Essentials for men

Guys, thank you for your attention! When we piloted this magazine we found 70% of men didn’t read any of our patient information. Their partners said they were a great support, but obviously not when it came to being well informed. While this section is not a substitute for the full monty*, we hope it will provide some useful shortcuts.

Crib sheet*

Subject and where to find it in this magazine

Just look up the table on page 16 to see what’s what

Hormones and medications, page 16

Basically, there are four types of treatment: wait for nature, use a fertility pill called clomiphene or letrozole, intra-uterine insemination (IUI) and in vitro fertilisation (IVF). IUI has the option of using donor sperm (DS). IVF also gives the options of using donor sperm, donor egg, or surrogacy (donor uterus).

Types of treatment, page 20

A woman’s fertility falls significantly from the age of 35, and virtually disappears by the age of 45. Fertility treatments such as IVF can’t overcome the effect of a woman’s age – only using someone else’s eggs (donor eggs) can do that. Up to the age of 50, a man’s age does not seem to affect the success of fertility treatment. Calculate your chances of a baby now and in a couple of years time using the biological clock on the FA website, or on www.biologicalclock.co.nz Read the 6 ‘tips for him’ on page 31. There is increasing evidence that men smoking, being overweight, and/or not having enough antioxidants in their diet can reduce the pregnancy rate in IVF and probably other treatments too. Lots of men are now taking Menevit which contains a combination of antioxidants. Fertility treatment can be an emotional roller coaster, and men and women often react differently. Guess who wants to talk and who prefers to bury themselves in work, retreat to the ‘man cave’ or something similar. The box at the bottom of page 35 has practical tips for partners, and so does the box on page 43. Sadly a lost cause for most men. BUT we wish we got a dollar every time a man says ‘wish I’d done that sooner’. Nearly every man will need to do a semen analysis as part of fertility diagnosis. A test for DNA fragmentation in sperm is also becoming common. Have a look at our Fertility Fact sheet on Male infertility and semen tests on our website or on www.fertilityfacts.co.nz

Importance of age, page 26 Lifestyle, page 31 Emotional support, page 34 Counselling, page 36 Semen tests, page 40

As part of your fertility investigations, your doctor will select what tests to do based on the chance of a particular test picking up something useful. Fast forward to a review consultation with your doctor if you have not become pregnant after 2 or 3 courses of treatment. The doctor says, ‘Let’s do some more tests’, and one of the tests shows something up. You may wonder ‘why didn’t the *!@#* doctor do that test in the first place?’ If you are the sort of person who thinks, ‘I’d rather do all the tests at the beginning despite their cost and despite a low chance of some of them being useful’ – then please tell your doctor at your first consultation. You and your doctor need to be on the same page. The diagram on page 40 illustrates the relative costs of various tests and the chance they will pick something up.

The problem with tests

You need to give written consent to the use or disposal of your sperm and any embryos created using your sperm. If you want to store sperm or embryos created from your sperm, for more than 10 years you will need to apply to the ethic committee for an extension before the 10 year anniversary of storage comes up. When embryos are created using frozen sperm, the 10 year period starts when the sperm was frozen. We won’t start treatment until we have received the signed treatment consent form. Your consent form records the important decisions that you have made about that cycle or course of treatment, as well as giving us permission to go ahead.

The law, page 44 Consent, page 45

About 10% of cycles are stopped before completion for one reason or another. This is not a total loss because we usually learn something useful for your next cycle. But it is always a disappointment at the time.

Potential problems with treatment Clomiphene, page 48 IUI, page 52 and IVF, page 67

Men have it easy unless they need surgical sperm retrieval (SSR) from the testis. If you are having SSR, you must read about the risks and side effects on pages 69–70 it is only half a page long. We have further information on sperm microinjection and surgical sperm retrieval in a Fertility Fact sheet.

Risks and side effects, page 67

For simpler treatments such as Clomiphene or Letrozole, IUI and using thawed embryos, we invoice at the beginning of the cycle and require payment before treatment finishes. For IVF, we invoice in three steps - when we issue the medications, before egg collection and embryology, and before embryo transfer.

Paying for treatment, page 81 Also see our separate fees guide

Pretty much the same for both treatments. We’ll tell you when we need it. You can produce it at home or in the clinic. It is best if we receive it within 60 minutes of production. One day’s abstinence prior is best. Follow the instructions on the semen analysis form that comes with the pot. When you drop off your sample, give us a telephone number in case we need to contact you and write your name on the form and the pot! (We’re not joking – some men forget.) If you are concerned about being away or possibly having difficulty on the day – discuss this with us well beforehand so you can consider banking sperm as a backup. In case you haven’t guessed, it is waiting for the pregnancy test. Re-read the boxes at the bottom of page 35 and on page 43, and the section ‘Waiting for your pregnancy result’ on page 85, and be gentle on yourself and your partner. Sorry, there are no short cuts. Using donor sperm, eggs, embryos or surrogacy brings an extra level of complexity – sometimes technically, emotionally, legally and in bringing up children. However, we will lead you through the issues (and you don’t have a choice because counselling is mandatory).

Our patient app

Salve is your treatment guide on the go and keeps all your fertility information in one place. The Salve app shares medication and appointments with both partners. So you can stay in touch and support your partner at key stages.

Sperm sample IUI, page 58 IVF, page 84 The hardest part, page 85 Using a donor (sperm, eggs, embryos or surrogacy), page 102

PATHWAY TO A CHILD 33