Free Avalanche by Julia Leigh

can’t do a fresh transfer.
    â€”Sorry, what does that mean?
    â€”Your body has started producing progesterone before ovulating. There’s nothing we could have done about it. It means the lining of your uterus will be out of sync with implantation. It could implant, it’s not impossible, but the window isn’t optimum. I don’t want you to look back and say “Why did we waste this embryo?”
    â€”What’s the cut-off for progesterone?
    â€”5. And yours was 6, it wasn’t 5.1 or 5.2. Some clinics in the U.S. freeze all embryos and don’t do fresh transfers.
    â€”So you’re giving me strong advice? Nothing wishy-washy?
    â€”I can only advise you. It’s up to you to do what you want.
    â€”But I have no medical experience.
    â€”Well, that’s my advice. Check with Dr. Nell when she’s back on Monday. You can take the pessaries until then, there’s no harm in that.
    Eleven eggs were collected, of which seven were mature. These mature eggs were injected with sperm. Overnight, four of the seven embryos showed signs of developing. By Day 3 only one embryo was going strong, with another two looking borderline. The lab assistants—always women—updated me on the process of attrition. I had to steel my nerves each time they called. By Day 5 I was left with one Grade A blastocyst—which quality-wise was the best outcome possible. The clinic had a complex system for grading embryos depending on the progression of cell division: a blastocyst was a Day 5 embryo that had developeda distinctive shape with an inner cell mass clearly identifiable within its fluid-filled cavity. A blastocyst had the best chance of resulting in a pregnancy. That said, embryos less developed than a blastocyst had also been known to be viable so there was—as ever—a wide spectrum of hope.
    Dr. Nell had returned to her office and I asked her again what she would do if she were in my shoes: a fresh or frozen transfer? This time she answered unequivocally, “If it were me I’d definitely freeze.”
    I was disoriented by the numbers, the odds, as if I were playing a game in which I didn’t know the rules, “Kindly Kafka.”
    â€”When you say my progesterone was 6 what does that mean? Was it 6 out of 10 or 6 out of 100?
    â€”It’s not out of anything. It’s a number and our cut-off is 5.
    â€”Is it true fresh transfers are better than frozen transfers?
    â€”Some clinics in Spain only ever do frozen transfers.
    â€”But what if the defrost doesn’t work? I only have one embryo.
    â€”The rate is 90 percent for a successful embryo defrost. Weighing it all up, my advice is to freeze.
    The horror, the horror: a 10 percent chance it won’t defrost.
    â€”All right, let’s freeze.
    An uncharitable thought . . . IVF seemed to be a great deal about levels and cut-offs. If number X, then do Y. I wondered if it was the medical equivalent of conveyancing in the legal world, which is to say, largely formulaic, a matter of following protocol.
    The lab was closed for Christmas break and also undergoing renovations so I had to wait until January to do my transfer. A friend had been following my travails, she herself was a veteran of IVF, now a blessedly happy and exhausted mother. I told her it was ridiculous but I was sad to think of my darling little embryo spending Christmas all alone in a freezing cold tank of liquid nitrogen. “It won’t be alone,” she said. “Our siblings are there too.” We are all lunatics. She had gone through the same clinic and was successful when she gave up trying withher own eggs and moved to using her husband’s sperm with a donor egg from a young woman in her twenties, one of her close friends. That child is adorable. Her view is that the science of IVF is as astonishing as the science that put a man on the moon. Her gratitude to her doctor is enormous. In her eyes he is like a pioneer