Avalanche Page 7

  And something else about that nineteenth-century engraving: as I was doing IVF it felt like medical science was moving at such a fast pace that whatever the treatment I was being prescribed it was already on the verge of being surpassed. This made for a substrata anxiety about “keeping up with the latest.”

  When I was in Bali a friend—successful in her treatment—had sworn by DHEA. I’d written to my doctor saying that a non-medical friend had recommended something called DHEA as a possible fertility treatment. What was it and did she think it suitable for me at this stage? The doctor replied that DHEA (dehydroepiandrosterone) was a weak male hormone that can be taken as a tablet three times a day. She said there had been a lot of work looking at DHEA as a way of improving egg quality and ovarian response to stimulation but the studies on the whole showed no improvement and as such there didn’t appear to be much benefit in taking it. Still, if I wanted to go ahead she would write me a prescription. Another quandary. I declined.

  If anyone says they chose not to have children because the world is already overpopulated, because the world doesn’t need any more children, I don’t buy it. I also didn’t buy it when my friend who has six children said the country needed more children because “otherwise who is going to pay for our retirement?” If a decision really is made, it’s telescopically micro, not macro. For instance, I did believe a different friend who said he’d never wanted to have a child because he thought it unfair—unkind—to inflict consciousness on another being.

  One mother said to me, “I don’t know how you can choose to be pregnant. Our kids weren’t planned. I wouldn’t have had the courage.” My response: “With IVF—you have to choose.”

  The titanium hook: I only need one and it could be the next one.

  I weighed myself down with more hormones. The scan showed nine large follicles. And a blood test revealed that once again my progesterone was high and the possibility of a fresh transfer was thrown in doubt. “I can only advise what I’d do myself,” said the doctor. “If you say you want to go ahead I’ll still treat you.” I chose to wait for a frozen transfer, as I’d done before. The run sheet: seven eggs were collected of which six were mature. Only three fertilized overnight. And by Day 3 of the countdown all three embryos were still going strong, which raised the exciting prospect that for the first time I might be lucky enough to get more than one embryo worthy of being transferred. How eager I was to fan the flame of hope. More than one viable embryo! Blessed bounty! I remember I received the good news when I ducked out of an actors’ workshop that I was auditing. Earlier in the day the acting coach—a man—had stopped a 20-something actress midway through her scene. “I can’t hear you! Speak up! As a woman you can have a voice, you’re not a child or a girl! Listen to this—women are allowed to have more power! Women are more powerful than men because they carry children!” I knew the coach was well-intended but his pep talk made my skin crawl. On Day 5 I called the lab for an update. An assistant said my results weren’t ready yet because “we’re busy assessing our patients.” How strange: I wasn’t sure if she meant the embryos themselves were her patients. Perhaps she did. That afternoon I got a call back: I had one early blastocyst, Grade B, and a morula that wouldn’t survive the thaw, and the third embryo had stopped developing altogether on Day 3. So they froze the blastocyst.

  I loved knowing the frozen blastocyst was sitting there waiting to be transferred. My icy jewel, my future. I waited a month for my high progesterone to settle and then did the transfer. Everything was timed to sync with my natural cycle. That morning Dr. Nell was running behind schedule so I meditated in the waiting room. I’d started seeing a new counselor, privately. A man. Unfairly or not, I’d stopped trusting the counselor at the clinic: should a fox counsel hens in the henhouse? I suppose I liked the male attention but also I’d grown to dislike confiding in a mother about my woes. The double bind: while I still had hope of becoming pregnant, perhaps in the next two weeks, it felt awkward to talk about giving up, eternal childlessness. I was too superstitious. And how could I grieve sincerely knowing there was still a chance I might soon be immensely happy? Half-grief, forestalled grief, was a kind of hell. To make it more bearable we focused on things like grounding oneself in the body, meditation. He mentioned the hara point, beloved of many traditions including Zen Buddhism. “It’s about two inches below the belly button and then two inches inside the belly. Put your attention there.” “Oh,” I replied, snow-blind, “you realize that’s the point of conception in a woman’s body. Where humans are conceived.” When I was in the chair for the transfer the doctor asked, kindly, “Are you all right? You’re very quiet today.” All the sadness in the world fell through the ceiling. “I’m OK,” I lied. I passed the paperbark tree on the way to my car but didn’t even touch it. In the parking spot reserved for Medical Practitioners Only I noticed a Bentley.

  When I refused to use Zovirax for a cold sore on my lip, saying it wasn’t suitable for pregnant women, my sister sighed and told me I was an idiot. After I ate some cold chicken salad from a bain-marie I was pierced with guilt lest I’d given myself food poisoning and compromised the baby. Day in, day out, my nipples were burning. Come Day 28 there were no signs of bleeding. Hope. Hope sharpened to need. I did the pregnancy test in the morning—a nightmare, Rebecca had to tap my vein while the needle was in place, tap tap tap, to encourage blood flow. Ten thousand hours later the nurse called and said, “We thought it might have been different because we hadn’t heard from you but I’m sorry, it’s negative.” That night I took a Valium and watched back-to-back episodes of Agatha Christie’s Poirot. Those mysteries were always solved. It was impossible to imagine the Belgian detective happy running after children.

  By now a private equity-owned clinic in Sydney had floated on the stock exchange and become the world’s first listed IVF company. Financial commentators said it had a great business model.

  My period did arrive a couple of days later and I went straight into a new cycle. “I want to firebomb that place,” said one of my friends. My donor was a prince and a gentleman. I let him know each pregnancy test how I’d fared and he always responded promptly with an encouraging message of support. My mother assured me she wished me well, “There’s nothing I can do but I wish you all the very best, really, I mean it.” Another friend—who is not Catholic and who had lost her first child at nine days old—gave me her picture of Piero della Francesca’s Madonna of Parturition, a Renaissance portrait of the Virgin Mary, heavily pregnant, flanked by angels, her hand resting on her gown, split open, a holy lapis lazuli blue. So beautiful. I taped that to my wall. One thing I found consoling was a message from a friend who—completely pro-choice—said each encounter between a sperm and egg was magical, brief or not. “Bathe in love, mourn in love if necessary, thank the spirits for even a micro-moment of passing through.” I confessed my fear of the abyss to my sister, who said I needed to start preparing.

  But what if my period hadn’t arrived? What if the test had been positive? My whole life would have changed. Just like that. I would have held my breath, warding off miscarriage, and at the same time every day would have been a joy. Morning sickness? Joy—I insisted. A child was a cure for nausea. My accountant had advised I shouldn’t sell my apartment and move to a bigger place unless I knew exactly where I stood—so I could have gone ahead with that. A new place with a room for the baby. A new suburb because I couldn’t afford to stay where I was. I would have opened my Hope Chest and pinned an embroidered wall hanging of colorful animals above the cot. Strung up paper garlands in the shape of butterflies and swallows. Run as fast as I could out of limbo.

  There was another way out of limbo. The dark and rocky path. I made the decision that I would only try two more egg collections and do as many transfers as there were viable embryos. It was extremely hard to nominate my own breaking point and I did give myself a sneaky backdoor which was something like “Well, see how you feel at the time.” But now the abyss was ripped from the ever-receding h
orizon and fixed in place. Crawl along that dark and rocky path. My doctor raised the unironic possibility that I may have a high level of Natural Killer cells, the main immune cell-type found in the uterus, and that I may be rejecting the embryo in the same way my immune system would fight off cells not recognized as myself, such as infections or cancer. There were tests the clinic could run—either a blood test or a uterine biopsy or both. She advised studies so far had demonstrated an “association” between high Natural Killer cells and infertility but a causal relationship had yet to be established. Yet, I heard her yet: the science was so new. One more blood test didn’t seem too onerous so I agreed to do that. Meanwhile the cycle was proceeding at the regular pace: injections, blood tests, scans. I was exhausted. Bone-tired. Knackered. They shoot horses, don’t they? For the first time I forgot one of my nightly injections and woke at 5 a.m. in a panic, berating myself for this sloppiness. Why did you forget? Have you lost faith that things will work out? My sister picked me up from the egg collection. This time, after my fourth general anesthetic in the space of seven months, I needed to go on a drip before I was allowed to leave because of low blood pressure. The results of that penultimate cycle were disappointing. Of the eight eggs collected six were injected with sperm but overnight only one embryo showed signs of fertilization. That lone embryo developed strongly until Day 3—it looked as good as it could be, Grade A—and Dr. Nell recommended we transfer straightaway rather than wait until Day 5 because we were only monitoring one embryo. When I looked at my inner moonscape on the ultrasound screen and saw the tiny white speck land on my uterus I was surprised to hear the doctor say, “That’s the baby.” The baby. I loved her for saying “the baby.” My not-yet-baby was real to her. I wasn’t entirely alone. Maybe the doctor would be the only person in the world who would ever refer to my baby. I thought it generous.

  A week later the Natural Killer cells test came back with a bad result: a high level of both the number of cells and their activity. I was with my sister and her two little girls in a café when the doctor called. I stepped outside. I was told I could begin the protocol immediately: a prescription was ready at the clinic for me to pick up. Treatment would involve me artificially suppressing my immune system for a period of three months. I would take a steroid, prednisone, and also a blood-thinning agent, Clexane.

  —What are the side effects?

  —The rate for cleft palate in the baby increases from one in 1,000 to three in 1,000.

  —And for the mother?

  —An increased chance of high blood pressure and high blood sugar.

  —My friend went manic after she took steroids for an ear problem.

  —Well, I don’t know about that . . .

  —When I took the test I was run down, I didn’t have the flu but I’d finished fighting one off. Could that have spiked my immune activity?

  —Possibly.

  —Can I retake the test now?

  —No, the reading would be off. We’d have to wait until next month.

  —On the Internet I read that this Natural Killer cell therapy is controversial. What’s the evidence?

  —It’s very new. There’s not really enough evidence to show the benefits of treatment outweigh the downsides of doing it. It’s up to you. The script is there if you want it.

  —Can I think about it and let you know tomorrow?

  —Yes, that’s fine.

  Artificially suppress my immune system for three months? I let the tears fall. When I reported back to my sister she frowned and said, “Where does this stop? It’s too much stress on your body. I hate to say it but the main thing is the age of your eggs so any extra hope is marginal.” I decided to hold off and retake the test.

  During that two-week wait I flew up to Thursday Island in the Torres Strait to do some research for a script. The Torres Strait lies between the far north tip of Australia and Papua New Guinea. The doctor had said it was OK to fly and I figured the length of the longest leg in the air—Sydney to Cairns, three hours—was manageable. My friend, a leading corporate lawyer, rigorous and hardheaded, had strongly advised me against long-haul flights after she suffered a miscarriage herself shortly after one such long trip. “I’ll never know if that was the cause,” she said. “But you don’t want to risk it.” From Cairns I flew to the tiny airport on Horn Island—a pit stop before taking the ferry over to Thursday Island—and learned my luggage had gone missing. Stupidly, I’d packed away my medication—my progesterone pessaries—rather than carry it in my handbag. So when I arrived at my hotel I asked the receptionist to call the local pharmacy to check if they carried the pessaries. They didn’t. Then she called the dispensary at the hospital—and I was in luck. I made my way there and arrived close to 5 p.m. when the dispensary was due to close. I presented myself to Emergency, extremely apologetic, feeling like a complete fool. Princess! No one else was waiting. I was informed the doctor was in with a patient. Tick-tock. What if the dispensary closes before the doctor can see me? I went to the desk and assured them, really, it would only take a minute for someone to write out a script. Finally the doctor, a woman who looked in her late twenties, emerged from a room. “We treat sick people here,” was the first thing she said to me. I made my case as best I could. Outside came the sound of a chopper approaching. “Those are my patients,” said the doctor. They were bringing in cases from the outer islands—who knows what? Machete cuts, croc bites, broken limbs. Anyway, she wrote me a script and I left with my pessaries hidden in a brown paper bag.

  While I was up there I got my period. I confided to one of the Islander women that I was doing IVF. Her mother had adopted out her first child to an infertile couple. Across all the islands and among those Islanders living on the mainland the practice of traditional adoption was—and is—common. Widespread. Both married couples and single mothers adopt out. And for all sorts of reasons, not only helping those who are infertile. There is no stigma. The adoption takes place within extended family so link to kin and culture is preserved. I read a report that said “people are considered greedy if they have too many children and do not share them with others. The underlying principle of Torres Strait Islander adoption is that giving birth to a child is not necessarily a reason for raising the child.” A clinic on the island would almost certainly go bankrupt.

  The results of my second Natural Killer cell test came back. Both my levels—amount and activity—were now normal. I was relieved—and dismayed. Dismayed to realize that I had so narrowly escaped such an aggressive treatment. I asked Dr. Nell to bring my results to the attention of the in-house lead researcher and she later advised that the clinic would in future refine its advice about when to take the test.

  To prepare for the abyss I tried to kill my baby. I defaced the little darling, removed its eyes, eye sockets too (pity the poor mother in Chernobyl whose baby was born with no eye sockets). I shrank and gnarled its limbs. I laid my umbilical cord around its neck like a noose. But it never worked. The childling was always resurrected, smiling, perfect.

  Whenever people asked “How are you?” by way of social nicety I lied through my teeth. “Not too bad,” I’d say. Or “Swings and roundabouts.” At least I didn’t say “Fine, thanks.” Or “A livid scar cuts across my very being.”

  One morning I got up early to watch the World Cup final. Germany vs. Argentina. Looking out of my window, high on the hill, I saw that the entire valley of houses and apartments ringing the beach had vanished in a whitish fog, a sea mist. That happened sometimes, maybe twice a year. Germany beat Argentina in the dying minutes of extra time. I liked how Lionel Messi conducted himself. He didn’t pretend. He wasn’t thinking, We played well, we did our best. You could see the snub blade of defeat, under his ribs. Even when he went up on the dais to accept a trophy for best player of the tournament he didn’t crack a smile. Something deeply meaningful to him had been lost. He—and his team—were truly defeated.

  A friend very gently asked, “How’s the other going?,” discreetly referring
to my IVF. I told her I was about to begin another cycle, “probably my last.” She reached under the table and pulled a present from a large bag. It was an Aboriginal painting in a muslin wrap. “I’m glad to hear that. Here—you can have this on loan for as long as you like. It’s a fertility painting, it has magical powers.” I was so touched by this kind gesture. “I conceived my children with it in the room and I’d love you to have it.” I tried not to cry. She tried not to cry. We smiled through our tears. Unspoken: her first child had died in utero at five months.