Slices of Humble Pie

One of the most humbling aspects of my IF experience was accepting that my professional knowledge did not provide any advantage. Looking back, I suppose it reveals how naive I was; that I thought I had the know-how to overcome the fertility challenges related to my age and the eventually discovered male factor infertility. In those early months after we had started TTC, I would dread patient visits for fertility consultations. I would carefully review any advice and recommendations to make sure I didn't reveal anything about my own experiences. Mostly I would think; 'you're asking me about how to get pregnant? Fuck if I know!' I had one patient with established anovulation, and I had to increase her Clomid to 100 mg just to get her to ovulate, but she conceived on her second cycle. I was so happy for her when she announced her BFP, but also had a sense of relief. Alas, I could help get somebody pregnant.

A year ago, I saw a 19 year old patient for an ER follow up. She had presented with abdominal pains and the required pregnancy test for all females was positive. Her HCG was 225, and not surprisingly there was no evidence of an intra-uterine pregnancy on her ultrasound, but also no mass or finding to suggest an ectopic pregnancy. She revealed to me that she always had very irregular cycles and could go anywhere from 4-6 months without having a period. She had been on Depo Provera for a while, which suppressed her menstruation and she had not resumed a cycle since her last shot, which was about 9 months ago. I asked her about possible timing of conception. She admitted that she didn't have a regular boyfriend, but had sex with a friend about two and a half weeks ago because they were "bored". She was likely 5 minutes pregnant. I reviewed that we would watch how her HCG levels increased and I would see her back in a week to repeat her ultrasound. Wow, I thought to myself as I left the room. I determine my peak fertility each month by POAS and can't get pregnant; this was probably the first time she's ovulated in nearly two years and she hits her fertile time just because there wasn't anything good on TV that night.

Her pain had resolved and her beta was increasing appropriately. I had her come back for an ultrasound when her levels were high enough that I felt confident that we would see evidence of an intra-uterine pregnancy. I was standing near the exam room door and I heard my medical assistant instruct her to undress from the waist down and place the drape over her lap. When I went in the room, she was sitting on the exam table, still completely dressed. I figured she must have been nervous, although as she had an ultrasound done in the ER over a week ago. I chatted with her for a bit and then showed her the probe and reviewed the steps with her. I gave her another drape and instructed her again to undress from the waist down and then I stepped outside. When I came back in,  she had correctly unfolded the drape and placed in on her lap, but her pants were still on. I went through the drill again and excused myself from the room. This time, I walked to the end of the hall. I was at a tipping point where I was going to either laugh or cry. Fortunately, it was the former and I placed my hand over my mouth to contain my laughter. At that moment I was reminded of how the Universe works in such random ways. My inability to get pregnant did not reflect any lack of intelligence. I quickly regained my composure and returned to the room.

This time she had finally taken her trousers off, but when she went to place her feet in the stirrups, I noticed that she still had her underwear on. Oh, fuck it. I was not going to leave the room for a third time. I thought back to when I was 18 at my first gynecology visit and remembered how nervous I was. As I didn't know that it involved a breast exam, I left my bra on and the male doctor struggled to unhook it. (Seriously, that is a skill every guy should possess; bonus points if he can do it single handed.) I simply told her, "I see you are more comfortable with your undies on, is it okay if I just slide them to the side?" She just nodded. I asked if she wanted to insert the probe herself, but she returned a terrified look. A few minutes later we were done; there was a single intra-uterine pregnancy at about 5 weeks. I left the room with the words she was waiting for, "you can go ahead and get dressed."

A few days later, I was charting at the nurses station when I heard a medical assistant start laughing. She called me over to her computer to share an email forward she received from a retired OB/GYN with whom she use work. (For reference, he's in his early 60s, never married and never had any children himself)

"Relationship Math"

Smart woman + Smart man = Romance

Smart woman + Dumb man = Marriage

Dumb woman + Smart man = Affair

Dumb woman + Dumb man = Pregnancy

To this day, she has no idea how much I needed to read that.