SART Fertility Experts - Male Factor

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and SART. These podcasts are provided as a source of general information and are not a substitute for consultation with a physician. Welcome to SART Fertility Experts, a podcast that brings you discussions on important topics for people trying to build a family.

Our experts are members of SART, the Society for Assisted Reproductive Technology, an organization dedicated to ensuring you receive quality fertility care. Hi, this is Dr. Paul Lin. I am a Reproductive Endocrinology and Infertility Specialist at Seattle Reproductive Medicine and former past president of the Society of Assisted Reproductive Technology or otherwise known as SART.

SART is an affiliate society of the American Society of Reproductive Medicine or ASRM. Remember, IVF success starts with SART. Welcome to this week's episode of SART Fertility Experts, titled The Silent Journey, The Male Partner in the Struggle to Build a Family.

My guest today is Mr. Dan Barker, who is the loving husband of my partner at SRM, Dr. Nichole Barker, another board certified Reproductive Endocrinology and Infertility Specialist and father of two wonderful children after a long, arduous struggle with male infertility. The purpose of this podcast is to discuss the expectations of the silent partner in the infertility couple. Oftentimes, the struggle to get pregnant has been erroneously assumed to be an issue with the female partner and not so much with the male partner.

Dan will discuss the male perspective and the ups and downs that oftentimes are not known or not talked about very often since much of the focus is on the female partner. Great to have you here, Dan. Welcome.

Thank you for having me. Glad to be here. You're welcome.

All right, let's get into this. Dan, give me a light intro into who you are and why did you get into this podcast? Yeah. Well, I live here in the Seattle area, south of Seattle.

We've been here since 2012. My wife and I moved out here from Ohio. We're from the East Coast.

I work at a tech company. I'm in product. As far as getting into this podcast, with my wife being infertility, the male point of view has come up a few times.

I've been happy to share my story. I've had friends who've went through this journey and have read some of the things that I've put out there. I know we had a blog post on SRM, which I've had actually a lot of friends respond to and say, hey, that article really helped me.

There was some good info. What did you do? As we're starting this journey, what should I be thinking about? I've been happy to share my story with folks in the hopes that it helps or at least provides some way to understand at least one person's perspective. Right.

I think your insight is going to be invaluable. The many patients that are going to be hearing this. Let's start at the beginning.

How did it get going? Did you just go see your regular primary care doctor? Was something going on? What was the trigger points for you in this journey? Yeah. For us, we got married a little later. I was in my 30s.

My wife understands all the details around that. We knew there might be some issues. When we got married, we wanted to have a family pretty quickly.

We wanted to start that process. When we did, we tried naturally for a while and things weren't really working. We thought, let's just make sure everything's good on my end.

Just as almost like a preemptive thing. Sure enough, we found out that the fertility factor on my end was really a challenge. It was a problem.

I was pretty shocked by all of that. That's what really started our fertility journey. We wanted to have a family quickly.

We just did a test on my end to see what my counts were. They ended up being really bad. Then that's what kicked everything off at that point.

That was in 2011 for us. You being a little bit of an older couple getting married later, you were pretty much proactive. If you were younger, when would you have done this testing and stuff if you had looked back? When do you think a guy should be starting to think about maybe discussing how long do you try and stuff like that? Yeah, that's a good question.

If I were younger, we probably would have tried naturally longer, I think. I went into this process as a guy. Our part in the fertility journey is easy.

We just have a simple part of it. I thought, for me, it was easy to get pregnant. I grew up thinking, look, if you're going to have sex with someone, there's a really good chance that they're going to get pregnant.

Be really, really careful about that. That was accurate as I went into this process. I learned, wow, even in really good cases and the best situations, it can still be hard.

We were fortunate that we went down that path and had those tests done pretty quickly, meaning we didn't wait two years or a year. We did it in a few months and it ended up helping us figure out how to take next steps that allowed us to have the outcome we wanted. When you found out that your sperm count was low, what were you emotionally feeling at that point? Was there failure? Was there disappointment? What was going through your head there? As a guy, I was pretty devastated, to be honest with you.

I always think of it as a superpower that you have to use with extreme responsibility. I'm like, all right, it's time. I've been thinking about this since when you're a teenager and you grow up and you learn about the reproductive process and you think, oh, it can happen quite easily.

Then you learn that it doesn't necessarily have to happen. It doesn't happen that way sometimes. It can be a challenge.

I thought it was a superpower. I'm like, all right, I'm ready to have a family. I'm ready to start having kids and boom, now I'm not able to.

It was pretty hard for me. I think as a guy, you immediately go into fixed mode like, how can I fix this? What can I do? All right. That's where this process, I think as a guy, you go into fixed mode and you're just listening like, what are my options? What do I do? When can I start? That's how I took it.

It was really hard for me. Yeah, it's super devastating and I guess is the main message there. Then sperm count low, how long did it take you to recover and then when were you ready to, what was the next steps for you in terms of evaluation? Did your wife go through an evaluation or did we get, what was the next steps for you? Yeah, if I remember correctly, this is going back to 2011.

We knew that we're going to go down the IVF path and we started that and we knew that I was the factor, the main factor here with my counts being low. We thought, let's see what we can do. We did one cycle there and fortunately, the percentages were extremely low.

The IVF cycle, they were saying, it's unlikely. We really didn't know what to expect, but we were fortunate enough to have that cycle actually work. That's what started the journey with our first child, Annie, who was born in 2012.

It was about, I don't know, maybe three or four months, if I remember correctly, as we went through that process. Then Nicole, my wife, was able to get pregnant and that's what started our journey. We were very fortunate, but going into it, I was like, I know it's my fault.

There's nothing I can do to raise my counts without some help. I really didn't know what to do. I was pretty devastated about the news, but happy that, wow, we were able to have a good outcome after one cycle.

It's a journey of emotions. Now it's up and down. It's crazy.

In the beginning, sperm count low, what were the options that were discussed with you in regards? You did an IVF cycle eventually, but was there any other options there available to you that were discussed with you? Why did you choose not to do or do them? What you remember, the side effects, and what went into that decision for both of you? I know that there were other options out there based on what the factors were. Because it was me and the counts were super low, it was, can we get what we need from the male side to start this process? The chances of that were pretty low. Correct me if I'm getting my terms wrong, but the counts were low and the motility was low.

They were like, we think we can find a few that will work and let's see what happens. Then you start to learn about this process. It's okay.

I'm supplying the sperm to this process, but then what's going to happen with my wife? My wife is going to go through this and she might have issues. Maybe there's problems over there. Fortunately for us, there were no major issues on her end.

She was able to produce eggs and everything. At that point, we were like, all right, let's give it a try. I think if I remember correctly, we had like two good embryos that resulted from that.

That was it. We were like, all right, let's see what happens. Were there any medications discussed with the very low sperm count that you had? Was there testosterone or any of those kinds of things or a sperm aspiration surgery where they removed the sperm from your testicle? Was there any discussion regarding that? Yes, we did.

They talked about, hey, let's do a cycle and see what happens. If not, if that doesn't work, there are these other things. I'll be honest, the thought of that was like, ooh, that sounds painful and not very fun, but I was like, whatever we need to do.

We went into it knowing that if this doesn't work, you could take testosterone and get my counts up that way, or I could have that surgery, which would be another really good option. It was basically, let's go down the normal path first. If that doesn't work, here's two or three options.

Take some medicine to help your T counts get up, or you could have the surgery, but let's go down the normal path first, see if it works, and then go from there. Yeah. Testosterone, not necessarily a good idea, but mostly Clomid, and there's this drug, and then HCG are the other drugs.

Testosterone, just to let the audience know, actually suppresses sperm collection. Clomid and those type of drugs are the option there. You're right.

That's just so you know, that's what I took. It was Clomid. Okay.

Yeah. Excellent. Excellent.

Just to clarify that. You're married to a really famous doctor there, and this is very daunting process. You just dove right in it.

Did you feel that having your wife being an expert in this field actually made any difference for you emotionally or anything like that? It's such a huge, I can anticipate such a huge guilt trip on your part, and she's having to do most of the work. What was that like for you? Yeah. That's a great question.

I think we were fortunate that she understands the process, so she knew what to expect going into it, but I would say it didn't make it any easier for us, and it didn't change the percentages of anything. Just because she's a fertility doctor and understands all of this, the process still is what it is. I was the male factor part, and so that was a big part of this was, how do we begin this process? Then as we get into this, what can I do? Then what is she going to have to do? That's where you really start to learn like, wow, to your point, the female part of this is pretty intensive.

There's shots involved, and the timing of things, and getting up and really organizing your day around some of this stuff, it changes your whole life. It really had a huge impact on us. There was a lot of pressure.

I'm like, man, I hope this works, and I feel bad because my wife is going through this process. I don't have to take shots. I don't have to do anything.

It's all revolved around her cycle, and what's happening, and the timing of things. There's a lot of communication and coordination. So yeah, I think for me, I just wanted to make sure I'm supporting her in that, but yeah, I felt pretty bad to be honest.

I'm like, man, I'm not even, there's nothing I can do. Kind of felt helpless sometimes. Yeah.

So would guilt be a correct? I mean, did that ever come across your mind? Like, oh my God, she's doing all the work, and I'm here the cause of all this work. How did you manage that? I mean, that must have been terribly emotional for you. Yeah.

It's interesting because when you go through this, you start to understand. I think women and men handle things differently, obviously, for the most part, and for me, I was struggling, and I was thinking about it all the time, and I was worried and guilty about it, but I didn't necessarily always show it. So my wife kind of felt like, do you even care about this? How are you not emotionally affected by this? Meanwhile, she's pretty emotional, thinking about it a lot, wanting to talk about it.

Maybe she's crying out of nowhere for whatever reason, and you're the husband, and you're like, babe, what's wrong? How can I help? Yeah. The emotional part of it is definitely a challenge. So one of the things that really brought us closer together as a part of this process was, first off, understanding what this journey really looks like.

It's an amazing miracle to get pregnant, right? This process is pretty amazing, and understanding the female part of it, I grew an appreciation for this whole process with my wife and how strong she was and her ability to get through things, and it really put me on, I needed to be on point and just think about, all right, what am I emanating? Am I asking the right questions? Am I showing her that, yes, I care, or how am I doing that? But we often have these conversations where she'd say, babe, you don't even, doesn't seem like you even care. Do you even care? You don't seem emotional or anything, and I'm like, yeah, I am. I mean, maybe I just process things a little differently than she does, and so that's going to come out.

I would say anyone on the journey, just know, depending on the situation you're in, your partner is going to have a different mechanism for going through this, and just be aware of that and be cognizant of it because it's different for everybody. I think that's a great point that you bring up, Dan. Certainly, resentment is a term that comes up a lot, and, you know, thank God it worked out for you and Nichole.

You became stronger together, but certainly, was there challenges, not to get too transparent about your interaction, was there challenges, that resentment, did that ever build up? You know, guys and male and females, they process stress very differently, and I would tell you, most females are obviously very emotional. You don't, you know, we all know this, and men are like, quote-unquote, the silent partner, and they process, and it's not that they don't care any less. I think they just process the stress very differently.

I mean, what do you think of that? Was that something that came up in your partnership with Nicole, that there was resentment sometimes, and you would lash out at each other? Is that a common thing? Well, I felt like she might resent me because it was my fault. So, going back to what you said earlier, like the guilt part, absolutely, and what's really hard as a guy for me was like, I can't fix this. Like, I can't work harder.

I can't go do something necessarily. I can take, so in this case, I didn't take any Clomid before Annie was born, our first child, but after Annie was born, and we were ready to have a second child, I had to take, you know, the Clomid. So, now it's like, okay, please work.

So, now there's more pressure there. So, I'm like, okay, there's something that I can do, even though I'm not doing anything. I'm just taking the medicine, see what happens, but, you know, I'm like, okay, I hope this works, because if not, it's going to be like, again, it's my fault.

It's on my shoulder. So, my worry was I didn't want her to resent me, but I would say, you know, having looking back on this, I think it would have been better if I would have just once in a while let her know like, hey, I am feeling guilty. I am feeling a little bit, you know, ashamed in some cases about what's happening here, and I'm sorry, but just know that I love you, and I'm, you know, I'm here to support you, and, you know, I just hope you know that I care, and I might not show it all the time.

You know, I might, you know, for me, it was like, I do, I go work out. I do other stuff. You might not hear it coming out of my mouth, but, you know, if I had to go back and do it again, that's something that I think we learned is, as a guy, I need to let her know what I'm feeling so that she can at least know that, yes, I am feeling what she's feeling, and we should probably talk about it a lot more, to be honest, but, you know, it's hard when you're going through it, because you don't know.

You're new to the whole process. I think that's a great point. You know, it's a challenge for the male partner to communicate to their partner that, you know, I care and stuff, because it's just very difficult.

We process. We go to our man caves. We work out.

We do whatever we do to deal with the stress, and I think it's a really good point for you, Dan, to bring that up to our audience that, at times, you know, they don't need a lot of interaction. They just need, at times, you know, that positive, hon, I'm dealing with this. I'm stressed just as much as you are, and I care about you.

I love you, and those expressions mean the world to the partner, and I think that's part of, also, it sounds like if you had to take one thing to do, if you had done it again, that would have probably helped you to kind of relieve a lot of your stress. Absolutely. Yeah, I mean, I had no one to really talk to, because, quite frankly, I didn't want anyone to know.

You know, I'm like, hey, I'm having fertility issues. Can we talk about this? Like, that's not really something I'm going to bring up to anyone, even like my parents. You know, I was like, I don't even want to talk about it to anybody, so yes, that's, you're absolutely right.

You know, I think what I learned, there's a lot, there's a lot more people going through this than what you realize, and so, yeah, reaching out and, you know, connecting with someone, you know, podcasts like this, or anything like, you know, consuming things, hearing from other people, their journeys, I think that's helpful, but in the end, you're right. You need to be able to express what you're feeling with your partner. Do you think that, I mean, it's not in a guy's, you know, DNA to start seeking counseling, but do you think that would have helped along the way, or it's, you know, something that's probably just, this is who we are.

This is the male side of the journey. Do you think that would have helped at all? Oh, that's a great question. I don't know.

It probably would have, yes. I think now that I've been through it, I can go back and say, yeah, this is, this would have probably helped, but again, I was in guy fix-it mode, so it was almost like, it sounds counterintuitive, right? I'm in fix-it mode, but I don't want to go to counseling. That's actually maybe what you should do, and just have a way to get it out because, again, our journey, we were fortunate.

Our IVF cycle, the first and the second one worked, but, you know, but there was a time lapse there where, you know, we were going through some tests and maybe a few things didn't work in between that we were trying to get to the point of, you know, being able to have an embryo and everything that maybe didn't work out, and so there's a lot of time there, so you just need to be cognizant of the time, and, you know, the longer that goes, you don't really realize it, but you're going through your fertility journey. You're still going to work, right? You still have work stress. You still have family stress or whatever else is going on in your life.

This just adds to that, so just be aware that this is going to, you know, this is new, and it's going to be hard for both you and your partner, so, you know, talk about it, you know, even if it's once a week, just talk about it, and I think that'll help for sure. Yeah, I think that's a good point. A couple, I just wanted to bring up as we finish off here, but a couple pain points that a lot of men kind of struggle with.

The sperm analysis. That, you know, that's a tough, that's a tough gig. Can you be as transparent as you can be about that process? Did it, was it scary? Was it embarrassing? Can you just tell about the test itself, and what were the challenges there, and what went wrong, and what went right on that? I'm sure it's not a perfect process.

Yeah, I'm not going to lie. The first time I had to go and give a sample, I was like, what am I doing? Like, what, how is this going to work, you know, because now you're taking something that you might do in private, and now you're doing it as a part of a process, and everyone knows what you're doing, and there's pressure there, and, you know, it's something that as a guy, I could easily do in my sleep, you know, like, I feel like it's super easy for me to do this, but now it's actually kind of hard. I'm like, the pressure's on.

Like, I need to produce. This isn't just about me. This is about, okay, what's going to result from this, and is it going to be good enough, and is it going to allow us to move forward, and if not, I had to come back and do multiple, you know, samples, so it wasn't once or twice.

It was like three or four times I had to do it, and it was awkward and weird. I'm not going to lie. You know, it's not a natural thing to have to do, so, you know, it was a kind of a hit to my pride.

I'm like, man, this is my fault again. Here I am, like, and now I have to produce, so there's pressure there, right? It's almost like it's game day. You're part of this process happens today, and it better be good because otherwise nothing's going to work, and I'm like, man, this is a lot of pressure, so.

Then all those emotions that you're feeling anyways are then compounded by the sperm collection itself. Exactly. I mean, you've got to go and, you know, finish the deed, if you will, and you're not in your bedroom.

You're not in your house. It's just different, and so, yeah, it's definitely a little awkward. Yeah, it's a little challenge, but, and then it was artificial insemination, IUI treatment.

Was that ever discussed with you from a patient standpoint, or was your sperm just not a candidate? Were you told some criteria as to why that wasn't your situation? Why wasn't that medically indicated? We did talk about that. I can't remember why we didn't go down that path. I vaguely remember it being because of my counts so low.

Yeah. I think that was the reason why, but we did discuss that and quickly took it off the table. There's a criteria, generally around 5 to 10 million sperm to even make artificial inseminations a practical outcome for you, and even then, you know, when you compare IVF with this artificial inseminations, this chance of success in live birth rates, they're so much more successful for IVF.

Not that IVF is applicable in every single scenario, but usually the sperm counts, and then Nicole was, she was good on her end, right? Oh yeah. All her numbers. That could be, you know, if you have a minimum of 5 to 10 million sperm per cc, and then the woman's, you know, of a reasonable age and numbers are good, artificial inseminations can play a role.

So I'm going to be honest. This is another factor for the male side that made it really hard for me. So, you know, I think about things as a scoreboard.

Am I winning or am I losing sometimes, right? And so we're thinking through factors like here's the options you have. Well, here's one option that might be pretty good, but guess what? Your counts are so low, we can't even do that. And I'm like, oh my gosh, are you serious? So it added to the pressure and kind of the, you know, the guilt.

And then on the other end of it, you know, Nicole is in a really good place. Like she's very fertile, I guess. And so here I am now it's all on me.

So yeah, that added to another layer of pressure. I would say that made it a challenge. Yeah.

Would you have rather had Nicole have some issues? Would that have helped a bit or would that have compounded the issue? You know what? Being that we were really fortunate to have two good outcomes and we have two beautiful children, I would say, no, I would never want it. Because I think to be honest, even though it was really hard for me, my process is actually pretty simple. I think in my mind, it's like, I need to, you know, I'm producing sperm, it needs to be modal.

Here's the counts. But with female factor, there's a lot more at play. There's a lot, it's harder.

And I've had friends and family who've went through that. And, you know, there's a lot of factors that go into that, that could be playing into the outcome. And on the female side, it's harder.

And so I think that would add to the stress for her and the process. So I'm actually, in retrospect, I'm glad it was me. And we were fortunate to have two good outcomes.

Well, that's an interesting perspective. Thank you. As we finish up here, Dan, is there anything that I should have asked that you wanted to communicate to our audience who are dealing with the infertility issue, whether it's male or not factor? Is there anything else that you would want to advise being being having gone through it? Yeah, well, I think the other partner in this is that we haven't talked about is your doctor.

And I know this from two angles, my wife being the doctor, but understanding that we had our own fertility doctor, it wasn't Nicole. So there's really three people involved, typically, or you know, there's a couple and then your doctor. So just know, I think one of the things that I would say is, you're all in this together.

And I can tell you, you know, from my experience with Nicole, and her practice and her deep care for her patients, that a lot of the doctors who are working in this field are working really hard to help families have good outcomes. And it's hard. The numbers are, you know, it's not a guarantee.

Some people want to know, is it, you know, is it going to happen? Yes or no, it's not binary. So just know your doctor's working really hard, and you guys are a team. And there's going to be points where you're frustrated, and maybe you don't understand what's happening.

And you feel like you need more answers. And that adds to the stress. But I would just say, you know, think about just supporting each other in the journey.

And everyone's journey is a little different. And just know that everyone, you know, that your doctor wants a good outcome for you. They care about this process.

And, you know, just, you know, know that they have the best intentions to help and everyone's a little different in that regard. Well, being a fellow physician and having the wonderful experience of working with Dr. Barker, thank you for those comments. I think we all are on the same team.

I think patients and doctors, we go down ups and downs with you. We just, you know, again, express it in a very different fashion sometimes, because we are so busy. But Dan, thanks for your time.

I appreciate all your words of wisdom. It's great. I hope that if it's a difference in one person's life, what you've said, I think we've made a huge impact.

Thank you, Dan. You're very welcome. Thanks for having me.

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