Although ovaries are not my specialty, I know them more intimately than most women going through infertility treatment. In my medical training, I held the shrunken ovaries of post-menopausal women during dissection. During my internal medicine training, I felt them in young healthy women as they flitted by on their yearly pelvic exams. I would not say I was an expert. I found ovaries to be ephemeral and shy, and very unlike their male counterparts, the testicles, which hang gregariously out in the open. Testicles boast about their ongoing sperm production. Men can produce sperm for their entire lives. Although recent research suggests that there may be egg stem cells in mice, we human women have finite number of follicles, our ovarian reserve. We start out with 100% of our reserve. Mine’s down to 5% now; in 6 months, it will be 3%. I lost 50% of my reserve like most women before I even thought about boys beyond their inherent risk for Kooties. The rest were wasted while I was in school and training and looking for Mr. Right. Bummer.
Initially, my husband and I thought our infertility was only “male factor.” Causes of infertility are divided by gender. Female factor infertility can be due to structural disruptions that limit passage or implantation of the egg and embryo, hormonal disruptions that affect the menstrual cycle, genetics, and a myriad of other causes. In men, once structural and genetic concerns are ruled out, male factor infertility boils down to sperm. They are measured for quantity, quality, and motility. Those guys have to swim!
My husband had a vasectomy during the course of his first, unhappy marriage. Therefore, we had male factor infertility with an easy solution—vasectomy reversal. Dan said, “A scalpel, near my junk, again?” I thought that we’d do the reversal and, within 6 magic months, I’d be pregnant. Before they would schedule the Dan’s surgery, I had to see a reproductive specialist to “clear me.” I was a bit offended. My ovaries were faultless, chock full of follicles just waiting to burst forth with the perfect ovum, like Eve offering Adam the apple.
Several people recommended my first doctor to me. She had been president of the American College of Reproductive Medicine. She was pale, almost bloodless as she looked down her pinched nose at me. When I challenged her recommendation that I undergo a series of laboratory and invasive testing costing over $2500, not covered by insurance, her eyebrows shot up and she peered at me imperiously over her glasses, as if to say, how dare you? I had done my homework and understood that none of the tests she offered had the positive or negative predictive value to assure or deny my fecundity.
“I have normal periods and consistent premenstrual symptoms. Isn’t that the best predictor?” I begged.
“You are thirty six years old and have never been pregnant despite twenty years of sexual activity,” she countered.
I recoiled. Did she just call me a slut? I fought the urge to yell back, “Of course I’ve haven’t been pregnant, you old cow, I’ve been on the pill for the last 18 years.” But, her comment cracked my stony belief in the infallibility of my ovaries. She was right. My teenage years had been rife with hormonally-fueled bad decisions, and I had only had missed period scare, that turned out to be due to illness. But, after that, I became a committed birth control pill user. Right? Except for those couple times…
I relented to undergo the ultrasound, and promised to return on the second day of my next cycle for the laboratories. The ultrasound was affordable, $250, available, and praised my “junk” enough to get me cleared for Dan’s surgery. My uterus was “gorgeous,” and my ovaries were “present with a follicle count of a woman five years younger.” I came home gleeful with this information. I was going to be like my grandmother who had my dad at age 42 in 1944, and not like my mother with her mid-thirties’ migraines heralding early menopause. No female factor infertility here. I was a stud-ette. I couldn’t wait to tell Dan that I was perfect and all we needed was to re-arrange his “junk” and we’d be set.
I’ve heard this “dividing the blame” from other couples that we’ve met going through this process. “It was all her,” one of Dan’s friends explained about his ex-wife. “I was good to go.”
“It’s really all him,” a friend whispered over a glass of wine in my kitchen with her husband steps away. “Male factor, you know,” she nodded.
A year later, despite new plumbing and sufficient sperm, we were still not pregnant and I was mortified that I ever hung all the responsibility on Dan’s neck. Dan and I scheduled an appointment with the new partner of my previous doctor.
The new partner was young, so fresh to the practice that the bookshelves behind her were empty, spare a few books. I loved her instantly, not for how she made me feel, but for the way she handled Dan. Dan has the most lovable and maddening qualities of an introvert. He’s attentive and open with me, but with strangers, he erects his Teflon façade. With a single comment from her, his usual façade evaporated. She was the husband whisperer.
We mapped out a plan for investigating what female factor infertility might be lurking in my pelvis as well as a repeat sperm analysis. She was upbeat and positive and I truly believed that we would get pregnant. Dan and I walked out hand in hand, the office staff smiling at us.
In contrast, the waiting room of Danuelle’s county clinic was an entirely different. Danuelle was my high school mentee. She became pregnant at the end of senior year of high school. We were at the county clinic for her first prenatal appointment. Nobody smiled. Nobody even looked up when I arrived with Danuelle and her twin in tow. I gave Danuelle a gentle shove to the reception desk, and mimed for her to get off her phone. My patience was razor thin. “Hon,” I thought to myself, “If you are old enough to get pregnant, you are old enough to check in for your own appointment. The appointment that it took you four weeks to make.”
The waiting room was vacuous with dusty mini-blinds at random heights creating an abstract light show across the scarred linoleum and modular furniture. It was the kind of modular furniture found only in county clinics and airports, where it was assumed that unless bolted to two other similarly uncomfortable chairs, people would wander off with them. There was nothing to read, unless you count breastfeeding pamphlets in eight languages scintillating. I staked out a chair across the room. Danuelle’s twin slumped in the modular loveseat ten feet from me, and, across the room, Danuelle sprawled on the only piece of furniture that resembled a couch. She had resumed her phone call with Clarence, aka Baby Daddy, after checking in at the desk.
It appeared that Clarence had the bad manners to go to football practice to avoid getting cut from the team instead of meeting us at the pick up point. And, now, he was hearing it from Danuelle. I felt sorry for the guy, despite my reservations about his role as Baby Daddy. He was now desperately trying to cover the 3 miles between their high school and clinic on foot and bus. Usually, shy and soft-spoken, Danuelle filled the empty waiting room with echoes her alternating wheedling and dramatic threats. We appeared to be the only ones waiting for an appointment, but her appointment time came and went, and we were still waiting.
Decades of western sun had faded the color photos to anemic pastels and cooled the hot pink Naugehyde upholstery to a sick mauve. The Naugehyde of the chair next to me had ulcerated long ago; the faux leather edges were smoothed like worry beads. Underneath the ulcer, grimy, anxious fingers had picked at the exposed foam. I gulped down my guilt, secretly adding up the money we had spent at our fertility clinic. It could have paid for a new suite of unassaulted chairs for this tired waiting room.
Danuelle was 14 weeks pregnant, or so. She wasn’t certain. The ignorant bliss of the unintentionally pregnant—I was counting days until I could pee on a stick, she wasn’t sure when she last borrowed money from her mom to buy tampons. Biologically, it made sense that she was pregnant. Strike while the iron is hot. Her ovaries were at their zenith, while my ovaries were as faded as the photos that I was staring at.
Clarence arrived moments before they called Danuelle back to her exam room. I secretly cheered for the kid. I was tired of hearing Danuelle tell me, “Everyone’s upset that Clarence got me pregnant.”
Her blaming Clarence for her pregnancy upset me more than the male vs. female infertility factor blame game. “Tsk, tsk,” I wanted to say, “You both should have paid more attention in sophomore year health class. I do believe that both of you had to be present to win so to speak.” I said nothing.
I stayed behind steaming off my thoughts as Danuelle, her twin, and Clarence disappeared into the belly of the clinic. I didn’t join them for many reasons. First, I wasn’t invited. Second, I was a bit peeved by the cast of characters and drama required for her first prenatal appointment already in her second trimester. And, third, most important, who was I in this theater? I was the driver, not her mother. I had been her mentor for almost 4 years. And, how did that go? Pregnant, but with a high school diploma. Success tarnished by an embryo the size of a peanut.
Initially, Danuelle said that she was going to have an abortion, because she and Clarence knew their limitations. I didn’t really believe this plan as I knew that she was taking prenatal vitamins, “the good kind with omega-3’s for the baby’s brain.” Clarence and Danuelle would walk to Target every weekend to look at baby clothes. I offered her feta the week before and she looked at me as if I stabbed her belly, “No fresh cheeses, they say.”
I knew she was keeping the baby when she put off scheduling the appointment. She wanted someone to tell her it was too late to have her abortion. She loved babies and hated school. She had raised her nephew through most of high school and she was more proud of him than pulling up her grades or her diploma. I had asked her if she got pregnant because she was scared of starting college. She looked at me with her timid, almond eyes and said, “Maybe.”
In stark contrast, I loved school and lingered in its safe and hallowed hallways. I was practical and postponed babies until my ovarian reserve was lower than interest on a savings account. I had already told her that I would not tell her what to do. It wasn’t my job as her mentor. My job as a mentor was to help her “navigate her decision process,” or some bullshit like that. Even if it was up to me, her decision to keep or abort the baby when seen through my dystopic lens was like the optician’s query “better one, than two?” in which both of the lens distort the letter miserably. I was paralyzed by my own struggle with infertility. I could not mentor on the subject of fertility. I had conflicts of interest with my conflicts of interest.
Clarence stalked out of the clinic suddenly, interrupting me of my downward spiral of thoughts. Danuelle’s head appeared from the door. “Can you come back with me?” It was the first thing she had said to me since I picked her up two hours prior, and somehow being needed made everything clearer in my head.
“Sure,” I said smoothly, as I rose from the tattered, modular loveseat. It was my first prenatal visit, and although it wasn’t for me, I was ready. I was the driver, not her mother. I was her mentor. Ovaries not required. And, along the way, she might mentor me. I could support her and would support her, come what may.