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June 2004-We were finally settled in the California area and were ready to make our first appointment with the infertility clinic.  There was a two month waiting list to be seen for an initial consultation so we took the first appointment and went on the cancellation list. August 2004-We were seen for our very first infertility appointment, and come to find out our infertility doctor had never had male patient with Cystic Fibrosis.  We discussed our options, and asked for a further explanation of the in-vitro procedure and what ICSI stood for.  We were informed that ICSI stands for Intra-Cytoplasmic Sperm Injection, and it is a new but well established procedure that was first performed successfully in 1992.  The procedure involves injecting a single sperm into the cytoplasm of each egg by using a fine glass needle.  At this appointment we decided that IVF with ICSI was the procedure for our needs.  I scheduled an appointment for the following month to have a female fertility evaluation and blood work.  To see a video of the ICSI procedure, click here.

September 2004-I was seen in the infertility clinic with my husband for my female work up.  The doctor performed all sorts of blood work, which came back normal.  I was also given a hysterosalpingogram which is an X-ray of the uterus and fallopian tubes and allows visualization of the inside of the uterus and tubes.  The purpose of the picture is to reveal any abnormalities of the uterus as well as tubal problems such as blockage and dilation.  I was also sent home with a prescription of Clomid and informed how to take the tests which is described below. I was instructed to call the office on the first day of my period (day 1).   On day 3, I was instructed to come to the office for a blood test.   On day 5, I was instructed to start taking my clomiphene citrate tablets (clomid).       Each pill was 50mg and I took two pills a day for the next 5 days On day 11, I was instructed to come to the office for my final blood test (FSH only), and that is the end of the test. When my Clomid citrate challenge test came back all within normal ranges, we were put on the IVF waiting list and were scheduled for February 2005.  The Clomid Citrate challenge test was administered to me in this situation to rule out any female infertility problems as there would be no sense in going through with the IVF if my body had some female fertility problems.  I am only 21 so don't be alarmed if you clinic requests you to do this test, it is pretty much standard now for all ages.

October 2004-Mark and I returned to the Urologist to review his second set of laboratory results.  To our dismay, his testosterone level had plummeted to below the normal range and his FSH and LH levels weren’t detectable at all.  This was very discouraging news to us, and the doctor began asking us all sorts of questions about what Mark had changed in his schedule, what supplements he had been using and if we could recall anything that might be relevant.  We couldn’t come up with anything, so we were told that the sperm retrieval would be postponed until Mark’s levels normalized again.  We were sent home with instructions to repeat blood draws at the lab every 2 weeks. October 2004-We returned to the doctor’s office following the blood draw to go over the newest results.  Once again the doctor had very discouraging news, Mark’s testosterone level was even lower than the previous test and the LH and FSH were still undetectable. I had done a lot of thinking to what we had done differently and the only thing I was able to recall that had changed is that Mark was started on Colistin in the middle of September.  I presented this fact to both his Cystic Fibrosis doctor and the Urologist, neither of which seemed to think that one had anything to do with the other.  That being the case, I decided to do some research myself and was able to find information that colistin has not been put through any type of reproductive testing.  For example, with both Pulmozyme (DNase) and TOBI, lab rats were given 20 times the normal dose, with no adverse fertility/reproductive reactions.  Both my online research and reading the information leaflet inside the colistin yielded no information on reproductive results, or if any studies were performed.   November 2004-For the second time for the second month in a row, we trudged back to the Urologists office all the while hoping that a miracle had happened and the levels were all normal again. Unfortunately, yet again this was not the case for us.  It was also at this appointment that the doctor informed us even if Marks testosterone, FSH and LH levels normalized in the near future, we wouldn’t be ready for a semen extraction prior to our In-Vitro scheduled for just three months later in February.  This was devastating news to us, just when we were getting so close to our dream of finally becoming parents, it was slipping away from us and the worst thing was that there was no medical explanation for what was going on.

November 2004-Mark and I sat down and made a decision against the better judgment of his Cystic Fibrosis doctor.  He decided he would discontinue his Colistin and see if that assisted in the normalization of any of his blood levels.  We figured that nothing else was making sense so we might as well see if this changes anything. December 2004-Mark was scheduled to have a blood draw this month,     but we decided to have the first “post colistin discontinuation” labs in January, to give his body enough time to hopefully recover and to help prevent us from getting discouraged because nothing immediately changed. January 2005-We choose a new Urologist to work with during the time away from blood draws and infertility doctor visits and ventured to our first appointment with “our” new Urologist this month.  The doctor ordered a Testosterone level, FSH and LH to be drawn for Mark first thing the next morning, and also gave him a prescription of Clomid.  Studies have shown that in some men with abnormal testosterone levels (and therefore decreased sperm production) clomid for the male can sometimes improve sperm count or motility.  The doctors were pretty confident that this abnormal testosterone level (as well as FSH and LH being abnormal) didn't have anything to do with his CF, but they couldn't identify what it was related to.  Click here for further information on Clomid use in males. Our Urologist called us with the results the following day, and I could have jumped for joy!  Although his testosterone, FSH and LH levels were not within the normal range, they had increased by almost 100 units since the last blood draw in November.  The urologist asked us to repeat the blood draw in the beginning of February and come back to see him sometime the week of the next blood draw. February 2005-We ventured to the Urologists office the first week of February and were again given wonderful news!  Mark’s Testosterone level had jumped again-this time by over 100 units and he was in the lower portion of the “normal” range.  His FSH and LH levels had completely normalized-finally we were making some progress.  We were informed that a “normal” testosterone cycle in a male’s body averages about 90 days.  The doctor relayed this information to us because he said now that Mark’s body is producing testosterone, FSH and LH at almost normal levels again, we will be able to do a sperm retrieval 90 days or more AFTER they completely normalize.

March 2005-We were offered the option of doing testicular mapping  which is a NON-SURGICAL technique that detects “pockets” of isolated sperm production and once these areas are located a MESA procedure can be use to find and extract the sperm for IVF and ICSI.  Mark and I decided that this would be a good procedure for our situation and in a long shot attempt; we had the doctors office request a pre-authorization for the procedure from our insurance company.   We hadn’t decided if we were going to use the mapping procedure if TRICARE (our insurance) denied the procedure.  We really needed to save all of our money for the actual retrieval because that would certainly not be covered.  During the third week in March, we received a call from the doctor’s office informing us that TRICARE had authorized the mapping procedure.  We were ecstatic and immediately begin calling our parents and siblings to give them the good news that we were one step further in the process.       There are quite a few different procedures that can be used for sperm extraction and they are: PESA which stands for Percutaneous Epididymal Sperm Aspiration and consists of “using a needle to penetrate the scrotal skin and draw small a small amount of sperm from the epididymis” (Dr. Martin Bastuba).   The MESA (Microsurgical Epididymal Sperm Aspiration) procedure gathers sperm from the epididymis for use with IVF/ICSI.  The MicroTESE stands for Micro-Testicular Sperm Extraction and is a “very exacting search for sperm under high magnification in cases of extremely low sperm production” (Dr. Martin Bastuba).  After much research and discussion with the doctor, we concluded that the MESA procedure would be best for our situation.    April 2005-We went in for Mark's Testicular mapping and after they had shaved him and prepped him for the procedure, it was requested that he sign a consent form.  The form indicated that we would receive separate billing from the Laboratory that the testicular tissue was being sent to.  This was quite a shock to us as we thought the entire procedure and lab fees were covered so we phoned the laboratory to see how much of a fee was associated with this procedure.  We were informed out doctor sends in 11 tissue samples per testicle and each side is $830 for a total of $1,660.  At this point, we regrettably informed the office that we could not afford to pay that lab fee as we were saving our money for the MESA procedure and the In-Vitro procedure.  They were very apologetic at the fact that we weren't previously informed of this information (a miscommunication) and asked us if we would like them to pre- authorize the laboratory portion of the procedure (nobody was quite sure why it wasn't done at the time of the procedure authorization but that's water under the bridge).  We informed them that we would like to go ahead and try to have that done, but the authorization and procedure would need to be done by the following week because the MESA retrieval was scheduled for just a little over 2 weeks later.  We were told that the results take about 2 weeks to come back from the lab, so if we didn't get it done the following week, it would be pointless to have it done at all.  And we were unable to reschedule the MESA procedure because Mark had plans to go out of town for the next few months.  We went home and were going to wait for Monday to see if anything was authorized yet.

May 2005-The remainder of our journal can be viewed by clicking here, or the forward button on the bottom of this page.