The Party Bus (Or: ICSI Is Not The Number That Identifies A Commercial)

(Warning: this post talks about rather graphic stuff.  It's way easier to just type it out rather than dance around it in endless euphemisms, so if you don't want to hear rather frank discussions of what happens in fertility treatments, you might want to go elsewhere.  But then again, if that's the case, why are you reading this blog?)

So, we did our first IUI treatment a couple of weeks ago on a really damp and gloomy Friday morning.  Suffice it to say that the weather should have served as our first clue on how the day was going to go.

In a nutshell: not well.  My washed sperm count was 500,000; for the highest probability of success, it needs to be above 1 million.  Not surprisingly, it didn't work.

Back up a second.  What's a "washed sperm count"?  In order to inject the sperm into a uterus, they have to remove the sperm from the, ahem, produced specimen.  (In blunt terms: the semen in the collection cup.)  Otherwise, the uterus will reject the semen, since it's never supposed to get in there; the cervix usually handles that job, but since IUI bypasses the cervix, the sperm need to be removed from the semen before they're injected.  Sperm washing is the process by which that happens: basically a big centrifuge separates the components, then an embryologist isolates the best-performing sperm and prepares those for injection.  The sperm count after that preparation is the washed sperm count.

(Total aside here, but worth mentioning simply for comic relief: fertility clinics are likely the only doctor's offices with subscriptions to porn-on-demand services.  Hey, you gotta do what you gotta do, and there is serious business to be attended to, right?)

So, my washed sperm count was too low, and it seems like it probably won't get any better.  My total count was 13 million per mL, which isn't too far below normal but hasn't moved much since the last time it was checked, in July.  In other words, they've corrected about as much as they can, and where I am now is probably where I'll stay, with some minor variance.

So we'll probably move onto plan B (C? D? I've lost track), which is something called IVF with ICSI.  You probably know what IVF is, but ICSI is something new-ish (last 10-15 years or so) that corrects for the problem I have.  Most IVF is focused toward female infertility: PCOS, irregular cycle lengths, that sort of thing.  Until ICSI (which stands for intra-cytoplasmic sperm injection; you'll understand in a second) came along, guys with non-swimming sperm pretty much had no option other than crossing your fingers and hoping it works.

ICSI replicates the process of the sperm fertilizing the egg, courtesy of a microscopic pipette that takes one sperm and sticks it into the egg, which in theory should get the ball rolling.  It corrects for sperm that can't find their way around the female reproductive tract, and it is also a godsend for low sperm counts; you only need as many individual sperm as you have eggs, so instead of needing a million you might need five or six.

Even in my low samples, they can find six sperm that could fertilize an egg.

Unsurprisingly, the success rate for ICSI is astronomical: our doctor told us that it usually is around 60% effective.  In fertility, 60% is as close to a sure thing as you're ever going to see.  The only complications are if they can't find any perfect sperm (that could cause trouble for fertilizing the egg and getting the embryo development process going) and whether or not the egg implants.  Considering traditional IVF usually has a 35-40% success rate - and likely lower for us given our situation - this is a very good thing.

And in the meantime, ultrasound pictures and pregnancy announcements continue to pop up on Facebook about as much as political posts and lolcats.  The more things change, the more they stay the same.

At this point I kind of feel like I'm standing at a bus stop where three or four routes make stops.  I'm waiting for one route, which hasn't come yet, and meanwhile 30 buses have stopped for the other routes and picked up the other folks waiting.  After a while you get really tired of waiting, but what else can you do?

The one thing that I'm sure of: when our bus does show up, there's going to be one hell of a party on it.

(In regards to the title: every commercial on TV and radio has something called an ISCI - Industry-Standard Commercial Identifier - code assigned to it; it's almost like a barcode to identify the commercial and make sure the correct one is running.  I just thought it was interesting that the acronyms are so close, even though they have absolutely nothing to do with one another.)