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.