Imagine that you were smart, and that you demanded the best of yourself at work and at home. That combination meant that whenever you applied yourself, you were successful.Imagine how you felt when that changed, and neither diligence nor drive could secure the one thing you wanted most. That was the situation facing Edmonton’s Vance Bosch when he discovered he was infertile, and that he was the reason his wife, Morgan Bosch, could not get pregnant.“It was such a shock. I felt numb and disappointed,” recalls Vance Bosch, 34. “I tried to block it out. I didn’t want to talk about it or express how I was feeling about it.“I went home and cried by myself. I hid in bed. And that’s not like me at all. I’m usually very active, outgoing, I want to be with people. Just blocking myself in the house was really uncharacteristic.”Infertility has been a growing problem for the last several decades, affecting about one in six couples. The rise can be linked, in part, to maternal age as women and couples defer child-rearing to concentrate on establishing a career, or getting their finances in order. Women’s eggs are less viable as they age, but there is also growing evidence that the viability of male sperm decreases with age, too (though not nearly as dramatically).Furthermore, a meta-analysis of studies on sperm count published in 2017 in the online journal Human Reproduction Update notes that sperm counts in Western nations have been in a free fall, plunging more than 50 per cent between 1973 and 2011.While infertility affects men and women more or less equally, experts note men may struggle more when it comes to opening up about the issue. Edmonton registered psychologist Dr. Terry Karpman, whose practice has focused on infertility for the last 10 to 15 years, says that in her experience, men have a harder time than women talking about their infertility — though she notes that’s also a generalization and therefore not always the case.“Women are generally more in touch with their own emotions and willing to share it. For men, they (may be) feeling it’s a reflection of who they are as a man,” says Karpman. “And it’s harder to share that with people.”“It’s really emasculating, humiliating,” says Vance Bosch. “It’s a huge pride and ego thing … as evolved as we are in this culture, there’s still a long way to go between that toxic masculinity, and having a man accept something is wrong, and be able to talk about it.”
Morgan and Vance Bosch pose for a photo in the nursery of their Sherwood Park home, Thursday April 25, 2019. The couple who were experiencing fertility issues are now 28 weeks pregnant with twins.
David_Bloom David Bloom /
Diagnosing infertilityWe are raised to think reproduction is natural, and therefore easy.“And when that doesn’t happen, couples are surprised,” says fertility expert Dr. Caitlin Dunne of the Pacific Centre for Reproductive Medicine, a private fertility clinic with headquarters in Vancouver and an office in Edmonton. “But, in fact, it affects 15 per cent. It’s a disease and it’s common to have problems.”There is a widely held misconception that most fertility problems reside with women, says Dunne. The truth is that the problem is split roughly into thirds, with one-third of the root cause coming from the woman’s side, and one-third from the man’s. A variety of factors make up the final third of the problem, including issues affecting both partners and “unexplained.”Infertility is diagnosed when there is frequent, unprotected sexual intercourse for a year or longer. Male infertility can be connected to low sperm production, abnormal sperm function or blockages that get in the way of sperm delivery. Genetic conditions, injuries, chronic health problems, a history of sexually transmitted infections and lifestyle choices (such as smoking and excessive drinking) may also be at play. Exposure to pesticides or chemicals can be a risk factor, too.Vance Bosch says that when he and his wife realized there was a problem getting pregnant, it didn’t occur to him, even for a minute, that he could be the source of infertility.The couple had been together for about six years before they married nearly four years ago. By then, they were eager to start a family. More than a year into the effort, with no results, they decided to seek help. Morgan Bosch, 35, got her results back first, and was proclaimed a prime candidate for pregnancy, with great eggs and clear fallopian tubes.Her husband chuckles, now, remembering his reaction to hearing that news.“I thought, ‘Well, that’s funny. I wonder what the problem is?’” Vance Bosch says. “It didn’t even click in that it could be something wrong with me.”But medical tests revealed numerous problems with his sperm. There wasn’t much hope he would be able to father a child the old-fashioned way.“It felt, for me, like a cancer diagnosis. It was such a smack in the face,” he says. “It was a rough appointment. I don’t even remember a lot about that entire day.”Once a man has tests and a diagnosis (which is covered by public health care), there are a few options for treatment, most of which are not covered by the provincial government here in Alberta (nor in most other provinces). Patients must visit a private clinic to get help, such as the Pacific Centre for Reproductive Services. Another Edmonton clinic, Whole Family Health, offers acupuncture and natural remedies to enhance fertility.Some couples will opt for donor sperm. Sometimes sperm can be improved with medication. If the problem is a varicocele, or a swelling of the veins that drain the testicle, a surgical procedure may be required, which is covered by public health care.“We always try the least invasive procedure first,” says Dunne, reached by phone from Vancouver.If a man has a mild or moderately low sperm count, doctors can filter the sperm to eliminate the unsuitable ones, and then insert the viable sperm into the uterus through a catheter in a procedure known as intrauterine insemination, or IUI. This costs about $600 per cycle.“You’re giving them a head start,” says Dunne. “For moderate or mild sperm problems, that can be enough.”The most advanced treatment for male factor infertility is intracytoplasmic sperm injection (ICSI). Doctors extract an egg and inject a single sperm into it, creating an embryo that’s later transferred into the uterus.“Men with very low sperm counts can achieve pregnancy this way and it has revolutionized the way we are able to treat male infertility,” says Dunne. “It is the most effective and, unfortunately, the most expensive treatment.”Each cycle of ICSI costs about $10,000. On top of that, injections are required for the woman so that she will release a lot of eggs per cycle that can be injected with a number of single sperm in order to maximize the chance that a course of ICSI will work. Some people have private drug plan coverage, but otherwise, medication can run as high as $6,000 per cycle.The cost of infertilityThe cost of private fertility treatment means that many people can’t dream about medical intervention. Morgan (who oversees group homes for adults with disabilities) and Vance (an operating partner of two Edmonton restaurants called Central Social Hall) scrimped and saved for two years before initiating ICSI.“We don’t come from money, we had a modest upbringing,” says Vance Bosch. “If we’d had the money, we’d have started the treatment sooner.”The treatment was rigorous, with many early-morning appointments for blood work and ultrasounds. Morgan Bosch had to become “a human pin cushion,” her husband recalls — receiving multiple hormone injections to make more eggs available during her next ovulation cycle. Eventually, a number of Morgan’s eggs were injected with Vance’s sperm. Five of those eggs made it to the embryo stage, and two were implanted into Morgan’s uterus.The Bosch family was lucky; the first cycle worked, and the couple is expecting twins in July.Though full of excitement about the arrival of the twins (both boys), they admit the stress of infertility took a toll.“Initially, finding out that we might not ever be able to have kids, it’s pretty earth-shattering news to hear,” says Morgan Bosch. “Finding out it was Vance and not myself, I felt like I didn’t want to show how upset I was. I wanted to be supportive.”She remembers that he simply wouldn’t talk at first.“He shut down because I think he felt he was letting me down,” she says. “I was trying to be supportive, but in a sense, I was devastated. Because this wasn’t our life plan.”
Dr. Terry Karpman works with families with fertility issues in her psychology practice.
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Opening up about infertilityKarpman, the psychologist, says people with infertility problems have to realize it’s not their fault. Knowing they are not alone can be a comfort, too.“I caution couples not to let this one issue define who you are. This can become all-consuming,” she says. “There is a lot more to who they are as a husband and a friend.”Karpman encourages men to seek support, but it’s not always easy to find. There is a support group for women with infertility issues in Edmonton, but nothing for men. Karpman says the Pacific Centre has considered setting one up, but they aren’t sure men would come. There is an Edmonton Infertility Support Group listed on Facebook.Edmonton’s Daniel Tse, a project manager working temporarily in Ottawa with the Canadian Digital Service, and his wife, Lillian Tse, an Edmonton speech language pathologist, have been on the infertility treadmill for more than six years. He says the stigma around male infertility is “huge.”“So much of the male identity is tied to performance, for lack of a better word,” says Tse.Tse says he and his wife fall into the category of “unexplained infertility.” Both their test results were good, but something isn’t working. The fact that doctors don’t know what the problem could be (Him? Her? Both? Neither?) doesn’t make it easier to talk about. It has been hard to discuss even with close friends, and awkward in social situations (some people who aren’t dealing with infertility joke that it must be great to be having all that sex). But, says Tse, it’s even more difficult to keep infertility to yourself.He says men struggling with fertility issues should talk about it, and earlier rather than later.“I would say, rip the proverbial Band-Aid off as soon as possible and talk to someone. Because the conversations will only get more difficult the longer you wait. Find at least one person. I’m glad I did and I can’t imagine if that wasn’t available. It would it would make it much more difficult.”Vance Bosch echoes that sentiment. Once he started talking about it, he learned there were numerous men with similar experiences.“I built a support network of guys going through that stuff. It started with an old business partner of mine who told me about a couple of friends of his who had zero sperm count, and some of the treatments they went through, and they’ve all got kids now,” says Vance Bosch.“I told my wife, ‘I never noticed Volvos on the road until we bought a Volvo.’ Now that I’m thinking about infertility and talking about it, people are coming into my life. It was super-helpful. I don’t know if I would have made it through without that.”firstname.lastname@example.orgFollow me on Twitter @eatmywordsblog