Thursday, July 31, 2003

things I learned today: K-Mart is an inherently depressing place. Just because pink donuts look good, doesn't mean they taste good. Don't try to get sense out of a bank teller who has demonstrated a complete lack of interest in your views. It's true that people start to treat you like a fool when you're a pregnant woman.

But most importantly: never get old, slow and disabled. like me with my dodgy pelvis, you will be reduced to stopping dead in your tracks when yet another Young Person barrels towards you, clearly expecting you to get out of their way. and when you're old, they may not actually see you standing in their path. At least I have that much.

the physio says I should not walk or stand if I can help it. this is completely counter to all my instincts, needs and wishes. and what am I supposed to do when we have various blind/curtain people trotting around our house suggesting swag curtains and other monstrosities? just sit in the kitchen and ignore them? hell no.

spotted today: one of those young people who would probably not bowl over an old, infirm person. She was maybe 20, with dirty blond hair streaked with brighter streaks, two twirls of it pulled back and tied behind her head,, forming a halo. She wore a purple jumper of no particular cut, wide black sailor pants, flat shoes and a large shapeless black shoulder bag full of her business. She crossed Wellington St on her way to her life, noticing nothing, reminding me most of those dogs you see from time to time; clearly knowing what they are doing, and not caring what's going on elsewhere.

Sunday, July 27, 2003

too busy. buying the pub, finishing moving house, fighting the &^$&^@# bank, which I eventually made settle without a proper repayment schedule b/c they couldn't get their act together - it would have fallen through if I hadn't panicked.
have a week off work now to "rest" - meaning get stuff done with one less thing, ie work, to do.
my hip has given up - another pregnancy thing - and all I want, and am going to get, is a long, hot BATH!

Monday, July 21, 2003

At last; the giant (3600 word) post in its entirety.
this ran in Sunday's paper. it's been a while since I was so scared to publish something, and so pleased I had.
feel free to wander off and busy yourself with other things; it does go on a bit...
EVERY morning between 7am and 9am, while the world is waking, drinking coffee and getting ready for business, a series of cars pulls into a leafy side street in East Melbourne.

One by one their drivers - young, female, childless - swing their legs out of the driver's seat. They feed the parking meter, then hurry across a carpark, entering under the sign "Maternity Unit", in search of a dream. Once inside they subject themselves to a battery of procedures - injections, blood samples and ultrasounds. Then it's back in the car and on to work, or back to the rest of their lives, leaving workmates and friends oblivious to their secret morning ritual.

I know, because I was one of them.

The hospital is the Freemason's and the clinic is Melbourne IVF, which helps around 700 couples to have babies every year. Inside, the scene is one of polite early-morning anxiety (the clinic opens at 7am to allow women to receive treatment without affecting the rest of the day). Women, and sometimes their partners, sit quietly in waiting areas or outside doctors' rooms or operating theatres, talking in low voices and flicking through old magazines. Waiting, waiting, waiting.

My IVF journey began in late 2001 when I realised it was taking me longer than it should have to fall pregnant.

At the age of 35, I was well aware of the dire warnings from fertility experts about the dangers of "waiting too long". So I visited my GP, along with my husband of 18 months, armed with temperature charts pinpointing my ovulation each month for a year, in case the GP told me to go away and keep trying. But she didn't: she referred me straight to an infertility specialist.

Before we saw the specialist, I had the first of endless blood tests; this one to confirm that I was ovulating. I was, which meant that we had two options; keep trying, or "investigate'' my reproductive system.

The latter involves getting in there and having a good look around. This can be done without surgery, but the most conclusive method is a laparoscopy under general anaesthetic. This keyhole surgery is relatively minor, and uses advanced methods and miniature cameras to limit any incisions to tiny cuts. Even so, the thought of it terrified me.
If it showed up a serious problem, we might never have children. If it showed that my fallopian tubes were blocked, we'd be referred on to an IVF clinic. The best outcome might be that I had endometriosis, a kind of misplacement of tissues that could possibly be cleared on the spot. We were given time to go away and think about it. We intended to wait a while, but just before my 36th birthday in May 2002, I bowed to the inevitable, and booked in for surgery in July.

Over the coming months I often thought about wimping out on the operation, but that would be tantamount to deciding to remain childless. Through everything that followed, that choice remained; do this, or don't have kids. It gave me a grim kind of strength.

The surgery, as surgery does, knocked me around. Over the several days of struggling to get from the bed to the couch that followed, I questioned how far I'd go.

The "investigation" had given us good and bad news. My fallopian tubes appeared to be completely blocked. That might seem to be a terrible blow, but by then I was beginning my own investigations, and I realised that things could be far worse. If the blocked tubes were my only problem (my husband had been given the all-clear), I was an excellent candidate for IVF. Blocked tubes are what IVF was invented for.

When Louise Brown, the world's first IVF baby, was born on July 25, 1998, the world treated her as something between a freak and a miracle. Now, almost one in 50 Australian babies is conceived with some kind of assisted reproductive technology - and Melbourne has always been at the forefront of research. Australia's first (and the world's third) IVF baby, Candice Reed, was born here on June 23, 1980, less than two years after Louise Brown. The world's fourth IVF baby was also born at the Royal Women's Hospital.

The basics of IVF haven't changed since the 1970s. By taking eggs directly from the ovaries, fertilising them outside the body and replacing them in the uterus, the tubes are bypassed and pregnancy is often achieved. Often, but not always.

One of Melbourne's IVF pioneers, Professor Carl Wood, began his infertility work by trying to fix the problem of blocked tubes. By 1969 though, he was working on in-vitro fertilisation, in parallel with the UK clinic that eventually helped Louise Brown's mother, Lesley, to give birth. Professor Alan Trounson, scientific director of Monash IVF and chief executive of the National Stem Cell Centre, says Wood's nature was to try whatever would work.

"He had all these patients who had infertility problems and he actually wanted to do something about it.''
Twenty-five years of refinement has brought what used to be a hit and miss procedure down to a fine art, though still a difficult one. Between 1978 and 1980, when Candice Reed (the first Australian IVF baby) was born, he worked with about 100 couples. With barely a sliver of hope, these women agreed to be admitted to hospital for regular blood and urine tests and frightening new forms of surgery.

"It was incredibly invasive and it was incredibly demanding," Trounson says. "You basically gave your whole life to doing this. Surgeons would carry out a laparotomy and if they were lucky, get one solitary egg cell to work with."

Trounson's background in veterinary science had taught him there was a better way. Although the UK researchers had had little success getting artificially stimulated egg cells to fertilise, he pioneered the use of a gentler drug, Clomiphene, to bring on "superovulation" of several eggs at once. Later, he developed the use of a large dose of a hormone called HCG as a trigger to ripen the eggs virtually on command.

In October last year, our own day to start the IVF program came. At this point, all I knew about IVF was that it involved needles. Lots of needles. At best IVF is a drawn-out, invasive and uncomfortable set of medical procedures that can deliver a healthy baby, sometimes two. But at worst, as I discovered partly for myself, but more through talking to veteran IVFers on the internet, it can be a nightmare game of snakes and ladders, heartbreaking but almost impossible to abandon.

New patients are put through an induction process lasting several hours: we saw our specialist, talked with a counsellor before signing consent forms and then we were walked through the complicated course of treatment by a nurse.

Surprisingly, the first drug I was put on was the contraceptive pill. This helps the clinic to time treatments so there are not too many women going through the crucial egg pickup and embryo transfers at the same time. Artificial though it all seems, these precise controls have helped success rates zoom upwards.

In November 2001, I began self-administering a powerful drug called nafarel acetate via a nasal spray twice a day. This had an even more incongruous purpose; to create a state of artificial menopause by shutting down my ovaries. I'd decided that my best chance lay with doing exactly what I was told, so I used the spray at precise 12-hour intervals, once in a car barrelling down Lonsdale Street in the middle of a night out.
Once my ovaries were officially "down regulated" I was ready to start waking them up again with a vengeance. This was the bit I had been dreading - injecting myself with an ovary-stimulating drug. It wasn't as bad as I'd imagined and in the end turned out to be no more than an inconvenience to be borne with gritted teeth. I couldn't quite face injecting myself so a sympathetic nurse friend gave me the weekday shots and the clinic did it at weekends.

We'd been warned that the hormones could cause mood swings like those of PMT or menopause, pregnancy or teenage hormonal rushes - sometimes all three at once.

I was hit by a wave of emotion about half-an-hour after each shot. I once wept irrationally at the sight of a shop window full of baby clothes, but on the whole I got off fairly lightly and soon learned to be ready for that hormonal rush and roll with it.

This was a crucial time - the more eggs I could hatch, the better our chances. I gave up coffee and alcohol (I missed the coffee more) and started force-feeding myself eggs, meat and nuts, acting on a random snippet I'd read somewhere about protein possibly helping eggs to form.

When the ultrasounds confirmed that I was responding well, the level of ovary-stimulating drug was increased and I was booked in for undoubtedly the worst part of the process: egg retrieval.

WHEN Louise Brown's mother underwent IVF in 1978, egg retrieval was done via an operation called a laparoscopy, conducted under a general anaesthetic. A needle was inserted through the navel and bladder to reach the ovaries, guided by an ultrasound scan. Back then, patients were lucky if one in 10 of their eggs fertilised (now it's more like seven in 10). Egg retrieval can now be performed less invasively via the vagina, and can often be done under sedation rather than anaesthetic.

Hating general anaesthetics, I opted for sedation. At 11pm on a Monday night, I went to a hospital outpatients service to be given the HCG trigger, and the retrieval was booked for exactly 36 hours later.

I hoped that like most women, I wouldn't even remember the egg retrieval. It's a finicky business, involving a fine needle attached to a suction tube, guided by the ultrasound scanner. The time window is short - a few hours too early and the eggs aren't ready, too late and they may escape the ovaries and be lost. Each egg, the size of the head of a pin, is extracted and sent to the laboratory where it's mixed with sperm, and hopefully fertilises. Staying perfectly still during retrieval is crucial, not only because of the delicacy of the work, but also because there's a major artery very close to the ovaries.

While I went through pre-surgery check-ups, my husband went to a private room to "provide a sample" for the lab to mix with my eggs; apart from one blood test, this was pretty much the extent of his duties. He came back in time to hold my hand through the retrieval.

I don't sedate easily and instead of floating off in a pleasantly drugged haze, I was acutely aware of each painful movement of the needle. I spent the next two days hobbling around the house in a doubled-over position, with heat packs clasped gingerly to my abdomen.

Meanwhile, I hoped, the eggs were fertilising in the laboratory.
On the third day, we returned to the clinic for the transfer - placing an embryo into my uterus via a catheter. Still tender from the retrieval, 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." Ten eggs had become 10 embryos, all of good enough quality to transfer; not bad for a 36-year-old.

Hearing her say "I'm putting the embryo in now" was one of the most surreal moments of my life; along with a moment earlier when, on a TV monitor hooked up to a microscope, we saw the four-celled blob that might become our baby, looking like a watery black-and-white four-leaf clover. Afterwards, despite knowing there was no way it could "fall out", I was afraid to stand up, let alone walk. But I did, and we went home to wait, and wait, and wait.

IVF has a reputation for producing multiple births, but they're not inevitable. In Australia, it's rare to transfer more than two embryos. This is civilised compared to what happens in clinics in the United States, most of which are private. There, transfers of several embryos routinely result in what's called "selective reduction"; which really means aborting some embryos to save the others in multiple pregnancies of five or six.

Trounson puts this down almost completely to the cost of IVF in the US. Because the cost to patients is $US15,000 per IVF cycle (compared to out-of-pocket expenses starting at about $1000 here), there are massive pressures to succeed in any given cycle. In contrast, the Australian approach is to use the best embryos first, then freeze the rest for later use. Freezing has reduced the need for repeated IVF cycles and contributed to increased success rates.

Unsure of how I'd respond, and wary of the medical problems associated with twins, we'd decided to transfer just one embryo at first, even if it meant it took longer to conceive. For two weeks we did time, waiting for the blood test that would tell us whether the transfer had "worked". I couldn't stay off the internet, surfing sites about early pregnancy, examining my body for tiny signs, and chatting to my "cycle buddies" at a British clinic about their symptoms.

Two weeks finally passed and I was told I was something I'd thought impossible; I was "a little bit pregnant". There was a detectable level of pregnancy hormone 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 knew we hadn't been successful. I'd been perhaps slightly pregnant for a few days, known as a biochemical pregnancy. This is common in non-assisted pregnancies (Trounson says up to half of all embryos are genetically unviable) and most women don't even know it's happened.

Even though I knew that success the first time was unlikely, I allowed myself to collapse just a bit at the news. I got a little too drunk one night, became a little neglectful of the household chores. When I had to go back yet again for a third and final blood test a week later, on New Years' Eve, I had to hide in the toilets for a little while until I could make myself walk down that corridor.

I also discovered I wasn't as ready as I thought for more medical treatment. At a routine visit to the dentist I felt like jumping from the chair when the moment came for yet another needle, yet more meekly holding still.

It seemed a small comfort when my doctor told us that my overall chances were now considered to have improved. IVF specialists love to talk in terms of the odds of pregnancy, but when it comes to your own particular case, even good odds aren't what you want to hear; you want an iron-clad promise that it will work, preferably this month.

Trounson can't give that, but he does believe the success rate of any clinic - defined as a pregnancy lasting beyond six weeks - shouldn't be less than 35 per cent of all women in more than two successive months. Of those pregnancies, up to a fifth don't result in live babies. In practice, this means that if there are no insurmountable problems, such as a complete lack of eggs or sperm, the longer you try, the better your chances.
At least our nine frozen embryos ("frosties" or even "snowbabies" to the women on the internet bulletin boards) meant I wouldn't have to tackle another full IVF cycle straight away. Despite being assured that it was likely one of our embryos would take - but there was no knowing which one - I felt that I was condemned to months of transfers, waiting, more transfers and quite possibly another IVF cycle. This, more than the treatment itself, is where IVF requires strength; as long as you're in the program, your life is in limbo.

For people trying to conceive, uncertainty seeps into every aspect of life. Decisions about taking jobs, buying houses, planning trips and anything else which requires looking beyond the next menstrual cycle are clouded, and the only way to resolve that is to get lucky or give up.

Throughout the whole treatment there was one thing which really annoyed me - the way the words "desperate" and "IVF" are so often paired. It made me cringe. We were never desperate. In fact I sometimes wondered, what if? What if we embraced the selfish life of DINKS, chose yearly overseas holidays, running two cars and complete freedom, over nappies, tantrums and damaged finances and careers?

Trounson's patients range across all ages and social demographics. What he doesn't see much of is the stereotyped high-powered 39-year-old career woman suddenly realising she's left it too late. "Absolutely not. It's a huge mixture of women . . . yes, there are business-suited women, (but) they may also be from the western suburbs, or new immigrant couples."

Some join the programme for a while, then leave. Maybe they realise they don't have the right partner, he says. Others are willing to try a couple of IVF cycles and, if they don't succeed, move on, saying "that's enough interference in my life". Others still, Trouson says, will persist for an astonishing 20 treatment cycles.

WE chose to go on. The convention is to wait one cycle after IVF, then transfer the next embryo(s) after the woman's natural ovulation. I started obsessively researching what might help an embryo to implant successfully.

Acupuncture is being seriously researched at several clinics, so I found a GP who could give me acupuncture. Coffee and alcohol were off the menu again. I took up yoga to help me relax. I asked for, and got, a course of the hormone progesterone (which can support pregnancy) for the period after transfer, more as a placebo than as a treatment for any real problem I have, I suspect.

Some studies suggest that very low doses of aspirin may help implantation for some women, and for once I went against medical advice and took a quarter of an aspirin nightly.

Then we embarked again on the two-week-wait, again with one single embryo which had not only thawed successfully (not all do), but come out of the blocks dividing at an encouragingly high speed. This one was not a four-leaf clover, but a whole golf ball of cells. Time seemed to slow down as the test date approached and the six hours between the blood test and getting the result seemed an eternity. I wondered how many of these waits I could take, and planned to move to two-embryo transfers soon.

But we got lucky that time: very lucky. I escaped the office on a Thursday afternoon and called the clinic from my mobile phone. The nurse told me it was "a good result"; when I should have been thanking her, I was demanding the magic HCG number - the level of pregnancy hormone in my blood. It was sky-high, almost high enough for twins, and I had to go for a walk in the park to calm myself before I could return to work. I sat down in a quiet grassy corner, looked out over the city traffic obliviously rushing past me in King Street and said aloud: "I am pregnant."

I'm now six months pregnant and looking back I can see just how lucky we were. To get away with under six months of treatment feels like a gift.

Sometimes I'm amazed I managed to go through it all; then I think of the women who are still trying, or who have given up after up to 10 cycles, or have had repeated miscarriages, or multiple medical problems, or all three, and I know it was nothing.

Twenty six years ago I would have been classed as "barren". Now I can already feel my child moving in my belly and, like Louise Brown's mother moments after her daughter's birth, all I can say is "thank you".

Sunday, July 20, 2003

ABOUT IVF

· FIRST IVF BABY: Louise Joy Brown, born on 25 July 1978 in Oldham, UK.

· First Australian IVF baby: Candice Reed, born on 23 June, 1980, at the Royal Women's Hospital.

· Total number of IVF babies born worldwide: One million-plus, according to Monash IVF.

IVF IN VICTORIA

· Total Women undergoing a full IVF cycle*: 3,926.

· Total number of IVF cycles completed: 4,821

· Women undergoing a frozen embryo transfer: 2,454

· Women who had babies or were pregnant from fresh or frozen IVF cycles: 1351

· Clinical pregnancies (lasting over six weeks) per IVF cycle: 22 per cent

· Pregnancies per frozen embryo transfer: 15 per cent

· Embryos still in storage: 21,435.

· Age groups of women treated

Under 24: 86

*25-29: 533

30-34: 1679

35-39: 1761

40-44: 849

45-49: 108

Over 50: 11

*Figures are for numbers treated, not pregnancies. All annual figures are for Victoria for 2001.

Source: Infertility Treatment Authority

WHY ARE THEY TREATED?

· Female problems: 1325

· Male problems: 1327

· Multiple problems (male and female): 1593

· Unexplained: 1635

THE COST

$1500: cost of a basic IVF cycle after Medicare rebates. Additional drugs, procedures and surgery fees are extra although some of the cost is covered by private health insurance.

$5500: cost of a basic IVF cycle for overseas patients.

Prices vary according to the treatment required and the clinic

MORE INFORMATION

· General information and discussion: ivfconnections.com (US site)

· Australian Infertility Support Group: nor.com.au/community/aisg/

· Conception/pregnancy site and discussion: essentialbaby.com.au
trying to post a huge piece; obviously I'll have to chop it into smaller bits. bear with me.
test

Wednesday, July 16, 2003

latest thing for people to say to me: "how are you?"

meaning "how are you, PREGNANT WOMAN???" and probably "ARE YOU BEING RESPONSIBLE AND NOT DRINKING AND SMOKING?" and a few other things besides.

I know people say that anyway. but people who have never inquired before are doing it. there's a certain tone to it. and the door-opening is getting ridiculous. this is not a whinge; it's kind of cute really.

Tuesday, July 15, 2003

house still disaster. whatever. hate electrician, without whom it seems nothing can really happen around the place.
on the upside, the baby is wriggling happily away and I am STILL able to ride my bike to work, ever more slowly.
think floor fumes are giving me headaches. that or general stress.

what a whinger. no, as my nephew says sometimes "it's all good."

Monday, July 14, 2003

believe me, the only reason I have time to be here is that Outlook is taking FOREVER to download my mail.
blogging is for people who tread the middle way; interesting lives with plenty of time to reflect.
but right now I'm no Samuel Pepys

for ages my life was boring; work, talk to builders work.
this weekend we moved house, were burgled, crashed the moving van, and within hours of being in the house the &%^$&^%$ electrician smashed FOUR of my favourite plates, plus a few other nice things.
then he thinks we're letting him use the backyard to work in! with our DOG there!

hah!

spent all day yesterday cleaning flat out. I'll miss the park and the lack of tradesmen turning up unannounced at 7 am.

and so, to work...

Wednesday, July 09, 2003

OK, I'm playing with wikis. all I can think of right now is to do collaborative lists, open to anyone who wants to help. simple but interesting.

so we have one on song titles about New York and New Orleans.

and one on what to name the baby.

go for it. please don't mess them up. this is kind of work for me; one minute I hear about it, the next I'm an expert writing about it! shallow, shallow.

Tuesday, July 08, 2003

erm, what?
sold flat. have lots of money. in theory.
currently bullying nephew to make him keep his promise to help us move.
will be lucky to have house back anyway. but it's happening either way.
FABULOUS bike riding morning. body is going to give up on it soon, though, I think. my 35-minute ride is now 45, and the bumps kill. oh well. only 3-4 years until I can start again.
sob

hey, batgrl is moving!
why wasn't I informed? so much for my ideas of a free holiday in Louisiana. yes, San Diego is nice. ho hum.
oh dear. have noticed wikis. a multiuser playspace with a serious side. possibly as cool as blogs.

but there is no time to work out how I can use this thing.

Thursday, July 03, 2003

remember that song "Angel is a Centrefold"? about a man who opens a magazine to find his unattainable teen dream girl from high school showing it all?

well, how am I supposed to feel about the news that Bob Crane, who played that charming GI in Hogan's Heroes that I had a slight preteen crush on, made home porn movies? and was murdered when I was 11? and that I can buy said porno tapes WITH BOB IN THEM?

shattered. that's how. and tempted? maybe. but no. I liked him with his cap on. hmmm, wonder if he wears his caps in any of the tapes?
no. not going there.
NO!