Monday 7th June 2010

Gestation: 36 weeks, 3 days

One year ago.

 

We walk into Leslie Fleischer’s rooms.

“Have seat,” she says, in her clipped voice.  I look through the window beyond, at the grey Melbourne morning outside.  “So we had a look in there, and we saw that your left tube was a bit tortuous, a bit wriggly.”

I look across at Suse, who is still putting her bag down.  It’s 8.45am, and we are at least the third patient for the morning, probably the fourth.  This woman means business.

“And then there was the right one,” she continues, reading from her fancy Apple screen, “which was blocked.  Which we couldn’t get any dye through.”  I watch her as she summarises, reminding us, but more importantly, herself of the case.  I don’t for a moment have illusions that our case is any more memorable than the last lady with blocked tubes.  “So what have you been thinking?”

“Well, when we spoke to you after the laparoscopy,” Suse begins, “we talked about trying for another three months, and then maybe going to IVF after that.”

“Look, I think that is a very sensible approach,” she says, opening her flip-book of uterine pathology, sitting smack-bang there in the middle of her expansive desk.  She flicks some more, past a couple of pages with interesting-looking growths in totally the wrong places. “What we would do is harvest the eggs, and then culture them.”  We’ve now flicked over to the IVF page.  On it we see a single celled egg, then a two-cell, four cell, eight cell and then multi celled zygotes.  Across the page we see six discs, the start of a human.  And it’s not even in colour.

 

“Here you can see it on day three,” she says pointing at the third picture, “and then on day five, by which time we call it a blastocyst.  This is what happens after we harvest your eggs and put them with the sperm.”  She glides a finger over the pictures, in case we don’t get it.  “And then on day five, we’d implant them into your uterus.”

“How many do you put in at a time?”

“One.”

“Good,” Suse says, “I’m scared of twins.”

“Well, there is an increased chance of monozygotic twins.  Sometimes the egg splits – we think from the handling process.  Chances are about 1% from the day three implant, and 3% from the day five implant.”

“Why’s that?  You’d think you’d have less chance from a more development egg?”

“Don’t know,” she says plainly.  There actually are some things that Leslie Fleischer doesn’t know.  But only because they are not knowable.

“Would you consider GIFT or ZIFT in Suse?” I ask.

“Well, we couldn’t do that in your situation.  There’s no point putting eggs and sperm unfertilised in the uterus, as they need the nutrients from the fallopian tubes.  We can only do that if the tubes are working.”

“Something else I’ve forgotten from medical school,” I say attempting a joke.

No one laughs.  Not even me.

“And you’ll need to go and have your sperm analysed as part of the work up.  You need to give a sample to Monash.”  It sounds strangely perverted.

“But I don’t even know Monash by his first name,” I try again.  Suse laughs quietly, one of her sympathy laughs;  Leslie smiles slightly.  “How soon?”

“As soon as you can book in.  There’s quite a waiting list.”

There’s a quite a waiting list to jack off for Sir Monash.

“Okay,” I say, a little too defensively, “I will.  And I guess you’re looking at sperm count and morphology?”

“That’s right.  Interestingly, ectopics can be caused by the sperm.  There can be issues with sperm quality, which can lead to problems with migration down the tubes.”

I feel strangely threatened by the assertion.  Is she suggesting that my sperm might be inferior?

“So is there anything Mark can do to help his sperm?” Suse asks.

“There may be nothing wrong with my sperm,” I interject.

“I mean, in terms of lifestyle,” Suse says.

Dr. Fleischer is already writing on a post it note.  She’s one step ahead of all of her patients.  I can see that now.  “Multivitamins, Vitamin D in winter, and fish oil.”  She passes the note to my wife.

“I think Suse was asking specifically about alcohol.  I was going to stop drinking for the week prior to her ovulating.”

“Well, that would be a waste of time.  Sperm takes seventy-two days to form, so you’d have missed the boat by then,” she says, again plainly.  I can’t help but feel a little admonished.  My medical knowledge and my sperm are both in question here.  Clearly.  “Just keep it to five to ten standard drinks a week.”

“Which I’m already doing,” I say, smiling.  “Except… well, except for… for my birthday…”  I trail off.

Leslie grabs eight more forms.

“So what are you thinking?”

“I think we’d like to try for three months and then see you,” says Suse.

“Great.  So give it three months, and then on day two after your period, you just need to come in and start seeing one of the nurses for the ovulatory medication, and then we’ll collect the eggs.”

“And we’d need to book in ahead of time for another laparoscopy?”

“What for?”

“To collect the eggs.”

“No, not anymore, we do it transvaginally.  We haven’t done it that way for years.”  Probably not since I was at Med school, in fact.

“That’s why I’m reading those books, love,” Suse says, patting my hand.  “You should probably read them too.”  I feel myself going red.

“So maybe you should start on these bits of red tape,” Leslie continues, now directing the instructions entirely at Suse.  I’ve obviously proven my inability to get it together.  “You need a Police Check and a Child Protection Order Check…”

“…You need a Police Check to have IVF?”

“As of January this year.  And only in Victoria, not in any other state.”  She looks at me, seeing the anger in my eyes.  “I know.  Don’t get me started.”

“And what are the costs like these days?” says Suse, trying to keep things moving.

“Well, again, in their infinite wisdom, the Government dropped their subsidy for IVF in January.  It is now about $2500 for a first cycle.”

“What was it six months ago?”

“$900.”

“So six months ago,” says Suse, “had we started then, we would have paid less than half, and not needed a Police Check.”

“Correct.”

“I understand the money,” I say, “but the Police Check?  Isn’t that blatant discrimination?”

“You said it, not me.”

“So, if someone, in an office somewhere decides you don’t pass a check, they can stop you from having IVF?”

Leslie nods, her eyes closing with fatigue as she does.

 

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