Adventures in Azoospermia

Words by Reanne Hasek-Watt

When my fiancé and I found out, a month before our wedding, that we would never be able to have children, we watched four seasons of Selling Sunset in three days. 

We didn’t go to work. We barely walked our dog. I can’t remember eating, but I guess we must have. 

We gorged on drama that wasn’t our own. 

*

Three years earlier, we shared a paddle board on a glacier-fed lake and talked about our dreams, passions, the meaning of life—typical third-date conversation. We sipped homemade margaritas, and I, brave on beverage and butterflies, shared my deepest desire. The one thing I really wanted to be in this world. The job I could feel in my bones was meant for me.

“I want to be a mother.” The words left my mouth like a confession. My stomach churned from the margarita and the waves of a powerboat passing by. 

But he wasn’t scared. He, too, wanted children one day. “Three, maybe four…” he said, smiling, daring me with his eyes. 

“Don’t mind my dad-mobile,” he said the first time I got into his car: a 2013 Acura RDX he called taupe, but looked more bronze to me. I’d never heard a 34-year-old man use the word “taupe” and I started imagining him as the father of my future children almost immediately. I had a timeline, and he had a smile that started in his eyes, a softness in his voice, and more depth than I think anyone really gives him credit for. 

“I like it,” I said. 

I really, really liked it. 

He was commercially handsome, and yes, I’d been instantly attracted to him. But that attraction only deepened over our shared vision of a big family and busy life. By the time the honeymoon phase ended, we still found passion in the certainty that we were building something together.

A year and a half later, we were engaged. A year and a half after that, half a year into trying, and six weeks before we were to be married, my fiancé opened an online test result that told him he had no sperm.

A quick Google search will tell you most men have anywhere from 15 million to over 200 million sperm per milliliter of ejaculate. Fewer than 15 million is considered low. And my dear fiancé who had spent the last several years strategically pulling out, had exactly zero per milliliter. That is, not even one. 

In the medical world, it’s called “azoospermia,” a word I had never heard before until suddenly I had. Azoospermia meant no matter how many times my fiancé and I try, how many ovulation trackers we use, or how long I hold my legs up in the air, we will never get pregnant. Already rare—affecting only about one percent  of all men—my sweet husband-to-be was further diagnosed with the most severe occurrence. Idiopathic non-obstructive azoospermia meant having biological children of our own was probably not probable. 

“We typically see this in cancer patients, or those who have abused hard substances,” one doctor explained. But my fiancé is the picture of health. He plays tennis several times a week, has visible abs, can run with me when he feels like it. He never smokes, rarely drinks, and snacks on fruit. Once a year, when he gets a cold, he milks a few extra days for attention and homemade chicken soup. But he is well. He has always been well. 

And so, we did more tests. All of which came back normal. His testosterone, while low, was within range. His FSH, while elevated, wasn’t off the charts. Google had no answers. His doctors had no answers. We were referred to a fertility clinic to explore our options. And then we got married.

In the weeks leading up to our June wedding, Vancouver experienced one of the wettest springs on record. It rained and it rained, and it rained. I felt like I might never see the sun again. Between dress fittings and nail appointments and pretending to be as happy as a soon-to-be-bride should be, I found my own private spaces to mourn, always careful to ensure my tears wouldn’t burden my already burdened fiancé. 

On the grey tiled floor of our walk-in shower, I cried great uncontrollable sobs that started deep in my notably empty belly. I walked laps around the same block by our house, crying into my phone, my mom’s ear on the other line, swollen raindrops pelting my waterproof red jacket. I sat in the taupe “dad-mobile” in the alley behind our house after work for minutes, or hours, I’m not sure, watching windshield wipers swipe back and forth, back and forth, back and forth—just barely keeping up with the downpour.

We considered calling the whole thing off. A wedding feels trivial when everything you’re supposed to do after no longer feels possible. And there was an unending list of things we feared: What if I end up resenting him? What does it mean to use a donor? What if he can’t see himself in our children? What if I can’t? What if there’s a part of someone who’s not him inside of me? What do we tell our children? When do we tell our children? What if we never get pregnant at all? What if we never have children at all? What if we lose ourselves in the process? What if we lose each other? What if this is where it ends?

When you’re referred to a fertility clinic there are intake questions and tests and blood draws and samples and an entirely new language to learn like TTC, ART, and IVF. With every additional semen test, we held our breath, hoping this was some big clerical error, a mix-up, or misdiagnosis. 

It was not. 

More acronyms and an HSG and an AMH confirmed my fertility. And so, we were given a long shot and another new word, “microTESE.”

Microsurgical testicular sperm extraction is a procedure where tissue is mined for healthy sperm. It requires a surgeon and a specialized staff of embryologists who spend up to 24 hours examining the tissue under a microscope with painstaking dedication. If they find even one single sperm, we might have a chance at a biological child. 

It would also require me to do IVF, a “synchronous cycle,” they called it, with an egg-retrieval scheduled within 24 hours of the microTESE so any sperm found could be used immediately. Timing mattered. Our doctor advised my now-husband’s sperm would never survive a freeze-thaw cycle. That is, if they found any at all. In fact, we would need to be prepared with donor sperm in the likely event the microTESE is unsuccessful. 

While infertility can make you feel frozen in time, space, decision, the world does in fact keep spinning. All around you, pregnancies are announced, babies are born. And you are there, but somehow outside it all. And people—friends, family, strangers in coffee shops—say things to you like, “you’re next” with a wink and “better get going” and “what are you waiting for?” And you do your best to react with a smile, a nod, or worst of all, a single tear. 

*

Parked on the side of the road, en route to work, I listened as our doctor relayed the plan. “If you want your best shot,” he said, “this is the way you have to do it.” 

My husband and I stayed on the line after the call ended, recapping what we had heard. Sperm would need to appear where we had no sign sperm were being produced. I would need to do IVF to have my eggs retrieved. Aforementioned sperm would need to be healthy enough for fertilization.  Fertilization would need to “take” for embryos to form and they would need to survive, multiply and thrive for five whole days to be deemed good enough to implant. 

Then we’d hope like hell that implantation stuck. Pray like hell to make it to 12 weeks. To live birth. To baby. The plan felt more like a series of miracles—each one requiring the next—and I wasn’t sure I believed in miracles. But it was something.

In mid-November, we boarded several planes to Costa Rica for a belated honeymoon. We arrived at a coastline shrouded in grey, a heaviness that wouldn’t lift. We spent seven days, instead of our planned two weeks, trying to escape the rain and unable to escape our infertility. 

On our first full day on the Nicoya Peninsula, we received an email from our clinic—if we wanted to proceed with our cycle scheduled for January, we’d need to make a deposit. And did we have a donor yet? 

In a late-morning downpour, the roof on our casita began to leak from the buildup of water, a relentless pressure from above. My husband told me he wasn’t sure he could go through with a donor. I hadn’t told him, but I had spent every free moment meticulously scanning every donor site available to us: an exercise that almost felt scandalous. I listened to voices, analyzed side profiles, scoured for anyone who had any characteristics at all that reminded me of my husband. I found none. I wasn’t sure I could go through with a donor either, but I was terrified of the alternative. If not a mother, who or what would I be? What happens to someone when their one true thing turns out not to be true at all?

We stopped calling it our honeymoon after the fourth day of rain and first of many payments we would make to the Pacific Centre for Reproductive Medicine. We wondered if we were doing the right thing; neither of us wanted to acknowledge that a positive outcome would be the closest thing to a miracle.  

*

In the first week of January, I started injecting stims. For 10 days, each night at seven p.m. my husband played Taylor Swift on shuffle while I readied the assortment of needles. He got good at the poking and the whole 10-minute affair began to feel intimate in its own way. We were making a baby. Or trying to. In the second week of January, an anonymous donor spent 16 hours in Vancouver to sign the necessary papers, undergo the necessary tests, and make his donation. In the third week of January, my husband had his microTESE.  

We kept things light in the changing cubby where we both wore hair nets. My husband removed his glasses and wedding ring and donned the medical dress I tied at the sides for him. “I’ve always wanted a daughter,” he told me, a final wish before going under. 

In the waiting room, I kept busy by refreshing my email—as if another SSENSE sale could keep my mind off my husband asleep on the table in the next room. When the surgeon came to find me, not the nurse, I wondered if it was good news or bad. “He’s awake and stable,” he said. “We haven’t found anything yet, but we’re still looking.” While his tone was encouraging, his words were not. 

Back in the changing cubby, hiding any evidence of my waiting room tears, I helped my husband get dressed. “You did it,” I said. “I’m so proud of you.” Still weak, unsteady from the procedure, he cried into my shoulder. “There’s no sperm,” he said. “There’s nothing there.”

My egg retrieval was scheduled the next day. Unable to drive, or do anything aside from ice between the legs, my husband dispatched me with a kiss, and I returned to the same waiting room I had spent the morning prior in.

“You’ll need to sign this release form,” explained one of the nurses. “It’s so we can use the donor sperm.”

So that was it. 

The finality of it all would take hours, weeks, months to settle in. I swallowed and nodded, unable to find words. My husband and I had spent the night prior cuddling, him sated on painkillers, Costco fudgsicles, and an ever-rotating icepack; me, just ever-grateful for him. We watched Selling Sunset—Crishelle fighting with Christine, Christine fighting with whoever/whatever—and tried not to think about what was happening in the lab across town. What was or wasn’t being found. We were both pretty certain of the results, happy we had tried, unable to consider anything beyond the next episode of our junk-food show.

“Has an embryologist spoken with you yet?” the nurse asked. Still unable to speak, I shook my head, no.

“Just a second,” she said. 

Mae entered the room. Another doctor in scrubs, face shielded by a mask. The door closed behind her, and though I could only see her eyes, I could tell she was smiling, counter to whatever brave, blank face I was managing to assume. 

“Okay,” she said. “We’ve found about seven to 10 viable sperm from your husband’s sample so far. We’re going to keep looking for a few more hours until your eggs are ready.” When my eyes began to water, she pulled down her mask, confirming the smile. “This is really good news,” she said. 

Moments later, I was escorted into the surgical room. Counting backward in tears, I thought of my sweet husband at home, numbed on painkillers that were more for his heart than anything else. It may not have been 200 million, but it was seven to 10. And we just needed one.

In February, we waited. And it occurred to me that even though male factor contributed to infertility in about 50 percent of couples unable to conceive, fertility would still always be a woman’s problem to bear. No matter her health, her age, how plentiful or good her eggs, how appropriate her choice of a husband, fertility is her body’s problem to solve. 

I prayed to my pillow, my womb, any God that would listen, to please let my body have the answers. 

*

In March, on the day my husband turned 40, we opened an online test result that told us I was pregnant. 

And tonight, it’s February again. And as I rock our three-month-old to sleep, there’s a moment he wriggles free from the nook in my arm and looks up at me. It’s raining outside and the drops lap at my bedroom window competing with the sound machine every mother I know told me we needed. And our baby smiles a smile I know so well. One that starts in his eyes. And I know exactly who I am. 

Reanne Hasek-Watt is a writer and the VP of Voice at Aritzia, where she shapes the language of a leading global fashion brand. Her essays and short fiction have appeared in independent literary journals. She lives in West Vancouver with her husband, two children, and a dog who sheds constantly. You can find her at @loveleighree on Instagram.