Thursday, December 26, 2002
I made some notes a few weeks back outside the clinic. today (boxing day) I sat down and turned them into this. I can't help it; I'm a compulsive writer. and I think I'll come back to it and if I'm pregnant by July, I might offer it to the publication I write for. it will be Louise Brown's 25th birthday next year. I don't know if I'd put my name on it, though...
Every morning between 7 and 9 am, while the world is waking, stretching, driving to work and drinking coffee, cars pull into a side street in East Melbourne and park under the plane trees.
One by one their drivers - young, female, childless - swing their legs out of the drivers' seat, trot to the ticket machine, drop coins in the slot, then march across the ugly parking lot of the Freemason's Hospital, entering through a door marked "Maternity", in search of a dream.
In the dream, they're just like other women. They're normal. They have sleepless nights, cracked nipples, shirts covered in baby vomit. They go through labour. None of these things are considered upsides of motherhood, but all these women yearn for it.
I know, because I'm one of them.
The scene inside the hospital at the crack of dawn is one of polite anxiety. women and sometimes their husbands sit quietly outside doctor's rooms and ultrasound clinics and in the waiting room of Suite 10, Melbourne IVF's main clinic, talking in low voices and flicking automatically through magazines.
Occasionally I've seen two women together, in a surgery waiting area or in the clinic waiting room and I wonder: lovers? sisters? an egg donor and recipient, or a mother and a surrogate mother?
Sometimes there's a child in the woman's arms, or trailing a toy train down the hospital corridor. Infertility isn't an absolute, and many couples go through treatment more than once to complete their family. Later in the day there are often new babies being cooed over - the Freemason's has a major maternity ward - and I wonder if the new parents realise how many envious eyes are on them.
Although the unifying fact of infertility is the missing child, the causes and treatment seem infinite. This game has more acronyms than the technology industry - IVF, ICSI, OPU, HCG, OHSS, IUI ....
Most of my discussions with other wannabe mothers have been on the Internet, in bulletin boards and chat rooms, via email and reading online journals.
From this, I've learned that we're very lucky in Australia. Private clinics rule the scene in the United States, and a single IVF cycle can cost ....
In the UK, where ..Mr ... IVF pioneer? name? .. is still practising, getting treatment is made more difficult by a combination of high prices and waiting lists; and waiting is the last thing you want to do when you're in your late 30s and infertile.
Some of the solutions seem somewhat barbaric to me; a woman with no money in the US can "egg share" with a wealthier woman. Essentially, this amounts to selling some of the precious eggs produced in the cycle to the other woman, in return for free treatment.
Here, Medicare will cover about three-quarters of a normal cycle, leaving somewhere between one and two thousand dollars for the patient to pay, although some of the more advanced techniques are not covered. Health insurance helps, but not as much - mine pays hospital bed fees and some drugs.
We're also very lucky in terms of what's involved and how successful it is; when Louise Brown was born, IVF involved much higher doses of drugs, long hospital stays and repeated surgery. Now, in Australia, about 2-3 per cent of all babies born are conceived with medical assistance.
The actual treatment varies a lot these days. My first treatment cycle was a "long down regulation" cycle, begun late last year after I was declared officially infertile due to either "tubal defect" or something called "unexplained".
First I took the contraceptive pill to stabilise my hormone levels and allow the clinic to time my treatment better.
Then I used a nasal spray with a nasty taste twice a day for several weeks. Once it was confirmed that the spray had "down regulated" me - effectively shut down my ovaries and uterus - I began daily injections of a powerful hormone to stimulate my ovaries. All through this I had regular ultrasound scans to watch my uterus and ovaries, and worried about the risk of overstimulation, which can land patients in hospital. I cut down on "bad" substances, like coffee and alcohol, and based on a random snippet I'd read, began eating large amounts of protein, just in case it helped.
As a grand finale, I took a massive injection of a pregnancy hormone exactly 36 hours before ovum pick up.
And as if it wasn't emotional enough stuff already, the drugs and synthetic hormones used in treatment have a side effect known as "emotional lability". this means you cry all the time. It means you feel premenstrual, menopausal and sometimes pregnant, sometimes all at once. Oh, and stress should be avoided during treatment!
The ovum pickup procedure isn't fun. It involves piercing the uterus with a needle and suctioning the eggs from the ovaries, with the whole procedure guided by ultrasound. It's sometimes done under anaesthetic, but more often under sedation. Sedation keeps you still, and often blocks the experience from memory, but it didn't with me.
Two days later when we came in for the embryo "transfer" - placing one or more into the uterus - my first reaction on seeing my doctor was "I'm not letting you near me." She replied "you will when I tell you the results." My ten eggs had become ten embryos, all of good enough quality to transfer. I felt like a six-year-old getting an elephant stamp at school - not bad for a 36-year-old!
There can be nothing more surreal than hearing the words "I'm putting the embryo in now"; afterwards, despite what I knew about how things worked, I was afraid to stand up.
We were wary of the medical problems associated with twins, so we'd decided to try just one embryo at first. For two weeks we did time, waiting for the day of my blood test. I couldn't stay off the Internet, surfing sites about early pregnancy and chatting to my "cycle buddies" at a British clinic.
The day finally came, and I was told I had achieved what I thought was impossible; I was a little bit pregnant. I had a level of pregnancy hormones but it was low and I'd need another test three days later. I thought I'd burst with anticipation. By the Monday, though, I already knew we hadn't succeeded - I'd been perhaps slightly pregnant for a few days.
........ ? what's next?....
In my journey through these rooms, I've encountered nothing but professional kindness from every nurse, doctor and clinician. From an anaesthetist (sp?) who flirted with me over my "beautiful veins" while I lay in a hospital gown on a table in an operating theatre, feeling more like a lab rat than a woman, to the nurses who urged me not to give up when things looked bad, to a specialist who took the trouble to phone me when negative results came in, the staff were not only apparently very good at their jobs, but seemed to care about how I was managing things. Their job must be a mix of vicarious grief and joy, as some couples fail and others succeed.
As for the (mostly) women I've met online, I've seen everything from despair to truly incredible willingness to persist with painful, expensive treatment with a low likelihood of success, through miscarriage after miscarriage and all kinds of bad reactions to drugs, often in the face of an insensitive world where friends say helpful things like "I'll loan you my husband," "why don't you just adopt", and relatives rebuke women who are unable to face newborn babies straight after a failed cycle, telling them they have an "unhealthy" attitude.
From time to time I've come across Web sites that claim the work of fertility clinics, with their conception outside the body and stores of frozen embryos, is immoral and against God's wishes. I have little response to this, other than my instinctive "get your hands off my body" feminist knee-jerk, and a conviction that a child produced at such a high price must have a at least as good a chance of unconditional love as any "naturally conceived" child alive today.
For normal people, reproduction is a mystery. You make love, you get pregnant, there's a child. In the world of "ART" (assisted reproductive technology), the mystery becomes a series of well-defined steps, measured at every turn in millimetres, dosage in iu, and hormone levels. The hours between divisions of the new embryo are timed, and the mechanics and timing of embryo implanation can become an obsession for a woman who has just had a "transfer" - one or more embryos placed into her womb.
Even the actual process of fertilisation is often technologized, as intracytoplasmic sperm injection (ICSI) is increasingly able to help men with low sperm counts or immobile sperm become fathers. (ICSI is a popular way of "reversing" the effects of earlier vasectomy, and isn't covered by Medicare.)
The only thing that remains mysterious and magical is the spark of life that flares at fertilisation. however much I learn about gene recombination and the way the egg manages to launch that new string of genes on a trajectory that can lead to a new human being, I don't think I can ever really comprehend what it is that happens
all I know is ....
Every morning between 7 and 9 am, while the world is waking, stretching, driving to work and drinking coffee, cars pull into a side street in East Melbourne and park under the plane trees.
One by one their drivers - young, female, childless - swing their legs out of the drivers' seat, trot to the ticket machine, drop coins in the slot, then march across the ugly parking lot of the Freemason's Hospital, entering through a door marked "Maternity", in search of a dream.
In the dream, they're just like other women. They're normal. They have sleepless nights, cracked nipples, shirts covered in baby vomit. They go through labour. None of these things are considered upsides of motherhood, but all these women yearn for it.
I know, because I'm one of them.
The scene inside the hospital at the crack of dawn is one of polite anxiety. women and sometimes their husbands sit quietly outside doctor's rooms and ultrasound clinics and in the waiting room of Suite 10, Melbourne IVF's main clinic, talking in low voices and flicking automatically through magazines.
Occasionally I've seen two women together, in a surgery waiting area or in the clinic waiting room and I wonder: lovers? sisters? an egg donor and recipient, or a mother and a surrogate mother?
Sometimes there's a child in the woman's arms, or trailing a toy train down the hospital corridor. Infertility isn't an absolute, and many couples go through treatment more than once to complete their family. Later in the day there are often new babies being cooed over - the Freemason's has a major maternity ward - and I wonder if the new parents realise how many envious eyes are on them.
Although the unifying fact of infertility is the missing child, the causes and treatment seem infinite. This game has more acronyms than the technology industry - IVF, ICSI, OPU, HCG, OHSS, IUI ....
Most of my discussions with other wannabe mothers have been on the Internet, in bulletin boards and chat rooms, via email and reading online journals.
From this, I've learned that we're very lucky in Australia. Private clinics rule the scene in the United States, and a single IVF cycle can cost ....
In the UK, where ..Mr ... IVF pioneer? name? .. is still practising, getting treatment is made more difficult by a combination of high prices and waiting lists; and waiting is the last thing you want to do when you're in your late 30s and infertile.
Some of the solutions seem somewhat barbaric to me; a woman with no money in the US can "egg share" with a wealthier woman. Essentially, this amounts to selling some of the precious eggs produced in the cycle to the other woman, in return for free treatment.
Here, Medicare will cover about three-quarters of a normal cycle, leaving somewhere between one and two thousand dollars for the patient to pay, although some of the more advanced techniques are not covered. Health insurance helps, but not as much - mine pays hospital bed fees and some drugs.
We're also very lucky in terms of what's involved and how successful it is; when Louise Brown was born, IVF involved much higher doses of drugs, long hospital stays and repeated surgery. Now, in Australia, about 2-3 per cent of all babies born are conceived with medical assistance.
The actual treatment varies a lot these days. My first treatment cycle was a "long down regulation" cycle, begun late last year after I was declared officially infertile due to either "tubal defect" or something called "unexplained".
First I took the contraceptive pill to stabilise my hormone levels and allow the clinic to time my treatment better.
Then I used a nasal spray with a nasty taste twice a day for several weeks. Once it was confirmed that the spray had "down regulated" me - effectively shut down my ovaries and uterus - I began daily injections of a powerful hormone to stimulate my ovaries. All through this I had regular ultrasound scans to watch my uterus and ovaries, and worried about the risk of overstimulation, which can land patients in hospital. I cut down on "bad" substances, like coffee and alcohol, and based on a random snippet I'd read, began eating large amounts of protein, just in case it helped.
As a grand finale, I took a massive injection of a pregnancy hormone exactly 36 hours before ovum pick up.
And as if it wasn't emotional enough stuff already, the drugs and synthetic hormones used in treatment have a side effect known as "emotional lability". this means you cry all the time. It means you feel premenstrual, menopausal and sometimes pregnant, sometimes all at once. Oh, and stress should be avoided during treatment!
The ovum pickup procedure isn't fun. It involves piercing the uterus with a needle and suctioning the eggs from the ovaries, with the whole procedure guided by ultrasound. It's sometimes done under anaesthetic, but more often under sedation. Sedation keeps you still, and often blocks the experience from memory, but it didn't with me.
Two days later when we came in for the embryo "transfer" - placing one or more into the uterus - my first reaction on seeing my doctor was "I'm not letting you near me." She replied "you will when I tell you the results." My ten eggs had become ten embryos, all of good enough quality to transfer. I felt like a six-year-old getting an elephant stamp at school - not bad for a 36-year-old!
There can be nothing more surreal than hearing the words "I'm putting the embryo in now"; afterwards, despite what I knew about how things worked, I was afraid to stand up.
We were wary of the medical problems associated with twins, so we'd decided to try just one embryo at first. For two weeks we did time, waiting for the day of my blood test. I couldn't stay off the Internet, surfing sites about early pregnancy and chatting to my "cycle buddies" at a British clinic.
The day finally came, and I was told I had achieved what I thought was impossible; I was a little bit pregnant. I had a level of pregnancy hormones but it was low and I'd need another test three days later. I thought I'd burst with anticipation. By the Monday, though, I already knew we hadn't succeeded - I'd been perhaps slightly pregnant for a few days.
........ ? what's next?....
In my journey through these rooms, I've encountered nothing but professional kindness from every nurse, doctor and clinician. From an anaesthetist (sp?) who flirted with me over my "beautiful veins" while I lay in a hospital gown on a table in an operating theatre, feeling more like a lab rat than a woman, to the nurses who urged me not to give up when things looked bad, to a specialist who took the trouble to phone me when negative results came in, the staff were not only apparently very good at their jobs, but seemed to care about how I was managing things. Their job must be a mix of vicarious grief and joy, as some couples fail and others succeed.
As for the (mostly) women I've met online, I've seen everything from despair to truly incredible willingness to persist with painful, expensive treatment with a low likelihood of success, through miscarriage after miscarriage and all kinds of bad reactions to drugs, often in the face of an insensitive world where friends say helpful things like "I'll loan you my husband," "why don't you just adopt", and relatives rebuke women who are unable to face newborn babies straight after a failed cycle, telling them they have an "unhealthy" attitude.
From time to time I've come across Web sites that claim the work of fertility clinics, with their conception outside the body and stores of frozen embryos, is immoral and against God's wishes. I have little response to this, other than my instinctive "get your hands off my body" feminist knee-jerk, and a conviction that a child produced at such a high price must have a at least as good a chance of unconditional love as any "naturally conceived" child alive today.
For normal people, reproduction is a mystery. You make love, you get pregnant, there's a child. In the world of "ART" (assisted reproductive technology), the mystery becomes a series of well-defined steps, measured at every turn in millimetres, dosage in iu, and hormone levels. The hours between divisions of the new embryo are timed, and the mechanics and timing of embryo implanation can become an obsession for a woman who has just had a "transfer" - one or more embryos placed into her womb.
Even the actual process of fertilisation is often technologized, as intracytoplasmic sperm injection (ICSI) is increasingly able to help men with low sperm counts or immobile sperm become fathers. (ICSI is a popular way of "reversing" the effects of earlier vasectomy, and isn't covered by Medicare.)
The only thing that remains mysterious and magical is the spark of life that flares at fertilisation. however much I learn about gene recombination and the way the egg manages to launch that new string of genes on a trajectory that can lead to a new human being, I don't think I can ever really comprehend what it is that happens
all I know is ....
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