This forum seems truly amazing to me. The information shared is accurate, the responses supportive, and (best of all) it does not perpetuate self-pity. Kudos to the mods and the members!
I need to decide between a full and partial IO and I'd like some feedback on my logic. My situation is somewhat atypical. My initial visit was regarding fertility. Diagnosis was something like 'azoospermia due to adult onset gonadotropic hypogonadism' and it was explained to me that, basically, not enough of the signal to create sperm was reaching my testicles. (Coincidentaly, the chances of having this are the same as having TC, about 1-2%.) My tumor was found during the ultrasound for the fertility workup. It's very small, 4-5mm (yes, mm not cm) and nonpalpable. The two US's were consistent and neither could find anything which would rule out possible cancer, given the description and location inside the testicle. However, all the blood work for tumor markers, etc. came back clean. Because of this, the small size, and the fact that there has been no change- the US's were 3.5 weeks apart, my urologist thinks its most likely benign. My gut feeling says he's right.
Here's where my decision gets complicated. Honestly, whether or not it's cancer has taken a back seat in my mind to the fertility isues. The cure rate for TC is SO MUCH higher than the cure rate for male infertility! My IO is most likely a week from Tuesday. He's going to remove the tumor and do the FSE, and see if he can extract healthy sperm from the removed tissue. I could opt for a partial, which would result in less removed tissue for the sperm extraction, but would leave more of the testicle intact. If the HCG treatment for the infertility takes, I'll have 1.5 testicles producing sperm instead of just one. Or I could have the full IO done and have that much more tissue sent to the sperm lab.
My initial thoughts are that I should opt for the full IO. I'm not confident that it will be easy to find healthy sperm, so the more tissue the lab has, the better. Even if the HCG treatment takes, studies seem to indicate that having the extra half-testicle won't increase my odds of getting us pregnant any more than a few percentages. (I think it was +/-4% that the urologist told me) and once I stop the HCG any sperm production stops, whereas if it's frozen it's there for the duration. I guess I'm thinking that if the HCG didnt work and I didn't give as much tissue as I could for the extraction, I'd regret that more than I'd regret having the HCG work and be missing a testicle. The other thought is that both testicles have reduced mass since the onset of hypogonadism. If much tissue is taken around the tumor, there's not as much to put back in the scrotum as there normally would be. So, walking around with a half-testicle could end up being a really small testicle! Phsycologically, that could be harder for me to deal with than having nothing on that side at all.
So, I'm looking for feedback on my thought process, anything I may not have thought of, or just your thoughts in general. I really appreciate having somewhere to voice these questions and look forward to reading your responses.
As an aside, the whole psych aspect of this has been very interesting to watch. At this point I have to admit that there's a part of my that wants to hear that the tumor was malignant. It wants to justify the feelings of fear and violation I've had. And that part of me would rather cope by saying I was a cancer survivor than say I lost a testicle to a benign tumor. I wouldn't wish cancer on anyone! We have a family history of cancer and it's a horrible experience for anyone involved, but that doesn't stop the odd ways your brain tries to grapple with this whole mess.