Inconceivable - Winning The Fertility Game
I'm surprised no one mentioned the effect of a high FSH on your environment. Seemingly overnight the entire Upper West Side of Manhattan swells into a giant, mocking belly. The playgrounds are invaded with mothers expecting their second or third child, or cradling newborns against their breasts. It seems almost daily there is joyous news of yet another one of Ellena's playmates becoming a big brother or sister. Each time the news feels like a humiliating betrayal to me.
Dr C is at the top of Lisa's list of referrals. Getting an appointment is surprisingly easy. His office is on the street level of a lovely brownstone in Greenwich Village. Ed takes a late lunch hour to meet me for a 2:30 appointment. Finally, my first specialist.
A young woman with two screeching bundles is holding court in his waiting room. That's what I call a good omen. "They're Pergonal babies," she says to no one in particular. "We worked hard for them."
I imagine her gravely injecting her thigh, while staring at a Gerber baby taped on her refrigerator door for inspiration. She walks out energized by her new motherhood and proceeds to load her car with the precious cargo.
Which route to take?
Dr C is an elegant, gray-haired man in his late fifties. On his desk sits a photograph of a beautiful woman holding twin girls. His daughters? Maybe his very first Pergonal twins? Nothing's sacred anymore.
Unaware of my silent indiscretion, Dr C begins to take a brief medical history. He asks me about first menstruation, first pregnancy, Ellena's birth, and the regularity and duration of my ovulation cycles, all of which he finds satisfactory. Prior to this visit, Ed was asked to get a sperm count, and it's comforting to know we're not lacking in that department.
Doctor C looks at the lab report with my FSH. "Forty-two is high. Very high," he says, sounding concerned.
"Doesn't the number fluctuate? Couldn't it just drop on its own?"
"Of course it could, but the fact that it even once went up this high is discouraging. Ordinarily, I would recommend Pergonal. It's a fertility drug that helps you release more mature eggs. You could administer it to yourself by daily injections into your buttocks. Only, I don't think with these numbers it would do much good. I wouldn't want to give you any false hope. The prognosis is poor. In vitro fertilization is an option. Of course you would have to get an egg donor.
"I still think we should run all the basic tests," he adds. "To make sure everything else is all right. And you'll need to have them, if you elect to go the IVF route. One more thing: before we schedule the tests I'd like you to meet with our staff psychologist, Dr R."
"Hope we can help," he says, shaking our hands on the way out. Later I hear him repeat the phrase to another desperate, smiling couple.
Three weeks later, going through subsequent visits, discussing lab results and additional options over the phone, it becomes quite clear Dr C has no idea who I am. Literally. I have a feeling he loses track of his patients in the maze of sonograms, biopsies, sperm counts, and referrals. Maybe he doesn't need to know me, as long as he knows his trade. As long as he updates my chart. Knows not to give me too much or too little of anything. Knows how to take a snip off my uterine wall and not hurt me more than he has to. So what if he thinks I'm the tall blonde instead of the short brunette?
The next step is our appointment with Dr R, the psychologist.
She greets us in the waiting room. "Don't worry, I have everything under control," says her neatly tailored dark suit and her breezy smile. For a moment I'm reminded of those flawless faces one sees behind the make-up counters at Bloomingdale's. A dab of color, a stroke of a brush and you're as good as new. Instead of glamorous photographs, the walls of her office are covered with colorful diagrams of the female reproductive system; on her desk lies a plastic model of a uterus and ovaries, and a couple of syringes.
The first order of business is to reassure me I'm not going through menopause. "Women seem to think a high FSH means menopause is just around the corner," she says, "but of course it doesn't mean that at all." She is pleased to be the bearer of such good news, happy to clear up a foolish yet understandable error.
"Does that mean I can have another baby?" I ask. "Unfortunately," she continues, "it does mean your ovaries are no longer producing fertilizable eggs. Now there are a number of procedures to compensate for this, various fertility drugs to boost the production of eggs and to improve their quality. In your case, however, the FSH is too high to merit the use of any of them. The only thing Dr C recommends is IVF with an egg donor or, if you want guaranteed results, adoption, or surrogacy." She hands Ed a business card of a therapist specializing in adoption, and another of a lawyer who helps couples find surrogates.
Before we leave, Dr R gives us a description of ovaries enlarged by doses of Pergonal. If I elect to do IVF, taking Pergonal is part of the process. "You would be closely monitored, but it's a powerful drug."
"And, no," she says in response to Ed's last question, "there is no documented case of anyone conceiving with these numbers."
A quiet moaning starts up at the base of my abdomen, and I reach for Ed's hand. His fingers wrap around my palm. I need to get out of here, but it seems Dr R is waiting for some sort of, preferably emotional, response from the two of us. Something to justify our presence in her office. Otherwise why would a consultation with her be part of the routine? A prerequisite for the rest of the tests? To provide us with a professional shoulder to cry on? In case, after fifteen years of analysis, I might not be aware of needing a therapist? Or was it to hear Dr D's diagnosis produced by a different set of vocal chords? Or, could it be that this conference was dictated largely by the rising cost of commercial real estate?
One thing is clear: the fertility roller coaster is in motion. And like it or not, I'm on it.