Miriam's casebook - Infertility
Peter, 29, and Jane, 27, have been trying for a baby for three years without success. Peter had non-specific urethritis (NSU) three years ago and was treated at a genito-urinary (GU) clinic. The problem hasn't come back. Peter also had mumps when he was 12. Jane wants some medical advice about what she and Peter should do next, but Peter isn't keen to see their doctor. In the end, Jane visits their doctor on her own.
Sharing infertility responsibilities
© Jupiter
For whatever reason, many men find it difficult to talk about the possibility of being infertile. Infertility is not linked with virility and it's helpful if men can separate these two things in their minds. If a man is found to have less than perfect fertility, there's now a lot that can be done to help him and his partner conceive successfully. In half of all infertile couples the infertile partner is found to be the man, but as I explained to Jane, the investigation of their fertility is best undertaken as a couple.
Primary infertility tests
Jane's doctor said more or less the same, and after about a week of soul-searching, Peter agreed to go along with Jane. The doctor took Peter's past attack of NSU (non-specific urethritis) very seriously - any sexually transmitted disease can interfere with fertility. The mumps virus, which may cause inflammation of the testes and damage future sperm production, can also result in problems. Peter had mumps at the age of 12, when his testes were extremely vulnerable. At the end of the first visit, the doctor asked Peter to go to the fertility clinic for semen analysis. He explained that both Jane and he would need primary tests. Jane's would be in the form of a smear test, a test for chlamydia, an internal examination, and blood tests to confirm that she was ovulating. Peter would have a physical examination of his penis and testes as well as semen analyses.
As the doctor explained, it made sense to start by checking the form and health of Peter's sperm, but Peter hated the idea of going to the fertility clinic and having to supply semen samples. He found the process cold, clinical, and inhuman. He felt torn. He wanted to do what was necessary, to please Jane if nothing else, but he felt isolated and persecuted. His morale fell lower and lower at the thought of finding out that their difficulties with conceiving lay with him.
Getting advice
Jane did her best to reassure Peter and show her love for him, but he went deeper and deeper into his shell, refused to talk about the problem, and became very uncommunicative. Jane felt increasingly estranged from Peter. He felt unloved, and they stopped having sex altogether. Jane, feeling desperate, suggested that they should get some counselling. Peter cut short the conversation by leaving the room. All seemed lost when the results of the semen analysis came back. Peter's sperm count was low - 5-10 million - and fewer than 30 per cent of his sperm were active.
At this point I insisted that both Peter and Jane give serious thought to seeing a counsellor if only to outline the possibilities open to them through fertility treatment. It was a great struggle, but Peter finally swallowed his pride and made an appointment to see a fertility counsellor with Jane so that they could be prepared for what was to come.
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Posted 16.11.2010
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