Epilogue Part I
“How brain cancer compelled Ashley and me to seriously examine, consider, and re-frame our future plans and dreams. Then PREPARE for them.”
Lots of sperm.
Now that I have your attention…
As we all should remember from high school biology and sex education classes, in order for a new human life to be created a wriggly, tadpole-like sperm cell typically has to swim up to a ready and waiting egg cell, slam head-first into it and, “BOOM!” Life! USUALLY, this marriage of sperm and egg is the result of an unplanned, romantic, and passionate encounter between two willing partners; a truly intimate dance and epic game of chance wherein the male sex partner deposits literally millions of sperm cells directly into his female partner’s vagina.
Here, these foreign invaders begin to swim furiously upstream while fighting an uphill battle against a formidable immune system opponent within the vagina’s extremely hostile environment. Each individual sperm cell jockeys for position as they elbow and muscle their way through the narrow choke point of the cervix and enter the wide open world of the uterus – the “Promised Land.” It is in this grand arena that the peloton of millions of sperm cells will make its final approach towards the Fallopian tubes where a (usually) single ovulated egg, or ovum, awaits fertilization. Out of the massive horde of spermatozoa, one and only one will cross the ovum’s membranous finish line first and earn the right to join its twenty-three chromosomes with those of the egg and form a complete unicellular zygote. To refresh your memory, this zygote will then begin to divide and subdivide itself over and over again through the process of mitosis to become a cluster of human cells known as an embryo (check out the photo attached to this blog post to see Kai Amani Paonessa as an embryo in a petri dish – his first official baby picture!).
Now, what if the male sex partner cannot produce ENOUGH sperm cells to overcome the vagina’s nearly impenetrable immune defenses such that at least one lucky spermatozoon will have a fighting chance at egg-fertilization glory? What if there ARE enough sperm, but they simply aren’t HEALTHY or STRONG enough to complete the long and arduous journey ahead? (“Damaged goods,” as I like to call them, sardonically.) These are just some of the questions that I was faced with on July 13th, 2015 – the day that I was diagnosed with brain cancer.
When Ashley and I first started dating in the summer of 2009, we had many of the typical “getting-to-know-you” conversations about our hopes and dreams for the future and our individual visions for our lives. Fortunately for us, we aligned perfectly on several key points: we both wanted to get married, build a home, start a family, and travel and experience the world. Knowing that there was a very real possibility that my brain tumor’s pathology report could reveal that the tumor was malignant in nature and that I could be faced with the prospect of cancer treatments of unknown type, intensity, and length, Ashley was prepared to ask my neuro-oncologist, Dr. Henry Friedman, some hard questions about what this all would mean for our plans to start a family in the near future, questions that had not yet even crossed my own mind as I still was not completely attuned to what exactly was happening in my life.
What potentially damaging and negative consequences could or would these potential treatments have on my own fertility and ability to father a child, and would we need to do something radical like collect and freeze some of my currently healthy sperm before it was too late?
Thankfully, Henry was already one big step ahead of us; as we sat across the table from him at the Preston Robert Tisch Brain Tumor Center at Duke, he seriously recommended to us that we bank some of my sperm while it was still clean and I was not yet undergoing any kind of chemotherapy treatment, “just to be safe” in case we were planning to get pregnant post-chemo. At that moment in time, the two of us relatively young thirty-four year-olds could not believe that we were actually having to have this conversation about whether or not we should bank sperm because one of us was about to embark on an unanticipated and uncharted journey through cancer treatment. Henry’s nurse practitioner went ahead and scheduled a consultation appointment for us at the Duke Fertility Center for the following week, an appointment that we simultaneously dreaded and regarded as one of the most important that we might ever have.
At the Fertility Center we found ourselves having some rather lengthy discussions with several staff members about the various components of the sperm banking process. First, we met with a financial specialist who laid out for us the up-front costs of collecting, testing, and packaging my sperm samples; ongoing annual storage fees for the freezer/storage facility that they contracted with somewhere in Florida; shipping and handling fees to get the sperm samples there safely; and insurance fees should something happen to the samples en route to the storage facility or AT the storage facility (think “loss of power to the freezer during a major hurricane in Florida,” which actually DID happen at one point, but that is a story for another time). Oh, and “spoiler alert,” none of this was going to be cheap!
Next, we met with a legal specialist who had us sign so much paperwork that you would have thought we were taking out a second mortgage and buying another house! In reality, these documents addressed legal and ethical issues related to the sperm specimens, issues such as who would have the power of attorney over them should something happen to either myself, Ashley, or both of us before we get the opportunity to use the sperm ourselves, and what should be done with the specimens in the event that we should both perish – should they be donated to someone else who is trying to get pregnant, or should they simply be destroyed? Who knew that freezing your own sperm could be so complicated?!
Last but not least, we met with the “logistical” specialist who presented us with options for the actual collection of my sperm: I could either go into the clinic and do it the classic TV way, in a small room with a stack of Playboy magazines and a cup; or I could get the “home collection kit” and do it in the privacy of my own home. Being the relatively modest and private person that I was at the time (clearly, a lot has changed since then), I opted for the latter, not realizing that it was not going to be as fun and easy as it sounded. Per the collection kit’s instructions, after masturbating into the provided clear plastic screw-top cup, I was to immediately put it on ice in a cooler, get in the car and drive the goods back to the Fertility Center within forty-five minutes of ejaculation. Never in my life had I been forced to masturbate under duress!
This was… different. It is surprisingly difficult to get into and maintain the “right” mindset for this task when you know that you’re “on the clock”; this is no longer a relaxing and pleasurable experience, but rather a monumental task. Our future prospects for starting a family and fulfilling one of our big life goals as a couple was suddenly hanging in the balance. It was then my great responsibility, my PURPOSE, and my JOB in that very moment, to jerk off into that plastic cup if we were to have any real hope of fulfilling our dream of starting a family in the future. No pressure.
One week later we received a phone call from the Fertility Center; the sperm I submitted tested perfectly for motility and numbers – they were strong little swimmers, and there were plenty of them! (Yaaayyy, Gold Star!!) A total of nine specimen vials (this number will become important in a later blog post) were filled, packaged, and prepared for their upcoming vacation of unknown duration in a freezer in Florida. Oh, sweet irony…