Thursday, September 3, 2020

Assisted Reproduction Is Not For Wimps

If, in order to get pregnant, every couple had to go through what couples experiencing infertility have to go through, there would hardly be any people in the world.

Old-fashioned reproduction doesn’t require vetting, but donor embryo programs do. In order to get matched with a donor-donor embryo at West Coast IVF, I had to have an hour-long informational phone call with a treatment coordinator, a medical consultation, and a couples therapy session with a psychologist who specialized in reproductive issues. All this to determine if my husband and I were suitable parents for an embryo created in a lab with the gametes of strangers.

You would think that the scheduling of all these things would be streamlined given that West Coast IVF had been in business for almost 15 years. You’d be wrong. The communication with West Coast IVF was a nightmare. At first, I blamed it on the time zone difference, or Californians’ lax approach to punctuality. But no. The clinic was either overloaded with desperate, empty-wombed women just like me or they just didn’t have their shit together. Probably both.

I became so frustrated with the dozens of unanswered emails and epic rounds of phone tag that I joined a private Facebook group of fellow West Coast IVF patients just to see if this experience was normal. Unfortunately, it was. One member said that navigating the administrative side of West Coast IVF “requires the patience of a saint.” And yet, the clinic managed to make babies. Tons of them. I know because I scrolled through all their pictures in the Facebook group while I waited for my umpteenth phone call to be returned.

Slowly, we made it through the steps, and soon it was time for the last one: our session with a reproductive therapist. When we arrived at the therapist’s office, there was an embryo recipient disclosure form with our names on it in the waiting room. It asked us to acknowledge the issues that might come up with a donor-donor embryo, such as: “I acknowledge that I might not feel how I expect to feel about embryo donation after the fact.” I couldn’t imagine feeling anything but elation, but I put my blinders on and initialed away.

The therapist ushered us back to her lived-in office where a "Fuck Infertility" mug adorned her desk. She was middle-aged, with funky glasses and bright orange hair. An East Coast transplant, she was forward and no-nonsense. We’ll call her Dr. Midler because she reminded me a little of Bette Midler in Beaches.

The appointment was intense; we were grilled on our and our family members’ mental and physical health histories, which were unflattering, to say the least. Rattling off all of the illnesses that have afflicted our relatives, I felt grateful that we weren’t passing our genes on to an innocent new being.

Then it came time to discuss why we chose to pursue a donor-donor embryo. I had prepared my lines ahead of time and made sure my husband knew what to say, too.

“I just want to give our baby the healthiest start possible,” I said. “This wasn’t how we planned it, but I’ve made peace with it.”

When Dr. Midler asked about our concerns, I said I didn’t want our baby to feel like a product we had purchased or to feel like she couldn’t look for her donors when she grew up.

Dr. Midler informed us that we couldn’t control how our baby would feel about her conception or whether or not she would want to seek out her donors or other genetic relatives. What we could do was be open and honest and have an ongoing dialogue with her about it.

Research has shown that it’s best to tell donor-conceived children about how they came to be from early on. Dr. Midler encouraged us to make our baby’s conception story a part of the narrative of her life from the very beginning, to normalize it. She gave us reading recommendations to help us do just that.

“Have you thought about if you want your baby to have a younger sibling?” Dr. Midler asked.

I laughed – because I laugh when I’m uncomfortable.

“I have, and I think that would be really wonderful,” I said. “But my husband will have to speak for himself.”

Cue deer-in-headlights expression. My husband had clearly not contemplated this at all. He fumbled for words for a minute.

“I just got used to the idea of one little person running around. I’m not sure about two yet,” he finally said. “It’s a conversation we’ll have to continue at home.” (Over a year later, it’s still ongoing. Ha. Story for a future post.)

We discussed our fears regarding telling our families about donor conception. Just announcing a new pregnancy was going to be a shock to them, so what would their reaction be when they found out we’d used a donor-donor embryo? (Chances were, they didn't even know what that was.) We were worried our parents would think we were selfish for deciding to have another child and for spending all this money to do so when I already had two kids.

“It’s not selfish,” Dr. Midler reassured us. “It’s not unusual for couples, when they remarry, to want something of their own.”

I hadn’t felt like we needed permission to want a baby, but when she said this, I realized maybe we did. And now we had it. 

But I doubted our families would be understanding.

“Everyone defines family differently,” Dr. Midler said. “For some, genetics are very important.” She launched into a story about a couple she worked with who had been infertile for seven years. One day, a social worker called them and said, “Do you want to become parents today?” Apparently, a mother had surrendered her newborn baby to a hospital.

The point of the story was that as overjoyed as the adoptive parents were, their families didn’t consider a non-blood relative to be “family” and ostracized the child. I knew Dr. Midler was trying to prepare us for reactions like that in our families; all I heard, though, was the fantasy of getting the “Do you want to become parents today?” call. Unfortunately, those out-of-the-blue adoption stories seemed like urban myths. Everyone in the infertility community had heard of one, but no one had actually been the recipient of that type of miracle.

Speaking of miracles, Dr. Midler wanted to know what we would do if we found ourselves pregnant with twins? This seemed like a silly question to me, as we'd already decided to transfer just one embryo (despite a very enticing offer from West Coast IVF to add a second embryo to our transfer for only $3K). But there was a small chance (around 1 percent) that our single embryo could divide.

“It’d be hard having twins, but we’d make it work,” I said. (What other answer was there?)

“What if you had triplets?” Dr. Midler asked. “Would you consider selective reduction?” 

Selective reduction is a medical euphemism for abortion. Basically, a doctor advises a woman pregnant with multiples on which fetuses are healthiest, then “reduces” the pregnancy to twins or a singleton.

“I don’t think I could do that,” I said.

Dr. Midler turned to my husband. I couldn’t fathom he’d have an opinion on this – but he did.

“I’d be OK with it if it meant the other two babies would be healthy,” he said.

I was flabbergasted. Dr. Midler and my husband stared at me expectantly, like I was the monster for not wanting to kill my hypothetical baby.

“I guess I’d have to make that decision if and when the time came,” I said. (Statistically, it probably wouldn’t.)

Dr. Midler shared that she’d had a “26-weeker” and that is was “gruesome.” I didn’t understand from her story if the baby survived or not. I was too afraid to ask.

Thankfully, we moved on to the educational part of the session. Dr. Midler showed us how to administer shots, both the ones in the belly and in the butt. My husband squirmed just watching her plunge down on the empty syringe; it was clear that I was going to be on my own when it came to anything involving needles.

And with that, our time was up.

In hindsight, we should have listened better. Instead, we’d been focused on making a good impression and getting reassurance that what we were doing with other people’s genes was OK. We were like many couples struggling with infertility: so focused on getting pregnant that they take a “by any means necessary” approach and throw caution to the wind.

There were a lot of points Dr. Midler made that went right over our heads that would come back to bite us in the ass later. But we didn’t know that then. We were just relieved the session was over and happy that we’d “passed.” Dr. Midler confirmed she’d send a letter summarizing our session to West Coast IVF. There were no more hoops to jump through.

“What a rollercoaster!” my husband exclaimed.

“More like a slower-coaster,” I huffed. It was early July. We’d been at this for six months – almost the length of a pregnancy – and were still not pregnant. The irony was not lost on me.

I was also aware that in the grand scheme of things, we were “lucky” because six months is nothing in the infertility world. The women who do this for years on end are truly warriors. Infertility is grueling AF.

But the administrative hell was over now. We were on our way. Now all we needed was a match

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