Infertility
Causes of infertility
Couples presenting with infertility will often want answers to two questions:
1. Why are we not getting pregnant naturally?
2. Please get us pregnant.
Early investigations are designed to try to find a cause for people’s infertility, which may be treatable. It is uncommon that there is simply one absolute ‘cause’ for a couple’s infertility frequently there will be combination of male and female factors. This is often different to people’s initial thoughts that infertility is a female issue. Women and men who we talked to sometimes described feeling guilt (or relief) when the ‘cause’ of their infertility was identified.
Clare described the guilt she felt about the fact that all their fertility problems lay with her.
Clare described the guilt she felt about the fact that all their fertility problems lay with her.
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I think it has strengthened us, definitely. That’s not to say that it’s always been plain sailing. Because it hasn’t. And I think there have been times when it’s been incredibly difficult. I think particularly because for me I feel an element of guilt about the fact that the fertility problems all lie with me. You know, [husband]’s perfectly healthy and given he was with a partner who didn’t have blocked tubes or any fertility problems at all he’d be a father by now. And I think that’s very very difficult to come to terms with. And I know from talking to other people again, to the, the Infertility Network that where you have an element of, you know, there’s a definite problem on one side or the other, whether it be male factor infertility or something wrong with the woman, that there is always that feeling or often that feeling of guilt that they’re the one, that partner is the one that’s stopping the other one from having children.
Mike felt guilty that his wife, who is much younger than him, would like to have a child but he...
Mike felt guilty that his wife, who is much younger than him, would like to have a child but he...
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Do I feel… yes I do feel guilt. Because there is a large age difference and yes, I did this sort of noble, you know, by the way I can’t have kids, but that was only, you know, when we were quite a couple. But then again it’s not something you are going to broadcast. Hi, I can’t have kids. You know what I mean. So it’s a balance isn’t it? You know, so, I do in that respect yes. It would have been happy for everyone if I’d fallen in love with someone my age, who didn’t want children anyway and that wouldn’t have been an issue, but you know, it just wasn’t to be and I will feel guilty if she doesn’t conceive because I will consider it my fault as such, because, you know what I mean. Your head knows it’s not. I didn’t ask to be ill. But that doesn’t make any difference to a person who wants children, they are going to be upset. And … the more failures you rack up the worst it will be and you know, that’s something that I suppose we will have to see later on. I don’t know. I have no idea how it will pan out.
Sometimes a couple needs fertility treatment because one of them has been sterilised, perhaps in an earlier relationship. Frances conceived with donor sperm because her husband had had a vasectomy. Laura was having IVF because she had been sterilised after her previous relationship had ended.
Multiple Causes
Multiple Causes
Often a couple’s infertility is caused by a combination of factors. Sandra’s husband had a low sperm count and she had blocked tubes. Carol’s fertility was affected by both her polycystic ovary syndrome (PCOS) and endometriosis. Sally had a blocked tube and fibroids which were thought to affect the chances of any IVF cycle she undertook.
Naomi and Martin had multiple factors contributing to their fertility problems. Martin knew that...
Naomi and Martin had multiple factors contributing to their fertility problems. Martin knew that...
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What didn’t help us, was the misdiagnosis that my husband had, where he was told by his doctor, very respectable. So we then had the discussion about how he would have felt had it not been very respectable and you know, he would have felt really, really guilty about things and, and it turned out that it was a problem. So, I then, he’d opened up to me, may be in ways that he wouldn’t have wanted to. I think it is actually beneficial that he did, but it was quite difficult for him I think.
And then also what didn’t help was the fact that I had had some irregular, some slightly high hormone readings earlier on, but they were just brushed under the carpet, you know, they’d found our diagnosis. They pigeon holed us being right infertility, that’s your problem, male factor infertility you need ICSI. Whereas I still feel very strongly that they should have done further investigations into me, because there’s hormone level called FSH, which my reading was high, and that is a sign that you potential, you are going to have a low quality or a low quantity of eggs. But they can overcome it to a degree in terms of quantity with the drugs that they give you during the cycle. So they kind of masked it for us. But actually I still think, the fact that I had that four years ago, and I’m no potentially going into an early menopause, they’re tied. But it does seem to happen that a lot of people I know have been given one particular diagnosis, and then all investigations have stopped. They then haven’t uncovered further problems.
So that was… it was difficult to deal with the diagnosis at the time. It was also quite difficult to deal with the sort of anger and upset after going through the trauma of three failed cycles, to think well actually was it really worth it, should we have done that. Or should they have done some more investigations early on and found out there was more of a problem.
And did you ever talk to the doctors about that?
They said that a lot of people with my level of FSH do go on to conceive perfectly well with IVF, which that’s may be the case, but there are other tests that can be done along side of FSH which I have also had done which have indicated that probably it wasn’t going to work for me. But they just say it’s a case by case basis and you know, no one really wants to talk about it.
Unexplained
25% of infertility is attributable to unexplained causes (NHS Choices 2017).
In around a quarter of cases couples have investigations that are inconclusive and are told that they have “unexplained infertility”. This can be very hard for individuals, as Catherine explained, “It all takes so long and so many of the tests are inconclusive. And for lots of people like us there’s never any reason found.” It can also cause problems in the clinical relationship between couples with high hopes of finding a solution and their fertility specialists who have to admit that they don’t know the reason for the problem.
Catherine contrasted the abrupt reception she got at one clinic with the private consultation...
Catherine contrasted the abrupt reception she got at one clinic with the private consultation...
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And the difference between them was extraordinary actually. One lasted about ten minutes. The doctor turned up an hour late, didn’t address my partner at all, didn’t talk to him, only talked to me. He said, “I think you’ve got polycystic ovaries.” I don’t know quite on what he based this. He said, “Have you got spots?” And I said, “Well, do I look as if I’ve got really bad spots? No, I don’t have spots.” He said, “Do you ever have unwanted hair?” And I thought, “Well, I think most women do actually.” He said, “Well, I think you’ve got polycystic ovaries. Go and have a scan now and come back in three months.” So I went to have a scan there and then, and said to the woman doing the scan, “Have I got polycystic ovaries?” And she said, “No.” But I still had to wait three months for another appointment. Meanwhile the appointment with the private doctor was just brilliant. And, you know, we paid for it, but it was still in an NHS unit. He was still treating us as he would have treated his NHS patients, and he was absolutely lovely. He was really sympathetic, really understanding. Gave my partner a physical examination, and no one had even bothered to talk to him before, and actually found something which could have been a problem, but wasn’t in the end. But it was completely different. I just felt much safer there. I felt that he was really working in our best interests. In the end no one could find anything wrong with either of us, and our infertility was always unexplained. Both the clinics recommended that we should go for IVF. But by doing it and paying for it we could do it right away the next month, and by doing it at the NHS hospital we were going to have to wait a year. So we decided to just pay and do it straight away.
Martha had conceived easily with her daughter but had difficulty when she started trying for a...
Martha had conceived easily with her daughter but had difficulty when she started trying for a...
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Well I had my daughter with no problem, I got pregnant with her quite easily and when she was about fourteen months old we started trying to have a second one. And, [exhales breath] well it became clear quite quickly it wasn’t going to happen as fast as it had with her, but you know, you sort of think, okay, well [little laugh], you know, just carry on with it and whatever. I mean I think probably people have told you this before, I mean everyone says oh you shouldn’t worry until it is like this long or whatever. You do start worrying, you know, after just a few months especially if it has been quite easy. And I would say by six months into it and nothing was happening I was really, getting quite worried about it, and so what I had heard was that you are supposed to wait for a year, you know if you are the age that we were then and so after a year I went to the GP and I still find it quite shocking because I have not heard of another place where they say this, but here they will tell you oh no, we won’t do anything till you have been trying for two years which just seems like a really long time. And when I kind of pushed that, what they said, is the reason why, some, I can’t remember how the percentages break down but they decided to on this thing that something like 97% of people do manage to get pregnant within two years. But if you actually look at that it is like sort of 89% of what they were in the first year and then this tiny little percentage in the second. So I think it is a bit of a strange way of going about it, but that is how they went about it.
And so, well we, you know, I guess at that point, I think at that point I talked the GP into getting a couple of sort of simpler tests like hormone tests and whatever, and, I had those done and they looked normal so everyone was kind of, you know, well go away, and whatever. Do you want me to keep going?
Yes. That is great but carry on.
Yes. And so it was probably, I lose track of the timing of this, but it would have been a few months after that that I just finally decided I couldn’t really cope with it. I mean because I am sort of glossing of the whole fact that this is incredibly, you know, difficult to deal with for everybody. While all of this was going on.
And so we decided to go and get some private investigations done and I should say that we were probably in a better position than a lot of people who do that because my husband gets private health insurance through his work and I am on it, which means that they don’t cover, they won’t cover fertility treatments, but they will cover investigations, which means things like, what I got was a laparoscopy and that would, you know, if you had done that privately it would have been sort of £2,000 but we didn’t have to pay for it, so that, it made a big difference in terms of being able to go a bit more quickly than the NHS would have had us go.
So we went and did that and by then it would have been probably a year and a half with still nothing happening and so we went and did that, you know, go and got some tests, and we got the tests you would get really, and nobody could find anything wrong, you know, it was unexplained infertility.
Causes of infertility in women
Factors that can contribute to a woman’s infertility may include endometriosis, damaged fallopian tubes, ovulatory problems and conditions affecting the uterus, the woman’s age, Polycystic Ovarian Syndrome (PCOS), gynaecological problems such as a previous ectopic pregnancy and medical conditions (e.g. diabetes). Lifestyle factors (e.g. being overweight or underweight) can also play a part.
Endometriosis
Endometriosis can sometimes damage the fallopian tubes or ovaries, causing fertility problems. As it can often take a long time to diagnose, it can be a contributing factor to infertility. However, it's estimated up to 70% of women with mild to moderate endometriosis will eventually be able to get pregnant without treatment (NHS Choices 2015). Susan for example had severe pelvic pain and endometriosis but she was in her forties before her doctors explained to her it was a potential threat to her fertility.
Endometriosis can sometimes damage the fallopian tubes or ovaries, causing fertility problems. As it can often take a long time to diagnose, it can be a contributing factor to infertility. However, it's estimated up to 70% of women with mild to moderate endometriosis will eventually be able to get pregnant without treatment (NHS Choices 2015). Susan for example had severe pelvic pain and endometriosis but she was in her forties before her doctors explained to her it was a potential threat to her fertility.
Carol assumed that her heavy and painful periods were normal and did not mention them to her...
Carol assumed that her heavy and painful periods were normal and did not mention them to her...
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I have to say, I am quite ashamed to say this, but I assumed that all women have painful periods. I took that as being the norm because from the age of eleven that is what I have suffered. And it is only probably about three years ago that I actually plucked up courage to say, “Well actually it is really painful. Sometimes I faint. And sometimes I can actually vomit. Is that normal?” And the people at the fertility unit were absolutely shocked because I had never said anything and it was at that point that they actually did the tests and had a look and could see that there was widespread endometriosis of a moderate nature. They did laser it, but I was told that about two thirds, in two thirds of cases it will re-occur. The endometriosis is actually very, very painful. It can be such… fortunately it only happens around a period, but sometimes the periods are excruciating. I have seen a pain management doctor and she actually told me that I should keep on top of it.
With fertility I have been loathe to take any extra drugs because I thought that had a negative impact on potentially become parents, but they actually said, “Well no, that is not the case. If you are going to have a period anyway, any analgesics only stay in the system for 24 hours anyway, and it is much better and it is less stressful to your body to actually be on top of the pain control rather than suffering this huge high, high spikes of pain. And then not dealing with it properly.
Also I think it is fair to say to any people, any women suffering from endometriosis that you do pass huge clots which are extremely painful. You do think the first time it happens, and you see these big hand sized clots, that you think my womb is falling out or something is dreadfully wrong and at times I have panicked. I have called my husband. And sort of said, “What is this.” And grossed him out as well. But that is normal for endometriosis sufferers and it is just something that you have to live with really. You can take all sorts of different drugs to help in terms of thinning the actual blood and things like that but I tend now just to deal with the pain with using Nurofen and Codeine when it is really bad and I also use a TENS machine which I found to be very helpful, so… and hot water bottles. I wouldn’t be without a hot water bottles front and back.
Blocked Fallopian Tubes
Fallopian tube disorders which include blocked tubes can often cause fertility problems together with other causes. Sandra had a laparoscopy which revealed one of her tubes was blocked.
Sally had a hysterosalpingogram scan which revealed she had one blocked fallopian tube.
Sally had a hysterosalpingogram scan which revealed she had one blocked fallopian tube.
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And after, I suppose, you know it was always stressful, you know, wondering if it had worked and you know, being good and avoiding alcohol and all these sorts of things, and then it was all sort of, you know, a bit disappointing when it didn’t work. And we had a few cycles. I can’t remember exactly how many and then, you know, when it… probably two or three and I think at that point, it was thought that it was worth doing some investigations on me.
And I had a hysterosalpingogram when they put dye into the tubes. And, they established that one tube was blocked. At that point I rather naively thought that perhaps you just, that I assumed sort of ovulated alternatively so you just figured out which side you were ovulating and you know, only went that time.
I don’t think they did terribly much to, you know, put me straight on that. And I, it tells you how long ago it was, I can’t quite remember but at the next stage, oh I suppose perhaps because of the blocked tube, they decided that, you know, we would be good candidates for IVF. So I had IVF… you know, three times in quite a short period and we were, you know, tremendously lucky because we had the means to, you know, pay for it ourselves. So we didn’t have the additional stress of, you know, wondering how we could pay, or you know waiting for a year while we saved up and I found it, you know, surprisingly straightforward.
Clare had been trying to get pregnant for three years before a scan revealed a blocked fallopian...
Clare had been trying to get pregnant for three years before a scan revealed a blocked fallopian...
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We talked about what to do. I was still considerably overweight at the time, and we talked about the fact that I could go on Clomid and see whether that would sort out my ovulation, but that really I needed to go away and lose the weight. Which was quite daunting. As I say I was 5 or 6 stone overweight. It was quite a scary prospect to have to lose all that weight, and be losing more time as well. You know, we’d been trying for nearly two years by that stage. But we decided in conversation with each other and also in conversation with family and friends that it was probably for my health, the baby’s health and everything else, it would have, make more sense for me to actually try to lose the weight first. So I started a diet, a very strict diet in the March of 2005. So this is now two years since we’ve been trying. And I lost the weight pretty rapidly. And we went back to the clinic in September 2005 and said, “Okay, we’ve done it. We’ve lost the weight. You know, what’s next?” And my consultant said, “Well, that’s brilliant, you know, you’re halfway there basically. Here’s the Clomid. Go away and try. I reckon you’ll be pregnant by Christmas.” So we rushed out the clinic, absolutely thrilled. You know, I’d lost all this weight. This was the magic tablet I was going to take to make me ovulate and to get me pregnant. We started taking them in September and we had naively very high hopes that that would be it, I’d be pregnant on the first cycle. And it didn’t happen. October, took them again. It didn’t happen. The drugs were starting to make me feel quite depressed as well, so that was making things worse. Took them again in November. And during that cycle we actually decided that we weren’t entirely happy with the hospital, and we’d go and pay for a private consultation. And we went to our local private fertility clinic, which we’d, you know, never considered before, and were told that not only was my polycystic ovarian diagnosis completely incorrect, but the scan showed that the Clomid was hyperstimulating my ovaries and I was produce, producing far too many follicles. And the scan further showed that I actually had blocked tubes, and I wasn’t going to be able conceive on Clomid. It would have to be IVF.
So this was now November 2005. So, you know, three months’ short of three years since we’d started trying. And we were absolutely devastated. Just couldn’t believe that all that length of time, nearly two years, that we’d just wasted completely, being given one diagnosis, for that to be changed, for that to be found to be wrong again. And in actual fact it was all a total waste of time. Because we should have just been sent straight for IVF to start with, because that’s the only thing you can do when you’ve got a problem with Fallopian tubes.
Ectopic Pregnancy
An ectopic pregnancy, is a complication in pregnancy where the embryo implants outside the uterus, mostly in the fallopian tube. An ectopic pregnancy can affect fertility if a fallopian tube has to be removed. Clara first had unexplained infertility and then two ectopic pregnancies before she conceived her son with IVF. However, many women conceive normally with only one ovary or fallopian tube.
Marine described how frightening it was to have an ectopic pregnancy which left her with only one...
Marine described how frightening it was to have an ectopic pregnancy which left her with only one...
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Then, so that was a year, so two years then after that I suppose it is, I got pregnant eventually. That was after the wedding when we were starting to think, now, we really, really, really want to get pregnant. Timing and I was doing graphs with the temperature. I was peeing on the stick. I was doing all that and then we did get pregnant and it was ectopic. And it was quite traumatic, I don’t know, yes, it was. I they thought that I had aborted, what do you say, miscarried.
Yes.
Yes, and so they had a scan. I was positive pregnancy test but the scan showed nothing. And then I went home and I still had terrible, terrible pains and bleeding and pure blood. So it was kind of clear pure blood. No clotting or anything like you do get with periods. And then they kept taking this blood test at a hospital and it didn’t go down, it just went up, up, up. So I think they were aware something probably, because the scan hadn’t showed anything they were like well, anyway I was admitted to A & E because of too much pain. In the end they said if you do get pain again, go straight in and it was just awful. Yes, so that was taken the next morning. So I was in hospital one night. I got an ear infection at the same time [laughs]. Oh it was horrible. But the longest night of my life I think.
And then I got the next morning they took it away and then they had to take the whole tube off, and then they said that the other tube looked fine, and the consultant said to try for another year, but if nothing had happened for that year, then to start investigations.
So we decided to have like fun that year and not think about it. But I did think about it and I think I didn’t acknowledge how traumatic it was. I mean I still get a bit tearful thinking about it now. I think I just felt I wasn’t allowed to be upset because so many people had harder times, blah blah blah.
So in the mean time they put on waiting list for IUI I think it is. But I kind of in my heart knew that it was the tubes, because although he said it looked fine, he said it was in a funny place and he put it right or something. I just thought there is something wrong with my tubes.
So when I eventually got the dye test, I was taken off the waiting list, because there was no point, because there was nothing, not a chance, not a single thing going up.
And then we were put on the waiting list for IVF and we decided to try some private attempts whilst we were waiting. So I mean we were very lucky, because we got two attempts on the NHS.
PCOS
Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of female infertility (NHS choices 2017). PCOS can also cause acne, hairiness (and hair thinning), weight gain and irregular periods. George said that his wife’s period had been up to 52 days late because of her PCOS, “And of course after day 28 she is thinking ‘oh this might be it’”.
Carol described how her PCOS means she struggled to keep her weight down.
Carol described how her PCOS means she struggled to keep her weight down.
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Well for polycystic ovarian syndrome what tends to happen is that the… follicles actually do contain eggs. Not all of them… but they aren’t released. I have a hormone imbalance in terms of too little progesterone. So instead of having the normal raise in a menstrual cycle when an egg will be released that hasn’t always happened. And what can happen you can have a period and not actually have an egg release. Or it can go on for months without actually having a bleed at all and that is usually when the doctors have to intervene.
The PCOS itself is one of those distressing conditions for women, because it leads to problems with skin in terms of acne. Fortunately, I haven’t had that. It can lead to hair thinning and male pattern baldness. I haven’t had that fortunately. But I have put on weight and I do suffer slightly from hirsuitism, which is hairiness in places you don’t really want it. But there again, somebody actually told me all women suffer that when they go through the menopause and PCOS women actually learn to deal with it as a much younger age and it doesn’t come as much of a shock to deal with.
In terms of weight gain, that has been very difficult. My weight I have to say, it has been up and down. I have ballooned sometimes and I have tried very hard to lose weight again. But the comforting thing is that doctors have actually said to me, providing that I am not more than 10% overweight, then it shouldn’t impact on the success of fertility treatment. In fact the jury is out on that. I think it is if you have a BMI of more than 28 then there would be a problem there, but I haven’t so I am learning to manage it, albeit I am at a fat phase at the moment. It is just one of those things and the fertility drugs haven’t helped as well. In the last two years I did manage to get down to about BMI of about 23 and I still didn’t conceive. So I am not too worried at this stage.
Causes of infertility in men
A third of cases of infertility are thought to be due to male factor infertility (Human Fertilization and Embryology Authority 2017). Conditions that may result in male infertility include low sperm count, problems with the tubes carrying the sperm, and problems with erection and ejaculation. Lifestyle factors can also have an impact for men, such as smoking, being overweight or having a job that involves contact with chemicals or radiation. (For more information see Human Fertilization and Embryology Authority or Infertility Network UK.)
Michelle and her husband went to a private clinic that pinpointed the problem as poor sperm quality. This was a considerable shock to them both because they had been told before there was no problem with Brian’s sperm count.
Brian had been told there was no problem with his sperm and felt it was a "kick in the teeth"...
Brian had been told there was no problem with his sperm and felt it was a "kick in the teeth"...
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I went to the doctor’s and he said, ‘Oh we’ve got your sperm test results back’ and he said, ‘They’re all fine, so many million whatever. No problem at all. We’ll wait and see what comes back for [wife].’ And I found out when we went to the private hospital afterwards that these two or three tests I’d had, he totally misread the counts on the, and it had been, the majority of the problem had been me all the time. Which was horrible because [wife] had been through so many other horrible tests. And for a woman it’s much, much worse than it is for a man, obviously. You know. She actually had a test done which gave her a horrible womb infection. She was in so much pain. I felt so guilty for that afterwards. And again blaming myself for it.
And what was it like when you actually heard that there was a problem with your sperm?
Complete kick in the teeth I think. You know, it’s, it’s as I said before you’re born into thinking, you know, you’re here on this earth to do what you do and you have children and you pass on your name. You pass on your bloodline and all that rubbish really. But it’s just that because it’s, it’s, no one ever says to you, but it might not happen. And when someone says to you, ‘Actually because of your sperm count and whatever you’ve got you’ve got a 3% chance of actually having natural, a natural birth. What do you think? You know you think, well you know, I thought wonderful, great. It’s not going to happen. We’re not going to have kids it’s the first thing I thought was [wife] wants kids. It’s a big thing she wants and I know she loves me but should we then be together. I started thinking, you know, should, should we split up. Should I make her not love me anymore so she can be with someone and have children. I think anyone would do. That’s a bit drastic, I know sounds a bit dramatic.
Mike had had strong drugs and surgery when he was younger for colitis so he was not surprised to...
Mike had had strong drugs and surgery when he was younger for colitis so he was not surprised to...
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So every now and again periodically I would have a letter from the maternity wing of the hospital and they were saying, “Hey we’ve still got these samples and do you still want to keep them.” And I would always say, “Yes. Why not?” And all that.
So… that continued until I met my future wife, who again is considerably younger than me, by seventeen years, purely co-incidence. And they just then sent a letter then, saying, you know, “We are going to destroy them or do you want us to...” You know, “To, do you want us to… test them?” It was something like that and something made me say, “Oh I’d better get myself checked out.”
So I… I did go, and get myself checked out and… they were very professional, very good, very matter of fact, and they said, “Unfortunately, you know, you are not able to have children. Your sperm just is not there.
Walter had a long series of tests (several decades ago) which concluded that he was not producing...
Walter had a long series of tests (several decades ago) which concluded that he was not producing...
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And the specialist said, examined me and looked at my sperm samples and said there did seem to be a problem there and it was actually extremely rapid for him to examine me and say, “Look, you know, you’ve got testicular atrophy, your testicles are much smaller than they should be and we don’t know why that happens to some people. It does seem to happen to some people, but the short answer is that’s why you’re not producing any sperm.” And you know, that’s the end of story.
I think probably, my recollection is that I probably had my trousers down at the time he told me all this. So it was a kind of a bit of a body blow to hear that. Although I suppose I had been wondering what was going on about the sperm, the poor sperm sample results.
Martin explains that it took a while for him to feel relaxed and open about his low sperm count....
Martin explains that it took a while for him to feel relaxed and open about his low sperm count....
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So we came terms with that and [wife]’s feelings. I think it took me a while just to be so relaxed about talking about it as I am these days. There is a perception, I use the word perception, a perception out there of how you think people will respond to you. You know, your peers, the lads down the pub, everyone that you know. So are they are going to look at you. Do you feel less of a man. How does that affect you and it took me a while just to get it into perspective. And I thought no it is not my fault, I have not done anything, you know, I suppose it was through having mumps as a child. There’s no physiological reason. There is no genetic reason. So they are a little bit baffled as what causes the problem.
But, so I thought no I am not going to be ashamed about this, I am not going to deny it, I’m not going to be embarrassed when I talk about it, you know, because I have got no reason to be, and you know, if I had any other kind of condition, people wouldn’t sort of condemn me or look at me in a different way, so why should I be any different about this? So I chose to be very upfront, I think to some people’s shock. You know, I was so upfront, even down to the case that the guys would sometimes used to just make a joke about it. And even today people come out with the most ridiculous comments, totally innocently and I fire back something really quick, you know [laughs]. And you can see the horror.
I mean just to give you an example, my boss said to me the other day, we were making some joke about a project and he said, “If that goes wrong I’ll have your balls.” And I said, “You can have them, they’re no good to me,” [laughs]. So all that kind of banter, and the reaction to that, is whoops I just dropped a clanger, but on the other hand they can see I take it in good faith.
Last reviewed July 2017.
Last updated July 2017.
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