Conceivability Houston, we have a problem. Apollo 13 1 From Here to Infertility Frontline Infertility Treatments When Richard and I got married, I was thirty and he was thirty-five. We are both big planners, and along with organizing our wedding and honeymoon, thinking about where we wanted to live now and in the future, and picking out colors for our new house, we had negotiated the kid thing at length well before the wedding. Two kids, not right away, but not too delayed either. I imagined we''d be a foursome by the time I was thirty-five, or shortly thereafter. I was a lawyer, working for the Washington, DC, office of a big Wall Street firm. Richard was a fund manager for an emerging-markets private-equity firm. We both worked a lot, traveled a lot, and had more than our fair share of fun.
It was important to us that we have plenty of adventures together before our two kids arrived. Eighteen months later, weary of the corporate-law grind and encouraged by Richard, I left my law firm for a job at a start-up in Silicon Valley. So what if it required me to commute regularly from DC to California? It was the year 2000, the start-up world was exploding, and I had the energy and drive. I threw myself into preparations for my new life as a West Coast entrepreneur. Before my first trip to Mountain View, California, I was so busy agonizing over what clothes to pack that I forgot to pack my birth control pills. When I discovered them missing, I ran through my options. I wouldn''t have time to get them before going to the new office in the morning. Could Richard overnight them to me? Could my doctor call in a prescription to a nearby CVS? Or .
Wait a minute. We''d been married for a year and a half. Maybe I''d just stop taking the Pill altogether. The thought was a strange relief. I called Richard, nervous and excited. Was he ready for a baby? No, it turned out he was not ready for a baby. Like me, he still lived in a universe in which as soon as a healthy not-too-old woman goes off the Pill, she gets pregnant. He needed time to prepare.
"Just a few more months?" he asked. I sighed, made a frantic call to a doctor cousin who faxed off a Pill prescription, and dashed to the pharmacy before it closed. It''s OK, I consoled myself. I could use a few more months too. As agreed, that June I stopped the Pill. When I tossed the empty pack, I thought to myself that with a little luck, I would be pregnant by the end of the year. But things didn''t go according to plan. Time passed, yet my period never returned.
Month after month: nothing. I grew more agitated by the day, increasingly believing in my gut that something was terribly wrong yet not quite ready to confront it. Work was very stressful, and I buried myself in my new job. No woman wants to believe that she has a fertility problem. And no one wants to go to that first appointment to find out. Although it should have been pretty clear that I needed an appointment--given that nearly six months after going off the Pill I was not yet ovulating, making it impossible to conceive--I still didn''t make my first appointment with a gynecologist until I felt pushed. By my mother, of course. Richard and I were due to fly to my parents'' home on Long Island for Thanksgiving.
My not-so-subtle mother had been dropping lots of hints about grandchildren, and I hadn''t had the heart to tell her that we were actually trying--or more accurately, trying to be trying. But now I wanted to have something to share with my parents when we saw them. Although it might seem surprising, my conversations with dozens of women revealed that they too held off seeing a doctor. Many dragged their heels before going to a specialist, or even their own gynecologist, and the overwhelming majority did not commit a great deal of time or effort to choosing a fertility clinic--at least their first fertility clinic. When women or couples are ready to seek help, they often choose a doctor or clinic that was referred to them, or that was convenient, or that they have heard of, and they rarely do much digging into things like success rates. Fortunately, in the initial stages at least, the front line in fertility treatment should be fairly standard from clinic to clinic and country to country. A first visit to a fertility clinic typically involves an exploration of a woman''s cycle and health history, as well as at least a discussion of potential male issues. The initial task is diagnosis--or at least attempting a diagnosis.
Is the woman ovulating? Are her tubes blocked? Does she have endometriosis? Are polycystic ovaries or polycystic ovarian syndrome a concern? Does the man have sperm issues? Inadequate sperm count? Low motility (slow swimmers)? Poor morphology (form)? Are any of these identifiable issues possibly masking another issue? In assessing a woman''s odds of conception, doctors will invariably try to assess both egg quality and egg quantity. My first visit, unfortunately, did not follow this pattern. I began by seeing a recommended ob-gyn in Washington, DC, not dreaming that I needed a fertility clinic. I quickly received my unwelcome first clue that becoming parents was not going to be quite as simple for us as Richard and I had anticipated. Near the end of a brief conversation with the doctor, she told me that I had a condition called polycystic ovarian syndrome (PCOS), a syndrome experienced by an estimated five million women in America (5 to 10 percent of all women of childbearing age), and one of the leading causes of infertility. I was truly shocked by the diagnosis. There was nothing in my family history, and nothing in Richard''s either, that had caused us concern about getting pregnant. Delivering the news of my diagnosis, the somewhat lethargic gynecologist blithely informed me that it was normal to go a while without a period after coming off birth control pills.
"Six months?" I asked. "Sure. It''s the polycystic ovarian syndrome. It''s common," she said, thrusting a pamphlet into my hands. "Read this. It''s no problem. Take Clomid, it makes you ovulate, and you can still conceive naturally." I had a syndrome? "Can you tell me a little more about it?" I asked, my heart beating just a bit faster.
"Read the pamphlet," she shot back, her disorderly salt-and-pepper curls obscuring her face. "Side effects?" She headed for the door. "Headaches, nausea." Just as she pulled the door open for me, she added, "Take Advil." I took the pamphlet and prescription from her hands. Clomiphene citrate, or Clomid, 50 mg taken daily, days five through nine of my (theoretical) cycle. It would assist my body with ovulation, and presumably therefore conception. I had no reason not to believe her.
I was accustomed to a world in which medicine could fix many problems, even my mother''s life-threatening leukemia several years earlier. Off I went, home for Thanksgiving turkey with my polycystic ovaries, a synthetic hormone to kick-start the process by inducing a period, 50 mg tablets of Clomid, and a bottle of Advil. My head was spinning with the diagnosis, but I decided I would wait until after Thanksgiving dinner to mention our new problem to my parents. I wanted to eat my turkey and stuffing in peace. But no sooner had I taken off my coat than my mother asked me hopefully, "Any news?" My mom is an academic, as is my dad. And my brother. And my sister-in-law. No major obstacle or decision in our lives escapes mention without being examined and discussed in minute detail.
I had no choice but to tell them about my difficulties and try to field their questions. "What exactly is polycystic ovarian syndrome?" asked my dad. Uncharacteristically, I had no real response. "How does the Clomid work?" asked my mom. Again, no good answer. I shoveled turkey into my mouth in an unnatural silence. Those who know me know that I am rarely at a loss for words, and I am usually quick to search for answers. But the doctor had been so dismissive, treating my problem as a triviality, and it wasn''t clear to me what to do or where to go next.
The reality is that I didn''t probe too deeply when I was diagnosed, or for a long time after. And I have discovered that I am not alone in this passivity. Looking back, I realize that I was just happy to have an answer. The doctor told me I had a problem, and that Clomid was the answer. If I just took Clomid, I would ovulate, and then I would become pregnant. Who wouldn''t want to believe that? Had I done any research then, I''d have learned that Clomid, often the first line of attack in the war against infertility and taken by countless women in America, yields somewhat controversial results. At first, the Clomid wasn''t so bad for me. I didn''t have painful headaches, as my doctor warned I might, but I also didn''t ovulate.
I experienced insomnia and mood swings but, for the most part, life went on. I had other things, for better or worse, to think about. The Internet bubble was bursting, along with company valuations and opportunities for fund-raising. What had started as a challenging but electrifying job in Silicon Valley had turned on its head. Deciding that the hours, travel, and stress could not be helping my poor little eggs to ovulate, and amid a tumultuous shake-up at the firm, I quit. Maybe now I would get my period. But it was not to be. Three months after my first visit, I was ba.