Designer Baby

by Aaron Elias Brunsdon

  Instantly we take a liking to the charismatic doctor. Dr Pisit is about six feet tall, handsome, mild-mannered and strikes me as sophisticated, worldly, noble and compassionate. He speaks fluent English with an underlying Australian accent and has a softly-spoken, articulate voice. He has a sense of assurance and calm, and I feel he honestly wants to work with childless couples like us to achieve our goal to be parents.

  In a subsequent appointment at his office we are interrupted by a loud cheer. A joyous commotion – what is going on? Dr Pisit politely excuses himself and upon his return notifies us that the racket outside is an overjoyed couple’s reaction to the good news of a twin pregnancy.

  He strikes me as someone who cares – driven and gifted with the ability to help others. On another occasion we see him exiting his office to congratulate a gay couple from Melbourne for whom he had successfully brought to term triplets. The three adorable one-year-olds, their parents and Dr Pisit engage in happy snapshots as the rest of the patients in the clinic marvel at the sublime moment, wondering how the couple could cope with three babies.

  Like most doctors, Dr Pisit is calm and speaks only when necessary. He answers all our questions with clarity. He explains the IVF process of how eggs are collected from Rebecca’s ovary, after which they are fertilised in the laboratory with Jayson’s sperm and placed into the surrogate’s uterus.

  “There are five vital steps to complete in IVF and you are required to be in Thailand for at least three of them, which will take approximately two to four weeks on this trip. This depends on how Rebecca responds to the treatment, which will determine when her eggs can be extracted,” he says calmly.

  “Our first most important step is to prepare Rebecca for egg collection,” he advises. “The second is sperm collection, for which Jayson has to be present and is normally done towards the end, just before the eggs are extracted, so they remain fresh for incubation. The third and subsequent steps you don’t have to be here for. Step three is the insemination, in which the sperm is injected into the egg so fertilisation can occur. Step four is when my team check if our fertilised eggs have become embryos. Step five is when these embryos are cultured in the laboratory for up to six days. The final step is when we assess the most advanced embryos for transfer into your surrogate’s uterus.”

  After the long consultation, with a mountain of information to digest, Rebecca is led into the adjacent examination room. She lies on a gynaecology table, wrapped in a sarong, prepped and ready for the ultrasound. Dr Pisit says it is acceptable for us to stay inside and watch the screen so long as Rebecca is comfortable. I hold her hands firmly, not knowing what to expect.

  “I wonder if the big probe he will insert into her privates will hurt her?” I innocently ask Esther.

  Apparently, I discover, broadening my knowledge of the female form, it doesn’t, and the vaginal probe ultrasound will allow us to view the ovaries and uterus. Dr Pisit places the probe inside her vagina, producing images on the screen similar to that of an X-ray. The ultrasound monitor shows the size and number of follicles produced in the ovary. It also checks how kosher the ovary is for fertility medications. A fascinating view shows fewer than three eggs in her uterus.

  “Rebecca, you aren’t ready to begin fertility injections. I will prescribe Folitropin and you can commence injections in two days’ time when your period is denser,” Dr Pisit says.

  Folitropin is commonly used to treat certain fertility problems in women, especially IVF patients. It provides the hormones to stimulate the ovaries to produce eggs. The two-day delay is a slight worry for we had a regimented plan in place. The delay would mean a couple more days in Bangkok. We thank Dr Pisit before quickly moving to Spurm’s office where we get a quick five-minute crash course on how to use and administer Folitropin daily. Spurm uses a pillow to demonstrate the process as we all watch intently.

  “Before injecting each dose, you must clean the injection site by rubbing with a swab of alcohol,” Spurm says. “It is important to change the location of the injection daily to avoid discomfort or problem areas

  under the skin of the abdomen.”

  She recommends Rebecca swap sides daily, alternating between the right and left part of the abdomen, injecting the medication under the skin or into a muscle once a day at the same time for a minimum ten days’ treatment. Based upon her response to the treatment, the medical team will assess blood and medical tests including further ultrasounds to determine the right dose for her and when to inject the next medication.

  “Who will do the injections?” we silently ask each other, the responsibility feeling heavy on our shoulders. I, for one, have never been entirely comfortable with needles so I remain quiet. Eventually Esther volunteers because she happens to manage a pharmaceutical company and is familiar with injections.

  We thank Spurm and book a follow-up appointment to see Dr Pisit on 15 April. We are done for the day and are looking forward to the three-day holiday of Songkran. The first and most vital part of the IVF process is over.

  16

  Songkran

  Songkran is a time for reflection, the most auspicious of the Thai festivals. For tourists like us, it is a time to have fun and celebrate with locals shooting water guns on the streets. Over the years the practice of shooting water guns has evolved into throwing large pails of icy cold water at the gathering crowd.

  Imagine us as unsuspecting tourists on one of these most auspicious days. We decide to get out of our “baby preoccupation” and have some fun. We head to the main area and buy 3,000-baht water guns from the local shopkeeper. The plastic guns come equipped with a backpack voluminous enough to fill three litres of water. Our fears of being “easy targets” are realised as we quickly get drenched, so we get a group alliance and start shooting.

  Kay had briefed us – simple rules – “No camera, phones or anything that could suffer water damage.” We buy plastic wallets sold on the streets for our cash and basic necessities, and stay away from tuk tuks (to avoid being sprayed with water in bucketfuls). If you are a serious combatant, then it is recommended you fill your guns with icy cold water for a single shot from the apparatus. This buys enough time to deter the opponent from shooting back. If you run out of water, for ten baht you can easily replenish the guns from the street hawkers who sell cold drinks in ice buckets.

  We are ready to do battle and head to Silom, the place to be, at midday. The streets of Silom are lined with pickup trucks and their beds loaded with buckets of ice-cold water. The traffic is closed off. Water warriors splash and target passers-by who line the side of the road, adding to the fairly chaotic scene where vendors are selling talcum powder. The powder is another hazard which some add to their arsenal.

  Within seconds, we are attacked by a tsunami of spraying guns. Our clothes are drenched but we maintain composure and absorb the energy of the festivalgoers on the streets. There are thousands of people. The fun and laughter that fills the air goes beyond expectation. So much life, colour and joy. We join in by shooting and wetting bystanders and locals on the streets. No one is spared. Small enclosures surround the Silom streets, packed with people dancing to Beyoncé and Thai pop songs. Go-go girls dance as water and foam are shot from seriously large pipes onto the merry streets, making it a surreal experience; freezing water hits you without warning. Strangers walk past you and rub talcum powder (paste) on your faces and hands. It is considered a good luck gesture.

  “Rebecca, duck!” I say, trying to alert her and protecting our asset.

  Everyone is having fun and these friendly water fights and street parties remind me of a time in my childhood when I used to have water fights with my cousins.

  When I glance at my watch, I see it is slightly after 4pm. None of us had noticed the time. Standing in the middle of Silom, drenched, we decide to head to the hotel for a rest before dinner. As there are no taxis, we finally resort to a tuk tuk, despite having been cautioned against it. The ride is a testy and frustrating journey. Apart from the tra
ffic, we endure gallons and gallons of water sprayed from the streets. Twenty minutes in the Bangkok traffic is no easy task, especially with water thrown constantly at you. We put it down to an experience of a lifetime and are thankful to arrive at the hotel in one piece.

  In two days’ time, I think, Jayson arrives. I count the hours to his arrival.

  The following day, our routine is thrown out the window. It is the day we inject Rebecca with her first dose of Folitropin, the first of many she will endure during the two weeks’ treatment.

  We gather around the table after having washed our hands. I ready the necessary clinical tools, i.e. the swab, syringe, needle and two small glass cylinders containing both types of medication. Esther extracts the contents of the cylinders into the syringe, stopping at various intervals to ensure there are no bubbles visible. If bubbles are present, it means there is trapped air in the syringe and it has to be removed by flicking the syringe lightly and gently till it dissipates.

  When the needle is full, Simon rubs the swab on Rebecca’s stomach before checking with us that it is the right area. We all nod in approval. Then Esther holds the needle. She is shaking slightly, slightly nervous but trying to stay calm. Finally, after another nod of approval from us all, she injects the needle into the abdomen and releases the medication into a flinching Rebecca. We all clap to applaud our joint achievement.

  The mother bird on the verandah has laid three eggs at the same time, a gracious omen we all smiled for.

  The next day, Jayson lands. I ask my new friend and driver Rim to accompany me to the airport. I met Rim on one of the taxi trips from Siam Square to the apartment. He gave me his mobile number, offering to personally chauffeur us to and from any places of interest. I took a liking to the devout young Buddhist gentleman, barely twenty-five and himself the father of several children.

  Rim drives me to the airport to pick up Jayson and along the way we engage in a long conversation. He speaks broken English but with sign language we manage to understand each other. He keeps prying into my personal life and soon realises that Rebecca isn’t my wife. He asks why a successful 40-year-old man like me was single without a family and children. I hadn’t made it clear to him about my sexuality and had no intentions in doing so. Pressed, I reveal I was in Thailand to become a father.

  I explain the intricacies of the treatment and the engagement of surrogacy to him. Rim is shocked at first, not realising that such a treatment could even exist, especially in his own country. After explaining to him in detail, he warms to the idea before offering chauffeur services for the surrogate to and from her medical appointments.

  Jayson exits the gate promptly at 4pm. I am thrilled to see him. We hug and exchange kisses, which causes Rim further confusion.

  We brief Jayson on the entire situation, especially about Rebecca starting her first dose of Folitropin. He laughs when we tell him about the water festivities.

  “I am sorry I missed it,” he says.

  That night at dinner, our second meal at Baan Khanitha, Rebecca becomes nauseated, trembling and feeling feverish with flu-like symptoms. Simon leaves dinner to take her home. Jayson and I are worried she is having an adverse reaction to the injections she had started the day before.

  Esther, our problem solver in any crisis, insists we take her to Bangkok National Hospital’s emergency department. Rebecca feels the opposite. I decide to ring Kay, trying hard not to panic. She suggests Rebecca may have caught a chill from the spray of icy cold water at Songkran.

  Back at the apartment, we circle the room.

  “Jayson, what should we do?” I ask him, very concerned about the situation.

  We google the side effects of Folitropin and read it is likely to cause some nausea and fever. Esther rings her pharmacist husband Paul in Sydney, who states the same, recommends monitoring her progress, and tells us not to worry unless her condition deteriorates. We take turns all night watching over her. We are so protective of her.

  Thankfully, she wakes the next day feeling better. We breathe a sigh of relief.

  We arrive at the Lumpini clinic at 11am. Jayson is both nervous and curious to meet the medical team. Today, he will undergo some blood tests to ensure he has no sexually transmitted diseases or anything that may have an adverse effect on the process. Rebecca will have a follow-up examination to determine the stage of her follicles: to track their size, quantity and the rate they are growing.

  Rebecca sits on the gynaecology table for the transvaginal ultrasound. This time Dr Pisit counts the follicles as Spurm scribbles away on our file. The follicles are a group of cells. They hover around Rebecca’s ovary like fish in water on the 3D screen. Interesting discovery, I have learned they will progressively grow to single mature eggs in days. I learn something new today, the wonder of modern science.

  The report is satisfactory. She is progressing well and nine follicles have been detected, each averaging the size of four millimetres. In order for the follicle to be considered a reasonable size for IVF purposes, it has to be thirteen millimetres or more in size. We have nine follicles growing steadily now. Good start, I think.

  Spurm gives Rebecca a blood test to measure her LH (luteinizing hormone) level. The blood test indicates any underlying problems in the significant hormone. The hormone, I believe, will stimulate the nine follicles, causing them to grow steadily. More follicles will also pop up in days to come. Another valuable lesson on women’s anatomy – today has been full of it, like a crash course on the birth gender.

  Jayson is waiting patiently for his “trial wash”, a test to check if he has enough healthy sperm. He also has to do some blood tests. In a spare moment, I approach Dr Pisit’s office to speak privately.

  “Jayson has had previous surgery for testicular cancer and I have read this can cause infertility,” I tell him. I had asked Jayson at that time if he wanted to freeze his sperm for use at a later date but we didn’t pursue the opportunity then.

  I ask Dr Pisit if this will affect or reduce our chance of conception. I can’t help but worry that it will.

  He keeps silent, thinking carefully.

  “Is his sperm likely to be sterile?” I press further. “I worry, because if this is the case, the use of my grain could not be Plan B. This is due to the blood lineage of Rebecca and me,” I add.

  “We have to test the sperm,” he says. “Step two of the IVF process is preparing the semen. We need one single good sperm from Jayson to inject directly into Rebecca’s mature egg in the laboratory. In simpler terms, his sperm does not need to swim up the fallopian tube to fertilise the target egg. Our process is fast-tracked and its travel route is shortened. Depending on the results, we will prepare the sperm for the process of insemination and the preparation method used for this purpose is called the density gradient preparation. This is the weak sperm’s saving grace, a method to spin the best out of the worst of sperms.”

  I am getting more relaxed listening to him. But the fear of dud sperms still lingers at the back of my mind.

  “If we choose to freeze Jayson’s sperm, the process is called cryopreservation, and the storage process is called cryogenic storage. Mr Elias, many former testicular cancer patients have fathered children. We must be hopeful in Jayson’s case because one of his testes would still work and is probably enough to do the job. After all, we only need a few good sperm and it is likely that we will find them from the millions we get.”

  I am still fretting. We have come all this way and the last thing we need are dud sperms.

  Jayson proceeds to the “Ejaculate Room”. We are smiling, giving him the thumbs up as he walks in. He has refrained from any ejaculation for more than a week and is probably looking forward to some relief.

  The famous room at All IVF is located at the back of the clinic, visible enough to the entire waiting room of patients. It is a tiny little corner room, just space enough to equip a flat screen TV, small sofa, some comfortable cushions, a stack of magazines and a little black box that stores pornographi
c films.

  The room we named the “Ejaculate Room” is where intended fathers go to ejaculate semen for conception. The clinic calls it the “Depository Room”. You can’t help but notice men go in and out discreetly like they are entering a sex-on-premises venue. Most try to be as straight-faced as possible and quietly inconspicuous before entering the prominent space.

  I find it amusing to watch the men – some inside much longer than others, I notice as I cheekily time the arrival and departure of several subjects. Most take an even six to eight minutes, due to their abstinence from any form of ejaculation for a one-week period to ensure the finest grade of deposit. This perplexing task is harder if you are gay, as there is only straight porn in the room to assist with the process.

  Before you enter, a jar is given to you and you are only allowed in one at a time. I am told politely not to enter with Jayson. This is due to the clinic’s fear of sexual intercourse occurring between subjects which could lead to the sperms mixing. Therefore the clinic’s rules are that this is a mandatory solo act. You have no choice but to brave the room as curious onlookers stare and time your highly anticipated visit.

  Once you successfully transfer the sperm into the tiny five-millilitre jar, the size of the apparatus so small you had better be a good aimer, you are to leave the jar and its contents in a small black box inside the room, then casually exit before a nurse discreetly makes her way into the room to empty the cupboard and take the jar into the laboratory to either freeze or use immediately.

  This is an experience Jayson will never forget, one to tell our child when he is old enough to understand the ethics of his conception. When Jayson finishes the tests, we leave for the luxurious new Bangkok Hotel for a facial and massage. After the two-hour long treatment, I quickly check my emails using the hotel’s Wi-Fi and read the following from Dr Pisit.