Confusing the issue

You know, doctors can be a slick lot, especially reproductive endocrinologists.  They have to be, I guess, if they're going to manage to convince you to hand over considerable sums in exchange for absolutely no guarantee.  Usually it annoys me — the refusal to commit to a position, the mincing of words — but on Tuesday it entertained me.  I loved watching the doctor furrow his brow as he read my chart, and hearing him finally settle on a non-actionable way to ask, "What the hell did they do with you?"

What he said at last was this: "I'm seeing certain things here that confuse me."  (I can just see myself telling anyone who will listen, "You know, they're supposed to be really good at Cornell, but I don't know — this guy just kept saying how confused he was.")

The doctor we spoke to was adamantly opposed to the notion that we should even consider donor eggs at this stage.  Given my age (almost 33) and my FSH (6.7), he said there was no reason to believe my eggs are unsalvageable.  When I asked him about the notations in my chart, which indicate that many of my eggs seem to have defects beyond the whole weak zona question, he paused to frame his words, then said, "There are so many human factors that influence the IVF process.  I would look to those, rather than to biological ones" to explain the problems I've had so far.

Slick.

And on the whole weak zona question, he communicated the same thing.  His theory was that I'd been triggered too late, that the eggs that ruptured were post-mature, on their way to degrading when the ICSI process finished them off.  They tend to trigger earlier at Cornell, with daily monitoring near the end of the cycle.

I asked him if he'd ever seen a patient with a persistent weak zona — a problem that manifested itself over repeated cycles.  He said they'd had one patient who never made any zona, a problem so rare that "we wrote a journal article about her," but no one with intrinsically flawed zonae.  He repeated his comment about the human factor.

Interesting.

He also said he would recommend decreasing the medication as the cycle progresses, and would opt for a pure FSH protocol rather than combined FSH/LH as I've had in the past.  But he didn't recommend anything arcane, and seemed to think a simple approach could work for us.

And I am beginning to think so, too.

It's a theory

I have a theory about why I'm infertile: I think my uterus may be situated on an ancient Indian burial ground.

A brief reproductive history of Christmas

Last year at Christmas we gave my family the news that we'd gotten married. We were on the schedule to do our first round of IVF in January. With a curious mix of optimism and pragmatism, we decided our families would handle the news of a pregnancy with greater enthusiasm if we were no longer, you know, living in sin.

On Christmas day my period arrived. In the pre-holiday shuffle I'd packed neither tampons nor ibuprofen, so I spent the bulk of the day in festive contortion with a giant wad of toilet tissue making the crotch of my trousers bulge most attractively. When we'd finally finished unwrapping the presents, I crept out to the nearest open gas station and bought a box of Tampax Slender Regular (the only flavor available) and about a dozen two-tablet pouches of Advil (the only denomination available).

This Christmas day was cycle day 14, and I ovulated right on schedule. But Paul and I spent the night in separate bedrooms, so unless some immaculate nookie took place that I don't know about it, I am not, at the moment, even remotely pregnant.

If you've ever had difficulty conceiving, you may be aware that there's a certain perverse comfort in knowing you're not pregnant. I don't even have to wonder. There's no urge to weigh my breasts judiciously in my hands on an hourly basis. I don't have to sneak into the second bathroom to plunder the Aladdin's cave of HPTs under the vanity. And I can worry that the twinges in my lower abdomen are the result of a grapefruit-sized fibroid instead of hoping that they're implantation cramping.

Drugged up

I ordered the medication today for my first IUI with gonadotropins.

After umpteen unsuccessful IUIs with Clomid, last year we moved directly to IVF without first trying IUI with injectables. Now we're taking a conceptual step backward. Since my only intrauterine pregnancy came about when a planned IVF was converted to an IUI, it seems reasonable to try again with the protocol that worked then.

I faxed the necessary paperwork to the nurse, who then called to ask me what drugs I wanted to use.

That's right. Apparently, without my knowledge, in its infinite wisdom the state has granted me a physician's license. I can prescribe my own regimen. So along with an impressive battery of opiates, amnestics, and hallucinogens, I have prescribed myself a three-amp program of Follistim.

(The smack I'll continue to buy from the industrious teen entrepreneurs down the street. Wouldn't want to abuse my newly-minted power.)