Warning: Contains descriptions of medical procedures and references to miscarriage
My wife is out cold. A nurse has just wheeled her back into our cubicle and pulled the curtain. The size of a small bedroom, it has space for a hospital bed under the window, a chair for me to sit in and a locker for my wife’s clothes. I hold her hand, hoping she wakes up. The anaesthetist promised she’d be under for exactly 15 minutes. It was going on 20.
I hear our surgeon lead the couple next door through to the operating theatre. It is their turn – her turn, more accurately. Only women produce eggs, so only women have their eggs “retrieved” for in vitro fertilisation. Their partners watch. As I stare at my wife, my mind replays what I saw, what she went through, accompanied by the carefully curated easy-listening music broadcast throughout the clinic.
I start from the moment the anaesthetist counts my wife to sleep. Not even his poorly timed joke about wishing he had ovaries can keep her awake. The other women in the room – two nurses, our specialist performing the surgery and the geneticist who will fish the eggs out of the follicular fluid – laugh awkwardly, then begin the procedure.
To my untrained, heavily invested and extremely anxious eyes, the operation is less certain than “retrieval”. Retrieval is what a post office worker does when you pick up a parcel. By comparison, this was almost haphazard. The success rate would turn out to be closer to that of our barely trained puppy fetching a ball.
Once my wife is confirmed unconscious, the surgeon somehow maneuvers a syringe into her uterus and, from there, pokes the needle through the uterine wall towards the unfortunate ovary whose month it is. Guided by the ultrasound screen above us, one at a time she drains the egg-producing follicles (pumped up unnaturally by weeks of dehumanising, self-administered hormone injections). To reach every follicle, her hands achieve some alarming angles. I look away and watch the drained liquid flow through a clear plastic hose to a row of test-tubes. It takes two to three follicles to fill each tube. The liquid begins clear, if slightly yellow, but by the end is stained red from my wife’s blood.
Fourteen follicles are pierced and drained. The surgeon is happy with this, but it’s not the main game. As each tube fills up, a nurse moves the hose along to the next. The full tube is passed to the geneticist, who takes it to her station and pours the precious fluid onto a glass plate under a microscope. Now the scoring begins. She calls out whenever she locates an egg before placing it into another dish. A screen on the wall shows me what she can see. Although the ovum is the largest cell in the body, visible to the naked eye, the search from above calls to mind a desperate ocean rescue, only without any high-vis or flares. She scans the glass plate and either finds what she’s looking for, or doesn’t. When all the liquid is searched and discarded, we have five eggs.
Now the surgeon expresses disappointment. She was hoping to get more out of so many follicles. Sometimes, she says, the follicles are just empty. Months later, when we regroup after exhausting this batch of eggs in just two embryo implantations that don’t take, she suggests a different brand of hormone might get better results. The uncertainty is frustrating, but uncertainty runs through the veins of the IVF industry. You get used to it.
As they usher me out of the operating theatre, I wonder if the eggs are hiding somewhere. Stuck in the corner of a collapsed follicle? Clinging to the inside of the hose, or a test-tube? Maybe on the ground after a nurse dropped the syringe at the end of the procedure? It looked like the surgeon was passing it carefully, as if the nurse was to make sure any remaining fluid made it into a test-tube. My desperation isn’t enough for me to ask out loud, “is there anything else [you] can do”? They are the experts. I have to trust them, but I know my wife, like me, was hoping for more.
Of course, an egg might have been released naturally into the fallopian tube. The timing of this procedure relies on a single hormone injection (the “trigger”) two days earlier. It is not an exact science and we were warned to avoid unprotected sex this month. The last thing we want is to conceive naturally and then implant an embryo alongside it, we are told. As my wife recovers from this “straightforward procedure”, I wonder if she’ll ever be able to laugh at how unlikely a natural conception is when someone has just reached through her to stab her right ovary 14 times after two weeks of hormone treatment. Over the next few days, as five eggs become two embryos through natural petri dish attrition (which we observe daily via an app) we both wonder if we’ll ever laugh again, at all. The clinic’s counsellor told us in our free session to lift each other up with hope to get through moments like this. We feel hopeless, but we tell each other we believe. This could be the one.
Back in our cubicle, my wife is still asleep. I think about her father’s poor tolerance for anaesthetic. I’m scared. Another nurse gets my attention. Now it’s my turn. “She’ll be alright,” the nurse assures me. “You need to head downstairs.”
Away from the needles and scrubs and beeping machines, the strangeness of IVF reasserts itself. It’s all big smiles and gentle whispers, warm lighting and closed doors. An industry that convinces people to spend vast sums to slightly improve their conception odds could only thrive with very effective brainwashing. It could have been based on a cult: it’s lucrative; the specialists are regarded (and rewarded) like high priests; the subjects are impregnated and children are the tantalising bounty for true believers. For some, it takes years to receive this blessing, if they don’t leave due to financial pressure, relationship breakdown or sheer exhaustion. There is free yoghurt in the mornings.
We tried the public system, where you can do a round of IVF for just over $1000. It started with a traumatic internal ultrasound that turned out to be a waste of time because the referral specified the wrong day in my wife’s cycle. We decided to see if we could buy peace of mind at a private clinic.
Our fertility journey, as the industry calls it, began anew with our GP. Like any private health endeavour, you establish a paper trail for Medicare to make it financially viable. Her referral unlocked three months of bulk-billed ovulation tracking. A long series of blood tests established that my wife was ovulating. For my part, I visited a private room with a recliner, a mini-bar and a video system loaded with pornography to find out my sperm were healthy. We already knew this much. We carry the dark memory of miscarriage every day.
Armed with the data, we met our new specialist. We had tried one before, when we first wanted to know about IVF. She sent my wife home crying, accusing her of smoking and being obese – neither of which were true. The new one was better. Extremely officious, she reminded me of a lawyer. Like we’d been wronged, but we had options. We could keep trying, or we could do IVF. Years of trying had got us nothing but disappointment, trauma and self-imposed social isolation from our fertile friends. Just hearing about other people getting pregnant became too painful. We were ready for IVF.
We put a third option of keyhole surgery to rule out endometriosis on the backburner. Already under the cult’s sway, we believed IVF would work, and that it would take less of a toll on my wife. Anyway, the bloods didn’t support a diagnosis of endometriosis. The invasive third option would eventually prove them wrong. But we first had to burn through tens of thousands of dollars, countless hormone injections, three visits to day surgery, 14 follicles and five eggs before re-entering the public system for a laparoscopy. With a general anaesthetic and through four keyholes in my wife’s abdomen, a surgeon found and removed endometriosis. It would probably grow back, but for the next six months we had the same chance at conceiving as a ‘normal’ couple. After exactly six months, we did.
In high school, I wrote a creative response to a biology assignment on the reproductive system. Titled “The Gametles”, it followed four fab sperm on a magical mystery tour. At the end of their biologically accurate journey, John spots the egg first. He is transfixed, drawn magnetically towards the large cell. “Oh no,” says Paul, losing his best friend. “Ono,” says John, in a clumsy reference to the woman many blame for breaking up the Beatles. “It’s perfect.” My own magical mystery tour, our fertility journey, has had more than its share of ‘Oh no’s, but there has been nothing perfect about it. And, like Yoko, my wife has been often blamed and paid the toll. In the best case scenario, she still has one life-changing medical ordeal ahead of her.
Back on retrieval day, my wife lies upstairs, unconscious. Scar tissue forming around her ovary to complement the then-unknown endometriosis. I return to the private recliner with a small plastic jar and force myself to watch some porn. When I get back upstairs, my wife is awake. We are dazed and confused, but together again. A year later, with a “natural” baby on the way, we still don’t know if IVF was worth it. For getting us used to uncertainty, perhaps it was. We might never know.