Secret men's business
October 3, 2004
Trent Humphries with his children Christian, 9 months, and Alexandra, 4.
Photo: Craig Sillitoe
Stories of men's experience of IVF are rarely heard, although they often involve heartache, humiliation and pain, as Liz Porter finds.
Army aeronautical engineer Trent Humphries, 34, knows how to stop a blokily competitive conversation about footy injuries dead in its tracks.
"I just say, 'How about eight stitches in the scrotum?' " says the father of two.
"They say, 'What do you mean?' I say, 'To go sperm fishing, for IVF. The doctor digs around (in the testicles) with a needle, looking for sperm'.
"And they go, 'A rrgh'."
"I win. It beats a black eye. It even beats a broken leg."
Last year, Humphries spent considerable time working up a more subtle way of explaining his experience of having an open testicular biopsy. He had been invited to talk to an audience of men on the IVF program about his experience of infertility and to explain the operation that helped him overcome it. Not surprisingly, he remains an enthusiast for the procedure, which has enabled him to father two children, a daughter aged four and a son nine months old, and help produce two more embryos, which he and his wife then donated.
But he has never had the opportunity to tell any other fellow male IVF clients his war stories, including his visit to an army medical clinic a few days after the procedure, when he thought he'd popped a stitch.
Humphries' "me and my testicular biopsy" speech was going to be one of three at an information night about male fertility, organised by Melbourne IVF. The occasion was advertised to all 400 on the mailing list and flyers for it were posted at the Melbourne IVF clinic. But not a single RSVP came in, and the night was cancelled.
Humphries was more disappointed than surprised. As the husband of the former head of an IVF support group, he had already noticed that most men on the program seemed to consider IVF "women's business". The turn-up at support group meetings and social occasions was usually 80 per cent female. And, in more than five years' involvement with IVF, he had never heard another man even raise the subject of male infertility, let alone men's feelings. Men's talk was always about their wives' medical issues.
"Men who have fertility problems worry about not being regarded as real men."
Why do men continue to exclude themselves from this conversation? Humphries pauses. Men who have fertility problems, he says, worry about not being regarded as real men. "And women network better and are better at supporting each other."
At any one time, around 4000 Victorian men are enrolled in an IVF program at one of 15 hospitals across the state. Each year, 40 of them will undergo the drastic open testicular biopsy procedure that Trent Humphries had (see box, next page). Another 400 men will have a shot of local anaesthetic in the scrotum before a less dramatic but similarly confronting operation known simply as testicular biopsy, during which a fine needle will be used to harvest sperm that do not find their way into the ejaculate because of blockages, caused by vasectomy, infection or congenital problems, in the sperm transportation system.
The widespread perception of IVF as women's business contradicts the facts, says Dr Rob McLachlan, consultant to Monash IVF and director of clinical research at the Prince Henry's Institute of Medical Research.
"In half of the cases of infertility there is a male component," he says. "A third of the time, the problem is exclusively the male's."
Yet men's stories of IVF are rarely heard. In cyberspace, the voices are almost exclusively female. Some of the thousands of items posted on internet IVF news groups and bulletin boards about drug side effects, frustration, infertility and grief are signed with two names. But the inevitable references to "my husband" suggest they have been written by the female half of the couple.
In the real world, women are the ones coordinating IVF support groups and contributing their stories to newsletters. Women are also the ones who make the phone calls for IVF appointments, even when they're arranging for a counselling session to help their partner.
So how different is the male experience of IVF from the female perspective? The only physical experience for the majority of men on IVF programs is their monthly sperm "donation" made in a hospital room furnished with porn magazines and videos, the "wankatorium", as 48-year-old Graham Burge puts it.
"Putting a needle into a man's testicles is always a big deal," says McLachlan. But some men, he says, also find the comparatively simple-sounding "donation" process unbearably stressful. "Very occasionally we have to give them Viagra, they get so worried about the performance process."
"Paul", a 45-year-old corporate sales executive who has attended two different hospital clinics, says the set-up of the donation environment seems purpose built to foster male anxieties.
"You're thinking 'I've got 15 minutes here and I'm trying to work the video (on one occasion he couldn't and found himself watching the news.) And everyone's outside and they're thinking, 'It's been 15 minutes and he still hasn't managed'."
Walking out afterwards is even worse.
"You feel like you've gone unidentified into an adult book store, thinking 'No one saw me' and then you've come out with a bag that says PORN on it.
"It's like everyone is waiting for you. And when you leave (after the sample has been checked), you say, 'Right, thanks, in a deep manly voice'."
The available videos, Paul says, don't always reflect the average man's taste such as one film where all the men are wearing ugly carnival masks. Later he asked a female specialist if a woman had been in charge of video-buying - and his suspicions were confirmed. One of his friends was less critical.
"He asked me, if I ended up getting the 'fireman' video, could I tell him how it finished. He never got to the end of it."
The inevitable gender-based inequity of pain for IVF couples only adds to the overall tensions of the process. As men say, with guilt in their voices, their partners are the ones having the invasive medical procedures.
While a man is giving his sample, his partner will be somewhere else in the hospital, under general anaesthetic, for the harvesting or "pick up" of a crop of eggs whose growth has been stimulated by a series of hormone injections.
Paul's partner "Lynda" says she was initially less than sympathetic when he complained of pre-donation nerves. "I was just looking at him, and thinking, I've been injecting myself, I'm puffed up, my ovaries are like two watermelons, my boobs are swollen, I've got to take off my nail polish and go under general anaesthetic - and I'm frightened of general anaesthetic. And that's what you're worried about?"
FOR Stella and David, both 25, of Wheelers Hill, the cost of IVF (about $1800 a cycle, with $600 for ICSI and $650 for a frozen embryo transfer) means renting, living with shabby furniture, and forgetting about saving for their own house. Married for two years, the graphic designer and supermarket administration worker started trying for a family immediately because they had been told that Stella's endometriosis might make conception difficult. IVF was recommended after they discovered that, because of an antibody problem, only 4 per cent of David's sperm was effective.
The couple rank finances as a major stress. Other couples suffer extra financial difficulty when the wife cuts back on work to make more room for IVF routines and complementary medical programs, designed to aid fertility.
In the meantime, after two cycles, the pair have also become painfully aware of the way that IVF increases stress, removing sexual intimacy from the process of trying to have a family.
Sexperts and psychologists repeatedly emphasise that sex is fundamental to the way men express and understand love. With female libido one of the first casualties of extended fertility treatments, men can feel marginalised and alienated.
"I can really understand how split-ups happen," David says.
"It affects your sex life," says Stella. "Sometimes you're just so physically and emotionally drained you say 'What's the point? We're trying to have a child. But having sex isn't going to get us anywhere. So I'm not interested'."
"Then I feel unloved," says David, "and think 'Well, maybe she doesn't like me any more. She's just (with me) to get the kid'."
Paul and Lynda's sex life has also suffered. "I could say we have great oral sex. We talk about it," Paul says.
Now, after two naturally conceived miscarriages and four failed IVF cycles, they are having a break from the program. But there is no question of giving up. "We are determined that we will become parents," says Paul. But when they resume IVF, it may be using a donor egg .
The main purpose of the break is to give 48-year-old Lynda's body a chance to recover from the hormonal treatment. Paul also speaks passionately about their need to reclaim their sex life and their happiness, both compromised by the stress of their all-consuming IVF regime.
Sex certainly isn't available as a comfort after a failed cycle, he says. "Then you have the period, and the emotional side of all the drugs still in the body. You can forget your sex life. And then you do forget about it. Before you know it, it's gone. With all the drugs, Lynda just doesn't feel like it. So I think 'Whatever', and go back and do my work. And you lose interest in it yourself."
At times, Paul has found himself wondering if the cost to his relationship was simply too great.
"But then I reminded myself it was because we want to have a family. I want to be able to have children and we just have to work harder at it.
"We go to counselling together and we talk about our feelings and listen to each other. The counsellor makes me feel comfortable that I'm feeling what the other guys feel.
"Other than delivering the sperm, I feel out of the picture in feeling what Lynda is going through. For Lynda, the whole focus for her is on this. And that's where it can develop into problems in the relationship. Me? I go back to work, I do other things . I have other things on my mind. And Lynda has all the hormones going through her body and it can become difficult."
The hormones provide a further disruption to marital harmony. Men speak of them with fear in their voices, shocked as they are (as women are) by the effect they can have on mood. "A bloke at work told me he'd had pots thrown at him," says Paul.
"It's like PMT times a million," says Lynda. "I cry at the drop of a hat, become extremely irritable. I know, I'm revolting."
Men are the inevitable punching bag during hormone-induced mood swings, says Peter Tainsh, 36, a retail property development executive, whose wife Julie has been having IVF treatment since April last year.
The word "rollercoaster" recurs as men describe the successive phases of anticipation, elation and disappointment in every cycle. Unlike conventional attempts at conception, where each month offers only one window for raised hope and crushing disappointment, IVF brings a series of anxiety-ridden stages, with the first step being the "pick up" of a good harvest of eggs.
But this wild ride is one where, as Peter Tainsh puts it, the man is "in the back seat". Or in the passenger seat without a map. Or back at the rollercoaster's departure station, watching. Every conversation with a male IVF veteran throws up its own vehicle metaphor.
"Men have little real control," says Tainsh. "I don't take the drugs, have my body probed, apply the patches, eat certain foods, jab myself with sharp instruments . . . have my hormones altered, feel tired, become uncontrollably moody. Although sometimes, as a man, I wish I could - at least to better understand what it is my wife really feels."
Tainsh wrote an article explaining his sense of never knowing what was the right thing to say to his wife and sent it to the Melbourne IVF support group newsletter. He added a list of do's and dont's , including "try not to jump into solution mode for every problem. Men are very good at this, and, according to my wife, this is really annoying". As Tainsh drinks a coffee in a shopping centre cafe near his office, his eyes follow a sudden succession of pregnant women shoppers.
"Sometimes we find if difficult being around friends who have children," he says. "Especially at Christmas. They have something that you want so badly - and you can't just buy it from a shop."
The different coping mechanisms of men and women are the source of much conflict between IVF couples, says Rita Alessi, head counsellor at Monash IVF. In her 11 years of counselling IVF couples, she has seen only a minority split up, with IVF tending to be the trigger rather than the cause. Sometimes the pressure of IVF might reveal that the man is less committed to having a child than his partner. But in most couples she sees the desire for children is equal.
"The whole experience of infertility is a significant life crisis," she says. "This might be the first time, as a couple, that they've been confronted with this kind of stress."
Couples tend to hit the wall with the third unsuccessful cycle. Women, whose lives have been dominated by the process, see their partners as being insufficiently supportive. Gender differences then kick in over the definition of support.
Men's tendency to be problem-solvers is stymied by infertility, where most of the issues are out of their control.
Meanwhile, women want to deal with their grief and frustration by talking about it, and men become frustrated by the process of talking about the same thing, over and over. Instead, they prefer to "withdraw and internalise" and to throw themselves into work or sport.
"The woman needs to vent (her emotions) and this triggers his pain. So he withdraws - and she tries to draw him out - and they clash.
"Misunderstandings happen. She says, 'You're not crying, so you don't care'."
Roger Cook, senior lecturer in psychology at Swinburne University and infertility counsellor at the Melbourne assisted-reproduction centre (based at the Mercy Hospital), says that it is a myth that men don't talk about IVF; they just talk differently.
"Men don't go into things in the same level of detail that women do," he says. "They might just make a joke about the quality of videos in the room (where they have to give their sample). That is the male way of acknowledging that there is a problem."
It's no surprise, he adds, that men attend groups only when with their partners, and that they don't set up their own IVF support groups. "It's just not their style to do that." Nor is it their style to pick up the phone and ring a counsellor."
FOR Brian Moran, whose marriage broke up a year after his wife's sixth failed IVF cycle, a main difficulty was what he now sees as the impossibility of truly empathising with emotions he couldn't feel.
An entertainment agent and a onetime Lifeline counsellor and trainer, Moran describes himself as a man with "a reasonable capacity to be sensitive to emotional issues".
"But I exhausted that," he recalls. "The injections were pumping up the hormones. I tried to give emotional support, but whether I did enough . . ." His voice trails away.
Now, 14 years after their separation, he recognises that his response to the repeated failure of cycles was a textbook example of gender differences.
"I'm very practical and I probably put my energies into the things that I could get a grip on." He waves a hand towards the large renovated living area of the Ivanhoe home he shares with his second wife and their two young children. "Looking back, I could have put less time into the other stuff," he says.
While his ex-wife nominates the wash-up of their IVF experiences as the main cause of their marriage failure, Moran sees IVF as one of several contributing factors. "It was how we coped with the pressures of IVF. The pressure it put on the relationship was traumatic. The failure of it was emotionally traumatic for both of us."
Rita Aless says some men are acutely aggrieved by the fact that nobody asks them about their grief and disappointment.
"Sometimes their pain goes unacknowledged. Everyone asks them, 'How is your partner going?' I've had men sitting in sessions weeping, and they could never do that with that their family or friends."
But throughout the 10 years that Graeme Burge and his wife Dee went through 13 unsuccessful IVF cycles, he never wanted to have a counselling session.
"If I had the opportunity to go to counselling, or do something else, I'd do something else," says this engineer with his own transport company.
His marriage, he says, survived the heavy emotional weather of IVF, emerging in even better shape. He and Dee were a team, with him happily agreeing that she was "more equal" when it came to IVF decisions.
Partnerships where the man dominates, he believes, will founder during IVF.
"There are only two outcomes (to failed IVF). You either separate, fall apart and disintegrate as a team, or you get closer," he says. "I am lucky, I am married to the best lady in the world. I didn't marry Dee for children but because I love her."
Despite their lack of success on the program, Burge kept up connections with the group IVF Friends "to give something back" and still speaks at occasional presentations. At these occasions, he says, he shares his store of funny of embarrassing IVF stories and "wankatorium" anecdotes.
Although he loves a glass of red and a slightly blue joke at a dinner party, his IVF stories never get an airing.
"It just doesn't fit into the genre," he says. "I don't know why, but blokes don't talk about it."
Burge is clear that the IVF experience has changed him, as a man, in ways that friends and relatives don't seem, to him, to have recognised.
"As soon as we stopped, I lost all my ambition to be the best CEO in the world. There was just no need." Without a family to support, and future educations to provide for, his hunger to run companies seemed suddenly pointless.
Married in 1986, Burge and his wife built a house in Warrandyte with five bedrooms and a rumpus room for the family they had planned. The couple still live there with their dogs, reconciled to a child-free existence.
"I have a successful marriage, a nice lifestyle, how can I call that failure?" he says. "Am I upset about not having kids? If I had one now, I'd go loopy in a month. I do get all emotional, but I need a few beers to do that."
He pauses, his eyes moist.
"The hard thing is not knowing if I'd be a good father or not."
Only too aware of all the things he's missing, Burge ticks them off.
"Taking your kids to the footy, to the cricket, to the movies, screaming at them for doing the wrong things, for pranging the car." At 20, he says, he was looking forward to being 40, and sitting in a pub with his son or daughter.
But, except for talking to his wife, the conversation about missed fatherhood has largely been an interior monologue. "I've never spoken to one of my friends about what its like not to be a father," he says.
"I've never been approached or asked how I feel about it, by men or by women."
Not being asked, he adds, has never bothered him.
"I've never raised it with anyone either." He laughs. It's a bloke thing.