After four vaginal examinations, the ultrasound wand is almost commonplace. At every visit, Dr. J uses the wand to examine and measure my ovaries and uterus, as well as the minute cyst that has not budged from the right side of my fallopian tubes since my first visit in March.
“I can’t find your uterus,” Dr. J says this morning.
“Well, I’m sure it didn’t go anywhere,” I say, trying to smile, though the discomfort of the wand borders on more than mild pain.
Dr. J removes the wand, sits back in his chair and closes his eyes, my attempt at humor not even registering. “Sometimes,” he says, “when you try too hard to look for something, you cannot see it.”
He may be referring to his inability to find my uterus on the ultrasound screen, but I cannot help but think there must be some larger, albeit unintentional wisdom here, if only I could find it.
A minute or two later, Dr. J resumes his search with the wand, ultimately finding my uterus tilted far back on the right side. “It’s hiding,” he says.
“Why would it do that?” I say, imagining this most private of organs scooting away out of his, or at least the white rod’s reach.
“I don’t know. Maybe you’re nervous.”
Never mind the fact that I’m lying on an examining table with an ultrasound wand rammed up my vagina; not to mention the three days of Follicle Stimulating Hormone injections I have been giving myself in order to trigger the development of multiple eggs—somewhere between two and four but not six or eight. The idea behind the FSH injections being to up the chances of a single conception; what’s to be avoided: multiple fertilizations. Long term, the practice risks over-stimulating the ovaries and can bring serious health complications, chief among them ovarian cancer; but short term the procedure is common practice and considered safe. On a more mundane level, because our health insurance does not cover these procedures we’re spending $2,500 a month for treatment. What’s to be nervous about?
“Well?” I ask, once he removes the wand and turns off the ultrasound screen.
“I don’t understand it.” His brow is furrowed, and the bright lights reveal the perspiration there. “No change.”
“What do you mean no change?”
Only now do his eyes meet my own. “No increase in uterine lining, no developing follicles.”
“Maybe we need to increase the dose,” I say.
He doesn’t seem to hear me. “Are you sure you are having regular periods?”
“Of course I’m sure.” He asked this same question during my initial visit to his meeting room where my husband and I faced him across an enormous faux mahogany desk littered with plastic models of female reproductive organs. At that visit, our three-year-old daughter, Sophie, accompanied us. For the first ten or so minutes, Sophie sat quietly on my lap; once ten minutes became fifteen, she began to squirm and tried to talk over our conversation.
“Here,” Dr. J said at that visit, thrusting a teddy bear in scrubs across the desk at Sophie. “Why don’t you play with this?”
Sophie grabbed the bear and although I was grateful to see her calmed, I knew I would have a hell of a time getting it away from her. Sweet as he was, even then I sensed that Dr. J was clueless when it came to children. His specialty was knocking women up via the latest in medical technology. Children belonged to another field of expertise, something Sophie seemed to clue in on right away.
My high-energy daughter was conceived when I was thirty-eight and my husband, forty-nine. There were no doctors involved, no drugs. I just left the diaphragm in the drawer one night. It was the second time in my adult life that I did not use birth control. Well into my thirties, the main focus was always not getting pregnant, or at least not focusing on getting pregnant. Sophie beat all of the odds. (“A handful,” the nurse called her as she tried to roll off the changing table the night of her birth. “A spirit determined to make her way into this world,” I tell her now.)
“How high a dose of FSH are you taking now?” he asks.
“Let’s increase it to the next level,” he says.
I remove the injection pen from the refrigerated package in my purse and the nurse sets the dial to 112.5.
“You’re to continue the injections for four days,” he says, already backing towards the door. “Then come back and see me on Tuesday.”
~ ~ ~
Four days later, Dr. J has no trouble finding my uterus.
“Well?” I say, once he’s measured the uterine lining, the ovaries, and counted the follicles containing tiny eggs.
“There are four eggs,” he says, “but they don’t seem to be developing.”
“What do you mean?” I feel as if someone has just hit me, hard, in the stomach. “I don’t understand.”
Dr. J looks weary and perhaps a little irritated. “You don’t seem to be responding to the injections,” he says. “There is no point in doing the insemination this month.”
My mouth is dry, and I have trouble swallowing. If I say anything, it is inarticulate at best.
He fixes me with the dark eyes I initially found endearing. “Are you sure you are having regular periods?”
“Well,” he says, “I’m not saying you’re menopausal—”
“Of course I’m not.” Wasn’t it just weeks ago that he told me my FSH level was at the top of the list for a woman my age; and didn’t he say my husband’s was “a young man’s sperm?” What was he trying to do, win our trust only to abandon us? At this moment, Dr. J seems to stand before me as a luxury car salesman – even though he’s not wearing an Armani suit – or a game show host: Bob Barker in bowtie and plaids. What kind of deal, I want to ask, have we made?
“Check her estrogen levels,” he tells the nurse, not the middle-aged one from Friday who seemed annoyed when I asked her to help me calculate the remaining amount of FSH in the injection pen to be sure I had enough, but the pretty young one with an eighteen-month-old son in daycare from eight to six.
Without another word, he is gone.
“Is it possible that the injection levels have simply been too low all along?” I ask the nurse now.
“It’s certainly possible. We don’t want to over-stimulate you. Look,” she says gently, as the needle pierces my skin. “I know how disappointing this is. What you need to understand—”
“Yes?” I say, too eagerly, watching as the vial fills with blood.
“Here,” she says, “we live day by day.”
It’s raining when I leave Dr. J’s office and step into the gray morning without an umbrella. The hospital grounds are under construction, so I have to walk the length of two hospital parking lots before I reach my car.
Dr. J told me from the beginning not to become too hopeful—What if it does not happen? What will you do then? You need to consider this now. I could recommend a good counselor if you want to talk. I told myself and him that I could handle the process.
By the time I climb behind the wheel, I’m sobbing.
Who did you think you were you kidding anyway? A voice inside me asks. Not get your hopes up indeed.
How could I prevent my hopes from rising? I began buying ovulation kits last autumn, at this late stage in my reproductive life learning to track that optimal window for conception.
And when that didn’t work, I obtained a referral from my ob/gyn, and my husband and I went to see Dr. J in early February. Following the blood work and other testing, we made a game plan. We’d give the procedure three months. I would inject myself with FSH for the first week of my cycle to stimulate my ovaries, and then Dr. J would set or monitor the day of ovulation so that it concurred with the artificial insemination. By the end of March, I had received my own hormonal lab kit from the Freedom Fertility Pharmacy, whose symbol is the silhouette of a pregnant woman with her head tilted back in joy, her arms raised in the air as if in salutation to the moon and sun.
“You need to slow down,” Bill cautioned when I suggested a baby name or talked about postponing a trip next summer if we have a child. His words come back to me now as I sit in the car gripping the steering wheel.
Still, there was that night a few weeks ago when he confessed that he, too, had been looking more closely at newborns. Ten fingers, ten toes.
And didn’t he hurry to the door to greet me, cheeks flushed, the last time I came back from Dr. J’s? (He didn’t just hurry; he practically ran.) “Well?” he asked. “How did it go? Tell me.”
The blue of his eyes, the eagerness I saw there, recalled our daughter’s. How patiently he has been teaching her to find and recognize shapes: circles in car wheels, triangles in roofs; and how absurdly happy when she pooped in the potty for the first time.
It’s only now that it really sinks in, the fact that these treatments might not bring a second child into being. A newborn. A sibling for Sophie. Am I really able to handle the kind of disappointment this process might lead to? By focusing so intensely on conception, transforming it into a lengthy medical procedure, aren’t I setting myself up for a hard-hitting fall?
“We haven’t even completed one cycle, and Dr. J wants to stop the process this month,” I tell Bill later.
“I don’t get it,” he says.
“Neither do I.” I don’t say so, but I’m beginning to wonder if Dr. J will tell us that he was wrong. Despite the blood work and the semen analysis, we are not good candidates for fertility treatments.
The next thing I know, I’m typing up a letter to fax to Dr. J.
It’s Friday before Dr. J returns my phone call. “I want to apologize for how I handled your visit on Tuesday,” he says. “Even before I received your fax, I knew I needed to call you back. It was a rough day.”
“Thank you,” I say, carried back to that airless, deflated cry in the hospital parking lot.
“Look,” he says, “I’m in my forties also, so I can understand—not entirely, but somewhat—how you feel. Fact is, you’re in the peri-menopausal years. Your body’s irregular behavior is proof of this.”
I listen to him outline a course of action whereby my estrogen and FSH levels will be tested at the start of my next period before we repeat the process. “We could try more aggressive treatments,” he says, then names various drugs and procedures, including something called Lupor, which suppresses the reproductive system entirely; and even though he doesn’t bring up in vitro fertilization, or any of the more drastic steps, there’s a sick feeling in my stomach.
Maybe this is not to be. Face that. You have to face that.
“I’m not optimistic, and I’m not un-optimistic,” he continues. “You’re a very healthy woman, but your body is behaving irregularly. For now, we’ll just have to wait and see.”
Here we live day by day.
For now, there are no answers.
What a funny business he’s in, I realize now, struggling to arrive at that out-of-reach objectivity. Not only did I get my hopes up very quickly, I began kicking around the idea of life with a newborn—Noah if he’s a boy, Fiona if a girl—and a four-year-old, easily picturing myself pushing a double stroller around town, or teaching Sophie how to give her baby sister or brother a bottle.
“I’m a little worried about you, worried about what you’ll do if this doesn’t work out,” a friend said recently. “Why are you so focused on having a second child now?” My friend is ten years younger than me and in the midst of finishing her dissertation. For the moment, she’s content with a dog and a yoga studio membership.
I tell her the truth, which means I tell her that Sophie has brought me more joy, as well as more heartache, than any other human being.
“Like I said,” she repeated, “I’m a little worried about you.”
Yesterday afternoon, Sophie and I set out on foot with the dogs and her stroller (just in case). I’m going to move at her pace, I told myself, resolved not to hurry her from one place to the next. We’ll take our time.
“Watch me, Mama,” Sophie said, hoisting herself onto a neighbor’s foot-high brick wall.
“You’re doing really well,” I replied, as she walked along, in one hand, an ice cream cone, in the other, the stuffed dog she’s taken to calling Swizzle.
Seconds later, she caught her foot on one of the bricks, then tumbled off the wall and into the ornamental grasses, which thankfully cushioned her fall.
I knelt beside her on the sidewalk.
“I scraped my knee, Mama,” she said, pointing to the reddening skin.
“You’re okay, lovey,” I said, brushing her off.
“I’m going to try again,” she said, and clambered back onto the brick wall.
Some twenty minutes later, we arrived at the elephant fountain two blocks away. We visit “him” almost daily, but not until this visit did Sophie stroke the wrinkled surface of his cast iron trunk, and swish her fingertips through the water that trickled out.
With nobody else do I look at the world so closely.
Because of Sophie, I’ve taken to salvaging butterfly wings and blue jay feathers. Because of Sophie, a walk around the neighborhood is a lesson in enchantment. “I’m going to turn myself into a bell,” she said a few months ago, “and then I’m going to ring myself.”
“I would love to have a second child, too,” my friend Rezka tells me during our daughters’ swimming lessons this morning. “But I’d never subject myself to fertility treatments.”
“It’s just for a few months,” I say.
“Even so, it’s dangerous,” she says, then plunges into an overview of Linda Carter, a.k.a. Wonder Woman, who, she claims, underwent ovarian stimulation during the treatment’s more experimental and less carefully regulated years.
I have no idea what to say here, except that when we were children, my little sister idolized Wonder Woman. We never missed her show on Friday nights. For just a moment, I picture myself in her sexy leotard and thigh high boots striding into Dr. J’s office, the show’s theme song accompanying my super-heroine moves. “What happened to her?” I ask.
“She never conceived a child,” Rezka continues, “and she died of ovarian cancer.”
The theme song fades out.
“Aren’t you afraid of what will happen to you, not a year from now, but in fifteen years once Sophie, and any others to come after her, really need you?”
“Like I said, I’m only planning on doing this for a few months,” I reply, as our daughters splash in the water some twelve feet away from us.
Rezka shakes her head.
“What scares me more are the miscarriage rates for women over forty,” I hear myself say.
She lays a hand on my arm. “Don’t think about that. You’re so healthy. Losing a baby can happen at any time, to a woman at any age.”
Even with Dr. J’s help, the odds are against my becoming pregnant and successfully carrying a pregnancy to term. The chance of becoming pregnant in any one month is about twenty percent in women under thirty, and only five percent in women over forty. Dr. J, too, has drawn my attention to the fact that my reproductive situation has radically changed since I gave birth to Sophie.
I’m not alone.
Dr. J, to the best of my knowledge, is childless and unmarried, and he reminds me a little, just a little, of my high school biology partner, Jimmy Hoffman, a smart, skinny teenager who imprinted a baby chicken to himself for his semester-long project. As soon as the egg hatched, Jimmy was the first person that chicken saw. It—“Noodle”— followed Jimmy everywhere. He even talked about taking it to college. Dr. J isn’t skinny, but I think he was once, and I’m sure he was probably awkward well into adulthood. In fact, he is rather awkward now. On his last vacation, he drove to Oklahoma—“the middle of nowhere”—to visit relatives. As difficult as it is for me to picture this Beirut-educated, balding Middle Easterner in Lubbock, Texas, it’s even more difficult for me to picture him in a small town in central Oklahoma. And I really cannot imagine him at a cocktail party, something I have done, in part to soften the embarrassing intimacy of those ultra-sound sessions and the comprehensive, all too direct nature of some of our talks (How often do you and your husband have sex? Do you experience pain during intercourse?)
It’s his profession that gives him an aura of divinity, at least a halo, for patients who seek out fertility treatments are—at least to some extent—desperate. At the very least, we’re extremely eager: wide-eyed, overgrown children before a Christmas display. Is that part of the draw for him, I wonder, recalling our last conversation: If you don’t get a period, we’ll make you get one.
Though Dr. J has not suggested anything so radical as what makes headlines in the field, reproductive endocrinologists have to be among the group of doctors at the top of the list for playing god.
I have been willing to go on board with this plan because my desire for a second child is that strong, and although my reasons are those of women throughout the world, they are certainly not rational. Don’t I have one healthy, beautiful child? Weren’t the last three years among the most demanding, physically and emotionally, of my life (and Bill’s)?
Strong-willed personalities both, now that Bill and I are regularly under-slept and worn out with juggling the demands of teaching undergraduate as well as graduate students, university responsibilities, and a household that includes two dogs and Sophie, not a week goes by without a fight. Usually, we argue over something as ridiculous as who was supposed to buy new pillows for a houseguest’s visit, or why I gave Sophie ice cream too late at night, a quarter scoop being the supposed cause of her high energy eleven p.m. antics.
“Sometimes, when you try too hard to look for something, you cannot see it.”
Am I beginning to see what I could not that day in the darkness of the ultrasound room? The etymology of fertility is not just about fruitfulness. It comes from the Latin ferre “to bear” or ”to carry.” The obvious connection is childbirth, but don’t endurance and the idea of ferrying across come into play here as well? Uncertainty is what I must learn to carry, and in time, regardless of the outcome, to carry with grace. After all, when I was waiting for the results of the amniocentesis during my pregnancy with Sophie, didn’t my close friend, now a grandmother, tell me that the unknown, the surrender of control, was part of a mother’s journey? Something I would have to learn to live with for the rest of my life?
This evening, after a late afternoon rain, Sophie joins me in the garden where I am looking for ripe tomatoes.
“Watch, Mama,” she cries. In her hand she holds a wooden stick to which Bill has attached some four feet of glossy pink ribbon.
“Watch me!” she cries again, bolder now, ebullient, as she begins to twirl in circles, plunging the stick up and down and around, so that the ribbon arcs and swirls around her, a pink rainbow undulating across the silver-blue sky.