Avalanche (2 page)

We bought a bottle of Cointreau and called it kissing syrup. Over breakfast he'd play love songs like Nick Cave's “Sweetheart Come” or “Do You Realize??” by The Flaming Lips. When we listened to The Beatles' “Come Together” we'd loudly interject, so the lyrics became “Come
Almost
Together.” He gave me a golden compass. I was erotically charged when he would help me zip up the back of my dress. We shared all our “elective affinities.” And our vulnerabilities—lovers' currency. One day we made a visit back to campus especially to kiss in the stacks of the library. We had our own names for local landmarks. I called him my Gentle Liege, my Ur-Prince, my Anarchist Master. He was also known as Captain Frolic, the Resplendent Quetzal, and the Magnificent Pigeon. I bought his favorite foods at the grocery store. He gave me the name Cheese Prices because I would despair at the cost of a block of cheese, calculating I needed to sell five books per block. We counted the days since we'd reunited at the airport—that was Day 1, we reset the calendar. Each night we'd give thanks for the day together; each morning we'd greet one another on waking. There were minor skirmishes at the border . . . and he would call an Emergency Meeting that involved him lying flat on the floor
and I would lie on top of him and we'd talk things through that way, nose to nose. It was summer so we swam together and took walks along the Bondi cliff tops. I pointed out an avalanche in a white curl of wave breaking against the shore. When we passed a man coming in the opposite direction with a baby strapped to his chest Paul squeezed my hand. We dared to discuss baby names. For some reason, I think because he already had a son, we only talked about girls' names. I said I liked names ending in “ia.” “Indicia,” he suggested. “And she'll know she's met the right person when they ask ‘Of what?' ” I didn't like it that much, thought it too tricksy, as if it belonged in a Thomas Pynchon novel, but we kept it as an option, a precious placeholder. Returning from a business trip, Paul bought a little teddy bear in a pink top at the airport. Whenever either of us would travel alone that teddy bear would go in the suitcase.

Our child
. In February 2008 we made our first visit to the IVF clinic. There was the not insignificant matter of a vasectomy to deal with, a procedure Paul had undergone not long after the birth of his son. Our plan, our hope, was that a vasectomy reversal would work and I'd fall pregnant naturally, wouldn't need further
intervention—but just in case the reversal failed or I had problems then we wanted to ensure we were in good hands. I went online to compare the success-rate claims of the two Sydney clinics I'd heard the most talk about. I didn't keep notes at the time but today I went back to the same clinic websites and looked at their information. I figure the statistics haven't radically altered: if anything the chances of IVF working have only improved over time. For women aged between 35 and 39, using their own eggs, one clinic claimed a live birth rate per embryo transfer (fresh and frozen) of 28 percent. A transfer is a procedure where an embryo is placed in the uterus or fallopian tubes; the embryo can be fresh or it can have been thawed following freezing. When I looked at the second clinic I found it presented its data differently. It used a narrower age range; didn't give exact percentages in numerical form but instead relied on a visual graph with columns per age group; and it counted only fresh transfers, not frozen. The graph showed that for women using their own eggs between 37 and 39 years there was a live birth rate of around 22 percent for each fresh embryo transfer. On the same graph the natural conception rate for a woman aged 37 to 39 was 10 percent. A direct comparison of success
rates between the two clinics wasn't possible—perhaps by design. And there was nowhere else I could turn to for clarity: in Australia data about the IVF industry has been collected but the success rates that identify specific clinics are not released to the public.

Back then, right at the beginning, I had an uneasy response to the so-called statistics. I told myself: each human body is a mystery; there are too many factors that distinguish one 38-year-old from another. What if one woman had only one ovary? What if another had endometriosis? Didn't they drag down the overall probabilities of success? An aggregate figure was not convincing. My own chances would surely be better (this was the irrational leap). Paul had another name for me: Pollyanna Juggernaut. Pollyanna was determined to look on the bright side, plow ahead. She would not, could not, countenance the abyss. I always liked Pollyanna Juggernaut: she would lead the troops to battle.

What actually swung our choice of clinic was not the data but a personal recommendation from a trusted friend, someone I'd known since high school and who was diligent by nature, always doing a lot of homework
before taking a step ahead. She'd tried one place and had no luck, then moved on. She recommended a man whom I shall call Dr. Rogers. “I didn't like him,” she said, “but he's the guy who got me pregnant.” Dr. Rogers, it turned out, according to his web profile, had an expertise in male infertility. So I went ahead and fixed an appointment.

The clinic was in the central business district, somewhere I'd largely avoided since graduation from law school. For me, a trip to the city had the novelty of a trip to the Big Smoke. We took the elevator to the fifth floor, both having made an effort to be well dressed, citified, as if stepping into the clinic together was as symbolic a first step in marriage as any state-sanctioned union. Heads in the waiting room did not turn. This was a temple of discretion. No one expected or wanted to be here. Immediately I noticed the wallpaper was neither girl-pink nor boy-blue but a considerate shade of yellow. The magazines on the low tables were up to date. Paul and I held hands (who reached out their hand first for comfort, to comfort, I don't know). Dr. Rogers was friendly. It must have been the kind of appointment he looked forward to—a new couple, committed to
having a child together, glowing with an undimmed hope. We hung off his every word. What we were chiefly there for was to talk about reversing the vasectomy. Ah, the vasectomy! Dr. Rogers reached into his drawer and pulled out a laminated flipbook of gruesome surgical photos. He regaled us with a detailed description of what would need to be done. Paul would have a general anesthetic. The tubes that carry the sperm from the testes along with other ejaculate are called the vasa (collective) or vas (singular). The vasa—left side and right side—had been snipped and the doctor would find the two ends of each snipped tube or vas, remove the scar tissue, and attempt to rejoin the ends. As a result, the sperm that Paul was currently producing and which couldn't find its way up the vasa would be able to flow free. A feat of irrigation engineering worthy of a Balinese subak master. A small mystery was solved for me: the sperm he had been producing with snipped tubes had just died on the spot and been reabsorbed by the body, it hadn't gone anywhere. Even if the tubes were successfully rejoined—the long length of time between the vasectomy and the reversal diminished our odds—it wasn't guaranteed the sperm would return. And if it didn't? Dr. Rogers
explained that during the procedure they'd also take a significant amount of sperm and freeze it so that it could later be used for multiple treatment cycles. And if we wanted, at any future time, fresh sperm could be taken straight from the testes, during another minor operation.

Testes: I felt squeamish; I sensed Paul was embarrassed, he didn't like being in a position where another man was so passionate about cutting into his balls. The doctor then turned his attention to me. He asked if I smoked (no) or drank (in moderation) and assessed my body mass index (healthy). Age? 38. “Hmmm, that's generally fine,” he said, “but I don't want to see you back here in two years' time.” Back in two years' time?
What are you talking about?
In Dr. Rogers's office, at his suggestion of a potential return visit in two years' time, I remember being a little offended.

“I've been pregnant before,” I jumped in. “Twice. In my twenties. Two terminations.” It was a good thing, I thought, it raised my chances. If I'd been pregnant before then odds were I could be pregnant again. I wasn't one of those unlucky women who belatedly discover some
serious problem with their uterus. I have never, not even for one second, regretted those terminations—not even now. Dr. Rogers picked up his pen. He drew a simple graph. Natural fertility on the vertical axis, age on the horizontal, starting at age 25 and running to 50. As a woman aged her fertility dropped, the downward slope became precipitous. He tried to impress on me the fact that my early pregnancies had less bearing on my current situation than I thought. They were a lifetime ago. Nor did he give much weight to the fact that my sister had easily fallen pregnant or that my mother had a late menopause. As soupy as the statistics were, as malleable, a woman's age was a key determinant in her chances of “taking home a baby.”

He ordered a battery of tests. We thanked him and left. Signed some paperwork at the front desk. Paid by credit card. We hardly spoke in the elevator, held our breath. Pollyanna Juggernaut deserted me. I was tiny. Thrown. Out on the street, Paul put his arm around my shoulders, pulled me close. I was thinking: I hope the reversal works; I hope my test results are OK; please, please, please, I never want to come back here.

There's a different graph Dr. Rogers could have drawn that first day in the clinic. Most IVF cycles fail, or to be more precise, most
assisted reproduction
fails. The best source of statistics I've found is an independent study by the National Perinatal and Statistics Unit within the University of New South Wales. Published in September 2015, the report analyzes data collected from all assisted reproduction technology clinics in Australia and New Zealand in the year 2013. It shows, among other things, that of 71,516 treatment cycles only 18.2 percent resulted in a live birth. Regardless the age of the patient, regardless the exact variant of treatment, most cycles failed. So Dr. Rogers could have marked treatment failure on the vertical axis and a woman's age on the horizontal. It's an industry predicated on failure. The true graph depicts a mountain with one face Hope and the other Despair.

I did my blood tests. Since I was young I've had a phobia of needles. My mother thinks it stems from an early childhood visit to the doctors when I yanked my arm away mid-procedure. What a mess. Once at the university medical center I was settling my account after a blood test and I heard a loud bang. I came to lying on
the ground with someone holding two fingers in front of my face, asking me to count them. When I'd fainted I'd accidentally swiped the receptionist's large intercom system off her desk and onto the floor—that accounted for the bang I'd heard. I was dragged by the feet through the waiting room into a corridor. It was nearing the end of the day so a kind doctor drove me home. Still, it doesn't seem to me hysterical to have an intense dislike of a needle piercing my vein and draining blood from my body. It's creepy. Also, I have bad veins, reluctant veins—which means that sometimes it takes more than one go to strike gold. (I'm so phobic I even cringe at typing the word
vein
.) I bruise; I get blood blisters; I break out in a rash. In the course of my treatment I did close to a hundred blood tests, probably more. I developed a strict routine: heat pack, lie down, left arm first, turn my head to the side and let the tears fall. Symptom: I would sink into a disproportionate state of vulnerability, the tears would rise unbidden as I resigned myself to that vulnerability. Needle out. Pressing my finger on my vein to staunch the prick was completely disgusting to me. “Please don't show me the vial of blood, just read out my name and birth date.” I never found it easy.

I became very interested in what age a woman had her first child. Just as I used to try to figure out when an author had published their first novel now I sought to compare myself with new mothers. The point of comparison was not to do better but to get a feel for the lay of the land. To gauge what was not impossible. Again, the persuasive illogic: if she could do it at age 38, 39, 40, 41, 42, 43, 44, then so could I. My sources were various. First, there were the anecdotal accounts among friends and friends-of-friends. Dozens of women in my broad circle had their babies late. One friend naturally fell pregnant at 45 and then at 47, thanks to freakishly good genes and—according to her—copious shots of wheatgrass. Later, when I began to confide that I'd started treatment, I would invariably be reassured and provided with an example or two of a recent success story. The media, too, was full of good news. It seemed that every second day a celebrity in her forties was having a baby. I gratefully swallowed the evidence.

The druids in the lab read my blood and reported back. Dr. Rogers talked us through the results. Amongst a raft of other things I was all clear for hepatitis, HIV, rubella, syphilis. My thyroid was fine. A full blood count didn't
present any problems. My iron was on the low side, as was my B12, but nothing dreadful. My progesterone and estrogen levels were normal. A genetic test showed I didn't carry cystic fibrosis. Nor did I have any sperm antibodies. The pelvic ultrasound concluded “No pelvic abnormality is detected at this examination.”

The doctor had also tested my follicle stimulating hormone level. The FSH test was supposed to give insight into the remaining number of eggs I had—but it could not tell me anything about the quality of those eggs. FSH is a hormone produced by the pituitary gland that plays a regulatory role in both stimulating the growth of follicles and letting the body know when it is time to ovulate. A follicle is the sac of fluid that surrounds a developing egg. As a woman ages and her stockpile of eggs diminishes it takes more FSH to produce an egg. The correlation seems to be that the more effort it takes, the higher the FSH reading, the lower the egg supply or “ovarian reserve.” A result of 8.1 was deemed by Dr. Rogers to be “reasonable.” Sitting there in his room I had the sense that all augured well: if the vasectomy reversal worked then a natural pregnancy wasn't out of the question.