Um, what birds and bees?

My friend T. just called to tell me her six-year-old daughter had asked her, "But, Mom, how does the sperm get to the egg?"

I told her she was lucky her daughter hadn't asked me.

"Well, Emily, the thing is, it doesn't."

Or maybe...

"The daddy sits alone in a grubby little room and frantically performs the secret handshake, while the mommy lies on a gurney drugged to the gills. Then a mysterious masked man introduces a needle the size of a shish kebab skewer into her bathing suit area. What? Wait, where are you going? Hey, why are you crying?"

Or, more succinctly...

"When a reproductive endocrinologist and my Visa card love each other very, very much..."

Any of you with children are welcome to give old Aunt Julie a call when it's time to have that awkward conversation. Or I suppose you could just buy a record, if you think it'd be safer.

"I'm sorry." And leave it at that.

Yesterday someone found this site by searching for the term:

appropriate response when a friend's IVF is unsuccessful

Thank you, anonymous searcher, for having the sense and kindness to know that there are appropriate things to say. (Contrast this with the preponderance of jackasses whose outpourings of wisdom resemble nothing so much as a broken sewer main.)

As a rule of thumb, I will say that funny hats and noisemakers are probably not in order.

But you may need more detail than that. Always eager to please, I will make a short list of some comments that might be appropriate:

• "I'm so sorry."
• "Oh, God, you must feel rotten. How are you holding up?"
• "Do you want to talk about it?"
• "FUCK. I was really hoping this would be the one!"
• "What can I do to help? Cook you dinner? Take care of your pets for a few days while you're feeling low? Bring over a fifth and get you really, really shitfaced?"

And, ever the completist, I will list some comments that will not be helpful in the slightest:

• "I know how you feel." No, you don't. You couldn't possibly, no matter how eager you are to share my burden. (Note: Even if you've been through several failed IVFs of your own, this is not the time to shift the conversation to yourself.)
• "It just wasn't meant to be." Thanks for the help, Nostradamus. Now shut your couplet-spouting trap.
• "You can always try again." You know what? At $15,000 a pop, maybe I can't.
• "Maybe you should just accept the situation and move on." Hey, great idea! *smacking forehead* I'll just accept the situation. Why, as soon as I set my mind to it I'll be over my grief in a jiffy! I'll move on. Now why didn't I think of that? Who needs the worthless baggage of lifelong dreams, anyway? Thanks! I feel much better now.

I'm sure this has been helpful.

I loved that cat

My cat died this morning.

He'd been ill since November. When he began displaying some uncharacteristic behavior (hiding, occasionally growling, failing to hop up onto my lap at every opportunity), we took him to the local vet, who diagnosed him with hyperthyroidism — easily treatable. So we treated him.

Unfortunately, about two weeks into the medication, he became extremely lethargic and light-sensitive, eventually losing his ability to stand, eat, or control his bladder. We suspected a brain tumor. We thought it was the end. (This dovetailed nicely with the failure and aftermath of IVF #3.)

In a last-ditch effort to save our cat, the vet took him off his thyroid medication and put him on a potent combination of antibiotics and steroids. His recovery was swift and startling. Within a day he was like a new cat — slightly weaker than he'd been, perhaps, but affectionate and friendly and ambulatory once again.

We took him to a specialist who dabbles in neurology, who said she was certain he didn't have a tumor. She believed his condition was a reaction to the thyroid medication. So we took him off the drugs and scheduled radioactive iodine treatment for him.

You can't know how relieved we were.

We took him to the thyroid hospital three hours away and left him there to board over the holidays while we were at my parents' house. I called to check on him daily — he was doing fine, I was told every time. When we returned, we went straight from the airport back to the thyroid hospital without even stopping at home — we were so eager to have him back. When we got him home, he trilled happily and walked around, sniffing and remapping all his favorite spots.

But then later that night, he became mopey. He seemed to want to hide.

His decline continued all through last week. Repeated visits to the vet revealed that his bloodwork was normal, except for a slightly low thyroid value. Thinking that was the problem — radiation thyroiditis, a reaction to the procedure he'd had — we supplemented his thyroid hormones and waited for him to improve.

He didn't.

More steroids, antibiotics, then subcutaneous fluids, then, when he stopped eating, syringe-feeding. Nothing helped. He couldn't walk very well. He spent most of his time with his nose pressed into any dark corner. He didn't seem to know we were there.

We took him back to the hospital yesterday so that he could be put on IV nourishment while we talked to yet another doctor. But when we went to pick him up this morning for his appointment with the specialist, he'd become unconscious.

The only thing to do was to pat him while the vet slid the needle into his vein. The liquid that was injected was bright pink. And then the cat's heart stopped.

You should know, by the way, that this wasn't just any cat. He was the cat of my soul. I've had other pets, and will again, but he was the one. He loved me extraordinarily, like I loved him.

He used to lie obligingly across my belly during my period, tireless in his service as a comforting live hot water bottle. When I lay sobbing after my last D&C, he brought me all his toys, lining them up carefully beside the bed in an effort to cheer me up. (It just made me cry more.) Paul and I used to joke that he could help us herd our children once they began to crawl, like a responsible sheepdog nipping at the heels of its flock.

Well, not now.

How crazy does this sound? I wanted my children to know him. He was a fine cat, friendly and faithful, and I will miss him horribly.

The law of conservation of splatter

Since getupgrrl's body is currently reluctant to cooperate, my body has apparently volunteered to step into the breach and cover the job for her. I shall explain.

The day before my period actually arrives, every system in my body conspires to be as revolting as possible. My digestive tract efficiently voids itself of every atom of waste matter it can find, ejecting it enthusiastically from both ends. My skin breaks out in a Milky Way of blemishes so luminous they would have inspired Magellan to pitch the goddamn astrolabe into the briny drink and navigate solely by zitlight. Several new chins arrive overnight thanks to the tidal forces of monthly bloat. And I am fairly certain I smell. Bad.

This is in a normal month, mind you. But today — cycle day 27 — the symptoms are so much more severe than usual that I'm convinced that this month I'm menstruating for two. It's the least a friend could do.

No need to thank me. It's nothing. Really.

how_i_feel_about_my_re.xls

I want to be fair.

My feelings about my reproductive endocrinologist are occasionally quite negative.  But I swear it isn't personal. 

In fact, on a personal level, I'm crazy about him. He's a lovely man who's shown me great kindness on many occasions, the sort of kindness I needed when everything went haywire: laughing dutifully at my feeble attempts at humor when most people would have been horrified.  He has never shied away from the questions, complaints, and occasional abuse with which I've ambushed him.  Although some of the decisions that have been made about my treatment have turned out very badly, I can't doubt the purity of his motives or the goodness of his intentions.

Based on a careful study of my journal entries (and recollection of a very few bizarre and smoking-hot dreams), I've concluded that the spikes of annoyance I've experienced over the last few months are really nothing personal.  I've found that the intensity of my feelings correlates directly with the success of a given phase of treatment.

Thanks to the magic of Microsoft, I have prepared a chart that proves this, including several important milestones over the last two years.  I feel it's quite persuasive.

Duly noted

Here are some quick notes from this morning's appointment for an ultrasound and bloodwork.

Time, gentlemen

I was up at 7 and on the road at 7:45 for an 8:30 appointment, determined to be punctual so the weekend staff wouldn't be detained longer than necessary.  Why did I bother?  Imagine my fury when I was the last patient seen this morning, finally entering an examination room at 9:50. 

Eight patients went in before I did.  Did they all have appointments before me?  If so, how did the staff expect to see eight patients before 8:30?  They'd have had to start at 5:50 to get them all in, with 20 minutes per patient.

"All the other patients were running late," the nurse confided when I complained.  I guess it's more important to indulge the inconsiderate by pushing everyone back than it is to reward the punctual by, you know, not making me wait almost an hour and a half to be seen.

Two mommies.  And another two mommies.  And another two mommies.  And...

If you're doing IVF at my clinic, it's easy to forget that there are same-sex couples also pursuing ART.  On weekdays the monitoring is done early in the morning, and I usually see women by themselves (though there is occasionally a stoic-looking man or two on hand, tight-lipped and white-knuckled).  The women are uniformly tired and strained-looking — a lot like me, only better dressed, fully made up, and perhaps a teensy bit more desperate, if you can imagine such a thing.  But on the weekends, anything goes.  Almost everyone is coupled off; many people bring children.  All of a sudden I realize that several of my co-patients are lesbians.

The interesting thing about seeing lesbian couples at an infertility clinic is that most of them aren't actually infertile, in need of big bad science to conceive.  Most of them just need a kindly, impersonal squirt — and most of them have a reasonable expectation that they'll succeed.

This is the difference, easily noticeable in the waiting room on weekends.  There's still a pall of despair hanging over the place thanks to freaks like me, but the several chatty lesbian couples I saw this morning were doing their best to lift it — talking, smiling, acting perfectly normal.  They made me enormously happy and reminded me that despite everything that's happened, I am still hopeful.  It was so refreshing, so unusual to see ordinary cheerfulness in this place, that I considered going over to thank them.

But not even I am that much of a dork.

Actual dialogue

Doctor, inserting ultrasound probe: Am I hurting you?
Julie: Oof.  Yes.
Doctor: Sorry about that.
Julie, trying to be game: Can't be helped.
Doctor: Sure it can.
Julie: Then knock it off.

The outlook

Ovaries quiet.  So far, so good.

Um, which one are you again?

It shouldn't surprise me, but my doctor has no idea what protocol I've been on in the past.  "We did six amps a day with you on that IUI when you got pregnant, right?"  No, four.  "Oh.  Four and full-dose Lupron."  No, four and half-dose Lupron.  "Oh.  When did we do six?"  Never.  "Oh."

An exhaustive list of the questions my doctor asked about my consultation at Cornell

Maybe I'm too stupid to be allowed to reproduce

Because this is cycle day 2, I am bleeding.  A lot.  Painfully.  Before mounting to perform my dazzling routine on the stirrups (which should, I believe, be an event in Olympic gymnastics) I dutifully extracted my super-sized roll of Bounty tampon...and forgot to insert a new one when I got dressed afterward.

This is precisely why my preference for black underpants is wise as well as stylish.

Can't work. Too easy.

As I lie fretting in bed at night, every bit as insomniac as I am during an IVF cycle, I think of every one of the very good reasons this IUI can't work.

Low motililty.  Abysmal fertilization in the lab.  Iffy Fallopian tubes.  Theoretically bad eggs.  No suppression, so possible early ovulation.  And the crappiest attitude north, south, east, and west of the Pecos.

But those, I tell myself, can be overcome.  They have been overcome, at least for a very short time, once.  Those reasons are mere technicalities, easily dispensed with by telling myself firmly, "It happened before.  It can happen again."

However, there's one reason I can't wave away: This can't work because it's too easy.

A quick comparison reveals all.

IVF: At least 31 days of preparation before starting stims.
IUI: "Oh, hey, my period's here.  Now where'd I put that syringe?"

IVF: $10K and up, without meds.
IUI: $210.  Sometimes I spend more than that on my hair.

IVF: Three injections a day.
IUI: Just one little prick.  Uh.

IVF: Progesterone suppositories, laying waste to any unfortunate defenseless underpants in their path.
IUI: A well-regulated vagina, prim and oozeless.

It must feel different when you're going from Clomid to injectables, going one more step up the ladder toward expense and invasiveness, but when you're moving backward from IVF to IUI, an IUI seems like a goddamn cakewalk. 

How could something so easy possibly work?  How could I get pregnant without the most extreme intervention, the most esoteric manipulation, the most ruinous expense?  Although it worked last summer, it worked only after the suppression and the daily barrage of injections of a planned IVF — to say nothing of the grinding anxiety and panic as cancellation loomed large.

This can't work.  It's too easy.  No pain, no gain...right?

This kept me awake last night for at least an hour after I went to bed.  And then it occurred to me: Why worry that I'm not putting myself through enough when the hard stuff hasn't worked, either?

And then I slept like a Benadrylled baby.

Googlewanking

For your mystified amusement, some of the winning search terms from overnight:

pregnant bikini I assure you that if I am ever lucky enough to get pregnant and stay that way long enough for it to show, the last thing you'll find on this site is pictures of me in a bikini. I didn't wear one when I was twenty, for God's sake, when I had the body of, well, a twenty-year-old. I wouldn't do it now, with my current body by Follistim. I admit that the idea of baring my needle-bruised thighs, my lap-scarred belly, and my hormone-bloated ass in public has a certain theoretical freak-the-mundanes charm, but even I'm not that much of a sadist. Look, the pregnant body can be lovely, but mine's a horrorshow before the terrifying things that happen to the near-term navel, so take your desperate quest elsewhere.

julie wants I guess someone is planning to buy me a present! Special hint: vodka is always the right size.

how things were in the olden days Well, sonny, back in my day you didn't need a doctor to get pregnant. You just did it and shut up about it. I swanny, the kids today with their Internets and their baggy dungarees and their test-tube babies...tarrrrrrnation, wasn't like that when I was a sprig.

doctor pregnant fuck In case anyone searches for this term in the future, I'll make it easy and collect all these words in a few short sentences:

• Fuck! Not pregnant. I blame my doctor.
  
• The only way a doctor could get me pregnant is if he fucked me himself.
  
• "Doctor! This creepy weasel searching for mama-porn got his ass kicked by an angry pregnant lady." "Fucker's flatlining. Don't bother with the CPR."

Update: I have a late-breaking addition from this morning's logs:

how do you get pregnant Lady, you must want the next blog over or something, because fuck if I know.

Day 5: Follipalooza

Didn't write yesterday about my ultrasound and bloodwork. Normally I'd go in on day 6 of stims to be checked. This time it was day 5, probably a mistake, but since I was eager to get a look I wasn't going to argue.

I'm doing well, with five respectable follicles and eight too small to count. On the one hand, I'm excited that my response is so good; it's very much in line with how I respond during an IVF with suppression, perhaps even a little better. On the other hand, I'm worried about that — for an IUI with gonadtropins you don't really like to see more than three or four mature follicles, and it looks like I could have more than that by trigger time. It would be a new experience for me to have a cycle cancelled by too exuberant a response, and a very great disappointment.

The danger of doing an IUI with numerous mature follicles has to do, of course, with the increased likelihood of multiples. But given our crappy fertilization record in the past, I don't feel especially concerned, and I hope I can speak persuasively about that if it becomes necessary.

Time for a jolt of reality, though. I look at the numbers and start to feel excited, but that excitement is almost certainly unwarranted. The success rates for IUI with injectables are low even under the best of circumstances, about 20% per cycle. And when you add Paul's low motility to the mix, and whatever is actually wrong with me, it seems obvious that our chances are greatly reduced.

I'm feeling hopeful even as I know how foolish that is.

Yes! Please send me 12 jam-packed issues!

There are many reasons that sitting in the waiting room at an infertility clinic might be a bit depressing. My clinic shares a waiting room with an OB/GYN practice, so there is a constant parade of pregnant women, each more blooming and happy-looking than the last. There is also consequently a related parade of tiny, tiny babies swaddled in Polarfleece, in the arms of proud-looking new mothers appearing for their six week postpartum checkup.

But that's not all. There's bad art on the walls. Now, I know you think you know what I mean when I say bad art. But you don't. You can't. Imagine, if you will, a palsied, slavering, lobotomized Doberman with a paintbrush stuck up his ass. Got it? Okay. That dog looks like Caravaggio compared to the reprobate responsible for these crimes against art. The subjects run heavily to animals among vegetation. One is some sort of great spotted cat, or maybe a hyena, amid a thicket of what looks like nothing so much as dark green pubic hair. Another captures a deer, or perhaps a flounder, peering over its shoulder apprehensively — almost a reproachful look back at its creator. "Why have you made me? I didn't ask to be born."

And of course there's the miasma of desperation that collects in the corners where the infertile patients huddle (well out of the pathway of the triumphant new mothers). If you were to draw a cartoon, you'd put in some thick, wavy hashmarks — stink lines — to depict the palpable sadness.

Those things are depressing enough, God knows, but today I discovered yet another reason to hate and fear this waiting room: the magazines.

Here is a list of the periodicals that were available for my perusal this morning as I waited:

• Parents
• Pregnancy Today
• ePregnancy
• Parenting
• American Baby
• Child
• Car & Driver
• Business Week

Number of times I have ever seen a woman paging through those last two: 0
Number of times I have ever seen a man paging through any of the first six: 0

Now sometimes I take in issues of The Economist or New Scientist and leave them prominently on the table as a low-key form of protest (having first carefully excised the address label). Today I didn't, and found myself without anything to read.

So instead I sat and wondered if there are any magazines out there for the infertile crowd.

You know. "Quick makeup tips to hide those nasty belly bruises." "Creepy global fertility rituals: What the Hell, give 'em a whirl." "10 good reasons to try very hard not to punch your sister-in-law's lights out."

I kind of doubt it.

But there should be. In fact, I'm considering launching one myself. Look for the inaugural issue in your mailbox in a couple of months.