Flotsam

Writing about relationship problems in the midst of infertility is hard–though some are brave enough to do it. But it feels taboo, somehow, and as if judgement is sure to follow. Which is odd: couples therapists are fond of naming money and sex as the two primary causes of marriage problems, and infertility hits both head on. So why should it come as a surprise that not all infertiles spend evenings with their “DH” lovingly fondling one another in the doorway of an empty—but tastefully appointed—nursery?
I have thought a lot about that in the past week, and the answer I have come up with is that there exists an archetypical, acceptable “Infertility Patient” whose stats are as follows:
Age: 35-39. If you are older you are “unnatural.” If you are younger, why are you in such a hurry? You have plenty of time! You should enjoy these years with your husband! You should probably also get plenty of sleep, because once you have children you will NEVER SLEEP AGAIN! Ha Ha, Ha Ha Ha!
Home: Spacious house in safe neighborhood. Furnished nursery. Fenced yard. 3BR, 2BA, Frplc, Must See!
Attitude towards other people’s children: Adoration and tolerance. Never annoyed by child (precociously) kicking back of seat on airplane. Never ambivalent or unsure about own desire/ability to parent.
Financial situation: More than comfortable after 4.8 million dollar inheritance received last fall from hitherto unknown distant relation. Student loans paid off years ago.
Relationship with spouse: “Brock is not only my husband, he is my BFF!” Married for at least three years. Never fight because agree on everything.

As I said recently in the comments over at Akeeyu’s, it seems that because parenthood is harder for us to achieve, we are also required to want it more. And to be worthy of that desire as well. We must justify the lengths to which we go to become parents by being especially suited for parenthood.
Am I making this up? Am I merely oversensitive because the Nearly and I are having difficulties?

Yesterday I filled an old prescription for birth control pills. I will be starting them this weekend, when my cycle ends.
I need a way to normalize my hormonal profile and reduce the intermittent cramping that started the first week of this cycle and has continued since. So migraine-inducing hormonal contraception it is. It feels like a step backwards, but that is the direction I need to go, for the moment.

I have been ready for children for longer than the Nearly. Then, after we got pregnant, we miscarried. Our plan was to try again as soon as medically safe, but after six weeks, suddenly he was back to Not Ready, afraid to go through another loss. I decided to use that time to have some testing done—little knowing it would be six months between my initial RE appointment and a diagnosis. During the diagnostic process, the Nearly’s enthusiasm–and our timeline–varied week to week.
By the time the diagnostics starting winding down months later, we seemed to have reached a consensus—not the one I had initially hoped for, but one I could embrace. I knew* that we would not be pursuing IVF for at least a few years because of the prohibitive cost and the Nearly’s feelings about debt. I knew that if lesser treatments failed, I was looking at a long wait before we could try again.

After seeing me sick from the Metformin on that ruined Saturday two weeks ago, the Nearly told me he wasn’t sure he wanted this life—me sick from medications, using my vacations for doctor’s appointments, the possible horror of another miscarriage, more semen samples from him, insurance forms and medical bills, the unremitting preoccupation with having a child. He feels he is young—and he is, only 28—and he does not want to spend these young years embroiled in an infertility battle, watching me cry, listening to me talk about clinical studies, and worrying about his sperm count. He is certain that he wants children–luckily that has never been in question, for us (and, unlike myself, he actually does find strangers’ children beguiling). But if we are going to need help conceiving anyway, he reasons, why not enjoy ourselves for four or five years until we have the money for IVF? IVF is the most effective treatment available, after all. If the IVF fails, we will save again for a few years and move straight to adoption.
And why not? I wish I could say yes! Let’s do that! But I can’t yet. And he doesn’t really want me to—he is afraid that if I did and was then not able to have biological children, I would resent him, always wondering if those five years would have made a difference.

I have avoided talking about this with anyone, as the one friend I confided in looked at me as if I were crazy–So just wait, she said, What is the big deal?
I know that relationships involve compromise–I am the one who took a corporate position and worked overtime so the Nearly could quit his job and work on his thesis. The Nearly and I have talked endlessly about possible solutions to the gap between the life we have and the life we want: who would work what job, who would go to school, who would take time off to write, where we might live, and where children fit into it all. And our issues go deeper than infertility, as deep as what kind of lives we want to live, in many ways. This past year has dripped by in tiny increments while I was both a steward of his career and a patient patient–waiting to be diagnosed, waiting to start treatment, waiting for him to be ready with me–even though every part of me wanted to rush forward.
I cannot imagine a life without the Nearly’s kindness and humor and his calming presence at the end of the day. Unfortunately, what it boils down to is this: he has a very clear picture in his head of how he would ideally spend the next five years.
So do I.
Our pictures are not the same.

So where does this leave us (hopefully, close to the end of this post, you grumble)? Right now things are weirdly peaceful between the Nearly and me. Better than usual, even. Possibly because this is the first time we have seriously considered parting, we are uniquely aware of what we stand to lose in each other, and how dearly we hold those things. We are enjoying the present. And we are trying to draw up a picture of the future that is appealing to us both.

*After The Presentation

Receiving a letter in this age of email, instant messaging, and captioned photographs shot deliriously from cell phone to cell phone—Look! A fat man! A funny hat! A chicken!—is a joy. Words, whole words, not abbreviated, linked together to form sentences, printed on paper by someone who cares enough to spell out the words “for” and “you”–yes, receiving a letter in this age of electronic communication is a joy.
Waiting for a letter in this age of email, instant messaging, and the aforementioned captioned cellular photographs, is hell. I should know. I recently waited four fortnights for a letter.
Even using words like “fortnights” though, doesn’t trick me into thinking that there is anything quaint or novel about waiting, in this craven, desperate way, for written communication. I merely felt Amish–stranded by the side of the Autobahn with a broken wagon axle as fuel-efficient Audis raced by, whisking the sensible black brimmed hat from my head.
I live on an upper floor of my apartment building, and the mailboxes are located downstairs, in a well-lit vestibule. In order to ascertain whether the mail has arrived, I must walk down three creaky flights of stairs carrying my keys, jangling as I go to announce to my neighbors the depths of my backwardness. Most people do not receive letters. Most people receive missing children notices, coupons for substandard supermarket products, and bills. Thus my neighbors had no reason to believe that I was waiting for a document of great emotional import–for all they knew, my days are so empty, so utterly bereft of the things that make life worth living, that the arrival of coupons for substandard supermarket products is, for me, a cause celebre.
I prefer to think they imagine me a detective, selflessly concerned with the welfare and whereabouts of Raoul Diaz, last seen 11/2/87, and Lauren Baxter, her age progressed photograph showing just the tired, drawn look I would expect in a woman who has been kidnapped for nearly 20 years.

Anyway, it finally arrived, this letter, from the editor of a small but respectable publication, and it was not pleasant reading. Rejection letters seldom are–my favorite being one I received last year that said: “This is not a reflection on your writing.”
How foolish of me to think so!
I suppose they just lined up all the submissions and threw hatpins at them.
The piece that was recently rejected was over a year old, as are most of the pieces I send out, and this recent rejection has made clear something I have feared for some time—I may actually have to do some new writing, one of these days. Much as I would like to believe in the possibility that diligent elves will one night transform the notes scribbled on sundry receipts, deposit slips and cocktail napkins into a book of well-crafted and—dare I say it?—brilliant essays, I am forced to admit that this is unlikely.
So I am thinking of starting an informal writing group to keep me on task.

Interest in the life and process of The Writer (especially among other writers, who simply cannot get enough of themselves) seems to be at an all time high. From Teething Biscuit to Bread Loaf: A Writer’s Story might be this year’s bestseller. Policemen, Botanists, Anesthesiologists—thousands have signed up for workshops and “Writing: It’s Not Just For Writers Anymore!” retreats.
As I cannot help but be aware that not everyone has the money, or indeed the inclination, to enter into an established community of artists all eager to hear what you think of their lesbian retelling of Hills like White Elephants, I thought it would be germane to outline the basic workshop format I have followed in the past, for persons yearning to start a writing group of their own.

You will need:
A colleague
1 bottle bourbon
Ice
Shaker
Red pens (2)
Maraschino Cherries
Sweet vermouth
Orange bitters
Chilled cocktail glasses (2)
Printed copies of your recent work

The Process:
1. Fill shaker with ice. Add a quantity of bourbon, half as much sweet vermouth, and 5 dashes orange bitters. Place lid on shaker, as well as cap (do not omit this step!). Shake. Pour mixture into chilled cocktail glasses and garnish with cherries.
2. Exchange printed copies of recent work
3. Exchange caveats re: recent work. This should take at least 15 minutes.
4. Uncap pens and settle in to read.
5. Startle like trauma survivor each time you hear the whisking of your colleague’s pen on paper—What is she writing? It’s that second paragraph, isn’t it? You knew the dialect was a mistake.
6. Take a large slurp of your Manhattan.
7. Offer unhelpfully vague opinion that colleague’s piece is well written, especially sentences x and y.
8. Ask colleague to tell you what her piece is really about. For both of you, this has nothing to do with plot, characters, etc.—rather, what theme, what universally felt and nearly universally ineffable truth, are you attempting to shed light upon with your inadequate linguistic skills? The following are examples:
“Well, ostensibly it’s about losing my first tooth, but it’s really about time.”
or:
“It takes place at a T-ball game, but what it’s about, really, is all of the tiny forms loneliness takes.”
This step should take a very, very long while. Longer than you would have thought possible. After this step, it is advisable to repeat Step 1.
9. Explain to your colleague that though you see what she means, though you get the connection between First Tooth & Time, or T-ball & Loneliness, you aren’t certain that the reader will grasp that you are dealing with larger things than teeth and team sports.
10. Colleague becomes depressed.
11. Assure colleague that she is the most talented writer you have ever known…
12. …much more talented that yourself.
13. Begin to cry.
14. Repeat Step 6.
15. Your colleague draws you a complex diagram of the narrative structure she thinks would be most appropriate for your recent work. This diagram is labeled with words and fragments of words which, while meaningful at the time, will seem inexplicable when viewed the next day.
16. Remark, not untruthfully, that the diagram looks very much like a squirrel.
17. Colleague is offended. Colleague says, frostily, that none of this matters anyway, as she is too busy working at meaningless job to write.
18. Brainstorm money-making ideas. These are not employment opportunities, but rather things like the scheme you will eventually settle on, which is selling your underpants on a singles telephone line.
19. Decide your panties will sell better in pairs, and if, in your phone message, you are hot lesbians named Chloe and Niki. Argue over who is Chloe.
20. Devote 15 or 20 minutes to the composure and editing of message.
21. Abandon scheme as too labor-intensive.
22. Repeat Step 1.
23. Colleague asks Why We Write.
24. Give speech about interpreting experience through language, touching on meaning of life and importance of humor in These Troubled Times.
25. Repeat step 6, and begin discussing failed past relationships.
26. Colleague demonstrates interesting hand-job technique on neck of bourbon bottle.
27. Nearly Fiance, shuffling past, is revealed to have seen entire demonstration.
28. Adjourn, agreeing to meet again next week, at the same time, but at your colleague’s apartment.

1. Take first dose of Metformin Friday evening.
2. Wake during night to ominous gurgling from digestive tract.
3. Saturday morning, tempt fate by telling the Nearly, the Internet, and your mother that though you feel poorly, it is Not So Bad, and certainly nothing you can’t handle with pluck, determination, and a dash of Pioneer Spirit.
4. Immediately begin feeling worse.
5. And–improbably–worse.
6. Around noon, become overwhelmingly sleepy, and go to bed—IN THE MIDDLE OF THE DAY. Generally you are hard-pressed to go to bed even at night without pharmaceutical assistance to silence the endless list-making of your mind, and the last time you went to bed IN THE MIDDLE OF THE DAY was after a trip to the emergency room and a dose of Compazine that knocked you unconscious.
7. Wake up at 2:00.
8. Go back to sleep at 2:30.
9. Wake up at 5:30 and lay in bed praying for a speedy and painless death.
10. Remember that excessive fatigue is a symptom of Lactic Acidosis, a rare and dangerous side effect of Metformin–fatal in 50% of cases.
11. Drag self from bed to computer.
12. Google “Metformin Lactic Acidosis So So Tired.”
13. Wonder why you are doing this anyway. You don’t want children. Children will want you to do things for them, like make them food cut into cunning shapes—you are much too tired for that. Besides, their incessant mewling will keep you awake.
14. Nearly, who has been eyeing you nervously all afternoon, decides this is perfect time to reveal things of shocking nature that put entire relationship in jeopardy.
15. Try to concentrate on what he is saying while simultaneously willing self not to vomit. Try to calmly discuss whether to dissolve partnership, but collapse sobbing instead.
16. Realize this is first day wearing newly re-sized Commitment Ring of eleven tiny diamonds purchased for you by Nearly over Christmas. Is this Irony? You think it might be.
17. Remind self to laugh about this, later.
18. Swat impatiently at spots in peripheral vision.
19. Become increasingly distracted by vigorous knife-throwing competition being held behind left temple.
20. Forgo second dose of Metformin in favor of charming bout of aphasia {What is the word for the opposite of yes? you say when asked if you want to Leave Nearly and Have Fresh Start With New Man}.
21. Remember that the word for “Hell” is “Migraine.”

So. Tra-la-la. As of today I am not on Metformin, the Nearly and I are still together, and my head feels just fine, thank you for asking.
Any of these things could change at any time.

For years there has been a squat brown building two blocks from my mother’s house, marked by a swinging sign that reads: “CPA’s”.
This superfluous apostrophe has provided me with hours of geekish pleasure. I always pictured the place as a specialty neighborhood tavern—accountants only—with abacuses (abaci?) hanging from the walls and bartenders wearing green light shades. Brass desk lamps line the bar, and tabs are tallied on an adding machine manned by a spectacled gentleman in shirtsleeves and armband. There are drinks, of course—the Standard Deduction (a martini sans vermouth) and the Tax Haven (w/umbrella). “The Taxman” plays on the jukebox, and a huge, gilt-framed picture of Alan Greenspan hangs upon the wall. Ah, CPA’s. Where everybody knows your Social Security Number.

Well, as of this morning, the sign has been corrected, and I feel oddly bereft. Now “CPAs” is just a small, slightly shabby accountant’s office. It feels like the end of an era, somehow.

In other news, I am not in liver failure! My liver function tests came back normal, which is excellent news, as I just opened a bottle of gin last night. I start Metformin Friday evening. I am having nightmares about the side effects already, and I have yet to swallow my first (huge!) pill. Also, can you really not drink alcohol whilst taking Metformin? Surely this is an urban legend or invention of reactionary pharmacists?
Which reminds me: I am going to set up a page in the sidebar with anecdotal information on Metformin. It seems to be a hot topic on PCOS bulletin boards, and wouldn’t it be nice if people Googling things like “Metformin nausea help someone help” and “Metformin diarrhea suicide” could have a sort of one-stop clearing house for suggestions on how to get though the early weeks, as well as personal experiences regarding effectiveness, how long side effects take to diminish, etc.?
Please, do email or comment with your experiences.

It is, as you are no doubt aware, International De-Lurking Week:

Now, I have not a thing against lurkers, really. But a girl gets curious, repetitively checking glancing casually through her stat report. Who are the average of sixty-seven people per day who peruse my site? They can’t all have arrived here unwittingly after searching for “Biggie Smalls honeys” or “recipe for ultrasound gel” (That was you, TomKat, admit it)—some must be actual, honest-to-goodness readers.
So, leave a comment! Tell me something about yourself!
Or not!
No pressure, I promise. I am delighted you are here, comment or no.

Because it has occurred to me that not all of you share my deep and abiding love for test results, today I offer you two separate posts. We here at Flotsam aim to please, and so allow me to present Door #1—a post about sundry non-reproductive topics, and Door #2—a post devoted entirely to Friday’s rather dramatic visit to Dr. Doctor.

Day 3 results:
FSH: 5.57
LH: 9.81
E2: 46.7
17OHP: 131
Testosterone: A burly 79. A result that should come with a tool belt.

Friday, with diagnostic codes submitted to my insurance company, Dr. Doctor made it official: I am infertile. I will not be able to get pregnant without medical intervention. The final verdict is PCOS with insulin resistance–my ovaries are swimming with so many immature follicles that Dr. Doctor never bothered to count them all. So many, in fact, that she will not let me go straight to injectables, due to the risk of high-order multiples. Her hope is that Metformin and Letrazole IUIs will work, as I have managed to get pregnant before.
The last time I got pregnant was also the last time I ovulated—November of 2004.*

Dr. Doctor and I continue to be besotted with one another–she took the liberty of photocopying all of my lab reports for me because she knows I like to “see the numbers.” There was much “Well what do you think, Doctor?” and “Oh Alexa, you know more about this than I do!”
Things we love:
1. The extended-release version of Metformin
2. IUIs
3. Blood tests
4. Each other
Things we hate:
1. Clomid
2. Sextuplets
3. Ovarian cysts
An attractive and fearsomely youthful medical student was there for the appointment as well, taking furious notes throughout.
The good news was the Nearly’s sperm analysis. Concentration was 117 million per ml., 234 million total.
His total motile: 100.6 million.
The Nearly is quite insufferably pleased with himself.
His viability was only 40%, but with 100 million motile, who cares? Morphology was 11% normal, which confused me, as Dr. Doctor was very impressed with that number and I thought it wasn’t high enough. But again, even a mere 11% of a gazillion is…a lot.

My thrombophilia panel was less cheering. Generally with multiple miscarriages they look for things that give one a greater tendency to form clots. Apparently, on the contrary, my blood takes so long to clot that I would be an unattractive surgical patient—they don’t like you to bleed out on the table:
Prothombin Time—Normal: 8.7-11.5 seconds. My result: 18.3 seconds.
APTT—Normal: 22-36 seconds. My result: 66 seconds.
INR—1.8
It makes this seem eerily prescient, doesn’t it?
I have to admit, I am flummoxed by these results. I assume they could have something to do with my miscarriages, but I cannot for the life of me figure out what. If any of you are hematologists, feel free to enlighten me.
I could either be missing a clotting factor or I could produce some sort of antibody to one of my clotting factors. They took more blood for a fancy mixing test {they mix my blood with different things and see what it does—it sounds like such fun I offered to do it at home, but Dr. Doctor nixed that idea} and I will probably end up seeing a hematologist. One possibility is that something is wrong with my liver, so they are running my liver enzymes. I cannot start my Metformin until those come back next week.

In case my liver was not getting enough exercise, and had become flabby with disuse, I went straight out after my appointment to meet my dear cousin for a drink.

*For those of you just joining us, the last time I got pregnant I was on the minipill, which suppressed my dysfunctional ovaries enough to allow me to ovulate, but not enough to keep the Nearly from knocking me up.
Yes. I got pregnant *because of* birth-control pills.