Oversharing - Baby Steps: Moving Beyond Stereotypes & Navigating Male Infertility Ft. Maurice Chammah

Episode Date: June 7, 2024

On this eighth and final episode of Baby Steps Season 2, Jordana is joined by Maurice Chammah, Pulitzer Prize winning journalist and author of "Let The Lord Sort Them," as he shares a deeply personal exploration of male infertility. With candor and sensitivity, Maurice delves into the emotional journey of discovering his own roadblocks to fertility, the societal taboos surrounding male infertility, and how his challenges with fertility made his marriage even stronger. Through his story, Maurice advocates for early testing, compassion, and destigmatization, offering a beacon of empathy and understanding for those grappling with similar challenges. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello and welcome back to Baby Steps. I'm Jordana Abraham and as always I am joined to introduce this episode by my big sister, licensed clinical therapist, Dr. Naomi Bernstein. Hey, bittersweet. This is the last episode for season two. It is. Yes. It's our last episode. This season was a little tough for me. I kind of thought like again like I would have it all figured out again by the end of the season. Not the case. And some days, you know, with anything that you're sort of like personally going through. It was tougher for me than others. But overall, I'm really happy we did the season. I thought we got a great range of new guests. We got a lot of different perspectives. A lot of people. We got a lot of surrogacy, I think, a lot more surrogacy than I had even anticipated. But every surrogacy story was a little different than previous ones. So I was glad to get like a large range of different types of experiences. But for today's episode, I got to speak to Maurice Chemaugh, which I was so happy that he agreed to come on and talk about his experience because he's really talking about male factor infertility and his personal experience going through it.

And it was really interesting to hear him talk about it, to talk about how there's really not much out there for men going through infertility. It's very like not spoken about. And he was saying even when, you know, when he and his wife would tell people that they're going through it, the immediate assessment. would be that it was her. Yeah. So, yeah. And he would say he would always correct them because he wanted to, one, like, not have them think that it was her, not that there's anything wrong with that or, like, morally wrong

with that, but just that he didn't want to continue the sort of, like, original go-to thought that it's always the woman. He wanted that to be, like, corrected in society. Yes. Oh, that's amazing. And it is so true. And it's so much easier to just stay quiet and not correct someone and make it. it like slightly uncomfortable, but he's making it maybe slightly uncomfortable for a really great

reason, which is to highlight that there is another perspective or just another experience that could be going on. And even for that person to then go and talk to someone else and tell them that this was male factor in fertility and just normalized talking about it the way that you've done a lot on this podcast talking about infertility in general. But having that out there. So I hope people can send this over to their boyfriends and their husbands and their brothers and their, you know, uncles and all the people that probably need to hear that they're not alone in this struggle. Exactly. And I think male infertility accounts for 40 to 50 percent of all cases. And so I never, I was telling him like, I never hear about it. So I never,

I didn't think that number was that high because I just don't hear about it. But I think it's just really much less spoken about, and I'm sure that's due to a number of reasons. But he was great. He really gave like a full rundown of what was going on physically, the reasons behind it. And also just like very interesting philosophical discussions on there in terms of using donor sperm and, you know, the way that we select those things, whether it's donor sperm or donor eggs and just the coming to terms with the idea that you will be a father to a child that might not be genetically yours. Totally. And the idea. It's almost, I don't know if you spoke to this, I'm really interested to hear the interview. When it's, you know, one person is genetically related to the child and the other parent isn't,

I'm sure there's emotions behind that and psychological factors behind that in terms of how you navigate that with your partner. And yeah, just the choosing of who you pick to be the biological father and all of that and how that, you know, I'm very curious to hear not just, I mean, for him, obviously, but for them together as a couple, like how those conversations go along the way, like kind of being a fly on the wall as those things go down. Totally. And he definitely gets into all of that. And he talks about having spoken to, you know, his friends who were a lesbian couple that have had children. And because in that case, there's always one parent that isn't genetically related to the child. So hearing those experiences and how that helped shape his view about

everything. And he just really opens up, has such vulnerability on this episode. and I was so glad that he decided to tell his story on here because I think it's so, so important, especially for men to talk about it. Totally. It seems like there's just really, because this isn't something that we've been talking about so openly for 10 years, there's just so much information and so many different experiences to hear about different people, different aspects. So I'm really glad that you did this.

I can't wait to hear this last episode. And yeah, let's get to it. Let's get to it. Thank you for joining me this season, Dr. Naomi. Oh, my pleasure. Hello and welcome back to Baby Steps. I am excited to introduce our final guest for the season. Please welcome Maurice Shema. He's a Pulitzer Prize winning journalist and he has written a book called Let the Lord Sort Them all about the death penalty, not related to this show. But we are so excited to have you and thank you so much for coming on to tell a little bit of a different version of the stories that we've been hearing on this podcast. So welcome. Yeah, thanks so much for having me. This is a strange role for me because usually I'm the one doing the interview. So I get to see what it's like on the other side. Now you can tell how nervous I am in the beginning of these. I feel like before I get into a groove, there's always a little like, I don't know, like a awkwardness. But yeah, so you understand. I guess. You sound great. And you're also, there's inevitable awkwardness.

And also you're like bringing people's stories out that are like sensitive and about like things. they don't normally share. So I think awkwardness is too much of a sheen would be awkward in its own way. Right. And even like, even now I'm just thinking about how I just introduced you and I said, I'm excited to bring you on. I'm like, is that the right word? I don't know. I don't know. But yeah, I would love for you to tell the listeners your story and really just go back, give some background and just take me back to like when you first decided that you wanted to start a family. Sure. So my. wife and I met in college about 15 years ago. We actually met in an Arabic class and we got married,

I'd say, eight years ago. And we always had an idea that we would have kids. But it was one of those things that we kind of perennially kicked on the road, I think, like so many people. My own father had been 60 when I was born. He was about 20 years older than my mother, which I think always just implanted in me this idea that you have time, right? Of course, what I wasn't. As a man especially, yeah. As a man especially, exactly. So I remember in college saying to my wife, we were just dating and I said, oh, well, you know, I may not have a kid until I'm 40, 50, 60. And she looked at me like, well, clearly not with me, right? And I and I thought about it for a second and I thought that why did I say that? But that was just the model that I had. I think that men have forever.

So we get, you know, into our early 30s. I think, you know, we kind of go over time. She probably had her own journey of wanting kids, feeling anxious about it. I certainly had plenty of that. Like anxious about like what having, the responsibility of having kids or anxious about like how it would go? I think anxious about the way in which it utterly transforms your life in all kinds of ways, both positive and negative. You know, both of us were working.

I had an intense job. There was a long period here where we were living in New York City. And I remember looking around and just thinking, unless I start making a million more dollars a year than I make now, having and raising a kid in Brooklyn seems extremely difficult. So there was definitely that kind of anxiety. And then in addition to my father being quite old, he also had Parkinson's disease for much of my childhood, which meant that he had, you know, very, very sick. He had a kind of severe form of dementia. He was in a wheelchair. And that's obviously a whole other conversation what it was like growing up with that. But what's relevant here is that it just left me with, you know, not a really strong bank of memories of like what a father is

like. And so I think I brought some of that anxiety into the decision making that I, that I, one half of me knew I wanted kids and liked the idea of having kids and, you know, enjoyed being around kids, but the other half of me felt like I was not very good with kids and didn't really know what fathers do because I didn't have a kind of model in a traditional sense. And then, of course, COVID, you know, it's like easy to just let COVID take over and you stop thinking about, you know, other things in your life. And so, you know, fast forward to a couple of years ago, you know, we're in our early mid-30s. I think I was 34 and my wife was 35 and we decide, okay, let's finally do it. And the first step there was simply just her taking out an IUD.

Right. And really at first, just not trying to prevent anything. And then after a while, we start timing things more to ovulation. I'd say this went on for about six to eight months. And it was starting to be long enough that, you know, once you reach your mid-30s, doctors say that only six months is. is how long you should sort of try before checking in about it with medical professionals, right? So the next steps really seemed to be that she would do more tests. There was a, you know, she was seeing a gynecologist. But in the air was, of course, the fact that it could be me as well. And I remember knowing or learning at the time that there were a fair number of tests that she would probably undergo before we checked me out. But it just happened to be that I had,

had a yearly checkup with my primary care doctor. I just can happen to mention in that checkup that we had been trying. And she just very offhandedly said, oh, well, let's order a sperm test. It's super simple. At your own doctor? Like, not even at your wife's doctor. No, my own primary care doctor. This was somebody I'd been seeing for years, but honestly, like, I would skip checkups all the time. So, like, when I look back on this moment, it feels very like happenstance that I just happen to say, oh, we've been trying to have a kid. It's been about six months. like and she said oh well might as well do a sperm test it's super simple so i do the sperm test uh you know i think i had an idea that you do it in an office and and you have these like ideas from when

you're younger that there's like porn magazines in like a creepy room right is it like that no it's actually funnier than that uh in that you do it at home and then at least my experience was you do it at home but then you have to like keep it at your body temperature until it gets to the lab, which meant that I had to do my thing into a cup and then either hold it under my armpit or like in the waistband of my pants and drive it to this lab, like 15 minutes away in the car. And I remember just like driving and being like, if I got pulled over, this would be a very strange scene. So I did that. And then I think it was the same day. I just got a call for my doctor saying like, oh, well, the result is not always.

expected. There's literally no sperm showing up in the semen. Can you explain just from a medical, I mean, obviously you're not a doctor, but just is sperm not semen? That's a, that's a different, just, I may sound very stupid. Just, what is the difference? And I sometimes used, I used to use them interchangeably. Basically, semen is the liquid that carries the sperm. And sperm is the little tadpole-shaped guys themselves that swim within it. And, and, and sperm is the little tadpole-shaped guys themselves, that swim within it. And so semen is, there's going to be a quantity of that, you know, like a few ounces. And then you're going to have within that a concentration of sperm.

So when you get a sperm test back, it's going to say the concentration, like the number of millions per milliliter or something. And then it's going to also have things like, and this is where it's more medical and I don't know as much, but morphology and motility, which are referring to, are the sperm healthy looking, the right shape, and then also are they, like, moving the right way, you know, are they swimming around, right? So there was nothing in there or was it like low? But there was just zero. It was utterly zero, which is, I was shocked. And, you know, my doctor, like, heard the pause on the phone and said, you know, it's okay.

It doesn't mean you can't have a baby. It just means that you might need some help. I remember feeling like I was fairly like emotionally centered and chill, but then my wife, like we were talking on the phone because she was somewhere else and I called her and told her and she said, well, it sounds like your voice is kind of shaking. And I was like, oh, really? You noticed that night. I didn't even notice it. The kind of standard practice in the situation is to do a second test to confirm it. So do my thing in a cup again, hold it in my waistband again, drive it to the lab, exact same result.

zero sperm in the semen. And the medical term for this is azuspermia, AZ-O-O-O-Spermia. There's another term called oligospermia that would be if you just had less than the ideal amount of sperm. But I was at zero. At this point, my primary care doctor says, okay, you go see a urologist about this. So you had your wife undergone any testing at that point? Or it was like kind of clear that this was that she didn't need to? At this point, it was clear that she didn't need to. I think if my initial test had shown some sperm or if it had shown totally normal, then pretty quickly we would have gone into testing for her. And eventually she did do some tests. I'll sort of get there in the context of this long saga. But at this point, no, she hasn't done any significant tests. It's possible

they did like a quick vaginal ultrasound to just check that things were broadly normal. but um nothing super invasive nothing super invasive at this point so at this point the protocol is to go see a urologist and my urologist explained to me that there are a lot of reasons why somebody might not have sperm in their semen some of them have to do with like outside forces that your testicles have been exposed to so for example if i had had testicular can answer and they did radiation, that could kill your testicle's ability to make sperm. Or if I had spent a lot of time in a hot tub or sauna, although I think even then there probably would be something, right? And then there were reasons that could involve a blockage, right? So

you could have like an enlarged vein in the testicle or some kind of like physical. I mean, if you just imagine a physical system out there. Right. Barron. or something that not letting them through. Exactly. It could be possible that my testicles are just making lots of sperm and there's some barrier keeping them from getting into the liquid, right? And then there was the last possibility, which was that my testicles just aren't making it at all

or are making so little that it's not making it in. The way it was explained to me is that your testicles are constantly making large numbers of sperm, and it's only the sort of excess top amount that's showing up in the semen. right? Like you just imagine this system that's like producing it and a lot of it just dies and recycles back, but then like some excess amount of it comes out in the semen. So we did a series of blood tests basically, I think at this point the sperm test, the semen test themselves were over and it was testing blood for different kinds of hormones. And those test results came back and my testosterone

was totally normal. But I had very, very elevated amounts of. a couple of other hormones. Hormones that actually women hear about in the context of IVF in fertility, like LH, luthanizing hormone and FSH. I don't know if those are familiar. I didn't even know that men had those hormones. They have them, yeah. Okay. And these are hormones that tell the testicles to make sperm and are in like kind of a feedback loop with the brain. But when the testicles are not making sperm, the brain goes into overdrive and produces a lot of it. So I had way elevated levels of these hormones, which suggested, it's not a direct link, but it suggests very strongly that the testicles just aren't making it at all or making a tiny, tiny amount because the brain is

saying what's going on. We need more. Right. More. Yeah, I see. And is that, did that cause any, like obviously looking back, did that cause any other symptoms or issues? that would have presented themselves or just the sperm? Just the sperm. It's a great question. I mean, obviously, if my testosterone had been low, there are other ways that that would manifest. I did a lot of Googling. I mean, I didn't, and I read a little bit of the medical literature, but I didn't sort of go

super deep on the research. And my understanding was that there was no definitive other symptoms that you could definitely ascribe to having these high hormone levels. it's possible that they kind of, you know, make you a little more tired and fatigued. And my friends all say that I'm sort of slothy and I kind of just like, I sleep a lot and really tired person. So, I mean, maybe, but that's a bit of a stretch. Seems like a stretch.

Guessing, right? You're always sort of looking for explanations. This was, I think, when the emotional reality of it set in much more hard than the first time. Because when I first found out that there was no sperm, I told my son. well, maybe there's some kind of block. And my urologist said, well, maybe there's some kind of quick little procedure surgery that fixes the block. You know, people get their toothed type. People get snipped in Mendo. So maybe up in akin to these types of procedures, there's some kind of thing I could do that would solve the problem. But this elevated hormone level made it clear

that it was really the problem was that my testicles weren't producing. And because there was no obvious cause like radiation from chemotherapy or something, it was almost certainly genetic, either something that was passed down to me or, you know, like a genetic flaw that enters the system at the moment that I was created. Which is probably kind of shocking for you when you're like, my dad had me at 60, like I've got the most, you know, fertile parents there are in a sense. It does make sense. Actually, in some ways it was the opposite. So, you know, I shared this news. with my mother. She took it very hard. And it turned out, actually, that they had struggled a lot to conceive me. Okay. And it was in the 1980s when the science around this was way less involved. IVF was

not that common yet. And as a result of it being hard for them, they went to a clinic about an hour and a half from their house. They had a drive to it. They were in Austin and this was in San Antonio. And that just speaks to, you know, had to go to a more major city to even, like, do this sort of stuff. Right. So that failed multiple times and they basically gave up. And then after they had fully given up, I came along. It's a total surprise conceived completely naturally. And my mother joked that I was a super sperm.

And my wife says, well, maybe you were a super egg. And I think maybe it was some combination of the two. Right. And did you know about these, like, fertility issues? before you started trying yourself? I knew that they had had issues, but I always, I didn't know the details, and I always chalked it up to,

she was like 37, and he was like 60. So probably it was age-related. Although now I have started to wonder, and I can say more about the science on this, it's not super well-developed, but I also had learned at one point that his father, my grandfather, was actually 60 years old when he was born.

Oh, wow. Which, first of all, just as a matter of mind-blowingness to me means that my grandfather was born in the 1860s, like when the Civil War was happening. That's crazy. Or that he would have been 120 years old when you were born? Correct. Wow. It's bonkers, right? Yeah.

Suffice to say, I never met him. And this was all in Syria where my father had been born. So there's very little information about. what happened with my grandfather, except, and this is very kind of like old world story, that what we know is that he and his wife struggled to conceive. We don't know who it was. And then as he got older, the rabbis in Aleppo, Syria,

and it was Jews in Aliposiria. It's a whole other story, said, you can take a second wife to conceive a child. So my 60-year-old grandfather takes a second wife who is 16 years old. Oh, my God. I know. And this is my grandmother, and they conceive fairly quickly. And so we're totally speculating on the science of what was going on,

but it's possible that he had some issues with his sperm that were kind of counterbalanced by the hyperfertility of a 16-year-old woman. Right. And then it's possible, and honestly, I think a reasonable guess, or at least, a convincing story I have told myself that some fertility issue was maybe passed down through the male line. And we know that that does happen. So I may have been the kind of like terminal case at the end of a line of men where there was like some issues with fertility sort of more with each passing generation. So and they're saying it basically has to be genetic. That's sort of what

they're telling you. Yeah. Yeah. Absence some cause that, you know, I was exposed to some radiation as a baby that nobody remembers or knows about, you know, some obvious or known external cause. It seems to be genetic. It may not be genetic in the sense of being passed down generation to generation, right? Because genetics also, it could have been like a flaw, a sort of deletion of some bit of chromosome when I was when I was developing myself. We don't know. This is the point at which I was going through all the kind of emotions. I think I in the end felt very lucky that I was raised in a way and it came to be a sort of person who doesn't see this stuff as like deeply attached to one's manhood or sense of being a full person. But it tested that for

sure. You know, I definitely had a lot of like, I am a flawed human being kind of feelings. I also realized that a lot of my anxiety, when in the past I would tell myself that I was anxious about parenthood and being a father, the standard kind of cultural narrative that we get is, yeah, you're jittery about it. And then you go to the hospital and the baby comes home and they look like you and all of these like deep primordial things happen. And you're just like so ready to be a parent. And then I thought, well, now if we're going to, regardless of which route we'd end up taking, there's a good likelihood I'm not going to be related to a baby because I'm not capable, physically capable of that. And is that going to make being a father harder in some way? And I think I ended up seeking a lot of advice and sort of like reaching out to some of my lesbian friends, particularly like I'm friends with a few women who are not the. a genetically related parent of their children.

And so it asked them about what that experience had been like. And they all really just alleviated a lot of my fears and concerns here. But, you know, there was very much the message that, like, being a parent is a choice you make and, like, something that comes to be through activities and the actions of being a parent. It's not just that you look like them and that that's kind of an antiquated way of looking at it. Yeah. And, I mean, I, you know, I see there's not like a ton of, like, there's not a ton out there

for women, but there's definitely a lot more, I think, than I've seen for like men in the space. So that's true. Yeah. Yeah, you're right. Like, like there's a lot, you look up memoirs on Amazon or influencers you talk about fertility and issues, things like like your series that you've been doing. The tendency is, and I think rightfully, the tendency is focused on women. but as a result, there was a few articles in books to find. There were a lot of Reddit threads. Remember we're talking about the different roots. Yeah, there's a whole world of like a male infertility Reddit threads that I found

just very helpful to know that I was not a freak and alone and that there were other people who had gone through this and then were confronting the choices that we were going to start confronting about how to grow our family and move forward. I also, I think I felt vis-a-vis my wife sort of very sad, like I can't give this thing to this person that I love that she's always wanted. You know, she always wanted sort of a standard experience around pregnancy and fertility. I mean, there's no one standard experience. But you know what I mean, the kind of like the conventional thing. And here we are going to doctors all the time because of my thing.

And there's a lot of like guilt and shame from that. Yeah, I think it's like, it's a lot of like mourning the story of how you thought it would all come together. That's absolutely right. Yes. And I think that that in some ways is very comparable to what women go through. It looks different, obviously. But there's a standard story of what pregnancy and having children looks like in our cultural and most cultures. And when you start to learn that it's not going to look like that for me, there's a bit of grieving that you do. I also had a bit of anger in the sense that I wish someone had said to me when I was 20 or 22, why don't you take a sperm test? Right. Because if I had learned that, then first of all, my wife would not have had to have an IUD for 10 years. She had this IUD that was preventing her from getting pregnant that she didn't need.

And that is, that sucks. I feel really bad for her. And I feel like complicit in that. And I don't know. If I had learned this about myself at age 20, 22, I don't know how it would have shaped the next 10, 15 years, but it would have shaped the next 10 and 15 years. And you just look back and think, I wish I had known this sooner. And given how simple a sperm test is, and this is where we get into kind of public health questions that are beyond me. But I want to, this is where I would love to interview doctors and researchers on like, would we all be better off if more men were test.

their sperm at younger ages in order to understand what they may be confronting should they pursue having a child in a similar way to the way that we tell women, oh, freeze your eggs or, oh, you don't have forever. So think about who your partner is and locking it down as soon as you can. Right. And even that, I think, you know, could be done a little sooner. I think maybe medically, it feels like that hasn't caught up to the like modern day tradition, whatever it is, where people are having kids later. I don't feel like the standard medical practice of the test that should be done for men and women, I think, you know, starting off simple blood tests or simple sperm tests at a lower age to when, because dealing with those things is probably also a lot less heavy when you feel like

you're dealing with something that you're taking care of for like far away in the future, as opposed to when you're already in it and like you wanted the kid yesterday. And the clock is ticking. And even if the man's clock isn't ticking, you, let's say you're 35 and you're married to a 35 year old, right? Like, this is something you do in partnership. So one person's clock is ticking. It's not like I'm going to leave my wife and go, you know, get with somebody 10, 20 years younger, right? Like the clock is ticking for both of you because you're committed to each other.

And if you'd had this information before the clock was ticking, it would have taken a lot of the pressure off, regardless of whose biology is at issue. Exactly. Yeah, totally agree with that. Hopefully, you know, medical practices catch up with that, but I feel like that's probably a little ways off. Oh, yeah, absolutely. I mean, the other fact here that I learned on this path was that,

just broadly speaking, male fertility sperm in general has been weakening over the last 10, 20, 30 years. So there are tests out there suggesting that, and the science on this is still very much like moving is my understanding, but there's some indications that more and more men are having fertility issues. I think my situation of having zero sperm remains pretty rare, but more and more men are having kind of suboptimal sperm. We think it may be having to do with diet and plastics and all kinds of other things. that are changing about our modern world. Yeah, who knows. And that science just seems like pretty nascent. Part of that, I think, is a, there's a bias to assume that every, that fertility issues

tend to be on the woman's side, even though something like half of couples who are, I think, 40 to 50 percent of couples dealing with infertility, it's at least partially on the male side. Right. Often it's combined. I think maybe 10 to 20 percent of the time it's just the man. And I found myself just as a cultural matter, whenever I told people that Emily and I were going through some fertility stuff, they would just, you could just tell it was her. And so almost instantly I would feel like I have to share that it's me just because I don't think it's a matter of like moral blame, but I don't want like the assumption to keep going out there in the world that it's always the woman. Right.

Yeah. And I think the less, you know, most of the information, most people have. have just anecdotally about what they hear. That's right. So I think that's, you know, it's good for just destigmatizing what's going on, nothing else. Absolutely. And I think that that's part of why I said yes to doing an interview like this and think about writing about this experience that I think it's good to destigmatize.

And it's part of a cycle where you also want more men to hear that this is common and that they're not the only man this has happened to and destigmatize it for the men in terms of like sharing emotionally what they're going through with this. In addition to kind of protecting women from having people making assumptions about them. So you find that it's genetic. Therefore, they're saying there's nothing you can do. There's not nothing. So this is then where we get to, I think, what I would say is kind of the climax of the story in the form of the, I use the word climax.

The climax of the story in the sense of the decision that we had to make, which was a series of decisions. But you're in the situation as a couple. And there's a few options. is adoption, right, which utterly takes away the procreating physically thing entirely. A second one was donor sperm, like basically producing a child with sperm that isn't mine. And then the third route, which is the one we investigated for a while and is we're talking through a little bit, which is that there is a surgery that I could undergo in which, and this is the TMI trigger warning moment in which they open up the testicles basically and look for sperm.

And it's called microtessi or microtesticular sperm extraction. And it doesn't always work. It works, I think, around half the time that they find sperm. And then what they do is they extract that sperm and then they use it in IVF. And they in fact use it in a specific kind of IVF called ICSI or intracidoplasmic sperm injection. Right. Oh, no, that makes sense. Yeah, that's how they do most, I think, IVF these days, is they pick instead of just, they used to just like, I think, put the egg in the petri dish and see which one gets there.

And I think nowadays they pick an individual one that looks good and they put it together. That's right. And we went to see a doctor that specializes in these procedures. and he was nice enough, but there was a, I'm not using his name, so I feel fine saying. There was like a machismo to the situation that was kind of like, I'm the cowboy who goes in there and finds the two sperm left and like makes me a baby with them with the latest, coolest science. He did say that, I said two sperm. He described a patient who had 11 sperm that they found.

Oh, wow. You're thinking sperm is typically measured in the millions. Right. Claim to have found 11 and that then a couple went home with a baby. But what they have to do is they look for the sperm and then let's say they find it. The sperm has to be healthy and not genetically fractured in any way. It has to be healthy and capable of fertilizing an egg. And then Ixie is not surefire.

It has to work, right? If you're only working with a limited number of sperm, then it doesn't matter how many eggs you've retrieved because you only have a certain number of sperm to work with. Right. And we were staring down a road where at each phase, the likelihood of success reduces further in terms of percentages. So, okay, let's say it's a 50% chance they find sperm. And then within that, there's some percentage chance that it doesn't work. But let's say it does, that it can fertilize the egg and then the pregnancy carries a term.

And this is where I started to read a lot of medical articles. And it felt like we're at the forefront of the science here because the first generation of children born through this kind of procedure are about you and my age. Okay. This started happening in the 90s. And so if there are ways in which these procedures kind of lead to increased risks of various problems, you don't always know that right away. I mean, if there was a higher association with chromosomal abnormalities or, you know, things that you could discover at birth, that's one thing. But there's some indication that, or we know that some of these fertility issues passed down generation to generation. So one scenario is that we would be able to produce a child this way

and then not even know until that child goes through puberty that they have the same fertility issue that I had. Right. And then I would have to deal with having made this choice that would bring this child into the world and then sort of sign them up for these issues. I'll zoom out and just say that this moment in the decision making really forces hard conversations with your partner and within your own brain about

what you really believe about procreation and whether, you know, it's okay to use the latest tools of science even when you're not really that sure about what the results could be. Are those the same risks as you would get from like IBF? There's some of the same risks, but there's a higher risk of the fertility issue, right? Right. So they actually did do an extra blood test on me when they were trying to determine the cause of the infertility that was looking for something called a Y chromosome micro deletion, which is a complicated way of saying that on like the Y chromosome, which is literally Y shaped. There's some little tiny, tiny piece missing. And that would definitely pass down to male children.

So sometimes couples will go through this and do IVF and they will. select a female embryo knowing that a male embryo would have a fertility problem. I will say that I have read that ICSI intraceidoplasmic sperm injection, both in conjunction with the surgery that I've described, but also just on its own, is associated with a slightly heightened risk of certain types of developmental disabilities. Interesting. I didn't know that. Yeah, it's slight. But I think, and maybe this is me over. thinking things philosophically, but I had this thought of like, if we give birth to a child

who's genetically related to me and this child has one of these issues that I know that I increase the likelihood through my decisions, like how do I live with that? How do I tell the child? Which is, I think, distinct from children are going to have issues and you never know what they're going to be. Right. Although, like, I guess if you had suffered from like depression and then you had a kid might you I guess you could think of it the same way too I mean this is sort of like a thing I guess that you know is like very genetic but there are I mean most people have some sort of genetic issues right that's right that they pass down to kids that's absolutely right yeah it's an interesting I'm saying yeah I agree it's an interesting like moral sort of philosophical question though

it is and it's one that it doesn't feel like there's a whole lot of like resources out there for thinking through right like like I'm not saying there's one right answer to any of this it's more like, so for example, when we said to the doctor who does the surgery, what about the risk that a boy child we create would have infertility issues of their own? And he said, well, who knows in 20, 30 years what IVF will look like? Maybe it'll be even easier and it'll be like kind of no big deal to conceive a child this way. And that to me was not comforting. But I guess I should say that I think every couple has to make this determination for themselves. I wish there were more books and articles and podcasts that help you think through what your own values are. Because, you know,

let's say the Christian conservatives have a certain kind of moral vision here about what you can and can't do in these situations. I think Jewish and Muslim communities probably have their own, or they do have their own, and I read about this a bit. But if you're kind of broadly secular and broadly open to going where the science takes you, the science is just sort of a series of tools and you really have to reckon with yourself, like, what do I want to live with? What does my partner want to live with? In all of this, I was dealing also with the fact that Emily, my wife, did not otherwise have a profile that said that she needed to do IVF, right?

So she was 35 at this point. And she was, there were, as we investigated these roots, we wanted to know, like, if it wasn't for my issues, would doctors be telling Emily that she should try IVF herself first? Right. And she, so this is where she started to do some of the more invasive tests, like an HSG. And it seems brutal. It's definitely, definitely painful. Recommend to anyone who's listening and maybe getting one, I recommend a Tylenol before. you going. Yeah, that was my sense of it too. And this was sort of like exploratory tests to see

can Emily conceive naturally easily or does she, on her own, is IVF the sort of better course of action? And all of her tests came back like basically as good as they can for a woman who is 35, by which I mean that obviously, like, the number of eggs she's releasing and all of this her ovarian reserves would be different if she were 20, but she was not in the zone of people where the doctors were recommending IVF. Right. Which meant, in addition to all of these moral questions that I'm dealing with, going down this road means putting Emily through an IVF that she would not otherwise need. So at this point, we're also investigating the second road, which is donor sperm, I'll just tangentially say that we definitely had conversations about adoption,

but after a while it became clear to me that Emily did seem to desire the experience of pregnancy, just broadly speaking, right? That was something that she found was valuable. We have plenty of female friends who do not want that, but she definitely seemed to want that, even knowing that it's painful and difficult, but it was, it was, seemed to be really like something she had envisioned for herself. So that meant adoption was sort of like set aside for the moment. And of course, I loved the idea of having a child that was genetically related to Emily, even if they weren't genetically related to me. Right. I think if you had asked me 10 years ago, do you care if you're related to a child? I would have said, eh, I don't think so. I don't really care.

And then once I learned that I might not be able to be related to a child, I had a lot of like, oh, God. Right. I guess I do really want to be related to a child. I think I was raised Jewish and I think that tradition in particular kind of like saddles you with a lot of thoughts about how this peoplehood passes down generation to generation and that, you know, you're part of this line of people and that you bestow that on a kid. And I had been raised with that and I had thought about it in a while. But I was like feeling very sort of torn up and complicated. And then eventually I think I came around the other end back to. if on one side of the ledger is I get to be related to this kid, but on the other side of the ledger is me going through a surgery,

Emily going through an IVF that she doesn't need to go through, a long strenuous path that involves disappointment, possibly at every stage given what I've described before about the surgery and finding sperm. Like going through all of that just to be related to the kid, or we find a sperm donor we feel good about and I get over these emotional things. And in the end, that just felt like the better path for us. Now, within that decision, we had a next decision, which was, if we're going to have a donor,

do we do someone we know or like a cryobank, went back to my lesbian friends who had been advisors through this. They told me about all these different options. Literally, if we knew somebody who was willing to do it, you know, we could have used what people call the turkey baster method and just done it at home where you inject sperm. But over time, I came to feel like we don't have an obvious friend candidate who I would feel uncomplicated about in this situation. There's a whole series of issues knowing the sperm donor creates, some of which can be beautiful that you kind of have this like more open, complex set of family members. They could be a kind of uncle figure. But just given how raw and intense this had all been already, there was a kind of like ease and

cleanliness to just buying some sperm from a bank. And then so when you're picking out a sperm donor, are you trying to find one that like looks or feels like you or has like an educational background? I don't know how much information they give you. They give you a lot. They give you a lot. And I talked a lot about this to both the lesbian couples I know, but also I happen to know a lot of women who are pursuing single motherhood through IVF at older ages. They're not married. There's like a movement called single mothers by choice. And so everybody's talking about how you pick sperm donors. And if you have no parameters, it's really hard because it's just this deluge of people and information.

And again, it really forces. is you to debate your internal feelings about nature and nurture and genetics. Or what qualities are? What qualities matter, right? So I remember thinking, like, I don't care if they went to an Ivy League school. I don't care if they were good at sports. I don't care about any of these things because I'm just not in my heart. And this is just a personal thing.

I'm not in my heart convinced that these things really passed down. I think part of this is an example for my own life where I'm a musician and really took to music at a young age and played the violin and did it professionally for a while. And so people would ask me, would you want a sperm donor who also had a musical aptitude? And I thought about it. And I was like, well, neither of my parents had a musical aptitude. I didn't get it from them. So what BS to presume that by picking this vial of sperm, I'm going to have like a little little child that really wants to play the piano, right? Right. I understand that somebody might have an emotional attachment to this. I don't mean to sort of denigrate any choices that other people make.

But for myself, I started to feel like some of this starts to feel like perilously close to trying to like genetically engineer your kid to be like you, which we all know is bad. We all know that when our parents tried to like make us be like them, it wasn't great. Yeah, it's your first test, almost parental test. Exactly. That's a great point. That's a great way to put it.

But parameter-wise, I did. So my father's family, as I've said, is serious. Jews. My mother's side is Irish and Italian. And I definitely feel very interested in connected to my kind of Mediterranean and Middle Eastern heritage in a way that I liked the idea of finding a sperm donor with some kind of Middle Eastern slash Mediterranean heritage. And the logic was that if they ever did become interested in their heritage on that side, the side that they were they didn't know the parent, that they would share that region of the world with me and my own, because I'm very curious about my father's life and Syria and these things. So I just

had this vision of maybe someday kind of sharing a tie to this part of the world with a child, even if we're not genetically related to each other. Going into that, was there also something about, like, I want to maybe increase the chances that this kid looks like me or, you know, it won't be immediately obvious that they're mine or not mine, although it would be, it would be, it's hard. It's never like immediately obvious usually, but. It depends. I mean, certainly there were times where I thought if we picked a donor who looked nothing like me. So if you're listening to this podcast, I have brown hair and brown eyes and got bald pretty young and have a beard. So I mean, I think to me the parameter was like,

if we could pick a donor with brown hair and brown eyes, that would, I think, alleviate. I'm not, I think, I was never concerned. turned about looking at a child and thinking that child doesn't look like me. But I did imagine that this child as they get older would move through the world. And if they looked really, really, really different than their father, there might be like looks or questions or things that like... Something extra for them to go through. Exactly. And I felt like this was about kind of minimizing what they would have to go through. Even as I fully, you know, I think another thing I was just scared about this whole route was like, does it psychologically affect a kid negatively?

just to be born to a sperm donor, just period. And the answer to that seems to be no, if you handle it well, which is to say, share it early and often. Don't make it seem like you were hiding something from the kid. And so that's a road that my wife and I will go down eventually if this happens. But we got to the point where she found, she tends to be the, it's really like shopping, honestly. Like you look at these sperm banks and there's like often baby pictures of them, but not adult pictures.

Sometimes they've written an essay. There were just a lot of times where I was like, I don't want to know that much about the person because the more I know, the more I'm going to be like looking for these little things in the baby. I just like I don't want to mess with that. And I think a big part of it was like trusting your emotions and thinking, I'm feeling good. So let's just roll with this feeling and buy some sperm and go down this road. So we did. We bought a bunch of sperm. Another piece of the story that I haven't dwelled on is that like what insurance covers in terms of male infertility varies wildly, you know, as it does with IVF and women. Right. So what did they cover? So they cover, I don't know if they would have covered that surgery that I described earlier. Interestingly, the doctor who performs the surgery does not bill insurance. So I would have had to pay for it out of pocket and just tried to be reimbursed. Right.

We didn't go down that road, but I was very, like, shocked by that. Like, you know, who has all this money around? It would have been. Right. And this seems like a classic case of it being a medically necessary situation. Absolutely. Right. Yeah.

Yeah. I mean, as medically necessary as anything in the fertility realm is. Right. Yes. Given that, and I have, I think throughout all this kept having to remind myself that it's elective. Like, that all of this is plus. We're adding to our family. You know, Emily and I have a great family.

We love each other. This is all additive. So insurance covers the procedures involving the sperm, but not the sperm itself. So we were on the hook for thousands of dollars that will pay off of sperm in vials. Per vial? You got a price? Yeah, you buy per vial. Some places are like around a grand.

Some places are around two grand. Some places charge different amounts based on the donor, which adds to me this creepy feeling of genetic control. Like that, oh, the Harvard. grad is more expensive. Yeah, I remember at Cornell, like, well, there was a class where there was like an ad for like an egg donor. And it was like, yeah, if you were like, I don't know, above a certain height or like, you know, they're targeting an Ivy League school or something. It did feel very like they're trying to like selective. The best. Yeah. Right. I often found myself thinking, I remember seeing those ads at Cornell myself and thinking and now I think, oh, what if I had just like done that? Because then I would have found out. Known, yeah, right. I would have known.

I would have, it would have worked. And someone else would have paid for me to learn this, exactly, at age 20 or whatever. So we chose to buy the sperm, we bought it, and that kind of brings us up to the present, which is that what we're attempting now is the IUI procedure, which is intrauterine insemination. So if you were to just take the sperm itself, and put it in a turkey baster or a, there's injectors that you can buy at the pharmacy that many couples use at home. That is a, that's called intracervical inflammation, ICI.

IUI is kind of one medical step above that, but way less than IVF. And it involves getting the sperm and putting it in a catheter, injecting it right up to the uterus. It's mild and uncomfortable, but nothing like an HSG. And in addition, to maximize the likelihood of success, my wife has been taking a variety of like hormone pills and a trigger shot, which is the same kind of trigger shot I think you would do before an egg retrieval. So a handful of like small scale medical interventions, although they still stink and make her feel like crap and I feel bad, right? Right. But we have a now we tried so so most people who succeed with iUI do so within three to four times but it's like a

curve so some earn five to six times um we've tried it once and it didn't succeed um but each time is like less than 20 percent chance of success right that's what they say for like the chance of natural conception i think is also like 15 to 20 percent right so this bumps it up a little bit maybe it gets you to 25. You know, some of the statistics, it's like kind of hard to know exactly how they fit to your particular case. So it's not like we have a discrete. This is our percentage likelihood of success with this set of medical factors. But it's less than 50%.

And the first one didn't succeed. And then the second one was last week and now we're waiting. Oh, wow. Good luck. Here we are in the famous two-week wait. Thank you. And if this doesn't work, then we try again. and we decide, and then eventually we decide how many times we want to try.

And then if it continues to not succeed, we consider, we would then be back in the realm of considering IVF. And if we're back in the realm of considering IVF, we're back in the realm of considering me going through the surgery. Okay. So that's not off the table? It's not entirely off the table forever. No.

We made the choice to go down this road of IUI with a sperm donor. and the idea was just like, this is the road we're taking right now, but I think we want a child and there's no sense in which we have no story in our heads that's like, if these things fail, we're just giving up on that. I think it's like we reassess. One thing I'd say a broad point that applies to men and women that I've learned through this process is that it's like really tempting to imagine, oh, what decisions am I going to make if this set of things plays out in this way?

but like it's really hard to do that and really mentally exhausting and you kind of have to just like live in the moment a little bit right with each thing that you've decided to do so if you had some words of encouragement for someone who's listening who might who's either going through this themselves or has a you know male partner that's going through this is that what you would say just kind of like one step at a time i would say definitely say one step at a time yeah you can't predict the future you can't know what's going to work and not work you know do the tests And then the other word of encouragement, I would say, is that at least in my own marriage, it has bonded us. I have found that it has, I certainly feel like it's brought the two of us closer together because it takes a lot to say, I want to go down this road with this partner, even though this is true, you know, even though this is hard.

It's like, if you imagine, like, the scenario where two people accidentally have a pregnancy at 18 and realize that I'm. really like each other. This is like as like the sort of other end of the spectrum as far away as you could get where it's like you're in your 30s, you're committed already. I knew I was committed, but like it feels even more intense and strong. And that is a kind of a silver lining that I feel like more happy and secure in my relationship than ever just as a result of the struggles that we're going through together. Because it's a struggle you do go through together. Yeah. I'll caveat that and say that I've definitely heard stories where this has ended marriages, led men into tremendous amounts of depression.

And that's why I think that it would help if there was less of a stigma around testing men and just more kind of open public acknowledgement at how much of the time infertility comes from the male side. And that that's like okay and the reality. Totally. Yeah. No, I agree with all of that. And thank you so much for telling your story. I'm sure so many people are going to listen and feel less alone and feel like more understood. And on the part of the marriage part, I think your wife seems very lucky that she has a husband who's very invested in learning everything and really sensitive.

So props to you also for that. Yeah. And I can tell that just by speaking to you. I obviously don't know her. But this was really interesting to hear. And it's a side of this whole thing that I really like I don't hear much of. And I'm sure it's out there. like you said, it's 40 to 50% of cases. I hear almost nothing about it. So I think it's really,

really important what you're doing. And thank you so much for coming on. Thanks for having me. Yeah, this was also a really good way to kind of like almost like publicly, well, take a baby step into telling these stories out loud and then kind of like workshop how you tell them. So thanks for the opportunity. You did a great job, both explaining all the medical things that I didn't understand and just like the emotional part of it. So that was great. And guys, if you want to check out Maurice's book, you can check out let the Lord sort them again not on this topic but I can tell I can tell it's a great book because you're just very articulate and you guys should check out everything he's doing thanks for that appreciate it awesome and that's it for us for this season of baby steps thank you guys for listening

baby steps is produced by me Jordana abraham and Shannon Sison editing by Jorge Morales pico guest booking by Ali Friedlander and be sure to follow at everything's fine on Instagram betches