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1
Diagnosis
Oh, if there were in me one seed without rust . . .
--Czeslaw Milosz, The Song
I love teaching. After twenty years of working in the theater, I recently got a master's degree and was lucky enough to land a job teaching Russian and musical comedy in the hottest junior high school in Manhattan.
But Kathryn, our daughter's baby-sitter, has quit. Now Ellena wants to have nothing to do with any of the possible replacements. Except one. Me. She is only ten months old, and every time I leave the room her wailing reels me back in. There is only one thing to do: stay home until she becomes more comfortable with new people.
After a couple of weeks at home, I realize Kathryn's sudden departure was a gift. I would never have dared to choose full-time motherhood over work. Never found out how much I enjoyed the preciously unhurried hours with my daughter: cruising with the baby backpack through our morning errands, walking around the Columbia University campus just north of us, or savoring our raisin bagel in the nearby bakery. We live in a fifteen-story prewar building across from Riverside Park, and if I lean far enough out the kitchen window, I can see a patch of green. It's not unusual to meet up with a cluster of park-bound strollers in the lobby. Within a week, Ellena and I are part of a neighborhood play group. As long as we can manage financially, I will teach in the evenings and continue being a full-time mom. Thankfully, my husband, Ed, supports my decision.
There is an added bonus to all this. With no teaching schedule to consider, the second baby could come anytime. Let's see, if it arrived nine months from now, my twochildren would be only nineteen months apart. Lying in bed at night, I take a deep breath and imagine movement under the slope of my belly. I see myself lean against the weight of a double stroller and wonder whether it will fit through our front door.
Three months later, I'm still a full-time mom, now a part-time teacher of English to speakers of other languages at Hunter College. It seems Ellena's sibling is taking a little longer than we anticipated. I'm not really concerned. After all, the last time I got pregnant on the first try. Three months is not very long. But I'm forty-two. A consultation with my gynecologist might be in order.
"We should take an FSH test," suggests Dr. Y. "It's one of the first things we look at in women over forty." A week later I call for the results.
"Oh, yes," reports the nurse, "your numbers are fine, within normal range." A sigh of relief, a phone call to Ed, all is well. In a few days I call to schedule further testing. I am stunned to find out that, although the numbers are not "abnormal," all is not well.
"The follicle-stimulating hormone helps the follicles inside your ovaries to develop into eggs. If the level is--over 20--" Dr. Y pauses--"your ovaries are not working as well as they should be. With an FSH of 42 there is not much I can do for you. You'll need to see a fertility specialist."
I sleepwalk through the rest of the day. How could I have been so arrogant, ignoring my age? Did I think my biological clock had stopped ticking just because it took me so long to find the right man? We should have started trying sooner. And what is my problem? Why does this hurt so much when I already have the most wonderful daughter in the world? How dare I lament with all those childless couples out there? Yet I can't undo the feeling of despair. I know how much Ed wants to have another child and how much we would love Ellena to have a sibling. Dr. Y refers me to a specialist. That must mean a specialist can help.
Dr. N strikes the first blow.
"I'm sorry," says the receptionist. "Dr. N will not accept you as a patient. Your FSH is too high. He doesn't feel he could help you." A decent man, he is saving me money. Yet all I hear is that it's so bad, he doesn't even want to try.
"What happened? You look sick," says Ed as soon as he opens the door. Of course, he's shocked. Last week there was nothing in our way except a few months of practice until we got it right. My impulse for self-flagellation wins out once again: "If only we had started right after Ellena's birth. They say that's the most fertile time. We should've known!"
A line of fear cuts across his face, but he is enlightened, as always: "We couldn't have moved any faster, we were not ready. Everything will work out. Do you remember when we first held Ellena? How tiny she was? How easy it was to love her? We'll love this baby no matter where it comes from."
Ed is right. I mustn't for a moment forget how lucky I am. Ellena, Ellenka. Her name combines the names of her two grandmothers (Edita, Helen) for double protection. In return she carries sparks of them in her blue eyes, the color and texture of her sun-bathed hair. I must be there for her. I can't give in to the feeling of defeat that sneaks up on me when I least expect it.
My friend Lisa and I went to college together. Our relationship has gone through its ups and downs, but still my hand automatically dials her number in times of crisis. She and her husband, Gary, have been members of the infertility subculture for the past four years, having gone from specialist to specialist to finally adopting their son, Sam, three months ago.
"This is the worst part, when they tell you something's wrong. It gets easier after that," says Lisa.
On Lisa's recommendation I call Resolve, a national organization for people with infertility problems. They might have some new information. I'm hoping for a recent breakthrough in research, someone to discount the FSH alarmists.
I leave a message briefly describing my situation. The woman who returns my call, Shelly, is only thirty-seven. She has an FSH problem as well. Like me, she has one biological child, though she had trouble conceiving the first time. Our hormone levels create an instant bond.
"I know how you feel," Shelly says sympathetically. "Our doctor suggested IVF, but it's not an option for us. We can't go through it again. We're in the midst of the adoption process."
I ask her if she ever tried alternative treatments. "Like herbs? No, not really," she replies. "I guess you never know, do you?"
Across a haze of information, a list of doctors and IVF clinics, I hear a certain resignation, a weariness I fear might be contagious.
The complimentary Resolve newsletter arrives a few days later with an entire page filled with information on support groups. I am not ready to join one, but it's comforting to know they're there.
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 two-thirty 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.
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.
Dr. 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 hands. Later I hear him repeat the phrase to another desperate, smiling couple.
Three weeks later, as we go through subsequent visits and discuss 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. C's diagnosis produced by a different set of vocal cords? 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.
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