Jim Henson's whirling in his grave

I think it would have been a better idea for my doctor to hold this afternoon's post-cycle consultation in a conference room instead of an examination room.

Paul and I perched uncomfortably on plastic chairs, the chairs that have held up my empty jeans and crumpled underpants on dozens of occasions. The doctor wobbled precariously atop a wheeled stool, not unlike the one from which he presided over my in-office D&C. And before us loomed the table, stripped for the occasion of its paper sheathing, but still bearing those jaunty cloth covers on the stirrups.

You know the ones I mean. Sometimes they're fuzzy socks. Sometimes they're hand-knitted booties. In my doctor's office, they're sticky purple vinyl, kindly supplied by our friends at Ortho. I suppose they're intended to make pelvic intrusion a little more cozy.

I admit it: the presence of the examination table threw me. It made me uncomfortable. I mean, I couldn't really listen to a single thing my doctor had to say, because the whole time the poor man talked, all I could think of was how much I wanted to snatch up the stirrup covers and put on a rollicking puppet show.

XXX libris

So I was thinking today about the naked lady magazines that are an inevitable feature of any clinic's "collection room." (I guess that's a nicer term than "wankatorium.")

I was wondering exactly whose job it is to select the visual aids. Are they chosen by someone with relatively cosmopolitan tastes, or by someone who picks them up gingerly by a corner, making a moue of displeasure? Is there some general medical consensus about which topics should be covered, or is it entirely an aesthetic decision on the part of the hapless curator?

Do they send the lowest-ranking staff member to that skeevy adult bookstore out by the airport? Do they keep petty cash on hand for just such occasions, or does the employee have to fill out an elaborate request for reimbursement? Description: January 2004 Manholes. Purpose: Client entertainment.

Or does the office simply maintain yearly subscriptions to an array of quality periodicals? Does the postman do a double-take when he sorts the daily mail and finds this month's Juggs nestled coyly beside this month's Breastfeeding Outlook? Who's in charge of sending in the card that says, "YES! Please send me 12 jam-packed issues of discreet, efficient masturbatory inspiration!"?

I know nothing of my own clinic's literature holdings. I keep meaning to send Paul in with a pad and pen so he can make me a list. The only helpful information he has volunteered so far is the intriguing fact that on the very top of the stack rests a pristine and current copy of The Journal of Light Construction.

I make a better moron than a hero

From my doctor, via e-mail:

As always, nice seeing you two yesterday...I just wish the circumstances were better. I am in awe of the resilience you folks have exhibited.

My response:

Some days I feel heroic. Other days I just feel stupid.

Today is one of those other days.

I talked to a friend about our situation and told her we might try stimulated IUIs as we vacillate about whether to do another IVF. "Is an IUI really expensive?" she asked.

"Nah," I said, "not in the grand scheme of things." I was thinking in terms of an IVF cycle, which would cost us upwards of $15,000 at Cornell, to say nothing of the money we've already spent.

But when I told her how much a stimulated IUI actually costs, her jaw dropped. "What sounds like not a lot to you," she said, lips pursed, "sounds like an awful lot to me."

Once again I was reminded of how dramatically my frame of reference has changed, and of how foolish and almost reckless this pursuit sometimes seems, even to me.

The money is really the least of it (and I know how fortunate I am to be able to say that). What embarrasses me most acutely are thoughts of the wasted time, the misplaced emotional energy, and the utter self-absorption of the last year.

Sometimes I feel heroic to have kept up the struggle in the face of such discouraging results. Like there's some intrinsic merit in pursuing a cherished goal with no thought to personal hardship.

But other times I feel like a total chump. One year, thousands of dollars, two pregnancies, and nothing to show for it all. All such a sad goddamn waste.

For unto us a child is born. Oh. Wait.

In an inexorable torrent, this year's Christmas letters have begun to come in. You know the ones I mean:

Matthew's doing great in his new position as Chief Executive Widgeteer. He really likes the work and the people, though he misses the family when he's off on those frequent business trips to Butt End, IA.

Jane loves her full-time job as a SAHM to Madison, Taylor, Montana, and Dakota. She doesn't get much vacation time, but the fringe benefits are worth it! This year we spent our days in a course of exhilarating child-directed study of the environment — Taylor especially enjoyed catching tadpoles in the pond!

Et cetera, ad infinitum, ad nauseam.

I've been working on my own holiday letter. Want to take a look?

Season's greetings from Julie and Paul! It's been a while since we caught up — you know how hectic things can get — so we'd like to bring you up to date on how we've spent the past year.

January got off to a great start with a big jolt of Lupron. Julie says that smuggling the needles past airport security, shooting up in her grandparents' bathroom, and hiding the used syringes in the waistband of her underpants was the perfect way to ring in the new year. She had a few hot flashes and headaches, but then so did her grandfather, who was trying to adjust to the dose of radiation being used to treat his prostate cancer — so at least she was in great company!

February passed in a whirl of activity. Those 7 AM pre-dawn drives to the doctor's office sure gave Julie and Paul a lot of quality time together. Though Julie celebrated her birthday that month flat on her back with her feet in the air, exposing her pelvis to another man, Paul came through as usual, giving her a roomy pair of Polarfleece overalls as a gift. A great present, considering the uncomfortable bloating and painful ovarian swelling! At the end of the month, we had seven eggs to work with. Of course, only one fertilized, but everyone insists it only takes one!

At the beginning of March Julie and Paul left for a whirlwind trip to Las Vegas. I guess Julie was feeling lucky, because her first pregnancy test showed we'd hit the jackpot! Too bad our luck turned mid-month, when we learned the pregnancy wasn't viable — but at least we knew Julie could get pregnant!

March didn't exactly go out like a lamb, with two doses of Cytotec and a D&C, but in April we finally settled the matter once and for all with a whopping dose of methotrexate. Julie says the worst part about losing her first pregnancy was that she couldn't drown her sorrows in vodka! (Ha! Ha! Just kidding, folks!)

In May the cat had a great month at school. He got all As on his report card and was chosen student of the month! Not even his infuriating seasonal house-spraying could diminish our pride. Julie was heard to grumble that the school didn't send home a bumper sticker about that...!

June brought lovely weather to our neck of the woods, though Julie was a little too bloated by then to do much gardening. That's right! We were finally underway with IVF #2. Of course, Julie's body had its own agenda — when a single dominant follicle developed, the IVF was cancelled and converted to an IUI. Oh, well! At least Paul got to have his fun! (Just kidding, honey!)

But our Julie doesn't take no for an answer! Those fireworks you saw in the sky on July 4th? Those were for us. Much to everyone's surprise, the IUI worked — Julie was pregnant again! And this time none of that vexing tubal business, either. Once we saw the heartbeat on little Cellface, as we called it, we knew this one was a keeper.

Oops! Boy, were our faces red in August, when we learned it wasn't. Oh, well — like they say, easy come, easy go!

September was a lovely month here, with the leaves putting on their colorful annual show. The cat must have wanted to shed his own foliage, too, because he began pulling his hair out in large clumps, leaving it to drift across the carpet like gray and white tumbleweeds. The vet said it was probably stress — who knew a cat could feel stress, especially with such positive, upbeat owners?

Boo! Did we scare you? For Halloween, Paul and Julie dressed as anxious, exhausted, white-lipped patients undergoing IVF #3. It was a shriek a minute when the process revealed a frightful problem with Julie's egg quality. As October ended, we were wondering "witch" it would be: a trick or a treat? Would either of the resulting two embryos turn into a boy...or a ghoul?

The month of November began just like its name: with a big old "no." But we had other things to think about besides our own minor disappointment — our friends having babies, Paul's beloved aunt's death, and the likely death of our faithful feline friend, who had gone blind and lost his ability to walk. But we all know God never gives us more than we can handle! By the end of the month we were digging into a big turkey feast, feeling thankful for all the many blessings we've described above. More gravy, please!

December finds us ready for a holly jolly Christmas as we scramble to buy presents for other people's adorable moppets. This month brings Paul's 45th birthday (getting a little too old for international adoption, dear! Ha! Ha!) and we'll mark our first wedding anniversary. We'll also celebrate the season by asking Dr. Kris Kringle for a second opinion. No one will see Mommy kissing Santa Claus, but, oh, the things he does with an ultrasound wand...!

We hope this letter finds you and your loved ones happy and well. Here's to a joyful holiday season and a new year just as wonderful as this one!

Love,
Julie and Paul

Now that I look at it, I guess it could probably use a quick edit.

Things which were good now suck

I am outraged, outraged to learn that baby aspirin, prescribed to many women to assist in embryo implantation, is now compounded with artificial sweeteners!

I hadn't tasted baby aspirin since the olden days of my youth. Any childhood fever brought with it the thrill of Russian roulette: would we get the St. Joseph's for Children (sharp, orangey, and delicious), or would we get a spoonful of sugar mixed with grown-up aspirin and water (bitter, gritty, and so vinegary it felt like your tongue was shriveling under the onslaught)?

Okay, low-stakes Russian roulette.

On the assumption that, hey, it couldn't hurt, I bought a bottle today and popped one while I was driving home. Imagine my indignation when I recognized the cloying sweetness of aspartame. Why did they do this? Are they afraid baby aspirin will give me cavities? Do they know that too much sugar makes me a little bit hyper? Do they think I'm concerned about the calorie count? Or are they now angling for the low-carb toddler market?

What the hell is going on?

I want my MTV

Today's winning search term:

good jackass ideas

I can only surmise that the person searching was looking for ideas that might get them airtime on MTV's Jackass.

Do you think IVF counts? Sign me the fuck up. If I'm going to volunteer for this, don't I at least deserve the Nielsens to go with it? My God, any pantywaist can set himself on fire while barricaded inside a Port-a-Potty, but it takes a real man to withstand needles in the ovaries.

Go with the flow

I haven't said much about the follow-up consultation I had after IVF #3 for the very simple reason that it yielded almost no new information.

When Paul opened his notebook at the beginning of the meeting, my doctor's eyes landed on the Cornell letterhead with the fixity of a soaring condor spotting a choice heap of carrion way, way down below. For the rest of the hour, his sights were locked.

So we got to hear a lot about what he imagines they'll tell us at Cornell, his impression of the doctor we'll be seeing, and his opinion on the cost of their program. When I was sufficiently bored beyond politeness by all this, I finally barked, "Thanks. Now. Less about their approach and more about yours, please."

As expected, he warmly embraced my idea that stimulated IUIs might be worth a try. Although I had several unsuccessul IUIs with Clomid, the only way I've ever achieved an intrauterine pregnancy was with gonadotropins and an IUI, so it seems worth a couple of tries. I can't tell if my doctor's enthusiasm is due to a sincere belief that it might work, or relief at the prospect of shifting the burden of conception back onto my body instead of his lab.

He assured me, by the way, that his embryologist was not drunk when she did ICSI on my eggs.

Speaking of my eggs, he took vigorous exception to my characterization of them as garbagey. I contented myself by scowling and muttering under my breath, "They're my eggs and I can call them whatever names I want."

I'm pretty much the epitome of maturity.

He allowed that the zona problem I have is uncommon, and offered no opinion on whether my eggs might perform better in vivo than they do in vitro. This pretty much cemented my conviction that going to Cornell for a second opinion is a good idea — I'd like to talk to someone who's seen a hundred patients like me. I know no one can offer any guarantees, but even an educated guess would be an improvement.

We had a long and confusing conversation about whether I should have another lap before further treatment. I was finally made to understand that my doctor's opinion is that if we're ready to forego future tries with IVF and just concentrate on IUIs and/or natural conception, I should consider a lap. But if we're willing to consider IVF in the future, we should leave the depths of my pelvis unplumbed, for fear of removing functioning ovarian tissue. "...Unless," my doctor concluded, "you really want a lap."

For the girl who has everything, I presume.

So the consultation didn't offer us anything much beyond confirmation of what we already knew, and had already considered trying next. Inasmuch as there is a plan, here's what we've decided, in helpful flowchart form:

She's crafty

My period arrived this morning, a day early. Eager to let my, uh, creative juices flow, I have scheduled a day of crafts to celebrate. Just in case any of you lead a Brownie troop, I will share my plan here.

Fun and easy menstrual projects:

• Thumbprint hamster

  Supplies: Blood, paper, thumb, Sharpie.

  Procedure: Press thumb into blood. Press gore-soaked thumb onto paper, rocking thumb back and forth to assure even coverage. Wait for thumbprint to dry. With Sharpie, add a long tail, some tiny toesies, lovable-looking ears, cunning little snout, and three spiky whiskers on each side of face. (Evil slanted eyebrows optional.) With Sharpie, write, "Thumbody isn't pregnant!" Slip into doctor's mail slot.

• Spin-Art

  
  Supplies: Blood, paper, scissors, salad spinner, bleach.

  Procedure: Cut a pleasing shape out of the paper. A heart is nice, but you might also consider the silhouette of a uterus wracked with painful cramps. Place shape flat inside salad spinner. Dribble blood onto the paper. Replace lid of salad spinner. Send shape and blood for a short whirl. Remove shape and let dry. Sanitize salad spinner with copious amounts of bleach. Place heart under windshield wiper of doctor's car.

• Untitled installation piece

  Supplies: Blood, bucket, expensive automobile, cover of darkness.

  Procedure: Stealthily approach your reproductive endocrinologist's parking space. When coast is clear, decorate vehicle with attractive lashings of red and brown. (Some artists strive for a Pollock vibe, but I work more in the mode of Rauschenberg.) Watch carefully for approaching authorities. Scamper away as fast as your Pamprin-doped carcass will carry you.

For the record

Among the photocopied pages from my file is the psychological evaluation the state requires before a couple undergoes IVF. I should note that said evaluation was performed by one of the cadre of skilled and caring mental health professionals getupgrrl captures brilliantly, velveteen and all.

I will treat you to some highlights from the report, with my comments:

[Julie and Paul] cite major ambivalence about having a child as their reason for wanting to significantly limit the number of embryos put back... A year later, I now invite my doctors to reinstall as many embryos as my body can manage to make. I don't really lose sleep these days over the possiblility of high-order multiples.

They report they currently have a nice lifestyle and are not 100 percent convinced that they desire to be parents... I felt it would be dishonest not to acknowledge some reservations about the ways our life would change. We do have a comfortable life (I would never have said "lifestyle"), and children will change that drastically, in some ways for the worse. Funny, though — I never saw this as a sign of ambivalence, as the psychologist clearly did. I saw and see it more as a gesture toward pragmatism, and possibly a sign of our true commitment to having children, even though we know we'll be losing some of the things we love about our life together.

[Julie and Paul]...report a history of anxiety and depression which they seem to be managing quite well together as a team...They both deny low self-esteem...Both deny thoughts of death and suicidal ideation. No evidence of delusions or hallucinations. Oh. Good. Not delusional. Whew. And if you were looking for problems with my self-esteem, it's not low you'd need to worry about.

[Julie and Paul] are a couple coming to seek fertility treatment but with expressed ambivalence about the procedure... I think you'd have to be a nutjob fruitbat wingnut not to feel ambivalence about the procedure. They stick needles into your ovaries, for crying out loud.

They do have concerns about the new responsibilities of having a child. I think their ambivalence will enable them to accept the results of any negative outcome of this treatment. This bit near the end sent me into a rage last night, and I find myself getting sputtery about it again. Can you see why? Wait, I'll rephrase it to make the infuriating part obvious: Because they're not sure they want a child, they will breathe a sigh of relief if this voodoo shit doesn't work. First of all, we are sure we want a child, and recognizing that it won't all be moonlight, roses, and unsoiled fuzzy sleepers doesn't dull that desire. Second, I defy anyone to "accept" the "negative outcome of this treatment" — the many Gothic ways in which things have gone haywire for us this year — with anything but rage, anguish, and a feeling of powerlessness so profound that I can barely make myself pick up the phone to order the next round of drugs. If my "ambivalence" makes this easier, I'd hate to see how people with "delusions or hallucinations" about the romance of parenthood handle it.

If I can make it there, I'll make it anywhere

We're heading to New York this morning for a couple of days of psychological hardening before Tuesday morning's consultation at Cornell. I will nurse my feelings of alienation among crowds of happy tourists. I will practice my snarl on blameless strangers. I will hone my anger at the universe as some clueless jackass on the subway refuses to let me off at my stop.

Can you tell I used to live there?

Back late Tuesday night, with an update to come on Wednesday.