Baby Steps

documenting our journey to parenthood

The Consultation

on April 29, 2011

On Wednesday, April 20th, 2011, at 10:30am, David and I walked into what we know will soon become very familiar territory. We had our initial consultation with Dr. Andy Toledo at Reproductive Biology Associates of Atlanta. I have been eagerly anticipating this day since David and I were married. I knew our journey would be different all along. This process would not be normal for us, but knowing that did not for a split second deter me away from yearning for one day, David Andrew Kinney, to be the father of my children. I knew God prepared my heart for this journey, and I can’t wait to jump right in.

As we walked into the reception lobby, we were greeted with a smile and the receptionist was already very familiar with us before ever even meeting us. She knew we were there to see Dr. Toledo and told us that he would be out to meet us in a few minutes. We waited no time at all. We were escorted into his corner office after the nurse made a quick stop to check my blood pressure. I had to nudge David and smile when I saw Dr. Toledo’s credentials hung all over the wall in his office – his name was Andrew Anthony Toledo. Andrew being David’s middle name and my very favorite name for a little boy *wink wink* and Anthony being my maiden name, I knew that this Doctor was meant to be! We noticed a lot of family pictures hanging in his office, and a few random alligator figurines strewn about (Florida fan?), and shortly after he walked in. He is such a kind and gentle doctor, and it’s so evident within the first minutes of meeting him.

We spent the next hour and a half in both casual and delicate conversation. There was this overwhelming sense of comfort and ease with him that gave both David and I a really good feeling about this process. Prior to our appointment, we were asked to supply them with all our medical records. I figured that was pretty normal for any doctor, but when Dr. T told us that he had taken them all home with him to “study” our situation, I was rather impressed. Before he even walked in, he already knew how our story was told, which made the entire meeting very relatable. Dr. T shared some of his own personal struggles with infertility, and taught us a lot about our own. He really gets to know you as a patient and despite what you hear about fertility clinics, RBA is not a “baby factory.” Every patient is treated with genuine care and concern. Our situations may be different, but the end goal is always the same. Dr. T assured us that we’d get there.

For obvious reasons, we spent a good majority of the consultation discussing the processes David would have to endure. After recapping David’s heroic journey of his fight against cancer for Dr. T, we began to discuss what our specific treatment would look like. Because I’m 26 (nearly 27!) and David is equally as young, and we’re both considered healthy, Dr. T was very optimistic about this process. If there’s nothing else I got out of the appointment (which isn’t the case at all!), it’s that Dr. T is optimistic. His optimism very quickly transferred to David and I.

To quickly recount David’s fight (and this story should never be told so nonchalantly as he really is a true fighter), it went like this – he was diagnosed with testicular cancer in Colorado, the very next day went to surgery in Denver to remove his testicle. After that surgery, they tested his sperm and all was healthy and plentiful. He began chemotherapy at Emory. After chemo, they tested his sperm again (chemo is what typically can “kill” your sperm) and still, all was healthy and plentiful. (David’s secretly proud of the fact that his one testicle can produce just as many sperm as the average guy’s two.) The doctors learned that the cancer had spread into his lymph nodes. He then had what is known as RPLND surgery. This is a very rare surgery that is only performed a handful of times a year.  It was during this surgery that the nerve was damaged and caused his sperm to essentially be misdirected into his bladder. This is known as retrograde ejaculation. Although it’s not been confirmed by a doctor that he has retrograde ejaculation yet, it’s very, very likely and appears to be what’s going on. Fortunately, in the midst of all his surgeries, David did bank some sperm which has been stored in Fairfax, VA for all this time. I think we have 4 viles, but that’s also something we need to confirm.

With that said, Dr. T explained that he has a colleague Dr. Witt who specializes in male infertility and also works at RBA. Dr. W would be more familiar with some of David’s specific circumstances and would like us to also meet with Dr. W so the two of them can sort of tag-team this process together. I’m excited to meet Dr. W next. However, Dr. T was able to explain a bit about what would need to happen as we begin. First and foremost, both David and I need to schedule another appointment to run all sorts of tests. David needs to confirm if he does have retrograde ejaculation and if so, are the sperm still healthy even after their detour into the bladder. I need to go through a slew of testing myself, too, to ensure all is well on the female said. We’re praying that it is, as we’ve had no reason to suspect otherwise.

Dr. T essentially described the process of IVF to us. It is a long journey that will undoubtedly take months of both preparation and action. After administering hormone treatments (he rattled off meds like Gonal, Cetrotide, Ovidrel, Crinoe, Serono and Ganirelix) to myself using hopefully small needles for a period of time (I think he said 5 days?) and mastering my ovulation cycle, we’ll administer the “trigger shot” right in my bum to start the process of producing more eggs and enabling the doctors to extract them. From there, I think 36 hours after the trigger shot, we’ll go to the doctor and he’ll extract as many eggs as he can from me (I think he said he was confident he could get 10-12). Simultaneously, David will have to undergo his own side of the process which his brave soul didn’t even budge while listening to. We’ll first need to do a “test run” to determine if he 1) has retrograde ejaculation and 2) if the sperm that go into his bladder are usable. If that’s the case, David will be forced to dehydrate himself for a period of time and eliminate all the pee that is in his bladder. Then, the doctor will use a catheter to insert some special fluid that helps neutralize the sperm so they stay healthy while they enter the “almost empty” bladder. Once the solution is in his bladder, he’ll get his little spermies to go there too and then another catheter will be inserted to extract the sperm/solution mixture. Then, they can separate the sperm and start partnering them up with my freshly extracted eggs. Sounds like fun, right?

Dr. T recommended this process first because if all goes as described above, we’d only need to go through that once. This assumes that we’ll be able to create multiple embryos outside the body and implant only 1-2 (twins are likely here, people) at a time. The rest can be frozen and could be reused the months after if, God forbid, the implanted embryos don’t take.  The subsequent months, we’d just go back and have the frozen embryos implanted and wait again.

I asked about IUI. IUI is more easily described as the “turkey baster method” which would not require me to have any sort of surgery to extract any of my eggs. Instead, we’d just use the catheter method and get David’s sperm out and then insert the sperm directly into me at the appropriate time during my cycle. The catch with this method is that if it doesn’t take (and the chances of success of IUI are less than with IVF), then David would have to undergo the whole catheter thing month after month. That basically equates to more time, more money, and more pain for my hubs. My wonderfully sweet husband said to Dr. T after hearing about this method, “well I feel like this whole thing is sort of my fault anyway so I would do whatever it takes to make this easier on Becky.” Melts my heart, hun, but NO. I don’t ever want him to feel responsible for this. We’re in this together and neither one of us should ever feel like we have to endure more pain or anything because of how we got here.

After the consultation with Dr. T, he asked to perform a basic exam on me. He invited David to attend, but he quickly declined. I understand. He’ll have to go through that too much in the future – no need to put him through it more than he has to! So I was escorted to the exam room as David waited for me outside. During the exam, Dr. T informed me that I have small, tiny fibroids in my uterus. Dr. T didn’t seem too concerned about them at all, though it was the first time anyone had told me that so I, naturally, got nervous right away. I was assured that it will not be a problem and it’s actually very common. He’ll continue to monitor them. Additionally, he told me that I have an abnormally small outer cervix. Again, he assured me this was okay, but again, I panicked. I trust him, but I think the news of both things caught me off guard a bit. I assumed I was healthy and everything was fine, and I think it just startled me to think that perhaps I’m being a bit too naive to this process. It may not go as smoothly as I’m hoping, but I am not throwing my optimism out the window just yet.

Like I said, this process will not be easy. Nor will it be cheap. Nor will it be quick. But irrespective of it all, David and I are excited about it and know that even with all the greatest doctors on the planet helping us, this journey ultimately belongs to Him. God is good.

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