In Praise of Early Sex Ed and the Glory of Academic Medicine

When I was three, my mom was pregnant with my younger brother Dan. Curious about what was going on in her belly and how it all got started, I asked a lot of questions. My parents gave me honest, accurate, developmentally appropriate information. I don’t remember that first conversation about where babies come from. Just that I always knew. Some might credit it to growing up on a farm. I credit it to my mom’s pregnancy and a little 70s paperback, “Where Did I Come From?” by Peter Mayle and illustrated by Arthur Robins. I still remember the bearded photos of those guys on the back cover of that honest, human, silly book. Pretty sure that over the next few years, I ended up teaching some friends what I thought everybody already knew.

Instead of sating my curiosity, my parents’ answers made it grow. Mom took me to the public library to find more information. Later she told me that she had been a bit self-conscious about the content of what she was checking out for her pre-schooler, but she didn’t let it show at the time. It turned out to be essential reading. Because it gave me language and information that I could turn into questions about why and how my body was already changing. I remember looking at myself in the floor length mirror one Sunday after church. My dress akimbo, I was still wearing a full-length slip. It’s just a flash, that early memory, but I remember thinking: Something’s different.

Precocious Puberty was the diagnosis. At age three, my pituitary gland was kicking into high gear. Usually, it waits until around age twelve to direct the endocrine system to start pumping hormones to the rest of the body, prepping the it for menstruation, breast buds, and a final growth spurt. When the doctors discovered what was going on, they were worried about me starting a period in preschool and hitting my final height by early elementary.

It was the mid-1980s and thanks be to God the University of Minnesota hospitals were working on a trial just an hour up the road. Dr. Ora Pescovitz and her right-hand nurse Barb Rutcher would become fixtures in my early life. (We ended up making annual visits to the hospital from age three to age twelve, with daily injections for the duration.) Along with Barb and Dr. Pescovitz were people like Judy, the best blood draw nurse ever, and so many others. But it was a process to find them.

Along the way, we had one visit to the Mayo Clinic (a truly excellent hospital), though my experience there was less than stellar. I don’t remember the name of the doctor we saw, just that in my mind he will forever be “Doctor Duck.” He used a Donald Duck puppet to speak to me. I don’t know if this is accurate or if my memory has papered over facts with emotional content, but I remember him quacking at me. I was only four at the time, but it was offensive. Dude. I’m a person, not a duck.

Barb and Dr. Pescovitz always talked to me like a person and treated me with respect. They talked me through every touch and exam, before, during, and after. They were kind and human. They didn’t speak over me, as though my parents were the only ones who mattered because they were the adults in the room. And they didn’t speak down to me. They made sure I was a participant in my care and understood what was happening every step of the way.

I liked this a lot, being treated like a whole person and an active participant in the care I was receiving. I like it when my medical providers talk to me. This is not universally the case.

The first of our IUI attempts (intrauterine insemination—one step up from a turkey baster) happened on a snowy Saturday morning in December of 2020. I had been peeing on sticks to track my ovulation and was excited to see the smiley face the day before. But I was also nervous. I had already managed to set my hair on fire that morning when blowing out the HOPE and JOY candles in the Advent wreath. The day was off to a great start.

It was early COVID days, so after dropping off his sample, Lucas wasn’t allowed to come back with me for the procedure. I stripped off my snow boots and my bottoms and scooted my butt to the edge of the paper clad table, feet in the stirrups. The nurse was kind enough and skilled as she threaded the catheter loaded with Lucas’s sperm through my cervix. But the room was so quiet. As she finished and was cleaning up her supplies, I thought to ask, “How likely are we to be successful with this?”

“Oh!” She sounded surprised. “There’s about an 18% chance this will work. Higher than regular intercourse (which has about 11% chance of pregnancy). Most patients, if they haven’t achieved pregnancy by their sixth IUI attempt, start exploring other options.”

Good information to have. Glad I thought to ask it. Would have been nice to get it from our doctor before coming in. This was all so new to us. How were we even supposed to know what to ask for?

After about six months of “good enough” care that felt kind of like we were on a cookie cutter conveyor belt, I started asking more questions, asking around, and talking more openly with trusted friends about infertility. It seemed likely that IVF would be in our future and with all that that entails physically and emotionally (more on this in another edition), I was starting to realize that “good enough” simply wouldn’t cut it. I started thinking about Barb and Judy and Dr. Pescovitz, realizing that it was okay to ask more of my care team.

Again, thanks be to God, a new outpost of the University of Iowa hospitals had opened recently in West Des Moines. In September 2021, we had our first visit. The experience of being listened to and cared for as a whole person echoed those early childhood visits to the U of M. They did a baseline ultrasound that day and the sonographer talked us through the whole thing. There was a screen mounted on the wall in front of me so I could see what she was seeing—my uterus, my ovaries, the lining, the likely corpus luteum from a recent ovulation. This care wasn’t something that was happening to me, it was happening with me. When we walked out of the office two hours later, I had to stop in the parking lot to cry. Lucas embraced me and said, “That was easily 100 times better. You were right. I’m so glad we made the change. You were so right.”

That first experience has been borne out in the care we’ve received over the last year. Last Friday we were in Iowa City for an ultrasound. This was the second of three ultrasounds we had in eight days to track the growth of follicles in my ovaries after starting to stimulate them. Instead of letting one or two follicles develop naturally, an IVF cycle works to suppress natural ovulation and develop a whole crop of follicles that can be harvested at retrieval. I’ve started to think of my ovaries as swimming with boba bubbles because there are literally dozens of follicles growing in there, some measuring over 18 millimeters. I feel juicy and bloated and a little sleepy.

But at that Friday ultrasound, we didn’t know how many follicles there were or how they were growing. Our sonographer was warm, competent, talkative, professional, and human. I mentioned that I’d been starting to notice an abundance of cervical fluid. “Oh, yes. We call this the ‘Mucus Monster stage’,” she said. “Look at that fluffy lining in your uterus! Perfect landing pad.” And as she measured and counted, she gave my knee a little squeeze, praising my ovaries with little exclamations of “Beautiful!” and “Good girl!” It’s hard to overstate how comforting it was to receive this encouragement from a woman with confident mom-energy. To hear that my body was doing what it was supposed to while in that vulnerable state with hormones pumping through me and the vaginal ultrasound wand inside. It was kind and encouraging and human.

I’m not sure what else to say at this moment other than that I thank God for the glory of academic medicine. I praise her for the wonder of scientific inquiry and for people who make it their life’s work to be curious about the body and to pursue answers and to share all of that in very human ways with people receiving their care. I give thanks for my parents who modeled a lack of embarrassment around questions of any kind and listened to what I was telling them about my body and helped me get the care I needed at a young age. And I praise God for the imprint that Barb and Dr. Pescovitz left on me so that when I needed better care, I had a model and an expectation for it. Today I give thanks for Dr. Mancuso and Courtney and Sara and Clare and Hilary and Hannah and Callie (with an amazing pro-tip about icing before intramuscular injections!) and all the others who are making my care possible. There’s so much life on the way to life!