by Julia Leigh
PROSECUTOR: Why did you persist in wanting to be a mother?
DEFENSE: I refer you to Exhibit A. Conversation with Elsie, age 2.
—Let’s play doctors and mices! Doctors and mices!
—OK, what’s that?
—You say, “A mouse is coming!”
—A mouse is coming!
I make my hand into a mouse, creep it close to her, then run the mouse-hand under her arms, begin to tickle. Soon the mouse-hand bounces up and down on her tummy.
—I’m not a trampoline! I’m not a trampoline! I’m not a trampoline! I’m a person!
—Oh, OK.
—Do it on your nose!
The mouse-hand bounces up and down on my nose.
—Your nose is a trampoline!
Mother’s Day was a punch in the gut.
I had a friend also doing IVF but in Europe, who was much more sanguine. She said her whole family was in good health, she had amazing friends, she loved her work, she lived in a wonderful city, and after much heartbreak she now spent every day alongside her beloved new husband. “Too much for one person, don’t you think?” They were seriously considering adoption. Perhaps if I’d had that option—adoption—I would have been less fervent. In a country with extremely tight adoption laws I reckoned my chance of adopting at approximately zero. Anyway, selfishly, at the outset I wasn’t that keen on adoption.
And now it was my donor’s turn to begin his visits to the clinic. He had an appointment with the doctor; an appointment alone with the counselor; and we did a joint counseling session together. There were consents to consider. (A donor always owned his sperm and could withdraw his consent at any time.) The quarantine had to be verified and the blood work reviewed so that it met all the standards of my clinic. His genetic screening also had to be reviewed. It turned out that since we’d both done our initial screening for cystic fibrosis a new test that covered a greater spectrum of mutations had become available and we needed to do that. I also redid my AMH and a lot of other things. Because of my donor’s family history the genetic counselor advised we needed to consider a range of potential chromosomal problems. There was a test that could be done at a hospital lab on the other side of town. I hesitated to overburden my donor, fearful he too might change his mind, so I decided I would be the one to take the test. If the results proved negative—which I expected—then the genetic counselor had advised I could put it out of my mind. Both parents needed to have the mutation for there to be a risk of passing it on to the child. Another thing had changed since my donor first froze his sperm. The law now required that at birth all donors be registered so that a child conceived with donor sperm could one day trace the father. He was happy with that.
The straws of sperm were shipped from one clinic to another. One precious straw was tested for the sperm’s motility and possible deformations. Under the microscope everything was swimming. When it was already too late I was ready to go.
After consulting with the doctor I chose to proceed with an IUI, intrauterine insemination, at a cost of AU$2,040 (US$1,832) of which around $670 (US$602) would be reimbursed by Medicare. I would do it with a nudge of Gonal-f, 75 IU, to boost my chances. On Day 9 the clinic would start monitoring me for my LH surge. I also had an ultrasound. It was similar to using a turkey baster at home (although I had heard the best way wasn’t a turkey baster but a plastic syringe acquired at any local pharmacy). Why did I involve the clinic, why not try at home? Well, I wanted the donor’s sperm to have cleared the HIV risk, and—more than that—I wasn’t sure he would have been comfortable making home deliveries. And why not go straight to IVF? My thinking was that my eggs had never had a chance: the problem had been my husband’s lack of sperm. I hoped that if my egg was exposed to healthy sperm then I wouldn’t need to undertake the more invasive, and expensive, IVF.
On the appointed day of ovulation I arrived at the facility. A nurse—there was no doctor involved—tried to insert a fine plastic tube into my cervix but after a good ten minutes of prodding, failing, she gave up, apologized and left the room to find another nurse. Alone, alone. The second nurse had better luck. The thawed sperm—which had also been rinsed and concentrated—was injected directly into my uterus. It was uncomfortable, like having a bad period cramp. I asked if I could keep lying down for fifteen minutes. Quietly excited, I tried to visualize conception, the sperm and the egg. I placed my hands on my belly and sent loving energy to the womb. My doctor had said I could stand on my head and meditate if I wanted but that kind of thing wouldn’t make any difference. I paid no heed. After I left, in a lane off the main road, I found a paperbark tree and peeled away some bark, placed it under my T-shirt, gently rubbed my skin in a circular motion. Absurd—but who cares. It was soothing. I believe in ceremony. Anything to counter the unnatural situation.
My friend in New York paid a surrogate. “She lives in a beautiful place, interstate, so much nature. The whole thing felt really natural.” Nature. Natural. She continued to repeat the word “natural” like a nervous tic or mantra.
The day after the procedure I called my sister in an embarrassed small panic. I’d absentmindedly eaten some sushi, which was a no-no according to one of the books I’d read, What to Eat When You’re Expecting. “Oh my god, you’re fine,” she said. “You can snort heroin for breakfast at this stage and you’ll be fine. Don’t be insane. It’s not going to be like this the whole time, is it?”
Good morning, darling. Every day I greeted my belly as if an embryo had implanted. Disregarding the odds of success I directed a loving monologue to what I hoped existed. I’d long harboured a platonic crush on my donor, considering him a trusted battle-worn compadre, and I believed the child of our friendship was also meant-to-be. (Did I still carry grief for the lost our child? Yes, of course I did.) During that first two-week wait I had a heightened awareness of my whole body. Rarely did I ever stop to consider how my body was functioning, what my cells were doing. Typically I completely ignored the subtle movements that go on all the time: the inflating, deflating lung; the inch of chyme through the intestine; the tremors of the liver and the kidneys. Not that I actually felt these things, but I pictured them, sensed them. What is that way of knowing? Out on the street I noticed that all the babies, toddlers, and pregnant women had cloned themselves so now they were everywhere. I smiled at young mothers. I was soft and optimistic, the holder of a wonderful secret. It’s easy to do anything once.
Blood. Bloody hell. Hopes raised, hopes dashed. But I wasn’t devastated: no need to take a fall straight out of the blocks. My mother was right when she said “It would have been an absolute miracle.” I opted to immediately do a second IUI, again supported with nightly injections of Gonal-f. It was impossible to gauge the quality of my eggs with only one try. I was monitored regularly—but not daily—and when the nurse called me with my scheduled time for the procedure I queried if the time wasn’t too late, if it were possible the LH surge could have begun on the day before when I wasn’t tested, if too many hours could have passed between an undetected surge and the procedure. She referred me to the doctor. He said: “I’ve seen the numbers a thousand times. This is how we do it. You have to trust me.” I asked him to quickly explain how the time window worked. “If you don’t trust me,” he replied, “we can cancel.”
The second IUI failed. As a next step Dr. Rogers recommended I use my frozen eggs and also do a fresh cycle at the same time. I took that to mean I’d do a new cycle, collect a new batch of fresh eggs, inseminate them, and at the same time, thaw the frozen eggs, inseminate them too.
—Why not just use the frozen?
—You get more with both.
—I’ve already got five frozen so why do I need more?
—Up to you.
—Is there a difference between fresh and frozen?
—There are no second-class children.
—I mean, is one more viable than the other?
—Not much difference.
—OK, I’ll just do frozen.
—Whatever you want. That’s reasonable.
Up to you. Pick your own misadventure.
Coffee. At the orientation the dietary advice I received from the clinic was to moderate my coffee and alcohol intake and take folic acid, 500 mcg daily. I asked what was “moderate” and was told one cup a day would be fine. A million websites and bulletin boards advised no coffee. They also advised countless other things. Stay alkaline. Wear a lead-lined apron on airplanes. Avoid bananas. I decided to cut out coffee completely. After three months of IVF failure I reverted back to one cup a day. I trawled the Internet and found the study about caffeine . . . it concluded that five cups a day was to be discouraged. Sometimes I felt guilty when I had my morning coffee: what if this coffee was the one thing between me and pregnancy? Most times I thought if one coffee a day kills my chance that dear embryo-darling wasn’t strong enough to last the nine months anyway. I oscillated between guilt and pragmatism, and that movement, that kinetic energy, helped drive the little engine of endurance.
I saw Paul at the pool. Vampire! Monster! I swam as if I were drowning, thrashing the water, wild-armed, wrenching my head from side to side. I moved fast. No chance to ruminate. At the end of each lap I paused to catch my breath. Exhausted.
The month after the second failed IUI I readied for a frozen egg cycle at an out-of-pocket cost of AU$2,705 (US$2,597). Again I was monitored closely so that we could time the transfer of the embryo to be in sync with my natural cycle. The frozen eggs would be thawed and artificially inseminated the day I naturally ovulated. I was told that three out of five eggs had survived the thaw and they had been injected with sperm selected under digital high-magnification by a scientist, a procedure called intracytoplasmic sperm injection or ICSI. Actually I always did ICSI—the doctors never recommended straight IVF, which is where the sperm fight it out in the Petri dish en route to the egg. ICSI cost an additional $730 (US$701) which in the scheme of things felt nominal (how quickly the scales transmogrify). Later I read a study that questioned why so many doctors always recommended ICSI, speculating there may be some benefit to a stronger, fitter sperm fighting its way to the egg in the Petri dish, just as it did under the auspices of Mother Nature. Overnight one embryo showed development—but it was atypical. “It contains three pieces of genetic information.” Three pieces of genetic information! The nurse told me that it couldn’t be transferred. My sister and I joked about dirty pipettes but in fact my egg had divided abnormally and carried an extra set of chromosomes. The nurse had further bad news: my remaining two embryos had shown no development. They would be kept another night and checked in the morning to see if there were any changes: I was warned this was unlikely but not impossible. I had been out on a boat that day, up and down, up and down, rolling on the heavy swell, and come evening I had full-blown vertigo. If I dipped my chin an inch to look at a screen I felt as if I were about to pitch face-first off a cliff. The next morning, in my vertiginous state, I got the polite, carefully delivered news that there were no signs of improvement. All five embryos were to be “discarded.” All five—gone, tossed away, discarded. For a long moment I was silent and then I quietly asked the lab assistant, “You definitely destroy them?” It troubled me how invisible everything was: how would I know what they really did with my embryos? Who monitored the checks and balances? Scenarios for horror movies made themselves known. Evil lab assistant sells embryos on baby black market; evil doctor fertilizes eggs with own sperm to create own private colony of children; evil research director conducts clandestine experiments to grow babies full-term ex-uterus . . . As it happened, in all my five subsequent egg collections I had a much better success rate with embryo development, always ending up with something that could be transferred.
I was having trouble sleeping so in the middle of the night I walked down to the playground at the end of my street. All the ghost-children were at play. There were little boys crawling over webs of rope, little girls kicking up their heels on the swings. They sang and squabbled and thrilled at making footprints in the dirt. I told a girl I loved her outfit. “It’s not an outfit!” she said. “It’s a tiger suit!” A black-haired boy sat beside me and whispered in my ear, “Change doctors.”
I went back to the same clinic website and found a new doctor, to be known as Dr. Nell. My GP wrote a referral. No one at the clinic asked any awkward questions as to why I was switching. On the wall of Dr. Nell’s office was a noticeboard pinned with thank-you cards and baby photos. Her manner was kind and thoughtful. We discussed my options for the next cycle. I’d do a new egg collection. She raised some “optional extras” that were available as part of the service. The first was a chromosomal test that could be done on the embryo that would cost an additional AU$3,670 (US$3,347). It was especially helpful, she said, for women who’d had recurring miscarriages. That test needed to be booked months in advance so I didn’t opt for it. For $265 (US$242) I was also offered “assisted hatching,” whereby a lab technician would use a laser to thin the outer shell of the embryo, making it easier—supposedly—for the embryo to “hatch out” prior to implantation. Older women, I was told, have a harder “outer shell.” The procedure carried a small risk of penetrating the shell and damaging the embryo. And on top of that—if I wanted—I could try “embryo glue” for $150 (US$137); this was also supposed to aid implantation. I asked her whether there was evidence for increased chances of success with the assisted hatching and the embryo glue. They apply pigeons, to draw the vapors from the head. She said there was no clear evidence but that if I went ahead I could say I’d done all I could. “What would you do if you were in my shoes?” I asked. She said, “It’s up to you.” This time I didn’t use the glue but I did in subsequent cycles. The cost ended up being $9,675 (US$8,824) plus anesthetist and outpatient surgery fees on top. Medicare reimbursed just under $5,200 (US$4,742). I had the dread feeling that I was voluntarily participating in “cutting-edge” medicine, that I was a part of some greater experiment, a credulous and desperate older woman, and the only thing that made me think these dread thoughts might be mere anxiety, that actually I was the lucky beneficiary of years of advanced medical research, was the calm and caring manner of my doctor, who on a personal level did seem sincere in her desire to help me fall pregnant, just as she had helped all the women who had sent her those colorful cards pinned to her wall.
One of the last conversations I had with Dr. Nell was along the following lines:
—Is there anything we would do differently next cycle?
—No.
—If you were a crazy experimentalist and I were a willing research participant, what would you suggest?
—We could try testosterone treatment for three weeks before the cycle.
—Testosterone? What’s that for?
—It helps egg quality.
—How come I’m only hearing about it now?
—There have been three studies in the past year.
—Is testosterone something the clinic offers their patients?
—We decide patient by patient. I know you like to see the evidence so I didn’t think you’d want the testosterone. There’s not enough evidence yet.
—Well, what else is there?
—Growth hormone—but I wouldn’t offer you that because it does have links to cancer.
—So we wouldn’t do anything different?
—No.
On Day 1 of my next period I called the nurses. I was told to come in that morning for a blood test. On other occasions I’d done my initial bloods on Day 2 and so I asked if there was a reason why I needed to come in on Day 1. The nurse said, “We can always go forward but we can’t go back.” That afternoon I received a call.
—Bad news, I’m afraid. Doctor has looked at the results and wants to cancel the cycle. High FSH.
—That’s unusual, that hasn’t happened before.
—It hasn’t been looked at before.
—Yes it has, I did a frozen cycle. How high was my FSH?
�
�13.
—And how high was it when I did the frozen cycle? Please check the file.
—11.
—Why did we take the bloods on Day 1? Maybe the FSH will go down by Day 2. Is it OK if I come in and test again on Day 2?
—Yes, come in.
My Day 2 FSH result dropped to 11.7. The doctor—not Dr. Nell but another doctor who was covering for her while she was away—decided the level was still too high and the cycle had to be canceled. When I asked the nurse about why my FSH might have been high she said, simply, “It’s cyclical, doctor said wait until next month.” When I got off the phone I cried. I had a great fear that I was too old, that my FSH would remain too high. The process was forever throwing up new ways to be disappointed that I hadn’t even dreamt existed. The constant uncertainty took a toll.
In expectation of proceeding with the cycle I’d canceled a work trip. There were so many opportunities I turned down in the course of my treatment.
One afternoon I struck up a conversation with a mendacious cab driver. He said, “I have seven sons, age 2 to 14. I’m 74. My wife is 62. She had the first four compulsory and then three voluntary because she wanted a girl. Yes, she was 60! I can drive you to my place and show you her passport! I drive this cab and do all the cooking and cleaning. I sleep four hours. I feel young. To be honest, it’s not her I love, it’s the kids.”