by Sara Connell
“Sara doesn’t have her left ovary—remember?” Tracey said, smiling and throwing me an apologetic look.
“Of course,” Dr. Colaum said. Winking at me, she said, “I was just checking.”
“Why not?” I said, trying to lighten the mood. “Do they ever grow back?” I laughed.
“You could be the first,” Dr. Colaum said, continuing the joke.
“We’ll do the hysterosalpingogram now,” she said, pulling on a pair of latex gloves. “You’ll feel a cramp as I inflate a balloon into your uterus and inject the dye. We’ll pump the dye a couple of times to determine that your fallopian tubes are open and functioning. I’ll do a closer examination of your uterus afterward. Then we’ll be done. You can watch along with us here,” she said, angling a flat computer screen toward where I lay on the table.
“Ready?” she asked. I guessed I was and nodded.
Dr. Colaum inserted the speculum and fed the tube through.
“I’m going to inflate the balloon now,” she said.
Tracey moved around the table next to me, as if standing guard. Suddenly, I felt a pressure inside my low abdomen, a pause, and then a long, flat pinch. I felt like my low abdomen had folded in on itself and bitten down. Hard.
The clamping feeling continued for a moment, like a musical note being sustained.
“Fuck!”
A yell had come out of my mouth, but I prayed I had used the profanity only in my head. I could not believe I might have just said the f-word in front of Dr. Colaum, seventy-year-old grandmother of fourteen, as if struck by some momentary bout of Tourette’s.
“I know,” Dr. Colaum said, without apparent offense. “It can hurt.”
I gripped the side of the table, bracing myself.
“That should be the worst of it,” she said. “I’m going to do a few more pumps of the dye, and then we’ll be done.”
Tracey offered me her hand, but I declined, preferring to continue holding the table.
“It’s not the first time someone’s yelled in here,” she said, and I gave her a weak smile. I’ll bet, I thought.
“The good news is that your tubes are clear and open,” Dr. Colaum told me, removing the catheter and speculum. “Everything looks good in your ovary. Your follicles look healthy and good, which bodes well for good eggs. You have such a nice uterus, too.” Tracey nodded in agreement. I looked at the fuzzy black-and-white screen, unable to make out the shape of my uterus amid the pixilation.
“Do they vary much from person to person?” I asked.
“There’s a wide variety,” Dr. Colaum said. “Shape, size, position in the pelvis.” Tracey nodded.
“You’re done for today,” Tracey said. “Take your time getting dressed, and take it easy this afternoon.”
I felt relieved. Now that I was no longer in pain, I was grateful for the test, appreciative more than I had anticipated for the confirmation that all my reproductive organs were healthy, functioning, and clear. I felt embarrassed for yelling in front of Dr. Colaum, though, and hoped I would not see her on my way to reception.
If I saw Rachel on my way out, however, I was going to give her a friendly piece of patient feedback. Specifically, about her recommendation to take Tylenol before the hysterosalpingogram.
Two Tylenol, my ass. Tylenol with codeine, maybe, or Demerol.
Chapter 4
I went in for my remaining fertility tests a week later, the same day as Bill’s sperm test. Once Bill provided a sample, a courier would carry it directly to the lab in a cooler, just like an organ for transplant. The lab would run tests the same day and provide a report for volume, motility (how many were swimming), and morphology (how many were a normal shape).
The morning of our joint tests involved a lot of shuttling back and forth between the lab, examination rooms, bathroom, and main waiting room. When we were finally done, we met in the waiting room and walked to the car together.
“It was a bad cliché,” Bill said when we reached the lobby. “I don’t know what the women’s test rooms look like, but mine was a seven-by-nine-foot room with a black La-Z-Boy chair and a table. The nurse hands me a cup and leaves. There’s instructions on the table telling me to collect as much of my ejaculate as possible and then fill out my name and social security number and avoid any spillage on the label. Really arousing. And you should see the material they have in there: two magazines, Playboy and Maxim, as if we’re fifteen. Some more variety and better ambience would have been nice,” Bill finished.
“They’re not running a gentlemen’s club,” I said.
“Well, then, they should let partners come in. I could have been done in three minutes if you were in there with me.”
“That’s sweet,” I said. “Don’t think they’d go for it, though.”
“Yeah, well, I got it done,” he said. “I really don’t like pressured donations, though,” Bill said. “Did you know that’s what they call it?” he said, revving up again. “My donation,” he repeated as he got into the car.
I couldn’t help laughing.
“Yeah, hilarious,” he said. “You didn’t just have to masturbate in a doctor’s office.”
“I’d take masturbation over the uterine crunch,” I said, the memory of the previous week’s test lingering.
“I don’t know,” Bill said. “I feel dirty.” But he was grinning.
Rachel called us to schedule a review appointment with Dr. Colaum once our results came back. Bill and I shuffled meetings and client sessions to make room for the consultation. We’d made the trip enough times to know it would be a minimum of three hours door-to-door.
“The good news is that you have all the necessary parts to have a child,” Dr. Colaum told us as we sat facing her desk once again. “Sara, you have great eggs, follicles, uterus, and open tubes. Bill, your sperm rate is high in both mobility and motility.”
Bill had announced on the drive that his “boys” were going to be pronounced stellar. He flashed a proud smile.
“We have a number of options,” Dr. Colaum continued, “in terms of assisted fertility.” In the past few weeks, Bill and I had talked to a handful of people who had seen fertility specialists. The majority of them had been prescribed Clomid, which we knew wouldn’t work for us because I had empty sella. One couple had done artificial insemination, and they knew a few others who had gone through IVF. All I really knew of IVF was that it was emotionally intense and carried a shocking price tag. I hoped Dr. Colaum would recommend something more moderate.
“What I suggest we try first,” Dr. Colaum said, “is what we call follicle stimulation, or stim.”
No IVF. I leaned back into the chair, shifting my back on the cool leather, and allowed myself to relax a little bit.
“Is there any way we could get pregnant on our own?” Bill interrupted.
“You could—possibly. But you could also try for years before becoming pregnant, or not become pregnant at all.” Dr. Colaum paused. “I don’t recommend it for you.”
A puff of air escaped my lips. I wasn’t surprised, but it was hard to hear officially that we had little chance of natural conception.
The evening of our joint tests, Bill and I had talked about what would happen if we were told we couldn’t conceive on our own. We were clear we wanted to be parents, so if we couldn’t get there without fertility treatments, we were willing to do whatever we needed to do to have a family.
Dr. Colaum explained that stim involved injections of a drug called Follistim, a gonadotropin drug named for its purpose: to stimulate the eggs in the ovaries’ follicles. Dr. Colaum wrote in our file as she talked. “We’ll identify the optimal days for conception and tell you to have intercourse several times during that three-day period. The night before intercourse, you’ll take an intramuscular injection of HCG to release the eggs from the follicle. If all goes ideally, sometime in the next week you’ll be pregnant.”
I had been taking notes while Dr. Colaum was talking, but stopped when she came to “intramu
scular injection.” I was lost. I was sure Tracey or Rachel would be handing us yet another packet that would explain everything, so I set my pen in my lap and listened.
“One additional thing to consider,” Dr. Colaum said, “is that there is a higher likelihood of multiples—twins or triplets—with stim.”
Bill looked at me and shrugged. The idea of triplets sounded completely overwhelming but also fantastical. I’d heard of people having them, especially people who engaged in the kind of fertility treatments we were considering, but perhaps by the same hormone-induced backward logic that made teenagers feel immortal or that made people practice unprotected sex, I could not imagine triplets happening with us. Twins, though, sounded overwhelming but fun. If we were lucky enough to be blessed with two babies in one pregnancy, I’d take it as a gift.
Dr. Colaum made more notes in our file. As I listened to her pen scrape the page, I grieved, for a moment more, the idea of making a baby by making love—no doctors, treatments, or money involved; just Bill and me, natural and organic. But I was also excited. We were crossing a threshold—from we’ll see what happens into actively trying to become pregnant.
Bill cupped my left hand, which I’d been resting on his knee. “We’re in,” he said. I nodded.
Our next step seemed like it would be easy. The stim kit arrived in a small box, sent directly from Braun Pharmacy, a specialist pharmacy in Lincoln Park. Tracey printed out a calendar that established August 6 as the day I’d begin treatment. The night before our start date, Bill read the instructions out loud while I pulled out the components of the kit.
The Follistim pen would become my favorite of the injection devices we’d use over the years. Even on first contact, I appreciated the ergonomic design, the cheerfulness, of the blue-and-yellow plastic pen, more like a Crayola crayon than like a medical device. The medication came in glass vials the size of small perfume bottles. The needles were tiny, too, no more than half an inch long.
“Follistim is given via a subcutaneous injection,” the pamphlet informed us, meaning it needed to penetrate the skin only slightly to administer the medication. The instructions were simple: Insert vial into pen tube, clean and attach needle with alcohol swab, clean skin with alcohol swab, twist pen top to designated medication dose (150 millimeters, in my case). Inject into abdominal region, depress until medication reading is at zero again. Swipe area with alcohol swab. Take Follistim medication at the same time every day.
Bill left me a voicemail midday, while I was in a session with a client: “I’ll be home to inject you tonight at seven!”
Bill offered to administer the shots for me, but the idea became less appealing as the day wore on. I worried that I’d be angry at him if the injection hurt. We’d heard some statistics about how hard fertility treatments could be on a couple, and had made a pact to stay positive and connected to each other throughout the process. When Bill arrived home with flowers and a bag of groceries to make dinner, I told him I’d be giving myself the shot.
He didn’t argue.
Bill cooked dinner and I laid out the supplies. When I had everything assembled, he filled two small flutes with champagne a friend had given him the day he left the ad agency where we’d met to start his own firm, almost exactly one year after we’d moved back from England. Over two nail-biting years, he’d build the business from nothing into a legitimate creative group that now supported the full-time salaries of himself and his best friend and creative partner.
Starting our fertility journey with a gift from another successful venture seemed auspicious, like breaking a champagne bottle over the bow of a boat. “You won’t be able to drink this once we’re pregnant,” Bill said.
“Woohoo,” I replied, taking a glass. We clinked the rims, and I took a small sip before quickly replacing the glass on the countertop. I had a task to attend to, and my hand was already shaking. Summoning courage, I pulled up my shirt and swabbed a patch of skin with alcohol. Bill filled the Follistim pen to the 150-millimeter mark and handed it to me, needle side facing him, the way you would pass scissors. I held the needle, poised an inch from my body, and then stopped. I couldn’t bring myself to inject. It suddenly seemed crazy to stick myself voluntarily, and equally silly to be afraid. I’d been stung by bees, by a wasp, and even once by a jellyfish. I doubted if it would hurt more than stubbing a toe, but I was paralyzed.
I held my hand there for another couple of seconds, looking at Bill, frozen in that preshot position. I wondered if diabetics felt this way before they administered their first insulin injection. It would take some getting used to. Finally, I plunged the needle into my skin and pressed the top of the pen firmly until all the medication had drained from it. Then I counted to three, as the pamphlet suggested, to ensure the medication was absorbed.
“Three!” Bill said, finishing the count with me.
I left the needle in for another few seconds—just to be sure—and then pulled out the pen and rubbed my skin with another alcohol swab. Bill peered at me, waiting. I shrugged and then began laughing. I’d hardly felt the needle, just the tiniest sting, less painful than the scratch of a fingernail. “That was easy,” I said, wiping my eyes on a napkin, feeling relieved and empowered.
“One down, twelve to go,” Bill said.
The nightly injections marked the countdown to our medically scheduled sex. As we approached our three-day window, Bill started dropping things and swearing a lot more in the kitchen. The day of our first scheduled “session,” I was lying on our bed naked, inviting the awe that accompanied the fact that this might be the moment our first child was conceived. Bill, meanwhile, was doing his kind of animal pacing back and forth across the room, still fully clothed. I asked him what was wrong.
“I’m the one who has to perform here,” Bill said.
“At least we get to have sex, right?” I said, trying to break through his anxiety. Normally, Bill would have pounced on the bed. In the entire time I’d known him, I’d never experienced him be anything but wildly enthusiastic about sex. His only complaint had ever been “not enough.”
Also, in the entire time we’d been together he had never had difficulty achieving or maintaining an erection, nor had he failed to climax. He was a virile guy. Despite this, he was disturbed. “It’s fine for you,” he said, pulling off his shirt and boxers and throwing them into a pile on the floor. “You can just lie there and do nothing, and it could still work.”
I decided not to respond to his interpretation of my role in the interaction but instead tried to coax him into the bed. “You’re gonna do great, honey. It’s just us and maybe, if this works out, a baby.” I found out that while envisioning an egg and sperm coming together in a divine moment of creation was a big turn-on for me, the idea was mostly pressuring, and not even a little bit erotic, for Bill.
We resorted to some sex talk and foreplay, and despite his fears, Bill ably completed the mission.
I stuck my legs up in the air afterward, even though none of the medical websites considered the practice one that definitively or even probably aided in conception. Bill collected his clothes from the floor, looking relieved and revived, and asked if I wanted to go out to lunch.
We agreed not to talk about stim or our schedule or if we might be becoming pregnant that very minute. “It’s our very first time,” Bill said. “It would be amazing if we got pregnant right away, but statistically, it’s more likely to take a little while.”
Still, the next day I spritzed our sheets with essential oils that were supposed to increase the chances of conception, and I moved the wooden fertility statue, which one of my colleagues in London had sent me, next to the bed on the floor. It was a two-foot-high aboriginal goddess with a pointed head and a silver- and red-painted face. Bill shook his head when he saw it but didn’t ask me to move it. We’d take whatever help we could get. “Just keep it on your side of the bed,” he said. “I don’t want that thing looking at me while we do it.”
The second day’s stim sex was bett
er. We took our time and laughed a lot. When we finished, Bill went to the store to get groceries for dinner. I walked to the park and lay in the grass. It was a Saturday, and the mid-August sun was just the slightest bit less yolky than it had been at the height of summer, its waning intensity a whisper of the fall that would come. I rotated my body until the sun was shining straight on me and tried to imagine my body as the earth, my womb as the great womb, as lush and fertile as a rain forest, the rivers, the trees.
I tried to sense if we could be pregnant, but I didn’t feel anything telling in my body. It was too early to feel anything anyway, I told myself. I imagined the process: Bill’s sperm propelled by its life force, burrowing like an arrow into the center of my egg, and the new embryo life that was formed floating weightless, as if in space, down the fallopian tube and into the uterine chamber, falling, falling, floating into a soft landing in the plush, cushioned lining of the uterine wall.
I stood up, my back stiff from the hard ground. The sun had moved further toward the west, and the afternoon felt long, timeless. I guessed we were probably not pregnant, but I would have been happy to have been proven wrong. My mind was already trying to guard my heart from disappointment.
Ten days later, I got my period. I took small joy in seeing a period again, even one brought on by fertility hormones. But we were not pregnant.
“You have a great attitude,” Tracey said, when she called to follow up and ask if we’d like to do another round. “I sensed that about you right away. It will make a difference. Keep positive. We’re thinking the best for you guys.”
I didn’t feel too disappointed. It felt good to be in a process, to have an expert team, to have a plan. Bill hadn’t had any illusions about getting pregnant the first time, and we were ready to try again. We’d confirmed that our insurance would cover the Follistim medication and office visits, giving us the means to continue immediately. I gave Tracey the go-ahead to call in our next order and told her I would pick up the Follistim from Braun Pharmacy myself.