They say getting old isn't for sissies. Neither is fertility treatment.

Going in, you know it will extract a huge cost financially, physically, and emotionally. What you can't know is that it will cause you to make moral and theological decisions that were never discussed in Sunday School, the consequences of which you will live with the rest of your life.

By the time you get to the in vitro part of the process, you've already discovered a number of things.

  • You've discovered that life isn't fair. Women who don't want children, desperately poor women who can't support them, women who are victims of rape or incest-even women for whom children will ruin their lives-get pregnant every day. And women who dearly want children can't.
  • You've discovered that, despite all those dire warnings in high school, sex doesn't necessarily equal a baby.
  • You've even discovered that sex with your husband in the sanctity of marriage at the right time of the month when you're pumped full of fertility drugs after months and years of earnest prayer, crying and pleading with God doesn't necessarily equal a baby.
  • You're about to discover that embryos don't necessarily equal babies, either. In fact, nothing equals a baby except a baby.

    In vitro clinics are strange places. It's somewhere no one wants to be, yet it's hard to get in. The most successful clinics have waiting lists of a year or more; and for couple who have already waited years for a child, that seems interminable. They're also dreadfully expensive. An average in vitro cycle will cost you between $10,000 and $15,000. Sometimes some of the costs are covered by insurance. Many times they're not.

    My husband and I told ourselves we were luckier than most: we would love to have children, but we weren't desperate. We'd be disappointed but still capable of a happy life if it didn't work out. As long as we'd come this far, we'd try one cycle of in vitro, just so we wouldn't get to old age wondering if there was something else we could have tried but didn't.

    I'm sure everyone has the perfect rationale for being there; how they've gotten the money, how it all makes sense. But once you walk in, once you actually start the process, you can't help but buy into the Baby Lotto Frenzy. You're there, and you're there to win. You're determined to be amongst the lucky couples whose adorable baby pictures deck the Winner's Wall: Christmas cards, birth announcements, hospital nursery photos.

    The big problem is-what they tell you only in hurried undertones as all the disclosure charts flash by-is that the vast majority of people who go through in vitro will remain childless. In fact, the percentage we were told was that only between one quarter and one third of women who do in vitro will have a baby.

    Still, you hope. And you pray. And you pay a very high price. You endure a daily cycle of being injected with cocktails of drugs, having blood drawn, and feeling your body swell as your follicles are stimulated and become heavy with many eggs at once. You're also taking drugs to thicken the lining of your uterus to make it as hospitable an environment as humanly possible. The way you feel some days, you're sure people are hanging curtains and wallpaper in there.

    Then they harvest the eggs, which is a horrible little procedure that I'm sure you don't want to know about. And let me assure you that every woman is paying rapt attention to exactly what's happening every step of the way. By this point you know things about your anatomy and the conception process that would leave a sex educator in the dust. You are doing everything possible to enhance your chances. And you know the universe is working against you.

    Finally, after the harvesting, the eggs are fertilized with the sperm of the potential father. Then you wait. You wait because most of the eggs won't fertilize-and because even if some turn into embryos, not all embryos are created equal. There are A embryos, which are your best chances; B embryos, which are still possible; and Cs, which are technically still embryos, but don't stand much of a chance.

    Usually they will return maybe six embryos of various grades to the uterus and freeze the rest, if there are any left over. The embryos that are used are those that will provide your best chance. Those that are frozen are the B team.

    The fact is, by the time I finished in vitro, I had developed a much different feeling about embryos than I had going in. Before I dealt with fertility, conceiving, carrying and having a baby all seemed vague and mysterious. Once I understood every phase, it all seemed like building blocks in a long process. I thought I would feel as though each embryo was a darling child of my husband's and mine, just waiting for a warm uterine lining. Now I know they're not. Even those few darling A's are looking for a chance to rush the exit if you don't block them with every weapon known to science.

    I can understand how people can think of embryos in a petri dish (there are no test tubes, sorry) as junior babies waiting to happen. But when they're yours, and you're infertile, you know the sad truth, that for whatever reason, most of them are not. I can also understand why there are so many unclaimed embryos in freezers.

    First of all, if you're one of the Baby Lotto winners, and your uterus is a baby heaven, chances are pregnancy will happen for you first time out. Chances are also likely that you suddenly have twins or triplets; your cup runneth over, your bank account emptieth out. So having more children becomes a frightening thought.

    On the other hand, if it's your third go-round (or your fourteenth), chances are good that none of the "freezer babies" will become viable. This is the B team, after all.

    Each new procedure costs money (generally around $5,000) and involves taking drugs. The lowest blow is that these drugs have the greatest chance of promoting cancer or other side effects-if you don't get pregnant. If you have already re-mortgaged your house and risked your health getting to this point, I can understand how it becomes difficult to go through another embryo return simply because you don't want to leave any unused embryos on principle.

    Some clinics have started offering an "embryo adoption" program in which you can donate your embryos to childless couples who can't form embryos of their own. Frankly, that sounds fine to me, though I think there's a limited supply of couples who want to carry a stranger's baby. And remember, also, that the embryos I'm talking about are the least viable embryos of women who were infertile in the first place. The possible success rate doesn't seem stellar. But, if I had some left and any good parents wanted them, I'd be happy to let them try.

    Then there's the question of stem cell research. Frankly, I've come to feel, if embryos can help save lives, well, that's lots better than being in the trash or ignobly disappearing from someone's womb, which is where most of them will end up under the best of circumstances. In fact, that's downright wonderful.

    In case you're wondering, I produced fourteen embryos. All were used. I had one baby with the first embryo return, and one with the second. But my husband and I had decided, were we to have twins or more with the first, that we would not choose to keep the second batch frozen.

    You see, fertility treatments have changed my theology. I realized it one day in the hospital O.R., when it was just me and a lab technician and a petri dish and a tube. How did he think about this job? I asked. How could he blithely choose which As and Bs to use and which to freeze? He looked at me like I was from Venus and he said cheerfully, "None of this is really in our hands, you know. We do what piddling little we know how to do. We put in the embryos, but then what happens is what was meant to be. It's all up to God."

    I have come to believe he's right. I believe God led my husband and myself to pursue children the way we did. I believe He led friends of ours to stop earlier than we did and adopt. I believe He shaped our plans and used them to fit His own. I believe He meant us to have two children, and it was totally up to Him whether they both came in the first batch, or one and one, or none and two.

    I've since been asked if I think embryos have souls. My answer is no. I believe that most of mine were just passing through. In fact, most embryos in healthy women don't implant, but you never realize it. You just "didn't get pregnant." I don't believe God would make so many souls that He never intended to bring to life. I do not feel that I was the mother of fourteen embryos. I am the mother of two children. Two wonderful, laughing, funny, spiritual people. And there's all the difference in the world.

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