Avalanche (7 page)

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.”

November 2013. I felt a small sense of pride when the nurse told me this month's levels were good—FSH down to 7.7, estrogen 202—as if somehow I had worked hard to deserve this merit.
This is the start of an amazing journey
. I blazed with hope. I was injecting 300 IU of Gonal-f each night. My breasts became extremely sensitive. Once again I was bloated and labile. When I put my travel card into the ticket machine on the bus I felt as if I were inserting my own fingers. I cut everything out—coffee, dairy, sugar, alcohol (that was hard). Each day I drank an alkalizer
juice from the health food store. I kept up my iodine-folate and multivitamin and added fish oil. All the small rituals. After my scan—which looked promising—the kind nurse said, “Hope you get some in the freezer.” That was my wish: to do a fresh transfer with one embryo and have others “left over” to freeze. Dr. Nell was away again on the day of my egg collection so it fell to a new doctor I'd never seen before to explain that in fact I wouldn't be able to do a fresh transfer that month, as planned. My last blood test had shown an unexpectedly high level of progesterone, a hormone produced by the ovary that plays a decisive factor in maintaining pregnancies.

—Your progesterone is at 6 so we can't do a fresh transfer.

—Sorry, what does that mean?

—Your body has started producing progesterone before ovulating. There's nothing we could have done about it. It means the lining of your uterus will be out of sync with implantation. It could implant, it's not impossible, but the window isn't optimum. I don't want you to look back and say “Why did we waste this embryo?”

—What's the cut-off for progesterone?

—5. And yours was 6, it wasn't 5.1 or 5.2. Some clinics in the U.S. freeze all embryos and don't do fresh transfers.

—So you're giving me strong advice? Nothing wishy-washy?

—I can only advise you. It's up to you to do what you want.

—But I have no medical experience.

—Well, that's my advice. Check with Dr. Nell when she's back on Monday. You can take the pessaries until then, there's no harm in that.

Eleven eggs were collected, of which seven were mature. These mature eggs were injected with sperm. Overnight, four of the seven embryos showed signs of developing. By Day 3 only one embryo was going strong, with another two looking borderline. The lab assistants—always women—updated me on the process of attrition. I had to steel my nerves each time they called. By Day 5 I was left with one Grade A blastocyst—which quality-wise was the best outcome possible. The clinic had a complex system for grading embryos depending on the progression of cell division: a blastocyst was a Day 5 embryo that had developed
a distinctive shape with an inner cell mass clearly identifiable within its fluid-filled cavity. A blastocyst had the best chance of resulting in a pregnancy. That said, embryos
less developed
than a blastocyst had also been known to be viable so there was—as ever—a wide spectrum of hope.

Dr. Nell had returned to her office and I asked her again what she would do if she were in my shoes: a fresh or frozen transfer? This time she answered unequivocally, “If it were me I'd definitely freeze.”

I was disoriented by the numbers, the odds, as if I were playing a game in which I didn't know the rules, “Kindly Kafka.”

—When you say my progesterone was 6 what does that mean? Was it 6 out of 10 or 6 out of 100?

—It's not out of anything. It's a number and our cut-off is 5.

—Is it true fresh transfers are better than frozen transfers?

—Some clinics in Spain only ever do frozen transfers.

—But what if the defrost doesn't work? I only have one embryo.

—The rate is 90 percent for a successful embryo defrost. Weighing it all up, my advice is to freeze.

The horror, the horror: a 10 percent chance it won't defrost.

—All right, let's freeze.

An uncharitable thought . . . IVF seemed to be a great deal about levels and cut-offs. If number X, then do Y. I wondered if it was the medical equivalent of conveyancing in the legal world, which is to say, largely formulaic, a matter of following protocol.

The lab was closed for Christmas break and also undergoing renovations so I had to wait until January to do my transfer. A friend had been following my travails, she herself was a veteran of IVF, now a blessedly happy and exhausted mother. I told her it was ridiculous but I was sad to think of my darling little embryo spending Christmas all alone in a freezing cold tank of liquid nitrogen. “It won't be alone,” she said. “Our siblings are there too.” We are all lunatics. She had gone through the same clinic and was successful when she gave up trying with
her own eggs and moved to using her husband's sperm with a donor egg from a young woman in her twenties, one of her close friends. That child is adorable. Her view is that the science of IVF is as astonishing as the science that put a man on the moon. Her gratitude to her doctor is enormous. In her eyes he is like a pioneer or astronaut. He is working at the forefront of miracle and wonder.

I bought my nephews a crazy number of presents for Christmas.

One day I was babysitting and after I'd nagged the boys to put away their LEGO the youngest commented, “You don't have kids so you don't know how we work.”

By Day 31 I still hadn't got my period. Never before in my life had this happened to me. I worried that because I'd done yoga in a heated room for a week I might have inadvertently messed things up; I worried that something dire had happened when I'd been slammed in my belly, bang on my right ovary, while playing tennis; I worried, I worried. I had a blood test on Day 33, which also happened to be my 44th birthday. “Happy Birthday,” said the nurse as she read out my birthdate. We
laughed. She thought it a pity I had to come in that day; I told her it was auspicious. When I left the clinic I noticed a man, a grandfather, leading a toddler across the street. Toddling. I felt a flush of heartwarmth at the sight of that little girl. Could she be enough for me? Did I need to place my own child at the center of the world? Was it enough that other beautiful children existed? If I could make the revolutionary shift from
I
to
We
, from
I
to
This
, perhaps that would be possible.

At last my transfer was scheduled. I woke at 6 a.m. and took a cab to an acupuncture clinic in the city that a friend had recommended. It was a public holiday, ghostly, no one else was around. Bend the rules of nature, bend the rules of time. The acupuncturist had kindly made a special trip to meet me. I liked her because she called me “darling.” I was there because I'd heard that acupuncture on the day of transfer could aid implantation,
potentially
aid implantation—the evidence itself was limited. Half an hour of lying on the table was about all I could take. When the session was finished I took a second cab from the city to the facility and considered the cab driver's Hare Krishna music a good omen. At reception I noticed Paul's name was typed on the consent form as my next of
kin so I drew a line through that, pressed down hard with the pen. I was directed to an airlocked changing room, known as the “Clean Room.” I felt like Charlie when he first enters the chocolate factory with Willy Wonka, wide-eyed. I removed half of my clothing and put on a hair cap, overshoes, and a blue papery gown. I then pressed a button to release the airlock and passed through to the pristine all-white surgery. A lab adjoined the surgery. I took a seat on what looked like a dentist's chair, spread my legs. There was a lot of identity checking and I had to repeat my name and birthdate in a loud voice because it was all being recorded. The doctor and the lab technician also had to loudly confirm details, which I guessed was part of the protocol for avoiding an embryo mix-up. On Dr. Nell's instruction I held the ultrasound wand over my belly, revealing my inner moonscape on a small screen. There was another screen perched high in the corner of the room that relayed from the lab an image of my embryo, greatly magnified. “It looks good,” said the doctor. “It looks just like the one in the book, doesn't it?” Since I didn't remember the images in the info booklet I didn't answer. “Yes,” she said loudly, “it looks like the one in the book.” The lab technician disappeared the embryo into a fine bendy plastic catheter.
She brought this tube to Dr. Nell, who tried to insert it into my cervix, but she had trouble and the lab technician was sent to find a stiffer tube. I know now that the more difficult the actual physical transfer the worse it is for the fragile embryo. On the moonscape screen I saw a minuscule white speck being released from the tube onto my doughnut-shaped uterus. I asked if I was OK to fly, do yoga, go swimming. Yes to all three, with the proviso I don't overheat. “And you can go to the toilet now, it won't fall out.” I returned to the acupuncture clinic for a half-hour session of deep relaxation. Afterwards I walked over to the art gallery and saw an exhibition of exquisite Korean ceramics,
Soul of Simplicity
. As I was leaving I spied the bus up ahead and made a run for it. I felt a twinge in my belly. Oh no, what have I done! I'm an idiot! You idiot! Quietly now: you idiot.