Lecretia's Choice

by Matt Vickers

  A cycle would begin, and we would try to stay healthy as Lecretia tracked something called the luteinising hormone, waiting for a surge in numbers that appeared a few days before ovulation and marked the optimum time to conceive. As much as I enjoyed making love to my wife, the introduction of a schedule into our sex life felt antithetical to passion. Nevertheless, we’d persist and there would be an anxious two-week wait to see whether we had been successful, during which Lecretia would carefully monitor her diet. She would test herself for pregnancy. Sometimes a promising faint blue line would appear.

  The arrival of her period was always heartbreaking for her. Every month she dared to hope, and every month she was let down.

  In early 2007, after almost a year with no success, we approached a medical practice that assisted couples in achieving healthy pregnancies. Lecretia and I were tested. The news was bad. She had endometriosis. Her fallopian tubes, instead of being smooth and clear, were striated and distorted. Lecretia described subsequent events in a diary she started after entering treatment.

  16 March 2007

  Nine days since I was told I have endometriosis and need laparoscopic surgery. I am devastated. I was completely unprepared for this and am surprised by how upset it has made me. It is getting easier to deal with but I am finding it very hard. I told Mai earlier in the week. She was very good about it. She advised me to treat it like a client problem and told me to open a file called BAB100/01! Tonight my new grad (who has two children at twenty-five) asked me if I had children, and then if I wanted them. It really upset me. We had drinks at Mai’s and there were children everywhere. I feel very much an outsider at these things.

  The purpose of the surgery was to remove as much of the endometriosis as possible, to give her eggs a better chance of reaching the womb. But Lecretia wasn’t convinced that the endometriosis was the sole cause of her problems. She started looking at other things in her life that might be contributing to her infertility, and an obvious candidate was work. Lecretia was barely sleeping—she would be home late at night and awake again and in at the office before I’d opened my eyes. She was under a lot of stress, and she’d had a few disagreements with Mai, too.

  27 May 2007

  The operation went well according to the surgeon, although he said the endometriosis was substantial. The operation was scheduled for the worst possible time with work, which made it more stressful. We didn’t try last month, as it was only a week or so after my operation. Matt has been very good about everything. I am lucky to have such a loving and supportive husband. I’ve had a couple of hideously stressful weeks at work. I don’t think I’ve been this stressed for a long time. I’m feeling much more positive, though. Before I was thinking that we would never have a baby, but now I’m thinking that we will get there. I think it is important for me to get more relaxation time. I wanted a promotion at work, but now I think I have come to the realisation that it is not more important than having a family. Work is causing me a huge amount of stress at the moment, and Matt is bearing the brunt of it, which is unfair. I’m going to try and be much more zen this week. We’re going to try again this month naturally and then next month start intra-uterine insemination. It sounds unpleasant, and it is bloody expensive, but we cannot get state-funded IVF until we have done three IUIs. Stupid. Matt’s sperm is fine, though, so that’s something. It’s just me who’s defective. I’m anxious that time is slipping away.

  I think my disagreement with Mai last week is helping me to realise I need to put other things ahead of my job. It’s hard, though. A friend said things would happen when I really wanted them to. Well, I really do.

  1 June 2007

  I dreamt last night that I had a baby boy. I delivered it myself in bed, but then I didn’t know what to do with it. Maybe I think I won’t know what to do with one.

  17 June 2007

  A colleague is pregnant after two months of trying. I’m pleased for her, of course, but it is like a dagger when I have just got my period. Picked up the IUI drugs today. Didn’t realise they are injections. Lucky I don’t have a needle phobia.

  Under New Zealand law, before in-vitro fertilisation or IVF is publicly funded, you must first attempt something called intra-uterine insemination or IUI. In IUI, they take a semen sample, wash the sperm so that only healthy, active sperm remain, then inject the sperm into the uterus. It’s the same thing they do with livestock, and it feels that way too.

  Even when you’re the fertile one, the procedure takes its toll. You feel like your fertility should be able to compensate for your lover’s problems. Getting pregnant with the help of doctors divorces it from sex and love: it becomes a medical exercise. You feel like you’ve somehow failed at love, and you start questioning yourself and whether you want it as much as your partner. Is there something psychological standing in the way of conception? Is there some basic chemical incompatibility between us?

  24 June 2007

  Started the first round of IUI this week. I’ve been injecting myself for the past six days. It’s not much fun, but I’m okay at it. I’m tired because I have had to be at the clinic early on both weekend days. My scan this morning showed that I had two follicles! Apparently my oestrogen wasn’t great, though. More blood tests every day this week.

  28 June 2007

  Insemination day today. I am nervous and excited. Hardly slept last night, though, so am worried that will have a negative impact. Matt had a cold and snored half the night.

  29 June 2007

  Insemination was fine. Didn’t like the stirrups. Was uncomfortable, like a bad smear, but not too bad. Twelve million sperm inserted. Had cramps last night but okay now. Bad timing as I have a huge deadline this week and Mai away from today. I am exhausted and have to work all weekend.

  15 July 2007

  Today is day five of my period. Round one of IUI did not work and I am gutted. Had counselling session on Friday. It was okay. It reinforced the need for Matt and I to stay solid as a couple.

  27 July 2007

  Awful week. When I finally finished work at 11 pm on Monday night I couldn’t sleep. Resolved to resign. I had a very heated discussion on Tuesday morning with Mai, which cleared the air. Got home from work at 1 am. Insemination was the next day. It’s so unfair that insemination day ended up being scheduled during one of the most stressful days of my working life. When I went to the bathroom just before I left to go to the clinic, I discovered I was bleeding. Had to have a scan and cervical examination and the doctor said the bleeding meant there was almost no chance of the procedure working. They had already prepared the sperm, so decided to go ahead because there would be no harm to me, but the message I got was that it was pretty pointless. Cried during insemination.

  9 August 2007

  I have a rotten cold, bad period pain, and found out yesterday that I need more surgery. Hysteroscopy now. It’s never-ending. I’m angry with Matt for being out tonight when I need some comfort.

  The purpose of the hysteroscopy was to check for polyps in Lecretia’s uterus, which might have explained her irregular bleeding. But it turned up nothing unusual. Our spirits improved. We felt better about going into our third round of IUI, but it failed too. Each pregnancy test remained agonisingly absent of blue lines, a blank space on an impersonal plastic oracle.

  3 November 2007

  I quit my job on Monday. Still can’t quite believe it. Mai took it well. She offered for me to work part time, or take less responsibility. It made it hard. She is making moves to promote Catherine and Nick now, which was predictable, but quite gutting all the same. I’m annoyed with myself for being so sad about leaving. I think Matt was expecting me to come home and celebrate, but I just came home and cried. I have poured my heart and soul into that job and despite everything I feel very sad about leaving. I have barely slept for a month. I am so confused about what to do next. Andrew Butler of Russell McVeagh wants me to work for him, which is very flattering. But so does Geoffrey Palmer.

  A few weeks earlier
I had bumped into Sir Geoffrey at an event at the Opera House, and we spoke about Lecretia in depth. I told him of the pressure she was under, and how the long hours she was putting in at Chen Palmer were making her very unhappy.

  ‘You’ve got to get her out of there,’ I said, as though asking a firefighter to rescue someone from a burning building.

  Lecretia resigned from Chen Palmer not because she disliked the work, but because having identified work as a contributor to her stresses she felt it was best to move on to somewhere with more manageable hours. Ultimately she decided to follow her old boss Sir Geoffrey Palmer to the Law Commission, where Geoffrey was the chief commissioner and she was appointed senior legal and policy adviser.

  After Lecretia left, Mai offered Catherine Marks a promotion to principal, but Catherine wasn’t interested in staying on at Chen Palmer without Lecretia. Catherine also resigned and took a job working with Andrew Butler and Tim Clarke at Russell McVeagh.

  Chapter 7

  AFTER FAILING THREE IUI cycles, we were now eligible for IVF. Though it’s now a common medical intervention, IVF is still somewhat magical. Over the course of a couple of months, a woman is given a series of drugs to stimulate egg growth, and to delay slightly the release of those eggs so that they grow to the right size. At the correct point in time, the patient comes into the clinic and is strapped into a chair, her legs spread indelicately apart. A nurse rubs her belly with conductive jelly and moves an infra-red scanner over it, which broadcasts images to a monitor. The scanner is manipulated until the ovary comes into view.

  The fertility doctor inserts a syringe into the ovary via the vagina and uterus. You can see the passage of the needle on the monitor. Once inside the ovary, the end of the needle seeks out egg follicles, which appear as small black disks, full of mystery and possibility. The doctor sucks the content of the first follicle out through the needle, and the small black disk shrinks into nothing. The procedure is repeated until all the follicles have been emptied. Then the eggs are taken away and mingled with the partner’s sperm in a petri dish.

  Numbers are very important in this world. The follicles are measured before they are sucked dry. Anything over fourteen millimetres in diameter is promising, and the more eggs that are harvested, the more chances of success.

  Lecretia’s ovaries were not producing eggs of the number and quality you would expect for someone of her age. Neither of these problems was insurmountable, but it was another blow in the ongoing struggle to conceive.

  24 January 2008

  Well, here I am in the middle of a round of IVF. I haven’t felt like writing. I’m doing okay and staying positive. I’m feeling a bit unsupported, but hopefully Matt will remedy that. I am very tired. I made the choice to go to the Law Commission and put family first. It’s going well. No stress. I found an IVF forum. It’s interesting to read about other people’s experiences. Makes me realise there are others who’ve had an even rougher time than I have. Despite the challenges I’ve faced, I am so thankful for everything I have. I am so lucky.

  This was Lecretia’s last diary entry. After finding her online forum, where women talked and shared their struggles to conceive, she focused her attention on others. She began to talk about her new online friends by their noms de plume, and I came to learn how others shared the struggles. It helped me too, I suppose.

  After that first IVF round, in February 2008, we spent three anxious days waiting to hear whether any of the eggs had made it to blastocyst stage. What the embryologists hope to see is a fertilised egg, divided neatly into eight evenly sized cells within its thick outer lining. A blastocyst looks strange, like a cluster of bubbles.

  At the end of our first cycle, we had two blastocysts. We had the first embryo implanted, and the second frozen.

  It was unsuccessful.

  After a few months, the second embryo was thawed, and implanted.

  It was unsuccessful.

  It was June before we could try again, but when we did, Lecretia had her best cycle so far. Eleven eggs were produced. We were over the moon. But only two made it to blastocyst stage. This time both were implanted.

  Lecretia got pregnant.

  We had wanted this for so long. Now we had it, there was a strange sense of disorientation. We were pregnant, and we were shocked. Suddenly all of the concerns of the past two years were replaced with new concerns. Is it healthy? Boy or girl? Where will it sleep? What will we call it? Do we need to buy a new car? A new house? Who do we tell? When do we tell them?

  Lecretia and I bought a book of baby names, and I remember sitting in bed with her on a Saturday morning, reading out names. Though she was still weeks away from showing, her hand rested tenderly on her belly, as if the developing embryo could feel her gentle touch.

  In her second month, Lecretia’s mood began to change and she developed a larger appetite. She was a lot more irritable towards me, but this was mitigated by a general aura of purpose and contentment. The thing that she wanted most in life was happening, and the future seemed clear and full of hope.

  Just before eight weeks, we went for a scan. When the ultrasound device was placed on Lecretia’s belly, a picture of the developing child came into view, and there was the flicker of a beating heart, the slightest pulse of life. Lecretia’s relief and her joy were glorious. ‘Matt, we’re having a baby!’

  The standard advice is that you start informing people at twelve weeks, but now we began telling our closest friends and family. There were many congratulations—the people we shared this with knew how much Lecretia and I had struggled, and what she had gone through.

  We were scheduled for a ten-week scan, and we drove to that appointment in trepidation, tempered with optimism. The clinic was in a leafy suburb. We sat down in its spacious waiting room, the minutes and seconds ticking by with the cadence of a heartbeat, until we were called into the obstetrician’s examination room.

  The woman we met was dispassionate and immune to our excitement. Lecretia got up on the bed in preparation for the scan and the consultant rubbed her belly with conductive jelly, and rested the scanner on it. Within a few moments, the image of the child appeared on the monitor, only slightly larger, and only slightly more distinct.

  ‘There’s the foetus,’ she said. She manipulated the scanner and the image, searching. ‘I can’t see a heartbeat yet,’ she said, ‘but sometimes it can be tough to locate at this early stage.’

  The next few minutes passed in absolute silence. Lecretia must have been in unbearable suspense—the arc of her life, and the beginning of her child’s, rested in the touch of the scanner against her belly.

  The doctor moved the device around Lecretia’s belly for another five minutes, seeking the correct angle. The image remained very still.

  ‘I’m sorry,’ she said. She withdrew the scanner, and the image on the monitor flickered out of view, leaving only blackness.

  Without a word, Lecretia pulled her top back down over her belly. She walked over and sat beside me, and we faced the obstetrician.

  ‘I estimate that the foetus expired somewhere in the eighth week,’ she said. ‘Given its size and your complications, we’ll need to schedule a D&C.’

  A dilatation and curettage is a medical procedure for managing miscarriages or, less commonly, abortions. It’s unpleasant, involving the scraping and scooping of the uterus to remove the foetal tissue. Lecretia burst into tears. For weeks, she had been imagining and picturing this growing baby, investing into it so much hope and love, fantasising about its birth and its childhood and its future, daydreaming about picking out its clothes, holding it close to her, feeding it, loving it. Now the fate of this tiny kernel was to be extracted by stainless steel and discarded.

  When we got home, we held each other and wept. I tried to console her, but there was nothing I could say. We grieved for a future which had been so close to becoming ours, taken from us in a few short hours. We were back to being the infertile couple, the childless ones. I sent an email to our close frie
nds, giving them the bad news, and added:

  I hope that you will remain discreet about this: we’d rather this news didn’t spread any wider than it has to. And if you should cross paths with Lecretia in the coming weeks and months, I would personally appreciate it if you could treat her with the appropriate level of sensitivity.

  We will do our best to continue on and try again. You’ll forgive us if you are not informed too early on should we meet with any success in the future. I do not want to have to send an email like this out ever again.

  A couple of days after the miscarriage, I was lying in bed with Lecretia. Her lips were moving very slightly. Sometimes she did this when she was intently thinking about something, as though she were rehearsing a conversation.

  ‘I’m sorry I’ve done this to you,’ she said, suddenly.

  ‘Done what?’

  ‘You married a dud wife.’

  ‘Darling, you’re perfect. I don’t want to be with anyone else.’

  ‘But I can’t give you children.’

  ‘Children are only part of this for me. It’s about being with you. That’s all I want. If we can have children, great. If we can’t, we’ll deal with that too. But whatever happens, we’ll be together. That’s all we need—we have enough to be happy. It doesn’t feel that way now, but we still have a future.’

  ‘You would have a better future without me.’

  ‘That’s not true. There is no future I want that doesn’t have you in it.’

  She fell back into silence, but I could sense that she was thinking.