Avalanche Page 6
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 on
e 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.
I began to wait. “What are my odds—of being pregnant?” was another question I’d asked Dr. Nell on the day of the transfer. Her reply: A Day 5 blastocyst has about a 40 percent chance. How wonderful, 40 percent! That night I felt extremely sensual, writhed like a snake, embodied metamorphosis, and avoided pleasuring myself because I feared contractions could disrupt things. The next morning I had a tiny amount of brown spotting which I’d read was an indicator of implantation. Oh the delight. And then, immediately, tamp down delight. Wait. Wait and see. My friend who subscribed to Chinese medicine strongly advised I cut out cold swims. “The little bean needs a warm nest.” So I did that. I was taking progesterone pessaries morning and night and my breasts swelled, grew sensitive. I hoped and believed I was pregnant. On Day 27 I noticed the slightest discoloration in my urine: a hint of blood. And I collapsed. Howled. Wept. Even though there was no full bleed I sensed my period was imminent. Down, down, down the rathole. The air there was thick and dull. My skin flushed, goose-pimpled. My eyes stang red-raw. My jaw clamped tight. I felt utterly bereft. Alone, alone. You have fucked up your life. The rats of the world scuttled and gnawed. I found it impossible to leave the house.
To make myself feel better I broke a vow and Googled my ex-husband. (A frightening thought: am I a brilliant masochist?) There he was—happy, smiling. In a Facebook photo his new partner sat on the sidelines watching him play cricket. Resentment is a curse. Repulsive: like putting on a soiled garment. Parading around in it.
This didn’t happen: I went to a Goddess Weekend where we worked on our inner Ancient Greek. We sharpened our swords and swore revenge. We hacked our way through grief.
All time was measured according to my menstrual cycle. “January” meant nothing to me. Days closest to my “due date” weighed heaviest. By Day 29 I still hadn’t had a full bleed. In the morning I did a blood test and then went to spend the day with my sister. She was eight months or so pregnant. We had lunch at an inner-city café that was popular with young families because of its mock-farm design: wooden pens with some real chickens and a well-fed pig. Little Elsie pointed to a rooster on a weather vane and said “Sky Chicken!” I was overwhelmed—by all the children, the Yummy Mummies, by Café Potemkin. Later we watched The Wizard of Oz while I gave my sister a foot massage. My phone rang: it was the nurses calling. From the measured tone of voice I could instantly tell the pregnancy test had been negative—as expected. “You can begin another antagonist cycle now if you want to.” When I spoke to the doctor she was gently reassuring: it was good that I had responded well to the egg collection; often it took people two or three tries for chromosomal reasons. “Sometimes an embryo won’t implant because of the chromosomes and there’s nothing we can do about that.” My sister consoled me. I tried to be brave because I didn’t want to pollute her.
I went to a dance class. A kind of free-form hippie dance class. A woman in face paint smudged me with burning sage at the door. It felt so good to reconnect with my body. During the night I had an orgasm in my sleep. Throughout my treatment I didn’t have sex, which made for the longest period of sexual inactivity I’d ever known. Injecting needles each night at 10 p.m. was unsexy; being bloated and hormonally loaded was unsexy; the white goop of progesterone pessaries during the two-week wait was unsexy; explaining I was doing IVF by myself was unsexy; I was unsexy. And recalibrating my fine chemical equilibrium was unnerving. Why invite a bull into the china shop? I’d even say a part of me didn’t want to bodily introduce any sperm other than my donor’s. Foolish. Minimizing. While doing IVF I allowed the world to become a smaller place.
Ways of having approximate sex: feel the heat of a stranger on public transport during peak hour; finger the downy peaches in the fruit store; call out “Coming!” to the man who brings home delivery to the door.
The baby was born. I attended the birth. Everyone cried with joy. I held the tiny newborn in my arms and smelled her.
How to be an object of pity? My sister has a great answer to this one. “Most people think only about themselves, they don’t really care.” Other people’s pity is flimsy. Harmless. If it even exists, it passes. Other people’s compassion is a boon. So it’s self-pity that’s the killer.
When I went to the counselor at the clinic she drew me a picture. “This is the grief,” she said, marking the page with an elongated black hole. “The divorce grief, the infertility grief.” She explained that when we were triggered by an event—it could be anything—we returned to the grief. She marked a dot near the black hole and drew a loop between them. She drew lots of dots, lots of small concentric loops. “And then, over time, we find we have fewer triggers.” She marked a dot at a greater distance from the black hole, drew a bigger loop. More dots, four bigger loops containing all the other loops. “See—it’s a butterfly.” I just nodded. I wanted to take a pin and stick it between my eyes. Pinned and wriggling on the wall.
February 2014. Eight eggs were harvested on my third collection. Five of those were mature and were injected with sperm. The lab assistants called on schedule with their morbid countdown. Please, please develop. You can do it! I was an embryo cheerleader. I filled those Petri dishes with love. On Day 5, the morning of my transfer, I learned that this time I only had a morula to transfer, not a blastocyst. I’d never heard of a morula before—essentially it is an embryo less developed than a blastocyst but still worth transferring. When I asked the doctor about the difference she said that the pregnancy rate for a morula was 25 percent compared to 40 percent for a blastocyst. My heart fell. Whatever eyes-wide wonder I’d had when first doing a transfer had dissipated and now Charlie’s chocolate factory was a factory plain and simple. Efficacious. I didn’t enjoy my acupuncture—all those pinpricks—and wondered whether it was worth pursuing. I still had hope the transfer would be successful, I still conducted my inner conversations with the embryo, but my hope wasn’t as intense as it had been before. I slept a lot. Snow fell in the night. I paid visits to my sister and the new baby. One day I was wearing a wraparound dress that she said looked handy for breastfeeding so we did a costume change. She lent me a loose blue dress she had worn up until the birth. “If I wear this dress,” I joked, “maybe it will rub off and I’ll get pregnant.” I waited and waited. Come Day 28 there was no sign of bleeding. That shy little hope grew and grew. How kind the nurse was when she took my blood. I held my breath all day waiting for the call. “I’m sorry, it’s negative.” I told the nurse I was too wrung out to go straight into another cycle. Wept on the floor.
I had my annual conversation with a woman (mother of two) who was once a close friend. “What’s next for you? Forget about babies,” said the friend. “The baby boat has sailed.” Bitch: I hadn’t breathed a word to her about my treatment. Wait and see.
Now I don’t care but for a long time I was circumspect about telling people I was doing IVF. Professionally, while there was still a chance I could become pregnant, it wasn’t wise. With friends I was careful about who I told. I didn’t want to tell my friend with breast cancer because she had enough on her plate; I didn’t want to tell my friends who were new mot
hers and obsessed with their babies; I didn’t want to tell friends who either were at ease not being mothers or those who found themselves childless in circumstances similar to mine; nor did I want to tell my friend who had remained close to my ex-husband. I didn’t want to tell people because I thought that unless they were involved in that world themselves they wouldn’t want to listen. Or they would only half listen and so diminish my experience. Or they would ask questions that required explanations too complex for conversation. Or they would offer advice based on hearsay and a general theory of positivity. Or I would make them uncomfortable because of my proximity to the abyss. Hush, keep your voice down, don’t mention it by name.
The following month was a respite. Thank all the gods. I jumped on a plane to Bali and for ten days worked on a commissioned script from a villa overlooking the Sayan Ridge in Ubud. The place was lush, verdant, abundantly fertile. Dense and green. I counted six layered storeys of green from my terrace. Vertical green. Ten thousand insects. I luxuriated in having someone bring me breakfast each morning. I did yoga and had massages: unashamed, a walking convalescent. Eat, Pray, Love—or “Eat, Pay, Leave,” as the locals say—who cares. It was good. It helped. I’d do it again in a heartbeat.
On resuming treatment I noticed that the white cockatoos who habitually roosted on a nearby roof antenna had fallen silent. It drove me crazy that Paul had turned his back and walked off into the so-called sunset while I was left with my pathetic hormone injections. Callous lotus-eater! Faux Buddhist! Fake feminist! Hey Orpheus, turn around! The rats had a field day. I heard myself referring to “my infertility” when talking to my sister. A slip of the tongue. I’d never applied the term to myself before—I wasn’t infertile, I was “trying to get pregnant.” To be infertile sounded like something already decided, finalized, irreversible. I had to drag myself back to the nurses. Dread intermingled with hope this time round. I wasn’t sure I could withstand another failure. The test of IVF, I came to realize, is to do with both intensity and duration. IVF is durational in the same way a lot of people can sit at a table and stare at a stranger for ten minutes but very few can do it for 700-plus hours. One day after I’d left the clinic I needed to do some shopping and had my carry bag of drugs with me. Those telltale nylon bags, just big enough for a cold pack: all women doing IVF could spot them a mile away. I bought a dozen eggs. Egg kit, eggs in hand: the moment was absurd. I was slipping. Rally! “You are Team Captain,” I told myself. “Keep it together. It isn’t what happens to a person but how they respond that counts. There is hope. It’s not over yet. You are Team Captain. Team Captain.” In the evening, after my needle, I practiced a visualization exercise, partially inspired by an engraved medical illustration I’d bought after my lung operation. It’s a page cut from a nineteenth-century medical book depicting a bust-sized portrait of a woman, alive, well, fully clothed, her head in three-quarter profile, whose chest is completely open, revealing her lungs and other internal workings. Gruesome and elegant. And hopelessly outmoded by today’s medical knowledge. So I pictured my own internal belly workings and saw follicles growing, sprouting out of my ovaries, each follicle a point of light. Lush, verdant, abundantly fertile.