Day 20: The Large Needle

Truth be told, I love giving Leah her daily injections.

For a few summers in elementary school, my parents enrolled me in a summer camp at the local university. I loved being in chemistry class with a bunch of other youngsters, moving fluids between vials and seeing what would happen. The same fascination carried over into chemistry classes in high school, when combinations of liquids would precipitate down in tiny nuggets we were not allowed to touch.

I enjoyed building things as a child, as well. My room was full of G.I. Joe paraphernalia the assembly which was required I performed myself, rather inexpertly. It was a dark day in my adolescence when my brothers--ten years my junior--stopped asking for toys that came delivered in boxes filled with plastic frames that needed to be carefully separated and put together.

Giving Leah her injections gives me that same feeling. There is only one pre-filled syringe. The menopur comes in an astounding four glass vials with little plastic caps that are surprisingly tight. The menupur also comes with a Q-cap for help in combining the drugs and filling the syringe. When it's time for Leah's injections, I lay everything out on the bathroom counter: the 3ml syringe, the 30g needle, the Q-cap, the two vials of powdered menopur, the vial of sterile saline, the Follistim pen, the small needle for the Follistim. This is Leah's gear. The Follistim even comes with its own carrying case. Some assembly required.

After the egg retrieval, Leah's medication changed. She started taking 50 mg of progesterone twice daily. The progesterone is different from the other medicines. It comes in a large ampoule holding 500 mg. The progesterone is also oil-based. It is more viscous in the vial. It is also delivered intramusuclarly.

There is only the syringe and the needle when I draw out the progesterone. I draw in 1 cc of air before inserting the needle into the progesterone. The nurse never explained why this is necessary, but I imagine it's to equalize any pressure beneath the sealed cap of the ampoule. I push the air into the vial and it bubbles slowly in. I lift the vial upside down and draw in a little more than 1 cc of the medicine.

The menopur dissolves quickly in the saline, but the progesterone is thick. There are small bubbles that come into the syringe with the medicine, and they effervesce like champagne. If those bubbles make it into Leah, she could die.

After I draw the medication out, I switch needles. The delivery needle is 25-gauge and an inch and a half long. I am not a person that's afraid of needles; I love to give blood and do so without fear. But this needle terrifies me. It is long and wide.

When I clear the syringe of air, the fluid does not squirt into the air. It spills over the edge of the needle and beads down the side. It is dark like maple syrup.

I don't want Leah to see the needle. Not even to tease her about her being afraid of something so small and harmless. The other injections were subcutaneous. They went through the skin into the layer of fat beneath. The progesterone is intramuscular. When Leah has covered he face with a pillow and rolled onto her stomach, I pull the needle out from behind my back. I clean a large area on the upper, outside quadrant of her bottom with an alcohol swab. As the alcohol dries, I check her hip to make sure I don't hit the bone.

The needle seems to go in forever. Deep. You can feel the needle moving through the skin, and then you can feel the needle moving through the layer of fat. Finally the needle breaks through and the plastic base is resting against her skin. I press the plunger as hard as I can while keeping the syringe still so she doesn't bruise. The plunger moves slowly and drives the medicine deep into my wife.

When the syringe is empty, I draw out the needle. I am supposed to massage the medicine into the muscle so it doesn't pool. I re-use the alcohol swab, because a few drops of medicine follows the needle out. Leah clutches the pillow to her face until it stops hurting, and then asks if I can stop massaging yet.

When she's ready, I take the needle and replace the cap. I twist the needle off the syringe and toss them both into empty bottle of Listerine we've now half-filled with the medical waste of the process.

Day 19: Illness

Leah is not at all well. She is prone to hypochondria and will complain about minor ailments and ask aloud whether she should consider seeing the doctor. This morning was different. She was very sick. She stayed in bed 20 minutes after her alarm. When she rolled over so I could give her her new shot, it would not stop bleeding. I had to put a compress on it for two minutes before the bleeding stopped.

Leah seemed weak but well after the egg extraction. Lately, she has been eating like a bird. Last night I made a pasta with quick tomato sauce with extra salt, and she maybe had two bites before turning her plate over to me and rolling onto her side. She says that she's not hungry at all and is only eating because she knows that she has to. She hasn't moved her bowels since the Monday before the egg extraction. She feels stuffed.

Before I left for work this morning, Leah was crying in the bathroom. The rule that I follow is that if Leah's complaining, she's probably all right, but if she's weeping on the toilet, it is probably time to spring into action. She says that she feels nauseaous. It is clear that something is wrong.

For the fifth or sixth time I check the checklist that they gave us at the Outpatient Surgery Center regarding Ovarian Hyperstimulation Syndrome (OHSS). The MILD and MODERATE symptoms are diarrhea and vomiting. Leah can keep food down, just not get it out afterward. Leah is not thirsty; there has been no change in urine amount or color.

Lynn, our IVF coordinator, doesn't usually come in to Fertility Treatment Center until 9, so I wait until my class is over until I call. Usually, the receptionist says that she'll see if Lynn is available and then send me directly to voicemail. I call on the drive back home and don't expect a call back for an hour at least. This time, Lynn picks up immediately, and I'm totally thrown. For some reason, this makes Leah's pain feel like a real crisis.

I tell Lynn Leah's symptoms, and she doesn't sound particularly worried. But Lynn always sounds just busy. She doesn't laugh at my jokes of sympathize with our setbacks. Lynn is short and clipped and speaks in purely declarative sentences. She says that Leah's symptoms are "classic" for Ovarian Hyperstimulation Syndrome. She assumes that Leah didn't go in to work today (she did). She makes an appointment for that afternoon, after Leah's out of work. She gives me specific instructions.

I am calm. I do not panic. I make a careful list of the things that I need to do, and then execute that list. I do not hurry through my dressing. I do not speed to the grocery store. I do not make egregious spelling errors on the text message I send to Leah.

At the grocery store, I pick up the high-sodium food and drinks that will help to pull the fluid out of Leah's abdomen, where it is gathering. I do not know what flavor of Cup O' Noodles is Leah's favorite, but I'm pretty sure that it isn't shrimp. I buy one beef and one chicken and the total cost is fifty cents. I pick up a six pack of the eight-ounce cans of V8 that I know Leah will hate. I buy four bottles of Gatorade blindly guessing which ones Leah might like (yellow, red, orange, purple). All of this food costs less than ten dollars.

Carefully I drive to Leah's school and sign in at the front desk with fifteen pounds of food crooked against my chest. When I reach her classrooom, Leah is teaching reading to her students. A parent helper is in the corner, and I call her over. I ask the parent helper, who remembers me from some school functions earlier in the year, to make sure that Leah always has one of these drinks in her hand as long as she's there.

When I finally turned to Leah, she smirked at me and said, "It looks like you talked to someone." I loaded the small refrigerator in the corner of her classroom with the Gatorade and five of the cans of V8. The sixth one I shook and opened and handed to Leah. She frowned at it. Her students didn't understand what was going on. When Leah first sipped from the can, she grimaced at it dramatically. The children asked her what was in the can, and when she told them carrot juice, more than half the classroom groaned in disgust. I told Leah about her appointment and showed her the Cups O' Noodles.

She couldn't have looked more appalled at her new lunch. I promised her that she didn't have to eat the noodles, but that the doctor said she had to at least drink the broth. This didn't make her feel better.

That afternoon I met Leah at Fertility Treatment Center and she looked much better. She still felt tender sitting down and standing up, but she wasn't crying on the toilet. We sat in the waiting room for maybe twenty minutes, and I knew Leah was feeling poorly when she didn't even want to play Burger Time on my cell phone.

Eventually they called us in and asked Leah to undress on the table again. There were still a pair of socks hiding in Leah's purse that she slid onto her feet. Before Leah sat on the table, she showed me how she had used a safety pin on her pants to keep them closed. She said that even her "fat pants" were too small for her stomach.

The doctor came in and gave Leah the ultrasound. He saw a small amount of fluid in Leah's abdomen, but nothing really to be worried about. He thought that she was doing great. He said there was another patient down the hall who didn't want to freeze her embryos and she was as sick as a dog right now.

The doctor didn't seem prepared to see patients. This was the first day that I could remember where he wore the traditional long, white coat, but it was buttoned further than he buttons his dress shirts usually. Denim pants peeked out from the bottom of the coat, and he was wearing expensive dark brown leather tennis shoes that no one would ever do anything athletic in.

When Leah was still on the table, she asked the doctor if we were for sure going to freeze the embryos and not do an implantation. He said we were definitely freezing the embryos. He said he'd go check on the embryos right now.

This was one of the real moments of wonder that I've experienced through this whole process. Our doctor was going into one of those harshly lit labs that are hidden from the patients and look at a bunch of cell clusters that would someday be our children.

"Are you really going to look at our embryos right now?" I said. I was practically lifting myself out of the chair.

"No, not really. I'm going to go look at the embryologist report."

Leah looked at me. She was tired. "Honey, you wouldn't open the oven while your cupcakes are baking, would you?"

The doctor put his hands deep into the pockets of his coat. "That's the basic priniciple. I'll be right back and you can get dressed."

The doctor was back in two minutes. He said that nine of the embryos looked really good, but that number could move up or down "a little" between now and Saturday. Also, Leah could go off all the drugs. Could she take tylenol? She could take whatever she wanted.

Nine!

Day 18: The Catholic Problem

I had a hard time going to sleep last night.

Leah is feeling well. She went to work this morning without problem, and was tired when she came home and immediately took a nap.

I've been worried about our embryos. I'm worried about money. I'm worried about what Leah's father asked after the procedure.

After Leah's last bloodwork came back in, the doctor assured us that we'd be freezing our embryos and be doing an embryo transfer after Leah's next cycle. But after the egg retrieval, the nurse set up an appointment for an embryo transfer this week. She said that they'd schedule the transfer in case there are embryos that "don't look like they'll make it" though the freezing process.

My dad worked in the insurance industry for 25 years. He worked with doctors every day and has grown skeptical of them over the years. He looks at them more as small-business owners (which they are) than as medical professionals with an interest in their patients' health (which they also are). When I paid over two thousand dollars for medical testing, he accused our doctor of a "cash grab." I assured him that a third party performed the testing (and was paid for it), and he repeated his accusation. When I paid another five hundred dollors for a second round of blood tests, for HIV and hepititis (something that United Blood Services performs for free every twelve weeks when I give blood), it was another "cash grab." And it's not just with doctors. When his dog came back from the vet with some elevated liver enzymes, he accused the vet of a "cash grab."

In the course of the paperwork Leah filled out before the egg retrieval, there was a waiver acknowledgeing that our doctor has a financial interest in the Outpatient Surgery Center. At the time, I thought that cut both ways. He makes money with the success of the center, but also is financially liable when things go wrong. This was different.

I looked at the paperwork we were given during our IVF seminar. Among the many, many papers were the cost sheet. When we got it, we were shocked at the bottom line. I was starting to feel like we were getting a good value with the daily blood draws and ultrasounds in the final week of the cycle. Now I looked more closely at how much the individual procedures cost. The embryo implantation costs three thousand dollars.

I don't want to call Fertility Treatment Center and ask them if Saturday's procedure "counts" as our embryo transfer for this cycle. In part this is because the business side and the medical side of the Fertility Treatment Center are sealed from one another. When I ask our IFV Coordinator how much something costs, she directs me to the Business Center. I wish that our nurses were more sympathetic to the costs of the process, but I also hope that they are not allowing cost to dictate care.

But cost is a factor. I do not want to explain this to our IVF coordinator. I'm not sure we can raise another sizable amount in two months to complete a real embryo transfer. I'm not sure that Leah could handle another failure.

The embryo transfer procedure this month would not stand a large chance of success, even as these things go. Leah's body has been wrung from the inside out. The embryos the doctors would be transferring would be by definition of the lowest surviving quality. Leah and I have tried to keep cost from being an issue. We've been fortunate to have family generous enough and able to give us a loan to go through this cycle. But we cannot afford to throw money away, or to throw bad money after good.

I am not Catholic. Leah was raised Catholic, but hasn't attended church in all the time I've known her. She was never confirmed because her mother was feuding with the leader of the confirmation program over some overnight lockdown when Leah had some kind of marching band performance. But so much work has gone into making these embryos that I can't help but think of them as my children. Already. Calling them embryos hasn't helped because they're still just future children, and the definition game doesn't seem to work when the embryos are yours. I consider myself pro-choice. So does Leah. At one point in our lives, we would have made such a choice (had we been able to make one). I would never tell anyone what to do with their embryos or their bodies.

But these are our embryos. The doctors say that transfering the embryos and having them implant could make Leah "really sick." The doctors say that the embryos transferred probably wouldn't survive, anyway. Leah doesn't want to go through the embryo transfer, and I don't want her to have to go through it.

But the procedure is scheduled. The nurse told Leah that they might not know if they'll perform the transfer "until she's on the table." What I want is to call Fertility Treatment Center and cancel the embryo transfer, no matter what.

But isn't there a chance? A chance those embryos could survive? That these are the embryos that Leah is (somehow) supposed to raise? The embryos are viable in some way. Could I make that call to cancel the transfer? What happens to those embryos after the call?

The worst part of me imagines a technician scraping the petri dish into a garbage can and tossing it into a sink like I do with leftover chicken cesar salad.

Months ago, Leah and I started praying every night before we fall asleep. When we pray, I ask God to give our doctors wisdom and skill in persuing our cycle. Now, I'm praying for God to watch over our embryos, and to give me wisdom. And patience.

Day 17: Fertilization Report

Selfishly I was a wreck for the 36 hours following Leah's procedure. Leah was weak but well after the egg retrieval. She didn't want to eat or drink, but we forced Pringles Sour Cream and Onion potato chips and flat Coke into her until, exhausted, she napped for three hours. During that time, Sandy worked on the puzzle and watched old television shows from our DVR.

I feel bad that I didn't worry about Leah. I worried more about myself. My role has been relatively small during this time. I took my own small medications, which were complete. I made sure Leah took her medicines. But I took no time off. I didn't really sacrifice. Instead, I worried.

I feel like I have been training for my role in the fertilization for sixteen years for this day, and that I'd somehow screwed it up. I wondered what I would do if the phone call came in that something had gone wrong, and that there were eggs, but no active sperm to find. Our past sperm donor was located somewhere around Fairfax, Virginia. It would take at least two days to get another sample, and another $800.00. My closest genetic relative is my brother. Could I call him away from his school in Flagstaff? He doesn't know about our project; what would I tell him? Would he do it? Would he be more fertile? Would I ask my father? Would I tell Leah if I had to?

I know that I made at least one mistake in preparing my sample. I know that I forgot to write the collection time on the sticker when I made the deposit and left the clinic to go running. But did I remember to turn off the light (or turn the light on?) when I left, alerting the andrology lab that the sample was ready? Would my precious, lazy genetic material sit unused on that shelf until it was no longer viable? Would Fertility Treatment Center call if it did? Would I have enough left to provide more?

I wanted to think about Leah, to care for her and her exhausted ovaries and recovering body, but I was instead thinking mostly about myself and about what might be wrong with me. My greatest fear was that this would be the finest, greatest letdown that would waste the past three months and so much money.

Luckily, everything came out fine. Fertility Treatment Center called Leah Wednesday afternoon to give the report. Leah on the drugs produced 22 eggs. The nurse she talked to said that she'd only been working at the Center for a few weeks, but she thought that 22 was a great number for an IVF cycle. Of those 22 eggs, 19 were fully mature.

Fertility Treatment Center fertilized Leah's eggs using the Intracytoplasmic Sperm Injection (ICSI). The doctors pronounce this "ICK-see." My memory of our IVF seminar is a little foggy, but the way I've been explaining it to my parents is that the doctor will grasp one of Leah's healthy eggs with a pipette, and grab one of my healthier sperm with a very small, very sensitive pair of tweezers. The doctor will then very slowly, very gently, jam my lazy sperm into one of Leah's eggs, and hope that nature takes its course.

I teased Leah that the embryologist was going to have a very long day considering how active Leah had been the past two weeks.

Of the 19 mature eggs, 15 fertilized successfully. I don't understand the success rate of these procedures, and the doctors are generally reluctant to provide averages. Part of me hopes this is because our situation defies the averages; Leah is so young and so healthy. Another part of me thinks that the doctors are wary of getting patients' hopes up. I don't understand what happened to the other four eggs. I understand that some couples have a hard time conceiving naturally, and that these things take time, but what happened here? Did a doctor's hand slip while performing the fertilization? Did one of the eggs fail? These are the mysteries of life.

The nurse that called Leah made an appointment for an embryo transfer for Saturday morning at 11:00 a.m. The nurses told Leah that even though they would prefer to freeze the embryos, there's a possibility that some of them may not survive the freezing process, and they'll want to implant them. Leah's father wants to make sure that if they do the embryo transfer, then we won't have to pay extra for the "real" embryo transfer in a couple months, after Leah's body has had an opportunity to rest.

After four days, we'll know how many mature embryos we have. I'm very excited, and I feel like, for the first time, that I have a part in this process.

Day 16: Outpatient Surgery Center

Leah and I slept through to our alarms the night before the egg extraction. At least, I know I did. Leah said that she slept well. Leah's mother Sandy came up from Tucson Sunday for the procedure. The day before, Leah and I went and got a puzzle for them to work on together: the poster for Breakfast at Tiffany's in one thousand random pieces.

Leah dressed in a t-shirt and a pair of workout pants as well as a pair of sneakers. I'd packed by bag the night before and laid out a pair of running shorts and a sleeveless running tee. Leah didn't have anything for breakfast, and I had the last of our milk to go along with a bowl of Honey Nut Kix that Leah tried and gave up on after two bowls.

I drove the three of us to the Center right on schedulue. We pulled up at the back entrance at 7:10 am. Sandy sat between Leah and I in the waiting room. Eventually an older, squat nurse came out to bring us in to the prep room. She's at least ten years older than any of the nurses at FTC, which makes me think that she was hired for her easy smile and matronly appearance.

The brought us into the first room in the building that I've seen with any real self-awareness. The room's softly lit with the kind of halogen track lighting Leah's admired at Ikea. Three chairs were on walls opposite of the door, and the nurse seated Leah closest to one of those machines that tracks the patient's heartbeat and blood pressure and beeps ominously. Sandy sat closest to Leah and I was seated all the way across the room. Behind Leah on the wall hung a triptych of photographs of blooming sunflowers. Their pistils and stamens were outstretched and welcoming, which seemed about right for the room.

Leah shares my low blood pressure, or she could have been dehydrated from her eight-hour fast. Her heart rate was in the mid-80s, which I think was impressive considering the stress she must have been under. After unwrapping the blood pressure cuff and unclipping Leah's finger from the machine, she tapped the backs of Leah's hands to bring a vein to the surface. She looks at both of her hands before streching Leah's arm to look inside the crook of her elbow. The nurse said that her veins look a little abused.

Leah signed whatever paperwork was placed in front of her without really reading it. One of the releases was an understanding that our doctor had a financial stake in the surgery center, which makes me more nervous now than it did then. The nurse took Leah's medical history, which was all well and good until they reached the part where they asked her what medications she is currently taking. Everyone in the room took a deep breath before Leah ran off the list: Follistim, Ganerilix, Menopur, Synthroid, doxycycline, cabergoline, liquid Vitamin D drops, her daily multivitamin, and folic acid. There wasn't a line on the nurse's chart for the synthroid. She ended up recording it on a margin.

After the nurse lead Leah into the changing room and handed her the surgical gown through a crack in the door, reminding her to leave the back open, she lead me into my own room to provide my part of the equation. As I worked, I tried to remember the last time I had performed so early in the morning. Everything went well. I put my specimen in the little nook where such things go and left the room.

They said that the procedure would take two hours. I have little interest in spending two hours alone with my mother-in-law in a waiting room while my wife/her daughter gets her eggs plucked from her ovaries with (presumably) some kind of catheter. I've never actually seen a patient under anesthesia in real life before--only on shows like House and E.R. For a moment, I indulged myself in the idea that Leah might look like the way that vets work with dogs under anesthesia. I imagined her mouth held open and her tongue fastened with a clip we use to close bags of potato chips. Then I slung my bag over my shoulder and slipped out the back door and to the car.

There was a moment when I wondered what I would do if something bad happened and I wasn't there. I'm am the type that's prone to panic, though. When someone at my dorm freshman year split his thumb open with the top of a can, I nearly hyperventiliated. There was no good that could come from sitting in that waiting room.

So I went to the gym and ran mindlessly for an hour. Happy and exhausted and ripe, I returned to the Outpatient Surgery Center three minutes before the nurse brought Sandy and I back to the recovery room.

Leah does not do drugs, and never has. But she was high when we came into the recovery room. She still had her surgical booties on and a blissful smile on her face when she saw us. She looked exhausted but happy. While Leah became herself, a different nurse pulled me aside and gave me the instructions for Leah's recovery that day. She was to lay on the couch and have a minimum of activity. She was supposed to drink lots of high-sodium fluids, like flat Coke or Gatorade or V-8. She should feel better the next morning. They gave me a prescription for Darvocet that never even got opened.

About 30 minutes after Sandy and I were lead in, they rolled Leah's wheelchair out to our car and we headed home--her to her puzzle and I to the recovery of my wife.

Day 15: FTC Egg Retrieval Instructions

You are scheduled to receive your HCG trigger injection on 4/19 @ 8:00 pm.

If using Pregnyl, Novarel or other intramuscular injection, it will be mixed using 1 cc - 2 cc of diluent into all of the powder. Ovidrel is in a pre-mixed syringe and is given subcutaneous. It is very important that the trigger injection be given at the scheduled time. Please page the practicioner on call if you have any questions or problems.

• Your last dose of Lupron/Ganirelix/antagon will be the day of your trigger shot.
• Your last dose of gonadotropins will be the day of / day before your trigger shot.
• You will begin taking Doxycycline the day of your trigger shot.
• You will not be seen at FTC the day following your trigger injection.

Please have nothing to eat or drink after midnight the night before your egg retrieval.**

• The morning of egg retrieval, take one 5mg tablet of valium with a small sip of water 1/2 hour before your scheduled arrival time.*
• Do not take your antibiotic the morning of retrieval.
• Your partner will take his lost dose of antibiotic the the morning of retrieval.
• Please arrive at the Outpatient Surgery Center, Suite 111, accessible through our Main lobby on 4/21 @ 7:30 am.
• Retrieval is scheduled to being at 8 am.
• Your partner will be asked to provide a semen specimen shortly after retrieval begins.
• We ask that you, your partner, or anyone else coming into our Surgery Center please refrain from any perfumes, lotions or other scented products. Please do not wear make-up, fingernail polish, jewelry, contact lenses, or scented products to your retrieval or embryo transfer appointments.
• Retrieval and recovery will take approximately 2 hours. You MUST have a ride to and from your procedure.
• Do not bring any personal belongings with you to your procedure.

When you return home, you will need to rest for the remainder of the day. You may eat and drink normally if you feel up to it. By the following day you should feel better.

The FTC IVF lab will call you the afternoon following your egg retrieval with an embryo report. They will begin the process of scheduling the embryo transfer, (usually 4 days after the retrieval).

Please call FTC if you experience any of the following:

• Excessive pain or tenderness not relieved by Tylenol.
• Temperature over 100 degrees.
• Bleeding heavier than a normal period.

Please do not bring children to retrieval or embryo transfer. Thank you.

* This is an outdated instruction. The Outpatient Surgery Center takes the medical history and performs its informed consent procedures immediately before the egg retrieval. For insurance purposes, you can't do this hopped up on goofballs.

** I woke in the night to Leah unscrewing the cap from the bottle of water she keeps at her bedside. I felt like slapping it out of her hand, but instead let her take one sip and then took the bottle away and placed in on the floor on my side of the bed.

Days 12, 13, & 14: Setback

Things are going fantastically well. Leah's responding well to the medicines. In Saturday's ultrasound she had enormous follicles. Her abdomen is sore for carrying so much.

Leah is responding too well to the medicines. Her ovaries are hyperstimulated. The nurse practitioner told us this on Saturday, after the ultrasound. She prescribed some drugs along with her precautionary antibiotic to reduce the symptoms of the hyperstimulation, but she didn't describe what is going on inside my wife.

What we know is that her body is producing too much estrogen. The doctor reduced her dosage of the Menopur on Friday to only one ampoule twice a day. This is problematic, but we don't know why. According to the nurses, she can get "really sick." The generality of that phrase is more terrifying than anything specific they could tell us.

According to our ultrasound on Sunday, her uterus looks beautiful, which has been a feature of our testing through every cycle. Leah's built to carry children. She has more than a dozen mature follicles. The doctor prescribed the trigger shot for Sunday night. Leah will undergo the egg extraction Tuesday morning, and they'll fertilize the eggs that day. The eggs will mature for four days.

And that's where the plan changes. Our doctors do not want to perform an embryo transfer this month. The amount of estrogen in Leah's blood is too high. The odds are against a successful pregnancy, and should a pregnancy take hold Leah "could get really sick" if her estrogen levels are this high.

I don't know what to feel. The process isn't complete; it's too early for despair. Leah is devastated. She started crying once we left the doctor's office, and when her mother came up from Tucson, she sobbed in her arms. Leah has endured so many disappointments. She wanted to have a baby before she was 30. When it was clear that wasn't possible, she's been motivated to be pregnant before she's 30.

The doctors say that after the egg extraction, she'll get her period in the next two weeks. Then she'll go back on birth control for another month, then go through another cycle where they will shut down her ovaries but closely monitor her uterus and watch her estrogen levels. They talked about estrogen pills and creams.

I'm still in shock. I have difficulty explaining how I feel because I'm not really sure what I think. I feel for Leah, and while she's being brave, I'm afraid her disappointment might poison the few days left we have in the process now. She will heal, but she can't stop fighting even though this battle is more or less lost.

What I know is that I'm still excited. We're repeating or expanding on successes right now. Leah's made multiple follicles before on other cycles; she's responded to these drugs before. But tomorrow we're going to be making a baby. A bunch of them, hopefully. If Leah has 15 follicles, and 10 of them contain viable eggs, and 7 of them create viable embryos, that would mean that by the end of the week Leah and I will have, according to pro-life demonstrators, 7 children.

What I know is that I'm still disappointed. Because those seven "children" are going to be frozen and will have to wait some 12 weeks before they'll be thawed out. And not all of them will survive the process. They say that Fertility Treatment Center has a higher rate of success with frozen embryos than with fresh ones. Because only the strongest embryos survive the process.

In a few days I'll be a dad. Kind of. How can I not be excited?

Days 10 & 11: Two Healthy People

Medical science can find no cause for my problem. I am a healthy person. My resting heart rate is 68 beats per minute. My blood pressure is 109 over 50. I stand 5'10 1/2". My weight has been constant at around 195 lbs. (192 lbs. this morning) for the last year and a half. I drink maybe once a week, but am not the kind of person who pops a can of beer after a long day at the office. I ran a half marathon in January in two hours, eleven minutes, and two seconds. There was a time in my life when I was in better shape than I am now, but not by much.

$2500 in testing proved that there was nothing wrong inside me. My Y-chromosome was examined closely and no microdeletions were found that could explain anything. My hormone levels are all within range. My hair and nails grow quickly. My metabolism runs a little bit slowly, perhaps.

There's nothing wrong with my genetics, either. I'm the eldest of four kids. My dad says that he could practically look at my mother and they'd get pregnant. His brother has two daughters. My mother is the eldest of three. My maternal grandmother had problems conceiving, but she said that the doctor opened up her fallopian tubes and she was pregnant the next month.

When my blood work returned, I looked at the results. The only questionable number was my testosterone level. It was on the low end, but it was well within the normal spectrum. A couple years ago, This American Life spent an hour examining the role of testosterone in people's lives. There was the story of a man whose body mysteriously stopped producing the hormone altogether. He sat in his bed all day, staring blankly at the wall. He ate because he knew he ought to, not because he had an appetite. He didn't want to do anything. Another story featured a person transitioning from female to male. When she began giving herself massive testosterone injections, her outlook changed. She'd see a woman on the street and images of her would come unbidden to her mind, flashing moments of unspeakable sexuality. She would find herself following women for blocks in New York City, transfixed by her form.

I do desire--I have an appetite. By nature I am a competitive person to the point that I'm frequently obnoxious to those who don't know me well. But I don't have the sex drive of some of my friends. One of my close friends broke up with his partner because she wasn't able to couple with him every day. That's not me. I'm usually satisfied making love two or three times a week.

Leah says that I look at my body more than anyone she knows. I think she takes this as vanity, but I'm really trying to study it. I look at my frame and wonder if I can find an explanation there. I'm stocky--I carry weight in my thighs as well as my abdomen. When I see myself in the mirror, I feel rectangular, not the V-shape that the books say is the ideal male form. When I was the closest to the BMI "ideal" weight for my height, people worried after my health. My frame is built to support.

I wasn't always this way. I was overweight in my teenage years and into my early 20s. At my heaviest, I was nearly 240 lbs. I was wearing size 42 pants before I decided that I needed to turn my life around in a serious way. I sometimes blame this time of my life for my problems, the times when I was careless with my body. I would drink four or five sodas a day, make chicken fried steak for dinner once a week. I know that excess abdominal fat produces estrogen in the male body. My voice on tape always sounds high and nasal.

I am working to improve my body. My dad was a runner when I was growing up. He ran several 10K races during the short Arizona running season. I run some, but I've been working to put on muscle and tone the body that I have. I feel sturdier at this weight than I have in a long time.

There's nothing wrong with Leah. She had her blood work and ultrasound today. The doctor said that she had "beautiful ovaries." She had 12 follicles on the right ovary, 10 on the left. The lead follicle (as they call it) was over 20 millimeters. The doctor said that Leah was doing great. Leah thinks that her ovaries look alien on the ultrasound screen.

We will be going back for ultrasounds on Saturday and Sunday. The doctor thinks we'll be able to give the trigger shot on Sunday, and hope for the egg extraction on Monday or Tuesday.

While Leah's insides are doing great, her outsides are showing signs of wear. The constant injections have produced bruises on her abdomen and thighs, although I try to be gentle. The Ganerelix gives her an itchy rash when injected in her thigh and stings deeply when injected in her abdomen. But she's faced all of this without complaint. I am proud of her.

Day 10: The Waiting Room

I am now taking 250 mg of Levaquin daily. I was supposed to start taking them Tuesday, but we didn't get a reminder from FTC, so I started on Wednesday night. According to the yellow stickers on the side of the bottle, I should "AVOID prolonged or excessive exposure to direct and/or artificial SUNLIGHT," "drink plenty of WATER," and "USE CARE" [sic on the allcaps] when operating machinery while on this medication. I guess this explains why I was so thirsty last night when I went to bed.

Leah went back to the doctor yesterday for more blood work and another ultrasound. Very exciting news. The blood work apparently came back fine, since we never heard from the doctor. The ultrasound revealed ten to fifteen follicles on each ovary, measuring between 10 and 12 millimeters. Leah's ovaries look like blackberries on the ultrasound.

In the past, we've tried to schedule our appointments at FTC in the late afternoons. That way, Leah doesn't have to find a substitute and I can join her and hold her hand through everything. Also, I have Burger Time on my cell phone, and she likes to play it while we wait. Because we're in an in vitro cycle, they have been scheduling our appoitments for early in the morning, and I haven't been able to leave work for a handful of them.

The waiting room at FTC is an interesting place, and Leah and I both have different experiences with them. The waiting room can seat twelve or fifteen people comfortably, even though I've never seen that many people in there at once. Patients can sit on a bench or one of the handful of chairs behind the bench. There's another large flat-panel television against the wall, but none of the seats actually face the screen. There's a large coffee table between the chairs assuring that no one has to come close to anyone else. A collection of anodyne magazines sprawl across the coffee table: People, Time, Businessweek, Good Housekeeping. Right now, about a third of the magazines have Barack Obama on the cover. To find someone reading the magazines is exceedingly rare.

Across from the seats is an enclave gently lit by track lighting with the array of slide-the-bead-along-the-wire toys I remember from my pediatrician's office. There's also a large toy box. This is one of the few places in the entire office that acknowleges the existence of children. Occaisonally a patient will bring one or two of their adorable children in and they'll be more interesting in playing than watching the children's movie on the television, which I think is a good sign about the kinds of parents this process produces.

Sitting the the waiting room at FTC usually reminds me of when I used to ride the bus, or when the few times that I have had the opportunity to take the subway in New York or elsewhere. Everyone is wearing a blank stare into nothing, and no one is talking to one another. Sometimes partners will talk to each other (Leah and I chatter constantly), but there's no cross-conversation, even though everyone knows why everyone else is there.

When Leah looks around the waiting room, she's jealous. She's jealous of the parents who already have kids, and brought them with them. She thinks these parents are being greedy and should be happy with the gifts they already have. She looks at the women who don't have children with them and knows that only 50 percent of them are going to be pregnant once their done, and hopes that she's on the right side of the actuarial table.

I look at the men when they're there. I study their faces for the kind of discomfort and nervousness that I hope I'm hiding. I try and see whether they are annoyed with their wives for roping them into this expensive proposition when there's nothing wrong with them. I look at their bodies and see if there's anything we have in common--if there's some common feature we share.

The women are almost always older than Leah; women who are fighting their biology and making one last stab at having a child of their own. They are frequenly busy and tired-looking. They check their Blackberries or sometimes their Wi-Fi equipped laptops while they wait. The younger women fall into two types. The first look middle class like us, and seem as nervous as we feel. They often bring their mothers or grandmothers to write the large checks that follow. When they walk through the enterance, we look at each other compassionately until they sit down and we ignore one another almost completely.

The other young women come alone and are immediately ushered in to the office proper. They are younger than Leah, probably in their early twenties. They are thin and pretty and usually blond. They come in wearing sweatpants with their university or sorority letters embroidered on their seats. Their hair is tied up in ponytails. It's hard not to think that these women are egg donors. Their apperance is rare but noticed.

When Leah's alone in the waiting room, I wonder how she sits. Is she uncomfortable? Is she watching Harry and the Hendersons or Cheaper By the Dozen 2 on the television? She's not reading the magazines. I like to imagine her calm and confident, pushing up her sleeve for the next blood draw.

Day 9: What I Do

When we began the in-vitro cycle, our very kind and understanding IVF Coordinator Lynn gave us a calendar where we could keep track of all of our medications and injections and everything else. The first page was dated, but the second page--beginning with the injection that will cause Leah's eggs to mature--was absent of dates. Frustratingly so.

I've been highlighting the dates to assure that I'm giving the injections on time. We're halfway down the page. It would seem like I'm pretty good with details, but I'm actually really bad at planning--hence, the highlighting. It's Wednesday now, and Leah reminded me that initially her egg extraction would be scheduled for Friday or Saturday. Even if we're two days behind the schedule, that's tantalizingly close now.

It also means that I get to become involved in a meaningful way. The next time Leah visits the doctor, he should be writing another prescription--for me, this time. I will be going through a cycle of antibiotics to make sure that my boys are clean and that there won't be any problems with the sperm side of the equation. I shouldn't really be that excited about taking antibiotics--I'm generally the kind of man that won't go to the doctor unless I'm in severe pain that won't go away. I passed out in the shower last year getting ready to go to work when I was ill and still didn't head over to Urgent Care. It's not just because I don't have health insurance, either (help, please, President Obama). But I am.

One of the great ironies of this whole process is that there's nothing that we know wrong with Leah. Her ovaries might be a little slow to respond (and have been through the last four cycles), but there's no reason to believe that she can't conceive. But despite there being nothing wrong with her (a fact that she's had to get used to), the responsibility for the procedures has remained on her.

It has been distressing that not being able to conceive a child has made me feel so, well, impotent. One of the reasons that I started this project was to provide myself with a little bit of agency but also for all the test tube dads out there to find some support (and it's 15% of couples trying to conceive that suffer from male-factor infertility). Honestly, after doing a lot of the research, I have begun to count myself fortunate that I suffer only from low sperm count (oligospermia) and not zero sperm count (azoospermia). There have been a couple of things that I've been trying to do to improve our chances of the doctors finding at least a handful of live ones when I make the meaningful deposit later this week (hopefully).

I take my mulivitamin every day with dinner. I also take a zinc picolonate suppliment with dinner, which is supposed to help with sperm development. I gave up pork for six months and have switched to decaf coffee. I've also started "hydrotherapy," which really means thirty seconds of blindingly cold shower after the usual ten minutes or so of lukewarm shower (upside: No steam to wipe off when it's time to shave). I've also started "dry skin brushing," which is exactly what it sounds: I run a brush over all my skin before jumping in the shower in the morning, brushing upward toward my heart from my hands and feet inward. I think I've made my routine intentionally onerous in order to offset Leah's injections.

Despite all that, though, I still haven't called the andrology lab to check the results of my last semen analysis.

Day 8: Other People's Babies

Yesterday I went back to the pharmacy. While I was waiting, two children came in with their father. They sat on the overstuffed chair next to mine. The girl, McKenna, showed me that she knew how to tie her shoes, and she eventually did. She was five. She also liked Disney Princess stories and could hopscotch on one foot.

Her brother Mathias was 3. He wore a frayed hospital bracelet and his blond hair was swept into a faux hawk. He was smiling but quiet. On his tiny feet he wore tiny shoes with yellow lions embroidered on the ankle.

The manager at our gym is very pregnant. The person who teaches next to Leah is also pregnant. Leah's other next door neighbor had her second child in January. She was on the Pill and got pregnant. We stopped watching E! News after seeing continuous Bump Watches day after day after day. Ashlee Simpson, Nicole Richie, Jessica Alba, Jennifer Garner, Naomi Watts, Jennifer Lopez (twins), Matthew McConaughney, and Brangelina (also twins) have all been featured. Both Colbie Smuthers and Alyson Hannigan on How I Met Your Mother are hiding their pregnancies behind large globes or flowing scarves or racks of basketballs.

Leah's brother and his wife married a year almost to the day after Leah and I. It was a lavish wedding at the La Paloma Hotel and Resort in Tucson, Arizona. It was the kind of wedding where the father of the bride wandered around looking dazed and checking the charges at the open bar (once closed and re-opened) and reminded all the guests how much the wedding was costing him during his toast. Leah wasn't drinking because she had ovulated the day before.

I was half in the bag already, but during the toasts, we saw something funny. The bride and groom were seated at a sweetheart table in front of the dance floor, and we saw the waiters pour their glasses. The bottle sat behind them, wrapped in a towel to keep cool. They were toasting with sparkling cider. We were the only ones who noticed, including Leah's parents.

J.C. and Melanie went to Hawaii for their honeymoon. They brought back gifts. For us, they brought back a five-inch wooden fertility Tiki that we now keep on the mantle by the door. Thanks.

The week after they returned home they announced that they were six weeks' pregnant. Why Melanie had torn open the zipper on the back of her gown was then explained. Baby Bryn was born in October, and is beautiful.

Leah and I have tried hard to deserve a child in this past year or so. I have tried to be kind to people, to smile at everyone I meet and to be less less judgemental of differences or others' faults. It has been good for me. I care more about others, which has made me a better person. I work harder for other people.

When I see a pregnant woman on the street or in the mall, or a father with an infant in his arms or strapped across his chest, I feel happy for them. It's a kind of bittersweet expectation that someday soon that should be me.

For Leah this has been more difficult. Every day she teaches the children of other people. When she went into her spring meetings, half of the teachers from her sister campus were expecting. She's been with me for ten years now, and been hoping for a baby for two. She's now seen her baby brother get a child when it was her turn. She says that it takes five months for her to stop being mad at someone who's conceived.

When Leah and I pray before bed every night, I pray for God to give her grace.

Days 6 & 7: The Children of Men

The doctor called after our Friday appointment. According to the message, Leah's estrogen "spiked to 61" (one feature of our conversations with our doctors has been the lack of context to a lot of the information that's provided--the severity of the spike is tantalizingly understated), and so we would have to give her another dosage of Menepur in the evenings. Leah's cell phone had died two days before the call came in, so we found this out at 8:00 p.m. Friday night and immediately administered the dose.

I went back to the pharmacy again on Saturday morning to make sure we had enough medicine to get through the weekend because the pharmacy is closed on Sundays. Another four hundred dollars. They're starting to recognize my face. Whenever we pick up the injectibles, the pharmacist asks if we need more syringes. We have such a back log of needles that our downstairs bathroom is starting to look like a setting in Saw II. When we first started administering injections, we put the old needles and ampoules in a little cardboard box on the sink. Now we are old pros and dispose of our syringes in the pro forma "sharps" container of an empty, repurposed Listerine bottle. When guests come over, it's easy to hide all of the materiel under the sink. It also makes an unpleasant surprise for snooping guests.

In December, I followed a masochistic impulse to read P.D. James's little thriller The Children of Men. I bought the book over a year ago when the Clive Owen movie came out. It sat on my shelf for over a year waiting to get read. When Leah and I saw the movie, we were both impressed with its technical achievements but never really thought that it would be talking about us.

For those who haven't read the book yet, it takes place in a near future when the world suddenly and immediately became infertile. All women immediately became sterile at the same time sperm counts around the world fell to zero. When governments went to check the sperm banks, they found all the sperm eliminated as well. The novel begins with the sudden, violent death of the last child born in the world. The first half of the novel describes such a world.

The Britain James describes in a study in despair. Government has become increasingly paternalistic; as the population gradually ages and becomes smaller, they consolidate the population to the city. Elections are farces. One of the more intriguing aspects of the world James describes is the government-run pornography houses. James follows a conversation between the ruler of Britain and the erstwhile protagonist. For the population of this Britain, sex becomes a pointless exercise when there is no possibility for procreation, but the government has to encourage couples to engage in intercourse in the hopes that a child might be conceived.

This is a long way of saying that Leah tried to seduce me Friday night. She put on the nightie that I bought her for Valentine's Day years ago, and cuddled up to me on the couch as we hurtled through a backlog on our DVR. She kissed my neck once we climbed into bed.

I like sex. I'm pretty good at it, and there's that rush of doing something that you're good at. But this process is the opposite of erotic. I'm injecting her with drugs twice a day to make her ovaries overproduce. We go to the doctor three times a week to check in. I've seen the image of her uterus so often I could to a police sketch of it. Every step is a reminder that we're closer to conceiving a child, but also that I've been unable to provide one for a year and a half.

I probably need to drink more.

Sunday we had our second ultrasound and they checked Leah's estrogen and progesterone levels. No word on the hormone levels is to be taken as good word, and we haven't heard anything yet. The doctor told us that Leah has been slow to respond to the drug treatment and that is going to push our schedule back by a couple days. That's the reason he increased the dosage of the injectibles.

In the ultrasound, overies are large, dark ovals. The follicles look like berries surrounding the ovary. Today, Leah had 9 follicles on one ovary, and 5 on the other. The follicles measured about 10 millimeters. They ideally would be at 14 millimeters. One follicle, when it matures, should contain one egg.

Leah is already feeling defensive about her follicles. She complains that everyone knows that when you ask 14 kids to do something, it takes longer than working one-on-one. She says her ovaries feel heavy and like she's been working hard. I've been asking her to make her "egg face" as frequently as possible. It's hard to define what Leah's "egg face" looks like. I think that it should resemble an infant trying to go to the bathroom--a kind of physical focus of gentle exertion. But when Leah makes it, it's more of a blank stare with mouth agape, a total inward focus. I remind her that the flies she's catching in her mouth are useful protein.

Day 5: The Long Wait

UNFORCED ERROR UPDATE: Leah and I accidentally didn't buy enough medications on Tuesday to get us through the entire week. Last night when I was checking everything was in place so I could sleep in a little bit this morning, I noticed that we only had 75 units of one of Leah's meds when she was supposed to take 150. I gave her the half-dose this morning at the usual time, and then gave her the other half after we visited the pharmacy to get more. The second dose was less than three hours late, so I think we'll be okay. Usually, this would be something that would keep Leah up all night and searching the internet for the worst possible news, but she actually took it really well. We both had sound sleep last night.

SIDE EFFECT UPDATE: Leah says that she's occasionally feeling her overaies at work. Since I don't have ovaries, I have no idea what that really feels like. I never take a moment to feel my testicles working. She said that every once in a while she'll feel a little twinge on her ovary, and then she'll know that they're working hard. Or something.

We tried for six months before I thought that anything might be wrong. I say "I" because Leah always thinks that something is wrong with her. She's a hypochondriac by nature, especially when she's bored. Early in our relationship she suffered from a moderate Obsessive Compulsive Disorder. There were times we could work around it--like when I turned off the lights at bedtime so that we could go to sleep--and times when we couldn't--like when Leah would become so frustrated reading the same sentence over and over, trying to get negative thoughts out of her head, that she would cry.

This early period was difficult for both of us. The usual woman's cycle is some 28 days, give or take. The Pill enforces that. Leah went through four or five different drugs before deciding on a low-dose birth control that wouldn't give her headaches. Her pill pack always held 28 pills: dark blue, blue, light blue, and white. Leah went on The Pill when she was 18; she was on it for nearly 9 years.

Making a baby is supposed to be easy. Nothing could be more natural. We figured that nothing might take for the first couple months because she'd been on The Pill for so long that it might have to wash out of her over some time. But we still tried really hard. "Getting there is half the fun," I'd joke with those few people I'd let know we were trying.

We checked on the internet for the "symptoms" of pregnancy. The first was always a missed period, but we were never really willing to wait that long. We bought pregnancy tests, but they are expensive and we didn't want to jinx anything or know early that we weren't pregnant. If the test was supposed to be accurate after 10 days, then it would still be accurate after 15 days.

The other symptoms or pregnancy are swollen, sensitive breasts, a sudden darkening of the areolae, sleepiness, etc. Late in the cycle, Leah pressed the palm of her hand against the side of her breast and grimace, lightly lifting each up and down. When she'd undress before bed, I'd squint at her chest to see if anything was any darker.

The wait would be unbearable. Leah never kept a calendar of her cycle, and didn't start until much later. We'd wait and wait and eventually decide she was officially late and that we might be pregnant. There's be a silent wager between us over who would broach the subject first and possibly put the kibosh on the whole enterprise.

Eventually, we'd make all communication through knowing glances. I'd know that she'd gotten her period because she was sad or stopped squeezing her breasts or when I'd find the wrapper for a maxi pad in the bathroom trash. Every month was a minor disaster when Leah blamed herself for again failing to hold on to our child.

Much, much later we found that Leah's cycle isn't 28 days, but closer to 40.

Day 4: Fertility Treatment Center

Side effect watch: Last night, Leah said that there were times yesterday afternoon where all she wanted to do was cry. This could be anxiety over the next month looking for a release, but Leah's not the kind of person who just starts crying. I wonder about the things that I'm putting into her body.

This morning I gave Leah her second round of injections. This morning she wanted them in her abdomen. I warmed the pen by rolling it in my hands before administering the shot. Our IVF Coordinator says that if the shot isn't warmed a little, it will sting.

You're supposed to grasp the abdomen firmly when administering the injections. By nature I'm a gentle, cautious person. When I gave the shots this morning, I apparently didn't grab firmly enough, and Leah was crying from the sting.

We have our second testing visit at Fertility Treatment Center tomorrow. FTC is a maze. I had been there six or seven times before I began to figure the place out. I wonder sometime if this isn't purposeful. There's an expertise and an ease that the employees show with the space that inspires confidence.

The building on the outside is cold and modern. All poured concrete and painted steel. The building itself is located at the ASU Research Park, and is named the Reproductive Medical Center. As far as I can tell, the only businesses there are the FTC and the pharmacy where they dispense the medications. Inside, the building is much warmer. I sometimes think about the designer of the space. The ceilings are higher than most doctors' offices, and there is lots of overhanging wood that breaks up the severe angles. Someone enjoys Eastern art, because there are pieces that can best be described as Oriental hanging here and there. In the reception area and the lounge where patients wait to pay they have flat-panel televisions playing movies on a loop. I'm always surprised and delighted by the movies that they choose to screen.

What isn't on display is the technology itself. The patient rooms are no different that those at a general practitioner's--maybe an obstetrician's. The room where the semen samples are collected are a little more designed and decorated. There are Oriental line paintings and a nicely designed sink. There's a hamper like the ones they have at Pier One Imports. Once there was a cracked door in the hallway and when I peeked inside I saw the molded plastic and unintelligible screens that one comes to expect from a high-technology medical space. It was the andrology lab.

I'm always a little more surprised by what the space lacks. There's little sense of humanity there. There are no photographs on the walls unless a nurse leaves her office open except for in the business office. There's no sense of humor--I'd like to think that some classy erotic paintings would enliven the collection rooms. The space reminds me of a nice law office.

I'm not certain that this is a good thing. The place reminds us that these people know what they're doing. But it doesn't usually say that we are important to them. There's a feeling that the place would get along just as well without us.

One would hope that the office would be willing to reflect their many successes. I worry sometimes that I never see them.

Day 3: Injections

Leah is terrified of needles. She has been ever since I've known her. When we went to the IVF seminar that the fertility center puts on, she clutched my leg so tightly I had five perfectly round bruises the next morning on the top of my thigh. She cried on the drive back home. She's gotten better over the past four months.

I teach at 7:00 a.m. most days. That means that I wake up at 5:10 or so in order to shower and get my mind together in order to leave by 6:05. I like to keep a tight, regular schedule, which helps when going through a strict regimen that we're doing now. The house is quiet in the morning. The sound of my spoon on the plate when I segment my grapefruit makes me wince. After I wake, Leah takes my pillow and presses it over her face so that she can get another hour's rest.

It takes five minutes to prepare Leah's injections. She takes two every morning (for now). One comes in two ampoules of white powder and one of saline solution. I take the syringe and draw out one CC of the saline and inject it into the first ampoule. The powder dissolves instantly. Then I draw out the solution and inject it into the second ampoule. The powder dissolves a little more gradually in tiny flakes inside the ampoule.

After I pull out the syringe and the solution I change the needle to a smaller gauge and clear any bubbles. I set this one aside and get the second syringe out of the refrigerator. This syringe comes in a pen. I attach the needle and set the pen for the proper dosage--150 units. The top of the pen clicks into place and draws out the air on it's own.

With the two needles in one hand and a alcohol swab in the other I climb the stairs to our bedroom, which is still dark. I turn on the light so I can see what I'm doing and Leah sits up in surprise. She rolls over onto her side and I clean the outside of her thigh with the swab. Her skin is cold from the night, so I'm not sure it's icy for her. She presses the pillow against her face so she can't see the needles, which I am hiding behind my back.

The first needle goes in without a hitch. I'm always surprised with how much pressure it takes to push in the medicine. In the movies, or when I was in the pediatrician's office as a child, it seemed frictionless, but Leah's body always seems to resist the needle as it does its job.

Leah has to explain to me how to use the pen. I thought that it would inject itself when I gave her the shot, but she insisted I had to drive the top of the pen down. It clicks under my thumb, but this needle is shorter than the other one. Then we're done, and I leave for work.

I know that the injections cause Leah a lot of anxiety, but after being off for the past 3 months, it feels good to have some agency with the process again. Leah's been getting blood pulled, taking pills every day, and worrying since late January, but all I have been able to do is wait.

It feels good to have a job again.

Days 1 & 2: Introductions

My name is Ben Kamper, and I am infertile.

I've never really put it that way before. It's simple that way. I'm not usually a confessional person. I don't talk about my feelings unless I'm in a fight or I'm trying to get someone else to speak from the heart. Part of this exercise is finding ways to open up about something with which, a year ago, I was deeply uncomfortable. I'll certainly talk about this more in future posts. Today, I'm more interested in outlining what the goal for this blog is, and the direction that I hope it will take.

My wife Leah and I have been trying to make a baby for 17 months now. Last April I got a semen analysis at the request of her general practictioner. When the results returned, I was diagnosed with ogliospermia, which means that the number of healthy, active sperm I can produce is low. Essentially, the odds of Leah and I being able to naturally produce a child were one percent of one percent of five percent. So we decided to try more technologically advanced options.

Yesterday, Leah had the first visit of our in-vitro fertilization cycle. She's been on birth control for the last 28 days or so, to give her ovaries a rest before the workout they'll receive over the next 18 days or so. Her visit consisted of a blood test and an ultrasound. The blood test covered a baseline of her hormone levels. The ultrasound checked to make sure that she had no ovarian cysts that would become trouble once her reproductive system gets kicked into overdrive. According to our N.P., her ovaries looked great.

We also wrote our first check of this process. $11,500.00. That's more money that either of us have ever spent at one time. It might be more money than either of us have ever spent in one month. Thankfully, that will cover all of the expenses through our doctor through this first cycle. It covers all the testing (at least two more ultrasounds and blood tests), as well as the egg extration, ICSI fertilization, a year of embryo storage, and an implantation. Insurance doesn't cover anything.

Today, we're picking up the medications for the first few days of the process. They cost $1,300.00. For the next sixteen days I will be giving her two injections every morning before I leave for work. We've gotten pretty good at this, me giving her the injections and her enduring them. When we're successful and she's pregnant, she'll be getting daily injections through the entire first trimester.

Right now, I think we're in good spirits. We've been disappointed for so long, I think we're ready to try something new. We're hopeful for the first time in at least six months, and I think that's good.

There's a lot that I want to talk about in this space. We've been working for almost a year now, and there's lots to tell. I'm planning on posting something every day, either what we're going through that day with the IVF cycle, or our experiences from the past. It hasn't been easy, but we've learned a lot about each other.