(In)Fertility

A couple of weeks ago I arrived home from running errands to Alex and Francine looking at photo albums together on the couch - of our wedding, Argentina adventures, and the Bean's baby book.

"I got my test results. I think I have super sperm," Alex tells me, an air of masculine pride to his voice.

Together we review the labs run on his "semen specimen" on the Kaiser website. Sure enough, his sperm count, density, motility, etc. were all well above the normative range. Guess he's lucky not to have to make any lifestyle changes, you know, like reducing to only a beer or two per week.

"Nice!" I said, meaning it. "Well, I guess it's a me-problem then."

I am now being followed by the Kaiser OB/GYN Infertility clinic. But I still don't find myself identifying with "infertility." For the most part, I just don't feel infertile. Other than a long history of bad menstrual cramps requiring a dose of Vicodin every few months, all my Lady Parts have more or less been healthy throughout my life. I associate "infertility" with ovulation disorders like PCOS (polycystic ovarian syndrome), uterine abnormalities like fibroids, endometriosis, or chronic health problems like cancer or thyroid disorders. None of these things apply to me.

But technically, by definition, infertility is defined as having frequent, unprotected sex for more than a year without pregnancy. So by definition, we are infertile. I keep joking that I'm barren, but apparently, by definition, I can't call myself that, because I already bore one child. Which brings us to what the world likes to call "secondary infertility." It's really no different than regular infertility, except to say that I've proven at least one time that I can indeed get pregnant.

As for a bit of personal uterine history - we became pregnant with the Bean in July of 2011, after ~5 months of "trying." She was born in March 2012. We immediately used our birth control of choice (condoms), and didn't start "trying" to get pregnant (buh-bye condoms) until after the Bean's 2nd birthday once I could, finally, allow myself to entertain the thought of growing, delivering, and parenting another child.

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Sidenote - I have had no other pregnancies - no miscarriages, no terminations. I did, in fact, have a true blue pregnancy scare once when I was 22 and totally ill-equipped to be a mother. And it wasn't the kind of pregnancy scare familiar to idiot college kid, where a period is a day late or no one knows when to expect their period in the first place. Nope, my pregnancy scare was when A DOCTOR TOLD ME I WAS PREGNANT. I was living in Telluride, Colorado, and "dating" a few different guys. One day I had terrible abdominal/menstrual cramps that weren't subsiding, even with Vicodin. I went to the medical center (where my BFF, Stacy, also happened to work). Along with getting my weight, blood pressure, and temperature, I peed on a stick. The doctor came in shortly after to tell me that she was concerned I was experiencing an ectopic pregnancy and immediately sent me to the hospital in Montrose, an hour or so down the road. Long story short, they did further work-up, discovered I was not, in fact, pregnant, but had experienced a false positive pregnancy test. But not before I told my dad, among others, about "being pregnant." May my father never utter the words "but don't you use spermicide?!?" again.
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So back to my current uterine sitch - Alex and I stopped using birth control (condoms) last Spring. After trying for about six months, I went to the OB/GYN in the Fall, just to check-in and make sure we were thinking about and doing everything we should be. You know, tracking, humping, and waiting. Because, really, there's not a lot more to it. But also, I was a bit worried because post-Bean I was diagnosed with a cystocele (I know, gross, not pretty, and totally TMI. Thanks to that rocket-paced and traumatizing delivery. And now I live in fear that my butthole will all but fall out of my body if/when I deliver another child. It is rumored to have happened to a friend of a friend of a friend) - and wanted to ensure it would have no impact on fertility, which it absolutely does not. We never expected to get pregnant right away with #2, and we were mostly having fun early in the process - still optimistic and mostly confident about adding to our family.

Not pregnant.

After a couple more months, a bit of frustration and a large dose of doubt set up shop in my brain. Sometime around Christmas I freaked the fuck out and called off Operation Second Child.  Can we really afford, financially, to have another kid? I'm struggling to be a mindful mother to the toddler we already have. Can we really afford, by way of time and energy, to have another kid?!? Do I even LIKE being a mom?!? We are just getting to a place where we can actually do things. I don't want to get fat all over again. And what about my butthole?!? If I continue to work part-time and pay for two kids in childcare, I'll literally net less than $100/month. Why fix what's not broken?

Chalking my reticence mostly up to financial woes, Alex and I duked it out until I felt like we were on the same page. Arbitrarily, I determined we would start trying again in February. So yeah, we took a month or so off.

Somewhere in there I started using the ovulation predictor tests my BFF had sent me (she's 110% Team Close Family of Four). I never did get a positive LH surge. And I also initiated acupuncture at my friend's clinic, Acupuncture Northwest, with a provider there who specialized in fertility, paying out of pocket for a few visits. She recommended I explore the book Taking Charge of Your Fertility, which I had just recently purchased. How I never learned so many of the things in that book is beyond me; I was astonished how little I know my own body, at the age of 33. Anyway, I soon learned that Kaiser indeed covers 12 complementary medicine visits each year, so I got a referral from my primary care provider to address my "neck pain" and saw a covered provider closer to our house.

Still not pregnant.

Last month I met with a nurse specializing in fertility. She got me up to speed about Kaiser's fertility coverage (they do IUI, but not IVF, and we pay ~50% of the cost for all things fertility-related). She recommended I purchase a different brand of ovulation predictor (Clear Blue Easy Digital) and use morning pee. She ordered blood and urine labs for me, and semen labs for Alex. We were grateful that all tests so far had turned up normal, and hopeful when I finally got a positive ovulation predictor test on Day 14. We boned three days in a row, exactly as instructed. Alas, Aunt Flo arrived for her monthly visit just in time for our Fourth of July trip to Bend, which we learned at McDonald's no less (we only eat there on road trips; that place usually makes my uterus cold and inhospitable and ashamed of the human race as it is, so I guess it's only fair).

We returned home from Central Oregon in time for the Day 3 labs, checking out my estradiol and FSH (follicle stimulating hormone). Again, all normal; there's nothing to suggest I have "diminished ovarian reserve." Basically, my eggs aren't prematurely aged. Don't know if I can say the same for my skin these days.

Two weeks ago I met with the nurse practitioner (NP), Kay Beadle, who specializes in fertility. She reiterated Kaiser's fertility coverage, verified my medical history, reviewed the labs I'd already completed, and explained the further evaluation that may lay ahead.

And then I cried in her office. But probably not for the reason many might assume.

She asked me about my pregnancy with the Bean.

"Great! I think I mostly enjoyed it. Everything was more or less uneventful and we were really excited."

And the labor and delivery?

"Traumatizing, but in a normal way. She came early, but there were no complications. She was happy and healthy. I fell in love with her, and I've come to call the two years following her birth my period of "post-partum elation."

And how are you feeling about a second pregnancy?

As I started to confide in her my conflicted yearnings for a second child (do I or don't I?), I found myself welling up, unaware that I had such emotions behind the matter. Responding to my embarrassment at the emotional outburst in the only way I know how - self deprecation .

"Sorry 'bout that," I say, as she hands me tissues. "I know this isn't your job. I'll let my therapist address the head stuff, and you can deal with the vagina stuff."

She asked me if I was indeed talking to my therapist about trying to get pregnant, and informed me that they also have a social worker in their department who specializes in "fertility issues."

"But I don't really identify with having fertility issues. Most women that I know with fertility issues are continually devastated that they can't get pregnant. My problem is that I'm not sure how badly I want a second baby in the first place, and now here I am pursuing medical evaluation and possibly treatment. Sure, each month I'm pretty disappointed when I start my period, and I know my husband absolutely wants another child, but I still waffle about how badly I want - or can handle - another baby in the first place."

She was open and patient and kind and told me that many women often feel conflicted about many different aspects of pregnancy and motherhood.

After leaving the appointment, I became aware of how isolated I had been feeling. It's not that no one cares. I have an open and loving husband, caring friends. I know many people who have endured different trials, tribulations, and tragedies related to fertility and child-bearing. There are a lot of vocal women out there representing really certain experiences - about trying to conceive, about having multiple children, about having only children, about having no children. But I haven't read, heard, or spoken about women's experiences somewhere in the middle. From women who are ambivalent, or those who lack clarity or certainty about their family plan. I recognize no one can figure this out for me, and there is no one "right" answer. And that just because I wanted to get pregnant with the Bean an 11 out of 10 doesn't necessarily mean I'll feel the same way about a second nugget. Nor do I necessarily have to. But I'm also not sure people should go around procreating if they don't really really really want an infant. Hence, the internal, somewhat isolating, turmoil.

And then there are the daily requests for a sibling.

"Mama, are you guys making a baby?"
"Mama, why are there two seats in this cart?"
"If I had a baby brother I would be the big sister."
"Mama, are you growing a baby in your tummy?"
"Mama, I want to grow a baby in my tummy."
"How come she has a baby sister but not me?"
"Mama, when I go to bed you and daddy can make a baby."

So incredibly sweet, but that's a lot of pressure.

Onward and upward we proceed. We are continuing with the recommended OPK, hump, and hope. If I get a positive OPK, indicating an LH surge, then I am to get my progesterone tested 7 days following the surge. If I never get a positive OPK, then I get my progesterone tested on Day 20. I've also been ordered a test called a hysterosalpingogram (HSG), which is performed in Imaging for closer examination of my uterus and fallopian tubes. It requires insertion of a catheter into my uterus, with the injection of some dye, so the radiologist can see if my tubes are open or damaged, and whether there are any abnormal growths on my uterus. The fertility specialist warned me that the test can be a level 6 or 7 uncomfortable/painful, but Rach has had the test herself, and doesn't recall it to be eventful in any major way. If nothing abnormal appears on the x-ray, then I am said to have "unexplained infertility," as in, there's nothing concrete to attribute my difficulty getting pregnant. The next step, should we choose to pursue it, would be the combination of Clomid and intrauterine insemination (IUI). Alex and I still need to determine whether or not we are wanting to take it to that next level, for a number of reasons. One, the chance of twins increases to 10%. And two, well, I need to figure out just how badly I want to have a second child, medical intervention or not.

As of this morning, I am Day 16 and have not yet obtained a positive OPK this cycle. I will plan to get the Day 20 labs on Wednesday, and then Alex and I need to have a series of conversations about both of our desires, anxieties, and collaboratively determine a path for our family. It's a little less isolating knowing that my partner is totally in my corner. And, of course, because he never fails to make me laugh in the process. Whether it's about my irrational fear of losing my butthole. Or quoting the totally inappropriate comments from our 3 year old daughter about our baby making. Or his report of getting his semen tested.

Alex: "Of course the lady who took my sperm was black."

Me, totally perplexed, "Why do you say 'of course she was black?' I don't get it."

Laughing, and maybe even blushing, he says, "Well, I mean, because, I watched this porn with black people in it and blew a load into a tiiiiny little cup. And then the lady who took my sperm was black."

"So you already went to the lab today? I thought you weren't feeling good. From whisky club last night and all. Oh shoot! I forgot to give you the bag."

"You had a paper bag?!? I had to put it in my pocket! That would have been nice, you know, to discreetly carry in my load in a brown paper bag."

Me, cracking up. "Wait, you watched porn? Black porn?"

"I didn't know what else to do with it. I put it in my pocket and walked inside. And then this lady comes out and takes my semen."

"Back it up a minute, where were you that you watched porn and blew your load into a little cup?"

"At the kitchen table."

"You were sitting at the kitchen table watching porn? Was your bare ass on the chair?!?"

"No. So anyway, the lady asked me how long it had been, and I said, 'Probably 15 minutes.' And she says, "Mmmhmm, yeah, it's still warm.' I was like, 'I gotta go.'"

"Bahahaha! That's hilarious. And totally awkward."

"But my numbers were killer! I was way over the low range. I'm so manly," he says, his chest maybe even puffing up a bit.

"Why does that make you so manly?"

"Because I can drink and cavort and carry on and wake up and still re-populate the earth!"