We used to go to an OBGYN at the hospital near our house, but now we see this rock star doctor forty-five minutes away because he specializes in endometriosis and awesomeness. His practice is a reproductive specialist’s clinic, even though we initially went to him solely for surgery. You can tell it’s a top notch establishment because there is not a single magazine in the whole office that has anything to do with pregnancy or kids. You will not find Fit Pregnancy, or Parents, or even Family Circle. You will find Time, and USNWR, and Sports Illustrated – but not the Swimsuit Issue, because this is a classy place. Even trying to live in a gender-neutral world, it’s hard to deny that most of the magazines lean towards more masculine eyes. On more than one occasion there have been some car magazines and a few Men’s Health’s. It is obvious who is sitting in the waiting room most often here. And that doesn’t even include the stash of motivational porn magazines in the bathroom.
I love this about the office. Even in my younger years the plethora of baby-center magazines at the OBGYN irritated me. It didn’t seem all that hard to get a subscription to Ms. for the other half of the clientele. A large chunk of us were there exercising our right to birth control, so might as well respect our decision instead of forcing us to read about diaper brands and the newest studies against plastic toys. Most often I ended up reading Highlights, which seemed like the only magazine that didn’t have an agenda.
When I go to see my doctor now there are never babies in the waiting room. There are never pregnant women. And there are definitely not pregnant women there with the kids they already had, which always sent me into silent crying jags at the other offices. The people in this waiting room tend to look like me. They have tired faces that stare blankly into space. They wait quietly and hardly ever read anything, but look deeply lost in thought. The couples don’t really talk to each other. And no one has ever tried to talk to me, or anyone else. It is a quiet, solemn waiting room, and yet it feels like an oddly peaceful place where no one is judging me and no one is flaunting any kind of reproductive success. It’s also painted a very calming blue color, which helps.
My last visit was in November. I had secured a few hours of early morning time off work for a consult after spending another night at the ER with severe pain and lots of black, tar-like spotting. MJ was not with me, so to make the visit cheery I wore a black dress with large swans all over it and listened to Belle and Sebastian on the way there (my definition of “cheery” is kind of low key). I checked in and sat in one of the soft tan chairs next to the side table with the magazines, even though I was too nervous to even look at them, much less read them. I always get nervous at doctor visits. Even routine ones. I always expect it to end with some grand declaration that I am beyond infertile; that I am one-hundred percent dried up and there is no point continuing on. A part of me used to, and maybe still does; long to hear something definitive like that. Something that would tell us, look, no matter how much more money you spend, or time you gives it, or effort you put into it, it is not going to happen. Sometimes I think at least then I could learn to move on. But I am kidding myself. I will not learn to move on, and I do not want to.
Martha is the poor nurse who has put up with my frantic calls, my crying over the phone, my constant questions, even my emailing of my chart for her review. She is a thin, attractive woman who looks to be in her twenties. I try not to hold that last part against her. She came to the door that morning and opened it with a smile and a wave. I walked back with her.
The doctor’s entire office setup is not very large and by now I have been in most of the rooms. They are all painted these calming water-like colors: light green, deep blue, a gray-blue combination, and lavender. I wonder if there is some palate out there marked “when your clients are emotional” or “how to calm the infertile woman.” They have nailed it.
My doctor’s own office has an exceptionally large chestnut desk that takes up most of the room, with two plush leather chairs sitting opposite. The back wall is painted a deep wine color that feels like royalty. His framed patents sit casually on a side wall as if he just thought to hang them to get them off his desk. There are no large photos of the reproductive system or dissections of cysts, or anything poster-like on any of the walls. Those are kept discreetly on small, laminated pages on the desk. I find this comforting too, though I am not sure why. When you sit in the chair opposite his desk you sink slightly into the soft leather. Since I am short, I end up nearly eye-level with the desk itself, and when the doctor comes in and talks to me from the other side it is like seeing The Great Oz learn down over you and dispense information.
Martha walked me in and let me sit. I had been there a few weeks earlier for an ultrasound and a blood test. The ultrasound showed no additional endometriosis, no added growths or new cysts. This was a great relief to me, though it offered no explanations as the pain or odd spotting – a reality that was becoming more and more frequent. It’s frustration to feel wrong, to know something is wrong and to not be able to know or figure out what. I was hoping he had ideas, but mostly I was nervous about the blood results.
Your AMH level is meant to show the number of follicles developing in your ovary. The test of AMH levels is meant to estimate the ovarian reserve. Six months earlier my previous OBGYN had his nurse inform me over the phone in the middle of the workday that my AMH was 0.3. “There is basically nothing we can do for you,” she told me after two years of visits, drugs, fertility work ups and plans. The silence was deafening. Eventually she asked if there was a fertility clinic she could recommend. I said “no,” and never went back.
My new doctor is from Taiwan, and has more credentials then I thought were possible. He has dark full hair and a small smile that comes out only when he first says hello. The rest of the time his face looks serious, not angry, just as if he was always deep in thoughts I could never understand. While I waited for him that morning, I tried to breathe calmly and not think about anything. I have tried this often to reduce stress. It has never worked.
He walked in, flashed his smile and shook my hand before settling in behind the great desk. Martha came with him, and pointed out things in my chart while he reviewed it. Charts make me nervous too. They contain all this information about me that I can’t see. Is “hopeless case” written in there somewhere? Do they think I overact to the pain? Have they figured out yet that MJ is not my husband (no, they have not).
“You’re AMH level came back,” he eventually got around to saying. “It’s a 2.1.”
I perked up.
“That’s still low,” he stated, no emotion one way or the other. “It’s not a huge difference from the last result, but it’s higher.” He went on then, “it doesn’t surprise me, you have one ovary and the endometriosis will affect your hormone levels.” He talked some more, said some other technical things that all flew over my head, mostly because I wasn’t really listening.
“Does this mean I can’t conceive naturally?” I asked timidly. I am always oddly timid around doctors.
He waited a second, his face lost in that heavy thinking again which was obviously not heavy to him. “No, but,” you could hear the hesitation in his voice, “it will be difficult.”
The rest of the meeting we discussed options, and I am sure there was a lot of useful information in it, but it comes back to me now only as a blur of emotion, a tight mess of guttural images without the specifics or details to flush them out. I know I was there awhile. I know I asked questions, got shown how to do self-injections, discussed changes in insurance, and listened to suggestions. I know these things happened, but in the end all I remember is that feeling in my stomach and the way his face looked when he said “it will be difficult.” It was the same face I have when a client insists on a trial I know they are going to lose. “You never know what a jury will do,” I will tell them as we plan for trial. “It will be difficult.”
In the end, I walked away with this plan: a one time monitored IUI cycle with injected fertility hormones. Clomid had not worked. Letrozole had not helped. I was to jump to the same stimulating fertility meds as if we were doing an IVF cycle. But of course we weren’t, because we could never afford it. We can barely afford this. One cycle, one chance to see. “The real help,” my doctor said pragmatically, “is seeing how your body responds to the medicine. This is the highest we can go. If we find you are responding to it and we’re getting eggs that means it’s worth trying again. But if you don’t respond,” he paused. I didn’t really need him to finish. He did anyway. He’s a very thorough doctor. “If your body does not respond to these medications, it never will, and there is not much chance with IVF.”
It’s been two months since I saw my doctor. We try each month to save up the money. I try to work on losing weight and taking my vitamins. I secretly hope each month even more than I used to, that we will get pregnant on our own, that we won’t need to pay so much for the procedure, that I won’t have to be told officially it isn’t going to happen. In two months I have not managed to save much. It is hard and frustrating and I resent the role money plays in my infertility story. But I have yet to actually get antsy. I have yet to pick a month as the goal month – the month money has to be saved by, weight lost done by, body ready for. Picking a month feels like picking the end.
Putting it off feels like a secret vacation, a lengthy snow day, a reprieve from reality and the inevitable facing of circumstances. Putting it off feels safe. Cowardly, immature and ultimately pointless, yes, but still safe. Safe like the relaxing watery colors of the doctor’s office walls. Safe like the quiet baby-free waiting room. Safe like all the child-free magazines to chose from. Safe like I long to feel instead of what I really am: vulnerable, terrified and sad beyond reason.