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By Mark Nethercote, September 21, 2011 10:00 am

Friday 17th September 2010

One year ago.

Every second takes a second – which is a long time when you’re watching.

I’m on call, and almost wish to be called in, just to pass time.

“I think this weekend is going to be really hard,” Suse says.  “I wasn’t worried until the candle went out.”

I feel myself bristle.

Suse hasn’t said it, but we both know that I was the one who didn’t want it lit.  We both know it’s my fault.  They mightn’t be my blocked tubes, but when it comes to the candle, I’m definitely the one who dropped the ball.

* * * * *

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By Mark Nethercote, August 26, 2011 10:00 am

Tuesday 31st August 2010

One year ago.

Suse is all over the shop.

In the last two days, she’s smashed the Pyrex jug, made a cup of tea with cold water, left me several unexpected presents in the toilet, and strewn an entire box of used tissues all over the house.  She’s got a constant headache, her skin has broken out, she feels increasingly bloated and nauseated, and her memory is shot.

This morning when we woke, I could tell she was on edge.

“Remember I’ve got my phone thing this morning?” I said.

“Sure.  But you’ll be done by 9.15?”

“No, it might take till 9.30.”

“But last night, you said you’d be done by 9.15.”

“No, last night, you heard that I’d be done by 9.15.  I very definitely said it might take till 9.30, because I thought it might be an issue.”

“But you’ve got to give me my injection!”

“Which I’ll do at 9.30.”

“But I’ve got to go to work!”

“And I’ve got to be on the phone.”

“Don’t you want to have a baby?” she said, breaking into tears.

It’s like a dose of turbo-charged PMS.

* * * * *

PMS is the acronym for Pre-Menstrual Syndrome.  We all know what it is, but approximately 5% of the female population know better than most.  According to Wikipedia, PMS is ‘a collection of physical, emotional and psychological symptoms that are related to a woman’s menstrual cycle’, above and beyond the normal discomfort expected of menses.

There are well over two hundred symptoms that have been attributed to PMS.  And these don’t include any of those experienced by their partners.  As an interesting aside, there is thought to be an evolutionary function to PMS, as it only occurs when a woman is about to menstruate, thereby reminding all around her that she has not fallen pregnant.  If her male suitor fails to impregnate her on a monthly basis, then irritability, tension and mood swings are potential motivators for rejecting him out of hand, making way for a more virile partner to move in, get her knocked up, and get on with the breeding.

Ain’t nature grand.

Technically, PMS is a phenomenon isolated to the final days of the Luteal Phase, the period between ovulation and menstruation.  And right now, thanks to our suite of injections, we are well and truly in the trenches of the Follicular Phase.

So, I can’t truly say that this is PMS.  While the symptoms may be similar, it’s a slightly different beast.  In fact, what’s going on here is a fully-fledged dose of POS: Pre-Ovulation Syndrome.  Or, as I like to call it, thanks to the drugs, PT-COS:  Pre-Turbo-Charged Ovulation Syndrome.

With Suse, PT-COS has been triggered because they are totally messing with her hormones.  She’s getting extra doses of some, and antagonists to others.  And while this may sound counterintuitive, it’s not.  It’s actually fascinating.

Unless you’re Suse.

The system in the body that controls hormones is known as the endocrine system.  The adrenals, the thyroid and the testes and ovaries, among others, are examples of endocrine glands.

Endocrine glands receive messages in the bloodstream from other organs further upstream.  At the top of the message system, unsurprisingly, is the brain.  A part of the brain known as the hypothalamus releases a whole bunch of hormones, including one called Gonadotrophin Releasing Hormone (GnRH).  This then floats downstream to the pituitary gland, which sits right at the base of the brain.  When the pituitary gets the GnRH signal, it releases two more hormones:  Follicular Stimulating Hormone (FSH) and Luteinising Hormone (LH).  These, in turn, circulate in the blood stream until they reach the ovaries.  The arrival of FSH and LH is like the green light for ovulation, and on getting this message, the ovaries begin to release their own hormones, estrogen and progesterone. These enter the blood stream, and float all the way back to the hypothalamus, like a messenger letting headquarters known that the signal got through.

The whole thing is a finely tuned balancing act.

Except in IVF.

* * * * *

With IVF, we’re messing with the whole project.  We’re deliberately unbalancing the whole act.  For the last five days, we’ve been injecting FSH straight into Suse’s belly.  Her ovaries, being obedient little things, have start to ripen the follicles.  This is all good and well, except that it means we’ve got extra estrogen and progesterone leaching all around the circulation, having a right old party.  The messengers are telling the hypothalamus to slow down the GnRH release, but with two of the follicles already at 16mm, the message isn’t getting through quite quick enough.

So this is where the Orgalutran comes in.  If you read the pamphlet, you’ll see that it’s ‘a GnRH antagonist, modulating the hypothalamic-pituitary-gonadal axis by competitively binding to the GnRH receptors in the pituitary gland’.

And while it sounds more like something that might occur to insurgents in Afghanistan, what it really means is that we’re blocking the release of anymore GnRH from the brain.   We are competitively antagonising those receptors.  And we wonder why my wife is moody.

LH is the enemy here.  If LH levels get too high, then the follicles will burst early, and we’ll lose the eggs.  So we’ve highjacked the system.  We’ve closed down the natural release of FSH and LH by stopping the GnRH with Orgalutran, and yet we’re continuing to pump her full of pharmaceutical-grade FSH to ripen her up like a battery hen.

And then, in two day’s time, we’ll give her one last jab of artificial LH, to get those grapes good and ripe, and thirty-eight hours later, they’ll pounce.  They’ll grab the biggest needle they can find, and suck out as many as eggs as they can.

But only after she’s knocked unconscious.

* * * * *

So, it’s semantics, really.  Whether this is technically PMS or not, we’re messing with Suse’s hormones.  We’re blocking the messages to her brain, and we’re overdosing her with messages to her womanly bits.

And if there’s one thing I have learnt about my dear wife, it’s that when we mess with her hormones, I will surely know about it.

* * * * *

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By Mark Nethercote, August 5, 2011 10:00 am

Wednesday 4th August 2010

One year ago.

From heavy-hitting Section Five, they move to the big guns in Section Six:  Statistics on Congenital Abnormalities.

Before you try this at home, you should know:

Of naturally conceived pregnancies,

- 1 in 6 end in miscarriage

- 1 in 14 will be premature

- 1 in 30 will have a birth defect of a moderate to serious nature

- 1 in 100 will die at or around birth

- 1 in 400 will have cerebral palsy

And with this fun-filled stat grab, know that IVF and introcytoplasmic sperm injection have a 30-40% higher rate of congenital abnormalities.  That takes the numbers from 3-4% to 5-6%.  Is this because of the subfertility or the IVF itself?  It’s hard to know.

If you’ve take our broken parts and can’t make them work again, does that mean they’re bad mechanics?  Or just that they’ve done the best they can with what they had?

But there are other conditions, like Beckwith-Wiedemann and Angelman syndromes that may well be switched on by the culture products in the lab.

That freaks me out.

That really does.

And there is a list of other chromosomal problems that come with the territory of ICSI, where the sperm haven’t worked properly in the first place.  Thankfully, for me, this doesn’t apply.

Then there’s the risks that are inherent from multiple pregnancies, which occur more commonly with IVF.  Twins occur in 1 in 80 in the general population.  It’s 1 in 10 with IVF.  That leads to smaller babies, premature babies, more cerebral palsy, more perinatal death.  Not to mention the risks to mum’s physical health, let alone her mental health.

Twins would be Suse’s ultimate nightmare.

But regardless – regardless of everything we do right and what we eat right – IVF babies remain three times more likely to be premature, and of low birth weight.  We’ve cut out the smoking, drinking, becoming fat, smoking pot, injecting poisons, eating ratsack, mainlining crystal meth.

We’ve stopped doing all of that.  They’re no longer on our to-do list.

* * * * *

And then there’s the risks for Suse.  The risk of Ovarian Hyperstimulation Syndrome.  The theoretical risk of cancer due to IVF drugs.  Breast cancer. Ovarian cancer.  Cervical cancer.  Take home message:  Breast and ovary cancer are no higher in IVF women, but unexplained infertility can have a higher incidence of ovarian and uterine cancer.  Just because.

If you’re unlucky in fertility, you’re just unlucky, it seems.

Oh, yeah, and also, cancer sucks.  Don’t get it if you can avoid it.

And then, it launches into the final stinger:

The likely outcome of the whole thing.

Of all the eggs we get and fertilise, 2/3 will make it to day three, and only 1/4 will make it to day five.

Of those we freeze and rethaw, there is also a one-third attrition rate.

So, to use an example, if we get twelve to start with, and a quarter make it to day five, that’s three all up.  We implant one of them, and freeze the other two.  And there’s a chance that only one will re-thaw properly.

Shitbags.  That’s way worse that I thought.

* * * * *

So, like I said, this is our last month.  In a few more days, Suse will ovulate from the good side.  The egg and the sperm, should the twain both meet, could avoid this whole hullabaloo.

We should be so lucky.

If not, maybe I’ll read the IVF Friends newsletter and pretend I’m in the snowfields.  Or I could try some of their distraction techniques.  I’m already meditating, but they suggest massage, aromatherapy and low impact exercise.  And apparently reading helps.

Maybe I do need to look at Suse’s wax-covered book.

* * * * *

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By Mark Nethercote, August 4, 2011 10:00 am

Wednesday 4th August 2010

One year ago.

This is a cycle.  You’ve got about a 30% chance each time.  That means a 70% chance of crying each month.

Sounds about right.

So, if we don’t get pregnant first time, Suse repeats urine and blood tests.  No more injections.  When she’s ready to ovulate, they thaw out one of our little friends, and repeat.  This, we call the Natural Cycle.  Snap freeze, then thaw slowly up to ninety-nine months later, microwave for twenty seconds, then put on a delicate cycle.

Air dry for best results.

* * * * *

The next section is my favourite bit.   It’s the Male Partner Information Chapter.

It begins slow:

‘Male partners with low sperm counts, and/or low sperm motility and/or abnormally shaped sperm and/or who have antibodies against their own sperm, are classified as “male factor” patients according to the World Health Organisation Guidelines.’

I imagine the guy with the low count, low motility, abnormally shaped juzz and antibodies is really glad that he just has ‘male factors’.

After this, they lay it on a bit thicker:

‘Please ensure 3-5 days of abstinence from ejaculation prior to your partners e.g. collection date.  Do not abstain for longer than 5 days.

Okay.  Ground rules are good.

‘Prior to producing your sample, please urinate and wash your hands.’ Before or after I touch my penis?

‘Label the container with your full name, date of birth, partner’s name and time of collection.  Unlabelled specimens cannot be used.’

Fair enough.

‘Ensure you have removed the top from the jar.’

What the fuck?

‘After you have produced your sample, we ask you wait approximately half an hour while we assess the sample.   You will be notified if a second sample is required, if not you may leave.  If you have been asked to produce a second sample, you will not be required to wait for the results, but will be asked to provide a telephone number.’

So that someone can laugh at you over the phone.

‘We understand that providing a semen sample on the day of the egg collection can be embarrassing and stressful.  We will endeavour to make this event as easy as possible for you.’

Except for providing any porn that won’t make you ill.

‘The semen sample may be produced at home and brought into the clinic in the appropriate sterile container.’  As long as you remembered to take the lid off.

‘It must arrive within one hour.  Alternatively, the sample can be produced at the clinic and your IVF Nurse can book an appointment for you.’

This is a service I was not aware of last time.  It probably costs extra.

‘When men are anxious and having difficulty producing a sample, a couple of hours break (i.e. a walk) may help.  Please inform our staff, so that they can adjust their laboratory schedule.’

If you have stage fright, just give us a call, and everyone in the lab will move their lunch break around, so that they can applaud when you turn up with your unlabelled pot without a lid on it.

* * * * *

To be continued…

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By Mark Nethercote, August 3, 2011 10:00 am

Wednesday 4th August 2010

One year ago.

The Second Manual is a bit more juicy.  The ‘Treatment Cycle Handbook’ begins with some mundane details:

- the number of embryos transferred per cycle (one)

- freezing the embryos (yes, please)

- the use of donor sperm and eggs (no thanks, we’ll supply our own)

It then tells up about the sequence of steps:

- Grow follicles,

- Time ovulation with blood tests and ultrasounds,

- Collect eggs,

- Put them in a blender with your sperm,

- Wait five days,

- Reimplant,

- Worry.

It includes some interesting facts:

-  The follicles will be 18-25mm when they get them out, but the ovum within is less than the size of a pinhead,

As well as some information that I wouldn’t have even thought necessary to include:

- ‘One or two ultrasounds will be performed to find out how many follicles are developing, what size they are, and where they are growing.  The scan is done vaginally, where the scan probe is inserted into the vagina.  For hygienic reasons, the ultrasound probe is cleaned after each use and covered in a clean, disposable sheath for each patient, so there is no risk of developing infections from these examinations.’

Really.

* * * * *

It explains the steps one by one:

1.  First of all, they have to prepare the ingredients, starting with the eggs.  Sometimes, the mum-to-be will be given the pill or a nasal spray to suppress her cycle.  It’s kind of like the reset button on a computer.  Suse doesn’t need this, and some women don’t.  I guess her inbuilt reset button is functioning okay already.

2. After this, she is given something to get the follicles within the ovaries stimulated.  This, crazily enough is called Follicular Stimulating Hormone.  It’s a daily injection, with a pretty small needle into the bum.  This happens daily for ten to twelve days.  Meantime, they’ll suck your blood and variously use the condom-covered ultrasound, to monitor progress.

3.  When they’re close to ripe, the injections change to Orgalutran, our favourite transformer.   This is the hormone antagonist, used to stop the eggs from bursting too soon, which is what nature is hanging to do.  This way, as many eggs as possible will be ready for the picking on harvest day.

4.  Finally, for the 36 hours prior to collection, a third injection, Human chorionic gonadotrophin (hCG), is given as a final little kicker.  This ensures that they will be good and ripe.

5.  Today, after 10 to 12 days of injections, hopefully mum-to-be will have a bunch of 18-25mm follicles for collection.  You return to the hospital, where an unusually large needle will be used to collect aforementioned eggs.  This will be done under sedation, through the back wall of the vagina and directly into the ovary.

This is done by someone with a very steady hand.

6. Meantime, they casually mention that I’ll need to produce another sperm sample.  There is no mention of whether they’ve restocked their porn collection.

7. They promise to prepare my good-looking sperm, and give them a shampoo.   The ugly ones will go straight down the sink.

8.  If too many are ugly, they might ask for a second batch.

9. My remaining fresh and sparkly sperm will be put in the oven with Suse’s eggs.

10.  Leave them alone for 18 to 24 hours in a fertilisation medium.  I guess this is the romantic bit.  Despite the fact that it all happens in a petri dish, they leave them alone to get to know each other.

11. The next morning they check on them to tell you whether not they liked each other.  And, more precisely, how many of your eggs invited liked how many of your sperm.   This stage is called ‘pro-nuclei development’.

12.  They ring you with the results.  You’ll wait all day on the end of the phone for this one.

13. They then switch the surviving embryos into a new culture medium for the next two days.  Human albumin is used in the culture medium, spun down from human blood.  The go to acute lengths to explain that Suse may therefore be exposed to hitherto undiscovered deadly viruses, fungi, prions, or aliens from another dimension.

But they hope, almost as much as we do, that this won’t happen.

14.  On days four and five, they move our progeny into something called a blastocyst medium.  The change in the mediums simulates the hormones and enzymes that the embryos would naturally receive while travelling down the fallopian tubes and into their resting place in the uterus.  But, as we don’t have fallopian tubes, we’ll use test tubes instead.

15.  On day five, you get another call to tell you how many made it to day five.  It may be one, it may be five.  It may be none.

16a.  If there are none:

Cry.  Then, after a few days, pick yourself up, and return to step one.

16b.  If there is one:

Then it will be reimplanted on this day.  This time they use the medium sized needle.  Hang on, it’s not even a needle.  It’s just a pipette, to squeeze the little blastocyst back into the uterus.

16c. If there is more than one:

As for 16b.  But the leftovers go into the deep freeze for a rainy day.

17.  Hope.  Pray.  Do whatever you need to do.  Do whatever you can, to help that the blastocyst stick to the wall like silly putty.  Make your intentions.  Pray to your God.  Make offerings to your creator.  Make your choice.  Do whatever you feel, that will help you.

18.  Wait.

This period is filled with a lot of hope and anxiety, and they suggest keeping yourself busy.  You can have sex as soon as you like, but the woman is not allowed to play squash or gymnastics, or anything that can leave you gasping for breath.

Maybe they do it different to us.  Sex is about the only activity that does leave me gasping for breath.

But I guess they’re not talking to me.

19. A mere eleven days later, without anymore needles, ultrasounds, blood tests, or medical distractions, they do a pregnancy test.

20a.  If pregnant:

Laugh, cry, hug, be joyful.  Have trouble believing your luck, despite the eighty-one injections, twelve ultrasounds, two laparascopies, one dye test, and all of your prayers.

20b.  If not:

Try, try again.  If there are any left to defrost and reimplant, return to 12b.  If you’re out of stock, do not pass go, do not collect $200.  Go back to the start.

And cry.

A lot.

* * * * *

To be continued…

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By Mark Nethercote, August 2, 2011 10:00 am

Wednesday 4th August 2010

One year ago.

So we’re into our last month of trying naturally.  August is our last chance before beginning IVF.  It’s the eleventh hour for nature.  The whole process is kind of surreal, to be thinking that September brings with it a genuine timeline for attempting conception – since we’ve been doing little else for the last 279 days.

And yet, after talking to Shelley, I’m kind of freaked out by the imminence of it all.  It’s weird that I could be, given how much I want it.  Had we managed to fall pregnant in the last few months, we’d now be well on our way.  If our first pregnancy hadn’t been an ectopic, then right now we’d have a five week old, we’d be sleep deprived, and on the precipice of our own insanity.

But instead, we’re not.

Instead, we’re still the infertile ones.

If we don’t get pregnant this month, injections will begin in about three weeks, we’ll collect the eggs in about five, and we’ll be reimplanting them in just under six.

In less than six weeks time, we will be trying to get pregnant.

Again.

With a little help from our friends.

But it all depends.

* * * * *

It depends on how many embryos survive.  In the time from egg harvest to reimplantation, the remaining numbers may be less than half.  Say they get ten eggs in the first place, more than five of them could be gone by day five.  Maybe all of them will.  It’s a tough battle at the beginning, especially when you’re living in a beaker.  We could go through a whole cycle, and get nothing.  Thank Christ the Government is footing the bill for the Orgalutran.

Suse has been urging me to read more.  She’s had a book by her bedside table, which has discreetly made its way across to my side, the cute black and white infant on the cover staring at me plaintively.  In it, a bunch of unlucky suckers recount how fucking hard IVF is.  I know that Suse gains solace from their hard luck stories;  it makes her feel less alone knowing that others have suffered too.  I just don’t know that I’m quite the same.  I don’t know that I need to learn the hard instructions.  I think I already know that.  Being a doctor kind of shows health’s short straws every day.  I really don’t think I need to read about them to know that they exist.

So instead, I turn to the manual.  I’m a manual kind of guy.  This is where we differ.  While Suse would choose to read a beautifully wax-covered collection of miserable anecdotes on the travails of being barren, I’d prefer to read the manual.

Men prefer manuals, women are from Venus.

So today, I open the labelled manila folder.

Yep, we have a labelled manila folder.

* * * * *

There are two manuals.  The first is called, ‘Guide to Getting Started Handbook, Version 3.1’.  The second is called ‘Treatment Cycle Handbook, Version 1.’  Both are A4 spiral-bound with a clear cover;  not dissimilar to my recent work contract.   Along with this I find a ‘Fact sheet about the Victorian ART Bill Update’, explaining why we’re being treated like criminals who need both a Police Check and a Child Protection Order.  There are also a smattering of pamphlets on ovulation induction, assisted conception, instructions for male patients, and long term sperm storage, in case I want kids when I’m seventy.

There are also the two editions of the newsletter that we have begun to receive from ‘IVF Friends’.  On the front cover of the July 2010 edition is a red British letterbox in a blizzard, piled up with snow.  The windblown side is almost snowed in;  Dr. Who’s door side is not.  On the August edition, we have a golden retriever, again in a field of snow, a small snowman plonked on his head.  Symbolically, I can only imagine that being barren is like a long cold winter, and ‘IVF friends’ are a communication group that you can use to call on friends.  As well as this, they will put up with you dumping your shit all over them.

* * * * *

I sift through more of the paperwork, to find ‘Treatment Cycle Costs Analyses’, another ‘ART Bill fact sheet’ (again apologising for suggesting we may be criminals), a ‘Service Agreement’, a ‘Safety Net Rebate Timeline’, and then the heaviest of them all, the ‘General Information Consent Form, Assisted Reproductive Technology Procedures Form’.

But first, the manuals.

The ‘Guide to Getting Started Handbook’ is a fluff piece.  Well, as far as instructions booklets go.  There’s the introduction, the Mission Statement and a Welcome Chapter.  They tell you who they are, and where they’re located, which is interesting, as we picked the book up from the clinic.  They spruik their research and development credentials and give percentages for causes of infertility (40% her fault, 40% his fault, 20% can’t blame anyone, damn it).  They talk about what tests needs to be done, what they do, and how big the needles are.

Check.

The most interesting chapter explains the history of the place, their impressive fertility rates claiming to be higher than other services in the state, and list their groundbreaking achievements since Carl Wood and John Leeton began Monash IVF in the 1970s.  They include:

- the first frozen embryo birth in the world

- the first donor egg baby in the world

- the world’s first pregnancy and birth from a sperm retrieval operation

- Australia’s first surrogate birth

- Australia’s first open testicular biopsy twins

- Australia’s first blastocyst baby.

About the only thing missing on that list is ‘first IVF baby’ – that honour taken by

Steptoe and Edwards in Manchester in 1978.  And while the claims five and six are getting into the ‘Guinness World Record for the Most Pikelets Eaten on a Thursday in St Kilda’ Type Categories, the first four are bloody impressive indeed.

This here is a world-class facility, which all began in a world-class University built out of brown brick in a suburb called Clayton.

For real.

* * * * *

To be continued…

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By Mark Nethercote, July 1, 2011 10:00 am

Wednesday 30th June 2010

Gestation: 39 weeks, 5 days

One year ago.

“Hello, Candace speaking.”

“Hi there, I was wondering if I could speak to someone regarding a couple of questions.”

“Certainly, I’ll put you through to Jessica.”

“Thank you.”  I wait for a moment, listening to another woman – I’ll call her Lizzie – tell me all about her centre’s marvellous attributes in a luxuriously silky voice, sounding more like an ad for a men’s club than an IVF centre.  She gets to the bit about her recent developments, when she is cut short.

“Hello, Jessica speaking,”

“Hi, Jessica, my name’s Mark…”

“…An absolute pleasure to talk to you Mark,” she butts in, gushing.  Kind of like Lizzie if she grew up on a farm.

“Yes, you too.  Ummm, I was just wondering about whether I could talk to you about the Child Protection Order check?”

“Oh you probably want to talk to Sarina about that one.”

“Okay, can I ask you about the counselling then?”

“Yeah, look Michelle’s the person for that, or maybe Janette.”  Candace, Jessica, Sarina and now Michelle and Janette.  Not to mention Lizzie.  My head spins.

“You’ve got a lot of people working there.”

“Thank you,” she says, gushing some more.  I can actually hear her blush over the phone.

“You’re really into your job, aren’t you?”

“I just love it so much, all these people I can help…”

“What’s your surname, Jessica?”

“Dove.  As in the bird.”  I grab a Post it pad and write her name in texta, underlining it twice.  I peel it off, and slap it on the inch-thick pile of paperwork.

“Excellent. I don’t need Michelle, Sarina or Janette. You’re my go-to man, Jessica.  My go-to woman, I should say.”

“But I’m just the receptionist,” she pleads.

“Rubbish,” I say, “you’re Susan and Mark Nethercote’s go-to woman.”

She giggles so hard that she nearly drops the phone.

* * * * *

Within thirty-minutes, Jessica has organised and emailed me my Police Record Checks, the Child Protection Order Check, the IVF Registration Form, and the Activation Form.  She has wriggled us into see the Finance Manager and the Counsellor as a back-to-back appointment.  Today.  The wait time is usually in weeks.   Jessica got us an appointment in ninety minutes time.

“Thank you so much for all of this, Jessica.”

“Look, they were a little bit flustered that I was pushing to get you in so soon, but you’re a busy man, being a doctor and all, and I know how hard it is to get in here, and you weren’t free tomorrow, and then next Wednesday you start full time work again, and it was going to be really hard for you to make it in, and you’ve got your semen analysis on Friday, and I really want for you to be activated, so that everything can get up and running, with the police checks and all – even though you’ve already had a million of them – what, each time you work in a new hospital?  That must get really tiring.  And Suse has been good enough to manage to squeeze us in today as well, and…”

Half of this is true.  The rest Jessica made up, filling in the blanks in her own mind as she went.  It was fascinating, seeing her verbalise her every thought, leaving nothing to the imagination.  Left to her own devices, she dramatised my predicament better than I could have on my best day.  I just let her run with it.

“…And… Well you know.  It’s a lot you’ve got on your plate.”

“It is.  And you’ve been an absolute trooper, Jessica.  You really are a lifesaver.  You are our go-to woman.”

“I know,” she says, gushing all over the phone.  “And you’ve been so wonderful to me.  I can’t wait to meet you two.”

I consider asking her to be our baby sitter.

But first things first.

* * * * *

Suse and I enter the building, and head up the lifts.  We rush through the doors of the centre, all purple and squared off and modern, and… Corporate.  ‘Reproductive Services’ isn’t like other parts of Medicine.  It’s so… swanky.  It’s something about the demographic, the age group, the vitality of the service as well as the fact that it’s all done in the test tube.  All that adds up to it being just that bit-more sanitised than other parts of medicine.  It’s Pre-Obstetrics -  Obstetrics without the swollen feet, sore backs and stretch marks.  It’s all so… fresh.

So fresh, in fact, that I suddenly realise that I’ve left my tax return at home, before remembering that I’m not at the Accountant.  The front desk is curved, but the woman behind it is not.  She sits upright, a ruler up her spine.   The desk has a logo, two intersecting semi-lunar shapes, just like my Accountant.  Below is the motto: “Life Starts Here”.

Like I said.  Swanky.

I mean, the place has a friggin’ slogan.

“May I help you?” says the woman behind the desk, without looking up.  She has a phallic alien-looking device attached to her jaw.

“Yes, we’re here to…”  Suse slaps me on the arm.  The woman shoots me a stare, before tapping at the Bluetooth-penis stuck on her face and continues talking.

“Sorry,” I say.  I feel dumb, totally out of my field.  This isn’t a hospital.  It’s a space ship.

“Is that Mark?”  I nod instinctively, before spotting the chubby woman appearing from around a corner.  She waves, and lets out a little squeal, before jogging over.   Her breasts bounce along as she bounds, and then as she pumps her fists in the air.  I don’t know where to look.

“Jessica, I’m guessing?”

She stops herself just short of us, kind of hugging the air between us.

“I’m so glad to meet you both.”

“Sorry we’re late,” says Suse, “we really had to push it to get here by now.”

“No, thank you for coming at such short notice.  It was really great of you to do that for us.”

“Only because of the strings you pulled,” I say.  “You’re our go-to woman  after all!”

She whoops, so loudly that the Matrix-clone almost falls of her chair.  She presses another button on the face-penis device, holding it carefully against her cheek.  With that, Jessica does actually hug us, both at the same time, her breasts pouring over us.  It’s awkward and weird, and kind of comforting, all at once.

“Come on through and meet Michelle.  We’ve got a lot to get through.”

* * * * *

Ninety minutes later, we’ve covered a lot.  We’ve discussed the blood tests and semen analysis.  We’ve completed the Child Protection Order Check, the Police Record Check, and the Registration Form.  We’ve been to finance and sorted out our Payment Plan.  We’ve been to the Counsellor, and discussed The Process.  We’ve met Sarina, Michelle and Janette, but haven’t yet met Lizzie.  We’ve contemplated what to do in the case of Suse’s death, my death, our divorce, our separation, if there’s a fire, a plague of locusts, a tsunami, a nuclear winter, a cataclysm, an Apocalypse or Armageddon.  In all but Armageddon, we get to keep the embryos.

We’ve sorted through or our inch of paper, and been given two more.  My frustration at the multiple, discriminatory police and character checks has all just melted away in the face of Jessica’s giddy positivity.  In amongst our pile of red tape are two, laminated, spiral bound books, one entitled “Guide to Getting Started Handbook”, and the other “The Treatment Cycle Handbook”.  They’re just like my tax returns.  I can tell you, if you get diabetes or renal failure, no one gives you spiral binding.

Other medical conditions just aren’t slick enough.

We walk out of our final appointment, and back towards the front desk, juggling our paperwork as we go.  As we arrive, Jessica scurries out from behind the front desk, sidling up close.  She takes Suse’s hand between hers like she’s about to read her palm.

“How did you go?” she asks, her eyebrows rising, her mouth slightly open.

“I think we’ve done it all.”

Jessica lets out a little yelp, before doing a little jig.  “I’m just so happy that we got it all done today.”

“So are we,” we say in unison.

She gives us a little hug.

“Thanks go-to woman,” I whisper, and she positively shrieks with delight.

God help us when we actually get pregnant.

“Thanks once again, Jess,” I say as we walk away.

“You just called me Jess,” she says, gasping.  “My friends call me Jess.”  She looks like she’s going to cry.  We keep walking.  “Good luck on Friday,” she yells.  “With your specimen.”

I give her the thumbs up, trying not to shake my head.  She stands there waving, just like my Mum does at the front gate after we’ve come to visit.  That’s who Jessica is.  She’s my Mum, in a twenty-five year old’s body.  With ridiculous breasts.  On speed.

As we walk, I take one last look back at the clone.  She sits at the desk with a plug up her arse, pushing the metal penis hard against her cheek, just wishing that we would all die.  Had the clone answered the phone, and not Jessica, I don’t think we would have got our first cycle in this year.

Maybe not this decade.

Instead with Jessica, we’re ready to go whenever we want.

Sometimes you just get lucky.

* * * * *

Comments (2)

By Mark Nethercote, June 7, 2011 10:00 am

Tuesday 8th June 2010

Gestation: 36 weeks, 4 days

One year ago.

A woman takes illicit drugs throughout their pregnancy.  Another causes Fetal Alcohol Syndrome in their unborn child because they drink heavily throughout the gestation.  A third beats their baby, breaks its bones.  The Department of Human Services gets involved, they get them back, and then they do it again.

And they keep on breeding.

Repeat cycle;  rinse and spin.

* * * * *

If I’m born with a child with liver disease, requiring a liver transplant, I can get that done.  For free.  The cost will run into the hundreds of thousands of dollars.  Similarly, if my child needs a heart transplant, and things are complex, the ongoing costs can mean that my child very quickly becomes a million dollar baby.  Again, all for free.  If my child is unfortunate enough to be born with cystic fibrosis, the cost of one of the inhaled medications, Pulmozyme, can cost up to $2000 a month.  As long as I can jump through the right hoops, I can get that subsidised by the Government.  For my forty years of life.  And this is just one of maybe five inhaled medications I will be on.

Yep, you do the maths.

* * * * *

But as of January this year, just six months ago, Kevin Rudd and the Labour Government decided to decrease the repayment of IVF from 80% to 35%.  Costs have risen from $900 for the first cycle to $2500.  Many couples require repeat cycles before having success.  Dependent on the procedure, this can increase out of pocket expenses to $7500 per cycle.

Repeat cycle;  rinse and spin.

I see you doing the sums.  The costs can add up very quickly.  But with success, IVF couples are born with healthy kids.  The burden to the health care system evaporates as soon as they get pregnant.  The Government has just bought themselves another tax payer.

Compare that to people with chronic ongoing medical issues.  Diabetes.  Obesity.  Chronic obstructive airway disease.  Cardiac disease.  Would the Government just stop providing hospital beds to these people?  Would they just suddenly make them pay for it?  Would they suddenly triple the health care costs to this minority?

No.  They wouldn’t.  It would be political suicide.  It would be further evidence of an uncaring Government withdrawing support for those in need.

But we haven’t got a chronic illness that will be with us forever.  We need a little help to produce another tax payer.

That’s all.

Suse and I will only need IVF for a year or two, five years at the absolute maximum.

I pay my taxes.  I work hard.  I contribute to the health system.  I’m a doctor for God’s sake.  I am the fucking health system.

In return – for once – I need the health system.

But because my wife has a blocked tube, if we want a family, we have to use IVF.  We have no choice.  So we will pay for the privilege.  Don’t get me wrong.  We’re relieved that we live in a time that we have this choice.  As are all IVF families.  A compliant lot, who will do whatever we can to have kids.  That’s why we’re any easy target.  We’re too busy trying to breed to get politically proactive.  Had we done it last year, the costs would have been a third.  It’s bad luck, but that’s okay.

That’s okay, I can swallow that.

But if we want IVF we need a Police Check?

Where are the Police Checks on the community at large?  Where is there a Police Check on any other person needing health care, any where in the entire system?

Do you need a Police Check to receive health care in jail?  Do you need a Police Check to be allowed to continue a pregnancy if you’re an underage parent?  Do you need a Police Check to get an organ transplant?  Do you need a Police Check to get dialysis?  Do you need a Police Check to treat you for HIV or Hepatitis C?  Do you need a Police Check to get health care if you’re an Aborigine?  Or if you’re a homosexual?

No you fucking don’t.

Because that is what we call DISCRIMINATION.

And discrimination is illegal in this country – last time I looked – although God knows what this Government has been doing while I haven’t been looking.

I get the money bit.  I get it.  I understand why they’re doing it – they’re just trying to balance the books.  And IVF is an easy target.  I think it’s wrong, and I think it’s short sighted, but I get it.

But the Police Check?

Now that’s a fucking bee in my bonnet.

The discrimination has begun.

The infertility discrimination has begun.

* * * * *

Comments (0)

By Mark Nethercote, June 6, 2011 10:00 am

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.

* * * * *

Comments (0)

By Mark Nethercote, June 3, 2011 10:00 am

Sunday 6th June 2010

Gestation: 36 weeks, 2 days

One year ago.

“It came.  Finally.”

“Your period?”

“Yes.”

Suse looks at me with relief.  I take a breath myself.

But with that, I feel a pinch of sadness as well.

Despite what I knew, and what I’d hoped for, despite what it would have meant, each time she has her period, each time it comes, it is the extinguishment of that underlying hope.  That underlying knowing that one time – one fucking time – some time soon, Suse’s period will be late.

And it will be late, because there is a baby growing in her womb.

Even though it wasn’t this time, and it was never going to be this time, and we did just about everything we could to stop it being this time, you just can’t help it.

You just can’t help it.

You just can’t help hoping that it was going to be this time.

* * * * *