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.
***