At 3:00 p.m., the day folds in half, the ink laid on, the paper smoothed together like a Rorschach test. On this side, what you have done, on the other, the rest of the day; what will you have when you pull them apart? The picture today is red, the correctors color, and I wish I could leave it closed, leave it on the table at this coffee shop.
I can pick out some words in the cloud around me. I hear BB King, “Ooh ooh oh, I know that I”… and then, from the woman on my right, “You know I said,” and later, the word “terrified”. “He got so upset” from the blond behind me. A deep laugh and “Now it makes more sense” from the girl in the green sweater, who must be in college, and from the new mother, with her child and its grandparents, “she did play, before” and back to the woman on my right, “they zip together, to make it really big” and the low click of the espresso measure. Everyone on a computer is quiet, as I am quiet.
I won’t say the words, won’t say to anyone but you: “Not today, not this month, maybe not this lifetime.” Better, perhaps; “It’s done for today, for this month, maybe for this lifetime.”
This is Day One, the first day of my menstrual cycle. I never noticed Day One until I wanted a child. I prefer first days: first day of class, of a project, a love affair, the first day of summer. Many days were, you might say, the first day of the rest of my life.
Today I was six days late and hoping, and when it started I had delusions that it might be implantation bleeding, the small amount of blood released when the fertilized egg latches onto the uterine lining. Implantation bleeding could be seen as the first day of a very different life: mine plus one.
Day One, Implantation bleeding; I had known of neither of these bloody markers before wanting to get pregnant. My education truly began when I did not get pregnant, when the doctor in my temporary home in the UK, said, “So you have been failing to fall pregnant for fourteen months?”
I only fall in dreams and off bicycles, but “falling pregnant” is what the British say, which sounds to me less Alice in Wonderland and more Little Timmy’s Down the Well. They are known, the Brits, more for their bracing clarity than for their comfort.
So I was ready to hear from the doctor about luteinizing hormones, about tracking my ovulation, sperm counts, penetration enzymes. I thought I knew what the next steps would be, though as it turns out I knew only half. What I did not expect, and what left me with the novel sensation of being perfectly perceived and completely unknown, was this: “Just relax and it will happen.”
I looked over at my husband and saw that we were both sitting a little too upright. I saw us as the doctor did: two Master’s degrees, one PhD, one M.F.A., corduroys, contacts, the careful wedding ring on the hand holding a list of questions. Mid-thirties, late thirties. We looked earnest, and anxious, and now furious, as the doctor went on. He had seen it, he said, over and over. “It happens exactly like this. When a woman stops worrying about falling pregnant, it happens. Stress makes it harder to get pregnant. So don’t worry about it. Let nature take its course.” He never asked me: Had I been pregnant before? What did I know about my cycle? Has my husband ever gotten a woman pregnant? At what point would we consider assistance?
Nothing. This doctor, a nice man with a long face and round glasses, knows nothing of me, of this life of mine, of the incredible moments, good and bad, that “letting it happen” has brought me. It’s how you get to the far end of your thirties without being married or having a child, this letting it happen, and it was not what I needed, or needed to hear.
“We are not stressed.” I said, and my husband turned toward me, on his face the question: Are we in the same room? “We are not stressed.” I said again. “We just want to know what to do.” Tests were scheduled: an LH test for ovulation, a hysterosalpingogram to check the condition of the fallopian tubes and uterus.
The perfectly named, impossible to pronounce hysterosalpingogram takes time lapse X-Rays of a reflective dye which fills the uterus and fallopian tubes and exposes blockages or problems.
“Sometimes women fall pregnant immediately afterwards,” the doctor said. Then, despite my silent plea, “it’s like a car having it’s pipes blown.” Fine. That analogy was probably inevitable, as were the blogs: “The WORST pain of my life!”, “Unbelievably painful!” Some women, the intake paperwork dryly notes, experience slight discomfort. I had none, though filming was a welcome distraction. I discovered that my uterus and fallopian tubes look like a big, blowsy elm tree, the uterus tipped to the right, one tube flung dramatically across my belly. I was declared “perfectly normal” by the technician.
If the HSG does not cause pain for all women, it’s fair to say all women do experience the choose-your-own-adventure quality of the search for the fertility problem. If you have a blocked tube, go back to clinic A. If not, continue to page 9, the penetration enzyme test, where your husbands’ sperm is comingled with harvested hamster eggs. Welcome to the weird, weird world of infertility.
But it is not Choose Your Own Adventure, because you cannot choose. You will have to learn, piece by piece, what your body and his body are capable of, what science knows and what other women have discovered.
What science knows about infertility it mostly knows about women, driven by scientific questions and by the market. Fertility clinics, fertility enhancement, fertility support, all of which treat infertility but do not use the word, are big business. Among the wisdom on offer: Reduce stress. Relax. The websites are flanked by advertisements for massage therapy, for spa treatments, for yoga. Selling lower stress to women trying to conceive is accepted, but is there any science to back this up?
I found one study, published in the Journal of Fertility and Sterility (the abstract is here) titled “Stress reduces conception probabilities across the fertile window: evidence in support of relaxation”. The scientists, a mix of British and American, took saliva samples from 200 women who were trying to conceive and measured the concentration of cortisol and amylase, biomarkers of stress. The study found a relationship between higher concentrations of amylase and lower fertility. This study has been linked to and cited, as evidence that stress interferes with fertility.
The study is good, but what does it mean? Amylase is a measure of biological stress, and is not necessarily produced from psychological or emotional stress. The study was very small, and it was empirical, not subjective; the scientists never asked the women to report if they felt stressed. Reducing the stress you feel may have no effect on fertility. The lead author, Dr. Germaine Buck Louis, a research scientist at the NIH, replied to my question, “There are very good instruments for measuring perceived psychosocial stress. This topic is beyond the focus of our current paper.”
Yoga, meditation, massage, may not reduce the type of stress the study measured. Stress is harmful, with or without fertility issues, but to use this slight study to sell anything to a woman trying to conceive just makes clear how little is really known about infertility.
Who knows the most about this frustrating lack of answers? The women who have lived with infertility , who can be found on TTC (Trying to Conceive) forums and blogs. The Bump, The Baby Zone, Baby and Bump, Two Week Wait, Fertility Community, The Mommy Playbook. I am in a foreign part of the internets.
There are jumping, flapping, animated emoticons, glittery “sticky beans” wishes and a shocking number of exclamation points. There are acronyms to rival the military, with a key at the bottom of the welcome page, which revealed that BFP is big fat positive (on an hpt, or home pregnancy test), bd is baby dance (sex, which is only one more letter to spell out) and, most alarmingly, bf is either boyfriend or breastfeed. Or both, I suppose, depending on the context. It felt to me like an oppressive party, decorated by gradeschool teachers: paper snowflakes, bowls of jellybeans, a relentless positive tension.
I also find I am not alone in my anger at being told to relax. The venom this advice receives ranges from exasperation to murderous fantasy, with prime space devoted to people who offer the option: “Why don’t you adopt? The world has enough babies” “My cousin decided to adopt, and bam! Pregnant the next week.” As if their lives determine the world’s population, or as if these are equivalent choices. As if adoption in the US is not expensive or lengthy, and as if almost every woman is not investigating that possibility. As if what they want counts for nothing at all. They have words for these people, and the “just let it happen” people. One woman recounts it, attaching a rolling eye emoticon, and a wave of response follows: furious pastel orbs, tapping their toes, shaking their fists, like loosed furbies or furious German elves. There are razor blades in that candy bowl.
They are incredibly generous with one another, these TTC women. They check in on one another, coordinate their TWW (two week wait) and provide hard won advice on side effects of medication, deciding when to switch treatments, how to handle the rollercoaster of hope and sorrow that I am starting to realize is the only way through this experience.
Each forum member, with names like “wishingfor3” and “infertileinmi” signs off with a chronological tour of duty. Here is a composite history:
The angry redhead is AF, Aunt Flo, the avatar, acronym and nickname for menstruation. The red face at the brick wall represents the obstacles, the BFN (big fat negative), she has two dogs, known as furbabies, and the two angels are miscarriages. The term furbabies disturbs me, the “sticky vibes” blessing--fertilized eggs which implant are called “sticky”—makes me hopeful and sad, thinking of a woman, thinking of myself, lying in bed at night, one hand on her belly, wondering.
The narrative economy of these stories astonishes me, coupling heartbreak with gifs, an incredible determination with anticipation of both misery and potential joy. That smiling angel emoticon? I can overlook, or imagine how it was placed there, to mark and to soften the blow of Trisomy 16. There is not one of them who is not afraid.
And then it struck me how deeply these remind me of military tours.
US Army Artillery (5/39 Arty, 1/75 Arty) Warner Barracks, Bamberg, Germany 1960-63 US Army Medic (Fort Sam Houston, TX, Brooke Army Medical Center, Valley Forge General Hospital, Post Hospital, Fort MacArthur, CA) TDY all over the world, 1964-69 SFC E-7 MOS: 55G10, 91B40, 91C40, 91F40 Ed.D in Rehabilitation Counseling, Certified Rehabilitation Counselor Retired, Licensed Clinical Psychologist 60% Service Connected Disabled; Life Member of the DAV since 1980 Independent Social Security Contract Vocational Expert 1983-2005, Contract Medical Expert 1987-2005
They have taken it up, and taken it on, and all of these are war stories. Glittery, hopeful, vulnerable war stories. You cannot troll these women, you should not troll these women. These are women who regularly, intentionally, take into their bodies drugs that can do this:
Blurred vision or vision problems (spots or flashes); headache; hot flashes; light-headedness; mood change; nausea; pelvic pain or bloating; stomach pain; vomiting.
Seek medical attention right away if any of these SEVERE side effects occur when using Clomid: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue) increased risk of cancer of the ovaries; over stimulation of the ovaries; spontaneous abortion.
Cold-like symptoms; diarrhea; headache; indigestion; mild weight gain; nausea; stomach upset. Seek medical attention right away if any of these SEVERE side effects occur when using Metformin/Pioglitazone: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision or other vision changes; bone pain; chest pain or discomfort; dark urine; difficult or painful urination; dizziness or light-headedness; fainting; fast or difficult breathing; feeling of being unusually cold; general feeling of being unwell; muscle pain or weakness; pale stools; persistent loss of appetite; severe or persistent headache, nausea, or vomiting; shortness of breath; slow or irregular heartbeat; sudden, unexplained weight gain; swelling of the hands, ankles, or feet; unusual stomach pain or discomfort; unusual drowsiness; unusual tiredness or weakness; yellowing of the eyes or skin.
They do it with a conviction I may not have. They are willing to do it all, to take all the options to meet the goal, and today, with my coffee cooling in front of me, the first in a long while, I think of why I want to be a parent. To see the world with another person, to discover what I know by teaching them, to discover what they know. To meet them, this person half of my heart and half of my mind, and wholly their own.
Twenty years ago, in neat symmetry, I was pregnant at the age of twenty. Twenty years on this side, twenty years on that. My life is so different now, and this moment shows it clearly: that I want this. That there is a grace in certainty. That there may not be a good reason. And that it may not happen. Not today, not this month, maybe not in this lifetime.
Margaret Jamieson is a writer, filmmaker and teacher who reads, watches and learns as much as she can.
Stills © Sasha Waters Freyer. Sasha Waters Freyer is a filmmaker, mother, teacher and amateur dressmaker. Her experimental and documentary films have featured dominatrixes, coal miners, artists, children, activists – inhabitants of the margins of our mediated landscapes – critical margins that are, in the words of Wendell Berry, “always freeholds of wildness.”