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Well that escalated quickly.

29 Jul 2018

So, my test results weren't exactly what I was expecting.


The Tuesday after my tubal patency test, I found myself again sitting in my specialist's office feeling anxious.  Wringing my hands as I waited for her to arrive, I wondered whether my test results would show that my fertility was good, or whether I might have to accelerate things faster than I was planning to.  My mother had been trying to tell me that she was confident I wouldn't have any issues, given that she conceived me naturally when she was 35 and gave birth to me at 36, but I couldn't help but wonder if I was going to be as lucky.


Dr P walked in, sat down at her computer, scrolled through my results on screen and turned to face me.


"Well Rebecca, first thing's first.  Your genetic screening showed no signs of Cystic Fibrosis, Fragile X Syndrome or Spinal Muscular Atrophy, so that's good."  She took a breath.  "Your anti-mullerian hormone levels, however, are a little lower than I would like.  When you last had this test four years ago, your levels were 24.4 pmol/L, which is right in the healthy range.  Now, though, they've dropped to 13, which is a little below normal."


My heart sank.


"I've also had a look at the report from your tubal patency test.  I can see here that you've got five active follicles on the right and six on the left.  I really would have liked those numbers to have been about double what they are."


I was both surprised and disheartened.  The doctor who performed my test the week before hadn't said anything about the number of follicles being low.  But I guess that wasn't really her job.


"Rebecca, have you ever fallen pregnant naturally?"


"Uh...no.  Not that I'm aware."


"I see.  But you've had exposure to sperm?"


(What a question.)


"Yes, but I've always been on the pill, so..."


"Right."  She turned back to her screen and began to type.  "I'm going to record a diagnosis of medical infertility in your case, Rebecca, rather than social infertility."


I almost couldn't believe what I was hearing.


"The good news though is that this means that you can skip the IUI procedures and go straight to IVF if you want to.  I can see that you've got your counselling sessions booked in over the course of the next month.  That means that we could be looking at as early as September for you to begin your first IVF cycle."


My head was reeling at the diagnosis and the speed with which things seemed to have progressed in a matter of minutes.  Not to mention just how much my AMH levels had dropped in the last four years.  How lucky it was that I took that test when I was 30, so that I had something to compare my current results to.  I would have been wondering if they'd always been that low otherwise.  Now I know that time is well and truly kicking my ass.  Of course I knew that fertility drops with age, but I wasn't expecting to be diagnosed as medically infertile at 34.  Then again, maybe the doctor was just trying to help me out by using the numbers in my favour so that I didn't have to go through a bunch of unsuccessful procedures.


Dr P scrolled back through my tubal patency results.  "I can see here too that you had some complications during the procedure?"  she said, referring to the vasovagal response noted on my report.


"Yes, unfortunately I had a bit of trouble.  It was a bit awful."


I took a deep breath and told her about how I had struggled to stay conscious;  how I was concerned that I was going to experience this same reaction every time I had to undergo an embryo transfer.  Thankfully, she reassured me that the catheters that they use for embryo transfers are much smaller than the ones used for patency tests.  "Hopefully,"  she said, "it will be a non-event for you.  But if it's not and you start having difficulty in the middle of an embryo transfer procedure, we can just put you under a general anaesthetic straight away.  If you want, we could schedule a test-run of a transfer procedure for you before you go through the real thing, so that we can monitor how your body is going to react, but my feeling is that it probably isn't necessary."


Well that was a relief at least.


It took me a few days to come to terms with Dr P's diagnosis.  I could definitely see how there were both positives and negatives to being assessed as medically infertile - a positive being that I could go straight to IVF without having to try artificial insemination first.  But confronting the reality that I'm not as young as I feel or look, and that I would have to get a move on if I want to have a family, was not easy for me.  When I first started out this whole process of choosing a doctor and undergoing tests, my rationale was that even though I wasn't ready to conceive immediately, I wanted to know what I was facing medically in case there were time-critical impediments I didn't yet know about.  And that's sort of exactly what has happened.  So instead of looking at conceiving in a year or so like I had envisaged, I'm now looking at starting it all a lot sooner.  Whilst I probably won't have all the necessary funds together by September - I'm going to need about $14,000 at my disposal for my first IVF cycle - it's now looking as though I might be beginning perhaps in December 2018 or January 2019.


On a positive note, a few days later a colleague at work who has gone through IVF assured me that my test results still weren't that terrible.  "Don't worry too much.  Just to give you a comparison, my anti-mullerian hormone was 3.  And I conceived on only my second embryo transfer."  I felt a little better.


Two weeks later, I had my first round of mandatory counselling sessions.  The first was with one of the clinic's sperm donor coordinators.  She spent an hour explaining how the donor register system works, and the rights of the child, the donor and myself in terms of us all accessing information about each other.


When my child is born, the donor will be notified that a child has been born using his sperm.  However on my child's birth certificate, under Victorian law, the donor will not be listed as the father - I will be the only parent listed.  The donor's identity will remain anonymous.  There will be an annexure on the birth certificate indicating that there is additional information about the child's parentage, which the child can apply to access upon reaching 18.  After that time, the child can legally obtain the identity details of their biological father and make contact if they wish to.


Prior to that time, at any stage, both myself and the donor can apply to the Victorian Assisted Reproductive Treatment Authority (VARTA) to make contact with the other - but neither the donor or I are obligated to respond to a request for contact if we do not want to.


Under Victorian law, donors are also prohibited from donating to more than 10 women.  Those 10 women may each have several children using that same donor, however.  VARTA also keeps a register of all siblings and half-siblings conceived using a donor - and it is possible to apply to VARTA to make contact with those siblings.


The donor coordinator handed me a whole new stack of consents, paperwork and literature to take home and wade through, and I popped them in my "IVF binder" and made my way to my next appointment with the psychologist.  One thing I will never get over in this process is how much information there is to digest.


I was completely unsure of what to expect from the psychologist.  As I sat across from her in her consulting room, the silences peppered throughout our dialogue seemed to last forever.  I felt the need to fill those silences with confident statements about my choices, as if I had to convince her.  I felt her eyes watching me and wondered if she was indeed scrutinising me, sussing me out, or whether I was just being paranoid.  We talked a bit about the legal implications of having a child using a donor - she recommended that I talk to one of the family law specialists at my firm as a precaution, as there has actually been a case of a donor being granted custody rights to his biological child, despite all the legislative protections in place.


We talked about how this was a plan I had had in my mind for years if I didn't meet the "right guy", and as I approach my mid- to late-thirties, it has now become my reality.  We talked about how I didn't really believe in the "right guy" anyway, and she nodded in agreement.  We talked about how the idea of family, and what constitutes a family, is changing constantly.  Why my previous relationships had failed and how I just wasn't willing to settle for someone who didn't treat me well just so that I could have a "traditional" family.


We talked about my diagnosis of medical infertility, and about how much we both hated the term "social infertility".  She was furious that any medical professionals even use it.  I felt vindicated that my anger about those two little words was justified.


We talked about what I would tell the child about their parentage - how I'm going to be honest and forthright as soon as the child is born.  I talked about how I was worried that if the donor didn't want to meet the child, the child might internalise that as a lesson that they are unworthy of love.  We talked about SBS's recent special on single people who started families on their own using donors and surrogates.  We talked about how important it is to choose language carefully;  she picked up on instances when I diverted from calling the donor a "donor" and instead called him the "father".


"He's not the father," she cautioned me, "he's just someone who has made a wonderful gift to you to enable you to start your family.  Be very careful never to refer him as 'father'.  He isn't your child's 'parent'.  He isn't going to have that kind of a role in your child's life."


She asked me if I had supportive people around me.  I told her yes, my mother and my sister have been incredibly supportive.  My friends and coworkers too.  When the subject of my father was raised, however, my resolve broke and I instantly began to cry.


Of all the people I have opened up to about what I'm doing, my father has been the only person who has been unsupportive.  It has been the one dark cloud that has prevented me from fully experiencing the joy and excitement of what I am doing, and I carry that sadness with me everywhere.


When I told my father I was looking at undergoing IVF, he shook his head and said to me, "I just don't understand why you can't just find a man."  That was his reaction.  Not joy that he was going to be a grandfather, or pride, or surprise.  Sadly, every subsequent thing he said was somehow worse than the last;  from "you're too much like your mother", to "you're one of these women who thinks that all men are rapists" (at no point have I ever said that), to telling me that when my drink was spiked when I was 25 years old, it was because of the friends I was keeping.  I was furious.  I yelled back at him.  I reminded him that I didn't know the man who spiked my drink.  And I refuse to accept responsibility for that particular man's actions.  He did it.  I'm not going to be blamed for someone drugging me.  I was just lucky that it didn't result in me being assaulted.


My dad knows what my relationships have been like.  He knows I was cheated on by someone I adored.  He knows I would have been miserable if I had married someone who just wanted to control me.  Those things don't seem to matter to him though.  Instead, I think he finds my independence to be a threat to men like him and by extension, a threat to himself and the way of life he has been privileged enough to enjoy.  My dad, who has never cooked a day in his life;  who never does something for his family without being asked, and who then complains if he is, is terrified.  If people like me start expecting more of men like my father, then they won't be able to sit back and enjoy the status quo as it has been for decades, even millennia.


And this is what I said to the psychologist.  I don't hate men, I just want them to do better.


Guys, I don't hate you.  I just want you to do better.  I know that you are capable of better if you really want to be.  This push and pull tug-of-war that men and women are battling right now is all because we expect more of you and we are tired of being treated like your unpaid servants, like a proxy for your mother, like your whore yet also like the Virgin Mary, and all whilst having you believe that you are entitled to our bodies, our time, our attention.  And I get that you're terrified and angry.  You were raised with society quietly and insidiously promising you that these things would all be yours.  But I believe that men and women are on the cusp of a new way of relating to and treating each other, and women aren't going to let it go.  As many as one in ten women who are currently undergoing IVF in Australia are single.  These numbers are not meaningless.


And I battle constant guilt over my anger at my father's reaction.  Because after every hurtful thing he has said, he's still my dad.


The psychologist shared my outrage and hurt at the way my father had responded to my plans, but offered me hope that maybe his tune would change once plans turned into a grandchild.


I left the counselling session exhausted and longing for a glass of wine and a hot bath, but I took with me some reassuring words that the psychologist had given me.  "I think you're going to be a wonderful mum," she said.  "I think that you're incredibly resilient and brave and strong and that you have a lot to offer a little person."  I spent the rest of the afternoon at work fighting off a headache and feeling emotionally drained, but I was also relieved.  I hadn't realised how much I needed to hear those words.


As I was writing this instalment, I received a phone call from my mother telling me that one of my paternal cousins has separated from his wife and they are now sharing custody of their three girls.  Of all my cousins on both sides of the family, that leaves only one who is still together with their spouse.  I also heard yesterday that an old family friend also recently separated from his wife and they are trying to work out what to say to their two boys.  My own parents, at 70 years of age, are probably about to separate themselves after decades of unhappiness - I can't even recall the two of them ever having liked each other in living memory.  I am reminded today of a lesson that I learned when B and I split up - that in relationships, as in life, there are no guarantees no matter how much you might love a person.  As this journey becomes more real and more daunting, it is a timely reminder that there is no shame or failure in deciding to do this on my own.


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