(It's taken me ages to update, but the problems I've been having sorting out my finances for uni have really been distracting me. This is only a short chapter for now to let you all know I'm still alive. I have actually done a little research for this part but I've probably misapplied most of what I learned! Enjoy anyway.)
Part 3
As they approached the doctor's office Carter began to hang back, walking ever slower as if approaching his executioner, so that by the time they arrived outside the office he had come to a complete stop. He watched as Abby knocked and entered the room but for some reason he couldn't get his feet to follow her, so he stood there and listened as she and the doctor shared pleasantries.
"Hello Dr Infante," Abby greeted.
"Abby! Good to see you again so soon," Dr Infante said, coming out from behind her desk to take Abby's hand in hers. "I thought I was seeing your husband today?"
"Oh you are. He's right..." Abby turned around to introduce Carter only to find that he wasn't behind her as she thought. She turned back to the doctor and spoke in a confused voice. "He *was* right here. I'm sorry, I think he's just a little nervous about meeting you...you know, under the circumstances," she added in a whisper.
"It's perfectly understandable," Dr Infante said softly. "We do find that some men react differently to women in this situation, so we try to take things as gently as possible. It's alright John," she raised her voice so that Carter could hear her in the hallway, "you can come in now. I don't bite!" Abby laughed softly, recognising the patient *I'm-dealing-with-a-child* voice she often had to use with Carter to get him to do something he didn't want to.
Realising how irrational he was being Carter found the courage to enter the room. First he poked his head around the door frame to see the two women smiling at him indulgently, then seeing Abby trying not to laugh at his sheepish expression he slinked into the room.
"You must be John," Dr Infante said, holding out her hand to greet Carter. "It's wonderful to finally be able to put a face to the name."
"Same here," Carter said as he shook her hand briefly then let it drop.
"Please take a seat," she said as she walked back behind her desk and sat down in her chair. "So how are you both feeling?"
"Not too bad," Abby said
"Nervous as hell," joined in Carter. Dr Infante laughed silently.
"I understand that you're both anxious to find out the results of the tests. Let me start by repeating what I said yesterday to Abby, John. I don't think there is any reason why you shouldn't be able to conceive under natural circumstances. Tests of Abby's hormone and ovulation levels suggest that everything is in order, and tests we've run with the samples you provided us with are encouraging. With the first one..."
"Why did I have to give two samples?" Carter asked, interrupting her. This was a question that had been bugging him for hours now and he wanted to get this out of the way before moving on to the results themselves.
"Well, we wanted to be thorough for one thing. We used the first sample you provided us with to conduct a mucus-penetrance test. In a third of cases of infertility the problem lies in the incompatibility of the partners so we wanted to be sure that your sperm were capable of moving through the cervical mucus."
"And?" He was squirming in his seat, finding this conversation decidedly uncomfortable. A quick glance at Abby told him that she was taking this all in, word for word.
"Good news," the doctor smiled, "the two of you are perfectly compatible."
Carter had been holding his breath while she spoke, and upon her finishing he blew the air out through his cheeks in relief. He looked across and smiled at Abby, who was also smiling back, but then realising that the doctor had not told them everything he turned his head back to face her. The question was on the tip of his tongue, but before he could ask it Abby beat him to it.
"So what's the problem? Why can't we get pregnant?" she asked.
"Are you sure you want Abby to be here for this?" Dr Infante asked Carter, putting off answering the question for a few moments. "Some people can find this a little personal."
Carter reached out and took hold of Abby's hand, then taking a deep breath he spoke to the doctor. "Whatever you tell me I'm going to tell Abby anyway, only I may not be so honest so it's probably best she gets all the details from you anyway."
"Alright then. The second set of tests confirmed that whilst you have a high sperm count and the morphology is normal, your motility is a little lower than we'd usually expect."
Carter paused as he took in what he had just been told and digested it. He started to speak but couldn't get the words out, so he cleared his throat and spoke in a slightly squeaky voice. "Are you saying that I have *lazy sperm*?
"Well, I question the use of the term 'lazy' but, essentially yes. Before ejaculation sperm generate the energy they need for motion primarily by burning fat, and after ejaculation they rely on the sugar fructose that is found in the seminal fluid. Your sperm, however, are burning up energy at a rapid rate and are not therefore generating enough for the journey ahead. They are, in effect, tired out before they even get to the egg."
"What can we do?" Abby asked, gripping onto Carter's hand.
"The protein carnitine facilitates the conversion form fat and sugar to energy, but recent studies suggest that carnitine levels are lower in the semen of men with low motility. By putting you on a dietary supplement called Proxeed I'd hope to see a significant improvement in motility within three to six months, and you should be able to conceive naturally."
"That's great!" Carter said, truly smiling for the first time since yesterday. "So when can we get started on that?" he asked enthusiastically.
"I'll write you a prescription before you leave, but there are just a few other questions I'd like to ask you first." She started to type notes into her computer as she asked the questions and didn't really raise her eyes to see his answers. "Are your sleep patterns irregular?"
"Sort of, "Carter answered. "I've been working more regular shifts since I became an attending but I still have to pull an occasional double."
"Uh huh," she typed something into the computer and then continued with her questions. "How about diet? Do you eat healthily, or junk food?"
"I eat as well as I can when I'm at home, but it tends to be whatever I can grab when I'm at work."
"Do you drink?"
"No."
"What about smoking?" She asked, not looking up from her computer screen and jotting down notes as he spoke.
"No...well, yeah, but not regularly. A couple a day at most. It's not like I'm addicted or anything...Why, is that important?"
"It could be," she said, jotting down some final notes and then removing her glasses to look at him. "Recent tests have shown that nicotine closes up the arteries that lead to the penis and can reduce the pressure of blood in the penis. Tell me, have you ever experienced Erectile Disfunction?"
Carter's eyes widened and he held quickly turned on Abby. "You TOLD her?!" he exclaimed. "I can't believe you said that!" He turned back to Dr Infante and started to explain. "It was just this one time. It was six months ago, I'd been on call for 36 hours straight, I was exhausted. I'm amazed I even had the energy to get up the stairs, let alone get..."
"JOHN!" Abby said in shock at what Carter had been about to say. He murmured an apology and slipped down into his chair, embarrassed. Dr Infante stepped in to calm the situation down.
"Dr Carter, Abby has said nothing to me about your personal life. I'm just trying to piece together possible reasons for your inability to conceive. In an otherwise healthy male the most common factors tend to be diet or lifestyle. In addition to the Proxeed I'm going to ask you to give up smoking, as it is known that smokers who quit immediately improve their chances of producing healthy sperm and conceiving. I also want you to both look into your diet and revise your eating habits." She stood up and held out her hand to say good-bye and Carter and Abby rose also. "I've sent a message through to the front desk and your prescription should be ready to collect. I've also arranged for an information pack to be made up for you to take home and read. Please read through it carefully."
"We will," Abby said, shaking Dr Infante's hand again. By this time they had reached the door and the doctor had opened it for them. "Thank-you so much for everything."
"You're welcome. Don't forget to make an appointment for next week so we can discuss your schedule. It was lovely to meet you, John," she added, addressing Carter. "If you have any questions don't hesitate to call."
"Thank you." He smiled tightly, still a little embarrassed by his little outburst and the situation as a whole. "Come on Abby, let's go."
Taking hold of Abby's hand he quickly made his way towards the front desk to collect the prescription and largestack of information booklets that were waiting for them. Abby barely had time to turn and smile at the doctor over her shoulder before he whisked her away and out of the centre, and the next thing she knew they were in the car and on their way home.
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Part 3
As they approached the doctor's office Carter began to hang back, walking ever slower as if approaching his executioner, so that by the time they arrived outside the office he had come to a complete stop. He watched as Abby knocked and entered the room but for some reason he couldn't get his feet to follow her, so he stood there and listened as she and the doctor shared pleasantries.
"Hello Dr Infante," Abby greeted.
"Abby! Good to see you again so soon," Dr Infante said, coming out from behind her desk to take Abby's hand in hers. "I thought I was seeing your husband today?"
"Oh you are. He's right..." Abby turned around to introduce Carter only to find that he wasn't behind her as she thought. She turned back to the doctor and spoke in a confused voice. "He *was* right here. I'm sorry, I think he's just a little nervous about meeting you...you know, under the circumstances," she added in a whisper.
"It's perfectly understandable," Dr Infante said softly. "We do find that some men react differently to women in this situation, so we try to take things as gently as possible. It's alright John," she raised her voice so that Carter could hear her in the hallway, "you can come in now. I don't bite!" Abby laughed softly, recognising the patient *I'm-dealing-with-a-child* voice she often had to use with Carter to get him to do something he didn't want to.
Realising how irrational he was being Carter found the courage to enter the room. First he poked his head around the door frame to see the two women smiling at him indulgently, then seeing Abby trying not to laugh at his sheepish expression he slinked into the room.
"You must be John," Dr Infante said, holding out her hand to greet Carter. "It's wonderful to finally be able to put a face to the name."
"Same here," Carter said as he shook her hand briefly then let it drop.
"Please take a seat," she said as she walked back behind her desk and sat down in her chair. "So how are you both feeling?"
"Not too bad," Abby said
"Nervous as hell," joined in Carter. Dr Infante laughed silently.
"I understand that you're both anxious to find out the results of the tests. Let me start by repeating what I said yesterday to Abby, John. I don't think there is any reason why you shouldn't be able to conceive under natural circumstances. Tests of Abby's hormone and ovulation levels suggest that everything is in order, and tests we've run with the samples you provided us with are encouraging. With the first one..."
"Why did I have to give two samples?" Carter asked, interrupting her. This was a question that had been bugging him for hours now and he wanted to get this out of the way before moving on to the results themselves.
"Well, we wanted to be thorough for one thing. We used the first sample you provided us with to conduct a mucus-penetrance test. In a third of cases of infertility the problem lies in the incompatibility of the partners so we wanted to be sure that your sperm were capable of moving through the cervical mucus."
"And?" He was squirming in his seat, finding this conversation decidedly uncomfortable. A quick glance at Abby told him that she was taking this all in, word for word.
"Good news," the doctor smiled, "the two of you are perfectly compatible."
Carter had been holding his breath while she spoke, and upon her finishing he blew the air out through his cheeks in relief. He looked across and smiled at Abby, who was also smiling back, but then realising that the doctor had not told them everything he turned his head back to face her. The question was on the tip of his tongue, but before he could ask it Abby beat him to it.
"So what's the problem? Why can't we get pregnant?" she asked.
"Are you sure you want Abby to be here for this?" Dr Infante asked Carter, putting off answering the question for a few moments. "Some people can find this a little personal."
Carter reached out and took hold of Abby's hand, then taking a deep breath he spoke to the doctor. "Whatever you tell me I'm going to tell Abby anyway, only I may not be so honest so it's probably best she gets all the details from you anyway."
"Alright then. The second set of tests confirmed that whilst you have a high sperm count and the morphology is normal, your motility is a little lower than we'd usually expect."
Carter paused as he took in what he had just been told and digested it. He started to speak but couldn't get the words out, so he cleared his throat and spoke in a slightly squeaky voice. "Are you saying that I have *lazy sperm*?
"Well, I question the use of the term 'lazy' but, essentially yes. Before ejaculation sperm generate the energy they need for motion primarily by burning fat, and after ejaculation they rely on the sugar fructose that is found in the seminal fluid. Your sperm, however, are burning up energy at a rapid rate and are not therefore generating enough for the journey ahead. They are, in effect, tired out before they even get to the egg."
"What can we do?" Abby asked, gripping onto Carter's hand.
"The protein carnitine facilitates the conversion form fat and sugar to energy, but recent studies suggest that carnitine levels are lower in the semen of men with low motility. By putting you on a dietary supplement called Proxeed I'd hope to see a significant improvement in motility within three to six months, and you should be able to conceive naturally."
"That's great!" Carter said, truly smiling for the first time since yesterday. "So when can we get started on that?" he asked enthusiastically.
"I'll write you a prescription before you leave, but there are just a few other questions I'd like to ask you first." She started to type notes into her computer as she asked the questions and didn't really raise her eyes to see his answers. "Are your sleep patterns irregular?"
"Sort of, "Carter answered. "I've been working more regular shifts since I became an attending but I still have to pull an occasional double."
"Uh huh," she typed something into the computer and then continued with her questions. "How about diet? Do you eat healthily, or junk food?"
"I eat as well as I can when I'm at home, but it tends to be whatever I can grab when I'm at work."
"Do you drink?"
"No."
"What about smoking?" She asked, not looking up from her computer screen and jotting down notes as he spoke.
"No...well, yeah, but not regularly. A couple a day at most. It's not like I'm addicted or anything...Why, is that important?"
"It could be," she said, jotting down some final notes and then removing her glasses to look at him. "Recent tests have shown that nicotine closes up the arteries that lead to the penis and can reduce the pressure of blood in the penis. Tell me, have you ever experienced Erectile Disfunction?"
Carter's eyes widened and he held quickly turned on Abby. "You TOLD her?!" he exclaimed. "I can't believe you said that!" He turned back to Dr Infante and started to explain. "It was just this one time. It was six months ago, I'd been on call for 36 hours straight, I was exhausted. I'm amazed I even had the energy to get up the stairs, let alone get..."
"JOHN!" Abby said in shock at what Carter had been about to say. He murmured an apology and slipped down into his chair, embarrassed. Dr Infante stepped in to calm the situation down.
"Dr Carter, Abby has said nothing to me about your personal life. I'm just trying to piece together possible reasons for your inability to conceive. In an otherwise healthy male the most common factors tend to be diet or lifestyle. In addition to the Proxeed I'm going to ask you to give up smoking, as it is known that smokers who quit immediately improve their chances of producing healthy sperm and conceiving. I also want you to both look into your diet and revise your eating habits." She stood up and held out her hand to say good-bye and Carter and Abby rose also. "I've sent a message through to the front desk and your prescription should be ready to collect. I've also arranged for an information pack to be made up for you to take home and read. Please read through it carefully."
"We will," Abby said, shaking Dr Infante's hand again. By this time they had reached the door and the doctor had opened it for them. "Thank-you so much for everything."
"You're welcome. Don't forget to make an appointment for next week so we can discuss your schedule. It was lovely to meet you, John," she added, addressing Carter. "If you have any questions don't hesitate to call."
"Thank you." He smiled tightly, still a little embarrassed by his little outburst and the situation as a whole. "Come on Abby, let's go."
Taking hold of Abby's hand he quickly made his way towards the front desk to collect the prescription and largestack of information booklets that were waiting for them. Abby barely had time to turn and smile at the doctor over her shoulder before he whisked her away and out of the centre, and the next thing she knew they were in the car and on their way home.
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