Still Infertile

"Why are you and Daddy going to the doctor together?" The Bean asked me in the morning.

"Remember what I told you yesterday?"

"No."

"Yes you do. Are we going to have our feet looked at?"

"Pft, no, that's silly."

"Then what?"

"Wah, wah," she pretends to cry.

I smile. "Yup, you got it."

"You're going to try and have a baby."

 

Well, kinda, but not exactly. We won't be LITERALLY trying for a baby in the Kaiser clinic room. That would be inappropriate. But we are going to talk to them about why we still haven't gotten pregnant, and what options we have available to us.

 

***

"Mama, tell me what the doctors did."

 

The doctors, a nurse practitioner, actually, didn't do a whole lot of anything, aside from ordering more labs. Blood draws timed for specific days of my cycle. But she did talk extensively with me and Alex about our continued issues with infertility. But not before Alex and I fought our way before, during, and after the appointment. I guess the post-separation honeymoon period can be easily squashed by a lengthy visit to the Kaiser Interstate medical clinic. Thanks to a long wait, talk of old eggs ("decreased ovarian reserve"), "incompatible reproductive systems" and "hostile cervical mucous," monthly pee tests, scheduling blood work, and a referral to an LCSW specializing in issues related to infertility. Throw in maternal ambivalence about a second child and paternal desires to procreate, and we've got a perfect storm for guilt, blame, and shutting down.

 

It's been nearly a year since I last had the extensive blood work completed, checking various levels reflecting hormonal peaks related to ovulation, the age of my eggs, etc. I've been instructed to get blood draws on Day 20/21 of this cycle, and Day 3 of the next cycle. The NP encouraged me to use ovulation predictor kits, and time sex on the day and the two days following a positive surge. She then explained that the likely next steps would include Clomid and IUI (intrauterine insemination, aka turkey basting), assuming I am in fact ovulating regularly. This would run us an extra $100-200 per cycle. Clomid does cause some negative side effects, including the increased incidence (risk?) of twins - my understanding is that 4-11 pregnancies out of 100 with Clomid result in multiples. 

 

I don't think Kay, the NP, took kindly to my inquiry about the possibility to 'reduce' should one become undesirably pregnant with two.

"Most people do not."

"But is it even allowed? Like at Kaiser? Or via insurance?"

"It increases the likelihood of miscarrying the other."

"Yeah, okay, I'm not at all saying that's what we would do, I'm just curious if it's even a discussion to be had at some point. We are NOT interested, or equipped, to have three children."

"What would you do if you got pregnant with twins naturally? I think that's how you have to think about it."

"Kill myself? I don't know. I can't really imagine that I would ever get pregnant with twins naturally," I said. Plus, using Clomid is not natural, I thought.

 

The Clomid would be timed to my cycle, and the IUI would involve taking Alex's semen, spinning it so that only the top 15th percentile of his sperm or something get inserted via some kind of medical-grade turkey baster inserts it directly into my uterus, foregoing the "hostile" part of my reproductive system. All of this requires that I pay even CLOSER attention to my cycle - pee sticks, my period, my cervical mucous, my body in general. That commitment alone horrifies me. In fact, it has the odd affect of making me not only feel fat and hate my body, but hate Alex, too. Like he's the one who wants the baby the most, and he doesn't have to do a damn thing beside splooge in a cup. And that's just to get pregnant. That speaks nothing to the myriad of changes me and my body have to undergo to then carry the baby, birth the baby, nurse the baby, and then raise the kid.

 

"If I could do all this for us, I would," he tells me. And I believe him. But he can't. And doesn't have to. 

 

***

I completed the Day 20/21 blood work, checking my AMH levels (anti mullerian hormone, whatever that is). Kaiser posted my results to my medical record promptly, but did not have any information by way of interrupting the test results. I assumed that meant everything was normal. But when I emailed the NP, Kay, to inquire about the possibility of completing the Day 3 labs elsewhere, as we should be camping and then in Tahoe for vacation, she provided additional information.

 

"The AMH demonstrates mild ovarian aging with the lab result being 0.71. You can consider starting treatment with Clomid/IUIs and whenever you are ready and do the labs a different cycle. I will order the Clomid medication and you can take starting Day 3 of your cycle if you decide to do that."

 

Her email goes on to tell me that there is controversy in the interpretation or significance of different AMH level ranges. According to Kaiser along with the OHSU reproductive endocrinologists they consult with, my AMH levels of 0.71 reflects "diminished ovarian reserve," which "signifies a short window of opportunity."

 

In other words, fuck me, I really am as old as I complain about.

 

"I'm sorry, babe. Do you want to talk about it?" Alex said to me after I texted him a copy of the email.

"Nope," I said, and went to shower. I surprised myself by actually crying about it. I didn't think I would be that affected by the results.

And later, "you okay, babe? I'm here if you want to talk."

"What's there to talk about? I have old eggs and now we know for sure it's all my fault," I say pitifully.

"I hope you know I don't think about it that way at all."

"Well that's nice, but I do. You're the one who wants a baby, I'm the one who only kinda wants one sometimes, and I'm the one who can't ever give you what you want."

I don't exactly remember, but Alex hugged me or said the right thing or was just silently sweet. Just another reminder how (mostly) well-adjusted, down to earth, and supportive he is.

 

***

The most stressful part of this whole infertility business is the waffling. One day I'm on Team Family of Four, and another day I'm shouting grateful expletives for having started my period. As I've said in the past, there is something particularly unsympathetic about being infertile but indifferent; it's a kind of lonely place to be. "Table for one, please," I imagine myself saying. 

 

As for the next step? We still don't entirely know. Although Alex and I have since recovered from our bickering, we haven't thoroughly re-visited the issue. A couple weeks later now and I'm thinking I want to keep trying the good ole fashioned way through the summer, maybe even with the aid of ovulation predictors. But I'm feeling pretty reticent about taking the treatment route. And I'm also not willing to just keep trying forever, or to not "try" but forego prevention; that's too whimsical for my blood. It's not that I'm morally opposed to Clomid and IUI, it just seems unnatural, and like I am defying what the world is trying to tell me, that I'm better as a mama of the one perfect Bean we already have. Like a "don't fix what's not broke" kinda thing. And not that she is the decision maker in the family (although sometimes it feels like the little queen actually does rule over the Closeman clan), she did tell me she'd be just fine if she never has a baby brother or sister. And Alex says the same thing, that ultimately he is delighted and so grateful for the family he already has.

 

I did get a few follow-up suggestions. One from the NP who recommended we explore an "anti-inflammatory diet." Another from Alex who said we should just bone even more (surprise surprise). And then one from Francie. She told me, "maybe you and daddy just aren't trying early enough."

"Trying what early enough?" I asked, unclear of the context.

"Making a baby."

I giggled. "Like early enough in the morning you mean?" I wasn't sure if she meant early enough in life, in my cycle, in the day, or just what.

"Yeah," she responds.

 

So before I even decide whether or not to try Clomid/IUI, I suppose I should eliminate caffeine and sugar from my diet, hump on the daily, and focus my timing on "earlier."