Simultaneous Workup

The Los Angeles Times had a story last week that with the incredulous headline “Men can be infertile too,” which shouldn’t be a surprise to anyone who spends any time thinking about infertility. In addition to surveying the common causes of MFI, the story also cites an IntegraMed survey of fertility centers. Unsurprisingly, the survey reveals that many doctors still ignore men when beginning infertility diagnoses.

Sixty-seven percent of those responding to the survey said that the female partner sought initial treatment for infertility.

“Both the male and female partner should be worked up simultaneously,” [Dr. Thomas] Walsh says. “Men are just as deserving of a comprehensive evaluation.” …

Unfortunately, men often resist being tested. Nearly half of all women responding to the IntegraMed survey said that it was only after pressure that their male partners were willing to seek medical consultation.

The reasons for this reluctance have not been well studied. Some fertility experts suggest it’s purely a macho thing—that a man’s sense of masculinity tends to be strongly tied to his ability to reproduce, making him afraid to acknowledge that he might have a fertility problem.

Of course, it’s almost certainly more complicated than that and likely involves a broad range of issues and concerns. It may simply reflect men’s general tendency to utilize healthcare less than women. But regardless of the reason, “When men feel responsible for infertility, it has a profound impact on them,” Walsh says.

I still am astounded by the reported reluctance by men to submit to something as basic as a sperm analysis. That women must undergo the discomfort of something as invasive as an HSG is only one reason to insist that men get over their embarrassment (if embarrassment it is that holds them back)—it’s simple fairness. But on another level, I suspect this is one very real consequence of the fact that infertility treatments are primarily paid out of pocket. Insurance companies are shrewd. They look for many ways to eliminate treatment costs (besides deferring costs to patients, though they do much too much of that). If more companies paid infertility coverage and it were discovered that early diagnosis of MFI save money in treatment in the long run, then they would leverage that knowledge to change doctors’ and patients’ behavior. As it stands, however, infertility clinics have captive audiences of desperate, cash-paying women who are willing to blame themselves for the fact that they cannot get pregnant. That the diagnostic tests for women cost so much more than for men is to their benefit. Why in the world would they want to rock that boat?

Independence Day

Better late than never: Thomas Beatie, the recently pregnant transgender man, gave birth to a baby girl on July 4. Meanwhile, Thomas Rogers’s overview of both the media coverage and the reactions to Beatie’s story from the transgender community is really interesting.

Stress

We talk a lot about stress in our house in part because K doesn’t react well to it. Her heart races sometimes—I’ve heard it—such as when her coworker drinks the potion and becomes Mr. Hyde, which happens all too often now, as if Hyde were taking over. Or like Spike when the Initiative installs a chip in his head, a nuisance but no less dangerous for being harmless. (The coworker has got nothing on James Marsters, though.) Ways to keep heartbeats regular are precious around here.

During our year of trying, before we knew the facts of the matter, I thought things would be more likely to happen if we (she) would just take the procreating more easily. “Relax,” I said. “You’ll never get knocked up if you’re always so tense!” I remained positive myself and tried to convince her that statistically, it was bound to happen. As it turned out, of course, relaxing had nothing whatsoever to do with it. K could have been comatose for every one of those twelve months and I wouldn’t have been able to seal the deal. By the end, I suspect that my reassurances (no longer so convincing even to myself) were almost as onerous as was fact that she kept not becoming pregnant.

I use that history as explanation why Peggy Orenstein’s essay in the New York Times Magazine, about how stress is probably more a cultural bogeyman than a real causal factor in modern life, is worth a sheepish link.

Thanks for Nothing, Chicago!

… because somebody must be blamed for my not getting the job.

Two-Pack

I spent half of Thursday interviewing for a job in Chicago. Professionally, it would be a good step, a bit less influence but more responsibility and chances to network and to learn my profession more thoroughly. Whether the insurance covers infertility treatments I did not discover, but I think if it is offered, I will take the job regardless. Here is haunted by the ghosts of old lives; here we have jobs with uncertain futures; here we have been assaulted by tornadoes and floods—it is time to leave.

But leaving is still shrouded in uncertainty. What is not uncertain are the twins, whose expectant parents we also visited. We learned that their own IF treatments included more than the surgical removal of an ovarian cyst and IF drugs. They also included IUI, and the thought of it, especially of his discomfort in the masturbatorium, makes me laugh. They were fortunate: after two years trying with sex and drugs alone, they were successful the first month. Their twins are identical, and they are excited.

But now that I’ve seen the result in person, I can say without reservation that I would never want to be pregnant with twins, and if K happened to come down with a case of them, I would be a nervous wreck the entire pregnancy, afraid for her as much as for them. That much baby in one body is insanity! Six months in, our friend already looks full term (for a singleton), and she is eating a zillion ounces of protein a day, and they are having to plan to deliver a month early in a hospital 30 miles from their house because it has the closest neonatal intensive care unit. How many ways multiples complicate pregnancy!

Well, now

… where did you come from, little blog?

We haven’t disappeared. The past two weeks we’ve watched our local river escape its banks and swallow the local university whole. It’s only just now spitting it out—very, very slowly. Meanwhile, I was working overtime. But I’m on vacay now, and things are relatively quiet, and I hope to reserve some time to write in the next several days. Not that this blog is shaping up to ever be published frequently, but maintaining regular schedules is sound practice, you know?

PS. Pictures for the flood-curious.

Some of my best friends are…

Yup, pregnant. What can I say about this that hasn’t already been said? Probably nothing. The nasty, evil, childless woman inside is even jealous of the ones who’ve previously suffered from infertility longer than we have…Now that’s just downright hateful.

But I’m off to focus on what a terrible person I am and to think about everything I should be writing for this blog but don’t have the heart to work on. And to hate myself for not job-hunting. And for the chocolate bar I just ate. And for the fact that I can be so self-absorbed when children are starving to death in Ethiopia and seven people in our state were killed by a tornado three days ago. You get the idea.

Damn PMS.

Conference

We did go to the conference last week, and it was a long drive after work and a seemingly longer drive home, and we didn’t see anything of Minneapolis although we did experience the way traffic patterns have changed since the bridge collapsed last year. It was a good conference, much more focused on the Twin Cities than the “Midwest Region”—about which more later.

Marital Rating Scale

We completed George Crane’s “Marital Rating Scale” as the sun set over the laundromat last night. If you happened to read it, you can probably guess that I fared much better than K: I hit 73 points for a “Superior” rating; with 45 points, K was only “Average.” Of course, she had a much higher standard to reach. She received only one point for “Can carry on an interesting conversation”; meanwhile, even though she keeps our finances in order, I received five points each for “Gives wife ample allowance or turns pay check over to her” and “Carries adequate insurance for family.” She did receive points for “Tries to become acquainted with husband’s business or trade,” “Likes educational or cultural things,” and “A good hostess—even to unexpected guests,” but the only way she could match the 20 points I get for being an “ardent lover” (laydeez) would be to care for four (!) children (“5 points each,” according to the scale)—the existence of which would negate the point of this blog.

Crane’s scales, which are dated 1939, are products of a national catching-of-the-breath, the very “What have we done?” moment that Betty Friedan describes brilliantly in The Feminine Mystique. Forget that World War II loomed ahead—the Great Depression was not far past, and who could blame more than a few men and women for pulling up short from the promise that universal suffrage had offered? And because there are always those who want to pull back from the brink anyway, more than a few others found ways to take advantage of the hard times past to wrench all those flappers back under the protective roof of the home. Crane’s scales represent to me that pulling away. What makes a woman successful by that standard is her ability to remain invested in one thing only—the home.

As I dutifully rated my own wife—a woman whom I have loved for much better reasons than her skill for sewing buttons and feigning interest in my work—I wondered how many women only came in at average on that test because they longed to be something other than that woman who must dress to cook breakfast, else her husband would look on her with disapproval? How many wanted their husbands to see them as flesh and blood and heart and bone, as someone who mattered for her own sake, and not as a misplaced symbol? The questions are not rhetorical—you and I both know the answer: too, too many.

Ménage à trois

Olivia Judson surveys the effects of sperm competition. Apparently, the males of many species are capable of adjusting sperm amount and quality on the fly based upon the perception of competition. Different-sized testicles in primates indicates competition, too:

A standard indicator of the risk of sperm competition is the ratio between a male’s body size and his testes: the larger the relative size of the testes, the greater the historical risk of sperm competition. (Larger testes mean larger numbers of sperm.) Chimpanzees—a species in which females are fantastically promiscuous—have enormous testes. Gorillas—a species where they’re not—have tiny testes. Humans are in between, albeit closer to gorillas than to chimps—which is consistent with a moderate, but not huge, risk of sperm competition in the past.

Therefore, she asks, “Do [human] men tailor their ejaculates depending on how they perceive the risk of sperm competition from one situation to the next?” She then goes on to postulate that it is likely given the fact that most male organisms do it, and she further suggests that adjusting the stimuli in a fertility clinic’s masturbatorium prior to IVF might improve the quality of sperm in any the ejaculate. Presumably, this would mean more Barnyard Adventures (conveniently loaded in the DVD player in my local masturbatorium) than titty mags.

It also raises the question why more doctors don’t prescribe MMF threesomes for male-factor infertility. On the one hand, it would bring into the open what genealogists have known for years, that paternity has never been as simple as monogamy would have it. On the other hand, not only is there the increased volatility that Judson suggests, but also “prior buffering” might help things along even further.

And I am only mostly jesting. Because on some level, the only difference between, say, becoming pregnant with anonymous (or in many cases, chosen-by-characteristic) donor sperm or through egg donation and surrogacy and some form of polygyny or polyandry (call it what you will: adultery, promiscuity, swinging) is mediation by doctors. But what if the maintenance of the illusion that, in infertility treatment, sex is sterile were to be proven (How could you ever prove it?) less effective than inviting your driver out for “Friday Night Specials”?

And then, of course, is the follow-up question: assuming that you are not already a swinger, if it were the case that a threesome would improve your partner’s chances of fathering your child, would you do it?

(Via, as is often the case in things like this, Unfogged.)