Avalanche, a love story, by Julia Leigh. Photograph: Penguin Random House
The day after the procedure, I called my sister in an embarrassed small anxiety. Id absent-mindedly feed some sushi, which was a no-no according to one of the books Id read, What to Feed When Youre Expecting. Oh my god, youre fine, she told. You can snort heroin for breakfast at this stage and youll be fine. Dont be insane. Its 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. Id 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 await, 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 entirely 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 newborns, toddlers and pregnant women had cloned themselves so now the latter are everywhere. I smiled at young moms. I was soft and optimistic, right holders of a wonderful secret. Its easy to do anything once.
Blood. Bloody hell. Hopes created, hopes dashed. But I wasnt devastated: no need to take a fall straight out of the blocks. My mom was right when she told: It would have been an absolute miracle. I opted to instantly do a second IUI, again supported with nightly injections of Gonal-f.
It was impossible to gauge the qualifications of my eggs with only one try. I was monitored regularly but not daily and when the nurse called me with my scheduled period for the procedure I queried if the time wasnt too late, if it were possible the LH surge could have begun on the previous day when I wasnt tested, if too many hours could have passed between an undetected upsurge and the procedure. She referred me to the doctor. He told: Ive ensure 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 dont 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 entail Id 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.
Ive already got five frozen so why do I require more?
Up to you.
Is there a difference between fresh and frozen?
There are no second-class children.
I entail, is one more viable than the other?
Not much change.
Okay, Ill only do frozen.
Whatever you want.
Thats reasonable. Up to you. Pick your own mishap.
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[ 0.5 mg] daily. I asked what was moderate and was told one cup a day would be fine. A million websites and bulletin board 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 totally. After three months of IVF failure, I reverted back to one cup a day. I trawled the internet and detected the study about caffeine … it concluded that five beakers 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 days I thought if one coffee a day kills my opportunity, that dear embryodarling wasnt strong enough to last the nine months anyway. I oscillated between guilt and pragmatism, and that motion, that kinetic energy, helped drive the little engine of endurance.
I assured Paul at the pool. Vampire! Monster! I swam as if I were drowning, flailing 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 $2,705. 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 working 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 hi-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, which in the strategy of things felt nominal( how quickly the scales transmogrify ). Later I read a study that questioned why so many physicians always recommended ICSI, theorizing there may be some is beneficial for a stronger fitter sperm opposing its style to the egg in the Petri dish, just as it did under the auspices of Mother Nature.
Overnight one embryo indicated development but it was atypical. It contains three pieces of genetic info. Three pieces of genetic datum! The nurse told me that it couldnt 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 growth. 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 barge 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 nation, I got the polite, carefully delivered news that there were no signs of improvement. All five embryos were to be discarded. All five run, tossed away, disposed. For a long moment I was silent and then I softly asked the lab deputy, You definitely destroy them? It troubled me how invisible everything was: how would I know what they truly did with my embryo? Who monitored the checks and balances? Scenarios for horror movies stimulated themselves known. Evil lab assistant sells embryos on newborn black market; evil doctor fertilises eggs with own sperm to make own private colony of children; evil research director conducts clandestine experiments to grow babies full-term ex-uterus … As it occurred, in all my five subsequent egg collects I had a significantly greater success rate with embryo development, always objective up with something that could be transferred.
I was having trouble sleeping so in the middle of the night I strolled down to the playground at the end of my street. All the ghost-children were at play. There were little boys crawling over web of rope, little girls kicking up their heels on the swingings. They sang and squabbled and thrilled at inducing footprints in the clay. I told a girl I loved her outfit. Its not an attire! she said. Its a tiger suit! A black-haired son sat beside me and whispered in my ear, Change physicians.
I went back to the same clinic website and procured a new physician, 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 Nells office was a noticeboard pinned with thank-you cards and baby photos. Her way was kind and thoughtful.
We discussed my options for the next cycle. Id do a new egg collection. She created some optional extras that were available as part of the service. The first was a chromosomal exam that could be done on the embryo that would cost an additional $3,670. It was especially helpful, she said, for women whod had recurring miscarriages. That exam needed to be booked months in advance so I didnt opt for it. For $265 I was also offered assisted hatching, whereby a lab technician would use a laser to thin the outer shell of the embryo, inducing it easier supposedly for the embryo to hatch out prior to implantation. Older girls, I was told, have a harder outer shell. The procedure carried a small risk of penetrating the shell and injury the embryo.
And on top of that if I wanted I could try embryo glue for $150, 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 vapor from the head. She said there was no clear evidence but that if I went ahead I could say Id done all I could. What would you do if you were in my shoes? I asked. She said, Its up to you.
This time I didnt use the glue but I did in subsequent cycles. The expense ended up being $9,675( plus anaesthetist and day-surgery fees on top ). Medicare refunded just under $5,200. I had the dread help feeling that I was voluntarily participating in cutting edge medicine, that I was a part of some greater experimentation, a credulous and desperate older female, and the only thing that induced me guess these dreaded thinks might be mere nervousnes, that actually I was the lucky beneficiary of years of advanced medical research, was the soothe 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 colourful cards pinned to her wall.
Extract from Avalanche by Julia Leigh, published by Hamish Hamilton, $24.99.