Bonnie and Josh are the proud parents of a seven-month-old girl, Cece.
When they tell people they experienced infertility issues, most immediately assume the problem lay with Bonnie. That was also Bonnie’s belief when they tried for their first child and were initially unsuccessful. Yet it was Josh who had the infertility issue.
Such stereotyping of infertility as a dominantly female concern is not surprising to their doctor, James Hotaling, MD, a urologist who specializes in male infertility issues and is director of Men’s Health at University of Utah Health. "There’s more awareness of couples having fertility issues where the male can be part of the problem, but it’s still way behind compared to the perception that it’s the female side. It’s better but not where we need to be."
Bonnie and Josh come from large families, both having six siblings. In Josh’s case, he’s the youngest of seven boys. So it was natural for the couple to want to have a large family. They met at a church and got married two years later. A few months after their wedding, they decided they wanted to start trying for a baby.
After four months, Bonnie was concerned that she wasn’t pregnant. Their siblings had always conceived quickly. "I just felt something wasn’t right and that we should start looking into it sooner rather than later," Bonnie says.
Bonnie thought the issue was with her. It never crossed her mind it might be Josh. She went to U of U Health’s Clinic in South Jordan, where a doctor told her he couldn’t see any problems. The doctor requested a semen analysis for Josh, "just to get it off the table," Bonnie recalls.
The analysis revealed that Josh’s semen had no sperm. "Our hearts just dropped," Bonnie says.
Josh works as an ER nurse in South Jordan, but despite his medical knowledge the diagnosis still came as a shock. "My brothers are having kids like bunnies. It’s kind of hard not to feel inadequate."
What helped him, however, was how supportive Bonnie was. "She said, ‘It’s our problem, not yours. We’ll go from here,’" Josh says.
Bonnie argues that, "It makes sense men have infertility problems as well as women. It’s just not something you’re going to hear as much. People don’t talk about it. Men can be a little more reticent." Indeed, Hotaling says, men seek healthcare at a rate of 40 percent lower than women. And when it comes to fertility, they shy away even more. "Men see infertility as a sign of weakness, as a reflection on their manhood."
Hotaling diagnosed Josh with a condition called spermatogenic failure. In this condition, the testicles are not making sperm normally and, if sperm is present, it is only being produced in a few pockets within the testicles.
Nevertheless, Hotaling told the couple, they might still have kids. He performed a highly specialized surgical procedure called a microdissection testicular sperm extraction (microTESE) which involves taking a patient to the operating room, putting them to sleep and using a high-powered operating microscope to search for pockets of sperm.
Josh thought he’d wake up from the procedure and Hotaling would tell him he had been unsuccessful. Instead, the urologist located sperm in one of his testicles.
The couple talked to an IVF specialist at University of Utah Health and had one of Bonnie’s eggs fertilized and implanted. When people asked why they were doing IVF, most assumed it was Bonnie who couldn’t have a child. Bonnie didn’t necessarily correct them, since she knew how stigmatizing public perception can be of male infertility. That perception didn’t extend to Josh’s six brothers who while they might tease him about most topics, steered clear of infertility when they learned about it. "They didn’t tease me until I started making jokes about it," Josh says.
A couple of days after the embryo transfer, Bonnie did a urine pregnancy test at home which showed a very faint line. "As the days went on, it got darker and darker," Bonnie says.
On September 16, Bonnie gave birth to Cece. They still have eight frozen embryos in storage and plan to have more children. "In all honesty, it was a lot of ups and downs, a roller coaster emotionally," Josh says. Through it all, though, their relationship only grew stronger.
"Even though it can be painfully hard in the moment, everything worked really well for us," Josh says. "We’d do it again in a heartbeat."