Friday, April 26, 2013

Why I'm so happy to have mens underwear in my handbag

Today we have had our first successful experience with fertility treatments: the second surgical sperm retrieval procedure was a success!!! :) Hooray!

It was such a dramatically different experience from last time; just about everything was different and the positive outcome feels like the icing on the cake.

How it went:

We drove up to Hamilton (3.5hrs) yesterday afternoon and checked into our motel. Went and got some dinner, bought some books, and then watched some crappy movies on telly back at the motel.

Since we had got some Valium for Hubby, he took that and was snoring pretty soon. I had a lot of trouble getting to sleep, and would wake up heaps during the night. Woke up feeling like I'd been jogging all night, whilst eating soap (you know that taste? Yeah, that's sleepless night mouth taste for me!)

I was afraid that Hubby might not get up to the alarm in the morning with the extra medicine, so I set me alarm for 6.45 and since I was already awake, I got the first shower! Ha!

Watched breakfast news on telly, I ate some toast and Hubby made baleful-eyes at me since he was nil-by-mouth until after the procedure.

We packed up the room and loaded the car. I signed out of the motel and we headed over to the clinic.

This time when we arrived the clinic was alive with people (last time we got there before the staff!) and we signed in and went to the waiting room. Very quickly we were called back through to the yellow pre-op room with the lounge chair in it. We met the nurse who would be looking after us, Nurse H.

Then began the parade of introductions. First off Nurse H wanted the pre-op health questionnaire completed (last time we had all this done perfectly before we got there, this time? Meh! If they want it they will ask!). Then she did Hubby's blood pressure (188/something) so definitely high.

The embryologist, T, came and introduced herself and started explaining how she would be behind the little pop-hole in the room with the micro-scope. We told her we knew that and this was our second time... she hadn't read our chart! Not promising...

Next came the person who made the whole event possible: the anaesthetist, K. She was super cute and amazing, and instantly put both of us at ease. She had a great sense of humour (talked about propofol being "the Michael Jackson drug") and a relaxed attitude - and hey, you want the one with the drugs to be cruisy, right? :) Once Hubby relaxed I did too, and after she left we even laughed a bit!

Hubby had to change into the glamorous hospital moomoo:

Fortunately, Hubby's gown wasn't open at the back! Image from:
The nurse came back and put a tray full of stuff to put the IV line in on the table, and went out again.

Then the RE arrived. Now, up until this point, we didn't actually know who would be performing this operation. We knew with about 90% certainty that it wouldn't be our original RE, Dr R, since when Hubby took the call for the appointment booking, the nurse had told him that Dr R wouldn't be doing it. So we thought, well then, it must be someone who won't make such a hash of it, surely!

And we were right. We got Dr S, the senior doctor at the Hamildog clinic! He was confident and his manner and calmness relaxed us greatly. Instead of going straight to TESE (biopsy, more invasive, incision, stitches etc), he said he would try both PESA (small needle aspiration from the epididymis) and TESA (large needle aspiration directly from the teste) first. He reasoned that since Hubby would be sedated, there would be no problem moving from one technique to another until we got some sperm, and this way he may even be able to get a sample without doing the biosy altogether.

The anaesthesiologist came back and said that she wouldn't insert the IV line until Hubby had walked into the OR and gotten on the table, in case he fainted. I asked if I could come too, and did Hubby want me to? Yes? Ok. So through we all went.

It felt a bit surreal, here were were again, people in the same places as last time. Except this time we had K the anaesthetist sitting on Hubby's left, and different people in the role of Doctor, nurse, and embryologist. Others in the room were: Hubby, myself, and other nurse (same as last time for surgery assistance).

K got the IV line in very quickly, and Dr S prepped "the area" with drapes and sterile swab. Hubby and I joked about no matter how much they warm that liquid up, you can never get used to that feeling!

I helped put on the blood pressure cuff on his right arm, and the surgery assistance nurse worked to get all the proper needles ready for the PESA, TESA, TESE procedures. Nurse H coordinated with the embryologist through the pop hatch to get dishes (petri dishes!) ready for the samples.

K started the sedation and Hubby's eyelids started to flutter. He was trying very hard to tell me something about getting the camera, I think, to take a photo of the procedure. But he was out like a light and snoring gently in no time. I rubbed his shoulder and told him I loved him as he went to sleep, then warned the doctors that they were about to be treated to some snoring! They assured me they were used to it.

First try was the PESA, with the smallest needle into the left side. This produced a small drop of fluid and T the embryologist found I non-motile sperm in it. Dr S proclaimed that this meant there were in the right spot, but would have to look further with TESA as the epididymis would probably not provide very much.

Next up was TESA, with the wider-gauge needle into the left teste. Very soon (and without half as much effort as last time! No squeezing, no worried looks! So little blood!) Dr S had the first piece of tissue. I could see if from where I was sitting as it was transferred into the petri dish. Nurse H passed it through the hatch, and T found 3 sperm in it, although she must have later complained that the tubules (where the developing sperm live) were very thin, since Dr S told her that there were more samples coming.

A butterfly needle and syringe, used for TESA. Image from:
Dr S went in with the TESA needle again and got some more tissue. When the needle came out it obviously had a sample on the end of it, and when they flushed air through the line, another sample came out! That's right! Another 2! He said that this amount of tissue was equivalent to what we could expect from an open biopsy anyway, and since there had been a total of 4 sperm found already he was happy to leave things at that. Hubby would not need the biopsy! I had to ask and check again!

Twice Hubby began to rouse but K just gave him some more sedative each time. The first time he tried to lift his head up a little bit and the second time was when is right arm fell off the side of the bed (!) - yes I know. The same bed, much, much too small for an adult man! Aside: last time the RE partially blamed the difficulty of the procedure on Hubby being overweight. Well, firstly, way to lay the guilt on Dr R! Good God woman, don't you have any compassion? And secondly, Hubby has worked really hard and has lost 10kgs in 3 months. So there!

The snoring. Well, yes, there was some snoring happening, and at one point I recognised the breath-motions that indicate sleep apnea to me. Normally I would roll him over or give him an elbow in the ribs to get him to take a proper breath. But of course, I couldn't really wiggle him during surgery! So I just asked them all if his breathing was ok, and Dr S assured by that his blood-oxygen was great, and K said that the "abdominal breathing" looked strange but that is was just deep sleeping breathing. I wasn't sure, mainly because he had an oxygen mask on his face and whereas before it had been fogging up with each exhale, now there was no fog at all. K lifted his chin with her finger and his airway opened and his took a great noisy snore, with fog, much to my relief. I must admit I didn't believe them when they said his breathing was fine, but it was resolved quickly and they listened to me and checked his vital signs so it was all good. I just know his snores so much better! lol!

To recap so far: 1 sperm non-motile found during PESA, 3 sperm found during TESA 1, 2 more samples received but not counted yet from TESA 2.

Once Dr S indicated that the procedure was over, things went very quickly. I was stunned (hard to explain the feeling. It wasn't relief, it wasn't happy, it was still so surreal that it was over and some had been found, but mixed with a very strong concern about how Hubby would feel upon recovery.

What I didn't expect was for him to come around quite so quickly. He started to wake, and I made sure to tell him that is was over, that he was very brave, and that is was a success. He asked "It's over already?" "Yes," I said. "Haha!" he laughed, which caused everyone in the OR to smile. He made other noises about not remembering anything once K put the IV line in, but he was very focused when Dr S leaned in and told him that the procedure was a success and we had found sperm. Hubby was still lying down, but moved to shake his hand and say thank you. Goodness, so polite and collected and still pretty much out of it! :)

Nurse H encouraged Hubby to sit up carefully and swing his legs over the bed. I pointed out the hatch to the lab, where we could see the embryologist working over several pinkly-tinted tiny petri dishes with her microscope. He commented that his "boys" were all in there now, and that they better do well. Nurse H, K, and the other nurse all made noise about them being both boys and girls, since he gets to decide! Cute! It was a very friendly and happy atmosphere. Nurse H got him standing up carefully, and then we all walked the short passage back to the pre-op / recovery room.

Hubby must have asked me how it went upwards of 7 times, and I remembered that one of the effects of the sedation was that he would have some confusion and loss of memory for a while. I joked with him that it was like talking to a goldfish. He told me it was great to get good news over and over because each time was genuinely the first time he'd heard it!

At various times an ice-pack, tea, and biscuits arrived. Hubby was instructed to get into his tight "supportive" underwear soon, and put the ice-pack on the op-site. Of course, he was grinning and forgetting and I was kissing and hugging him too much and it was hard to get him to actually put pants on. That is where the title of this post comes in. He'd brought the wrong undies, so I dashed down to the car and grabbed the tighties plus the tramadol = first lot of undies in the handbag! He got changed, drank tea, we took photos (sorry, not going to post those here, they're just for us), and I told The Story Of How The Sperm Were Found several more times.

Nurse H came back and took a blood pressure reading, removed the cannula, and read out the post-op instructions. All in all the procedure itself took about 15 - 20mins, and we were able to walk out and go find a cafe to fill up a ravenous Husband at about 10am.

He has minimal bruising, a small amount of swelling, and with tramadol, neurofen and panadol has been pain-free the rest of the day.

UPDATE: the embryologist called at 3.30pm and told Hubby that they managed to get 10 straws frozen! One was thawed and it looked amazing, apparently "couldn't be better"! She said it was enough for 5 x cycles! Wow! We did a verse of this song to celebrate:

So, it has been a very good day!