Mental health issues in the infertility space, by J R Silver

It’s been a while since I last penned an article for IVF Babble and I wonder whether, on a subconscious level, that is because I have been putting off writing about a subject that has weighed on my mind since the early days of my azoospermia journey: mental health.

If I cast my mind back a decade, I was in my early 30s, soon to be married and blissfully inexperienced in battles of the mind. For sure, I was an obsessive perfectionist dating back to my early school years but this had usually worked in my favour, excelling academically and progressing well in my career. I had also been blessed with near perfect physical and mental health, as appeared to be the case with most close family and friends.

Mrs Silver & I, now six months married, returned from a relaxed sunny break in the Caribbean. I put in my usual post-holiday call to my beloved parents and was taken aback to learn that my older sister had been taken unwell. I probed a little deeper and discovered she had been diagnosed with breast cancer. Not to worry, I thought, this is 2013, most people fight off breast cancer with ease.

How very wrong I was. My sister passed away just 9 months later, following a very aggressive form of triple negative breast cancer, caused in no small part by her having inherited the BRCA 1 gene. I too tested positive for the cancerous gene (thankfully, statistically much less damaging for a man than a woman), confirmed by genetic testing on my sister and me in the Summer of 2013.

The second half of 2013 was consumed with close family time, as we rallied around my sister and prayed for a miracle that sadly never came. We grieved my sister’s death in the 12 days before Christmas but, even before the festive period finally commenced, I was already back at work, travelling into London 5 days a week in the pre-Covid working world.

I was wrong again. Burdened with the BRCA 1 gene, and with my wife and I yet to conceive naturally, we visited CRGH fertility clinic to explore whether PGD (Pre-Implantation Genetic Diagnosis) may be an option for eliminating the BRCA 1 gene from our future lineage. “Yes” was the answer, on the proviso that my wife and I had lots of healthy eggs and sperm to play with.

We let nature take its course but, by the Summer of 2014, there had still been no immaculate conception and patience was wearing thin. Mrs Silver & I were sent for fertility tests: the wife’s results came back first, a glowing pass. A little niggle at the back of my mind got a bit heavier. A couple of weeks’ later, I chased my GP for my results late one Friday afternoon. To my chagrin, the GP told me he had the results but would not discuss them until I arranged an in-person appointment. My head was now racing and I pushed the GP to tell me what the results were.

Not to worry he said: it was highly unusual to have such a result, so we would run the test again to confirm it was an error. Two more weeks passed, again Friday afternoon ticked around and again the GP had gone silent. My wife and I were celebrating my 35th birthday at a theme park, our stress levels rising as the day went on, not just on account of the terrifying rides Mrs Silver kept dragging me onto. Finally, I put a call into the GP and was put out of my misery: the sperm sample had again come back with nil sperm.

So here I was, just 15 months back from the Caribbean, and in that time period I had seen my sister taken ill and rapidly deteriorate, as well as been diagnosed myself with BRCA 1 and, to add insult to injury, azoospermia.

Truth be told, I felt ok and not overwhelmed with shame or resentment, perhaps because I had some perspective gained from the loss of my sister that meant that, whilst an infertility diagnosis was obviously gutting and life-changing, it was nowhere near as bad as what befell my sister. And my azoospermia could actually be seen as a massive positive, as my firing blanks meant I was not able to pass on the wretched BRCA 1 gene to any future offspring.

But all was not so well beneath the surface and it would later transpire that my usual coping mechanisms had likely been severely depleted by recent events. Early in 2014 things started going wrong at work. I began to get recurring migraines: initially caused by work stress but, in time, brought on by my obsessive mind worrying about whether I was going to get a migraine. Then my brain started to go hazy whenever I attempted to read anything remotely complex: 10-page work documents that would typically take me 10 minutes to skim through became 1 hour torture chambers where I would finish reading with a migraine and vague recollection of what I had read.  And, as the year passed by, I was increasingly struggling to communicate in the work environment, my mind clouding over repeatedly, triggered by the slightest bit of self-doubt, melting down in important presentations and other more trivial situations.

Whilst presenting before some members of senior management, a colleague had to step in, not once but thrice, to rescue me when I had lost the ability to speak. I was mortified and, on reflection, entering a dark depression but, encouraged by Mrs Silver, I sought professional help for my mental health.

I initially tried CBT (Cognitive Behavioural Therapy) but quickly decided that was not for me, the cynic in me refusing to engage properly in the process. Then I moved onto hypnotherapy but quickly tossed that aside, dismayed at the lack of instant results TV shows such as those hosted by Paul McKenna had implicitly promised me. Third time lucky I struck some gold: referred to a Harley Street psychiatrist, and with me a very willing patient, she recommended putting me on anti-depressants that would also have the added benefit of tackling my  anxiety.

This time I trusted the process, building rapport with the specialist and prepared to be patient until we got the medication to the most impactful dosage. By year-end the black cloud had started to lift. My social skills bubbled back to the surface and I no longer dreaded getting out of bed and travelling to work in the morning. My recurring migraines became less frequent and I began to read with more clarity and communicate in a way that was reminiscent of my former self.

But I did not get complacent: 2015 saw me spend time with a therapist to complement the medication, whilst Mrs Silver and I also commenced couples counselling with the most wonderful of ladies from Chana, the fertility support charity. This latter relationship is one that still continues  and has played a huge part in our being able to build our special family, with two young children conceived via my wife’s top-quality eggs and seeds kindly gifted by a sperm donor.

I remain obsessive and a perfectionist, for a leopard rarely changes its spots but, allied with ongoing medication, have learnt ways to better manage my middle-aged mind. I have also spent precious time away from the office, not just cherishing my close family and friends, but also showing empathy and acceptance towards my unique genetic make-up. This includes the monkey on my back, one that may have lain dormant for my first three decades, but is now a regular fixture that I cannot erase but the medication and therapy has helped it to co-exist inside my less troubled mind.

I did not initially come across a form of treatment that worked well for me and it took me time to accept that there would never be a perfect solution. Instead, each individual experiencing a mental health journey should not be afraid to speak out and seek help and hopefully, given the abundance of different options available in our increasingly diverse and accepting world, find some peace of mind, sooner rather than later.

Read more from J R Silver:

https://www.ivfbabble.com/jr-silver-author-of-sharing-seeds-tells-us-how-he-embraced-the-option-of-donor-sperm/