The Male Factor

An Excerpt from…


By Michael J. Heard, M.D.

A few sperm in the right place can make all the difference in the world.

The morning schedule was completely full of male patients in the Houston infertility clinic. You would think that men had more than enough sperm to get the job done without help. Obviously, this wasn’t the case for many.

Kandy Henderson was sitting at her desk full of charts looking over the morning schedule when Eric Johnson, the first patient for the morning arrived. Mr Johnson was scheduled for a routine SA or semen analysis. He and his wife had recently been seen for a consultation for infertility. They had been trying to conceive without success for 2 years. Mr. Johnson was a tall handsome businessman dressed in a gray penstripe suit with slick jet black hair and wingtip shoes. His gold Rolex watch sparkled on his wrist next to his dark suit and tan skin . As he entered the clinic, it appeared that he didn’t really belong there. Kandy could tell that this was probably her first patient of the morning.

“Hello … Mr. Johnson?”

Eric Johnson nodded his head ‘yes’ to her question. “Welcome to the fertility center. I’m Kandy Henderson. I think I met you and your wife for initial consultation. You are right on time. Let’s see, you are here to give a specimen for a semen analysis. Is that correct?”

Dreading the appointment, Eric Johnson was already irritated with Kandy’s choice of words. Anger appeared in his sharp blue eyes that set behind his wire rim glasses.

“Yes, that’s right,” he said sharply. Eric jumped right to the point. “An easier way to say it might be that I am here to masturbate or ‘jerk off’ into that cup you have for me in your so called ‘collection room.’ Is that correct?” Raising his voice with force, he said, “I can’t believe my wife has talked me into this. I really don’t think it’s my problem anyway. She’s the one that can’t get pregnant.”

Feeling the blow of his anger, Kandy replied, “Now, now, now. I know you are a little nervous, Mr. Johnson. But we have men do this for us every day here in this clinic. And you must remember that 40% of infertility is due to male causes. We must make sure and cover all our bases and thoroughly evaluate each couple. We are just trying to help the best we know how.”

“This isn’t as easy as everybody thinks, you know. A man can’t just perform on command.”

Sensing his irritation and aggressive talk, Kandy made a comic analogy to his work. “Well, you are an investment banker, Mr. Johnson. People have to perform on command in your business all the time.”

“That’s not the same thing. And you know it!”

“Yes, I guess this is just a little more on the personal side. But I’m sure you are aware that the statistics show almost all men have masturbated sometime in their lives. Therefore, I’m sure you know exactly what to do.” Kandy knew she could control him. She just had to get through to his emotional side a bit.

“That’s not fair, Kandy. My situation is completely different,” he said with a somewhat fearful tone in his voice.

“Oh, come on, now, many men have been in your situation. It’s not that bad. Let’s just cut with the small talk, ok? I think you are delaying the inevitable. You’ll do just fine.” Kandy cut the conversation short. “Just go in there and DO IT, ok?” Kandy had control of the moment and she loved every minute of it.

Eric started to lose control of the conversation and plead for some sympathy. He could feel the sweat and tremors start to affect his hands. “Ok, but what if I just can’t do it? This place is starting to stress me a little. This is not like being in my own home.”

“Although some do collect at home, we feel it is best to have patients collect in our facility so we can get the most accurate results.” Kandy pulled a small plastic cup from her pocket and held it out to Mr. Johnson. “Here is the famous cup you spoke of to collect in,” she said with a smile. “We also have a variety of magazines and some nice videos to help you out if you need them. After you are done, just ring the bell and I will come by to pick up the specimen. It’s as easy as that.” Kandy smiled at her patient but he didn’t smile back. Sometimes you just couldn’t put these men at ease. Their ego was too big to overcome.
“This is probably one of the hardest jobs I have to complete,” he said looking down. “What if I just can’t do it, Kandy? My wife is going to kill me.”

“Don’t worry. This is not going to kill you, ok? Give it your best try and if you really can’t give us anything, then let me know and I’ll help you out.”

Eric Johnson gazed at Kandy with a confused look. Kandy smiled again.

“We have MEDICAL ways of helping you out,” she said. “We use them as back up just in case. I haven’t had one patient that couldn’t produce in a long time. So don’t you worry.”

Eric hesitated before he began to walk forward into the collection room. He had a look of intense fear on his face. Although Kandy had tried to calm him, nothing had prepared him for this moment. He felt like a dead man walking who had just gotten some last words from Sister Helen Prejean. It was as if he was on death row and had to donate one of his kidneys to survive.

Eric saw Kandy smile as she slowly closed the door behind him. She then placed a ‘DO NOT DISTURB’ sign outside. She could hear the lock turn and the sound of footsteps walk into the inner collection room which also had a door to shut. This particular collection suite had been nicely designed for complete privacy. It housed a large bathroom with an adjoining inner room that had a comfortable couch with a VCR and enough adult magazines to fill a drug store. It was very quiet and secluded once the patient closed the door for privacy. She thought the setup was one of the best in the city. Up in urology, the guys had to collect INSIDE the examination rooms with the office staff walking and talking right outside. It was far from being private and secure. The patients in the fertility clinic really didn’t know how well off they really were.

Kandy had a sigh of relief as she walked away from the collection room door. She always found herself in the middle of these little daily dilemmas. It was a part of her job and even though she didn’t always like it, she had to put up with it. “Men-you can’t live with them, you can’t live without them,” she whispered quietly to herself as she walked back to her desk. I should get a lot more pay for this job. The things that I have to do to help this place out!

Lorna, the front desk receptionist came over the intercom into Kandy’s office. “Kandy, Ms. Johnson is on line four. She wants to know about how her husband is doing. Could you speak with her?”

Kandy was amazed how intuitive and obsessive infertility patients were with their evaluation and treatment. They tried to control every step of the process and could stress their husbands without them even knowing it sometimes. Kandy collected her thoughts and picked up the phone.

“Hello, Ms. Johnson. How are you?”

“I’m fine Kandy. Has my husband come in yet?”

“Yes, he’s here. I just put him in the room to collect. I’ll give him some time and see what happens. We can call you with the results once they are available. We usually have the initial results available within a few hours.”

“Thanks, Kandy. You are so sweet to take care of my husband. He gets so worked up about things, sometimes. Please call me with the results. He wouldn’t even tell me if there was a problem if you called him first. I do hope that he doesn’t have a problem. He would NEVER want to be evaluated any more than just to provide a semen sample. I think he might have a nervous breakdown.”

“Don’t worry, I think he’ll do just fine,” Kandy said. “I’ll let you know when the results are available.”

“Thanks Kandy. And don’t let him know I called. He’ll just get more angry if you know what I mean.”

“I know EXACTLY what you mean. Goodbye, Ms. Johnson.”

“Goodbye Kandy.”

Kandy hung up the phone and thought about all the similar conversations she had with other patients. She had kept secrets more than she could count. Her job involved more than just treating infertility. She also wore the hats of marriage counselor, social worker, and even sex therapist. Her job turned private sexual intimacy between couples into a daily business.

Twenty minutes had passed since Kandy had put Mr. Johnson into the collection room. The paperwork for the day was already starting to pile up and more patients were arriving for their ultrasounds and bloodwork. Kandy heard the door to the collection room open and saw Mr. Johnson stick his head out. She was surprised because he hadn’t rung the bell yet.

“Kandy, could you come in here please?” Mr. Johnson had a quiet tone in his voice.

“Yes, Mr. Johnson. Is everything alright?” Kandy walked into the outer bathroom area just outside the collection room. She looked at Eric Johnson and couldn’t believe what she saw. Small beads of sweat had formed on his brow and his hands were shaking.

“It just won’t work for me, Kandy. It’s completely dead. I can’t believe I am trying to do this,” he said with a nervous tone. “I think I need some help here. I mean-you know what I mean.”

Kandy had dealt with this problem before. And she knew exactly what to do.

“That’s ok, Mr. Johnson. I don’t think that your organ is really dead. Let me see what I can do here” Out of her pocket, Kandy pulled out a small bottle of medication and opened the top. “Here, take one of these, it should help you out.”

“What is it, Kandy?”

“It’s viagra,” she said with a smile. “We use it to help patients out when there is a problem in the collection room.”

“You have got to be kidding. Will this stuff really work for me? I am so nervous and anxious right now, I can’t even think straight.”

“We’ve found it to work very well in our patients that are a little stressed and can’t produce a specimen by themselves. We don’t use it all the time-just when it is necessary. Now, you aren’t taking any heart medication or street drugs like poppers are you?”

“Why do you ask?”

“Well, the medication can interact with nitrates that are used for cardiac problems and amphetamines that people take off the street. We don’t want you to have a sudden problem with your heart in our collection room. I think you would be really upset if I had to call a code blue down here and use the crash cart. Now THAT has NEVER happened down here before.”

“No, I don’t use cardiac medications or street drugs,” he said with a nervous smile on his face.

“Now the medication takes a little while to work. It’s not the same for everybody. Since you haven’t used it before, it will probably work quickly.” Kandy knew the medication took 30 minutes to an hour to work according to the manufacturer but was relying on placebo effect with her nervous businessman.

Mr. Johnson took the pill from Kandy’s hand and swallowed it down with a cup of water. “Now I want you to go back inside, relax, and try and get in the mood. I know it’s not easy, but just give the medicine some time to work, ok? You’re all dressed up in your suit today, so why don’t you just remove some of your clothes and turn on a video. Our collection room isn’t that bad. And no one is around to disturb you.”

Eric could not believe he was listening to a nurse give him instructions on how to masturbate. But then again, she was right. He was here to find out WHY his wife couldn’t get pregnant and he could unfortunately be part of the problem.

“Thanks Kandy. I feel a little better now.” Mr. Johnson shut the door, turned the lock, and went back into the collection room.

I’ll give him about 15 minutes, Kandy thought. This one won’t be that hard. Kandy returned to her desk to find a mountain of charts that were already piling up. Leigh Ann, the well-trained ultrasonographer, had already scanned 6 patients and piled the charts on her desk. It was baseline day and all the new IVF patients were getting scanned to see if they were ready to start their ovarian stimulation. The ultrasound results were correlated with the estradiol level to see if the ovarian function had been downregulated with the lupron injections that affected on the hypothalamus, ultimately shutting down the ovaries. Kandy was highly trained with years of experience and quickly reviewed the charts that had been completed. She was amazed how these drugs that came from urine of menopausal nuns of all places could stimulate the ovaries to enlarge to 10 times their original size with mature follicles that would produce eggs for harvesting. Each patient’s ovaries were unique with their own personality. You learned about them during the serial ultrasounds that were used for monitoring the growth of the follicles during the cycle stimulation. Some patients didn’t respond to the drugs and had difficulty developing follicles and eggs for harvest. Poor Suzi Jackson was one of those cases. She had an elevated FSH level, or follicle stimulating hormone, which signified that her ovarian reserve was diminished. She came from the east coast to have IVF because the doctors there refused to consider using her own eggs because of the poor results from her clomid challenge test. This test measured the ovarian response to taking clomid, a fertility drug. If the values returned high, then the chance for success was low. However, Kandy was well aware of many patients who had conceived with only a few eggs available for fertilization. It’s hard to base future success on just one test, especially when there are some many other variables to consider. Suzi was hoping to be one of those unusual patients as well. Kandy’s thoughts were interrupted by the sound coming from the collection room.

Ding dong . . . ding dong. “That must be AVON calling,” said Lorna at the front desk with a smile. “Someone has a package to deliver.” “Oh, Lorna, you tickle my funnybone sometimes,” Kandy said with a laugh. I think I deserve a prize for helping this guy collect in all of but 15 minutes. That’s not even enough time for the viagra to take effect. Not too bad for placebo effect. I think it’s higher than what they say.”

Kandy went to the collection room door as Mr. Johnson was opening it. “It worked, Kandy!” he said with a smile. “I’m glad Mr. Johnson. I didn’t think you would have that much trouble. Now leave your specimen there on the counter with all the pertinent information and I’ll see the lab personnel starts your analysis in a little while.”

Mr. Johnson turned back to face Kandy as he headed for the front desk. “Thanks for your help Kandy. I feel like I have just climbed Mount Everst all by myself! Hey, that stuff really works too. Can I have some to take home? It may help me and the mrs deal with this fertility stuff a little better. It is hard to perform on command.”

Kandy was taken off guard by his question but quickly thought of a good reply. “I hear what your saying Mr Johnson, but we don’t usually give this medication to men for use outside the clinic. You’ll have to go to the urologist for that. Plus, if we gave it to everyone that was having problems with infertility, we would deplete the national supply of the drug. I think communicating with your partner along with a good counselor could do just as well if you didn’t have a problem to begin with.”

“I understand what you’re saying, Kandy. I was just kidding,” he said. “Just don’t mention my little problem to my wife, ok? She would start stressing that it would probably affect the results somehow. Thank God she is out shopping and doesn’t even know I’m here now.”

With a smile on her face, Kandy said, “Don’t worry, Mr. Johnson, I won’t mention any of this to her.” Lorna could see the bright twinkle in Kandy’s eye. This was not the first time she had kept secrets from couples about what really happened inside the clinic. What they don’t know won’t hurt them anyway, Kandy thought. As Mr. Johnson turned to leave, he had a fresh new look on his face. “And please, Kandy, call me Eric. We are in this together, aren’t we?”
“In a way, yes we are, Eric.”

He opened the door and left the clinic.

“You’ve done it again, Kandy,” she said. Another satisfied male customer. You do have a way with the guys around here. I’m sure they’ll shower you with gifts just like always. One thing’s for sure, though, you have a lot of secrets to take to your grave, girl. The things you nurses have to to in this business just amazes me. I am happy to keep my job as the front desk clerk thank you very much.”

“You know we have to take the good with the bad, Lorna. Collecting the specimen is one thing. Getting the results is another. It’s a roller coaster speciality in this place. Some days you are happy as a clam and other days your mad as a hatter. I guess it’s good to have a balance. I just hope that our businessman gets a good return on his investment if you know what I mean.”

“I know what you mean, Kandy. I know EXACTLY what you mean.”

The clinic rang and Lorna quickly picked it up. “Texas Fertility Center,” she said with a soft voice. The expression on her face turned worrisome. She quickly made eye contact with Kandy.

“Kandy-they want you in the ER immediately. Your son was just brought in by ambulance!”