Feature

A Place At The Table

In vitro fertilization wasn’t for me. Until it was.

August 2012
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I am not an anomaly. One in six couples is infertile, and my experience—the in vitro fertilization experience—is becoming increasingly common. I am one of the growing number of women who has had a specialist on speed dial. I’m one of thousands each year who, when passing through airport security, has had a doctor’s note explaining the pouch of syringes and liquid hormones packed deep in her luggage. At a dinner party a couple of years ago, six of the 10 couples seated at the table were undergoing fertility treatments; we just didn’t know it at the time. Today, I have more friends and acquaintances who have sought fertility help than not.

I recently attended a meeting at my older daughter’s elementary school. In that room of 20 parents, three had twins. In nature, the chances of having fraternal twins is one in 60; identical twins is one in 250. The influx of multiples shouldn’t be possible. But since 1980 there’s been a 74 percent increase in the number of twin births in the United States. This is the result of two things: an increase in reproductive technology like in vitro fertilization, and, in our modern world, a surge of women waiting longer to begin a family. Women older than 30 have a higher chance of conceiving twins. I was 33 when Ella was born.

The New York Times reports that in this country, some 58,000 babies—not all of them twins, of course—are born of in vitro fertilization each year. Around the world there are an estimated four million IVF babies alive today. Our daughter Georgia is one of those children. The first published case of a “test-tube baby” was in 1974 (coincidentally the year I was born), but the first confirmed case was Louise Brown, who was born in England four years later.

Fertility treatments have changed dramatically over the years. In the 1970s, they consisted of a lot of guesswork. Today, there’s a fertility industry with multiple entry points. The least invasive option: popping a couple of courses of the ovulation stimulant Clomid (about $100 for a month’s supply). Twenty-five percent of women will get pregnant within a three- or four-month cycle on the drug—which is slightly lower than the normal rate of conception in fertile couples. There’s also intrauterine insemination (IUI, though commonly called artificial insemination), in which sperm are deposited into the uterus via a small tube. IUI’s success rate runs 35 percent when used with a drug like Clomid. The cost is comparatively affordable at $600 to $800 per attempt.

The most effective procedure, however—and, at an average of $15,000 to $20,000 per round, the most expensive—is in vitro fertilization. It’s also the most invasive. Injectable hormones force the ovaries to (hopefully) produce an abundance of eggs, which are captured, fertilized with sperm, and grown in Petri dishes. After several days, any surviving embryos are assessed for vitality and either transferred to the uterus (usually one or two at a time) or frozen for future use. There are multiple variables, such as the quality of eggs and a woman’s age, but success rates for women in their mid-30s come in around 35 to 40 percent.

At Denver’s Colorado Center for Reproductive Medicine—one of the world’s most respected fertility clinics—the IVF success rates are substantially higher at 67 percent. CCRM sees 250 to 300 new patients from all over the globe each month. Starting in January 2010, that new-patient list included my husband, Heath, and me.

 

Our oldest daughter, we now know, really shouldn’t have been able to be born. And yet she arrived just as planned. Heath and I were married in August of 2005, and Ella, all seven pounds, 14 ounces of her, was born in time for Mother’s Day in 2007. My pregnancy was effortless: I didn’t even know I was pregnant until I was nearly three months along. I was never sick. My only craving: fresh oranges. My only aversion: peppermint. We traveled to Italy for a babymoon, and up until nine months I continued my 6 a.m. workouts most days of the week. Two days before my due date, I baked and frosted 60 vanilla cupcakes for a friend.

Two days past my due date—and after 30 hours of labor and marginal progress—I was too exhausted to continue. Ella, who is named after Heath’s great-grandmother, came into this world by Cesarean section. Following the first gauzy moments of relief and elation, my doctor informed us that Ella’s head had been stuck in the birth canal. Without modern medical techniques, one of us, if not both of us, would have died during childbirth. Looking back, I’m quite sure the underlying lesson—you can’t plan everything—was lost in the haze.

Several days later, we strapped our baby girl into her car seat and headed home. We nestled her into the carefully planned nursery. Drawers held tiny folded clothes and freshly washed blankets. Her changing station was stocked with diapers, wipes, and tubes of Desitin. We checked and rechecked the baby monitor. We were scared out of our minds.

Our introduction to the world of parenting was, all considering, a smooth one. Ella was an easy baby. She ate well, slept well, and was generally smiley and even-tempered. Heath and I would sit in the backyard and marvel while Ella babbled and explored the world. We were doing it.

Shortly after we blew out the candle on Ella’s first birthday cake, we began to feel the tug of expansion. Heath is the youngest of three boys, all spaced about two years apart. I’m the eldest of two girls by nearly six years. We hoped to have our children close in age. We wanted them to grow up together, to be buddies and playmates, and to ultimately support each other as they moved into adulthood. That summer we began trying for baby number two.

By October, I was expecting. We were overjoyed; everything was going according to plan. Even so, I was caught up in the frivolity of the things I couldn’t have: wine, rare meat, sushi, Gorgonzola. Hot yoga and running were also out, as was ski season. I knew the sacrifices were short-lived and worthwhile, but they annoyed me. We traveled to Mexico, and I sipped virgin piña coladas, stayed in the shade, and attempted to suck in my stomach while I still could. The day before we left for home, I discovered prune-colored blood in my bikini bottom. I remember gasping.

I called Dr. Cristee Offerdahl, my gynecologist of 13 years, the moment we got back to the United States. She worked me in and did an ultrasound. On the monitor, in the middle of the gray mass, we could see the spastic flutter of a heartbeat. Our immediate relief was tempered by the news that the baby was measuring six weeks instead of eight, and that the heartbeat was slower than normal. I scheduled a follow-up appointment. Heath and I walked to the elevator squeezing the blood out of each other’s hands.

We tried to remain hopeful, buoyant even. My calendar could be off by a couple of weeks. The baby could be growing slowly, which would be concerning but not necessarily dire. But an ultrasound a week later confirmed what we already suspected: There was no growth; the fluttering heart had lost its fight. It’s a cold, sickening moment to realize that you’ve lost a baby—that you are suddenly a statistic. You are the one in three. I felt guilty for finding annoyance in the small sacrifices that come with pregnancy. I couldn’t help but think about the being—the size of a pebble, with emerging hands and feet—withering and dying inside of me.

There are two options after miscarriage: allow the body to expel the fetal material or have it surgically removed through a procedure called dilation and curettage (most commonly referred to as a “D and C”). We elected for the latter, and the next morning we arrived at an outpatient clinic at 5:30 a.m. Before I was wheeled into an operating room, Dr. Offerdahl gave both Heath and me hugs. Her blue scrubs felt soft against my face.

When I awoke an hour later, a nurse handed me a graham cracker and a paper cup of ginger ale. Heath was there. He explained that all had gone well but that Dr. Offerdahl said there had been an unexpectedly large amount of tissue. My eyes were still wet when a nurse wheeled me out to the car.

 

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