Authors: Julia Leigh
At my orientation session, reorientation session, a city nurse talked me through the three types of needle I'd need to use in the course of the egg collection. She demonstrated on a little patch of fake skin: a square of foam covered in plastic the color of milky tea. I had a few practice jabs myself. Before leaving I was reminded that counseling was available anytime I wanted.
On Day 2 of my period I had my blood tested for FSH, progesterone, and estrogen. That afternoon I got the call from the nurses that my hormone levels were good and that I could start with one injection of 200 IU of Gonal-f in the evening, a moderate dose because this was the first time and the doctor needed to gauge how my body responded. Gonal-f is an artificial hormone, made from recombinant DNA, structurally identical to human follicle stimulating hormone. Scientists tested its efficacy on female rats. Common side effects include headache, ovarian cysts, nausea, upper respiratory tract infections, mastalgia, abdominal pain, diarrhea, vomiting, dizziness, sinus infections, vaginal bleeding, fatigue, back pain, and mood swings. In addition, serious pulmonary conditions have been reported, such as acute respiratory distress syndrome. Rare cases involving blood clots have resulted in death. The basic principle
was that by injecting myself with an unnaturally high amount of this hormone I would stimulate my ovaries to overproduce eggs. Usually each month the body naturally releases one mature egg (on rare occasions, two). At age 42, with stimulation, best case was releasing something in the realm of ten to fifteen eggs. The balancing act was to produce as many eggs as possible without causing ovarian hyperstimulation.
The advice was to do injections at around the same time each night so I chose 10 p.m. because that way I wouldn't have to cancel too many evening engagements. Even then, I did have to duck out of dinners early, make excuses. Thankfully, the Gonal-f injection wasn't too bad. Because it didn't involve piercing the vein, taking blood from veins, I convinced myself I could manage it. The delivery mechanism was efficient. I swabbed myself with disinfectant, dialed up the amount of hormone on a pen, unwrapped a needle tip from its packaging and screwed it into the pen, then picked a spot on my belly, about two inches below the belly button, either to the right side or the left. I laid everything out before me as if I were a surgeon about to undertake a major operation. There was a moment when I had to overcome an instinctive aversion to injecting
myself, a bit like the moment I face every time I get into the swimming pool. I love to swim, but each immersion requires overcoming an aversion to the affront of cold water. Deep exhale: inject. Hold for ten seconds. Breathe and count. Carefully release. Unscrew needle tip and put in a sharps container. Pack it all away and put back in the fridge, next to the butter and the lettuce. Most times the injection passed without incident. I did jab myself once when careless, also I panicked that I'd screwed the needle tip in too tight and that I'd break the glass vial trying forcefully to unscrew it. When each injection was over I felt a small sense of accomplishment. Done. The methodical experience lent itself to
a sense of purpose
. One part of international travel that I have always enjoyed is making a connecting flight, being alert, following an anonymous fluoro-lit corridor through no-man's-land and thinking of nothing more than getting from A to B: pure and simple. There is comfort in purpose. Part of me wanted to have a child just so I could have an inviolable reason for being. Sweet purpose. Sweet dark purpose, secret of secrets: a child would save my life.
For a two-week period the clinic monitored me closely for effects of the hormone load. This involved almost
daily blood tests. After the results came in, usually around midday, I would get a call from the nurses with advice on my next dosage. With every instruction the nurse would say something like “The doctor would like you to do X, Y, Z . . .” so that even if I never saw the doctor I would know he was there, behind the scenes. I had my first trans-vaginal ultrasound on Day 6. The nurse was very kind, applied the goop to her instrument and went about the procedure in a straightforward manner. Still, it was undeniably strange to be lying there, legs spread, feeling something probe around internally, all the while looking at a screen showing a number of dark blobs whichâI was toldâwere my follicles, the sacs of fluid containing my eggs. The nurse took the dimensions of each follicle and measured the thickness of my endometrium. In all, I had nine follicles of a promising size, a potential nine eggs maturing. I felt nine times bloated and nine times labile. I couldn't read the newspaper without crying.
A second needle was introduced to my nightly regime. I would continue with the Gonal-f but add Orgalutran which would stop the eggs from releasing: they had to remain in place for collection. That needle was a little
more difficult than the Gonal-f. The needle tip itself was thicker and it required more force, more overcoming, to puncture the skin. I also had a reaction to it: some redness and swelling. Sometimes there was a kind of bubbling under the skin. Quite normal, I was assured. The hormones built up, snow in the night. After another ultrasound and more monitoring a blood test detected a sharp increase in my body's luteinizing hormone, known as the LH surge, an indicator I was naturally readying to ovulate in the next twenty-four to forty-eight hours. My belly was swollen, I was busting to get those eggs out. I was given an exact time to inject Ovidrel, the third and final needle, known as the trigger shot. Press the trigger, release the eggs. It was drilled into me that the timing of the trigger shot was critical; the clinic had coordinated a requisite thirty-six to thirty-eight hour window between the trigger and the time of my scheduled operation. I carried out my instructions with the precision of an astronaut.
In the taxi on the way to the facilityâpart outpatient surgery, part lab, part clinicâit occurred to me that it would be a terrible time to have a car accident. The building itselfâthe place where all the precious embryos
were storedâwas nondescript, fronting a major road. A catastrophist, I also wondered what would happen if the facility burned down: all those dreams would perish.
Surgery is an adventure: I told myself this as I took the elevator to reception.
Curious and curiouser
. I paid money and signed more consents. I spoke first with the administrators; then with the nurses; then with the anesthetist; then with the doctor (faintly comic in his paper shower cap). I tried to meditate during the intervals of waiting. There was a reassuring efficiency to the process: time was of the essence, clearly, but there was no sense of hurry. I gave myself over, submitted to their ministrations.
First, do no harm
. It had been explained to me that even though I had nine follicles on the ultrasound I might not end up with nine eggs. This was because not all follicles contain eggs and it was possible there could be “technical problems” with the doctor's retrieval. Please doctor, have a steady hand. I stripped off my clothes and put on a disposable gown. Laid on the cold trestle table. “I'm going to need your help,” said the anesthetist and he asked me to lift my legs into the padded stirrups. A lab scientist or technician read something out
for me to confirm. So sci-fi, I couldn't quite believe I was doing it. A cannula went into the top of my hand. And then I was unconscious. When I revived I had a piece of masking tape stuck to my palm with the number six written on it in black felt-tip pen. My teeth would not stop chattering. The number six, what did that mean? A nurse told me six eggs had been collected for freezing. I asked for some Endone to relieve my cramps: made the most of the facility. After a period of observation I was allowed to go home. I called a taxi.
An aside: the day I was instructed to use the Ovidrel trigger I was also given another pen of Gonal-f 900 IU. Each pen cost AU$572 (US$598). The reason for this anomaly was because the treatment is heavily reliant on the results of the morning's blood test and sometimes the bodyâessentially mysteriousâreacts in ways that are not anticipated. When I returned the unopened pen to the clinic the receptionist asked me if I had kept it cold. I told her she shouldn't think about reissuing it. No problem: the pen wasn't reissued, nor was I charged. I got the feeling that $500 was loose change that had slipped behind the sofa.
I didn't ask my sisters or a friend to pick me up from the facility. I wanted to minimize the whole experience, get it over with. I felt foolish. Pathetic. The fact that this had been a spermless dry run with no chance of an embryo was unbearable. On the way back I couldn't have cared less if I died in a car crash. Imagine: the car tumbling off the side of the bridge. How soothing. All the rats came out to play. My anger at Paul was icy cold. Imagine: his car tumbling off the side of the bridge, along with his new family. And midair, struck by a laser beam, totally evaporated. Even my spiteful fantasies were hollow and impotentâthat too made me sad. I planned a greeting for the next time I bumped into himâ“What makes you think I don't hate you?”
At the same time as I was freezing my eggs I put feelers out about getting some sperm. I asked a dear friend whom I respected a great deal, ten years younger, a single father, living on the far side of the world. He was planning to visit Australia and I hoped that when he was here he could make a donation. It was a flawed plan from the outset because I was unaware the clinic could not turn around a sperm donation in a week, the length of
his visit. I'd mistakenly thought the process would be simple: a few papers to sign, the deed itself, and Bob's your father. On the phone I said, “I have a big ask I would have liked to do in person but it's not possible. Would you consider being a sperm donor? No financial responsibility, no custody.” Wow: he asked for time to think about it. We spoke again a couple of weeks later. “It's been on my mind every day but I just can't do it. Not for the reason you probably think but because I can't imagine that amazing kid being out there and me not being the father. I couldn't handle knowing you might meet someone and another man would bring up the child. You'd be an amazing mother, it would be an amazing kid, but I can't. I'm so sorry it's not what you want to hear.”
Very stupidly, I asked an ex-lover who was married. The idea appealed to him. He wanted to know if he would have to tell his wife. Yes. That fell over.
I was talking to my sister as she was driving down the coast with her husband and two boys. I updated her on the latest sperm rejection. “Just use my hubby's,” she
said. “You can use it. I'll ask him.” She asked then and there in the car. “Sure,” he said. “Why not.” It happened so quicklyâtheir tremendous act of kindness.
Because I live by the beach I have quite a few friends who volunteer as lifesavers. They are all strong swimmers who unlike me have mastered their fear of heavy swell and they can go out into the surf in all kinds of weather. One night I was at dinner with three lifesavers and I asked if anyone had ever actually saved a life. Yes, they had: one friend was strolling along an unpatrolled city beach in autumn when she noticed someone facedown in the water. Her first thought wasâThat's a weird place to scuba dive. Then as she got closer she realized the person was in trouble. She raced into the water, fully clothed, and dragged the man back to shore. He wasn't breathing. She did everything rightâthe mouth-to-mouth and CPRâand when he was taken away in the ambulance he was alive. She didn't visit him in the hospital, never had any contact with him again. One of those things. The other two lifesavers had paddled out while on patrol to rescue those who were drowning.
My sister's husband began his visits to the clinic.
He was assessed for eligibility, gave his medical history, went through an overview of the consent forms, did his various blood tests, a urine test. He gave a sperm sample and after it was tested he returned to give more that could go into frozen storage. The known donor sperm workup cost AU$930 (US$966). I never asked him for any details about how he managed ejaculating upwards into a cup. The clock for the quarantine period was set ticking. One thing: we waited for a month to get back the sperm analysis. This was a failure of communication. Things do slip through the cracks. The patient learns to be vigilant.
Once the quarantine period had started the counseling began. My sister and her husband went to the clinic together and talked with a counselor about the legal framework of a donation and the implications for their family. What would they say to their two boys? What if I had a girl, would my sister feel jealous? It was a thorough process. A time was scheduled for the three of us to return together for a second group counseling session, something I dreaded. In our wildest girlhood fantasies about future husbands and babies (our wild-straight fantasies) we never imagined this scenario. In addition, my
sister's husband was required to do genetic counseling and undertake a series of genetic tests to identify any chromosomal abnormalities, cystic fibrosis or thalassemia (a disease of the red blood cells). Some results would take three to six weeks to come in. He asked his mother to draw up his family tree, a full family medical history, as required by the clinic. None of us realized the extent of what would be involved when we set out and he dispatched each chore with good grace. We joked about our family topiary.
My sister called with some bad news. She'd been to a BBQ and her father-in-law had made it clear that he was strongly opposed to the sperm donation. “Over my dead body,” were the words he used. He worried about his grandchildren. The very concept of IVF did not sit well with him: “I'm sorry but it's not right.” She said they were still prepared to go ahead if I really wanted but now it was harder for her husband, who had a close bond with his dad. “Thanks for letting me know,” I said. I was tiny. Dearest sister. Who wants to cause a family rift, who wants a child to be born in a storm? I chose not to go ahead and drank the brew of time wasted.