After two years of trying, my husband Tom and I began to seriously consider reproductive technologies to conceive a second child.
“Do you think I could love another child as much as Mirabel?” I asked him.
“Infinity divided by two is still infinity. Right, darling?” he said.
The words bring to mind a photograph framed on my desk. In it, my 75-year-old mother stands with her face to the window; in her arms, an 18-month-old Mirabel. Their bodies appear in silhouette so that what we see are the outlines of two people at the beginning and at the end of their life journeys. Beyond the window, in that flood of light that washes out much of the color, stands a pair of young aspen trees, their gray-white branches green with spring.
They say a picture is worth a thousand words; were I to try to encapsulate this one’s meaning, I would emphasize the way it speaks to the passage of time, but also to time’s continuity.
“When you have another baby, Mama, I’m going to hold her hand on the carousel,” Mirabel told me recently. “I’ll protect her, make sure she isn’t scared.”
If anything has made my journey toward conceiving this second child more remarkable or just absurd, it’s that I became pregnant with Mirabel the second time I left the diaphragm in the bathroom cabinet. On the April night in 2006 when Mirabel was conceived, I was 38 and in the midst of assembling my application for tenure and seeking an agent for my novel. A high-stress time by anyone’s standards; and yet Mirabel, Tom and I believe, was determined—was meant—to make her way into this world.
“Why in the hell did we wait so long?” I cried when we began trying again, methodically using ovulation kits and thermometers.
Mirabel was nearing three when my gynecologist referred us to Dr. M, a balding Middle Eastern reproductive endocrinologist very close to my age. At our first meeting, his brown-black eyes shone like deepwater stones, and he spoke as rapidly and with as much knotty bravura as any good salesman or any one of the theory-driven colleagues in my English department. He told us about everything from the temperature-controlled insemination cups to the state-of-the art ultrasounds to the fact that he’d overseen the hyper-stimulation of his sister’s ovaries and the two in vitro fertilization (IVF) procedures that led to the birth of his nephew. On Dr. M’s desk stood models of the female reproductive system; on his walls, a barrage of diplomas (he earned his medical degree in Beirut) and an ornate sterling silver cross. Given that this is a university town in Texas where people stage protests outside abortion clinics and too many bumper stickers support Creationism and the Right to Life, this despite the nearly 16,000 local children living in poverty in this town, the cross on the wall made political sense.
In June and again in October 2010, Dr. M hyper-stimulated my over-40-year-old ovaries using a hormonal cocktail that, the second time around, cost me a month’s salary. The second time, I became pregnant and was delusionally happy for all of 14 hours.
“You mean I’m not pregnant?” I said when the results of the second blood test came in.
“You’re chemically pregnant,” Dr. M said.
“What do you mean ‘chemically’?” I asked, naively secure in the nausea I had first experienced with Mirabel, the same nausea I experienced now.
“Your hormone levels are too low to sustain the pregnancy,” he explained.
My period arrived two days later. For the next month, I cried during departmental meetings (but thankfully never in front of my students), and I often took long, late night walks during which I could weep under the cover of darkness, all the while gulping in the fresh, cold air.
“You’re in the peri-menopausal years, Jacqui,” Dr. M told me. “If only you had come to me a year ago…”
“We’ll keep trying,” said Tom, confessing that he, too, was looking more closely at babies and their fathers at airports, in coffee shops, at grocery stores, and on the playground.
Simultaneously, I began exploring international adoption only to discover that it has a waiting list of several years. Apparently, hoards of traditional and nontraditional professional couples and singles, many of them in their 30s, 40s, and yes, even 50s, now wanted to adopt a child, a process complicated by the more daunting bureaucratic networks that needed to be negotiated since international adoption violations and instances of “child trafficking” led to more rigorous rulings from the United Nations.
We went back to the Office of Reproductive Technologies. By May 2011, Tom and I had decided to commit to the most radical reproductive technology of them all, sans surrogacy: IVF using a donor’s eggs.
What had brought about this decision?
It may have been that Dr. M’s October 2010 injection of Tom’s sperm into the path of the eight eggs released by my hormonally hyper-stimulated ovaries resulted only in the short-lived chemical pregnancy. Or that the largest closet in the house we bought after Mirabel was born was now crowded with clothes, from newborn through toddler and well into little girl, (and don’t get me started on the shelves of picture books) that I did not give away despite the births of two baby girls in my circle of friends. Or it may have been that Mirabel had long ago outgrown her tricycle and now barreled down side streets on her purple Tinker Bell bicycle with its bright green training wheels. Or maybe the stake Tom and I sensed in that afternoon at the pool when a colleague, the father of two grown children, put three-year-old Mirabel’s foot in his mouth and said with bewildered longing, “The next thing you know, she’ll be heading off to college.”
Trouble was, by May 2011, the enterprising Dr. M had left our university town with its three-dozen churches, its Mormon temple, and its single synagogue, for another university practice, this one in downtown Los Angeles.
Trouble was, Dr. Phillips, Dr. M’s former partner, would not handle IVF with a donor’s eggs.
“Why not use your own?” A close friend asked.
I reminded her that our 42-year-old friend gave birth to a baby girl with Down syndrome last July and that there were staggeringly higher rates of miscarriage for pregnant women over 40.
“But why won’t you do the IVF?” I asked Dr. Phillips, trying to smile back at her on that sunny morning in May 2011.
“I have Dr. M’s patients now as well as my own,” she said, looking at me over the expanse of a desk very much like Dr. M’s, one that held those same models of the female reproductive system. Perhaps because Dr. Phillips is blonde and blue-eyed and Texas-born, she saw no need for a cross on the wall. “To work with donors, it’s so much more complicated. I’d have to apply to the FDA for a permit.”
“Besides,” she leaned closer, her smile waning, “I don’t know if you realize it or not, but the nature of the procedure has changed dramatically since Dr. M described it to you last fall.”
“What do you mean by ‘dramatically’?” Tom or I asked.
“The main change is that the fees an agency can charge for egg donation have been deregulated.”
Dr. Phillips did not say, in so many words, that egg donation has now become a for-profit business, but that is not too far from the reality, I discovered, once I began looking up agencies whose costs—simply for signing on to work with them—often began with an agency fee of 8 to 10 thousand dollars.
“So, if you won’t do the IVF, would you recommend someone who would?” I said instead.
“Of course.” Smile restored, she fetched her planner and wrote down the names of two medical practices: one in Houston, the other in Dallas.
Overwhelmed by their 40 to 50 thousand dollar price tags, I telephoned Dr. M in Los Angeles.
“She sent you to the Cartier of reproductive endocrinologists,” he said.
Deregulation or no deregulation, in October 2010, Dr. M had quoted 18 thousand dollars as the cost of IVF using a donor’s eggs.
“If we were to work with you,” I said to Dr. M over the phone on that fateful day last May when I sat in the garden watching Mirabel play and the idea came to me of continuing the relationship I had begun with him rather than starting all over again with a Cartier endocrinologist in another Texas city.
“Yes?” Dr. M said.
“Well,” I said, still queasy at the idea of foregrounding the financial when it came to my desire for a second child, “could you give me an estimate of how much it would cost?”
“Twenty-three, twenty-five thousand,” he said, “maybe a little more.”
Over the course of the next few days, we forged a plan whereby Tom and I would individually come to Los Angeles for the insemination and transfer, while Dr. Phillips would act as the “satellite,” performing all of the other ultrasounds and tests. None of the procedures would be covered by my insurance, and so on top of the package cost of the IVF at Dr. M’s facility, I would pay for individual ultrasounds, blood work, and related consultation to the university hospital here in Texas.
Having hashed out a plan, albeit a provisional and financially daunting one—“I’ll sell another novel,” I vowed—I began logging hours in search of an egg donation agency and then a donor in the Los Angeles area. (“You don’t want to have to fly in the donor and then put her up in a hotel,” Dr. M explained.)
In addition to this practical criterion, Dr. M urged me to find a donor who had successfully participated in the process before. “We need to know that she’s responsible,” Dr. M. said, bringing back those mornings I pulled out the syringe and injected myself with hormones that were temperature-sensitive and as expensive (per dose) as a five-course dinner at the very best restaurants in which I’d never eaten.
The second criterion he specified: a donor no older than 25, 27 at the most. “Ovarian reserve diminishes around 30, sometimes sooner,” he said, making Mirabel’s birth seem almost astounding, a feat worthy of some high wire artists and not two middle-aged academics. The way Dr. M talked about reproduction, it seemed a miracle at times that any child got born without his help or the help of one of his colleagues.
But then again, isn’t birth the greatest miracle there is? Isn’t the chance to re-experience that miracle and wondrous years that follow—“Why do bats hang upside down, Mama?” “Five fish kisses please, Mama” “For Halloween, I’m going to turn myself into a bell and ring myself”—the reason for me to navigate this surreal world in which it became commonplace to hear Dr. M say, “I like her ovaries,” or “If we get you pregnant, Jacqui, and I’m very, very optimistic, all this will be worth it.”
It’s nothing less than surreal to plug some human characteristics into a database—blue or green eyes, ages 20 to 25—and call up a string of photographs of the actual women who meet these criteria. Even more surreal, and perhaps also sublime in its original, terrifyingly beautiful form of the word, is the realization that one of these women could provide half of the genetic material for the child I would hopefully carry to term and then raise as my own.
By mid-June, I felt sure I had found my ideal donor. She shared my hair color and my height, and her freckles reminded me of my mother as a young woman. Yes, this donor was 28, older than Dr. M preferred, but she had successfully donated before. The result, the donation coordinator told me, was triplets.
She was also the single mother of a small daughter very close to Mirabel in age, and she was working her way through nursing school. In one photo, she posed beside this daughter, who perched on a wooden horse on a carousel.
“She’s very nice,” Dr. M told me over the phone following their first meeting in July, “but she’s not really like her picture.”
“What do you mean?”
“She’s not exactly obese but…”
“What are you talking about? Her weight is listed as 140,” I said.
“That has to be an old number.”
Turned out, it was an old number, as was the fact that she now had not one child but two—the reason for the weight gain.
“How could the agency not have included that information?” Dr. M asked.
“Well, at least it’s a good thing,” I said. “I mean, she has another child, right?”
“Not necessarily,” he said, revealing again (I thought) his bias against people actually conceiving babies the old-fashioned way.
In the end, my ideal donor’s weight did not prove to be the deciding factor; instead, it was the lesser-tested-for anti-Mullerian hormone (AMH) that indicates ovarian reserve.
“Her number is only .87, and we want it to be well over 1,” Dr. M explained, when he telephoned me in early August.
“But she successfully donated,” I said.
“That was more than two years ago,” Dr. M said. “Two years ago, you probably had at least .87 ovarian reserve.”
“Fine, fine,” I said, not bothering to remind Dr. M that I was a decade older than my ideal donor when Mirabel was born.
He was the doctor, and I was determined to check off every criterion on his list. The stakes were far too high not to, for there is no middle ground when it comes to pregnancy. Either you’re pregnant, or you’re not. Either you give birth to a child, or you don’t.
Eventually, I found the donor myself. B’s hair is inky black. (“She dyes it,” Dr. M told me, having asked her this outright.) B’s eyes are blue like my own, but more an arctic blue and less aquamarine. (I want a child, not a mini-me.) She is fair-skinned. (“Did you realize she has Persian ancestry?” Dr. M asked.
“Yes, of course,” I said, having been drawn to her blend of ethnicities and to the presence in her background of both Christianity and Judaism.)
B is also well educated with a degree in the romance languages. (And according to Dr. M: “She reminds me a little of you. She is very high energy, and she gets really, very anxious when she doesn’t think things are going exactly as planned.”
Thanks a hell of a lot, I thought.)
She also satisfied Dr. M’s requirements: She was 25, a successful previous donor (outcome: twins), and according to that test for ovarian reserve that ruled out the single mother with whom I believed I felt a connection, B had an excellent egg supply.
“Why does the number of eggs matter so much?” I asked.
“Remember, Jacqui, we had eight follicles when we stimulated your ovaries.”
“And it resulted in a chemical pregnancy. So again, why? Odds?”
“Exactly,” he said. “We don’t just want 10 over 10. We want 12 over 10. If it doesn’t work the first time, we want some in reserve.”
Now that I had selected B, the egg donation and surrogacy agency sent me a list of some 20 California lawyers specializing in this branch of law. Reading through their profiles, I remarked on the number of personal connections to infertility among the primarily women lawyers: One had a sister who had undergone IVF using an egg donor to conceive her twins; another had a family history of infertility, though she herself was unmarried and without children. The attorney I settled on had the most exceptional history, and I admit, that was a factor in my choosing her. Ten years ago, at the age of 40, this attorney underwent 10 IVF cycles using her own eggs before she finally gave up and selected a surrogate to carry her twins. Reminded of the month of tears that followed the chemical pregnancy, I marveled at the attorney’s stamina and her ability to hold it together.
“I used to be a long distance runner before my knees gave out,” she told me during our single 90-minute phone conversation during which time she methodically talked me through the 12 to 15 key stipulations on the 17-page contract; among them, a clause that made the donor financially liable were she to intentionally or just negligently botch the ovarian stimulation cycle.
Fast forward to early December, the day of my father’s 79th birthday and the day of the egg retrieval. I am sitting outside Mirabel’s dance class feeling exceptionally dizzy and nauseated from the six milligrams of estrogen I have been taking in preparation for the transfer. For the past five days, I have also been taking three bullet-sized progesterone suppositories to convince my body I was pregnant. I could barely function well enough to finish up my semester, not to mention drive—what would I possibly tell a cop were he to pull me over?
Midway into the dance class, my cell phone rang. It was Dr. M.
“Good news!” He proceeded to tell me that the donor, who had undergone the same hormone regimen while injecting her belly with an additional daily hormonal cocktail intended to hyper-stimulate her ovaries, had produced the superlative number of eggs: 30.
I leaned against the wall, trying to think through the song they were dancing to inside—“Santa’s reindeer clop—clop—clop…”
“This isn’t just a 10 over 10, Jacqui,” Dr. M said. “This is the 12 over 10.”
The dance music blared in the background, and I closed my eyes. This was the happiest I had ever heard Dr. M. He was positively jubilant. Of course I wanted him to be happy, as his happiness seemed to suggest our imminent success. And yet, I was terrified because my keen attention to his tone—the very fact that I answered my cell phone in this situation while being drugged up to my eyeballs and unable to make sense of the biography I was supposed to be reading—told me just how deeply invested in this experience I had become.
“Okay,” I said, “so what does it mean?”
He laughed. “God forbid we should have to repeat the procedure, but if we do, we will have an excellent reserve. And our freezer is so good,” he laughed again, “you could even decide not to come now.”
“Not come now?” Are you out of your mind?
“We have 30 eggs. Now, we’ll see how many form embryos.”
A year ago, I would have been horrified or at least sickened (and not just from the estrogen-progesterone mix) by the idea—no, the fact—of this truly obscene number of eggs. A woman’s eggs are numbered at her birth. If B gave away 30 to me, and 30 to the previous donor, and if she did this procedure once more, she would be further taxing her own reserves, not to mention dramatically increasing her risks of reproductive cancers given the drugs involved in ovarian hyper-stimulation…don’t go there, Jacqui, I told myself.
Three days after the egg retrieval, Tom buckled himself on a plane to Los Angeles to donate his sperm.
Exactly one week after that, I, too, flew to Los Angeles and checked into a hotel with an Art Deco swimming pool (my idea of a splurge), not realizing (until Dr. M informed me at the time of the transfer) I would have to spend the duration of my stay in my hotel room bed. Thankfully, I had brought several manuscripts to read, my own and those of my students; given the anticipation, not even the progesterone could keep me asleep.
Anticipation—the word comes from the late fourteenth century anticipationem (Latin) and means—fittingly enough—“preconception” or “preconceived notion.” It’s a defining part of IVF, for if you use a donor’s eggs, there’s a steep momentum to the process that is extraordinarily difficult to explain until you stand outside it.
Six, seven months of planning for or at least taking into account every possible case scenario, both the practical (12 over 10 ovaries) and the bizarre (a donor who might want to intentionally botch the process) and ultimately it all comes down to 45 minutes in a doctor’s office, less if you consider that the actual procedure takes maybe a minute, less time than an orgasm, and without any of the ecstasy, though I did will or pray that little embryo a safe passage.
The morning of the transfer, I arrived at the office at 7 a.m. Dr. M met me in the waiting room. Tears, an embrace, lots of energy, for I had not seen him in some fourteen months since the October meeting that followed the end of the chemical pregnancy.
“We have selected the most perfect embryo,” he said, leading me into the office.
“What?” I said. “One? I thought we were going to do two.”
“You wanted one.” He smiled.
Yes, I had raised the question—three days before—of implanting only one embryo, but I hadn’t made a decision.
Or had I?
“It’s the best thing for you,” he said. “You have your career, you have Mirabel. How would you manage with twins?”
(“What would you rather have?” Dr. Phillips had asked at my last appointment. “Twins or none?”
“Twins,” I’d said at the time.)
Sitting in Dr. M’s L.A. office at 7 a.m., estrogen and progesterone firing through my system, and that overwhelming excitement I knew I had to temper, I had no idea how to answer despite the certainty of my response to Dr. Phillips. It was 7 a.m. for god’s sakes. My cheeks burned.
“The chance of twins is 25 percent,” said Dr. M.
“And the chance of pregnancy with one?” I asked Dr. M now.
“Fifty percent,” he said.
(“Did you go through all this for 50 percent?” Tom would ask.
“Don’t think of it in those terms,” Dr. M said. “What you want is one.”)
The attorney had called this experience a kind of roulette. How had she managed to endure this procedure 10 times? Women undergoing IVF can’t drink. Nor are we supposed to exercise too vigorously. What did that leave her? Prayer? Meditation? Or did she just work longer hours knowing how much all of this was going to cost?
“If it doesn’t work this time, you can come back—anytime,” he said. “It will be so easy.”
I looked at Dr. M’s dark eyes, like stones in deep water.
Is there any point in trying to recover a moment in time once it’s gone? Countless people have asked that. There was the man who ran the red light at the intersection and killed the passenger in a colleague’s car. And the friend who decided not to do the amniocentesis and so discovered, at the time of her daughter’s birth, that this beautiful child, this long-awaited child, had been born with Down syndrome? (“Why did I think that, at 42, I could have a healthy child?” my friend wept, as I held her in my arms. I didn’t answer, just pulled her closer, picturing myself squatting in the rain beside Mirabel as we watched snails perform some oddly graceful courtship dance.)
“If it’s meant to be, it’ll happen,” my friend said.
“Things happen for a reason,” another said.
“Why won’t God let you have another baby?” Mirabel asked.
You have to make a choice. It was now 7:15, and Dr. M had to drive across town to his other office within the hour.
“Okay,” I said. “We can go with the one.”
“Good.” Dr. M smiled. “I have something for you.” He handed me a photograph of the embryo, the outline of a black circle with some wavy activity against a blue background.
It looks like the planet Mars, I thought, reminded of Mirabel’s fascination with the solar system. Was this a sign?
Five minutes later, once I had swallowed the requisite dose of Valium necessary to relax my uterus, I lay on one of those leatherette lounges and watched the ultrasound screen as a threadlike catheter nudged that fragile, five-day-old embryo deep into my uterus.
“Now, just lie here for 20 minutes, and then you can get up,” Dr. M said. “We’ll call a taxi. When you get to the hotel, go right to bed and don’t walk around until dinner. I don’t want you to move much until you get on that plane tomorrow night.”
“Right,” I said, astonished when the brisk, almost militant IVF coordinator actually hustled me out of the room after exactly 21 minutes.
What did I look like walking into the lobby of that small hotel at 8 a.m. on that overcast Monday morning? The neighborhood was iffy, and a man had propositioned me outside that same hotel just the night before. I do know that with every step through the mahogany-walled, slightly decrepit lobby, I feared dislodging this fragile cargo; and already I was ruing the fact that I had agreed to implant only one.
“If you’re going to do it, you need to see this as an adventure,” a reproductive biologist told me of the IVF experience.
I’m adventurous, aren’t I?—I mean, 12 years ago I walked a month-long pilgrimage across Spain. And I’ve hiked countless mountains, driven across the country solo, trained for a marathon, adopted four homeless dogs. But is IVF really an adventure? (“Yes, I’ve been taking all six milligrams of the estrogen, and now that I’ve added progesterone to the mix, things are going to really get exciting!”) An act of faith? (“Anything’s possible, even miracles.”) Madness? (“At some point, you just have to accept biology.”) I thought of the other intended mothers in Dr. M’s care, the ones who didn’t have careers and children. Was IVF an adventure to them? What about my attorney and her twins and the story she could tell about what it took to bring them into the world? Did I want such a story? Could I even survive the making of it?
Two days later, I flew back home, continued my dizzying hormonal cocktail, celebrated the holidays with friends and family (most of whom knew nothing of this experience—“What’s new?” they would ask brightly), and waited.
The first blood test was scheduled for December 27th, but because of the holiday I had to wait until the 28th.
In the end, I waited until the 29th because my parents were visiting from Chicago, and I didn’t want to make the last day of their visit about this news. I had felt so sure I was pregnant I didn’t feel I had to confirm it just yet—I’d had my fill of tests, doctors’ offices, the constant involvement of other people at every single level. On the day of the transfer alone, there was Dr. M with his catheter and his ultrasound machine; and guiding the ultrasound was the female resident in the marine blue scrubs (with the double diamond wedding bands) who’d given me the heart-shaped blue Valium; and then there was the IVF coordinator hustling me off the leatherette couch and into the cab.
I’d never told Dr. M that I delivered Mirabel without any pain medicine—I can’t count the number of times he asked if she was a C-section. How amazing, I thought, that person could again be me, watching as a newborn emerged out of my body. I didn’t tell him the nausea had returned, but differently—or so I thought—as had a fatigue even more overwhelming than that caused by the ‘sleeping hormone’ progesterone.
And I wanted to enjoy it.
But the first blood test result showed the HCG, or human chorionic gonadotropin, at 23. By the 29th, it should have been 50. That fateful, fatal pregnancy hormone was struggling to hold on.
“So we’re probably looking at another chemical pregnancy?” I asked the nurse who telephoned me with the result.
“Probably,” she said.
“No, no, it’s an okay number,” Dr. M said later.
“Okay,” I said, but I didn’t believe him.
On the first day of the New Year, I knew, conclusively, what my body already told me: I had lost the pregnancy.
For a fragile 10 days or so, I had been pregnant; now, I wasn’t.
“What’s the next step?” I asked Dr. M when he telephoned. (“I was on the flight from Istanbul when I got the second test results,” he told me. “I was very sad.”)
He sighed. “The next step?”
“Yes,” I said, determined not to let my voice break. “What’s involved in preparing for a second transfer?”
“Well Jacqui,” he said, “before we can do anything else, we have to wait for you to bleed.”
Jacqueline Kolosov is a prose writer and poet whose work has appeared in Orion, The Cimarron Review, The Southern Review, and in several anthologies. “Preconceptions, Or Frontiers” is part of Motherhood, and the Places Between, a series of essays about reproductive technologies and parenting. One of the essays in that series recently won The Bellevue Literary Review’s annual contest. Kolosov’s third collection of poetry, Memory of Blue, will be published by Salmon Poetry in fall 2013.