Monday, March 31, 2014

Obsessing About Numbers

Dear Ellie,

You may not realize this, but as much as I love numbers and statistics, I have no natural aptitude for mathematics.  Still, it fascinates me nonetheless and when it comes to all things you, numbers have always brought me great comfort, even when the numbers weren't in our favor.  Back when your mother and I were trying to have you, I spent many late nights going over the numbers.  At every juncture, I calculated the odds of a successful pregnancy over some period of time or through some procedure.  Those odds became especially tense when we started our high tech in-vitro fertilization cycles.  Each cycle cost around $25,000 and gave us one shot at a 40 percent chance of pregnancy.  The first cycle was a success, and once your mother was pregnant, I recalculated the odds that we'd have a baby: 67 percent chance of successful birth without a miscarriage.  Unfortunately, a few weeks later, that other 33 percent chance reared its ugly head and we lost the pregnancy.  

Each setback on our journey made me cannier with numbers, and I searched for them everywhere.  I sat in the university library and dug up research documents.  I was pretty much the only man on fertility forums, patrolling for references to knowledge that might give us an advantage.  I wondered occasionally if I had some kind of unhealthy obsession.  Whether I would be better off just giving up and accepting life without you.  Some part of me felt deeply... pathetic... for wanting you so much.  

I started analyzing the various factors that would increase our odds.  Weight loss and exercise would up our chance of a successful IVF cycle and reduce the chance of miscarriage by 5 percent for our age group.  A high protein diet, an extra 5 percent.  Expensive medications and vitamins and extra high doses of folate would eek us out a few more points on the margins...  and so a year before the we embarked on the IVF cycle that gave you life, your mother and I transformed our lives to seize every advantage we could get.  

However, when we tried to extract eggs from your mother's ovaries, everything went wrong and all of those extra percentages that we fought so hard for came crashing down.  Her ovaries weren't stimulating.  We maxed out on every medication in the book and even resorted to human growth hormone that blistered your mother's skin upon injection.  We were supposed to get around 20 eggs.  We only acquired 3.  Suddenly, our odds of pregnancy collapsed to some tiny fraction of what it was before.  I felt like we'd wasted years of our life.  Usually, a successful IVF cycle requires numerous fertilized eggs because most of the eggs will never become an embryo and many embryos are of a quality that are too low to survive.  We fertilized all 3 eggs, not knowing whether any would last.  After a few days of maturing in a "petri dish," there was just one left.  There you were, one tiny gem, ready to beat the odds.  You were put back into your mother and the diagnostic numbers came back so low two weeks later that we weren't sure whether your mother would stay pregnant or not.  But she did.

I felt like the clock was reset.  We had advanced back to 67 percent, possibly higher due to all of our lifestyle changes.  Then there was the blood a few weeks later, on the day that Oliver the Friendly Eel died.  This was the first time we thought you were gone.  I remember sitting in the shower before our trip to the doctors office, going over the number in my head.  It was probably a miscarriage, but it could be something benign.  Was there, perhaps, a 10 percent chance that you were still alive?  When we arrived at the doctors office for the ultrasound, your mother's eyes popped open when the doctor said, "Well, its still there."  And indeed, there you were, alive and well, a little black spot on the ultrasound monitor.

When we at last heard your heartbeat for the first time, our odds of success went up to 90 percent.  When we reached halfway through the pregnancy, we kicked our feet back.  And why shouldn't we?  Now, there was a 98 percent chance that you would be born alive and healthy.  Our odds had never been better.  However, our strange relationship with statistics wasn't over, yet. 

Again, the blood came and your mother was in the hospital at 22 weeks of pregnancy.  Not only did we fall into that perilous 2 percent, you were born in that ghastly gray zone between viability and futility: born as a micro-preemie.  What is the likelihood of being born a micro-preemie?  About 1 in a 1000.

Suddenly, a whole new world of numbers emerged that we'd never expected.  On the surface, it appeared as though you had a 50/50 chance of survival.  I didn't like those odds, so I determined that you weren't a median 24 weeker.  You were a girl, after all, and that made you stronger.  Back to the university library I went.  Apparently, girls survived far, far better at your age group.  83 percent.  But there had to be more factors that gave you better odds.  Did all of our careful planning make a difference?  And you were so active.  Wasn't that a good sign?

But there was an even bigger number that concerned me.  The specter of disabilities.  The average 24 weeker had an 80 percent chance of mental disabilities of one kind or another.  Ouch.  But again, if look closer at the variables, you can determine where a micro-preemie sits on the bellcurve.  Risk factors that you may or may not accumulate.  Again, you were a girl.  This was good.  Boys were 3 times more likely to have neurodevelopmental impairment than girls so that moved you along the bellcurve in the right direction.  But this was just one variable among many.  When you were first born, there was a virtual minefield of potential risk factors that would substantially increase your risk of mental disabilities.  Any one of these mines you might step on.  Sepsis in your blood increased your chance of mental disability by about 2.5 times.  Severe brain bleeds, 3-4 times.  Necrotizing intestines, 3 times.  And there were many more factors: hypoxic episodes, low weight, small head circumference, and the list goes on and on.

As the weeks went by, you dodged one risk factor after another.  No brain bleeds.  No necrotizing intestines.  No sepsis.  No brain lesions.  So much could have, and should have, gone wrong.  But it didn't.

So now, where we sit now, looking at the stats,  I would say that your odds of having a "normal life" have never been higher.  The numbers have never given me more confidence that you'll be able to read these letters, one day.  

Still, after all that we've been through, I feel like its only a matter of time before some absurd and improbable thing swoops in and takes you away from us.  When you were born a micro-preemie, even though I was aware of the obscure odds that such a thing could happen, I wasn't surprised or in disbelief when it did.  I'd been expecting it, all along.  Hadn't it happened so many other times before?  

Your mother and I are ruthless empiricists.  There is nothing in our principles or beliefs that makes any room for superstitious thinking.  Still, with all that's happened, I feel like your mother and I are two people that have managed to spin fate when its comes to our struggle to start a family.  Or perhaps, that there is only so much happiness and harmony that can exist in any two lives before one's supply of good fortune is exhausted.  I wonder though, during these uncharacteristically superstitious moments of mine, whether the polarity of your good fortune was reversed upon your birth.  That somehow, you have changed the equation of our family's fate.  That you won't be a victim of the numbers any longer.       

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