Friday, June 14, 2013

The Consult (otherwise known as The End is Near)

Dr. P is a tall man, fit and, most ideally for my adventure...calm. If I were to receive news of an imminently terminal illness, I'd want it to come from him. He has a way of breaking bad news that left me feeling surprisingly OK.

The back of his office is loaded with dozens of fertility talismans, carvings and masks apparently given to him by patients. Primitive people as well as the most sophisticated women of Los Angeles use them to bring on the baby-makin' juju. Propped up behind him as he talked, these hand-crafted creatures brought a little wild, fertile life into this 14th floor corner office. Dirty, imperfect and slightly terrifying, they stood like an army in defense of chance and luck. And boy, did I need them there while Dr. P spoke of the statistics and science stacked heavily against me.

First we discussed my situation. Forty-two. Unmarried. Without a babydaddy. I explained my boyfriend's lack of desire to have another kid. Dr. P nodded silently at that, and I didn't let myself tear up at the thought, because I'll admit it, I'm sad about that fact. But I'm bucking up.

I told Dr. P I was considering my options: 1) having a baby now with a sperm donor, 2) fertilizing an egg with a sperm donor, then freezing the embryo, or 3) freezing my eggs.

“Yep, those are your options,” he said, then launched into a very well-trodden lesson in fertility.

After a refresher course on how a baby is made, complete with hand drawings, he showed me a scary line chart: a woman's chances of conceiving based on age. It had the same drop-off-the-cliff curve of an estrogen chart that I recently saw in my gastroenterologist’s office, titled Understanding Menopause. I took a picture of that chart with my phone as I waited for the doctor. I've shown it to many women since because it was so shocking, so terrifying, that viewing it always evokes gasps. For women in their late 30s and early 40s, it's a bitchslap in the face. That chart struck so much fear into my heart it motivated me into this office.

Both charts, the estrogen levels and conception chances, look a lot like the profile of an elephant facing to the right. The elephant's back is conception rates (and estrogen levels) in our 20s and 30s. His head is our late 30s. The sudden drop down at his truck, a perpendicular line, is age 40, 41, 42. By 44, when estrogen levels are mere morsels on the cage floor, rates of conception are, uh, shitty.

I knew I needed to do something quick, but now I knew just how quick.

Dr. P went through my options for conceiving with a little help from medical tools.

IUI: Interuterine Injection. That's basically the turkey baster technique, with finer instruments. When the ovary releases the egg, the doctor inserts a long tube into my uterus, squirts in a vial containing thousands of spermies, and then we keep our fingers crossed that one of the little guys will successfully woo my egg so the two can settle down together in the comfy lining of my uterine wall.

IVF: Invitro Fertilization. This is the test tube baby option. It starts with me shooting myself up with lots of ovarian stimulation drugs to promoted extra egg growth, then when the eggs are ready, the doctor sticks me with a long scary needle (I will not be looking at that) and pulls them out. The viable eggs are then injected with sperm, and we watch them like fussy hens to see if they grow into an embryo. The ones that do are allowed to keep growing for a few days in the lab, like a bacterial sample, and the embryos that do well are then inserted into my uterus. Then we cross our fingers and hope at least one settles into my uterine lining to begin its nine month journey to become fully human.

After explaining the science, Dr. P explained my statistical chances of conceiving at my age with each technique. There's no need to belabor the point. It sucks. I fall below the 6th percentile, even with the meddling efforts of IVF. That's not a failing grade, that's blowing off the whole semester of classes.
What's worse, as Dr. P so calmly put it, is that my chances are decreasing every month. He didn't use the word “plummeting” but the picture was pretty clear. I was more than halfway down that elephant trunk, heading straight for the dung heap.

“I'd want you to be pregnant by the end of the year,” he said without a quibble. Apparently 42 is a milestone age for women's fertility. It's like the last gas station before hitting the desert.

Dr. P tells me, every year, he helps several women who are 42 get pregnant. That success rate drops to “a few” every year for 43-year-old women. But after 43, it's a veritable wasteland. “I can remember the names of all the women I've helped get pregnant at 44.” And he's been doing this for 25 years.

Maybe he just has a really good memory, I tell myself. But his expression says otherwise.

To be clear, we are talking about the statistics for women who use their own eggs. Women who use “donor eggs,” eggs carrying the genetic codes of whoever gave them away, have an easier time becoming pregnant in their 40s and even their 50s. But I was hoping for a shot to raise a little half me. Call it arrogant, selfish, egotistical, snobby, whatever. But I believe there is an intrinsic human drive to produce our own offspring. It's the hard wired impulse that has motivated the survival of the species. I admit I have it. If I can't have my own, then I will consider other options, but for now a genetic progeny is the goal.

Dr. P then explains egg freezing. It involves the same process of jacking me up with stimulation drugs to retrieve as many eggs as possible from my ovaries. Instead of fertilizing them with sperm, the eggs are slowly frozen and stored for an annual fee until I find the right sperm, at the right time, or just say, Fuck it, it's now or never.
Next to the diagrams and statistics Dr. P was drawing out for me on a sheet of paper, he wrote “Lots of pressure” next to the IUI and IVF pictures, explaining that if I wanted to get pregnant that way, we'd need to start right away, like today.

Next to the egg freezing, he wrote, “ Less pressure.” Meaning, by putting my eggs on deep freeze, I could stop the clock on their aging. They would forever be 42 years old. How many chances in life do we get to stop time? If only I had come in when I was 38, or 32, or even 22, when my eggs were as springy and robust as my 22-year-old ass.

Knowing what I know now, I've begun to be the preacher to young women about preserving our eggs. As women interested in a life other than just being a mother, delaying said motherhood later and later, we are delaying our chances of actually being able to do it. Men don't have this problem. And the fact that women do skews how we must navigate our decisions. It is one of the most significant influences shaping the course of our lives and careers. That's why I'm so thrilled and grateful that medical science is catching up with women's lib.

Egg freezing, while not perfect, is about choice and control and, yes, liberation. Women still spend a disproportionate amount of our lives waiting for men. Waiting to find the right one. Waiting for them to propose. Waiting for them to be ready for children. Of course, we also are waiting for our own lives to be right to bring a child into it, but now we can put a stop to that nagging ticking clock that has always complicated our ambitions, our dreams and our relationships with men. We can shut it up, or at least quiet the countdown that beats irrepressibly in almost every woman's heart. By putting our baby-making opportunities on ice, we are free from the tyranny of our hard wired impulses that consciously and subconsciously motivate us to find a mate and make a baby.

That impulse often distracts women from our other ambitions and dreams. It sometimes requires us to give up on our careers and life adventures. It causes some women to settle for the wrong man just because he offers the dream of motherhood and family. Certainly, it's frustrating and frightening to men. What is scarier to a man than a woman desperate to get her hooks in him permanently with pregnancy?

I wonder what would women's lives look like if we took the biological clock mostly out of the equation? How would it change the dynamic of how we moved through the world? I can imagine a future when egg freezing is affordable and a common practice for ambitious women. I can see these women moving farther ahead in their young lives, and feeling less anxiety about finding a babydaddy. This will be good for men, not bad. Both men and women will be better able to decide if they are right for each other without the added pressure of a subtextual ticking clock.

But back to my situation... the woman who didn't stop the clock...

Dr. P very diplomatically acknowledged the in-between place I am at with my boyfriend (who I'll call D) the man with three young sons, who is definitely not ready for a new baby now but could be in the not too distant future.

“You give yourself some time with this,” Dr. P says of egg freezing, “and maybe in a year, you can tempt him with a daughter.”

Wishful thinking. Low odds. Big risks. But that's where I'm at. It's all I got.

So I leave the office with a big decision to make right away: Start trying to get pregnant immediately with a sperm donor, or freeze some of my eggs on the low-odds chance I'll soon have a man in my life who wants to breed and raise a kid with me.

Yeah, right.

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