With Love From Cape Town

‘Annette is coming in for her seven-week scan this morning,’ Sally announced. ‘Keep your fingers crossed, everyone.’ The mood in the room turned sombre.

‘This is Annette’s third attempt,’ Catriona explained to Robina. ‘The first time the embryos didn’t implant, the second time, she had a positive pregnancy test, but her seven-week scan, the one we do to determine whether the pregnancy is ongoing, showed no evidence of a heartbeat. As you can imagine, she was distraught. She and her husband have agreed that this will be their last attempt—she was thrilled when this most recent pregnancy test was positive—but they are naturally extremely anxious. I think she might be one of the women who said they’d be happy to talk to you.’

‘Who’s doing the scan?’ Niall asked.

‘I am,’ replied Sally. ‘I looked after her through her other treatments.’ She chewed on her lower lip. ‘I don’t know how she’ll cope if we don’t find a heartbeat. And I will hate being the one that has to tell her.’

‘Let’s just wait and see,’ Catriona said soothingly. ‘There’s no point in getting ahead of ourselves.’

‘I have a patient I’d like to discuss,’ Niall said. ‘It is a difficult case and I’d like to know how everybody feels—particularly the embryologists—before I see this lady.’

Everyone turned curious eyes on Niall.

‘I have been approached by a woman who wants us to carry out PGD—pre-implantation genetic diagnosis,’ he said to Robina, for the benefit of the camera. ‘She has a family history of breast cancer in the family and all the female relatives in her family have either died or have had the disease. As a precaution, she decided to have a prophylactic double mastectomy when she was eighteen, after genetic testing showed that she carried the variant BRCA1 gene.’

There was a sharp intake of breath followed by a murmur of sympathy from around the room.

‘Now that Isabel has joined us…’ he smiled at the curly-haired embryologist sitting on his right ‘…we are in a position to offer this service. But I want to know how everyone feels about it.’

‘Could you explain what it involves, Niall?’ Robina asked, knowing that this was exactly the kind of thing her viewers would be interested in. She only had a vague memory from researching her book of what the procedure involved and progress in this area was rapid.

‘I’ll let Isabel explain, as she’s the one who’d be doing the procedure.’

‘I’ll try and make it as simple as possible.’ Isabel took a sip of water. ‘We stimulate the ovaries, in the same way we do for our infertile ladies, and then fertilise the eggs in the lab. Once the eggs are fertilised they start dividing—one cell becomes two, two become four and so on. We wait until we have eight cells, then we remove one and test for the BRCA1 gene. If it’s positive, we move on to the next embryo and so on until we find one that doesn’t carry the gene. When we do, that is the embryo we replace.’

‘Don’t some people think this is too close to eugenics?’ Robina asked. ‘As in designer babies?’

‘Not at all,’ Niall interrupted quietly. ‘This isn’t selecting embryos based on hair colour or intelligence or anything like that. This is selection that will prevent someone almost certainly suffering from breast cancer later on in life.’

‘I know some people find it distasteful,’ Isabel continued, ‘but the truth of the matter is that we select embryos anyway to put back.’

Robina was puzzled. ‘What do you mean?’

‘We add sperm to all the eggs we retrieve. Say we have fourteen. Out of those, sometimes only a proportion will fertilise. We study the ones that are under the microscope and grade them according to specific, recognised criteria. We select the ones with the best grades, and choose one from these to replace. So in a way we are already selecting. PGD only takes it a step further.’

Robina was fascinated and knew viewers would be too. Some might find it controversial, but she had never shied away from controversy. She would present both sides of the argument and leave people to make up their own minds.

‘Isn’t destroying perfectly healthy embryos wrong?’

‘Sometimes we freeze the leftover embryos—the ones that are of good quality, that is—in case the women want further treatment. If they don’t, then yes, we dispose of the remainder,’ Isabel continued, her face animated. It was clearly a subject that was close to her heart. ‘In many ways it’s no different to what happens in normal pregnancies. The ovary starts to produce several eggs, but there is always one dominant egg which then releases a hormone that stops the other competing eggs from developing further. In a way we are simply replicating nature.’

‘The issue I have is more of a scientific rather than a moral one,’ Niall said. ‘Not for this gene, which would be present in every cell of the embryo, but when we are testing for other genetic conditions, for example Down’s syndrome, there is the risk that out of the eight cells, we test the one cell that doesn’t carry the genetic abnormality and are led to falsely believe that the embryo is free of the condition. It is important that anyone considering PGD understands this.’

‘She wouldn’t be considering it if she weren’t desperate,’ Mairi interjected. ‘And she’s already shown how serious she is by having a double mastectomy. I’m not surprised she doesn’t want her daughter to go through the same thing.’

Robina leaned back as lively discussion broke out around the table. She wondered how it felt to have to make these kinds of decisions on a daily basis, knowing you held people’s dreams in the palm of your hand. Her heart went out to all the couples. The people in this room had such power over their lives. How could so many women bear to put themselves through so much potential disappointment and heartache? She knew she couldn’t put herself through it again. Never, ever. She had thought she would never get over the pain of losing one baby. How could she possibly risk doing it all over again?

‘Let’s take a vote,’ Niall said. ‘Everyone in favour of my seeing this lady, remembering I intend to make sure she understands the pros and cons before we proceed, raise their hands.’

It seemed that everyone was in agreement.

‘Let’s move on then,’ Niall said, but before he could continue, the receptionist popped her head around the door.

‘Annette has arrived for her scan, Sally. I’ve made her a coffee, but I don’t want to keep her waiting—she looks terrified.’

Sally stood. ‘Are you coming?’ she asked Robina, who immediately got to her feet. ‘Keep your fingers crossed, everyone,’ she added over her shoulder as Robina and her cameraman, John, followed her out of the room.

Sally showed Annette and her husband into one of the consulting rooms and then left them with Robina and John while she went to set up the scan.

Annette was pale and held on to her husband Mike’s hand as if for dear life.

Robina asked the nervous couple if they were sure they were happy to be filmed. ‘You can still change your mind,’ she told them gently.

‘No, we said we’d do it and we will.’ Annette raised her chin. ‘We want people to know what it’s like to go through IVF.’

Robina nodded to John, who focussed the camera on Annette.

‘Only people who have been through this know what it’s like.’ Annette’s voice was so soft, Robina had to strain to catch her words.

‘At first, every month you hope that this will be the month, but you tell yourself not to get too excited, but you can’t help yourself. You just want it so much. And then, when it doesn’t happen, it’s like a dark cloud descending on top of you. So you ask yourself, why me? What is wrong with me? And then eventually you realise that you have to seek help, because it’s not going to happen on its own—no matter how much you want it to. Suddenly, you can’t bear seeing babies. Sometimes you’ll cross the street so you don’t have to look at them, and you even avoid friends and relatives who are pregnant or have young children—even though you know it’s wrong and selfish.’

She took a shaky breath. Robina wanted to reach out and put her arm around Annette’s shoulders and tell her she knew how she felt, but she forced herself to stay still and let her have her say.

‘People tell you to relax, that it will be all right, that there is always adoption, and yes, for some people adoption is the right thing. But although they mean well they just don’t know how much it hurts not being able to have children of your own.’

She paused for a moment, her eyes welling up with tears. ‘And then, when you decide to go for IVF, you think that this is it. That soon you’ll be pregnant. Oh, you know the treatment might be unpleasant, but you don’t care. And they tell you it might not work, but you’re not really listening, cos you have hope again. So you do everything you are told, and loads of other stuff that you read about on the internet and in magazines—just in case. You go through the injections, do the diets, try the alternative treatments—put up with the hormones making you a little crazy, because you just know that soon you’ll be holding a baby in your arms, and you’ll do anything to have that feeling. Then when the drugs work, and they take you to Theatre, the hope is almost painful. So you have your eggs collected, but you have to wait again to see if they fertilise, and if they do, and one or two are replaced, you have to wait again to see if they implant. And even if you know there is still a chance you won’t fall pregnant, you go out and buy the cot, and start to think of names. And it’s the longest two weeks of your life as you wait. You are almost too scared to do anything, even though you know it won’t make a difference, and every twinge and niggly pain terrifies you. Then, at last, it’s pregnancy test day. And you tell yourself you must be pregnant because you couldn’t bear it if you are not.’

Annette took another deep breath. ‘But if you are like me, then the first time the test was negative, and I couldn’t believe it. I was devastated. But Mike wouldn’t let me give up, so we tried again. And this time the test was positive. We were so excited, even though Sally warned us it was only the beginning.’

She paused as Sally re-entered the room. ‘We didn’t listen, did we? We told everyone and they were so happy for us. But something didn’t feel right. I tried to tell myself I was imagining things, but I wasn’t. This time we got as far as the seven-week scan—like the one we are having today. But there was no heartbeat. We had lost our baby.’

Robina swallowed the lump in her throat. She also recognised the terrible feeling of loss; even though her baby had been no more than a few centimetres in length. A baby was no less mourned because it was only a tiny embryo.

‘C’mon,’ Sally said gently. ‘Let’s get you scanned. I think you’ve waited long enough for this moment.’

A few minutes later, Annette lay on the bed looking even paler and on the verge of tears. She’s expecting bad news, Robina thought. It’s written all over her face. Or at least she’s preparing herself for the worst.

The room was deathly silent as Sally ran her probe over Annette’s abdomen. Annette clutched Mike’s hand as if he were a life-raft and if she let go, she would drown.

But a few minutes later a huge smile spread across Sally’s face. ‘A clear, strong heartbeat.’ She swivelled the monitor so the couple could see. ‘See just there.’

Robina craned her neck to see where she was pointing and, sure enough, the steady movement of a heartbeat flickered on the screen.

‘Are you sure?’ Annette whispered.

‘One hundred per cent. You can relax, we’ve got an ongoing pregnancy.’

Annette burst into gut-wrenching sobs and her husband gathered her into his arms. ‘I can’t believe it,’ Annette hiccupped once she had regained her composure. ‘We’re going to have a baby. Thank you, oh, thank you.’

‘Congratulations,’ Robina said. ‘I’m so happy for you both.’ With a bit of luck, in a few months’ time this couple would be holding a much longed-for baby in their arms. Robina’s throat tightened and she knew that tears weren’t far away. Annette’s story had brought too many painful memories flooding back.

Leaving the ecstatic couple with Sally, Robina found the staff in Reception gathered around a woman who was proudly showing off a baby, who, judging by its size, was somewhere around two to three months old.

‘Isn’t he just gorgeous?’ Linda was saying. She noticed Robina. ‘Dr Zondi, come meet our latest arrival, little Matthew.’

She held out the baby and, before Robina could protest, handed her the tiny bundle as everyone looked on. For a second Robina’s heart froze. She hadn’t seen, much less held, a baby since her miscarriage. Now she had no choice but to accept the infant.

John was filming, his camera trained on her face. He was one of the few people who knew about the miscarriage, but the thought probably hadn’t entered his male head that she would find cuddling a baby difficult. She forced herself to look down at the tiny bundle she held in her arms. His eyes were closed, and impossibly long lashes fanned plump cheeks. She inhaled the baby smell of him and the numbness in her throat spread into her chest, making her feel as if she could hardly breathe. If her baby had lived, she would be due about now. Don’t let me cry, she thought. Don’t let anyone speak to me, cos there is no way I could force any words past my throat.

She glanced up and over the heads of the nursing staff and saw Niall watching her intently. Without a word, he crossed the room and gently took the baby from her arms.

‘Ah, let me see,’ he said, holding the baby as if he’d had years of practice, which, of course, he had. ‘What a fine-looking lad. You must be very proud of him.’

Robina backed away as Niall diverted attention away from her. She was shaking and desperately needed some time on her own to compose herself. Mumbling something about the Ladies’ to no one in particular, she walked as steadily as she could, on legs that had turned to mush, towards the bathroom.

Inside, she slumped to the floor and laid her head on her knees, taking deep, gulping breaths. Her hands were still shaking and she could feel the pressure of tears behind her eyes. It should be her, holding her baby. She caught her breath as a fresh wave of grief washed over her. She couldn’t break down, not here. She needed to regain her composure before she went back out. Maybe Niall was right and she should never have agreed to this programme. She was still too raw, too vulnerable. Thank God, he had seen how close she had been back there to losing it, and had rescued her. How on earth was she going to manage weeks of this? Especially if every time she saw a baby, she thought she would disappear inside herself from the pain of it?

But it was too late for second thoughts. She had made a commitment and she never backed out of anything, regardless of the personal cost. Somehow, although she didn’t know how, she would have to lock her feelings back down, deep inside. It was the only way she could continue. She had done it before, and she could do it again. Couldn’t she?

Chapter Four

NIALL sat across the desk from Mr and Mrs Thomas trying, but not quite succeeding, to ignore the cameras. After studying the financial projections, he had been forced to agree with Lucinda. The clinic needed to attract extra funding. So he had agreed to the documentary, but it didn’t mean he had to like it. And to add to his discomfort, Real Life Productions had insisted that Niall, given his international reputation, be the one to appear on camera. Mark, the third doctor, and Elaine had made no secret of their relief that they wouldn’t have to.

‘You’re used to appearing in public,’ they had teased. ‘God knows, your picture has appeared in the press often enough recently.’

They were right, but only because the press wanted pictures of Dr Zondi and her husband, out together and still very much in love. The press hadn’t a clue, Niall thought bitterly, and it was just as well. The thought of having his personal life discussed in the papers made him squirm.

Robina had chosen an unobtrusive spot, just to the left of his patients. She was looking drawn, Niall thought with a stab of anxiety. Holding that baby had hurt—she had put her professional face back on, but the way she was nibbling her lip told him she was struggling to hold it together. Damn it! He should never have agreed to this project. Never mind about the finances of the unit, they would manage somehow—but would Robina? He didn’t care what she had said about being able to cope—she was more affected than she’d imagined she’d be. But the woman was stubborn. He knew that to his cost. He dragged his thoughts away from his wife, concentrating on the anxious man and woman in front of him.

Mrs Thomas, Eilidh, was 38, and her husband already had a child by a previous marriage. Either of these reasons on their own made them ineligible for NHS treatment.

‘We only met a year ago,’ Eilidh was saying with a fond look at her husband Jim. ‘I had more or less given up on meeting the man of my dreams. Then he walked into the room and, bam—just like that. We fell in love.’

Niall couldn’t stop himself from sliding another glance at his wife. He knew exactly what Eilidh was talking about.

But if the same thought occurred to Robina there was no sign of it. In the last few moments she seemed to have managed to get her emotions under control. Cool, calm Dr Zondi was back, and she was concentrating intently on what Eilidh was saying.

‘We started trying for a family…when was it, love?’ Eilidh turned to Jim for confirmation. ‘About six months ago. I know it isn’t long, but my GP thought that, given my age, we shouldn’t wait before we sought expert advice. So here we are.’

She’s anxious, Niall thought as Eilidh chewed on her thumbnail. But then again, almost everyone who ever sat in that chair was nervous. They came to him filled with their hopes and dreams, hoping that he’d be able to work some magic that would give them the child they so desperately longed for. And most of the time he did. But not always. However, he knew there was a good chance he could help the hopeful couple in front of him.

‘I have the results of your tests here,’ he said.

Eilidh gripped Jim’s hands and chewed more fiercely on the thumbnail of her free hand.

‘Bill’s sperm test is perfectly normal—that’s the good news. But the test we did for your ovarian reserve, Eilidh, shows that, as we’d expect from someone your age, your fertility is declining.’ Niall kept his voice matter-of-fact.

‘What does that mean?’ Eilidh asked. Her pale face lightened another shade.

‘It means that you are unlikely to conceive naturally, but are a good candidate for IVF,’ Niall explained.

Eilidh sank back in her chair and smiled with relief. ‘Thank God,’ she murmured. ‘I was terrified you were going to tell us it was hopeless. That getting pregnant was impossible for me.’

‘It doesn’t mean I can promise you a pregnancy,’ Niall continued. ‘Sometimes, no matter what we do, women still fail to conceive. And sometimes they conceive but are unable to carry the pregnancy to term. I don’t want to paint a negative picture, but you should be prepared.’

But Niall suspected even as he said the words that Eilidh and Jim weren’t really listening. Like so many couples, they couldn’t bring themselves to think about the possibility of failure. ‘That’s why,’ he added, ‘we suggest you make an appointment with our counsellor. You don’t have to see her but I would recommend it. She’s excellent and is there should you need to talk to someone neutral at any time through this process.’

Niall couldn’t prevent another glance at Robina. Sure enough, her eyes had widened in surprise. When they had first started experiencing problems in their marriage, she had suggested a counsellor. But he had refused. The thought of airing their dirty linen to a stranger was just too much. If she had truly loved him, they should have been able to sort things out themselves. Now he wondered if he should have agreed.

He took the couple through the process; how the clinic would take control of Eilidh’s cycle and give her drugs which she would need to inject every day for roughly ten days. In addition, Eilidh would have to come in for regular scans of her ovaries as well as blood tests.

He went on to describe the side effects of the drugs and didn’t mince his words when he explained the more unpleasant aspects of the treatment.

‘Are you sure you want to put yourself through this, love?’ Jim asked his wife. ‘I didn’t think it would be so…awful for you.’

Eilidh looked her husband straight in the eye. ‘What does it matter if we get a baby at the end? I’ll be all right. I can do anything as long as I have you!’

They smiled at each other and Niall felt a flash of envy. If only he and Robina could share their troubles in the same way.

‘Once your ovaries are producing enough follicles and are at the right stage,’ he continued, ‘we take you to Theatre and you’ll be given a sedative. We remove as many eggs as we can from your follicles and then we will use Jim’s sperm to fertilise them in the lab. At that point the fertilised eggs become embryos. Depending on how many fertilise, we will make a decision on when to put one, or two, back. Either day two, three or day five. Are you following me so far?’

Eilidh and Jim nodded mutely.

‘How do you decide whether to replace one or two embryos?’ Jim asked.

‘Essentially it’s up to you. The HFEA, the UK regulatory body for fertility clinics, recommends that only one embryo is replaced at a time. That’s because twin pregnancies carry a greater risk of complications. However, the chances are smaller of one embryo implanting successfully. We’ll go over it again when we get closer to that time but, as I said, the final decision will be yours.’

Jim and Eilidh nodded sombrely. ‘I think we’d like to know more before we decide how many embryos to have put back,’ Jim answered for them both.

‘Good decision. It’s a lot to absorb in one go,’ Niall said gently, ‘but you’ll be seeing one of our specialist nurses on a regular basis. They will be only too happy to answer any questions you may have as we go along, and they have stacks of literature that you can take away with you. Does that sound okay?’

‘Does it hurt—I mean the bit where you take the eggs?’ Eilidh asked.

‘It can be uncomfortable,’ Niall admitted. ‘That’s why we sedate you. But, I can promise you, you won’t remember a thing about it afterwards. You might be a little sore for a couple of hours, but we’ll give you something for the pain.’

He spent a few more minutes going over the same ground with the excited couple before he called in Mairi, who would be co-ordinating their treatment.

‘Mairi will answer any other questions you might have,’ Niall assured the couple, ‘but if you ever want to speak to me, you have my number.’

‘Thank you, Dr Ferguson.’ Eilidh was beaming and two bright spots of colour stained her cheeks. ‘I know there’s a chance treatment won’t work, but you have given us hope. That’s all we can ask for.’

When the couple had accompanied Mairi from the room, John made to follow, but Robina stopped him. ‘We’ll pick them up later through their treatment,’ she said, ‘but in the meantime, let’s give them some privacy.’

When John left the room in search of some coffee, Robina turned to Niall. ‘Thank you,’ she said quietly, ‘you kept everything very simple. I’m sure our viewers will appreciate that.’

Niall smiled wryly. ‘It’s the way I speak to all my patients,’ he said slowly. ‘My God, woman, don’t you know me at all?’

And there was the rub. She didn’t really know him or, for that matter, he her. Niall had always thought they would have the rest of their lives and had looked forward to years and years of learning about the complicated, complex woman who had agreed to become his wife. Instead, he thought bitterly, it had all started to go wrong almost as soon as they’d married. Truth was, things hadn’t being going well even before the miscarriage. He had been so busy at work, and Robina’s new career in the media had taken off like a bullet. At first he had shared her excitement about the job, even though it had meant postponing the honeymoon, which had somehow become permanently postponed.