Dawn and I were married on April 30, 1994. It was a joyous and wonderful day for us and we had a great time. And no sooner was the ceremony over than we were looking forward to starting a family--to having kids. We had been out of school for two years, we both had good jobs, and we'd already dated for six years. We felt it was time to move on--to become Real People, full grown-ups like our parents.
You see, while some of our friends were looking forward to waiting to have children, Dawn and I wanted kids while we were still fairly young. We both grew up with young parents, since Dawn and I are both the oldest children; and my father and mother were twenty-three and twenty-two when I was born, and Dawn's mother was only eighteen--although her father was twenty-six. At the time of our nuptials, we were both twenty-three (although Dawn would be twenty-four in a few days). So we were already late, if our parents were anything to go by.
But we were to discover something which we were told at Pre Cana before we were married. One of the couples that was giving us instruction told the assemblage of soon-to-be-married Roman Catholics, ``It's amazing that something you tried so hard to avoid during college ends up being so difficult.''
Anyway, Dawn had been taking birth control pills for a few years prior to the wedding, so right afterwards she stopped taking them. We started off with a visit to her long-time gynecologist to discuss our plans with him. Apparently, current medicine is of the opinion that women who stop taking the Pill should wait about three months before they attempt to conceive to reduce the incidence of birth defects. So we spent three months using an alternate form of birth control before we could start the work of having a baby.
The three months went by and in August we took to our work in earnest. But we were disappointed. Conception failed to occur. Dawn's periods have never been all that regular, and so we got our hopes up a few times; but each time, eventually--forty days later, thirty-eight days later--her period would arrive, and we'd start the cycle all over again.
But doctors tell you to wait a year before checking for problems. If, after a whole year, neither of you are pregnant, then you should talk to a doctor. So we kept our hopes up and put in our time for a whole year--until August of 1995. And what work it was, too.


But still our attempts were unsuccessful, aside from the usual pleasant side effects. So we returned to Dawn's gynecologist and discussed the matter with him. He told us that we should be tested for infertility. He explained that he likes to test the male partner for infertility first, since the test is so much easier than any of the tests for the female, except for a simple hormone blood test, which he had performed on Dawn already and which had come back okay. We had to agree that I should be tested.
And yet, I wasn't fully happy, because, for some reason, the doctor one talks to about these things is the woman's doctor, possibly because there are no doctors specifically for men. I think I'd like a doctor just for me, though, because such a doctor would be much kinder about this sort of thing, I think. Certainly, they would design a much more pleasant environment for the extraction.
In any case, I found myself in the hospital, carefully holding in my lap a piece of paper upon which were written two very unpleasant words: ``semen analysis.''
Now, I was not filled with apprehension the way the men always are in sitcoms or movies. For some reason, the men in these shows are always upset about these things, flustered and surrounded as they are by jokes about pornographic videotapes and bored nurses. None of this bothered me, nor did the very idea that my sperm might not be working. Their performance reflects not at all on my performance as far as I can tell--so the little buggers might very well be sleeping on the job without my knowing it, and I'm perfectly willing to run them through hoops to find out. The very idea of what I was about to do didn't repulse me either, since it's got to be much easier than any other extraction method I can think of. I remember what I went through to get my gallbladder out, so I find this preferable.
But what was bothering me was that I had to sit in a cramped windowless room with a woman who came in to get her ``tube'' changed--I'm sure I don't want to know--while I waited for the incompetent desk person to process me rather than getting processed by the competent desk person who had ``stepped out.'' And then I needed to pay with two checks, not one, which I found after I'd made one check and the competent desk person returned and re-did all the paperwork of the incompetent desk person.
And then I finally arrived at the moment of truth. But missing was the smoothly efficient, if bored, nurse of the sitcoms; missing was the comfy private room with the magazines and videotapes; missing was the pleasant if banal music piped over discreet speakers. What there was was a lab full of bustling Hispanic and Filipino nurses busy taking blood and urine samples from several people. One nurse detached herself, read my paperwork, and took me aside.
``Do you have the specimen with you?'' she asked.
In a way, I did, but in another way, I didn't. ``No,'' I said.
Then she went looking for a specimen container, which was not to be found. Some time later, a different nurse found me, gave me a container, and pointed me towards the bathroom.
The bathroom. Where were my magazines? My videotapes? My private room and comfy chair? This was all wrong. Could this have been my punishment for not going through the same emotional motions as a sitcom father-to-be? Have I upset some delicate balance of the universe?
Well, it all worked out in the end. But then my big fear became the dread phrase: ``insufficient sample size.''


Well, the results did not, in fact, come back ``insufficient sample size.'' They did come back, however, less than satisfactory. Apparently, my sperm are a lot like me--slow, lazy, and given to not moving much. Further, unlike me, they are not abundant. Dawn's gynecologist referred us to a urologist.
(Once again, I must complain. The first doctor a man sees about his infertility problems is a gynecologist--someone who clearly is not the right guy. And the next doctor a man sees is also not a specialist in male private parts. Women have gynecologists--doctors who just work on, in, and around female genitalia. But as soon as something goes wrong on a man, he has to pick a doctor from another profession, like urology or proctology. Men just don't have their own doctors. I'd like to find a peniologist or maybe a phallologist or somesuch and have him work on me.)
Dawn and I went to the urologist's office in a nice new office building in downtown Jersey City. After waiting a while in the waiting room and then waiting a while in an examining room, the doctor came in.
He was short and compact. His weatherbeaten face was topped by salt-and-pepper hair and matching curly hairs peeked out from his open-throated Polo shirt. He had strongly calloused hands and wasn't wearing socks with his deck shoes. After being briefed by us on the problem and squinting his bleached-blue eyes at the lab's semen analysis results, he curtly told me to drop my pants and was quickly much less gentle to my testicles than I usually like to be.
``You've got varicoceles,'' he told us, and proceeded to explain rapidly that varicoceles are varicose veins in the testes which do not return the blood from the testes to the heart as efficiently as they ought to, thus raising the temperature down there and thus preventing the proper growth of sperm cells. He explained that they were fairly common and were only correctable through surgery, which he would do, and which would cause me some discomfort for a couple of days. ``Although,'' he added, ``It might take you a little longer because of your obesity.''
He ordered that we get another semen analysis done in a month and see him again then and left. The visit had lasted less than fifteen minutes.
We were somewhat taken aback by a doctor that would recommend surgery after a seemingly cursory examination, but Dawn and I figured it was no big deal until he actually tried to talk us into it.
A month passed. I went and sacrificed myself to the gods of testing once more. The analysis returned with the same results. We went back to the urologist. The visit was almost word-for-word the same as our previous visit.
After that, I decided to do some research on these varicocele thingies. And I found something very interesting about fertility books: Every one that was written after the mid-Seventies says that anywhere from 40 to 50 percent of all infertility problems are with the male in the couple, with the rest being female, and some very small percentage being trouble with both partners. Despite this, each book has only one slim chapter near the back on male infertility, while the other 450 pages are devoted to female infertility. There are at most two paragraphs given to each of all of the things that can go wrong with the male reproductive system. Apparently, while everyone can agree that males have their problems, no one is interested in actually studying them.
Great. The consensus of opinion seemed to be that varicoceles might or might not be a problem, and that surgery might or might not be a good idea.
I decided I need to talk a bit more to Dawn's gynecologist, figuring that he'd seen a lot of infertility problems go by. Dawn and I went to see him.
Dawn's doctor was convinced that my problem was varicoceles and that surgery was the answer.
``But,'' I said, ``one of the articles I read said that varicocele operations are actually useless and only pay for doctors' country club dues.''
``Oh, no,'' replied the doctor, ``Your doctor no golf. He vindsurf. Sometime he come into office and is vindy and he say, `Cancel appointments, vind today,' and leave, go vindsurfing. So you hope, on day of operation, no vind.''
No vind indeed. It looked to me like it was time for a second opinion. Dawn made me an appointment with the head of Urology at Hackensack Medical Center.
When I told my father, after the visit, that I had gone to see the head of Urology, he asked me, ``And did he look like the head of Urology?''
``Yeah, he did,'' I replied.
``Bald head?'' my dad asked. Now I knew where this was going.
``Yes, Dad, he had a bald head and only one eye and a very wrinkly chin, okay?''
He was much more thorough than the previous doctor, and somewhat more gentle, though I think doctors are never as careful with us as we would like them to be. The doctor even checked something I didn't need or want to have checked: my prostate. Those of you who don't have prostate glands, be thankful, because that means that no one can press on them. It isn't even a little fun.
His conclusion was the same, though. I had these veins which, traitors that they were, wouldn't keep the blood from flowing backwards, and so that blood would just sit there in my testicles, keeping them warm and mostly spermless. Once again, my body had betrayed me, doing something without asking me first.
So now I had three doctors and my wife telling me to get this operation. So I did, on November 14, 1995.
So I was laid up for a while, swollen in areas that should never be swollen and wearing a little elastic slingshot to keep everything from bouncing overmuch. My penis became like the head of a turtle, only rarely coming out to look around. It wasn't too bad--that is, until two days after the operation when I went to bathe for the first time and removed the dressings that had been put on at the hospital.
Now, let me give you an idea of what I was expecting from this operation: The doctor would make two small incisions, each about an inch long--maybe a little bit longer because of my weight--below my waist but above the groinal area. He would cut the veins leading up from my testes, which would cause the blood to re-route to hopefully non-varicosed veins, solving the problem. Then he would close me up, and I'd be in ``discomfort'' for maybe five days.
I removed the dressings and found that the inch-long incisions had turned out to be closer to six inches long, ran almost down to the nether regions which I'm fond of, and that they were held together with staples. I looked like the groin of Robert DeNiro's Frankenstein's monster--I expected my testicles to pipe up at any moment, ``Did you sew me togedduh? Did you bring me ta life?''
I was just a bit perturbed, therefore, when we went to see the doctor a week later and he told me he'd lied to me. He removed the staples and Dawn and I went into his office.
``I'm a little concerned about the speed of my recovery,'' I told him. I explained that I'd been expecting little incisions and to be back at work already. I was in nowhere near good enough condition to attempt returning to work. I thought the operation was supposed to be much less, well, intense than this.
``Let me put it this way,'' he said, pressing the tips of his fingers together and leaning back in his chair. ``If I'd told you, `You will have significant swelling and discomfort, long incisions, and your penis will retract into your abdomen,' would you have gotten the operation done?''
The stupid thing is, I would have. Why? Because I and my wife wanted kids. If they'd told me I would have to hang from my testicles for six weeks after the operation, I probably would have done it anyway.
So my doctor had lied to me.


It was about two or three weeks later before I stopped wearing the slingshot and my penis didn't return to normal for another couple of months or so, much to my chagrin. And it was four months before we could find out if the operation was a success. Our doctor told us to have another semen analysis done then. ``Unless you're pregnant, of course,'' he told us.
Well, by April, we weren't pregnant yet, so I went and made obeisance to the Goddess of Fertility again and gave in another sample. (By now, I was becoming a veteran of sample procuring, and finally had found a very satisfactory way of procuring samples--practice makes perfect. If anyone ever needs to go through this, ask me and I'll divulge my secret. Otherwise, my lips are sealed, in deference towards those of you with vivid imaginations (which are now no doubt working overtime, ha ha).)
And the results were, to quote my father when Dawn called and told him the news: I should get a big red ``S'' tattooed on my chest, and Dawn should get pregnant if I just drop my pants in the same room with her.


We were thrilled. I was more thrilled, naturally, because this meant that the awful operation I'd had to endure wasn't for nothing. And yet there was an undercurrent of worry, because if I was now capable of firing through armor plate, why wasn't Dawn with child yet?
All futher reading into the matter did was convince me that it's a wonder the human race has made it this far. Given all the difficulties involved in conception, I simply cannot figure out how there are any people left. There have to be enough sperm to break down the female's body's defenses, and then the mucous at the cervical opening has to be the right consistency, and then the ovum has to have been released properly, and the right number of sperm have to reach it within an amazingly tiny window of time, and then even if all of this comes together and the egg is fertilized, there's still a fifty-fifty chance it won't attach to the side of the womb. And given all of the things that can go wrong with this entire process--low sperm counts, high acidity, high temperatures, bad timing, and so on and so forth--I can't believe there are enough of us to crowd me so badly on the subway train.
Naturally, we began to worry that there might be something wrong with Dawn as well. She particularly began to worry about it. The idea that she might be broken was quite painful to her--more so than it was to me, and also more painful than the idea that I wasn't working properly. And I really couldn't help in any way, except to get her to the doctor and tested.
But Dawn's doctor wanted us to wait a bit on testing. First, he wanted to try using Clomid. This drug is the first gun used by most doctors in the infertility war. It's not an extremely powerful drug, and it rarely results in multiple pregnancies. What it does is stimulate ovulation, and in fact it also stimulates spermatogenesis, and I would have had to take Clomid if my sperm count didn't come up. It's a neatly multipurpose chemical, Clomid is. Dawn took it for five days starting shortly after the end of her previous period, and did so for two cycles of about forty days each.
After this, we began to get our hopes up again. If Dawn's period ran late by a couple of days, we ran out and got a pregnancy test. They all came back negative. After having been on the Clomid for two months, we tried an ovulation prediction test, too. I imagine that test worked, but that ovum failed to meet its dream sperm.


Worrying became something of a full-time occupation for the both of us. There wasn't much we could do at this point to help the process along, except perform as necessary and wait the month or so to see how it turned out. This constant waiting became very draining.
Dawn began to get fed up with me, with herself, and most of all with her gynecologist. It turned out that Dawn's job, though, had a program with its insurance that brought in a gynecologist every so often to examine anyone who wished to be examined. Dawn decided to take them up on this offer--to cheat on her regular gynecologist, run around behind his back with another doctor. I for one was shocked, but also beginning to wonder if we were getting the full story from our doctor.
My wife came back with a lot of bothersome information. She said that the new doctor, who was a woman, had discovered that Dawn has an inverted uterus. Worse, she said that it was possible that Dawn had been getting pregnant almost every month, but that either the inverted uterus or some biochemical factor was causing her to miscarry-- she called them ``silent miscarriages''--month after month. The new doctor suggested getting a new round of hormonal tests. She also suggested that Dawn stay in bed for eight hours after sex--in essence, going right to sleep-- instead of getting up and moving around afterwards, as she usually did.
Our heads spun. Inverted uterus? Hormone problems? Silent miscarriages? Why hadn't we heard any of this before?
I told Dawn not to get upset and that we should return to her regular doctor and talk to him about what we'd heard. So we did.


``Are you sure she is board certified?'' he asked us.
``I'm pretty sure she is,'' answered Dawn.
``Because tese tings you are telling me, dey are all wrong,'' he said. ``Inwerted uterus, dis means nothing. You could show me ten of your friends, and five of dem, dey have inwerted uterus. And dese tests, if dey say, `no pregnant', den you no pregnant. Are you sure she board certified?''
Well, Dawn wasn't as sure as maybe she should have been. But the doctor wanted us to move ahead--he wanted to bring out the heavy artillery, the gonadotropins. These are the hormones that need to be injected, the ones that are implicated in those sensational multiple births you read about in the papers. He didn't do that sort of thing in his office, he told us, but he referred us to someone who did.


Now we really had something to think about. I was very reluctant to take this next step--I didn't think I wanted children that badly. It seemed to me that there was a huge investment of time and energy required for the use of gonadotropins, and I doubted that I was prepared for it. I didn't think I could go through all of that effort--daily injections, the waiting, the testing--only to be disappointed again.
But Dawn, she really wanted kids. She seemed willing to go that distance--and if that much didn't work out, she would go on to in vitro fertilization and whatever other methods could be had, no matter how small the chances of success.
Frankly, I was somewhat scared. But we agreed to table the discussion at least until we got back from our vacation.
I guess it was just as well, too, given the surprise we were going to get when we got to Florida.