Scanning the Horizon

May 4, 2010 at 5:41 am (Uncategorized)

Well, as you know I was glad to see the back of last week, and this week has already shown itself to be superior: yesterday we passed the latest in an on-going series of significant pregnancy milestones: the 7-week scan. Everything’s dated rather strangely, so even though we only had the positive test result a mere three weeks ago, the pregnancy is somehow in the seventh week of development. Strange but true. So it was back to IVF Australia yesterday to check for signs of life – nerve-shattering to say the least.

I went downtown early in the hope of meeting Llew for lunch first. I’m not having “cravings” as such, but I am getting very fixed ideas about indulging my every foodie whim. I think this is called “working it,” and apparently I have no shame. So as it happened, I’d already fixed on my pre-scan lunch destination with War Room intent quite some time ago: the Olive in the Strand Arcade. A note about this outlet: we’ve been worshipfully falling on the Olive’s chicken schnitzel, zucchini, cress and satay rolls since, oh, 1997, when a friend of ours from The Australian first led an expedition of hungry pilgrims from the News Ltd headquarters in Surry Hills to the Strand. Oh, happy day. Llew and I have faithfully returned to the Olive on a semi-regular basis ever since – I even worked it and its signature satay roll into my MS, for god’s sake, although it’s true those pages eventually hit the cutting room floor – and yesterday, I had a hankering. I was smacking my chops in anticipation all the way from the ferry to the arcade, right up until I danced along the ground floor and disaster struck. The Olive wasn’t there.

It wasn’t there.

Dumbstruck, beginning to panic, I paced up and back, scanning all the signs and shopfronts for that familiar and beloved sign. You have to understand that this place is enormously popular – the queue for one of their special combos is out the door without fail every single lunchtime, and everything is sold out by the time they close their doors, usually at about 3 pm because they simply don’t need to stay open a moment longer. I just couldn’t comprehend the evidence before me, especially not since I’d seen it in its usual spot not more than 10 days ago. WTF??? Dazed, I turned and stared the length of the arcade, and there was Llew walking toward me. His smile faltered as he too registered this strange new schnitzel-less landscape. We paced a little while longer just to satisfy ourselves that this nightmare was indeed real, and then I summonsed the necessary courage to step inside this foreign, transformed shopfront and enquire as to the cruel fate of the #5 blackboard special and indeed the entire operation (hoping, of course, that a simple relocation was the answer). The woman standing behind her gleaming new counter – untroubled by a single customer, I might add, which is absolutely awful, but I can only imagine that for regulars the shock is deep and the wounds will take a while to heal – rolled her eyes, gritted her teeth, and, in the thin voice of someone who’s been asked this tedious question far too many times already for a week in the goddamn job, said, “As far as I can figure, the lady who owned the business retired.”

And just like that, the Olive is over, and my dream sandwich is gone. After shaking our fists at the heavens, we exited the Strand with heavy hearts and growling stomachs. Where to now? Oh, how bleak the lunch options did appear! Then Llew brightened, and guided me across the street and down a dodgy little laneway that both smelt bad and appeared entirely without promise.

“What… where… is that wee?”

Temperance Lane, my friends, and therein our salvation lay. Recommended to Llew by one of our friends and invisible from George Street, right up the lane and around the bend, sits Grasshopper, a new restaurant and bar space that’s only been open a few weeks. I hasten to recommend it because this Monday lunchtime, we were the only people dining, and that is a crying shame, as our food was fantastic. It wasn’t a stand-up-to-eat takeaway sandwich, but it more than soothed the pain of the Olive’s untimely disappearance. Highly recommended, and the atmosphere would be really fantastic at night. I had a rather glam and zesty take on a prawn cocktail, Llew had a sensational lamb salad, the sour dough bread was excellent and the truffle butter perfectly spreadable. We went for entrée size because mains would have made for an expensive lunch, but they were ample portions, and for a sit down meal of this standard, the value was good. It was an excellent discovery, and we will certainly be back.

Then it was on to IVF Australia. In no time at all it was action stations, and Llew and I were in the ultrasound room with Nurse E. Llew said later he hadn’t felt he’d had sufficient time to prepare, so when Nurse E said, “There’s someone in there…” he just went into a state of acute shock. We both did.

“Where?” Llew demanded.

Nurse E explained what we could see on the screen, and sure enough, though we couldn’t hear anything, there was an unmistakable pulsing spot on the screen. A heartbeat. A rapid heartbeat.

Dr P joined us. We were still too stunned to speak.

“That’s what we’re looking for,” he said, peering closely at the image on the monitor. “It looks like we’ve hit the jackpot this time.”

“Congratulations,” said Nurse E, beaming from ear to ear.

Then after Dr P took the measurements and did whatever else he needed to do, it was all over, very quickly. I dressed and we rejoined Dr P in his office next door. Next step, he said, would be the 12-week scan. That’s when they’ll do all the testing for the likelihood of Down’s Syndrome and much else. It’s definitely no picnic, this pregnancy stuff. It’s more like an endurance test, lurching from one checkpoint to the next with the anxious hope that everything is all right but always with the sobering fear that it might not be. I think after yesterday I’ve decided that’s just a ghastly way to exist. I want to just feel glad and hopeful and let the careful management of expectations go hang. Shouldn’t this be a time of outright optimism, no holds barred happiness at the possibility that all will be well? I think so. I’m tired of tamping down my positivity and sounding a note of caution every step of the way. It’s not right, at least for me, it’s not the right attitude, not the attitude I care to embrace.

Everything was FINE until I got back out to the Reception area and the nurses who’ve looked after us at various points started coming out one by one to congratulate us. Then I started bawling (gawd, just thinking about it is making me well up again now too). Nurse K – who has been there since the beginning and is still looking after me – had to fetch me a box of tissues, and then she started looking like she was about to start crying too. They’re so kind and good – their interest and sincere excitement was almost as overwhelming as the little ultrasound image Dr P fitted into a little card for us to take home. It’s just a form card, congratulating us and wishing us good luck with our pregnancy from everyone at IVF Australia, but boy, I really think they mean it.

As for that pulsing dot on the screen, it was completely mind-blowing to see a heart beating inside me that is not mine. There is someone else in there. And that is one of the most profound realisations of my entire 37 and a half years of living my own life.

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25 Comments

  1. litlove said,

    Aww that is just so lovely. Many, many congratuations, Di, and just take the very best care of yourself now. No stress, no rushing, no unnecessary worries and deadlines. Pregnancy is work, real hard biological graft. But I loved the feeling of being double-teamed. I remember standing outside the examining room for the viva of my Mphil and saying to my kicking bump, any hard questions, I’m going to refer to you, okay? It’s an incredibly special feeling.

    • doctordi said,

      LL, with the exception of last week’s plummeting morale (boo hiss), I’ve embraced slow living the same way I regard slow cooking come winter – very enthusiastically. I can see it is hard work growing an actual person – I am so tired already. But that seems to be all I am, so I am just taking it easy. Still walking, but winding back the social calendar and feeling a bit less concerned about my shaky writing career.

      I love that story so much. It’s really making me smile. And although that level of intimacy with the teamster is a way off, I must say I did find just the evidence of having someone else on board absolutely huge.

  2. charlotteotter said,

    Glad to hear it’s a superior week! So thrilled to hear all is well, baby-wise. I second Litlove – take care of yourself, on all levels. I, for one, am glad to hear that you’re putting food at the forefront. That is where it should be.

    • doctordi said,

      Thanks, Charlotte, I shall. I am trying to avoid people and situations that aren’t any good for me or upset me or wear me out. It’s quite clarifying. Food is always at the forefront, darling, don’t you worry about that!

  3. Charlotte said,

    Such great news, still. And I get anxious every time I see you have a new post so I hereby join your positive optimistic expectation brigade. Much better way to live!

    congrats, again

    • doctordi said,

      Charlotte, yes, you MUST, because the LAST thing I’d ever want to do is project my anxiety onto you or anyone else – good grief, I blog far too often for that to be a tenable situation!!!!

      Here’s to blind dumb happiness – it certainly won’t hurt.

  4. Fugitive Pieces said,

    I am humming “We Are Family” and shaking my sequinned tailfeather ALL round the kitchen… Go, little disco baby!

    • doctordi said,

      Laughing – I think, Fugitive, you should definitely be put in charge of the Baby J disco soundtrack. So far I am really liking these tunes! And we must have rhythm.

  5. Grad said,

    This is just the best…the happiest news. Pass that tissue box over this way. You take care of yourself, Tootsie Popper. You and Llewie should positively wallow in unbridled joy and happiness and optimism and…schnitzel, if you can find it. Thinking of you.

    • doctordi said,

      Oh, Graddikins, you’re choking me up again!! You’re in CAHOOTS with those nurses, aren’t you? I thought you’d approve of the attitudinal shift – I think I got the idea from you in the first place. And Graddikins knows best.

  6. Lilian Nattel said,

    That little heart beating is such wonderful news, Di. Congratulations, I echo everyone who said take good care of yourself, and enjoy your happiness.

  7. doctordi said,

    Thanks, Lilian. Yeah, it was crazy. It is really there. I will do, but also I want to thank everyone so much, really from the bottom of my heart, for all your ongoing support and friendship. This is a team effort if ever there was one.

  8. davidrochester said,

    A new restaurant and happy confirmation of a little freeloader, all in one day! Now *that’s* a good afternoon.

  9. doctordi said,

    The little freeloader – I like it! Thanks, David, for adding another nickname to the growing list. So far we have OLF (our little friend), Baby J, Disco Baby, and now Little Freeloader. This is fun!

  10. Pete said,

    Also tearing up a little this side, which is not good since have patient due. But yay re the little freeloader. S/he’s certainly getting good food by the sounds of it. Who wouldn’t want to hang around with the two of you?! And I love it when you talk about food. Of course the food at my disposal here at our sick bay is very bland (since I have to pack it myself before 6.30am) so am happy (and jealous) to read about Sydney’s culinary delights. Holding thumbs for the 12-week scan. L will also be delighted (and she’s already feeling broody!)

    • doctordi said,

      There’s no shortage of food to go ’round, Pete, that is for sure! The little freeloader is definitely on to a good thing in this house!

  11. Samantha said,

    Congratulations Di!

    Another one of the Holy Grails has been met. May it long continue.

    Regards,

    Sam

  12. doctordi said,

    Sam – there you are! I’ve been wondering where you’re at with all this – what is happening your end? Thank you so much – here’s hoping.

    • Samantha said,

      Hi Di,

      Actually I haven’t been able to post due to bad news and I didn’t want to detract from your increasingly good news!

      I decided in my two month break from IVF to take myself off and get my ovarian reserve levels checked as it isn’t something that my clinic routinely offers and I was curious. I know that your clinic offers such tests. Did you have them done?

      I went to my GP and asked to have my FSH, Oestradiol, Inhibin-B and Anti Mullerian Hormone (AMH) levels checked, the latter of which is the best marker for ovarian reserve and which she had never done before. I then duly returned three weeks later for the results. For a woman in her twenties, her level should be between 20 and 25 pmol/L. From age 30 the level drops significantly and once you dip below 14 pmol/L you are in the diminished category. By my age you would expect it to be around 9 pmol/L (I discovered all of this after the fact through research). My AMH was 1.5 pmol/L. My doctor asked me if I was expecting such a result and I said “no, I am genuinely surprised.” I walked out of the clinic in shock.

      From subsequent research I have discovered that I have what’s called diminished ovarian reserve due to premature ageing of the ovary. My results placed me in the bottom 5% for my age group and it is therefore expected that I will be one of the 10% of women who enter an early menopause, certainly before I am 45 and quite possibly as early as 41. The threshold for menopause is an AMH level of 0.61 pmol/L which I am only 0.89 pmol/L away from reaching.

      My peak fertility was during my early to mid twenties. The steep decline in my fertility began not at 37 but at 32, only a year after I met my partner. I had no idea. We began trying when I was 35 when quite frankly, it was too late. Two years later when I was diagnosed with damaged fallopian tubes and I entered the IVF program I was 38; again too late. I basically have the ovaries/eggs of a woman closer to the age 50 and yet I am only 39.

      The risk factors are primarily genetic (my mother never lived to see menopause and I never thought to ask her mother), surgery to the ovary (which I have had), pelvic infection (which I have probably had due to my damaged fallopian tubes) and a vegetarian diet (something to do with androgens in meat converting to testosterone which the ovaries need). But had you told me at 12 that becoming a vegetarian would lead to an early menopause, I would have thought it was so far off anyway, as to not give a toss! The risk factors I don’t have are smoking, endometriosis, and treatment for cancer. But in most cases, they can find no cause.

      Diminished ovarian reserve places you at much greater risk of recurrent miscarriage and trisomy chromosomal disorders basically because you have so few eggs left that most of them are damaged. A poor AMH result cannot predict that you won’t have a baby, but the odds are overwhelmingly not in your favour.

      A week later I spoke with my IVF doctor who confirmed that the results were not good and he said that there was no time to waste. I said that I felt “the time was nigh” and given that I would be 40 (or closer to 50 fertility speaking) in August, that there was no point continuing beyond that date. He said that 40 was arbitrary but did not deny that my chances were slim but miracles do occur with women like me and he has seen it firsthand. He said perhaps he needed to become my coach to keep me going. Hah! The odds are well and truly stacked against me and anyway, why should such a miracle happen to me? I’m no more special or deserving of such a miracle than anyone else with my AMH level. When we saw him last week for a review meeting, he said “you may be one of the lucky ones”. Yes, well I may be but then again, I may not be. When he told me that my chance of a miscarriage was 5% following the 6 week scan and a week later I became that 5% statistic, I said to him later, not “why me?” but “why not me?”. He said “that’s a good way of looking at it”. It’s all so random and in the end will be based on finding that one good egg, if indeed one good egg of a 39 year old woman going on 50, even exists.

      I really wish that my clinic routinely offered the AMH test in its initial blood screening tests. Then I could have been counseled as to my incredibly poor prognosis and be left to make the decision as to whether I thought gambling with all my disposable income on the off chance of becoming one such miracle was worth it. Instead, 12 cycles, one miscarriage and $20,000 later, we are now confronted with these hard truths. But I suppose that’s not the way the infertility industry works now is it? It’s all about keeping alive the hope that you will be one of the 50% of the women to succeed, not one of the 50% of women who don’t.

      Still I do really respect and trust my IVF doctor and the relationship we have built over the past two years means a great deal to me. After cycle number 12 failed this month following a mild stimulated antagonist cycle which garnered 4 eggs, all of which yet again refused to fertilize, he has now counseled me to return to doing natural cycles to see if we can turn around my appalling fertilization rate (which stands at 25% compared to a norm of 60%), as we had better luck (if you include one miscarriage) when we did natural cycles. He reckons if there is no improvement over three such cycles then it is time to call it quits or to seek donor eggs. Given I will be 40 by the time these three cycles are completed and that will total 15 cycles; it will indeed be time to call it quits.

      In the meantime, I have been grieving the loss of my fertility, my hopes of becoming a mother, my impending early menopause and mid life which I was not expecting to confront quite yet, and my own mortality. Instead I am now thinking more about the trip we will take to Antarctica should the miracle not eventuate, which is a far more likely outcome.

      I work with a number of younger women ranging in age from 23 to 38, most of whom are single and looking for men to have babies with or are in relationships with reluctant men (see below). The youngest of these women will be 24 this year. She is in a stable relationship and wants to start having children before she is 30. Today I asked her when her mother went through menopause. She replied 41. I told her about the AMH test and counseled her to get it done as she too may be at risk of an early menopause and if so, then she must commence the baby making in earnest as soon as possible. Perhaps my post IVF mission will be to become an ambassador for those 10% of women at risk of any early menopause, the only way for them to be diagnosed as such is through this simple blood test?

      I’ve also come to the conclusion that our one billion old biology’s do not match our 50 years emancipation as women for today as we celebrate the 50th anniversary of the contraceptive pill, I cannot help but wonder, yes but at what cost? The Pill according to one eminent economist has been the single biggest contributor to our booming modern economy as it essentially freed women from their biological destinies and allowed them to enter the world of paid work. More importantly it gave women for the first time, control over their fertility. But it also freed men from sex equals risk of pregnancy equals marriage equals children so that many of them today are not “ready” to have children until it is too late for increasing numbers of women. They are reluctant men who can theoretically keep fathering until they die and marry younger more fertile women when they are “ready”. Women have no such luxury.

      The Australian Bureau of Statistics estimates that of all current women of reproductive age, 25% of them will never have children; most, not because they don’t want them. A mere 7% choose not to have children and 7% are derailed by medical infertility. These numbers have remained static for some time. The biggest group is the 11% and growing number of circumstantially childless women who want children, but do not end up having them due to circumstances beyond their control, such as meeting the right partner at the right time or a relationship breakdown during the crucial reproductive years (25 to 35), reluctant men, higher education and demanding careers. Not to mention a society that does not value nor make it easy for women who have invested a lot in their education and careers and who also want children (which is 93% of all women). We need a new maternal feminist political campaign that agitates for policies such as extended paid parental leave along with better sex ed in schools that reiterates over and over again to both girls and boys that women’s fertile years are but a brief moment in time; and for 10% of women, it is shortened.

      As I’ve said before, I wouldn’t swap my life with a young girl in Niger, 50% of whom have their first child before they are 14, or with the women of Timor, who on average bear 8 children each. However, privileged women of the West may have more attractive options in life but a growing proportion of us are losing the ability to mother, which is not only a great loss for those women but for society as a whole.

      Regards,

      Sam

      • doctordi said,

        That’s an AWFUL lot for you or anyone to take in, Sam, and thanks for sharing it with me and the good people who visit here. I don’t know where or how to even start responding. This is difficult stuff, no doubt about it, because it changes the playing field, which we only so belatedly discovered was never level, no matter what we all believed when we were young and desperate to avoid the dreaded P word. No one really talks about egg reserves until there’s a problem. I didn’t know the first thing about mine. In fact, Dr F my obstetrician prescribed Clomid – a follicle stimulation drug – for me without testing my AMH first… this now seems completely incomprehensible to me, especially since I suspect it reasonably enough gave me an undiagnosed case of Ovarian Hyper Stimulation Syndrome. The side effects of the Clomid and my second round reaction to the IVF drugs were simply too similar to be coincidental, and I got the mild case of OHSS despite Dr P, my IVF specialist, being absolutely vigilant about the dosage because he knew my AMH result was high.

        So yes, he ordered that blood test as part of preliminary discovery, so before we even began round one he absolutely emphasised the state of my egg reserve, which was fortunately encouraging. He and Dr F have both stressed this since (according to Dr P, I unexpectedly have the egg reserve of a younger woman), and the effect has been very reassuring despite the trials with fertility generally. What pains me now, reading this, is that you’ve had not only the opposite experience – I’d love to know why no qualified medical practitioner thought to run this test before now – but the opposite result. I am so, so sincerely sorry to hear that, Sam, because I do understand the implications fully, and it is a huge thing to digest at this stage of the game (game makes it sound so light-hearted… I need another more appropriate word, like ordeal).

        Everything you say resonates with me very strongly, I think you’re absolutely right. There’s a whole dimension of feminist thinking that seems to be MIA – all these important markers of progress, like the Pill, greater economic/job opportunities and opening university admissions to women, have an entire complex spectrum of effects that it feels like we’re only now starting to feel. There are consequences both to the individual and the community that I don’t think have been anything like sufficiently analysed or understood, and certainly conversations at every level and age of society have a lot of gaps and pauses that desperately need to be filled.

        Sam, I think it’s incredibly impressive, quite overwhelming, actually, that even as you are coming to terms with what all this means for you and your hopes and your husband and your life together, one of your very first reactions is to reach out to protect and defend others and to try to prevent this belated awakening happening to women you both do know and those you don’t. That quality already makes you much more of a mother than, for instance, my own has ever been.

        I remain as hopeful as ever, and why not you indeed?
        Onwards,
        xxx

      • Samantha said,

        Thanks Di. I really appreciate your empathetic and kind words.

        I’m not surprised that your AMH was higher than what would be expected for your age. All those eggs, OHSS, low dose FSH and so many frozen embryos all point to high fertility. In fact your treatment was not much different to my friend who was 28 when she began and whose baby is due in 3 weeks.

        For us both, it is almost certainly down to the luck of the genetic draw.

        I just wish my IVF clinic had run the test prior to commencing treatment because finding out now, so late in the ordeal, is distressing. I only learned of AMH during the course of my treatment due to the extensive research I have undertaken.

        I blindly began treatment knowing my chances were reduced due to my age (38 at the time) but never thinking they were that reduced.

        And thank you for the very touching compliment in reference to your own mother. Whatever it was that your mother didn’t give you, at least she passed on her high fertility genes, and that you can be thankful for.

        Regards,

        Sam

  13. Norwichrocks said,

    Marvellous news Di! I haven’t been able to check blogs for about a week, but I’m (sort of) back online now and DELIGHTED to hear that there’s someone in there.

    I had lunch with my friend of the IVF (donor egg and donor sperm) twins yesterday. They’re now three months old and I sat looking at them thinking, I remember when you were just tiny heartbeats and raised hormone levels, and then seeing them in the first 3D ultrasounds… it is such a joy to know that your is coming along so nicely, too.

  14. doctordi said,

    NR, thank you for making me smile at the thought of those precious little huggable bundles – I am so pleased for your friend, and yes, so gobsmacked by the path each and every one of us took as we heavily contested our way into life.

  15. doctordi said,

    Yes, Sam, I wish they had too. I find it really distressing myself just hearing it from you, so I can’t imagine what it’s like for you. I just don’t understand how such a fundamental question isn’t answered as part of deciding treatment in the first place. Actually, I was talking to Llew about it last night, and his recollection is that we pushed for the test to establish my egg reserve… I can’t really remember if we insisted or if Dr P was going to run the test anyway, although I do know we did ask him about it because I’m an ex-smoker so was concerned after the info evening that I’d damaged my reserve.

    Yes, that’s how it happened. I remember now. I panicked at the info evening, so when we had our first consultation with Dr P after that, we asked if there was a way to check for a damaged reserve due to cigarettes. He said there seemed to be a correlation between egg reserve and egg quality, so did the test, and was satisfied that the reserve was high enough that I appeared to have dodged the smoking bullet. But now I wonder if we would have had the test ourselves had I not had the ex-smoker status trigger the additional line of questioning. I just don’t know the answer. Dr P would probably say he would have run the test anyway, and perhaps he does do it routinely, but we did have a potential threat that framed our own concerns somewhat differently, because I was more concerned about the ten years of smoking than my age.

    I am very thankful for my own lucky draw, I am, and hopefully this one will stick and be healthy and turn into a loved human being, but I am also sincerely affected by this, and I hope, hope, hope returning to the natural cycle succeeds. You’re doing everything you can, Sam – I hope there’s some peace for you in that no matter what. I’m crossing fingers, pressing thumbs, and making wishes for you and these next steps. xxx

    • Samantha said,

      Hi Di,

      Thank you; you are being very kind as ever. I really do appreciate your heartfelt words and good wishes.

      I know that your clinic now advertises the AMH test on the front page of its website under News Headlines dated 19 February 2010. My clinic has yet to do so. Did you know that the test was invented at the University of Adelaide 5 years ago? I repeat, 5 years ago.

      Today my 33 year old partnered and childless colleague whom I share an office with told me that after telling her 33 year old childless single female friend about my dramas and the AMH test, that her friend wanted more details. So I enthusiastically printed off info and gave both my colleague and her friend copies and said “it only costs $60 and can be done through your GP”. “That’s it?” she said. “That’s it” I replied.

      My period has arrived 4 days earlier than anticipated (the joys of fast approaching menopause is a shortening of the menstrual cycle (and in particular the follicular phase) which means I can squeeze in even more cycles (and just in the nick of time as yesterday I paid off the credit card from the last one!) So onwards with cycle #13 which happens to be my now departed paternal grandmother’s lucky number. This time last year I entered cycle #5 which led to the ill fated pregnancy so maybe #13 and May are in harmony? Last week when I said to my IVF doctor that “cycle #1 led to fertilization failure and in hindsight, was a portent of things to come”, he replied, “Samantha, it sounds as though you are reading tea leaves!” Tea leaf reading is probably as good as anything else at predicting my chances!

      Regards,

      Sam

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