Saturday, December 31, 2011

NINE

 “Cate, I’d like to talk to you alone for a minute.”  Dr. Seuss looked at Jon.  “Would you mind waiting outside, Jon?  It won’t be long.  Just a few doctor-patient things.”

Jon’s lips parted with surprise at his gentle but firm dismissal.  He stared at the doctor for a moment, then turned to look again at Cate.  


“Uh… okay.”  Jon blinked at his wife.  “I’ll meet you in the waiting room, I guess.”

Cate gave Jon a small smile.  She wasn’t sure why Jane wanted to talk to her one-on-one, but the Doctor obviously had her reasons.  “Okay.  I’ll be out in a few.”

Jon nodded uneasily, then stood and held out his hand to Dr. Seuss.  “Thanks, Doc.”  He didn’t sound quite sure if he should be thanking her or not.

Dr. Seuss took Jon’s hand and gave it a reassuring squeeze before shaking it in farewell.  “Nice to see you again, Jon.  I hope you have a lovely weekend.”

“Thanks,” Jon repeated, this time sounding a little less off-balance.  “You too.”  He turned to Cate, leaning down to brush a kiss across her cheek.  “I’ll be right outside.”

Cate nodded, then waited as Jon crossed the room and let himself out of the office.  Her eyes met the physician's, silently questioning.  The doctor's response was simply a smile of calm reassurance.

When the door closed with a click, Dr. Seuss stood and rounded her big desk.  She settled into the chair Jon had just vacated, at Cate’s side.

“I just wanted to be sure you’re okay,” the doctor stated quietly.  “I know the news is disappointing, for both of you.”

Cate sighed heavily.  Her gaze dropped to her hands, now twisted together in her lap.  She shrugged.  “I’m not gonna lie, Jane.  It does feel like a punch in the gut.”

“Jon seems a little angry,” Dr. Seuss observed.  “And that’s okay.  It’s a common reaction to the diagnosis.  Especially from men who are used to running things.”

Cate chuckled quietly.  “He doesn’t hide his impatience too well, does he?”  Her lips curved into a glum smile as she continued to stare at her hands on her lap.  “Don’t take it personally.  He just doesn’t accept the idea of ‘unexplained’.”

“Neither do you.”

“No… I don’t.”  Cate looked up at her doctor, her smile fading.  “It’s not in my nature.  My whole professional life has been about finding answers.  Every problem has a solution; every mystery an explanation.”

“But sometimes you have to dig a little deeper to find it, no?”  The doctor’s voice was calm, but firm.  “Cate, there’s a long way to go yet with your case.”

“I know.”  Cate sighed again.  “It’s just so damned frustrating.”  The word came out as a husky growl.

Dr. Seuss nodded empathetically.  “Yes, it is.  You’re doing everything right, following all the rules… and nothing.  Not yet, anyway.  And Jon probably feels the same way, knowing all the steps you’re taking.”  She paused, waiting for her patient to respond.   Cate didn’t speak, again dropping her gaze to her lap.

Jane took a breath before continuing.  She didn’t want Cate to mistake the topic she was about to broach.  


“I also just wanted to be sure you’re really okay with me referring you to Dr. Klein.  Jon was pretty quick to answer for you.”

Cate chortled softly at her doctor’s concern.  “I’m perfectly fine with Dr. Klein, Jane.  I like him, and like you said, he’s one of the best in the City.”  Again the corners of her mouth turned upward in a wry smile.  “What you saw there was my husband’s typical reaction to being told something isn’t working:  ‘Find a way to make it work’.”

Dr. Seuss grinned as Cate mimicked her husband.  “Sounds familiar.”  She regarded her patient for another long moment.  “Look, Cate… I know you and Jon are true partners in your marriage, and that he is as invested in this process as you are.  But sometimes in cases like this the man, for all his good intentions and husbandly devotion, just can’t completely fulfill the role his wife needs.”

“More than just a sperm donor, you mean?”

Jane chuckled, glad to hear her patient make one of her usual wisecracks.  “Yes.  And even more than that… more than a cheerleader and hand-holder and confidant.”  The doctor’s expression softened.  “Cate, there are many women out there who are experiencing the same emotions you are.  They can understand what you’re feeling.”

Cate arched a brow.  She knew where Dr. Seuss was headed with her commentary.  “You think I should join a support group?”  She couldn’t hide the suspicion in her tone.

“Many of my patients have found them beneficial.”

“I don’t know, Jane.  I don’t even see how that could work.”  Cate gave her doctor a skeptical look. “I mean… how could I sit in a room full of sad, strange women and complain about not being able to get knocked up by my rich, famous, rockstar husband?”  She snorted bitterly.  “I’d look like a snotty, whiny bitch.  Not to mention what would happen if somebody in my… therapy group…” She made air quotes to further emphasize her words.  “… told the tabloids?”  Her lip curled in distaste.  “Yeah, no thanks.”

Dr. Seuss nodded slowly.  “All valid points, Cate.  But there are infertility groups that operate under rules of confidentiality.  And there are a number of famous and high-profile couples who struggle with infertility.  They have similar concerns about their private lives becoming public knowledge.  They also have a common experience and a true empathy for how you feel, both about what you’re facing personally and about the extra pressures celebrity can bring to an already stressful situation .”

“You mean Infertility of the Rich and Famous?” Cate smiled half-heartedly but shook her head.  “I don’t think so.  I just don’t feel comfortable opening up to strangers.  I never have, and I don’t foresee that changing.”  She shifted in her chair, crossing her legs and turning a little, to face her doctor.  “After all, Jane… I’ve spent my whole adult life keeping secrets.  Why would I want to share any now?”

Dr. Seuss had to nod at Cate’s point.  “Well, I guess I can see that logic.”  


The doctor's smile softened as she gazed for a long moment at her patient.  She knew her next comment would probably not be any more welcome than her initial suggestion.  


“There are other options, you know.  Ones that would involve privileged communication.”

Cate resisted the urge to roll her eyes at the implication.  Jane’s just doing her job, Cate silently reminded herself as she felt a little pang of annoyance that her doctor would try to push her toward psychotherapy.  She took a breath before answering, choosing her words carefully.

“Jane, thanks for your concern.  But I don’t think I need to see a shrink, either.”

Dr. Seuss didn’t flinch, fully expecting Cate’s defensive response.  “I wasn’t thinking of a psychiatrist, necessarily,” she countered smoothly.  “There are psychologists who specialize in infertility and pregnancy loss.  For both couples and individuals.”

Cate nodded unenthusiastically.  “I know.  I’ve done the research, remember?”  Her statement came out more sarcastically than she meant it to. 

Cate sighed again, then gave Dr. Seuss an apologetic smile.  “Jane, I know you just want to take care of me.  And I appreciate it, really I do.  But I’ll be fine.”  She reached up to drag a hand through her thick auburn hair, leaving her bangs slightly tousled.  “I’m just… well, I guess I’m a little bit overwhelmed right now.  But I’ll sort it out.  I just need some time alone, to think it all through.”

“Fair enough.”  Dr. Seuss gave Cate a direct look.  “But Cate, I’m going to email you a couple names and numbers.  Just in case you change your mind, or if circumstances change.”

“Okay.” Cate agreed resignedly.  “I’ll put them in the file, along with all the other info.”

Dr. Seuss regarded her patient for a long moment, then put on a brighter smile.  She had one more item she wanted to subtly address.  “So, is this the weekend you and Jon are going Upstate?”

Cate nodded, relieved at the change of subject.  She had had enough Crazy-Doc talk.

“Yes, it is.  Jon’s daughter is a freshman, and it’s her first College Homecoming.”  Cate’s smile broadened as she recalled how excited Stephanie had been to invite her and Jon to the weekend festivities.

“That sounds like a lot of fun.”  Jane smiled.  “Probably as much for Daddy as for Daughter.”  She had talked with Jon enough to know he had a soft spot for his eldest child, like most fathers of little girls.

Cate laughed softly.  “Yeah, he’s pretty pumped up.  We’re going up this afternoon; he doesn’t want to miss a thing.  Not the pep rally, not the bonfire, not the parade… and of course not the football game.”

“Sounds like a nice getaway for the two of you,” Jane observed.  “Maybe you’ll have a chance to sneak in a little romantic alone time?”

Cate chuckled again and shook her head.  “Probably not.  Jon’s boys will be there too.  They’re pretty much full-time, hands-on entertainment.”

“Oh, you’re taking them along?”  Dr. Seuss’ eyes narrowed slightly as she carefully watched Cate’s response.  She knew Cate had a good relationship with Jon’s kids, but after this morning’s unwelcome news Jane wasn’t so sure her patient was ready for a weekend surrounded by walking, talking reminders of Jon’s virility.

“No.  Dorothea’s bringing them up in the morning.  So at least we’ll have the cabin to ourselves tonight.”

Dr. Seuss chuckled softly though Cate’s statement made her inwardly flinch.  “You’re all sharing a cabin?  Wow.  Talk about family togetherness.” 

Cate shrugged, but smiled tiredly.  “Yeah.  It’ll be kinda crazy, but Jon loves having the whole family together.  That’s when he’s happiest.”

Jane’s brow furrowed.  “You know Cate… I have to admit, I find it remarkable that you have such a cordial relationship with Jon’s ex-wife.”  She let a little smirk slip.  “I mean, I share your perspective.  My husband was previously married, and has children from that relationship.  They’re grown now, but still…  I’m not sure how I’d feel if Harrison’s ex-wife was as present in our lives as Dorothea is in yours and Jon’s.”

Cate paused, mildly surprised by Jane’s candid comment.  “Well… I guess I don’t really think much about it.” She felt a little twinge of guilt at the half-fib.  “It just is what it is.  She’s the mother of Jon’s children.”

Dr. Seuss nodded, but remained quiet.

Cate shifted again in her seat, uncomfortable with the silence.  For some reason she felt a need to further explain.  “I mean… I like Dorothea.  Even before I met her – or Jon – I had a lot of respect for her.  She’s strong, confident, and a great mother.  And now that I know her really well, that hasn’t changed.  We’ve become friendly.”

“She and Jon certainly seem to be devoted to their children.”

“Oh, Yes!”  Cate nodded emphatically.  “They try really hard to be parents first and exes second.  And I think they do an outstanding job, especially with Jon’s crazy schedule.  That’s one of the reasons they spend so much time together when he’s home.”  She smiled warmly.  “And the Kids are great.”

Dr. Seuss cocked her head to one side.  “You’re part of that equation too.  As a Stepmother.”

Cate’s lips pursed.  “Yes, I guess so… I just don’t really think of myself so much in that role.  I mean, Jon’s children and I do get along well.  They’ve always accepted me.  But Dorothea’s their Mother.”

“And Dorothea?  Has she always been accepting of you?”

Cate nodded again.  “Sure.  Things were a little tense at first, of course.  But once we got to know each other it all worked out.  And now we spend time together.  We all do.  One big happy family.”

Jane silently noted Cate’s choice of words.  While they were cheerful on their face, the phrase only underlined the doctor’s concern for what may lay ahead for her patient.

“That’s great, Cate.  For you and Jon.  For all of you, actually.”  


Dr. Seuss gave Cate a little smile, then her voice dropped to the calm, subtly commanding tone she used with her more reluctant patients.  “And while I’m sure you’ll all have a wonderful weekend together at Stephanie’s school… I want you to promise me one thing.”

Cate’s eyes locked with Dr. Seuss’.  She automatically searched her doctor’s gaze for a motive, trying to read any hidden agenda that may be there.   “What’s that?” she inquired quietly.

“You and Jon take some time alone, and talk.  About today.  About Dr. Klein.  And about what you both want, and what you’re willing to do to get it.”  Dr. Seuss paused, letting her words sink in.  When she spoke again her tone had turned motherly. 

“Cate, you’re facing what may be a long and difficult road.  Modern science is wonderful, but while it can do amazing things biologically, it can’t solve matters of the heart.  You and Jon need to be prepared for this journey upon which you are about to embark.”

Cate’s eyes moistened as she stared into her doctor’s kindly green-eyed gaze.  She nodded, then looked away.  “I know, Jane,” she sighed.

“You need to let Jon know how you feel, Cate.  All of it.  Your excitement, your hesitations, your fears.  Then together you can make your plans.”  


Dr. Seuss reached out to pat her patient’s knee.  “But above all, you need to be honest with yourself, Cate.  There are many ways to be a Mother without giving birth.”

The doctor’s words hit their mark.  Cate felt a lump rise in her throat as she saw in her mind Jon’s smile – the special little secretive one he gave her every time they saw a baby.  He was so excited about having another child...maybe even more excited than she was. 

Cate nodded silently, unable to bring herself to meet the doctor's gaze.

“So,” Dr. Seuss gave Cate a moment to collect herself, then gave her patient's knee another little pat before withdrawing her hand.  “I’ll call you Monday to see how you’re doing, okay?  And I’ll be sure Dr. Klein’s office sends you a confirmation for your Friday appointment.”  


She winked when Cate finally looked up in acknowledgement.  “And when I review your fertility log on Monday morning I fully expect to see detailed reports of all kinds of wild college-weekend sexual escapades with that Rockstar Hubby of yours.”  Jane gave Cate a cheeky grin.

Her tease made Cate laugh, lightening her melancholy.  “Okay, Jane.  You’ll be the first to know, I promise.”

“Ah, sometimes I love my job,” Dr. Seuss grinned.  She slapped her palms lightly against her thighs before standing.  “Now go, and have a great weekend.  And take a little time for yourselves, okay?”

“Okay.  Cate nodded and stood, following Dr. Seuss’ lead.  “Jane… Thank you.  For everything.”

“Anything for my favorite patient.”  The doctor smiled and accepted Cate’s hand, then her hug.  “Keep your chin up, Cate.  Today’s just a little pothole on the road to a happy destination.”

Cate chuckled at her doctor’s analogy, then stepped back.  “I’ll try to remember that,” she replied honestly. 

“Good.  I’ll talk to you Monday.”

“Have a nice weekend, Jane.”

“You too.”  The doctor watched as her patient turned and headed for the exit.  When the door closed behind Cate, Dr. Seuss let out a long breath.  Then she moved back to her desk to prepare for her next appointment.

*****

Jon jumped to his feet when he saw Cate enter the waiting room.  Not able to wait for her to cross the room to him, he moved swiftly to meet her.  Jon stopped in front of his wife and reached for her hand, giving her a little smile.

“Hey. Everything okay?”

Cate nodded, smiling tiredly at the concern in Jon’s voice.  “Fine.  Jane just wanted to chat a little.”

“Oh.  About me?”

Jon’s tease caught Cate by surprise.  She frowned.  “No. Not exactly,” she replied defensively.  “You know, it’s not all about you.”

Jon’s eyes widened at Cate’s chilly tone.  “Cate, I was kidding.  Of course it’s not about me.  It’s about us.”

Cate felt a stab of regret as she regarded Jon’s hurt expression.  She had no idea why she had just snapped at her husband, why his gentle joke had set her off.  Hell, she hardly had any idea how she felt at all.  She was just… numb.

“I… I know.” Cate pulled her hand away from Jon’s and shoved it into her jeans pocket as her gaze dropped to the floor.  Suddenly she felt an overwhelming urge to get out of this place, this office where she had spent too many nervous hours lately.  She needed space, both physical and emotional.

Cate turned away from Jon and hurried over to the rack where she had hung her leather jacket earlier, when she and Jon arrived for their meeting with Dr. Seuss.  She felt him follow her, his bewilderment obvious in his silence.

“Jon, I completely forgot, I need to run over to my office.”  Cate heard the lie roll unconvincingly off her tongue as she slipped into her jacket and reached for her scarf.

“Whoa... What?”  Jon was caught off-guard by Cate’s abrupt announcement.  “Cate, you took the day off.  We need to get on the road, remember?”

Cate nodded, turning her back to Jon as she knotted her scarf around her neck and blinking furiously to keep her tears of frustration at bay.  “I know, but I just realized… yesterday I forgot to send the affidavit draft over to Terry.  I have to get it to him today, so he can work it up to present it to the Magistrate on Monday.”  She tried to make the made-up excuse sound credible though she knew Jon could see through her lie.

“Okay… So send it from home.  You have your laptop, and that encryption thingie…”

Cate shook her head vigorously as she headed for the door to the medical office suite.  Jon followed her, unsure how to react.  “No, I need to send it from work.  There are some attachments I don’t have at home.”  Cate pushed through the door and hurried toward the elevator, her husband in pursuit.

“Cate…”  Jon reached out to grab her arm, trying to slow her pace so he could talk to her.  He raised his hand in surrender when Cate shrugged out of grasp and continued down the hall.  “Cate!  For Christ’s sake!  Hang on a minute!”

Jon’s bark stopped Cate in her tracks.  She winced at the anger in his tone, knowing she had pushed too hard.  Cate closed her eyes and took a deep breath, then slowly turned.  Her cool gray gaze met his, and she prayed her true motive was well-masked. 

“Jon, I need to go to the office.”  Cate’s voice was low and clipped.  “I won’t be long.  Go home.  I’ll meet you there in an hour, then we’ll go.”  She turned away and fiercely punched the button to call the elevator.

Jon let out an exasperated sigh.  There was no sense arguing with her, especially not here in the middle of the hallway.  


While he believed Cate was heading for her office, Jon knew her excuse was bullshit.  She was running.  It was what she did when she got scared, when she needed to hole up somewhere and think.  As much as Jon hated it when Cate did that, he understood.

He had to understand again.  Especially this time.

“Okay.  I’ll go home and wait for you.”  Jon’s voice was quiet and resigned.  “But please, Cate… just call me when you get to your office, okay?  Let me know you’re there?”

Cate’s façade almost cracked at the emotion in his plea.  She swallowed hard, then nodded.  “Okay.  I will.”

“Baby…”  Jon took a hesitant step closer to Cate, then another.  He gazed down at her, his blue eyes swirling with concern.  “Do what you need to do, but then come home to me.  Okay?”

A soft ding announced the arrival of the elevator car.  The doors opened with a soft whoosh.

 Cate felt her eyes moisten as she heard Jon’s unspoken message of support.  She nodded and looked away.  “I will.  Promise.” 

“Okay.  Cate, I love you.”

“I love you too, Jonny.”  Cate raised her face to Jon’s and gave him a sad smile, then turned and stepped into the elevator. 

Jon raised a hand to her as the doors slid shut, then sighed heavily and let it fall to his side.  He knew she would keep her word; she always did.  


He didn't know if Cate would actually go to her office, but wherever she ended up she would isolate herself so she could analyze her emotions and logically arrange her thoughts.   In an hour or two she would be back, calm and quiet and apologetic for causing him worry.

It was her way of freaking out. 

The corner of Jon’s mouth curved upward as the phrase crossed his mind.  He sighed again and reached for the elevator call button.  It wasn’t like he could blame her, given the morning’s disappointment.  Hell, he was a little freaked out himself.  


Today their fears had become real, no longer just shadowy suspicions of their worried minds.

Jon stared unseeingly at the elevator doors until they quietly parted.  He stepped into the little cubicle and pressed the button for the ground floor.

He would go home and wait for her, as he promised.  Then together they would face their new reality.

Saturday, December 24, 2011

EIGHT


“...My diagnosis is Age-Related Unexplained Infertility."   

The doctor’s quiet words sent a chill down Jon’s spine.  He swallowed hard, then looked at Cate.  The sight of her bowed head made his heart ache.

He had to be strong for her. 

Jon took a deep breath and shifted in his chair.  Giving Cate’s hand another squeeze of reassurance, he leaned forward and stared intently at Dr. Seuss.  He wanted to be sure the doctor knew she had his full attention.

“You’re the expert, Doc.  But I think you’re wrong.”  Jon’s voice was firm and carried a hint of challenge.  “There has to be some explanation.”

Dr. Seuss looked back at Jon, her kind green-eyed gaze locked with his icy blue stare.  Her expression didn’t change, but she inwardly smiled at his defensiveness.  Good for you, Jon, she thought.  Fight.  It’s what your wife needs you to do. 

 “There may well be, Jon.  Without further, more extensive testing we won’t know whether there’s something else coming into play here.”  Dr. Seuss quietly smoothed the papers back into their stack and closed the folder, then sat back in her chair.  


“But sometimes medicine doesn’t have an answer.  Approximately 15 percent of the couples who experience infertility receive an ‘unexplained’ diagnosis.  A few of them go on to have normal, unassisted pregnancies, but many of them undergo assisted reproductive procedures, with varying degrees of success.”

“So this is far from hopeless.”

Dr. Seuss saw Cate’s head raise and slowly turn toward her husband’s words, then toward her.  The doctor gave Cate a reassuring smile before responding to Jon’s statement.  “It’s not hopeless at all, Jon.  There are still options.  But they aren’t options I can provide you here.”

Jon nodded and glanced at Cate, then sat back in his chair.  He pulled their clasped hands onto the armrest of his chair and covered them with his other hand, silently telling her everything was going to be fine now.  He was taking charge. 

“Okay.  What’s our next move?” 

“I will refer you to a fertility specialist.  If you wish, I will continue to monitor your care and consult with whomever you choose, but what I can do for you in this practice is limited.”  Dr. Seuss reached for her tablet and pushed the button at the top to activate the display. 

“Jon, you had your semen analysis done by Dr. Klein’s office.  As you probably know, he is one of the foremost fertility specialists in Manhattan.  I highly recommend you consider consulting with him, or I can give you a few more names.”  She tapped at the screen of her tablet, pulling up her list of contacts before looking up at the couple.

“If Dr. Klein’s the best, then he’s the one we want,” Jon answered firmly.

Dr. Seuss arched a brow at Jon’s declaration, then looked at her patient.  “Cate, what do you think?”  While she appreciated Jon’s assertiveness, she wanted to be sure he didn’t completely discount his wife’s wishes.

Cate nodded slowly, then looked at Jon before speaking.  “Dr. Klein’s reputation is excellent.  And if Jon’s comfortable with him…” 

“There is certainly an advantage in going with Dr. Klein, in that he’s already familiar with your case,” Dr. Seuss agreed calmly.  “Unfortunately, time is a factor for you.  If you choose to proceed with any assisted reproductive technologies you need to begin as soon as possible.  But…” She paused and smiled gently.  “A second opinion is rarely a bad thing.”

Cate shook her head.  “He would be the second opinion, Jane.  You’re the first.  I trust you.”  She sighed resignedly.  “If you recommend Dr. Klein, then that’s who we’ll see.”

“Okay.”  Dr. Seuss dropped her gaze again to her tablet and tapped several times at the screen to bring up her colleague’s website.  She and Barry Klein, MD, were longtime friends and partners in the practice of reproductive medicine.   As such, they shared an agreement to schedule their referrals in each other’s calendars without making their clients go through the normal, time-consuming channels of waiting for a rare open appointment.

“It looks like Dr. Klein has some time open next Friday morning… Are you both available?”

“Yes.” Jon answered immediately, before Cate could speak.  “We’ll make it work.”

Dr. Seuss looked up at Cate, momentarily ignoring Jon’s declaration.  “Cate, that good for you?  Or do you need to check your schedule at work and get back to me?”

“No. It’s fine.”  Cate gave Jon a long look, her expression softening as he returned her gaze with a gentle smile.  “I’ll make it work.”

“That’s my Girl.”  Jon’s voice was gentle as he pulled Cate’s hand up to his lips and planted a soft kiss on its back.  “The sooner the better, right Doc?”  He addressed his question to the gynecologist though he never turned his smile away from his wife.

Dr. Seuss nodded her agreement as she again dropped her gaze to the tablet.  She quickly tapped in Cate’s name, filling the open slot on Dr. Klein’s electronic calendar.  Then she linked the appointment to Cate’s profile on her own site, so her patient would have access to it via her own iPad and phone.

“So Jane… what are we looking at? Other than meeting with Dr. Klein, I mean.” 

The doctor set the tablet on top of Cate’s medical file, then moved them both aside.  She clasped her hands and rested them on her desk, ready to give her patients what she knew they needed now:  as much information as she could give them.

“Well, Jon, Cate… your next steps will ultimately be determined by how you decide to go forward.  These days there are a number of options available to couples trying for a child, which is good news.  But some of them take quite a bit of time, which is to your disadvantage.  So, you will have to make a decision pretty soon about how you want to proceed.”

The doctor paused and watched the couple exchange a look, then Cate nodded.  She looked almost guilty as she spoke. 

“I’ve been reading up on… options.  Just in case.  IVF, IUI, hyperstimulation…  They all sound so…”

“Scary,” Dr. Seuss finished gently.  “I know, Cate.  But I’m glad you’ve been doing your research.  As you've said, you can never have too much information.”  She smiled warmly.  “But before you get to that point, there are a few other steps first.”

“Like what?” Jon spoke up.  “More tests?”

“Yes.  For Cate, anyway.”  Dr. Seuss nodded.   “If you want to continue to try for a child, I am almost certain Dr. Klein will want you to have few more significant and invasive tests.  Most likely he will want you to have both an HSG and a laparoscopy, since right now we’re looking at an ‘unexplained’ diagnosis.”

“Aww, Christ.  More acronyms.”  Jon grinned gently as he made his mock complaint.  He looked at Cate and was glad to see her smile in response.

Dr. Seuss laughed.  “Yep, sorry Jon.  More acronyms.”   She took a breath before launching into her practiced recitation. 

“Cate, Dr. Klein will most likely first order a hysterosalpingogram, or HSG, to check the patency of your fallopian tubes.  It's a radiological test where a special dye is inserted through the cervix into the uterus and fallopian tubes, then x-rays are taken to evaluate the reaction of your reproductive organs to the dye.  It also can identify physical blockages or impediments to pregnancy such as cysts, fibroids, or scar tissue.”

She paused and waited for the couple to nod their understanding before continuing.  “And, based on your medical history, Dr. Klein will most likely also want you to have a laparoscopy to evaluate the physical condition of your reproductive organs.

“Wait a minute,” Jon interrupted  “A lapper… whatever.  A scope.  Is that a surgery?”  His brow creased with concern.

“Yes, Jon, it is an outpatient surgical procedure.”  Dr. Seuss confirmed.  “It’s similar to what you had done on your knee this past summer after your injury – an arththroscopy.”  She paused to smile at the “Aha!” expression on Jon’s handsome face at her analogy.  “It’s quick in and out, with minimal recovery time.  But it is an invasive surgery, performed under general anesthesia.” 

Dr. Seuss took a breath before continuing.  “In a laparoscopy the doctor inserts a fiberoptic telescope into a small abdominal incision to examine the outside of the ovaries, fallopian tubes, and uterus.  Through the procedure the doctor can detect fibroids, scar tissue, or other physical defects that might impact fertility.  If the defect is minor it can often be immediately corrected or surgically repaired during the procedure.”

Again Jon frowned as he considered the doctor’s explanation.  “You said Dr. Klein will probably want Cate to have a laparoscopy because of her medical history… Why?  What’s in her records that make you think that?”

“Scar tissue.”  Cate answered quietly.  “From my shooting.”

Dr. Seuss nodded at Cate’s answer.  “Yes.  Because of the proximity of your injury to your reproductive organs, it is possible there was physical damage and scarring.  If that is the case, it most likely went unnoticed during your initial treatment and recovery.”

“How soon?”

“As soon as possible.  Dr. Klein keeps one day of his schedule clear each week for surgical procedures.  You will do the HSG at a radiology lab, but he will perform the laparoscopy himself.”  


Dr. Seuss consulted her tablet, sliding her finger across the screen to move the windows.  “I see that you have had intercourse twice within the ovulation window, so it’s possible you could be pregnant now.  Of course we won’t want to interfere with a potential developing pregnancy, so any invasive tests would be done only after a negative determination.”

“In other words, after my next period.”

“Yes.  And as soon as possible after, before you ovulate again.  You are considered an urgent case, Cate, due to your age and your medical history.  You’ll go to the front of the line.”

“Great.  The one time it pays off to be old.”  Cate’s half-hearted wisecrack sounded hollow.

Jon gave his wife a gentle smirk before addressing his next question to the doctor.  “Then what if those tests come back clear?”

Dr. Seuss looked Jon straight in the eye, knowing he wouldn’t like the answer.  “Then the diagnosis will remain Unexplained Infertility.” 

Jon’s jaw tightened as inwardly he bristled at the term.  Even at his and Cate’s first appointment with his urologist before having his vasectomy reversal, Jon had cringed at the word “infertility.”  He hated its negativity.  Coupled with “unexplained,” it was almost unbearable to hear.

“What would that mean for further treatment?”  Jon’s voice was controlled but challenging.

“Well, there are a number of options.”  Dr. Seuss sat back in her chair, pulling her hands onto her lap.  “One would be to do nothing, to continue to try to conceive naturally, as you have been.”

“But that’s not working,” Cate observed quietly.  “We’ve been trying for over six months.”

“Yes.”  Jane replied calmly.  “And taking your age into consideration, that’s not the course of action I would recommend.  I would tell you it’s time to consider ART.”

“What kind?” Jon’s question was pointed.  “I’ve heard of IVF.  But isn’t that a last resort?”

Dr. Seuss shook her head.  “Not necessarily.  There are a number of therapies you could try first, depending upon the diagnosis and your preferences.  And Dr. Klein’s advice, of course.” 

“What do you think, Jane?”  Cate asked, raising her gaze to meet the older woman’s.  “If you were me, what would you do?”

Dr. Seuss looked back at her patient and saw the thinly-veiled desperation in Cate’s eyes.  She smiled calmly, though under her professional demeanor her heart twinged sympathetically.  “Cate, I can’t answer that question.  It wouldn’t be fair to you, or to Jon.  And it would be unprofessional of me to give you my personal opinion, if I had one.”

“But you can at least tell us what some of the options are.”  There was a hint of panic in Jon’s terse command.  Dr. Seuss turned her gaze before answering.

“I can, in broad terms.”

Cate swiveled her head to look first at Jon, then back to the doctor.  “I think I have a pretty good idea, Jane.  But could you tell Jon, please?”  She curled her fingers against Jon’s, silently asking him to stay calm.

“Sure.”  Dr. Seuss smiled gently.  “Probably the first thing Dr. Klein will present for your consideration is ovarian hyperstimulation.  That means artificially stimulating the ovaries so that they release multiple eggs in the hopes that there will be more “targets” for fertilization.”

Jon settled into his chair, unconsciously taking his full-attention listening pose now that he was starting to get some answers.  He crossed his legs and pulled Cate’s hand onto his knee. “You mean fertility drugs.”

“Yes.”  Dr. Seuss nodded and glanced at Cate.  “Obviously the concerns with hyperstimulation alone would be achievement of multiple pregnancies.  But often this technique is used in tandem with other ARTs, to make them more successful.”

“Such as?” 

“Techniques in which artificial means are used to assist in fertilization of the egg.  One would be Intrauterine Insemination, or IUI.  That is a technique in which harvested sperm is inserted into the fallopian tubes via a tube passed through the cervix.  It increases the volume of sperm available to reach the egg upon ovulation, thus increasing the statistical odds of fertilization.” 

Dr. Seuss paused as she reached to move aside her electronic tablet and flip open Cate’s medical record.  “If I recall correctly…” She paged through the chart with one hand, then raised the sheaf of papers to peruse some writing.  “You had Jon’s sperm harvested and frozen during his vasectomy reversal…”

“We did,” Cate answered.  “But would we use that sperm for IUI?”  Her brow furrowed in confusion.

“Probably not.  Since Jon’s tests have been normal, most likely IUI would be attempted with fresh sperm.”

Jon raised a brow.  “You mean I’d need to… uh… provide a new sample… every time we wanted to try IUI?”

Dr. Seuss smiled.  “Yes.  Most likely.”

“Oh.”  Jon frowned slightly, then shrugged.  “Okay.  And what are the chances of success with IUI?”

“I can’t answer that question, Jon.  Success rates fluctuate dependent upon a number of factors.  But it is generally considered a reliable option for the right candidates.”

“So what about IVF?”  Jon dropped his chin and peered at Dr. Seuss.  “From what I’ve heard, that’s kind of the big deal.”

Jane nodded slightly and glanced at Cate before answering.  She knew that, like many of her patients, Cate held an unspoken fear of  In Vitro Fertilization treatment.  Though such fears were unfounded, the spectre of lab techs in white coats making babies in petri dishes still caused even the most educated and confident women a moment of pause.

“It is a very advanced procedure,” Dr. Seuss explained carefully.  “But it is one that has been used very successfully, to the point that it has become mainstream in treatment of infertility.” She saw Jon frown again as she used the diagnostic term.  


“In simple terms, a woman’s eggs are harvested, and sperm is collected from the male.  When timing is optimal to achieve implantation, the egg and sperm are mixed together in a laboratory, to achieve fertilization.  The fertilized eggs are then placed the woman’s uterus with the hope that they will implant.  If implantation is successful, pregnancy is achieved.”

Jon nodded.  “And don’t doctors usually implant more than one embryo,  to improve the odds?”

“That’s correct.” Jane nodded at Jon’s question.  “And that is also why IVF often results in multiple pregnancies.  It is not uncommon for twins or triplets to result.”

For the first time Jon cracked a genuine smile.  He looked sideways at Cate.  “You could be OctoMom.”

“God, No!” Cate exclaimed.  Then she smiled sheepishly at her outburst.  “Besides, that was kind of a freakish situation to begin with.”

Dr. Seuss laughed, relieved that Jon had lightened the intensity of his questioning.  “That’s right, Cate.  In fact, the ethics of reproductive technology are such that implantation of that many embryos would be frowned upon.  Most doctors would only attempt to implant three or four fertilized eggs in an IVF procedure.”

“So IVF is actually a pretty good option,” Jon remarked.  He slouched a bit in his chair, visibly relaxing. 

“It can be.  But the downside of IVF – or IUI for that matter – is that with each attempt, the probability of success diminishes.”  Dr. Seuss looked at Cate as she saw her little nod of agreement.

Jon pulled his lower lip between his teeth for a moment as he considered that fact.  “So, you want to get it right the first time,” he observed.

“Preferrably.  But obviously one can’t always predict or promise that.”

Jon turned his head to give Cate a long look.  “So, if we find the best doctors, the best labs, the best hospitals…” he mused out loud.

Cate gave Jon a melancholy smile.  She could see the wheels turning in his mind, just like they always did when he was confronted with a challenge.  She loved that about him, his optimism that with hard work and the right tools he could solve any problem.

Unfortunately, this time the problem may be beyond his control.

“Those things would certainly increase your chances of having a successful IVF experience, Jon.” Dr. Seuss answered for Cate.  “But they aren’t guarantees.  There are still a lot of human factors involved.”

Jon dropped his chin and gave Dr. Seuss a long look.  Cate couldn’t stop a weary little chuckle as she watched her husband attempt to stare down her physician.  She had no doubt that Jon’s stink-eye would have no impact whatsoever in this situation.

“Jane, I think that’s good for now,” Cate observed quietly.  “That gives Jon some ideas about a few of the options.  Assuming we’re candidates for them.”

Jon turned his gaze to Cate, his expression softening.  “Is there something else?”

“There are a few other options, Jon,” Dr. Seuss answered.  “Perhaps something to think about, depending on what further tests show.  If necessary, donor eggs or even surrogacy could become viable alternatives for you.” 

Jon saw the flicker of pain in Cate’s blue eyes at Jane’s mention of surrogacy.  His heart clenched.  Though he had thought ahead enough to realize IVF or some other scientific help may be in their future, he hadn’t even considered bringing another person into the picture.

His gaze swung back to Cate’s doctor, his handsome face now painted with concern.  “You think we might… might not be able to make a baby on our own?”

 “I didn’t say that, Jon.  But it is possible that you may want to involve a third party, if it comes down to it.”  Dr. Seuss smiled gently.  “But let’s not get too far ahead of ourselves, okay?  One step at a time.”

Jon slowly nodded, then looked back toward Cate.  “Yeah,” he agreed, his voice suddenly husky.  He gazed at her for a moment, then smiled.  “Besides, we’re not gonna get to that point, right Baby?”

“Right.”  Cate swallowed hard and mustered a smile.  She gazed back at Jon, willing herself to believe his platitude.

Dr. Seuss quietly watched Jon and Cate’s silent exchange.  This was the scene she had witnessed many times in her decades of practice, the moment when she could predict whether the road ahead of a couple would be smooth or rocky.  


What she saw here made her smile.  Jon’s devotion to his wife was unmistakable, his willingness to do whatever it took to support her, admirable.

But then again, there was a saying about a road paved with good intentions.

Saturday, December 17, 2011

SEVEN

FRIDAY

The office was silent save for the muted tick of the ornate grandfather clock that stood in the corner.

Jon snorted at the irony of the audible metaphor.  In this room of all places he was painfully aware of time's solemn march, every second pulling their dream a little further from their grasp.

He turned to Cate and saw she wasn't paying attention to the clock or to anything else in the room.  She was lost in her thoughts, staring unseeingly across the desk and out the window.

Jon's gaze traced slowly over her profile, his heart squeezing as he once again noticed the dark circles under his wife's tired grey-blue eyes.  The little lines at their corners were deeper now than they had been just a few months ago.   

This had been hard on her, he knew.  Hell, it had been hard on him.  But each month, when once again she was faced by her body's betrayal, Cate put on a brave face.  She tried to pretend she wasn't disappointed, forcing a smile and gently telling Jon they had to be patient, it would just take time. 

But then she silently disciplined herself, adding another task to her growing list of sacrifices and rituals to try to gain control of her rebellious body.  With every passing day and week and month Jon could sense Cate’s desperation growing, despite her calm façade and her quiet platitudes. 

Time was working against them.

Finally feeling Jon's gaze, Cate slowly turned her head and gave him a weary half-smile.

"You okay?"  Jon's soft voice held a husky note, betraying his unease.

"Yeah."  The word was more of a sigh as Cate nodded slowly.

"Wanna tell me?  Where you were just now?"

Cate shrugged and turned her eyes back toward the big mahogany desk in front of them.  "Just thinking."  She slumped a little further into the leather wingback  armchair.  "That I've spent almost as much time in this office the past few weeks as I have my own office."  She chuckled half-heartedly.  "You too."

Jon smiled wryly.  "Yeah. I've read every damned magazine in the waiting room.  Twice.  They need to get some new fucking literature."  He chuckled softly as he watched Cate's nose crinkle at his lame attempt to lighten the mood.  "But it will all be worth it, today."

Cate turned her face back to Jon, mild surprise registering in her look.  "You think so?"  

"Yeah.  I do."  Jon smiled reassuringly though he didn't feel the least bit confident in his prediction.  "Today's the day we figure it all out."

As if on cue the rhythmic tick-tock of the clock was interrupted by the loud click of a turning doorknob.  With a rustle of fabric and paper the doctor strode across her office and rounded her desk.  She dropped a thick white file folder on the desktop before settling into her leather chair.

"Well, hello again, Bongiovis."  Dr. Seuss smiled warmly at her patients.  "And how are we today?"

"Fine, thank you," Cate replied quietly. 

"Good."  Jon echoed his wife's lie.  "Hopefully about to be a lot better."  He gave Cate's gynecologist one of his most charming smiles, as if the gesture might convince her to share good news.

Dr. Seuss chortled softly as she pulled the reading glasses dangling from a chain around her neck up to perch on her nose.  As one of Manhattan's top OB/GYNs she had many patients who were married to handsome, charming, wealthy captains of industry and hard-charging executives.  Most of those husbands were reduced to nervous, stammering adolescents when they accompanied their wives to this office.  

But not this one.  Dr. Seuss had long suspected Jon's dazzling grin was an automatic defense to mask to his unease, judging from the way his blue eyes darted around her office when he thought she wasn't watching.  She was fine with that; there were worse ways to spend a half-hour every other week than with a smiling rock star and his lovely wife. 

"So.  Cate, Jon... I have the results of your tests."  Dr. Seuss opened the white folder and peered down at the sheaf of papers inside.  “We have a few things to talk about.”

Automatically Jon reached for Cate's hand, his fingers curving over hers on the leather chair's armrest.  He looked at her profile and saw her expression was stoic as she stared at the file on Dr. Seuss’ desk.  He squeezed her hand, then looked back to the physician.

“Okay, Doc.  Let’s hear it.” 

Dr. Seuss nodded before flipping through the top few pages of the file.  Her voice was calm and professional when she began her report.    “Jon, we’ll start with you.”

She glanced up, peering over the frame of her reading glasses giving Jon a reassuring little smile.  “Dr. Klein sent over the results from your blood work and your last three semen analyses.  As far as your blood work, everything looks good.  No factors, nothing out of range, no infectious diseases.  All clear.”

Jon nodded and glanced again at Cate.  She hadn’t moved.  Still she sat silent, staring ahead.

Dr. Seuss flipped another page and ran her finger down a column of numbers.  “As for semen tests, again, no abnormalities.  All three recent tests show good sperm morphology and motility.  And your sperm count is in the high-normal range, which is good.”  She paused and looked up. 

“Quite frankly, Jon, that was one of my concerns given the rather lengthy period of your sterilization prior to your vasectomy reversal.  But everything seems normal for a man of your age with your reproductive and medical history.” She smiled at his visible sigh of relief.  “You probably have a combination of good genes and excellent physical health to thank.”

Jon chuckled quietly and nodded.  “Thanks, Doc.”  Again he turned his head to look at Cate.  He saw her swallow, then her lashes fluttered briefly.  Jon gave his wife’s hand another gentle squeeze as he realized she was steeling herself for the worst, for the alternative to his clean bill of health.

Dr. Seuss also noticed her patient’s subtle reaction.  She knew very well what was going on in Cate’s mind; many of her patients who struggled to conceive carried the same guilty fear:  What if it’s me?  The gynecologist paused and looked at Cate for a long moment, until Cate’s tired blue eyes raised to meet hers.  She gave her patient a motherly smile before continuing.

“Cate, your basic blood workup looks good as well.  Again, no negative factors, no infectious diseases, your hemoglobin is normal and your white count is in the low-normal range.  Your thyroid appears to be functioning normally.  And your cholesterol and sugars look excellent.”  She nodded approvingly.  “Your diet and exercise regimen has certainly paid off in the general health department.”

Cate gave a small nod, her first sign of acknowledgement since the doctor had begun her report.  She took a deep breath and slowly released it.  Her hand moved under Jon’s, turning her palm upward against his.  Without looking she laced her fingers between his, the gesture a silent request for his reassurance as she waited for the other shoe to drop.

Dr. Seuss flipped a few more pages of the chart.  “Now, as for your hormones…” She paused while she evaluated the figures, then looked up at the couple before her.  She gave Cate a little smile, making sure she had her attention.  


“We analyzed your early blood draws for natural levels of the hormones associated with reproduction.  Now, I know you’ve done some research and we’ve discussed this.  But for your husband’s benefit..."  The doctor turned her smile to Jon, whose expression had sobered to match his wife's.  "... Here’s what we look at in an initial fertility workup."  

“A couple weeks ago, before onset of menses… before your wife got her most recent period… Cate submitted a blood sample for a full fertility screen.  We wanted to see if all the hormones that affect her ability to get and stay pregnant were within normal ranges, without being influenced by any medication or supplement.”

Jon nodded his understanding, thankful that Cate’s doctor was dumbing down her explanation for his benefit.  He had a rudimentary understanding of the female reproductive system, but he would be the first to admit he had no idea how it all really worked.  “Okay.  So what’s the verdict?”

Dr. Suess smiled patiently at Jon’s nervous question.  “What we found out was that Cate’s reproductive hormones seem to be normal for a woman her age.  Now mind you, that doesn’t mean her levels are optimal for fertilization and implantation of an egg.  We rarely see optimal levels in women over 35 due to age-related changes in their bodies.”  The physician turned her gaze again to her patient.  “However, for a woman of 43, Cate, your levels are right around where we’d expect.”

This time Cate’s relief was more visible.  Her shoulders slumped as she exhaled softly, and her tightened jaw relaxed a bit.  But when she spoke, her voice was quiet and cautious.  “What about the other tests?”

Jon’s brow furrowed at Cate’s response, and he turned his questioning gaze to Dr. Seuss.  “Yeah, what about all those other trips to the lab Cate had to make?  Were those for something different?”

“Sort of.”  Dr. Seuss nodded before continuing her explanation.  “In a fertility screen we pay particular attention to a couple different hormones that affect the production and release of the egg and the implantation and sustainment of the embryo.  As you might expect, these hormone levels fluctuate throughout the menstrual cycle.  But if those levels are exceedingly high or low at a given point in the cycle, they can indicate problems with ovulation or uterine hospitality.” 

Seeing the frown of concentration on Cate’s husband’s face, Dr. Seuss paused her explanation to give him a moment to catch up.  When he nodded slowly she continued, speaking directly to him.  “Jon, since you went through multiple pregnancies with your first wife, you may have heard of some of these hormones or terms.  But I’ll give you a quick rundown anyway.” 

“In Cate’s initial fertility screen we looked primarily at levels of FSH, LH, estradiol, progesterone, and androgens in her blood.   FSH is follicle stimulating hormone, which stimulates the development of the egg.  LH is lutenizing hormone, which triggers the egg’s release from the ovary into the fallopian tube, which is where fertilization occurs if the conditions are right.  Estradiol is also known as estrogen, and it is the hormone that stimulates the preparation of the cervix and uterus for implantation of the fertilized egg.  Progesterone stabilizes the uterine lining and supports early development of the embryo, once it has implanted in the uterine wall.”

The doctor paused again, giving Jon a little smile.  “You with me so far?” 

Jon nodded.  “I follow.  And yeah, I’ve heard of those things before.  Just never really paid enough attention to learn what they did.”  He gave the doctor a guilty little grin.  "In one ear and out the other."

Dr. Seuss chuckled warmly.  “Well, that’s an honest answer.  And you’re paying attention now, so that’s what counts.”  She glanced at Cate and was heartened to see a small smile from her patient.

“So anyway, we also look at androgens, which are “male” hormones such as testosterone that are produced naturally in minimal amounts by the female body.  The reason we check androgens is to be sure there are not excessive levels that may interfere with follicle stimulation or cervical mucal production.  In other words, we want to be sure the male hormones aren’t overpowering the female hormones and preventing them from doing their jobs.”

“Releasing the egg and keeping the womb ready for it to land.”  Jon finished the thought for the doctor, grinning proudly.  He turned his head to give Cate a smile when he heard her quiet chuckle.

“Exactly.”  Dr. Seuss nodded back at Jon before turning her attention to her patient. 

“Cate, here’s what we found in your case.  Your LH and androgen levels were normal, which rules out Polycystic  Ovarian Syndrome.  I didn’t really expect to find any abnormalities there, since you are not symptomatic of PCOS.” 

Dr. Seuss fell back into her typical pattern of explanation with Cate, not bothering with layman’s terms.   She knew Cate preferred clinical terminology in their professional discussions; it enabled her to separate fact from emotion.  Dr. Seuss had no doubt her patient's preference was partially due to occupational habit, but she suspected it also was an unconscious defense mechanism:  one that allowed Cate to shove her emotions aside until she was ready to deal with them on her own terms.

The doctor waited for Cate’s nod of understanding before continuing.  “Your FSH and estradiol were slightly elevated, but not enough to be a major concern, especially once we compared those levels to your later test results.  Conversely, your progesterone levels were on the low end of normal, but still within parameters.”

“Well, that’s good.  Right, Jane?”  This time Cate’s voice carried a faint note of hope.

“Yes, it is a positive sign.  But the other tests are more indicative of your reproductive function.”  Dr. Seuss thumbed through several more pages of the thick medical chart.

“So, once these baselines were established we did more blood tests to further evaluate your ovarian function.  The test we did was called a CCCT, or a Clomiphene Citrate Challenge Test.”  She glanced back at Jon and saw he was following along, though clearly concentrating hard.  “ In plain English, we wanted to see if you were ovulating normally.” 

“Specifically, what we were looking for was the reaction of the FSH and estradiol levels to artificial interference.  Cate, we tested your FSH and estradiol levels on the third day of your menstrual cycle and again found them slightly elevated.  Then you took a course of clomiphene citrate for five days, and we tested you again on day ten.  On the tenth day your FSH levels had declined, indicating normal ovarian function.  And you noted in your basal body temp record that you ovulated approximately three days later, which is normal.”

A relieved sigh escaped from Cate’s lips, causing Dr. Seuss to pause again and give her a little smile.  Cate exchanged a look with her husband, then her blue-eyed gaze turned back to the doctor.

“So, if my hormone levels are all within normal range and I’m ovulating normally…”  Cate’s question trailed off as she remembered Dr. Seuss’ advice from her last appointment.  Though it may seem counterintuitive, if these tests show something it’s actually a good thing.  They will tell us what to treat.  That’s a step in the right direction.

Dr. Seuss saw in Cate’s crestfallen expression that she knew what was coming.  She felt a twinge of sympathy for her patient as she again regarded the chart.  Though she had delivered this news thousands of times to thousands of patients of whom she was fond, it never got any easier.  But it was her duty to be thorough and honest.

Dr. Seuss softly cleared her throat and continued.  “As for other factors, you are having frequent and well-timed intercourse.  Cate, you have reduced or eliminated any lifestyle factors that could affect normal body function, such as smoking, alcohol, caffeine, and various foods and additives.  You are healthy and active.  I noted no abnormalities in my most recent physical pelvic examination and your Pap was clear.”

“But…” Cate’s voice was hoarse, laden with disappointment.  “If there’s nothing wrong… if the tests show nothing wrong…”

Jon’s heart sank at the sadness in his wife’s unfinished question.  He may not comprehend all the biochemistry of these tests, but he had paid attention to the research Cate had shared with him over the past few months.  He had even done a little of his own, to try to understand what she was going through and what obstacles they may be facing.

Jon squeezed Cate’s hand, clasped in his, before speaking.  “If the tests are normal – for both of us – that means…”

Dr. Seuss reached up to pull her reading glasses from her face.  She gave the couple a sympathetic smile and nodded slowly.

“Cate, Jon, I’m sorry.  I was hoping we’d get some answers from all of these tests, and we did, in a way.  We know that your body chemistry is normal, and it’s likely not to blame for your inability to conceive thus far.  But without further, more extensive and invasive tests, there’s just no way to identify a problem.” 

Cate looked down at her lap as her eyes moistened with frustrated tears.  She blinked rapidly, trying to will them away.  She knew what Dr. Seuss was going to say.  In a way it was almost worse than the now ruled-out alternatives, that Jon’s sperm was abnormal or that she was not ovulating properly. 

It meant there was no one or nothing to blame, that there was no factor to control.

“Again, Jon, Cate… I’m sorry.  But at this point, my diagnosis is Age-Related Unexplained Infertility."