We Wanted a Test Tube Baby
The doctors warned us that it wouldn’t be easy. We didn’t know how right they were.
(Page 3 of 6)
I had to leave town on business for a few days, and by the time I got back, Sarah had decided. It bothered her that I had changed my mind two weeks before we were to begin the program, because she never considered not doing IVF. Her logic was simple. If she tried it and by chance it succeeded, we’d have a child; if she didn’t try IVF, we wouldn’t have even that slight chance. Therefore she wanted to go through with it. She believed that it would be worth it; she would just have to get used to the shots. I had known that that was going to be her decision. Ruby had said that women who went through IVF were heroes. She was right. Husbands were supernumeraries in the IVF drama; the wives made the real sacrifice. Injections, chemicals, surgery, waiting, waiting, waiting—all for a 20 per cent chance of success. I would never understand maternal zeal. Before we knew it, the ordeal had begun.
On May 26 Sarah received her first injection of Pergonal, a preparation of natural hormones given to stimulate the ovarian follicles—blisterlike sacs on the ovary. Theoretically, each sac contains an egg. As the follicle grows, the egg within matures. In IVF, when you stimulate the follicles, you hope to stimulate the eggs. A nurse gave Sarah the shot at St. David’s emergency room. Though a quick injection of two cc’s of Pergonal, about a quarter of the length of a number two pencil, it was painful, and Sarah’s hip hurt the rest of the day. When she got home, I made a map with two spheres signifying Sarah’s buttocks. I put an X where each injection went. That way, we wouldn’t forget where each one was. It was our butt map. It was worthless. After the first few injections I gave up on the map. The injection had to be given in about the same stamp-size area on either hip away from the spine, away from the hipbone, and into the muscle high on the buttock. If the injection was too close to the spine there was a danger of infection if it hit the bone, or if it hit the sciatic nerve, paralyzation; too close to the hipbone, and there was more pain. Hitting the right spot was no consolation—it hurt anyway.
Three days into the program Sarah began taking a synthetic fertility drug, clomiphene. Its chemical makeup looks like estrogen, and it works indirectly on the ovary by masking the amount of estrogen present, fooling the brain into increasing the stimulation of the ovaries. During her lunch hour, she had to leave school and drive to the hospital for her daily Pergonal injection. Ruby gave Sarah the second injection of Pergonal. This time it took a minute and a half to inject; the emergency room nurse had done it too fast. Ruby explained that the shot should be administered slowly for Sarah because of her body type. Sarah called me to tell me how it went. It had been very painful; she had almost fainted. I wanted to know if she was having any reaction to the drug yet. That was most in my thoughts. She was worried about headaches. Though so far there were none, we were waiting for the side effects. It was like standing out in a field during a thunderstorm.
Several more days of shots went by. School was finally over, but there would be no break for Sarah. With more injections and fertility drugs, the pain and discomfort increased. The heating pad was now part of Sarah. She stayed on it day and night. I was concerned that it would raise her temperature and affect other more delicate things, like a BB-size follicle. Approaching medicine with a layman’s logic, I called Ruby to see if that was true. “Would heat hurt anything?” Nah, it didn’t matter.
Remember when we were told to brush our teeth in a circular motion? Well, some years back, that was changed to a downward motion. A circular motion was wrong. Medicine is like that too. It gets amended. Remember thalidomide? Remember when DDT didn’t cause cancer? Remember when you used that heating pad? Remember when we injected your wife with progesterone? That’s why I always asked questions based on a logic that most doctors laugh at. That’s why I usually got an answer sounding like, “You stick to your business, and we’ll stick to ours.” Or, “Nah, it doesn’t matter, and when it does we’ll let you know.” My wife’s body was at the mercy of medical science. Advanced, yes; deductive, certainly; unpredictable, always. It was part of the ferment of my cynicism.
The second week was rough. Dr. Vaughn was watching Sarah’s estrogen level and the growth of the follicles in the right ovary to determine how many eggs he might get and when he could perform the surgery. He looked for an estrogen level of 800 to 1600 picograms per milliliter in the blood and a follicle size of 18mm, about the size of a grape.
Monitoring was done by checking the estrogen level in the blood and examining the follicles on a sonogram, a picture produced by sound waves bounced off the pelvic area and picked up on a computer screen, a sort of body radar. Sarah reported to St. David’s lab at seven-thirty every morning for a blood draw. Afterward, we would go across town for the sonogram. She would get her Pergonal injection around midday depending upon the results of the sonogram and her estrogen level.
That was a two-heating-pad week, one for her butt and one for her arm, where the blood was drawn. Sarah asked for a phlebotomist who was experienced with squeamish victims. Every bit of empathy helped her with the needles.
Fortunately the ultrasound was painless, though uncomfortable. Sarah had to drink a quart of water before the sonogram, so that her bladder would fill, making the abdominal area more pronounced. Chris Kellogg, one of the ultrasound technicians, was very kind and helpful, pointing out on the screen the follicles on the ovaries and other internal minutiae. Ultrasound technology still needs refining. The low resolution and definition is reminiscent of TV in the fifties. Sort of like trying to pick out a white dog in a snowstorm. But things like the small, pea-size follicles were visible enough to tell the doctors what they wanted to know. In our case, Sarah had one 9mm follicle visible on the left ovary and two on the right ovary, of 9mm and 10mm.
We called Ruby every morning to get Sarah’s estrogen level. One morning’s blood sample showed a level of 550 picograms per milliliter. Sarah was encouraged, because her body was responding to the stimulation. But the follicles and the estrogen level needed to double in size within four days if we were to go on to surgery. At that time Ruby wouldn’t list your name on the board in her office unless surgery was certain. To be listed on the board was an indication of partial success. We weren’t there yet, and the image of the board lingered in Sarah’s mind.
On the ninth morning, a phlebotomist drew two more tubes of blood. Then we drove over for the ultrasound. It was eight-thirty on Sunday. Chris seemed to snap out of his early-morning fog as he slid the ultrasound scanner over Sarah’s lower abdomen. Three follicles were visible on the right. They were 9mm, 11mm, and 12mm. The left still had only one follicle, but it had grown to 12mm. Dr. Vaughn wanted to see at least two 18mm follicles before he would operate. We still had a way to go.
Sarah’s estrogen level, on the other hand, was 1154. It had doubled overnight. Dr. Vaughn didn’t want her to have an injection that day, because the level was high enough. So she got a much-needed reprieve from the Pergonal. Her hips were swollen and bruised; lying on either side was painful. We heard that some women had no problem with the shots even with twice the dosage Sarah was getting. Of course it helped to have a layer of fat on one’s posterior to buffer a one-and-a-half-inch needle. Sarah was not so fortunate. She was paying the price for a taut body.
The next morning’s sonogram showed most of the follicles had stopped growing. One more was visible, but others had gotten smaller. And Sarah’s estrogen level had dropped to 662. She resumed the injection schedule because the estrogen had not increased on its own.
She was disappointed that her body couldn’t produce enough hormone. It seemed to continually need external catalysts to make things work, as if it were unnatural. She started thinking about getting canceled and not making the board. She began to consider when she could repeat the program.
But by Tuesday morning the follicles had started to grow again. They were at 15mm, 12mm, 7mm, and 7mm on the right ovary and 13mm and 11mm on the left. We were encouraged, but the sizes and the 780 estrogen level might not reach the accepted threshold in time. We were still afraid that we would get canceled.
There was some relief at the prospect of failure, of reaching the goal we had drilled into our heads. Going through the apprehension, anxiety, and pain a second time did not seem unreasonable, though. We weren’t alone in this strange dialectic, this charge of the Light Brigade mentality forged of parental desire. Of the program’s 33 couples, four returned to try again. Two of those would have their babies in October. If we were eliminated, Sarah wanted to try again in July. I heard myself agree with her.
The next day, a Wednesday, was a bad one—four blood draws. Dr. Vaughn was looking at the estrogen level and for a surge in luteinizing hormone, which signaled egg maturation. When the LH level surged, ovulation, or the follicles’ release of the eggs, was near. If it surged, Sarah would go into surgery a day earlier. If it didn’t surge, a human chorionic gonadotropin injection, which boosted LH, would trigger ovulation anyway in 36 hours. The HCG would be injected today if her follicles and estrogen showed enough cooperation to warrant continuation of treatment.
My Library
