by Julia Leigh
Testes: I felt squeamish; I sensed Paul was embarrassed, he didn’t like being in a position where another man was so passionate about cutting into his balls. The doctor then turned his attention to me. He asked if I smoked (no) or drank (in moderation) and assessed my body mass index (healthy). Age? 38. “Hmmm, that’s generally fine,” he said, “but I don’t want to see you back here in two years’ time.” Back in two years’ time? What are you talking about? In Dr. Rogers’s office, at his suggestion of a potential return visit in two years’ time, I remember being a little offended.
“I’ve been pregnant before,” I jumped in. “Twice. In my twenties. Two terminations.” It was a good thing, I thought, it raised my chances. If I’d been pregnant before then odds were I could be pregnant again. I wasn’t one of those unlucky women who belatedly discover some serious problem with their uterus. I have never, not even for one second, regretted those terminations—not even now. Dr. Rogers picked up his pen. He drew a simple graph. Natural fertility on the vertical axis, age on the horizontal, starting at age 25 and running to 50. As a woman aged her fertility dropped, the downward slope became precipitous. He tried to impress on me the fact that my early pregnancies had less bearing on my current situation than I thought. They were a lifetime ago. Nor did he give much weight to the fact that my sister had easily fallen pregnant or that my mother had a late menopause. As soupy as the statistics were, as malleable, a woman’s age was a key determinant in her chances of “taking home a baby.”
He ordered a battery of tests. We thanked him and left. Signed some paperwork at the front desk. Paid by credit card. We hardly spoke in the elevator, held our breath. Pollyanna Juggernaut deserted me. I was tiny. Thrown. Out on the street, Paul put his arm around my shoulders, pulled me close. I was thinking: I hope the reversal works; I hope my test results are OK; please, please, please, I never want to come back here.
There’s a different graph Dr. Rogers could have drawn that first day in the clinic. Most IVF cycles fail, or to be more precise, most assisted reproduction fails. The best source of statistics I’ve found is an independent study by the National Perinatal and Statistics Unit within the University of New South Wales. Published in September 2015, the report analyzes data collected from all assisted reproduction technology clinics in Australia and New Zealand in the year 2013. It shows, among other things, that of 71,516 treatment cycles only 18.2 percent resulted in a live birth. Regardless the age of the patient, regardless the exact variant of treatment, most cycles failed. So Dr. Rogers could have marked treatment failure on the vertical axis and a woman’s age on the horizontal. It’s an industry predicated on failure. The true graph depicts a mountain with one face Hope and the other Despair.
I did my blood tests. Since I was young I’ve had a phobia of needles. My mother thinks it stems from an early childhood visit to the doctors when I yanked my arm away mid-procedure. What a mess. Once at the university medical center I was settling my account after a blood test and I heard a loud bang. I came to lying on the ground with someone holding two fingers in front of my face, asking me to count them. When I’d fainted I’d accidentally swiped the receptionist’s large intercom system off her desk and onto the floor—that accounted for the bang I’d heard. I was dragged by the feet through the waiting room into a corridor. It was nearing the end of the day so a kind doctor drove me home. Still, it doesn’t seem to me hysterical to have an intense dislike of a needle piercing my vein and draining blood from my body. It’s creepy. Also, I have bad veins, reluctant veins—which means that sometimes it takes more than one go to strike gold. (I’m so phobic I even cringe at typing the word vein.) I bruise; I get blood blisters; I break out in a rash. In the course of my treatment I did close to a hundred blood tests, probably more. I developed a strict routine: heat pack, lie down, left arm first, turn my head to the side and let the tears fall. Symptom: I would sink into a disproportionate state of vulnerability, the tears would rise unbidden as I resigned myself to that vulnerability. Needle out. Pressing my finger on my vein to staunch the prick was completely disgusting to me. “Please don’t show me the vial of blood, just read out my name and birth date.” I never found it easy.
I became very interested in what age a woman had her first child. Just as I used to try to figure out when an author had published their first novel now I sought to compare myself with new mothers. The point of comparison was not to do better but to get a feel for the lay of the land. To gauge what was not impossible. Again, the persuasive illogic: if she could do it at age 38, 39, 40, 41, 42, 43, 44, then so could I. My sources were various. First, there were the anecdotal accounts among friends and friends-of-friends. Dozens of women in my broad circle had their babies late. One friend naturally fell pregnant at 45 and then at 47, thanks to freakishly good genes and—according to her—copious shots of wheatgrass. Later, when I began to confide that I’d started treatment, I would invariably be reassured and provided with an example or two of a recent success story. The media, too, was full of good news. It seemed that every second day a celebrity in her forties was having a baby. I gratefully swallowed the evidence.
The druids in the lab read my blood and reported back. Dr. Rogers talked us through the results. Amongst a raft of other things I was all clear for hepatitis, HIV, rubella, syphilis. My thyroid was fine. A full blood count didn’t present any problems. My iron was on the low side, as was my B12, but nothing dreadful. My progesterone and estrogen levels were normal. A genetic test showed I didn’t carry cystic fibrosis. Nor did I have any sperm antibodies. The pelvic ultrasound concluded “No pelvic abnormality is detected at this examination.”
The doctor had also tested my follicle stimulating hormone level. The FSH test was supposed to give insight into the remaining number of eggs I had—but it could not tell me anything about the quality of those eggs. FSH is a hormone produced by the pituitary gland that plays a regulatory role in both stimulating the growth of follicles and letting the body know when it is time to ovulate. A follicle is the sac of fluid that surrounds a developing egg. As a woman ages and her stockpile of eggs diminishes it takes more FSH to produce an egg. The correlation seems to be that the more effort it takes, the higher the FSH reading, the lower the egg supply or “ovarian reserve.” A result of 8.1 was deemed by Dr. Rogers to be “reasonable.” Sitting there in his room I had the sense that all augured well: if the vasectomy reversal worked then a natural pregnancy wasn’t out of the question.
I nurtured this belief that I would fall pregnant naturally. Why be nervous? If it really were true that only 10 percent of women aged 38 fell pregnant naturally (and I had my doubts) then I would be among the millions of women in the world who had once upon a time fitted that description. Pollyanna Juggernaut could do amazing things with the figures. I would be one of the lucky ones, an exception. After all, didn’t I have a track record for beating the odds? When I was 27 I was diagnosed with a tumor in my left lung. It wasn’t possible to do a biopsy at the time of the bronchoscopy, there was too high a risk of bleeding. Because of the central location of the tumor, the whole lung (and lymph nodes) had to be immediately removed. Lung carcinoma is the leading cause of cancer death. I had the operation and waited days for the result. When the registrar told me the amazing news—it was a carcinoid, not carcinoma—I just nodded like I’d been told it was three o’clock in the afternoon. He said I was a hard lady to please. This was because usually less than 1 percent of all tumors in the lung are carcinoids, a relatively slow-growing neuroendocrine tumor. I was on morphine but really I was so blasé because I had never taken on board the known likelihood of carcinoma. Before surgery I had willfully disconnected from the probabilities. In my critical state they weren’t helpful.
In the public imagination—as I perceive it—there’s a qualified sympathy for IVF patients, not unlike that shown to smokers who get lung cancer. Unspoken: “You signed up for it, so what did you expect . . . ?”
Nearing the end of my treatment it became harder and harder to
kid myself that I was lucky, exceptional, or altogether outside the realm of statistics. The real reason I didn’t want to know about the IVF numbers was that I was desperate.
Our probationary year disappeared. During that time I decided to put up my hand to direct my screenplay. It was a long shot the film would get made since I’d never directed any sort of film before. My novel was published: I was happy with the reception. For Paul’s birthday I gave him a word. “To smund: when a woman, a wife, lays her length upon a man, her husband, and with slow loving sinuous movements caresses, presses her soft warm breasts against his chest.” One day we were walking home from the grocery store, and I said something very homey, something like, “When we get home I’ll put the potatoes on.” “Will you, Mrs. McGillicuddy?” he replied. It was a sublime moment: the birth of Mr. and Mrs. McGillicuddy, there on the footpath, fully grown, the long-married homey couple, the cardigan wearers, the ones who put the potatoes on. After that we often used to call each other Mr. or Mrs. McGillicuddy, it became one of our fondest endearments. In November 2008 Paul underwent his vasectomy reversal. And on the December solstice, as agreed, Mr. and Mrs. McGillicuddy were married.
Scene from a marriage: Night in the highlands, we had a fight and he ordered me out of the house. I had nowhere to go. Because I’d never learned to drive I wasn’t able to get in the car and drive back to Sydney. I walked into town and found a pub, closed, where the staff were having last drinks. Knocked loudly on the door. I tried not to cry as I apologized for disturbing them, asked to pay for a room. Upstairs, lying in the narrow bed, fully dressed, I took out my phone. Paul had left many messages. I thought about switching it off before letting him know I was safe but I also had an urgent desire to hear his voice. Heartbroken, remorseful, he begged to come and pick me up and I agreed.
That is how in my 39th year I came to make love, for the first time in my life, with a deep desire to physically conceive, to procreate, to make a baby. It was so beautiful. Crossing over into one another, imagining the pleasure of orgasm as a kind of nurturing magic field for the moment of conception. A molecular union. Lovefucking for our child. And today I remain thankful for those experiences. But it was impossible to sustain, that keenly pitched sacred pleasure. As month after month passed and I did not fall pregnant the obligation to make love on the days around my time of ovulation became wearisome. One month Paul had a conference in a country town at “that time” and I traveled up there to be with him so that we could try. We stayed in a chintzy bed’n’breakfast. I can’t remember exactly how it happened but we were meant to make love in the morning before our early departure, at around 6 a.m. That was the opportune window. I had no genuine bodily desire whatsoever but was amenable to a pragmatic quickie. Paul tried—with no luck. Too much pressure. A situation that for the two of us was equal parts frustrating, humiliating, chintzy, and bathetic. It cast a pall over the day. He didn’t like—and nor did I—how our lovefucking had become so colored by the desire for a child, as if that were now its sole purpose. We agreed we’d try to take the pressure off and not be so focused on my menstrual cycle. All that meant was we didn’t talk about it while I remained acutely aware of exactly how near or far I was to ovulation.
There came a day when I reached a sunken crossroad. My film—miraculously—got its coveted green light, the full financing was committed. What to do: how could I direct a feature film and become pregnant at the same time? The stress of making the film would be bad for the baby; potential health complications would be bad for the film. Which-way, which-way, which-way. Where were the omens? After a week of sleepless nights I told Paul I wanted us to stop trying to get pregnant, I said I would take precautions for six months until the film was shot and I was in the edit. He was disappointed and though he didn’t say as much I worried he saw my choice as a betrayal. It made him wary, and wariness, in retrospect, is poison in a union. Even if he’d tried to persuade me to drop the film I don’t think I would have done so. Sometimes I wish I had been less fearful.
I completely immersed myself in making the film and I neglected my husband. There were repercussions. “You’re so busy I might as well not be here.” One night during the shoot he repeated his trick of ordering me out of the house (at the time we were living in a new apartment we’d bought together). A few days later he left to spend time with his son who was now 14 and living in Ireland with his mother. The film wrapped: he didn’t call. On the day of his return we had a fight. His anger was frightening and intolerable. I took half of my stuff and moved back to my old place which was just around the corner. I can’t stand it! There followed a complicated tangle of emotions—hurts, desires, everything else. Bamboozling at the time. Two people in love and at odds. A Gordian knot would have been child’s play. I’m not sure I could ever explain it. He said he didn’t sign up for me putting my career ahead of everything else, he said I was blind to how my work bled into our lives and obscured all the good things. He wanted more balance. A few weeks later he issued me with legal papers for a full property settlement through the family law courts, to be effective immediately. He wanted the title deed to our new home transferred into solely his name: he’d pay out my share. He wanted to undo all our joint bank accounts and other assets, a complete financial separation. In other words, a divorce. But he refused to call it a divorce. He wanted us to live together “under two roofs.” He wanted a moratorium on talking about a family. A moratorium! For how long? Indefinite. He’d pilfered the word “moratorium” from one of the couples counselors, the one who gave us a book that said there was a finite number of possible types of relationship, something like 1,392 or maybe 3,921. Then Paul modified his position and said we could “shuttle between the houses till the baby comes.” Topsy-turvy. I thought the property settlement was such a sniveling low demand that ipso facto it warranted divorce. We signed the legal papers in my lawyer’s office. I was in tears. That night he came over to my place and we slept together.
Why are you writing this, Rat-wife? Rat-patient. Hey, Queen of the Rats, why?
I guess it’s common sense but I sincerely believe in the truth of what I’m writing and at the very same time I know Paul would shape a different story. What’s more, I know my own next sentence could turn this way or that.
We reconciled. Beloved singular man, wondrous sea creature, hand-holder—I forgave him everything and vowed to do better in his eyes. Mr. and Mrs. McGillicuddy went back to the clinic. A sperm test showed the vasectomy reversal had failed. The initial sperm flow post-op had been “respectable”—said the doctor—but the test now confirmed a zero sperm count. No sperm. If we wanted to proceed we would have no choice but to begin IVF using the sperm frozen during Paul’s operation. Neither of us asked for how long Paul had been without sperm, it seemed discourteous, impossible to know. (A good question: why didn’t we test it earlier?) Part of me was pleased—if the reason I hadn’t already fallen pregnant was because of low or no sperm flow then that problem could be rectified. What was scary was my own ovarian reserve. My FSH level was retested and it had held steady. Another marker for ovarian reserve was an AMH test. Anti-Müllerian hormone is a hormone secreted by very early ovarian follicles. The clinic ran the test and analyzed the results in their own lab. Like the FSH test, this test could not tell me anything about the quality of my eggs. Nor was the test conclusive: on the upside, I was informed there had been several reported cases of women with undetectable levels of AMH who had fallen pregnant. My level came back as 6.1—which was fractionally better than average for a woman my age. Ovarian reserve diminishes over time: that was the golden rule. When I was tested again in 2012 my level had gone up to 8.3. Alice in Wonderland. I asked Dr. Rogers how that was possible. He shrugged it off. He said a woman of 25 had a level of 50; it was all relative; my reserve was low. I should be glad, he said, the clinic would treat me. It seemed that only a veil of science shrouded the vast mystery.
The doctor didn’t try to sugarcoat things, he said he was happy to proceed, all my re
tested bloods and ultrasound were fine but my age—40—was a problem. He gave me an approximate 20 percent chance of success. Thank you, thank you. I was so grateful, so willing. I didn’t hesitate for a moment to abandon Mother Nature. He filled out a consent form for Paul and me to sign that specified our treatment. Ran us through the costs. I played my inner trick of pretending it was all Monopoly money. He checked his watch, smiled kindly, inclined his head toward the door.
If I were devout I would paint exquisite ex-votos on small tin sheets in a Mexican style, illustrating the miracle of IVF conception. A woman with her legs in stirrups. And floating in the surgery theater a little cloud, and in that cloud a sperm nosing into an egg, or perhaps an eight-celled embryo implanting into a red-lined womb. I’d go into churches and pin wax effigies of sprouting ovaries to the wall, in the same way the faithful pin up effigies of their ailing arms and legs.