Today, an interview I did for the Sunday Times Magazine appears as part of a larger feature on male infertility, written by Sarfraz Manzoor. When I sent in my answers a few weeks ago, it didn’t occur to me that it was going to be published on Father’s Day (I should have known!) but I suppose it’s good the voice of infertile men is being heard on a day when the childless tend to get airbrushed out of the greetings cards and mugs.
While I’m pleased to have been interviewed, and to appear as part of a wider discussion, inevitably the style of piece meant that a lot of what I wrote didn’t get used. Unusually, I was quite pleased with the writing I sent in, so I thought I’d reproduce the full copy of my reflections as a blogpost. It tells a potted version of mine and Sheila’s story – if you’ve read other posts on this blog, then much will be familiar (and apologies to Dave and Lizzie, who are introduced late on, because I was writing this for an outside audience, but you get the idea) but I hope you find it useful.
There is no script
I suppose for much of my life before my infertility diagnosis, I was absent-mindedly following the script that sort of gets handed down to us, God knows where from, that the path of a good life means meeting someone, falling in love, settling down and having kids, with thoughtfully worked out names that fit harmoniously within the family line, and we then set sail as a family unit into the great beyond of life.
In the most part, this scripted list was getting nicely ticked off. I met Sheila at university in 2003, we moved back to London after graduating, got jobs, married in 2005, were working our way up in the world and then, quite naturally, after about five years, our desire turned towards enlarging our family and we started trying. Both of us have one older brother, and we’d talked of having a bigger family, but after a year of ‘trying’ and no pregnancy to speak of, we went to the doctor for investigation.
An unhappy room
I did my first semen analysis in a small closeted room in Bart’s hospital on a Monday morning, heading in to work a bit late straight after depositing my sample through a shameful slot, returning the NHS-funded ladmag (I couldn’t stomach the harder core material) to its boxfile. I didn’t give it much thought, but when the doctor phoned, they asked me to repeat the test as something wasn’t right. Second time round, I put a bit more effort in, but I’ll never forget the day I received my diagnosis, from a doctor I’d never seen before, sat next to Sheila in our local GP surgery.
‘You have zero sperm’ – erm … come again?
how many? zero? none? not any?
These lines are from a spoken word poem I’ve written about my diagnosis with azoospermia, in autumn 2011, and those four words are verbatim what I heard; that’s how I found out that I was infertile, and this fairytale script I’d inherited from birth, wasn’t going to make it to the stage.
It was a pretty blunt blow and, for a few months, my reaction was to try to put a brave face on the news, to ‘be strong’ and look positively at the options that were still at our disposal. I saw a private consultant, who performed extra tests and helped get us a referral to a urologist at UCLH, where in the summer of 2012 I underwent a micro-TESE, minor surgery under anaesthetic to see if any sperm could be detected in the teste under a microscope. We found out by letter that the procedure had been unsuccessful, that there were no sperms to extract, on 27 July 2012, the day of the opening ceremony of the London Olympic Games. It was a mad contrast, the numbing grief of dashed hopes passing through me, through us, as the Red Arrows passed over our house in East London.
A change in the internal monologue
In between that ‘zero’ moment and the unsuccessful surgery were a few months of pretty traumatic mental health. The brave-face period didn’t last long, and I spiralled into quite a debilitating depression for a few months, making work impossible, even choosing what I wanted for dinner a monumental challenge. The initial onset was an anxiety attack, which manifested itself in waves of tears which I couldn’t control. I needed diazepam to help stop me crying. I had counselling, CBT was most effective in helping me understand what was going on and how I could cope and thrive again. I had a few ‘return to work’ interviews, but it was once I handed my notice in that I found being back at work was achievable.
When I look back on that time now, I realise I was unwell, and needed treatment to get better. At the time, the scariest thing was an instant change in my internal monologue. I’d always been enthusiastic, positive, outgoing, but suddenly the voice in my head was saying ‘You can’t do this, you can’t do this’ – a mantra that infiltrated everything and tripped me up at every turn.
My infertility diagnosis was the underlying factor, and that wasn’t something I was going to be cured of (my azoospermia is genetic, caused by the absence of the AZF-C gene from birth), but over time this was something I discovered I could live with. I chose to keep on believing in the possibility of abundant life (my Christian faith teaches me to have a grace perspective; my infertiltiy diagnosis brought that sharply to the test) and a house move to Cambridge in 2012, coupled with the new challenge of training to be a vicar, allowed Sheila and I to regroup and reset.
Carguments and pressing pause
No doubt our journey with infertility has been the hardest test of our marriage. It’s taught us to lean into discomfort and communicate the harder, deeper things, because if we can’t be a team through that, being infertile threatened to drive a wedge between us. Seeking support and love outside the relationship, from friends who let us let off steam, relieved some of the pressure. Being in a Christian community for the hardest years of coming to terms with my diagnosis, let a lot of light in and was brilliant. Moving house pressed a pause button on treatment (at the time, you couldn’t begin fertility treatment on the NHS until you’d lived somewhere for 12 months) and this gave us much needed time to discuss deeply our options, what we thought about assisted conception, to make choices once the initial grief had subsided. There was stuff that needed saying, and was better off said than bottled up. I remember a car journey, in which Sheila admitted feeling angry with me, angry that I couldn’t give her a child, angry with herself for feeling such anger, since it wasn’t really my fault that I was infertile. The dashboard on both sides of the car was pretty wet as we made our way up the M1.
Decision time
After the year was up, we decided to seek an NHS referral to a clinic, to begin fertility treatment with donor sperm. We were approved for 5 rounds of IUI, which was the least invasive route available to us. We tried the first two rounds without the supplementary drugs to boost Sheila’s chances. We’d never had sperm in the mix before, so we wanted to see how we’d do as close to natural as we could get. I was there, by Sheila’s side, both times the insemination happened, our jolly female gynaecologist with a memorable Italian accent talking us through the procedure. That second time was successful, and our son was born in May 2015, a month before we moved back to London for me to be ordained as a deacon in the Church of England.
You’re not alone
Throughout really, we realised that in our own strength we were going to struggle to navigate the emotional rollercoaster of infertility and treatment. Quite early on, during the onset of my breakdown, Sheila had written to a carefully selected group of friends and family (mainly people we knew would pray for us) to let them know what we were going through. This was primarily to ask for prayer, but also it saved us having to ‘have the conversation’ – telling people you’re struggling is really draining and takes vulnerability – we opted for an electronic shortcut!
Then, in the sanctuary of a theological college community, although we didn’t know people well, we decided to open up about our struggle. Vicar schools are notoriously fertile places – many of the female spouses were or got pregnant while their husbands were training. We couldn’t face the questions and assumptions we’d endured at church – ‘When are you going to have children?’ we wanted our struggle to be seen. But opening up did a lot of good within our community – another couple, Dave and Lizzie, were going through multiple miscarriages at the same time, and by finding each other we felt less alone. The women joined a support group – called The Tent – which gave them a space to grieve, listen and talk. The men went for a curry, and supported each other less through words, and it remains a difficult area for men to open up about. During that time we started a blog, Saltwater and Honey, which wrestles with identity, childlessness and faith; a community has formed as a result.
One thing we’ve observed is that although it’s much easier for the women to write, and tons of women respond and comment on the posts, whenever Dave or I write something, we get a massive response, because it seems so rare that men are sharing about their infertility. I’m not sure why that is, but the myth of masculinity = virility might be one factor.
More recently, I’ve started using spoken word to tell the story of my infertility, and got to perform a couple of poems at Fertility Fest in the Pit of London’s Barbican. It’s a decent metaphor, ‘speaking words in the pit’ – infertility can feel like a lonely place. But the numbers speak for themselves – half of infertility in couples is down to the male factor, and this is one in six couples we’re talking about, so we’re not alone, we have a voice, the grief isn’t imaginary and our story matters.
