The private hell of failed IVF: a review of Julia Leigh’s ‘Avalanche’

avalancheJulia Leigh is a novelist and film-maker from Australia who has written an exquisite gem of a memoir of going through unsuccessful fertility treatments, to be published in the UK on 6th October 2016 by Faber & Faber.

Avalanche: A Love Story is a short, compelling read and has stayed firmly (and sometimes unsettlingly) in my mind since I read it a week ago. It has caused a storm of protest over at the New York Times where an author I respected for her honesty about the difficulties of motherhood, Rachel Cusk, hauled Leigh over the coals in much the same excruciating and traumatising way she herself experienced upon the publication of A Life’s Work in 1997. In doing so, she mirrors the experience that many of us childless women know all too well: the trivialisation of our personal tragedy.

As someone who has been at the forefront of being honest about the emotional and social devastation of childlessness for several years now, I’ve a great deal of experience of how very unwelcome raw honesty about childlessness can be for those who’ve never experienced it and don’t wish to acknowledge the pain it can cause. For those with the luxury of denial:

“I didn’t want to tell people because I thought that unless they were involved in that world themselves they wouldn’t want to listen. Or they would only half listen and so diminish my experience. Or they would ask questions that required explanations too complex for conversation. Or they would offer advice based on hearsay and a general theory of positivity. Or I would make them uncomfortable because of my proximity to the abyss. Hush, keep your voice down, don’t mention it by name.” (Leigh: 101)

I consider myself to be in my seventh year of recovery from childlessness, dating it from the day that I acknowledged that I would never be a biological or adoptive mother. I was forty-four and a half and that day will be one that I predict will flash across my timeline when I die. Because it was a kind of death; the death of fifteen years of dreaming, hoping, planning, praying and trying to become a mother. And it was the death not only of having a baby, but of having a family, of having a chance to heal the wounds of my own childhood by doing it differently with ‘my’ children. It meant the end of ever becoming part of the community of mothers that my friends belonged to, and in the bleak future I envisaged, it meant no grandchildren, no-one to be my advocate in old age, no-one to visit my grave and the end of my genetic line. For those who think that you ‘can’t grieve something you never had’ I’d like to offer them this on a plate and see how easy they find it to digest…  In fact, without the grieving process to guide us through this wasteland, I have no idea how any of us childless-not-by-choice women would ever get to the other side and find a way to navigate the rest of our lives in a society that finds childless and childfree women abnormal, sad, selfish and somehow ‘not real’ women.

As someone who hasn’t personally experienced fertility treatments but who has supported thousands of women who, like Leigh, have come out the other end of this ordeal without a baby, Avalanche gave me a visceral, first hand account of what it’s like to deal with the process on a practical as well as an emotional level. For example, I knew about the regular self-injections, and have seen photos of it, but it wasn’t until I read Leigh’s account that I could imagine it for myself:

“The advice was to do injections at around the same time each night so I chose 10 p.m. because that way I wouldn’t have to cancel too many evening engagements. Even then, I did have to duck out of dinners early, make excuses. Thankfully, the Gonal-f injection wasn’t too bad. Because it didn’t involve piercing the vein, taking blood from veins, I convinced myself I could manage it. The delivery mechanism was efficient. I swabbed myself with disinfectant, dialled up the amount of hormone on a pen, unwrapped a needle tip from its packaging and screwed it into the pen, then picked a spot on my belly, about two inches below the belly button, either to the right or the left. I laid everything out before me as if I were a surgeon about to undertake a major operation. There was a moment when I had to overcome an instinctive aversion to injecting myself, a bit like the moment I face every time I get into the swimming pool.” (Leigh: 56-7)

It is precisely this level of detail that makes Avalanche so compelling, so feverishly solipsistic. For women gripped by babymania, whether they are actively involved in fertility treatments or not, it is a state of mind we know all too well. In the very first blog I published for Gateway Women in 2011, I named it ‘the tunnel’: a state of mind where every experience, every decision, is mediated through the unrequited lust for a baby, for a family. And yet is precisely this claustrophobic experience that Cusk, in her front page (!) review fails to understand as the genius of this novel, rather than an example of Leigh’s prose ‘faltering’. Cusk claims that the novel is ‘overwhelmed by numbers, data, Kafkaesque interpretations of statistics, invasive medical procedures undergone in a fever of superstition or increasingly untenable hope.’ To me, as the sealed vault of many thousands of similar tales of physical, emotional, financial and spiritual bankruptcy, it has the unmistakable and nightmarish ring of veracity.

When I was first approached to review this novel, I researched Leigh to see if I could find out more about her book before I agreed; I needed to check that it didn’t end, as the vast majority of articles and books on this subject do, with some kind of ‘miracle baby’. And it doesn’t. Instead the ending tip-toes into the territory that I, and many others, have reluctantly been forced to explore – what happens after. In a culture where evil or nasty female characters in films or fairy stories are always childless, and where childless female politicians are viewed with a mixture of pity and suspicion, this is a task that little can prepare you for:

“Soon after I stopped I was haunted by the IVF. All the Googling I’d done about pregnancy-related topics came back in the form of advertisements for things like Clearblue pregnancy detectors or maternity clothes. I took care not to expose myself to painful situation and made a mental note to avoid grocery shopping at 3:30pm, which was also school pickup time when the streets were running with kids. I expect I’ll need to manage the terrain in this way for quite some time. Most of the baby things I’d collected I gave away. There were moments when I wanted to pick up my coffee cup and hurl it against the wall…” (Leigh: 131)

Leigh’s book captures the nightmarish reality of going through IVF treatments, whether you are lucky enough to ‘take home a baby’ as the fertility industry puts it, or not. It also, for me, as a British woman, makes me realise how much worse the experience is for those women who live in countries such as Australia and the USA where it remains unregulated. Many times in the book, Leigh is offered procedures that are fresh from the lab, barely tested, and asked to make her own judgment on whether to add them to her treatment regime. I was shocked, appalled and saddened by her experience at the hands of the medical profession. ‘Do no harm’ seemed to have been replaced by ‘on your own head be it’. By the end of the novel, she reports that her ‘health was a ruin’ (Leigh: 131) and I was not at all surprised, as I know of many women struggling with inexplicable health conditions post-IVF that the fertility industry has yet to acknowledge. We are a generation of lab rats.

As the novel closes, Leigh signals as her new destination, ‘a commitment to love widely and intensely. Tenderly. In ways that I would not have previously expected. I to You; I to We; I to This. To unshackle my love from the great love I wanted to give to my own child.’ (Leigh: 133).

It is an ending that makes me much more hopeful that any number of ‘miracle baby stories’, because in the end, the world cannot but benefit from such courageous love. And it needs it, badly.

Avalanche, by Julia Leigh is published by Faber & Faber in the UK on 6th October, 2016.
Click here to pre-order.

This review is part of the Avalanche blog tour, organised by Pamela Tsigdinos of Silent Sorority. To read more reviews by other infertility / childlessness bloggers, check out some of the others below:

Jody Day is the Founder of Gateway Women, the global friendship and support network for childless women and the author of ‘Living the Life Unexpected: 12 Weeks to Your Plan B for a Meaningful and Fulfilling Future Without Children’ (2016, Bluebird/PanMacmillan). 

28 Comments on The private hell of failed IVF: a review of Julia Leigh’s ‘Avalanche’

  1. I have also felt, and maybe wrongly so, that if I had any other ‘disability’ would others be so quick to be so critical. We are taught at a young age (some of us then) to have compassion for those differently abled. Why does this seem to evaporate with infertility?

  2. Leigh seems to have put into words every idea and thought that I had myself when doing IVF, particularly about not wanting to tell people about it and all the reasons for that: to avoid their positive stories and pointless cheerleading when only I knew how bad the chances of success were; to avoid their questions when it was all too complicated and based on bad science; to avoid infecting people of childbearing age with my bad luck, “my proximity to the abyss”…. she is spot-on. Like Leigh, I did the daily injections and took the drugs, in a country where ART is not regulated and the major clinics in the capital like SIMS and Merrion, which I attended, never publish their live birth rates (big shout out to Ireland!). I did not perform them “in a fever of superstition or increasingly untenable hope”, thank you Rachel Cusk. I was uneasy about what they were doing to my body and pretty hopeless about whether they would work, but I did it in the way that you always take medicines that are prescribed to you for a condition (in my case, endometriosis). I was also more or less asked to make my own judgment on whether to add certain drugs to my treatment regime, or take them at all (e.g on whether ingesting large daily doses of estrogen might kill me as estrogen-dependent cancer had killed my mother at 39: “Hmm – your call: depends how much you want a baby, and we can get you one by Christmas”). I applaud Leigh for bringing out this book and I hope more of us will follow suit, in fact I feel my fingers itching right now….
    Fab review Jody.

  3. Hi Jody – Love this review!! I don’t know where I’d be without the grieving process either – that necessary, monster of a thing! But so easy to avert in this A) culture full of disdain for normal human emotions and B) with a life- altering loss that almost always goes unrecognized. It’s a wonder any of us notice it, never mind go through it.

    I too shuddered at Cusk’s entire review, most definitely when she “interprets” the middle/end of the book as ‘overwhelmed by numbers, data, Kafkaesque interpretations of statistics, invasive medical procedures undergone in a fever of superstition or increasingly untenable hope.’ It never ceases to amaze me that what I now perceive as normal most fertile people can’t even begin to imbibe. In a strange way, and I do not condone her review at all, Cusk’s clueless insensitivity only confirms the magnitude of our losses.

    So affirming to see the “emotional and social devastation of childlessness” in writing – thank you for that.

  4. I really enjoyed reading this post – I’m glad that Leigh’s writing about IVF is something that opened up the reality of going through the procedures and clinics. Your point about the regulation of the industry vs no regulation is well taken also. Here in the US, it is so dependent on the doctor/clinic. Some are more aggressive, some more cautious, some are ethical, some are skirting the boundaries and it can be tricky to suss out what’s what until you’re multiple thousands of dollars and/or months into the process.

    Love the ending of the post about courageous love and how it cannot help but make the world a better place. I hope that books like Leigh’s (and posts like this) will open that door to making such love more widely accepted, understood, and honored.

  5. Thanks for this review, Jody…sensitive, warm, and caring as you always are. I found Cusk’s review breathtakingly cold…in fact, “icy heartlessness” is the term that comes to mind. Cusk’s logic was hard to follow…what I heard her saying is that women need to have a little more respect for their own “destiny” –whatever that means, and realize that their willingness to go to the ends of the earth for their goal is not borne (!) out of love, but out of their own stupidity and ultimately their own selfishness. Cusk doesn’t admit that the only difference between the fertile and the infertile may be a tiny speck of luck and that the fertile may be driven by selfishness from the get-go. (But we’ll never see that, will we, because the fertile’s wish is satisfied, with no gritty struggle on display). I think Cusk may genuinely want to see nomos flourishing with a Plan B, but very few of us get there without struggle and grit. And struggle and grit are heroic in and of themselves (as in the statement I thought was the Olympic motto but isn’t: “not the triumph but the struggle.”)

    • Hi Dara – thanks for unravelling Cusk’s tortured argument – I couldn’t quite get there myself and when I approached it got to cross to continue any further! I agree that she totally fails to recognise that ‘selfishness’ is inherent in all drives towards parenthood, unless it is against your choice. Motherhood is full of ‘struggle and grit’ (as her own book shows), so why deny that experience to the infertile experience? Yeah, maybe becoming a parent is ‘stupid’ in some ways, but so is love, and so many other wonderful non-rational parts of the human experience! Julia Leigh’s book shares so much humanity and love and fearlessness in exposing the crazy mindset of a woman going through fertility treatments. If it had been about another medical condition, would Cusk have felt so willing to rip her to shreds?

  6. “We are a generation of lab rats.” Unsettling, but true. I think it was you, Jody, who first made me aware about how unique our generation is, being the first generation of women for whom having children was a true choice, and also for whom ARTs were widely available to assist conception. That’s a whole lot of change to absorb. Some of it has been good, yes, some of it not so good, and there have been a whole slew of unintended consequences we are only just beginning to think about.

  7. I love this post! Like you, I don’t have personal experience with fertility treatments, but I do have friends who went through it and I know what the fertility clinic tried to pressure us into doing, and at least on some level, I get it. (My last interaction with the fertility clinic may have involved me inviting them go go f*** themselves.) But that’s the beauty of this book; whether or not you went through fertility treatments, this book is relatable.

    • Hi BnB – thanks for your comment. I wish more women and couples felt empowered to say the same to their clinics. It seems trying to stop is hard, and for business reasons, they often don’t make it any easier…

  8. What a great line – ‘To unshackle my love from the great love I wanted to give to my own child.’ It is not just women who have been through IVF that this line will resonate with. It may ring true for anyone who is frustrated with the dominant position that nuclear families have in our society and our desire as childless women to be part of a community in which we can relate to children in a special way that is different from being a mother.
    As a slight aside – My current frustration is not having been able to get a ticket to see Yerma on the London stage – perhaps it is Gateway women who are filling the seats to a sell out situation! Am hoping that it goes from the Young Vic to the West end.

    • Hi Bronwen and thanks for commenting. I wish it had been GWs filling up seats at Yerma but I don’t know any of us who got in to see it apart from my niece, who went to a preview as she’s studying it at uni. I too hope it gets a transfer to the West End.

      I have achieved what Julia Leigh wishes to do; I have ‘unshackled my love’ and it feels mighty fine and I highly recommend it!

  9. I confess I’m scared to read this book (I’m also a ‘graduate’ of failed fertility treatment) but I’m going to- partly as solidarity but mostly because I know that in the end it will help me to keep working through the grief. Thanks to Gateway Women that I’ve got this far and can even contemplate picking it up! I’m grateful to Leigh and everyone who has the courage to talk about this… here goes….

  10. Great review. Having two failed IVF cycles behind me (I’m hoping to do a final try in a few months), I was able to relate to a lot. My clinic in Germany also offers lots of the unproven “extras”. At the IVF information night we were also advised to get all the extras since otherwise we would always wonder if it would have worked had we gotten x,y or z! If someone were to get all the add-ons it would cost around 2thousand euro extra.

    I also do feel like a guinea pig sometimes, that the doctor doesn’t really know and just suggests things “well we could try such and such next time”. It is such a huge money making business with little thought to the feelings of the people going through it. The IVF handbook at my clinic has loads of photos of pregnant women and happy couples on it, but a small sentence at the beginning saying that there is no guarantee that treatment will work and you should “prepare” yourself for that. I’ve no idea how someone can possibly do that. Prepare for it not working, yet spend so much time and money hoping for the dream…

    • Hi and thanks for commenting. I think the ‘sell’ that you might ‘regret’ not doing a certain unproven medical procedure is shocking!!! It is almost impossible, as you rightly add, to ‘prepare yourself for it not working’ – nothing can prepare you for it. But it is possible to recover from it if it doesn’t, if that time comes…. Wishing you LUCK (which is what a lot of IVF is down to). Hugs, Jody x

  11. I shall certainly be buying this book. We need so much more work on this topic, and so brave of the author to share her own personal journey. Such a shame NYT review was so condescending but then this just highlights the arrogance on this topic.

    • Hi Gillian – yes, the NYT review is a shocker and just shows what Brene Brown told me, ‘that infertility and childlessness are the number one area of human empathy failure’. Jody x

  12. I can only say thank GOODNESS she has written this book. For all the unrecognised and invisible trauma around this subject, the more brave souls who step forward and tell their stories, the better. I’m looking forward to reading it.

  13. I am in awe of your review and the expansiveness and complexity you cover in this post, Jody. Perhaps because I did do the rounds of endless needles, ultrasounds, hormones and surgeries that I locked away my own horror at what I was willing to endure.

    Your piece should be required reading to all who casually bat away the grief and immensity that we face when childless by circumstance. Further, it is in ‘seeing the book through your eyes’ that I realize just how much blame I have taken upon myself for not doing a better job of being my own patient advocate as I bumbled along in the unregulated fertility industry. I stupidly assumed that the doctors and clinics were there to ‘do no harm’ rather than to admit their own fallibility and lack of understanding about the intricacies of biology.

    In short, I am hopeful that in getting our stories into the greater discourse we will remove some of the stigma that comes with childlessness, the blame we place on women and men who didn’t ‘come away with a baby’ and create a new understanding of the very real grief that accompanies the ‘deaths’ that you write about so poignantly. Thank you for participating on the Avalanche blog book tour.

    • Hi Pamela – thank you for your comment – I am a bit stunned and very honoured that I could have given YOU any food for thought about YOUR own experience – and I’m happy that it was one that has perhaps allowed you to be more self-compassionate with yourself. Through my experience in taking part in Jessica Hepburn’s Fertility Fest in Birmingham/London (UK) this year, I got to meet a number of very high profile IVF industry people in the UK, including the Chairwoman of the HFEA and I was impressed by their commitment to both improving the clinical and emotional experience of British women going through fertility treatments. I am so very sad that this model (which isn’t perfect but tries so hard) isn’t something more widely followed around the world. Hugs, Jody x

  14. Dear Jody,
    What good and timely fortune to have stumbled upon your blog/website. No coincidence, I’m sure!
    You come across as a beautiful and courageous woman – and wow, what a community you’ve created! I’m looking forward to reading more..
    Blessings & thanks, Amit

  15. Hi Jody. I enjoyed this book, too, and you do a great job of reviewing it. It really made clear what happens with fertility processes. My issues are different from Julia Leigh’s, but I could sympathize. I will be recommending this book to my readers at Childless by Marriage.

    • Hi Maria – thank you for your comment. As we both know, sticking your head out about childlessness is not something our culture wants to hear about, so I really value the way you support me, and other women, who are doing so. Hugs, Jody x

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