So much of this process has been about exercising control. We are in control over what we do, but that hasn't lead to any success or any results. We gave up control, to our fate and to God, and that didn't work. So now we have ceded control over Leah's body to the Fertility Treatment Center. It feels often that we're along for the ride.
I feel very much like we are children again. We are supposed to follow directions, to show up on time, to be good listeners generally and not to ask the questions that come with being an adult. We have gained control over our reproductive future by relinquishing control of our reproductive future.
Much of the way that the treatment has worked on Leah is by making sure that she's a blank slate. The IVF cycle began with Leah going on birth control for 28 full days. After her eggs were retrieved, her cycle completed and now she is on it again. She has completed 17 days of birth control and has gone off the Pill for hopefully the last time. Tomorrow she has another ultrasound and blood draw.
Leah is also on a new drug, Lupron (leuprolide acetate), 20 units per day. It's not quite as fun as the other drugs. The Lupron comes in a little box containing a large vial and a bunch of alcohol wipes and tiny syringes. The syringes are the same ones that diabetics use to administer insulin.
I wake up in the morning to give Leah her shot. The syringe is small, like the Ovidrel. There's only 0.2 ml that I inject; the syringe is more narrow than a #2 pencil. I have to wipe the top of the ampoule with one alcohol swab to assure a sterile environment, and draw the medicine directly into the syringe. It's much harder to see bubbles in the small syringe, and I don't want to waste medicine clearing the needle. I don't want to be the one husband who gives his wife an embolism; I watch Leah closely after I give her the injection.
The lupron is given subcutaneously. Leah's used to the shots at this point. She covers her face with the pillow more out of habit than from any real fear, but today's injection seemed to be hard going in. Because the needle is so small, she hasn't bruised at the injection sites.
Lynn says that the Lupron is going to "quiet" Leah's ovaries. They don't want Leah producing an egg or allowing Leah's body to build its own uterine lining before the embryo transfer. The lupron will be administered for the first 15 days of Leah's cycle, and will stop eleven days before the embryo transfer. FTC will take over the job of Leah's ovaries for this next month.
The side effect of the Lupron was immediate. The embryos must be what's in charge of estrogen production, because Leah immediately became more aggressive and angry once the Lupron started. Leah has done a good job of hiding what must be significant emotional side effects of taking such massive amounts of hormomes during the IVF cycle. She says that there are times when she wants to do nothing but cry, but when she's with me, she seems like her normal self. But on the lupron Leah has been quick to anger. She's also much more motivated to exercise than I have seen her since our wedding. On the lupron, she's found a way to work out at least 30 minutes per day and hasn't complained about going to the gym with me.
We are mentally, spiritually, and physically prepared to have a child. Leah and I are getting along well; neither of us are stressed at all. I feel like we are closer for having gone through this process. I certainly know more about her than I ever have before (I could draw a picture of her uterus freehand now), and she has strength inside her that I cannot comprehend. We are both really hopeful and confident that we are going to have success.
I hope that fertilizing the egg is the hardest part. We have the hoping for the best down, but there's a creeping part of my mind that is trying to prepare for the worst. I'm not sure I know how to.
Wednesday, May 20, 2009
Tuesday, May 19, 2009
Two Good Months
Dr. Rychlik's office is not like the rest of Fertility Treatment Center. The art of FTC is generally Asian-influenced, dark woods and brass. Dr. Rychlik is clearly the junior member of the practice. When we've had the opportunity to work with Dr. Craig, the nurses have always tried to impress us--and maybe him.
Dr. Rychlik's office faces west; when we meet him in the afternoons, light spills through the blinds and over the large credenza under the window. On the credenza are framed photographs of his blonde daughters. They look so much like the kind of pictures that come with frames that I find myself looking in the corners for bar codes. It's funny, though. There's a distance--maybe ten or fifteen feet--between the credenza and the enormous desk where we were seated. The desk is wide enough that when Leah and I hold each other's hands, our elbows are extended, but it is also deep enough that when Dr. Rychlik leans across it and slides material to us he keeps us at more than arm's length.
The office itself is huge--the size of a racquetball court with lower ceilings. There is a large bookshelf against the north wall that holds volumes that remind me of a law office. Behind the desk is another, more functional desk. This desk is cluttered with patient charts and the doctor's monitor, which I find myself at pains to read but can't really make out. There are model airplanes on small stands scattered around the office. They are not the kind of models one buys at the hobby store and takes home and assembles with rubber cement and tweezers. They are the kind of models that one sees at aeronautic trade shows. They look heavy.
When we first got our diagnosis from Dr. Rychlik, he explained our options to us. On the back page of our chart--which had the kind of bland diagrams of the male and female form that one might find in a high school health textbook--he sketched a diagram of the female reproductive system: two ovals for the ovaries on the wide corners of the trapezoid of the uterus.
He drew out the traditional method of conception. Some dots were jabbed onto the narrow end of the uterus and arrows followed the path of healthy sperm through the cervix and up to the waiting egg. Then he diagrammed intracervical insemination. The sperm dots were deposited just inside and then followed the same path as their fellows. Finally, he drew intrauterine insemination, where the sperm showed up right near the ovaries, where the fallopian tubes would be. He said that FTC could shorten the distance that the sperm had to travel to reach the egg.
He looked at the results from my semen analysis and wrote some numbers in the margin of the page. You needed so many healthy, active sperm for each level of intervention. My sample didn't reach the threshold for even intrauterine insemination (IUI).
"Right now," Dr. Rychlik said, "I would say that the course with the highest liklihood for success is to go ahead with IVF."
The doctor scheduled both Leah and I for an enormous amount of blood work. He couldn't explain why my count was so low, so he wanted to check my hormone levels. He also wanted to look over my Y-chromosome to see if any errors there might explain the problem. We asked if there was anything we could do, and he said that there was nothing.
There's always some question for me about how much the doctor wants us to get better. The practice makes far more money from a cycle of IVF than they would if they told us to keep trying and hope for the best. So Leah and I ran back home to our computer and seached for solutions to low sperm count and male-factor infertility.
What we found was that I needed to generally pursue a healthier life. I had to stop drinking, because alcohol is bad for sperm production. We had to stay cool, which isn't easy when the Arizona summer was just beginning. We gave up our weekend hikes in South Mountain Park. I was already exercising six days a week, but Leah's doctor said that I had to stop running. I went to our sporting goods store and bought a chest strap with a sensor inside which monitors my heart rate. I stopped running and started walking. I had to keep out of hot tubs, which I never had much interest in, anyway. Because I was exercising less, we adjusted our diet so that we were eating less, as well. Because obsesity is a cause of infertility. We bought multivitamins and started taking them every day. We started eating more raw vegetables. I've never been someone who enjoyed a steaming hot shower, but I adjusted the water from warm to mildly lukewarm in the mornings and after I got back from the gym.
Dr. Rychlik said that FTC never moves forward with a diagnosis after only one test. He drew a sine curve above his diagram. He said that the the male body works on a cycle similar to a woman's. It's possible that when I was tested, I was at the low point of my cycle. He drew a dot in a trough on the curve. Or, I could have been at the high point of my cycle. He drew a dot near the crest of the curve. We'd know more specifically how we should move forward after the results of the blood work and the second test came in.
The male body takes about 72 days to make sperm from scratch. I lived as well as possible during this time. It was like being fifteen again, except that Leah and I were still trying sincerely to conceive on our own. We continued taking her basal body temperature every morning and charting them.
At the same time, I tried making marginal improvements in my lifestyle. I bought new underwear which was baggier and less supportive than my old ones. I tried to be aware of when I was standing with my legs together, or crossing my legs at the ankles instead of resting an ankle on top of my knee. Even at the times, I had doubts about the efficacy of my self-treatment. But I believed that when you were living on the margins, as we were when it comes to my production, that even marginal improvement could be helpful.
A couple months later, after the blood work was complete, I went back in for another semen analysis. Three days later, I called for the results. Jody called me back. "There wasn't significant improvement," she said.
That night, I bought a twelve-pack of Miller High Life ("the champagne of beers") and took it with me over to a friend's house. I drank ten beers and didn't feel any better.
Dr. Rychlik's office faces west; when we meet him in the afternoons, light spills through the blinds and over the large credenza under the window. On the credenza are framed photographs of his blonde daughters. They look so much like the kind of pictures that come with frames that I find myself looking in the corners for bar codes. It's funny, though. There's a distance--maybe ten or fifteen feet--between the credenza and the enormous desk where we were seated. The desk is wide enough that when Leah and I hold each other's hands, our elbows are extended, but it is also deep enough that when Dr. Rychlik leans across it and slides material to us he keeps us at more than arm's length.
The office itself is huge--the size of a racquetball court with lower ceilings. There is a large bookshelf against the north wall that holds volumes that remind me of a law office. Behind the desk is another, more functional desk. This desk is cluttered with patient charts and the doctor's monitor, which I find myself at pains to read but can't really make out. There are model airplanes on small stands scattered around the office. They are not the kind of models one buys at the hobby store and takes home and assembles with rubber cement and tweezers. They are the kind of models that one sees at aeronautic trade shows. They look heavy.
When we first got our diagnosis from Dr. Rychlik, he explained our options to us. On the back page of our chart--which had the kind of bland diagrams of the male and female form that one might find in a high school health textbook--he sketched a diagram of the female reproductive system: two ovals for the ovaries on the wide corners of the trapezoid of the uterus.
He drew out the traditional method of conception. Some dots were jabbed onto the narrow end of the uterus and arrows followed the path of healthy sperm through the cervix and up to the waiting egg. Then he diagrammed intracervical insemination. The sperm dots were deposited just inside and then followed the same path as their fellows. Finally, he drew intrauterine insemination, where the sperm showed up right near the ovaries, where the fallopian tubes would be. He said that FTC could shorten the distance that the sperm had to travel to reach the egg.
He looked at the results from my semen analysis and wrote some numbers in the margin of the page. You needed so many healthy, active sperm for each level of intervention. My sample didn't reach the threshold for even intrauterine insemination (IUI).
"Right now," Dr. Rychlik said, "I would say that the course with the highest liklihood for success is to go ahead with IVF."
The doctor scheduled both Leah and I for an enormous amount of blood work. He couldn't explain why my count was so low, so he wanted to check my hormone levels. He also wanted to look over my Y-chromosome to see if any errors there might explain the problem. We asked if there was anything we could do, and he said that there was nothing.
There's always some question for me about how much the doctor wants us to get better. The practice makes far more money from a cycle of IVF than they would if they told us to keep trying and hope for the best. So Leah and I ran back home to our computer and seached for solutions to low sperm count and male-factor infertility.
What we found was that I needed to generally pursue a healthier life. I had to stop drinking, because alcohol is bad for sperm production. We had to stay cool, which isn't easy when the Arizona summer was just beginning. We gave up our weekend hikes in South Mountain Park. I was already exercising six days a week, but Leah's doctor said that I had to stop running. I went to our sporting goods store and bought a chest strap with a sensor inside which monitors my heart rate. I stopped running and started walking. I had to keep out of hot tubs, which I never had much interest in, anyway. Because I was exercising less, we adjusted our diet so that we were eating less, as well. Because obsesity is a cause of infertility. We bought multivitamins and started taking them every day. We started eating more raw vegetables. I've never been someone who enjoyed a steaming hot shower, but I adjusted the water from warm to mildly lukewarm in the mornings and after I got back from the gym.
Dr. Rychlik said that FTC never moves forward with a diagnosis after only one test. He drew a sine curve above his diagram. He said that the the male body works on a cycle similar to a woman's. It's possible that when I was tested, I was at the low point of my cycle. He drew a dot in a trough on the curve. Or, I could have been at the high point of my cycle. He drew a dot near the crest of the curve. We'd know more specifically how we should move forward after the results of the blood work and the second test came in.
The male body takes about 72 days to make sperm from scratch. I lived as well as possible during this time. It was like being fifteen again, except that Leah and I were still trying sincerely to conceive on our own. We continued taking her basal body temperature every morning and charting them.
At the same time, I tried making marginal improvements in my lifestyle. I bought new underwear which was baggier and less supportive than my old ones. I tried to be aware of when I was standing with my legs together, or crossing my legs at the ankles instead of resting an ankle on top of my knee. Even at the times, I had doubts about the efficacy of my self-treatment. But I believed that when you were living on the margins, as we were when it comes to my production, that even marginal improvement could be helpful.
A couple months later, after the blood work was complete, I went back in for another semen analysis. Three days later, I called for the results. Jody called me back. "There wasn't significant improvement," she said.
That night, I bought a twelve-pack of Miller High Life ("the champagne of beers") and took it with me over to a friend's house. I drank ten beers and didn't feel any better.
Thursday, May 14, 2009
What Infertility Feels Like
None of my closest friends have children. None of my closest friends are, to my knowledge, even trying for children. My parents had no problems conceiving, and neither did anyone else in my family.
I think this makes it difficult for our friends and loved ones to really empathize with Leah and I. We have sympathy. I think people are familiar with disappointment. That's a feeling that we all know, to a greater or lesser extent. But going through this difficulty is more than experiencing disappointment.
When Leah and I first started trying to conceive, things were great. We waited for nine years of birth control pills to filter out of Leah's body. We were trying all the time (which was extra great); every month brought the expectation of happy news and us having this little, happy secret that would be just ours until everyone would be happy to know. After all, it's bad luck to tell anyone through the first trimester.
That lasted for three or four months. After that, things started to become serious. We became students of Leah's body. We bought tools to help us understand: the two-decimal sensitive Basal thermometer, the Basal body temperature chart. Leah learned the length of her cycle. I learned that Leah's luteal phase (the time after ovulation) is longer than the average woman's. We planned our time together around the schedule, saving up for week long sprints in the middle of the calendar. I drew a line with a red felt pen on the two-degree jump when Leah ovulated. We kept a stack of calendars so that we would have a good idea when she would ovulate. We read to each other in bed afterward while she elevated her pelvis above her heart.
But there's also conflict. Leah takes extra-hot showers, and I accused her of poaching her eggs. Leah blamed herself and her body, always taking responsibility. Love-making became a means to an end, and expediency shoves aside romance. During the Olympics we spread a comforter on the floor of the living room so we could make love before we were both too exhausted to perform but not miss any of the events. I stopped asking whether Leah got her period and started looking for telltale wrappers in the bathroom trash. We didn't tell anyone we were trying because we didn't want anyone's pity or disappointment when nothing was happening.
After months of that we sought professional help. We worked hard to become worthy of conception. We started praying every night before bed. We worked hard to become healthier, eating better and trying to listen to our bodies. We saved more and spent less. We never ate out. We stopped going to movies. We began bringing bags with us to the grocery store to limit our impact on our environment.
We took advantage of the techonolgies available to us. We went through four cycles of artificial insemination. We still avoided taking pregnancy tests when we were allowed to. We were supposed to take pregnancy tests on Thanksgiving and Christmas Eve. Leah has taken more time off work in the past two months than she had in the previous five years.
All this is about disappointment, but that's not the only thing.
There's a biological urge to procreate. Leah feels this more keenly than I do, and have felt it for years now. We've been together eleven years, and a child represents the culmination of that time. Our sister-in-law once said that she'd never want to have a child once she's thirty, since she "wouldn't be able to bend over" to take care of one. Leah's mother feels her age more than anyone in my family. Leah has begun walking with the same hip and ankle stiffness of her mother. She feels the passage of time.
For me, it's no so much about a biological clock. I've always wanted a child. I've wanted to have one when I'm thirty. I'm not going to reach that goal now. But it's not about acquisitiveness, either. It's not another thing to have, like a big truck or a 2500 square foot house. It is, in part, about reaching another milestone in my life. With my education and career, it's not clear that I have many left. The expanse of my next 20 years of work stretches before me. There are things that I want to pass on. I feel deeply that I can be a great father. There are lessons I have learned not only from my father's successes but also his mistakes, my own successes and mistakes.
But it's not only that. My sister's child was conceived when her husband had been out of work for almost a year. I talked to a woman yesterday whose nineteen-year-old, unmarried sister was six weeks' pregnant with a child whose father could be one of three men that she slept with within the week she'd ovulated. Baby Bryn was conceived to prevent her mother from being shipped off to Iraq with her Army Reserve unit. Everyone's heard stories of women who have "trapped" men into marriages by accidentially getting pregnant.
There's a deep sense of injustice that Leah and I feel, but we cannot discuss. We try hard not to indulge ourselves in self-pity. We are goal-oriented people. We have done everything we can to deserve a child; I can't imagine anything else we could do. But it's not about deserving. Terrible people have, and will, be able to have children for reasons that have nothing to do with their capacity to love or care for them.
I spent hours trying to find a metaphor that describes what it's like to deal with infertility. It's not like wanting something really, really, really bad and not getting it for Christmas or your birthday. There's no one that can give you a pregnancy. It's not like studying really, really, really hard for a test and still getting a C+. There's no amount of work that one can put in to conceive a child. It's not like sending out 200 applications and doing 50 interviews and still going jobless. There's no market that will improve; there are no lesser options from which to choose.
I decided that the closest thing was that being an infertile couple is like being the Boy in the Plastic Bubble. We can live without conceiving our own child. Leah can survive without knowing what it's like to nurture a living thing inside herself for nine months. I can accept that I'll never be in a hospital waiting room expecting good news without (really) fearing terrible news. But, at this point, that doesn't feel like really living.
Leah and I are living in a bubble where there are three women every day at our gym with enormous bellies and little versions of people inside them. We are in a bubble where we see five strollers and six kids while we're grocery shopping. We can't escape the bubble, but what we want has no price, can't be given or negotiated for. It's kind of like that.
It's easy to think that this is just fate. That there is a biological issue that has no cause and no cure. But fate can't be resisted; fate can't be reasoned with. I can't accept fate. I can't accept destiny. If I'm to believe that this project has a chance of success, I have to believe that there's a plan and that Leah and I have some agency to execute it.
I have to believe that we have some control.
I think this makes it difficult for our friends and loved ones to really empathize with Leah and I. We have sympathy. I think people are familiar with disappointment. That's a feeling that we all know, to a greater or lesser extent. But going through this difficulty is more than experiencing disappointment.
When Leah and I first started trying to conceive, things were great. We waited for nine years of birth control pills to filter out of Leah's body. We were trying all the time (which was extra great); every month brought the expectation of happy news and us having this little, happy secret that would be just ours until everyone would be happy to know. After all, it's bad luck to tell anyone through the first trimester.
That lasted for three or four months. After that, things started to become serious. We became students of Leah's body. We bought tools to help us understand: the two-decimal sensitive Basal thermometer, the Basal body temperature chart. Leah learned the length of her cycle. I learned that Leah's luteal phase (the time after ovulation) is longer than the average woman's. We planned our time together around the schedule, saving up for week long sprints in the middle of the calendar. I drew a line with a red felt pen on the two-degree jump when Leah ovulated. We kept a stack of calendars so that we would have a good idea when she would ovulate. We read to each other in bed afterward while she elevated her pelvis above her heart.
But there's also conflict. Leah takes extra-hot showers, and I accused her of poaching her eggs. Leah blamed herself and her body, always taking responsibility. Love-making became a means to an end, and expediency shoves aside romance. During the Olympics we spread a comforter on the floor of the living room so we could make love before we were both too exhausted to perform but not miss any of the events. I stopped asking whether Leah got her period and started looking for telltale wrappers in the bathroom trash. We didn't tell anyone we were trying because we didn't want anyone's pity or disappointment when nothing was happening.
After months of that we sought professional help. We worked hard to become worthy of conception. We started praying every night before bed. We worked hard to become healthier, eating better and trying to listen to our bodies. We saved more and spent less. We never ate out. We stopped going to movies. We began bringing bags with us to the grocery store to limit our impact on our environment.
We took advantage of the techonolgies available to us. We went through four cycles of artificial insemination. We still avoided taking pregnancy tests when we were allowed to. We were supposed to take pregnancy tests on Thanksgiving and Christmas Eve. Leah has taken more time off work in the past two months than she had in the previous five years.
All this is about disappointment, but that's not the only thing.
There's a biological urge to procreate. Leah feels this more keenly than I do, and have felt it for years now. We've been together eleven years, and a child represents the culmination of that time. Our sister-in-law once said that she'd never want to have a child once she's thirty, since she "wouldn't be able to bend over" to take care of one. Leah's mother feels her age more than anyone in my family. Leah has begun walking with the same hip and ankle stiffness of her mother. She feels the passage of time.
For me, it's no so much about a biological clock. I've always wanted a child. I've wanted to have one when I'm thirty. I'm not going to reach that goal now. But it's not about acquisitiveness, either. It's not another thing to have, like a big truck or a 2500 square foot house. It is, in part, about reaching another milestone in my life. With my education and career, it's not clear that I have many left. The expanse of my next 20 years of work stretches before me. There are things that I want to pass on. I feel deeply that I can be a great father. There are lessons I have learned not only from my father's successes but also his mistakes, my own successes and mistakes.
But it's not only that. My sister's child was conceived when her husband had been out of work for almost a year. I talked to a woman yesterday whose nineteen-year-old, unmarried sister was six weeks' pregnant with a child whose father could be one of three men that she slept with within the week she'd ovulated. Baby Bryn was conceived to prevent her mother from being shipped off to Iraq with her Army Reserve unit. Everyone's heard stories of women who have "trapped" men into marriages by accidentially getting pregnant.
There's a deep sense of injustice that Leah and I feel, but we cannot discuss. We try hard not to indulge ourselves in self-pity. We are goal-oriented people. We have done everything we can to deserve a child; I can't imagine anything else we could do. But it's not about deserving. Terrible people have, and will, be able to have children for reasons that have nothing to do with their capacity to love or care for them.
I spent hours trying to find a metaphor that describes what it's like to deal with infertility. It's not like wanting something really, really, really bad and not getting it for Christmas or your birthday. There's no one that can give you a pregnancy. It's not like studying really, really, really hard for a test and still getting a C+. There's no amount of work that one can put in to conceive a child. It's not like sending out 200 applications and doing 50 interviews and still going jobless. There's no market that will improve; there are no lesser options from which to choose.
I decided that the closest thing was that being an infertile couple is like being the Boy in the Plastic Bubble. We can live without conceiving our own child. Leah can survive without knowing what it's like to nurture a living thing inside herself for nine months. I can accept that I'll never be in a hospital waiting room expecting good news without (really) fearing terrible news. But, at this point, that doesn't feel like really living.
Leah and I are living in a bubble where there are three women every day at our gym with enormous bellies and little versions of people inside them. We are in a bubble where we see five strollers and six kids while we're grocery shopping. We can't escape the bubble, but what we want has no price, can't be given or negotiated for. It's kind of like that.
It's easy to think that this is just fate. That there is a biological issue that has no cause and no cure. But fate can't be resisted; fate can't be reasoned with. I can't accept fate. I can't accept destiny. If I'm to believe that this project has a chance of success, I have to believe that there's a plan and that Leah and I have some agency to execute it.
I have to believe that we have some control.
Tuesday, May 12, 2009
Parental Consent
I was asleep in the guest house when Leah told her parents of our diagnosis and asked for help. We made a special trip down to Tucson to tell them after we went through our IVF seminar at the Fertility Treatment Center. We went down with our bags and our little folder stocked with business cards and a largely uninformative PowerPoint presentation.
She told them that the procedure would cost $15,000.00 and asked what they could do. They told Leah (as I found out later on the drive back) that they could help with artificial insemination but couldn't do anything with in-vitro. I took this as a financial consideration and not a statement about whether her parents wanted anything of me taking up semi-permanent residence inside their daughter.
When I finally came into the house for breakfast, the conversation was over. Leah had slid the folder back into her bag and the conversation was largely over.
Leah was at work when I spoke to my parents. I told my father first.
My father had just retired and was trying to find ways to spend his time. I came over one Friday afternoon after I'd finished working and sat him down and poured myself a glass of wine.
"Leah and I have been trying for a while now to make a child," I said. I watched his face and his eyes crinkled because he thought he knew what was coming next. "And we've gone through some testing and it seems like we can't have them."
The first thing that he wanted to know was whether there was something wrong with him. I tried to put him at ease. It was weeks before he figured out that there was not anything wrong with me. I'm physically healthy. It was just the way I was. I've done everything I could to improve the situation but nothing had taken.
He took it well. He was disappointed, and it took him some time to process, but I think he eventually figured things out. He said that him and my mother were an unusually fertile couple. He said that he could look at my mother and she would get pregnant. Eventually, he quoted Woody Allen's Husbands and Wives and asked if this was because I masturbated all the time.
Maybe it wasn't a terribly comfortable conversation.
I told my stepmother the same thing when she came home from work. She took it a little better. She had suffered a series of ectopic pregnancies in her first marriage and then after the married my father. She finally realized that it was my stepbrother who was the "fluke," and that she's just made a certain way. She asked how Leah was doing, and how Leah's parents had taken the news.
A week later I sat down with my mother and grandmother. I told them about the diagnosis. My grandmother took it really well. She could tell that we had been frustrated for months, and was happy that we were working on a solution. She had experienced problems when she and my grandfather had just married. She said that her fallopian tubes were closed, and that the doctors "went in and opened them up and a month later" she was pregnant with my mother. She asked after Leah. She asked if we'd thought about adoption.
My mother started crying almost immediately. I have never known what to do when my mother cries. She did not like the idea of us going through artificial insemination. She wanted us to take some time to think things through. She wanted me to see more doctors. She had a friend who was a naturopath that I could see.
I tried to tell her that this is what we are doing, and that we wanted her to know. Please don't tell my siblings.
The struggle for me is not about asking for help. I know that all of our parents love us and would support us however they could. I also know that this is a medical issue; there's no virtue or vice associated with our infertility. What I worry about is our infertility defining our life and our relationship. I don't want to be asked every month how we're doing. Leah does not want so many people to be disappointed if things don't work out. Even if it kills her to hear it, she wants to be told about the celebrations in the lives of others when they are successful.
It took me four months to tell my parents that something was wrong.
She told them that the procedure would cost $15,000.00 and asked what they could do. They told Leah (as I found out later on the drive back) that they could help with artificial insemination but couldn't do anything with in-vitro. I took this as a financial consideration and not a statement about whether her parents wanted anything of me taking up semi-permanent residence inside their daughter.
When I finally came into the house for breakfast, the conversation was over. Leah had slid the folder back into her bag and the conversation was largely over.
Leah was at work when I spoke to my parents. I told my father first.
My father had just retired and was trying to find ways to spend his time. I came over one Friday afternoon after I'd finished working and sat him down and poured myself a glass of wine.
"Leah and I have been trying for a while now to make a child," I said. I watched his face and his eyes crinkled because he thought he knew what was coming next. "And we've gone through some testing and it seems like we can't have them."
The first thing that he wanted to know was whether there was something wrong with him. I tried to put him at ease. It was weeks before he figured out that there was not anything wrong with me. I'm physically healthy. It was just the way I was. I've done everything I could to improve the situation but nothing had taken.
He took it well. He was disappointed, and it took him some time to process, but I think he eventually figured things out. He said that him and my mother were an unusually fertile couple. He said that he could look at my mother and she would get pregnant. Eventually, he quoted Woody Allen's Husbands and Wives and asked if this was because I masturbated all the time.
Maybe it wasn't a terribly comfortable conversation.
I told my stepmother the same thing when she came home from work. She took it a little better. She had suffered a series of ectopic pregnancies in her first marriage and then after the married my father. She finally realized that it was my stepbrother who was the "fluke," and that she's just made a certain way. She asked how Leah was doing, and how Leah's parents had taken the news.
A week later I sat down with my mother and grandmother. I told them about the diagnosis. My grandmother took it really well. She could tell that we had been frustrated for months, and was happy that we were working on a solution. She had experienced problems when she and my grandfather had just married. She said that her fallopian tubes were closed, and that the doctors "went in and opened them up and a month later" she was pregnant with my mother. She asked after Leah. She asked if we'd thought about adoption.
My mother started crying almost immediately. I have never known what to do when my mother cries. She did not like the idea of us going through artificial insemination. She wanted us to take some time to think things through. She wanted me to see more doctors. She had a friend who was a naturopath that I could see.
I tried to tell her that this is what we are doing, and that we wanted her to know. Please don't tell my siblings.
The struggle for me is not about asking for help. I know that all of our parents love us and would support us however they could. I also know that this is a medical issue; there's no virtue or vice associated with our infertility. What I worry about is our infertility defining our life and our relationship. I don't want to be asked every month how we're doing. Leah does not want so many people to be disappointed if things don't work out. Even if it kills her to hear it, she wants to be told about the celebrations in the lives of others when they are successful.
It took me four months to tell my parents that something was wrong.
Monday, May 11, 2009
Mother's Day
This was our second Mother's Day since Leah and I decided to make a baby.
I think it would be a difficult day for Leah, anyway. She teaches elementary school, and so she spent two days this week helping her students celebrate their own mothers. Even the grocery stores sprout special displays reminding shoppers to remember their mothers.
The day is fraught for me, also, but in a very different way. My parents divorced when I was in eighth grade, and my dad remarried ten years ago. I've been saddled with a mother whom I am too much alike. I struggle with showing my appreciation for her bringing me into the world and helping me become the person that I am, but also with being honest about how I feel about the person she's become in the last few years.
Yesterday it was 102 degrees in the Valley of the Sun, where we make our home. Mom decided that she wanted to celebrate her day by grilling seafood. Her four children were to gather at the trailer park where her partner lives with his father from three o'clock until six-thirty. There was to be a beach theme.
When she called me to let me know the plan, she said that she planned to cook seafood. She knows that we've been trying--I sat her down with my grandmother when we first were going to try artificial insemination, but we haven't given her an update since October. At the end of our conversation she asked, delicately, whether she should have some chicken or steak on-hand for Leah. I appreciated her asking.
We bought my mother's present and card on the way to the park, a gift certificate for a pedicure and one of those long cards with rhymes and cartoon rodents and a pop-out hug at the end. Leah signed the card in the car, and I was sitting in the parking lot figuring out what to write. After a couple of moments, I decided "LOVE YA, MOM!" was the appropriate sentiment for the moment and stuffed the card into the envelope. Leah saw what I wrote and said, "That says a lot," as I affixed the little golden seal.
The day was hot but fine. I saved the shrimp appetizers from burning on the grill. I drank five or six small margaritas to propel me through the afternoon. I cooked the long, pink side of salmon, which I was afraid to eat.
Finally we opened presents. Mom sniffed over the pound of Starbucks' Cafe Verona from my youngest sister, Sally, in a good way. She'd heard of the spa where Leah and I had procured the gift certificate. Apparently they were known for their exotic designs. The second child, Anne, after me, brought two bags. One for my mother and one for our grandmother later that evening.
Anne is two years younger than me. She was an indifferent student through high school and never finished the community college coursework she enrolled in some years after high school. She works as a kind of office assistant. She married five months after Leah and I did, originally setting their date 364 days after our wedding. She and her husband knew each other for six months before becoming engaged. He is a mechanic.
When my mother unwrapped her gift, it took a couple of moments to figure out. It was a heavy chrome frame with spaces for five photographs: a large portrait in the center and four small heart-shaped spaces in each corner. Inside the central area a blue square of construction paper was framed. The glare from the sun on the glass made it difficult for everyone to read at once, but eventually we deciphered the message:
"HAPPY MOTHER'S DAY FROM THE DUNLAP FAMILY: ANNE, NATE, AND ONE ON THE WAY!"
My sister is nine- to twelve-weeks pregnant. Her tentative due date is Christmas time. My mother started crying. She understood why Anne wasn't eating any of the seafood.
The announcement didn't hit me like a punch to the gut. Time didn't slow down. There was no rush of adrenaline. What immediately went through my mind was, It's still very early, there are plenty of things that could go wrong. I am not proud that this was my first reaction.
While many were cooing and congratulating, I folded my hands at the picnic table and prayed desperately for grace, for myself and for Leah. Leah put on a good show, but we left minutes later, before Mom could bring out the Boston creme pie she'd bought.
There is a part of me that's happy for Anne. All I think she's really wanted to be was a mother. Up until now she and her husband have gathered around themselves a menagerie of animals (two Labradors, two ferrets, a chihuahua, salt-water fish, a horse) that I imagine are vessels into which they pour their love.
The larger part of me is angry, betrayed, disappointed, and frustrated. My other sister, Sally, understood immediately how we felt. She looked at Leah and asked if she wanted to be the first. It's easy to feel like we deserve this more. We're better educated, have more financial security, and have been working for this more.
The sad thing is that none of that matters.
We're still praying for grace. When Leah got home, she called her mother and sobbed on the phone with her four half and hour. Sandy must have been worried, because she called back twenty-five minutes later to make sure that Leah was okay.
We are allowing ourselves a little bit of time to indulge some of our uglier urges. We've decided that while we might not have the first baby of either of our families, we'll certainly have the best one. Leah is committed to holding onto twins. I am spending not inconsiderable amounts of time thinking of redneck names that Anne can name her child. When we calm ourselves down, we know that it will probably be a good thing for our children to have older cousins to pal around with. Especially considering how precocious our children are likely to be.
We are going to be taking some time off from family gatherings from the time being. We understand that people are going to be excited, even if we can't share in it right now. We'll come back to the fold, but for the moment we feel pretty alone in this project.
At least we have each other.
I think it would be a difficult day for Leah, anyway. She teaches elementary school, and so she spent two days this week helping her students celebrate their own mothers. Even the grocery stores sprout special displays reminding shoppers to remember their mothers.
The day is fraught for me, also, but in a very different way. My parents divorced when I was in eighth grade, and my dad remarried ten years ago. I've been saddled with a mother whom I am too much alike. I struggle with showing my appreciation for her bringing me into the world and helping me become the person that I am, but also with being honest about how I feel about the person she's become in the last few years.
Yesterday it was 102 degrees in the Valley of the Sun, where we make our home. Mom decided that she wanted to celebrate her day by grilling seafood. Her four children were to gather at the trailer park where her partner lives with his father from three o'clock until six-thirty. There was to be a beach theme.
When she called me to let me know the plan, she said that she planned to cook seafood. She knows that we've been trying--I sat her down with my grandmother when we first were going to try artificial insemination, but we haven't given her an update since October. At the end of our conversation she asked, delicately, whether she should have some chicken or steak on-hand for Leah. I appreciated her asking.
We bought my mother's present and card on the way to the park, a gift certificate for a pedicure and one of those long cards with rhymes and cartoon rodents and a pop-out hug at the end. Leah signed the card in the car, and I was sitting in the parking lot figuring out what to write. After a couple of moments, I decided "LOVE YA, MOM!" was the appropriate sentiment for the moment and stuffed the card into the envelope. Leah saw what I wrote and said, "That says a lot," as I affixed the little golden seal.
The day was hot but fine. I saved the shrimp appetizers from burning on the grill. I drank five or six small margaritas to propel me through the afternoon. I cooked the long, pink side of salmon, which I was afraid to eat.
Finally we opened presents. Mom sniffed over the pound of Starbucks' Cafe Verona from my youngest sister, Sally, in a good way. She'd heard of the spa where Leah and I had procured the gift certificate. Apparently they were known for their exotic designs. The second child, Anne, after me, brought two bags. One for my mother and one for our grandmother later that evening.
Anne is two years younger than me. She was an indifferent student through high school and never finished the community college coursework she enrolled in some years after high school. She works as a kind of office assistant. She married five months after Leah and I did, originally setting their date 364 days after our wedding. She and her husband knew each other for six months before becoming engaged. He is a mechanic.
When my mother unwrapped her gift, it took a couple of moments to figure out. It was a heavy chrome frame with spaces for five photographs: a large portrait in the center and four small heart-shaped spaces in each corner. Inside the central area a blue square of construction paper was framed. The glare from the sun on the glass made it difficult for everyone to read at once, but eventually we deciphered the message:
"HAPPY MOTHER'S DAY FROM THE DUNLAP FAMILY: ANNE, NATE, AND ONE ON THE WAY!"
My sister is nine- to twelve-weeks pregnant. Her tentative due date is Christmas time. My mother started crying. She understood why Anne wasn't eating any of the seafood.
The announcement didn't hit me like a punch to the gut. Time didn't slow down. There was no rush of adrenaline. What immediately went through my mind was, It's still very early, there are plenty of things that could go wrong. I am not proud that this was my first reaction.
While many were cooing and congratulating, I folded my hands at the picnic table and prayed desperately for grace, for myself and for Leah. Leah put on a good show, but we left minutes later, before Mom could bring out the Boston creme pie she'd bought.
There is a part of me that's happy for Anne. All I think she's really wanted to be was a mother. Up until now she and her husband have gathered around themselves a menagerie of animals (two Labradors, two ferrets, a chihuahua, salt-water fish, a horse) that I imagine are vessels into which they pour their love.
The larger part of me is angry, betrayed, disappointed, and frustrated. My other sister, Sally, understood immediately how we felt. She looked at Leah and asked if she wanted to be the first. It's easy to feel like we deserve this more. We're better educated, have more financial security, and have been working for this more.
The sad thing is that none of that matters.
We're still praying for grace. When Leah got home, she called her mother and sobbed on the phone with her four half and hour. Sandy must have been worried, because she called back twenty-five minutes later to make sure that Leah was okay.
We are allowing ourselves a little bit of time to indulge some of our uglier urges. We've decided that while we might not have the first baby of either of our families, we'll certainly have the best one. Leah is committed to holding onto twins. I am spending not inconsiderable amounts of time thinking of redneck names that Anne can name her child. When we calm ourselves down, we know that it will probably be a good thing for our children to have older cousins to pal around with. Especially considering how precocious our children are likely to be.
We are going to be taking some time off from family gatherings from the time being. We understand that people are going to be excited, even if we can't share in it right now. We'll come back to the fold, but for the moment we feel pretty alone in this project.
At least we have each other.
Thursday, May 7, 2009
A New Protocol
Leah was drug-free for ten days.
One week after the egg extraction she got her period. It arrived a week earlier than if she had a regular cycle. This is perfectly normal. I called Lynn to let FTC know of Leah's status, and Lynn said that this was perfectly normal. There was nothing to worry about, but we should come in to the office as soon as possible.
We went in Friday afternoon.
Lynn sat Leah and I down and went over the report from the embryologist. Eight embryos went into the freezer. Somehow, the embryologist grades our embryos. Leah and I are both over-achievers (we met at the Honors College at the local university--Leah lived two doors down from I at McClintock Hall). Grading brings us great anxiety.
Two embryos graded "Good." Another six were graded "Fair/Good." No explanation was given for the grading process, or what the grades mean. We didn't ask, in part because we were speechless in gratitude that we had some success. Hours after our meeting, Leah worried about the "Fair/Good" embryos. Despite the rest of our meeting.
There was another sequence of signing, initialing, and dating. We re-signed the statement of Patient Responsibilities. This document outlined responsibilities I hope would be automatic for anyone who is about to invest $15,000.00 or more in the process. We promised to show up for our appointments on time. We promised to take our medications every day when instructed.
The second sheet outlined a more difficult decision. Lynn said that the embryologist recommends that we transfer two or three embryos at the end of our protocol, and that Dr. Rychlik would likely make the same recommendation. There is some chance that all three embryos would implant, and that we would have some chance of "higher order multiples," triplets or more.
We have no desire to become octomom and octodad or even nonomom and nonodad. But for the first time I am understanding the impossible decision that Octomom Nayda Suleman faced. There's no question that Suleman was irresponsible in transfering so many embryos during her IVF cycle. There's even less question that her doctor was deeply irresponsible, not only to his patient but to the embryos for which he surely bore some responsibility, in performing such a transfer.
But once the embryos are transfered and begin to develop, one procedure remains available. That procedure is called "selective reduction." I am uncomfortable with euphemism as a general rule. Selective reduction refers to the doctors returning to the patient's uterus and (I assume) disloging several embryos to give the remaining embryos a chance to develop.
This procedure is unsavory in the best of cicrumstances, but when it is put to a patient who has made such an investment in a successful procedure, it must seem abhorrent. I would think this is one of the reasons that FTC has us sign up for the procedure before the transfer is performed. Perhaps the patient can be reminded of their decision once they are facing it. We declined the option of selective reduction in the hope that we can be responsible before we are faced with such a decision. Leah has an extraordinarily small frame. Right now, it's difficult to imagine one or two other people inside of her, much less four or five.
During our meeting, there was a shift in the language that Lynn used to refer to our project. In the past, Lynn would use the future conditional in speaking about success. "If you get pregnant," then this or that will happen. "If you get a positive pregnancy test," then we'll come in and take another one. With this visit, her language changed.
Now she says "when you're pregnant." When she first said that, I got really excited. I waited for her to say it again, just in case she misspoke the first time. She didn't. Leah doesn't think the change is remarkable, but this is the fifth time we've gone through the process, and it has always been "if" not "when."
I'm thinking this is because it's not the implantation that is the difficult part of maintaining a pregnancy. When we talked to Dr. Rychlik after our fourth artificial insemination cycle, he said that he's seen a 47 year old woman who is still capable of carrying a child. What is the difficult part is actually conceiving the child. Leah produced 19 mature eggs. Of those 15 fertilized. Of those, 8 survived well enough to be frozen until next month. It's a wonder that any of us make it this far.
Leah is back on birth control now, and will be for three weeks. She thinks that the birth control is making her angry. I'm just excited that the doctors seem like we're almost there.
One week after the egg extraction she got her period. It arrived a week earlier than if she had a regular cycle. This is perfectly normal. I called Lynn to let FTC know of Leah's status, and Lynn said that this was perfectly normal. There was nothing to worry about, but we should come in to the office as soon as possible.
We went in Friday afternoon.
Lynn sat Leah and I down and went over the report from the embryologist. Eight embryos went into the freezer. Somehow, the embryologist grades our embryos. Leah and I are both over-achievers (we met at the Honors College at the local university--Leah lived two doors down from I at McClintock Hall). Grading brings us great anxiety.
Two embryos graded "Good." Another six were graded "Fair/Good." No explanation was given for the grading process, or what the grades mean. We didn't ask, in part because we were speechless in gratitude that we had some success. Hours after our meeting, Leah worried about the "Fair/Good" embryos. Despite the rest of our meeting.
There was another sequence of signing, initialing, and dating. We re-signed the statement of Patient Responsibilities. This document outlined responsibilities I hope would be automatic for anyone who is about to invest $15,000.00 or more in the process. We promised to show up for our appointments on time. We promised to take our medications every day when instructed.
The second sheet outlined a more difficult decision. Lynn said that the embryologist recommends that we transfer two or three embryos at the end of our protocol, and that Dr. Rychlik would likely make the same recommendation. There is some chance that all three embryos would implant, and that we would have some chance of "higher order multiples," triplets or more.
We have no desire to become octomom and octodad or even nonomom and nonodad. But for the first time I am understanding the impossible decision that Octomom Nayda Suleman faced. There's no question that Suleman was irresponsible in transfering so many embryos during her IVF cycle. There's even less question that her doctor was deeply irresponsible, not only to his patient but to the embryos for which he surely bore some responsibility, in performing such a transfer.
But once the embryos are transfered and begin to develop, one procedure remains available. That procedure is called "selective reduction." I am uncomfortable with euphemism as a general rule. Selective reduction refers to the doctors returning to the patient's uterus and (I assume) disloging several embryos to give the remaining embryos a chance to develop.
This procedure is unsavory in the best of cicrumstances, but when it is put to a patient who has made such an investment in a successful procedure, it must seem abhorrent. I would think this is one of the reasons that FTC has us sign up for the procedure before the transfer is performed. Perhaps the patient can be reminded of their decision once they are facing it. We declined the option of selective reduction in the hope that we can be responsible before we are faced with such a decision. Leah has an extraordinarily small frame. Right now, it's difficult to imagine one or two other people inside of her, much less four or five.
During our meeting, there was a shift in the language that Lynn used to refer to our project. In the past, Lynn would use the future conditional in speaking about success. "If you get pregnant," then this or that will happen. "If you get a positive pregnancy test," then we'll come in and take another one. With this visit, her language changed.
Now she says "when you're pregnant." When she first said that, I got really excited. I waited for her to say it again, just in case she misspoke the first time. She didn't. Leah doesn't think the change is remarkable, but this is the fifth time we've gone through the process, and it has always been "if" not "when."
I'm thinking this is because it's not the implantation that is the difficult part of maintaining a pregnancy. When we talked to Dr. Rychlik after our fourth artificial insemination cycle, he said that he's seen a 47 year old woman who is still capable of carrying a child. What is the difficult part is actually conceiving the child. Leah produced 19 mature eggs. Of those 15 fertilized. Of those, 8 survived well enough to be frozen until next month. It's a wonder that any of us make it this far.
Leah is back on birth control now, and will be for three weeks. She thinks that the birth control is making her angry. I'm just excited that the doctors seem like we're almost there.
Friday, May 1, 2009
Day 21: Three People Who Have Visited My Wife's Vagina
It's difficult to tell the turnover that takes place at Fertility Treatment Center. People move in and out; it's difficult to tell who has been promoted and who's left for good.
Jody is an older, kindly woman who works as a nurse. We haven't seen her for a while. She always smiles and tries to put the patients at ease. Her demeanor makes me think that she specializes in working with new patients and that's why we haven't seen her in a while. She's almost as small as Leah and was the only person who reflected our disappointment when the artificial insemination cycles failed.
Lynn is our IVF Coordinator. She's brisk but nice, like a particularly busy bank teller. She's dark and when I've gotten to see her office she has pictures of her husband in fatigues on the wall behind her desk. She returns my calls quickly, and always is patient with my questions and concerns. She's quick to remind us that things are normal and that things are going well, but she's cautious with information, as well.
We've worked with three doctors so far. Our main physician, who is in charge of all of our diagnoses and treatments, is Dr. Rychlik. He's almost too young, but he's quick to smile and he's chatty with me. He usually wears slacks or jeans and a blazer over a dress shirt open three buttons. He's clean-shaven and has messy dark hair. He's always busy and running late, but he has an air of confidence that borders on condescension. When he gives Leah her ultrasound, he's rough and sudden and she feels uncomfortable until he's done. He'll sometimes forget to warm the ultrasound gel.
Dr. Craig we've only seen once or twice. He's tall and lean and balding. The awards FTC has affixed to the entry hallway mostly have his name on it, as well as the bronzed patent for a new way to freeze tissue. He wears a bow tie and is nice and polite. Leah says that he is gentle with the wand of the ultrasound. His mein gives cofidence, and he is patient with our sometimes supid questions. He gives us more information than we want, in a way that is easy to process.
When the male doctors administer the ultrasound, there's always a female nurse present. She stands in the corner with her back against the door. She turns off the lights so the doctor can read the screen. She holds the folder holding our test results and the many pictures of Leah's uterus against her chest and listens. For a long time I thought the nurse was there to take notes and observe the procedure. I realized that the nurse comes in to make the patient feel more comfortable. She's there so that there's another woman in the room while the doctor is working.
The third doctor is Reeka. She's the nurse practicioner. She has gone through what we're doing, having successfully conceived using artifical insemination on the third cycle. She's gentle with Leah and patient with the both of us. She is a calming influence in the room. When we ask her questions, her answers are elliptical and unsatisfying, but somehow put us at some ease. Leah says that she is gentle with the wand, and when Leah gets jostled, Reeka apologizes and is more careful.
Jody is an older, kindly woman who works as a nurse. We haven't seen her for a while. She always smiles and tries to put the patients at ease. Her demeanor makes me think that she specializes in working with new patients and that's why we haven't seen her in a while. She's almost as small as Leah and was the only person who reflected our disappointment when the artificial insemination cycles failed.
Lynn is our IVF Coordinator. She's brisk but nice, like a particularly busy bank teller. She's dark and when I've gotten to see her office she has pictures of her husband in fatigues on the wall behind her desk. She returns my calls quickly, and always is patient with my questions and concerns. She's quick to remind us that things are normal and that things are going well, but she's cautious with information, as well.
We've worked with three doctors so far. Our main physician, who is in charge of all of our diagnoses and treatments, is Dr. Rychlik. He's almost too young, but he's quick to smile and he's chatty with me. He usually wears slacks or jeans and a blazer over a dress shirt open three buttons. He's clean-shaven and has messy dark hair. He's always busy and running late, but he has an air of confidence that borders on condescension. When he gives Leah her ultrasound, he's rough and sudden and she feels uncomfortable until he's done. He'll sometimes forget to warm the ultrasound gel.
Dr. Craig we've only seen once or twice. He's tall and lean and balding. The awards FTC has affixed to the entry hallway mostly have his name on it, as well as the bronzed patent for a new way to freeze tissue. He wears a bow tie and is nice and polite. Leah says that he is gentle with the wand of the ultrasound. His mein gives cofidence, and he is patient with our sometimes supid questions. He gives us more information than we want, in a way that is easy to process.
When the male doctors administer the ultrasound, there's always a female nurse present. She stands in the corner with her back against the door. She turns off the lights so the doctor can read the screen. She holds the folder holding our test results and the many pictures of Leah's uterus against her chest and listens. For a long time I thought the nurse was there to take notes and observe the procedure. I realized that the nurse comes in to make the patient feel more comfortable. She's there so that there's another woman in the room while the doctor is working.
The third doctor is Reeka. She's the nurse practicioner. She has gone through what we're doing, having successfully conceived using artifical insemination on the third cycle. She's gentle with Leah and patient with the both of us. She is a calming influence in the room. When we ask her questions, her answers are elliptical and unsatisfying, but somehow put us at some ease. Leah says that she is gentle with the wand, and when Leah gets jostled, Reeka apologizes and is more careful.
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