up bar or dumbbell equipment to do the intense-but-effective sessions, so they came up with Insanity. Every bit as psychotic and vomit-inducing as P90X, Insanity uses only one’s own body weight and gravity for resistance. Sounds great, but I think Insanity may be even more hardcore than P90X because it’s designed for a 60-day cycle, instead of the 90 of P90X. That both scares and excites me. I have the kit at home and am about to begin. I’m also counting on this to get me prepared for the Marine Corps Obstacle Course Challenge in September.

THE BABY PROJECT. I haven’t talked about this in specifics, yet, so here it is, for the benefit of my obsessive record-keeping and because when I searched for information, I found very little of it, so this may benefit others in our shoes. Some years ago B.C. (Before Cindy), Mr. W lost his mind (or perhaps he was being mind-controlled like a zombie) and had a vasectomy. I didn’t take our relationship very seriously initially because marriage and kids were not part of the equation for him. It wasn’t that I was set on getting married and popping out children, but I wanted the option, as I had explained to many friends that first year Mr. W and I were “hanging out.” On our 1-year anniversary, Mr. W started talking about wanting to give me “a real commitment.” I told him that was unnecessary as I didn’t believe he was any less committed as my boyfriend as he would be as my husband. The man was committed from day 1, more so than I was, except for some computer games but that’s a whole other addiction. Year 2, he started talking about possible children together. My parents were, of course, pushing for some sort of outcome to this relationship because they didn’t want me to die alone (I know, Asian fatalist gene). Mr. W’s thoughts were about artificial insemination by a family member, and one of his brothers seemed amenable to it. That way, he figured, the genetics would still be the same, or similar enough. I was not thrilled about having the conversation later in life when I would have to tell my kid, “Dad is really Uncle W, and Uncle X is really Dad, and Cousin Y is really half-sister Y, but I’m still mom…” It’s hard enough to have to re-assess and re-identify one’s own parent(s) (I think it’ll happen involuntarily), but an entire extended family, too? This kid would go nuts for awhile. Mr. W seemed to understand this and appeared open to an anonymous donor. Around this time I happened to have dinner with two doctor friends, Lily (radiologist) and Arnold (cardiologist). I blubbered about this obstacle, and both just stared back at me across the booth at Claim Jumper. They didn’t see the big deal.
“But he had a vasectomy!” I repeated.
“So?” Arnold said lightly. This is when I found out that he had taught fertility prior to going into cardiology. Apparently (apparent to him, not to me), modern medicine and technology have found a way to just go into the scrotum with a tiny syringe, before the area where the vasectomy had disconnected the vas deferens, and extract some swimmers. What happens after that was unclear to me, but I was hoping they could just use whatever they extract and put it in fluid like a donor sample, and “turkey baster” me (I think that was how Arnold characterized it). He did warn me that a smaller percentage of men, especially if they’ve had the procedure done awhile back, develop antibodies to their own sperm as a way for the body to get rid of free-roaming critters that have nowhere to go. Arnold’s lack of being impressed by our predicament gave me (and Mr. W) hope, Mr. W proposed at the end of Year 2, I accepted, and we were married on our 3rd year anniversary.
I dragged my feet on the baby thing, enjoying my lifestyle too much. Mr. W enjoyed our vacations as well, but time was more pressing for him because of the age difference. He told me a few times that I better figure out whether I want a baby because he’s not getting any younger. So somehow, we figured that we’d take our last two kid-unfriendly vacations this year (the hedonistic Polynesian vacation was #1; high-adventure Australia late fall would be #2) and then have a baby. We would be married a little over 2 years then.
I’m going to get into detail about the fertility process, so if you’re interested, click “more,” below.

April 12, we went to a highly-recommended reproduction medical group; we know some couples who have successfully conceived with that clinic’s assistance. The initial consultation with our fertility doctor cost $250, but that opened up our file, assigned us our doctor with whom we had an extensive conversation about our issues and concerns and potential treatment plans, and ended with a vaginal ultrasound. We learned through the ultrasound that I’m reproductively normal and healthy, no obstructions, no misshapenness that would be an issue with bringing the baby to term or delivery (the doctor said I have a very attractive uterus), and I have “plenty of eggs” in my ovaries. At the time of the ultrasound (it was half a week before I was expecting my period), I had something like 16 “ripe” eggs in one ovary, and 18 in the other. (Older women or infertile women have less eggs, sometimes less than 10 between the 2 ovaries.) This is important because it means that our infertility is solely due to Mr. W’s vasectomy, which puts us in the “voluntary infertility” category, so insurance is not going to cover any of this. It also means that I will get the most conservative and least expensive treatment possible. I had another concern — some years ago I underwent the LEEP procedure, which means a chunk of my cervix, which is what holds the baby in during pregnancy, was removed. The doctor who performed the LEEP did so under the presumption that I’d never planned to have kids, as I only discovered after the procedure. This made me paranoid that he took a bigger chunk of my cervix than he otherwise would have. Shortened cervixes due to LEEPs and cone biopsies may cause an “incompetent cervix” in some people, which means when the baby gets closer to full term, the cervix starts opening prematurely, which causes a miscarriage or premature birth. The fertility doctor reassured me that a LEEP uses an electrical scoop that takes out the same uniform chunk of flesh no matter how hard the doctor would’ve pushed, so being unaware of my need for a cervix later on would not have made the LEEP doctor take out a bigger chunk. He said I simply have to bring to my obstetrician’s attention that I’ve had a LEEP done and they’ll keep an eye on the strain on the cervix. If it looks like the baby’s starting to “beak” (poke through the cervix), there’s a procedure that can be done where the cervix is stitched closed for support. (heebie-jeebies) But only a small percentage of women get incompetent cervixes.

Now that we have established that I’m a healthy fertile 33-year-old, the next step depends on Mr. W. The fertility doctor gave us a list of local urologists they have worked with in this field. We were to choose one and make an appointment, with the goal of finding out whether sperm can be extracted from Mr. W. There are several ways of extraction. Ideally, his body would not have built up antibodies to the sperm, and there will be plenty of young sperm in the epididymis. A tiny needle extraction is all that’s necessary in this case. If there are no sperm here, they’ll go a little deeper into the testes, where even younger sperm in a normal man would be. If there’s nothing there, as sometimes the antibodies invade deep to destroy the sperm, they’ll take a biopsy of the layer of cells where the sperm are made in hopes of finding infant sperm they could pluck out and use when they examine the tissue under a microscope. They’ll have to let the baby sperm mature a few days before they could do anything, as the sperm will just lay there otherwise. A small percentage of men who develop antibodies to their own sperm have aggressive antibody invasion that would destroy even this sperm-making tissue, in which case no live sperm would be found anywhere.

Assuming sperm of any sort could be extracted, these sperm will all be immature young sperm because they didn’t have the time to mature through the process of swimming through all the coils and ducts in an unsnipped man. This means a turkey-baster injection in me would be impossible with extracted sperm; the sperm would be unable to swim to the egg and would be unable to penetrate the egg. So here’s the sucky part for me.

I’d have to undergo In Vitro Fertilization (IVF). I give myself hormone shots, two a day (this is the lowest dose since I’m already reasonably fertile, otherwise some people go thru more shots per day) into the skin/fat layer of my abdominal/stomach area. (heebie-jeebies) The hormones will stop my body from ripening my eggs in preparation for the next ovulation cycle. Normally, every menstrual cycle, a bunch of eggs “ripen” in the ovaries at slightly different rates and then the body takes the ripest one closest to the “exit,” kicks it out, and that’s the egg going into the Fallopian tube. The injections will pause the process mid-way, then I change to different hormonal injections that will suddenly allow ripening. This lines up all the ripe eggs so that they’re all in the same stage of ripeness, giving the fertility doctor the maximum number of ripe eggs to choose from. He will extract some of the best eggs in a minor outpatient surgical procedure (he said 6-10 eggs, but since I have so many eggs, we can go to the high end of the spectrum to make sure we get the healthiest specimens) directly from the ovary with a small incision from the side of the vaginal wall. From those extracted eggs, he will choose the best 3-6 and fertilize them with the harvested young sperm in a petri dish.

Because extracted young sperm are not mature (motile) enough to penetrate the egg membranes by themselves, a procedure called intracytoplasmic sperm injection (ICSI) is necessary. In the petri dish under a microscope, the young sperm will be directly injected into the egg. Success rate of fertilization this way is 75%-85%. The doctor will watch the eggs for a couple of days and choose the best fertilized ONE (cuz I’m otherwise healthy) to implant in my uterus. In an older woman in her mid-late forties, for example, a doctor may implant up to 3 eggs in hopes that one would take. For me, one is fine because the doctor anticipates no problems and he doesn’t want to risk multiple births (twins, triplets) in someone of my petite size. We’ll likely keep the other fertilized eggs in frozen storage for awhile, and if the first egg doesn’t take, then we’ll implant another later on. This process from start to finish, assuming a successful first cycle, will be around $12,000. The urologist visit and sperm extractions add about $3000.

This course of action assumes sperm are successfully extracted from Mr. W. If no sperm are there, we’ll go the donor route. The fertility clinic has a list of reputable sperm donor clinics we could use. We’d go with one of them, select a donor based on the guy’s profile (physical description, family medical history, some donors provided their own baby photos, the profile even has information as to the guy’s talents, hobbies, education, occupation, sibling information, parents’ and grandparents’ medical history/background/education/occupation/cause of death/age). We have the peace of mind of knowing that the sperm samples are put through a battery of tests for not only diseases the donor may have, but for the sperm’s genetic predisposition to hundreds of diseases based on susceptibility of the donor’s race to particular genetic diseases (lupus, etc.). Basically what we get is sperm that’s been more thoroughly screened than anyone would ever screen their own partner’s medical geneology for. I had come to terms with the possibility of using anonymous donor sperm, and was mostly comforted by knowing that this would be healthier sperm than what I would be getting from Mr. W, who has a family history of hypertension, high cholesterol, cardiac problems, etc., all of which have his family members (and himself since his heart attack last February) on a lifetime of medication. Plus, going the donor route means turkey baster insemination, no egg harvesting, no fertility shots for me, and the total cost would plummet from $15,000 to a few thousand. Of course the downside would be the talk I’m still going to have with the kid one day when I explain family history to him/her, and the possible effects this would have on the kid’s sense of belonging in the family, or on Mr. W’s psyche.

May 20. We’d selected the urologist from the list. We went with the cream-of-the-crop, multiple award-winning doctor working (Chief of Urology) and teaching at UCLA Medical Center (Best in the West, AND of course, I’m partial to Bruins) who wrote the book on male infertility, quite literally. The initial consultation took approximately half an hour in the exam room, and cost $400. Great news, the doctor called our case “a slam dunk.” “There’s plenty sperm in here,” he said during his examination of Mr. W, “I’m sure of it. In both sacs, too.” So the testicular sperm aspiration method (TESE) with a needle will be used, which is less invasive than the microsurgery method (MESE) in which a piece of testicular tissue is biopsied for sperm. TESE is also the less expensive method at $2000. “We salivate when we see cases like yours,” the doctor told Mr. W. “We know your sperm work because you’ve had two kids, your kids are healthy, you’re otherwise healthy, and the epididymus is full. 87% chance that we’ll find what we need.” (We also learned that the fertility clinic we’re going through, or at least its founders, used to be part of the same UCLA Medical group. More Bruins! It’s a sign!)

So the next step is to discuss timing with our fertility doctor. If we’re going on the Australian vacation, then I’ll undergo the series of fertility shots for a couple of weeks upon our return in late fall/early winter, then they’ll extract the eggs from me and prepare them, the day before they want to fertilize, Mr. W will get his TESE with the urologist we met with, and the fertility lab will do its magic in the petri dish. I assume that within a few days, I’ll be returning for implantation. If that first cycle is successful, then we transfer to a regular obstetrician that insurance covers. If not, then we either resort to the frozen fertilized embryos for another implantation, or perhaps make a new batch of fertilized eggs from frozen unused eggs and frozen unused sperm, depending on what is kept (which has yet to be seen).

I’d just like to note that my mention of future costs are estimates. I can only give accurate numbers as to what we’ve already paid, which is $250 initial consultation with the fertility clinic, and $400 initial consultation with the urologist. But I’m being as detailed as I can be right now simply to put the information out there, in case there are others in our position whom this information would benefit.