October 27, 2010

IVF Story Part 2: Hello Embryo

Commencing IVF at age 41 is a little bit like deciding to go back to school and do your HSC. You just know it's going to be fantastic when you finally get what you want at the end of it, but you feel kind of embarrassed telling people.

You're worried they might think, in no particular order, that:

(a) at 41, you are far too old and might be better off going to get your anti-delusional meds upped rather than your eggs harvested

(b) you would be better off spending all that money on a long shot at the Melbourne Cup

(c) you should have tried harder the first time around, when you were young and presumably a lot more fertile, instead of leaving it till the last minute (silly girl!)

(d) you're an idiot.

The Referral

Now I'm not usually the type to worry about what other people think, but when my lovely, very supportive, but very honest GP raised his eyebrows at our plans, I began to have doubts. He gave me a look that pretty well encapsulated thoughts (a) to (d) above, plus a little 'WTF?' on the side.

"You do realise that, at your age, the chances of success are fairly small?" he warned. "And are you sure you want to go back and do the whole baby thing again?"

"Yes and yes," I replied, trying not to sound like my fists were up, even though they were. "I've read all about it. I just want to know, at the end of it, that we've done everything we can do to have another baby. If it doesn't work, then that'll be that."

"Alright then, if that's what you want" he said, like a parent finally agreeing to let their kid on the rollercoaster, even though he knew they would be scared shitless and probably throw up.

The First Appointment

So armed with our referral and, in my case, a defensive mask of false bravado, we had our first meeting with Dr Mark Bowman at Sydney IVF. (Note: the home page of the Sydney IVF website is dominated by a very reassuring picture of a couple who look like they would remember the Hawke years and know who Spandau Ballet were - the man even has GREY HAIR! We felt immediately at home.)

Dr Bowman is charming, knowledgeable, straight-forward and an absolute expert in his field. He went through the process with us, made sure that we understood the success rates for our advanced collective years (98 - holy shit!) and smiled politely through my little speech about our history of fertility and why we were doing this and how worthy and sensible and non-delusional we were.

But my justifications and over-sharing weren't necessary. This man was Rio Tinto and his commodity was babies. In a nice way. His job was to arm us with knowledge, mine our bodies for the necessary elements and put a viable embryo into my body. And he would do it with professionalism, good grace and humour. I was ready to buy shares.

The Tour

After our appointment with Dr Bowman, we visited the IVF clinic where we met a very pleasant nurse named Amanda who gave us a tour, showed us some videos of the entire process and gave us a beautifully bound journal and some folders full of DVDs and other information.

And let me just say, Sydney IVF does good stationery. Tiffany blue, gorgeous graphics, excellent quality stock - if part of all that money was going into printing and graphic design, then this stationery-freak was happy.

We then met with the finance lady who went through all of the costs (you can see detailed costs and rebate information here). This was the bit I had been dreading, but actually it wasn't as scary as I thought. And although I knew Visa or Mastercard would be particularly delighted, it was good to know that it was something we could easily manage on a credit card if we had to, and not have to either save up for or take out the equivalent of a loan on a Ferrari for.

The Process

And so the baby-making began. If you want to know all the ins and outs and wherefores of the IVF process, you can read about it here.

It starts with a call to the nurses on the first day of your period. You would never think that calling a complete stranger and announcing "Hello, I am calling to let you know I am menstruating!" could be so thrillingly exciting, but it really is, because you know this is the very start of the whole baby making process that could lead to an actual, um, BABY! Yeah!!

Then there are lots of injections, which you do yourself at home, either in the tummy or the thigh (I chose thigh - seemed less close to the temple of the womb which I imagined could look like a colander by the end of all those injections. Ridiculous logic I know). You are injecting FSH (egg maturing hormone) to make sure lots of lovely eggs come to maturity at the right time, instead of just one.

Now, for the needle-phobic among you, this could be quite confronting. Get your partner or friend to do it for you and look away. You'll hardly feel a thing. But really, it's not that bad and is easy to do yourself. It can even be quite fun if you have kids or a needle-phobic partner to stick the needle dramatically into your thigh with a blood-curdling yelp just as they enter the room. The happy endorphins released from your wicked laughter at the look of horror on their faces will take any sting away immediately for you, although you may have to sit the poor love down and make them a cuppa.

Then after about 5 or 6 days of that, you inject another hormone to stop the eggs from releasing too early, but keep going with the FSH needles too. At this point you wonder how drug addicts can ever be bothered with all those fiddly darn needles, but you keep jabbing away, and put up with the slight bruising and itchiness that can appear.

There are also lots of blood tests and ultrasounds, for which you need to travel into the clinic at the crack of dawn every few days, and towards the pointy end of the process, daily. I actually enjoyed those early morning runs into the city in the pre-dawn light, walking past all the baristas grinding their beans and putting out their tables on the footpath, sitting in the hushed foyer of the Kent Street clinic waiting for them to open.

Eventually, an ultrasound/blood test cocktail tells the nurses you're ready to inject THE TRIGGER! No, not Roy Rogers' horse (oh dear, showing my age again), but the hormone which will loosen the eggs from the follicles within 36 hours. This is also a warning not to go anywhere, even if your French lover offers you an impromptu trip to Paris, because in 36 hours you have a date with Dr McBaby to harvest your eggs. Which is just as well, because by this time you will be feeling like a squat old apple tree, fully laden with over-ripe fruit that is ready to drop. Like the heavy feeling you get the day just before your period. Times ten.

Egg Collection

If it wasn't for the lovely stationery, the extremely personable nurses, the cappuccino machine and the fabulous magazines, you could be forgiven for feeling like a laying hen in a chook house when it comes to the egg collection part of the operation.

After changing into one of those unflattering gowns, as well as a redeeming and rather attractive bath robe and putting the equivalent of paper condoms over our shoes, we were led into a long room with curtained cubicles running down each side. We were ushered into our very own laying box - I mean, cubicle, where we received a visit from a nurse with a happy disposition and a consent form, followed by a scientist who told us everything she was planning to do to our eggs once collected ("Over-easy, soft centre, toast on the side? Ha ha ha" - yep, the nervous jokes were bad).

Then it was off to meet Dr Bowman for a quick anaesthetic, knees up and in ten minutes it was all over. We were able to watch everything on the ultrasound screen as he inserted a giant needly thing and sucked in the eggs from every follicle.

The big question was - how many eggs? Given that the average retrieval is between 5 and 20 eggs and only 6 for women my age, we were surprised to have produced a grand total of 14 eggs. As a couple of parental geriatrics, we were rather pleased with ourselves, and would have done a high five if it wasn't for the fact that I still had my legs akimbo and such frivolity seemed a tad inappropriate.

The Man's Bit

Because it's all a bit personal, you'll just have to take my word for it when I say that John's part in proceedings was almost exactly like they show in the movies. Or like the start of a joke, "A man walked into a room and picked up a girly magazine . . ." You get the picture.

Although neither of us expected to see a mini-bar full of juice and soft drink, it makes sense when you think about it. A man could work up quite a thirst under the circumstances.

The result at John's end was also excellent. We felt proud that we'd both been able to stay off the booze and produce good quality eggs and sperm, even if they were vintage. The daily pill popping of Elevit and Menevit also seemed to have paid off.

The Sciencey Bit

The reason you want as many eggs collected as possible is because there is a lot of 'drop off' along the way. By the time it came for the scientists to inseminate my eggs with John's sperm, 3 of the eggs had already died. Of the 11 that were inseminated, another 5 did not survive over the next 5 days. It's a case of 'survival of the fittest' and only the 6 strongest embryos survived.

If all this seems too weird and far-removed from what happens naturally, it helps to remember that at this stage, the embryos are still a microscopic group of about 75 to 100 cells. No face, no arms or legs - really a teensy weensy ball of fluid only just visible to the naked eye. The lack of survival at the embryo stage happens all the time in-utero; the difference is that with IVF it's all happening in a petri dish and being monitored by a whole lot of clever people in lab coats.

The Transfer

So about 5 or 6 days later, it's back to the chook house for another knees up affair, only this time the good doc is putting a real live embryo inside you - a hugely momentous event that is over in a few short minutes (Sound familiar . . . ?)

Despite the doctor's assurances that "it can't fall out", you walk out of there very, very carefully, get into the car and cross your legs.

It's time to wait.

The Two Week Wait

No more visits to the clinic, no more ultrasounds, just a looooong wait until we were able to find out if we were really truly pregnant. Fortunately I still had medication to keep me busy and make me feel like I was doing something useful. Progesterone this time, the hormone required to support the pregnancy. But this time, it was in the form of a pessary rather than an injection.

It was strange waiting for those two weeks to pass, wondering every day if the embryo was still in there or if it had somehow slipped away and been flushed down the loo. I didn't have a particular feeling one way or the other. I was just holding on to hope, reassured by the fact that we still had 5 embryos frozen at Kent Street that we could use if necessary.

I guess part of me was not wanting to get my hopes up so I downplayed it in my head. "Hope for the best, expect the worst" was my motto.

The Pregnancy Test

Finally, the day arrived. I drove in for my pregnancy test and then spent the rest of the morning pretending not to look at my phone.

When it finally rang, the news was not good. "I'm afraid you're not pregnant," said the nurse.

My heart dropped into my stomach.

"Oh well," I said, bravely. "There's always next time. What's the next step?" I sat there slowly taking it in while she went through the next process.

I didn't feel like crying, although of course I felt sad. I just felt more determined for the next time. I was going to be stoic, damn it!

I called John and told him. He was disappointed too, but we decided to celebrate nevertheless; to reward ourselves for what we'd been through by enjoying a nice dinner at our favourite restaurant, including a bottle of wine, something that we had forbidden ourselves in an effort to produce the healthiest eggs and swimmers.

It was January 30th. In a few days, my period would come and there would be nobody special to announce it to. We were told we could try again the following cycle which would begin in March. A Christmas baby then. Good.

I uncrossed my legs for the first time in two weeks. Let the wait begin . . .

Click here for IVF Story: Part 3 - Nice Needles & New Attitude

October 22, 2010

The Nursery

In six terrifyingly short weeks, we have a new tenant arriving. A newborn child who will expect somewhere decent to doss down, perform ablutions, maybe invite a few friends over to suck on dummies and generally just, y'know, chill out.

Instead we have a room filled with old mattresses, empty boxes, a drawer full of odd socks, some handy coils of rope and a bottle of 20 year old single malt. This sounds like the room of a 15 year old boy (except instead of the single malt it would be a half empty bottle of gatorade with mouldy bits floating on top).

If I were this baby, I would just stay where I am till these people who call themselves parents get their act together. Sure there isn't much leg room, but there's cereal on tap and the woman sure knows how to get a rocking good waddle going on!

October 13, 2010

IVF Story Part 1: The Pity Party that set the wheels in motion . . .

Just over a year ago, I was going about my business one morning, having taken Jack to school, put on a load of washing, brushed my teeth and negotiated a peace settlement in the middle east for the prime minister - all the usual, mundane things you do of a morning - when it suddenly hit me.

I was 41 years old and I didn't have another child. Of course, I already knew that. But the fact of it hadn't really walked up, slapped me across the face and tipped a beer into my lap. Until now.

I felt myself being washed away by an unexpected tsunami of grief - a real Pity Party Ho-Down with my old acquaintances Regret and Self Reproach as the main guests.

I couldn't believe I'd been so arrogantly naive as to think I could get pregnant easily and so flippant in brushing off my failure to conceive after 5 years. I had told myself it didn't matter, that life was good, that I was lucky to have a child of my own and three great step-children. All the usual justifications we women are so good at. But all along, I had been ignoring the gnawing voice deep inside telling me that it really
did matter. That I wasn't finished with this baby business.

Well that voice made itself heard, loud and clear, on that Tuesday morning last year. Now I'm not normally a weepy emotional person but that morning I sobbed for Australia - a self-indulgent, snot-filled, puffy-eyed Kleenex extravaganza.

Eventually I pulled myself together (as you do; after all, these moments can't last forever because after a while you do start to feel faintly ridiculous, especially when you run out of tissues and catch sight of yourself in the mirror with a bit of toilet paper sticking out of your nose!), and got on with my day, having no idea how, at the age of 41, I was going to get myself in the family way.

The next morning, I met up with my friend Elizabeth who is a few years older than me but many years wiser. She gave me a piece of advice that changed my life. Without that piece of advice, I would not be sitting here 7 months pregnant. That's pretty darn life-changing don't you think? 

So what did my wise, clever friend Elizabeth say? She told me very gently, but bluntly that, at 41, I still had options for falling pregnant, but at 46 those options would have all but completely disappeared and did I really want to look back 5 years down the track and realise I didn't give it the very best shot I could and exhaust every single available option while I still had the chance? 

Did I? DID I???

I hugged her, drove home, sat down at the computer and typed 'IVF' into Google.

I'm not sure why we never considered IVF before then. I certainly had a lot of uninformed non-factual 'facts' roaming around in my brain about the subject. Perhaps you do too. Here's what I thought about IVF:

1. It is for infertile couples
And after 5 years of trying to conceive with no medical reason why we couldn't, we weren't officially infertile were we? Duh!

2. It is horrendously expensive and would require us to get the equivalent of the loan on a waterfront cottage in Palm Beach Um, not quite. We could put the initial treatment on our credit card as the out-of-pockets were less than $5,000 - in our minds, a small price to pay for the chance to conceive. The second cycle was even cheaper because we were using the embryos from the first cycle - out-of-pockets approximately $1500.

But let me clarify, one woman's
'affordable' is another woman's 'are you out of your freaking mind, that's expensive' and I understand it's not within everyone's reach. But, and this might be lousy advice, if you can beg, borrow or save up for it, in my opinion it is worth every cent.

Let me also say that for those who don't conceive and continue to pay for cycles over many months and years, it can become a financial nightmare and yes, horrendously expensive. It doesn't help that the government has reduced the Medicare rebate for IVF treatment but that's a whole other story! Julia I love you, but for that particular piece of legislation your government needs a good spanking.

3. It is an emotional and hormonal nightmare for not just the woman, but for the couple
For me? No, I enjoyed the experience. For John? You'll have to ask him, but I swear he only raised his eyebrows once or twice. A week. At the most.

For many couples, however, it is a horribly taxing emotional and hormonal journey, particularly if they are trying for their first baby and nothing is working. IVF can seem like the final solution (and for many couples it is) so when cycle after cycle doesn't work, with all the attendant physical side effects, 'nightmare' is probably not an adequate word to describe what they go through.

So I sat there and spent two hours eating up every word, every fact, every case study on the Sydney IVF website. The stories submitted by women who'd gone on to have IVF babies were particularly compelling and as I sat there imagining what I would write if that were me, I realised that I'd bought in to the whole IVF shebang. It had me - hook, line and sinker.

But how to raise it with John? We'd officially 'given up' on another baby. We'd had our kitchen cabinet meeting and were sticking to the party line.

I waited about a month, during which I began to doubt the whole idea. My 41st birthday was looming, Jack was a wonderfully self-sufficient 6 year old and surely, after 4 children, my husband deserved to retire from broken nights and shitty nappies.

But those women's stories stayed with me. And then there was Elizabeth's story. She had said "If I were still your age, I'd do everything I could to make it happen. You don't want to live with that regret when it's too late to do something about it."

She was 100% right. I was already the 'sliding doors' type - wondering if I should have pursued a high paying corporate career, wondering if I should have had children younger, wondering if I should have worn the nude heels instead of the strappy gold heels to my cousin's wedding in 2002. I didn't want to add to that list.

That night, I tentatively approached John "Call me crazy, but what if . . . "

To my amazement, delight and undying gratitude he didn't hesitate for even a second "Let's do it. Make an appointment and let's just do it."

We agreed to give it 3 attempts and approach the whole thing with as much levity and humour and pragmatism as possible. After all, we were 41 and 55 respectively. According to the success rates on the Sydney IVF website, our chance of success was less than 30%. But at least we would know that we had tried everything and if it still didn't work, then so be it. We would put the idea to rest forever.

I called Sydney IVF in Kent Street with my heartbeat pounding so loudly in my ears I could barely hear the receptionist. We made an appointment for 10 November 2009 at 12.45pm with Dr Mark Bowman - the man who would throw our ingredients into a cocktail shaker and hopefully mix us up a lovely little baby. I couldn't wait.

Click here for IVF Story: Part 2 - Hello Embryo

Click here for IVF Story: Part 3 - Nice Needles & A New Attitude

October 8, 2010

In These Shoes?

I was up bright and early to attend an Inspiring Women networking breakfast this morning which was due to start at 7am.

That meant heaving 32 week pregnant body out of bed, showering and attempting to pour said body into a dress that would (a) look halfway professional, (b) not show too much flesh between gaping buttons, (c) not allow for an unseemly escape of the ultimate muffin top and (d) allow me to make an emergency wee stop with a maximum of two manoeuvres.

I chose a black knee-length number in fabric that I like to describe as poly-stretchy-manmade-ester (not a natural fibre in sight) but it seemed to fulfil all requirements. The problem is that it's black and dull and not exactly the cheeriest garment with which to greet a beautiful sunrise over Long Reef headland. So I accessorised with red. Red pendant, red resin ring and a pair of lovely (if pregnancy-inappropriate) red velvet wedge heels.

Exhibit A:

John asked me if I planned to walk to the venue, which would be a fair question to ask under normal non-pregnancy, non-heel-wearing circumstances, considering it is only 2 blocks away.

And I said "In these shoes? I don't think so" which reminded me of this completely fabulous and awesomely cool song by Kirsty MacColl which you absolutely MUST listen to. Right now. Go on . . .

I guarantee it will make you want to tap your foot, sway your shoulders, and maybe even click your fingers in a groovy fashion like Elvis in Blue Hawaii, as you imagine sitting at that bar in Guadalajara, sipping something pink and fizzy, waiting for the man with the faraway look in his eye . . . .

Happy Friday everyone. Have something pink and fizzy for me will you? Ta.
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