Six percent -- the number hangs in the air, clinical and indifferent.
Nathan sits still, hands clasped in his lap. Elena's hand rests on his knee, warm and slightly clammy, gripping tighter than usual. He hasn't looked at her since they sat down.
Across from them, Dr. Elaine Sutter flips in their file. Her straight posture and neutral expression are hard to read. The overhead lights reflect off the thin metal frame of her glasses as she begins to speak.
She turns to the beginning of the file again, her voice even, controlled. "Let's go over the specifics. Nathan, your sperm count is nine million per milliliter--below the normal range of fifteen million or higher. Your motility is also slightly reduced, meaning fewer sperm are capable of reaching the egg, most likely a result of childhood cancer."
Nathan absorbs the numbers, cold and precise.
"For reference, a couple with no fertility issues has about a 20-25% chance per cycle. So, for them, after one year there is about an 85% chance they will conceive. Given your situation, your probability of conception is around 6% per cycle. That means you have about a 50% chance of success after one year."
Elena thinks as she exhales, barely audible. "But it's possible?"
Dr. Sutter nods. "Yes, it's very possible, but it likely will take longer."
Dr. Sutter turns to Elena. "Your results are positive. Your ovarian reserve is strong, and your ovulation cycle is regular. However, your cervical mucus is slightly more acidic than ideal. This can reduce sperm survival rates."
Elena frowns. "Is that something we can fix?"
Dr. Sutter nods. "It's a minor factor. Some diet adjustments, hydration, and supplements can help balance the pH, so it's not a severe issue.."
Nathan's fingers twitch slightly. Elena shifts beside him. "So what do we do?"
Dr. Sutter folds her hands. "There are medical interventions like intrauterine insemination (IUI) and in vitro fertilization (IVF), but we typically recommend those after about a year of trying without success--unless there are known medical concerns. Since you'd prefer to avoid those for now, I'd suggest starting with a fertility medication, like letrozole, alongside lifestyle modifications and addressing the physiological factors we discussed. These steps may help improve your chances more naturally."
Nathan sits up slightly. Elena tilts her head. "Okay, that makes sense, but what do you mean by behavioral changes exactly?"
Dr. Sutter pauses briefly before answering. "The biggest factor is stress. Chronic stress raises cortisol levels, which can interfere with ovulation and reduce sperm production. It can also affect libido and sexual function in both partners. Managing stress through relaxation techniques, regular exercise, and adequate sleep can help. Beyond that, tracking ovulation carefully, maintaining a balanced diet, and ensuring frequent intercourse--especially during peak fertility windows--are all important strategies."
Elena lets out a breath, saying "So keep the gym membership?" with a half-smile.
Dr. Sutter smiles gently. "Absolutely." We underestimate how much mental health affects reproductive health."
Nathan nods, but his thoughts have already moved on.
Elena asks, turning to Nathan before the doctor, "Anything else we can do? Any other research we might consider?"
Dr. Sutter continues, "Another area of research is uterine contractions and sperm transport."
Elena raises an eyebrow. "Meaning?"
Dr. Sutter leans forward slightly. "Some studies suggest the female orgasm may assist in guiding sperm deeper into the reproductive tract."
Elena lets out a short, slightly disbelieving chuckle. "Wait--you're saying...?"
Dr. Sutter smiles slightly. "It's debated, but it's called the 'Upsuck Hypothesis.' First proposed in the early '90s, it suggests that uterine contractions post-orgasm create a suction-like effect, drawing sperm toward the fallopian tubes."
She leans in and adds, "With this in mind, there may be things you can do to enhance the quality of your sex to encourage orgasm in Elena. To me, it's important to look at the cumulative effect of stacking your efforts. The psycho-emotional component to this is stronger than many health professionals would care to admit."
Elena glances at Nathan, then back at the doctor. "And this actually helps?"
Dr. Sutter nods. "Potentially. The evidence is mixed, but there is some correlation between female orgasm and increased sperm retention."
Nathan's fingers tap absently against his knee.
Dr. Sutter looks down at her desk for a moment as if flipping to another section in her brain. Then she looks right at Nathan before turning decisively to Elena.
Leaning in on her desk, the doctor says, "Lastly, ejaculation depth. Some evolutionary biologists propose sperm deposited closer to the cervix may increase survival rates because the cervical environment is less acidic than the vaginal canal."
Elena raises an eyebrow. "So... position matters?
Dr. Sutter gives a neutral shrug. "Potentially. A study in The Journal of Sexual Medicine examined penetration depth and its relationship to female orgasm. Some participants reported a higher likelihood of orgasm with partners who had longer penises, possibly due to increased stimulation of the anterior fornix and cervix. But again, this is just a theory--we're digging deep here. Statistically, there's no proven correlation between penis length and fertility."
Nathan absorbs that detail without reacting. Elena shifts slightly in her chair. "So, basically, we just... keep trying?"
Dr. Sutter smiles. "If there's no success within six months, we'll reevaluate."
Elena nods, as if reassured. Nathan gives a small nod as well.
'Well, unless you have any other questions for me, I think that's it."
Elena reaches for her purse, "Thank you, doctor."
***
The moment they step into the hallway, Elena stops. She lets out a breath, shaky and thinking. "I thought it might be worse."
Nathan searches her face. Her eyes are glassy, but she isn't crying. "It's not nothing," he says.
"It's still a decent chance," she replies, nodding, chewing her lip, then glances up at him. "You're okay?"
Nathan doesn't answer right away. He isn't sure if okay is the right word. There's a tightness in his chest that hasn't loosened since they sat down in the office, a growing pressure behind his ribs. But Elena is watching him, waiting.
So he nods. "Yeah, I mean, I wish things were different, but I'm dealing."
Elena exhales in relief, then steps toward him, wrapping her arms around his waist. She presses her forehead against his chest, her breath warm through his shirt. For a moment, they just stand there, holding onto each other, absorbing the weight of it.
Nathan smooths his hands down her back, slow and steady, like the simple rhythm of it can calm them both.
"We'll figure this out," he murmurs against her hair.
Elena nods against him. "Together."
There is no hesitation in her voice.
***
The car ride home is quiet, thick with unspoken thoughts. Elena sits beside him, hands folded in her lap, eyes fixed on the window as the buildings blur past. She isn't crying. She isn't angry. She's just... absorbing. Nathan, on the other hand, feels like he's waiting for something to hit him.
The numbers were clinical, indifferent to emotion. Beside him, Elena sits quiet and firm--the set of her jaw, the steady rhythm of her breathing-- all telling him she isn't ready to talk.
***
With golden hour light coming through the window above the sink, Nathan sits at the kitchen table, his laptop open in front of him, his screen glows in his glasses. The faint sound of the refrigerator and a dog barking in the distance are the only reminders of the present moment. His mind isn't here. He is back in the car, the weight of the situation still pressing on his chest.
Yet it isn't the sterile doctor's office or car ride home that burns in his memory now--it's that night at the Lamplighter Motel outside of Tulsa, their first road trip. With the neon vacancy sign flickering against the storm, Elena on the edge of the bed, arms wrapped around her knees, staring at the floor like the words she is about to say have been clawing at her.
Nathan closes his eyes. The room is dark. He can still hear the rain against the window, the freeway traffic interjecting over the low hum of the motel heater.
Elena's voice is quiet, unshakable. "I want my own baby," she says softly, as if lowering her voice might make the words easier to say. She turns toward him. "I can't do what Rachel did. What Jennifer did. I just... I can't."
She exhales, almost shuddering. "They tried so hard to love them. They gave them everything. And it didn't matter. It was never enough."
Nathan's grip on the beer bottle tightens. He swallows. "What?"
Her voice sharpens. "Rachel has to lock her bedroom door at night. Jennifer--she still has nightmares about the things that boy did."
She shakes her head. "And I know how it sounds. I know it makes me a bad person. But I don't care. I need any child I raise to actually be mine. To come from me. To come from us."
She looks at him, watching his face, trying to judge his reaction.
Nathan sets his beer down, exhaling slowly, trying to absorb it. This isn't a conversation he expected--not now, not this early.
"So adoption's not an option?" he asks, more to himself than to her.
Elena shakes her head. "No. Not for me, if I'm honest."
As Elena wipes a hand over her face, the wind slams against the window, thunder rolls over them, "I can't go through what they did. I won't. If I can't have a baby of my own... I don't think I can do it at all."
Nathan opens his eyes. His heart is pounding.
***
The doctor's words linger for Nathan, turning over in his mind until they connect. The upsuck hypothesis. Ejaculation depth. The subtle but undeniable advantage of anatomical variation.
Nathan opens a new browser tab and begins searching. A flurry of academic papers, forum discussions, and fertility websites fills his screen. One study in The Journal of Sexual Medicine reinforces the connection between deep penetration and sperm retention. Another outlines the potential benefits of post-orgasm contractions. He skims abstracts, pasting interesting parts in a document, weaving together a framework that makes sense -- to him at least.
With every click, every statistic, it starts to fall into place. He stumbles across a discussion on evolutionary biology, citing how female orgasm might enhance conception. Another paper explores the link between psychological arousal and reproductive efficiency.
It isn't just about mechanics--it's about the body's instinct to respond. To dominance. To submission. To overwhelming pleasure.
He lets out a slow breath, fingers hovering over the keyboard.
He isn't naive. He's known Elena's little secret for a long time.