When the time comes to talk about how babies are made, I will take a deep breath, smile, and start with, “Not always how you’d expect.”
"Do you want to know the gender?” my doctor asked. “Yes!” I responded without a moment’s hesitation. I’m a journalist, always wanting to know more. And yet this wasn’t the moment I had dreamed about. I wasn’t standing beside a frosting-shrouded cake, armed with a knife to reveal the pink or blue crumbs. I wasn’t lying on an exam table with a sticky ultrasound probe pressed against my abdomen.
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I wasn’t even pregnant.
I was on the phone, standing awkwardly in a quiet hallway at work. What my doctor was offering to reveal was not the gender of a baby but the gender of a clump of cells. Two, actually—a pair of frozen embryos my husband and I had spent tens of thousands of dollars to create.
“They’re boys!” he said excitedly.
The news gave our embryos life and filled me with dread. It was the latest surprise in my years-long march to motherhood, a precursor to What to Expect When You’re Expecting that could have been titled This Is Not What I Expected at All.
As a teen I had scripted a tidy life plan: married by age 27, two daughters before 34. I assumed that when I was ready to have children I would have them, in no small part because my mom used her own fertility as a threat. She cornered me as a high schooler with a rotating cast of boyfriends and grabbed me by the shoulders: “Your father and I got pregnant on the first try,” she warned.
I met my husband, Matthew, when I was 27 (already behind schedule!). We got married four years later and started trying for a baby two months before our first wedding anniversary. I anxiously peed on the fanciest ovulation sticks I could find. With every twitch or pang in my pelvic area, my heart soared. It sank just as quickly with the start of my period.
About a third of couples get pregnant in their first month of trying. That number jumps to 80 percent after six months. My gynecologist encouraged us to try for a year, but I began to worry after nine months. I was 32 and had sprung from my mother’s insanely fertile womb. So why wasn’t I pregnant?
We got our answer after a dozen doctor’s appointments and a battery of tests. My husband was diagnosed with a balanced chromosomal translocation, meaning that pieces of two chromosomes were swapped. It’s unusual but not uncommon: Around one in 560 people has a balanced translocation. Most people don’t realize they even have it until they try to reproduce, because it can lead to a higher risk of miscarriage and birth defects.
The news was devastating. We cried. We sulked. We fought. It was a disorienting time. I selfishly blamed Matt for something completely out of his control. And in our lowest moment, he offered to call it, to let me find someone else I could have a baby with. But that was never an option. I wanted a family with the man I adored. At his doctor’s recommendation, we jumped straight to in vitro fertilization (IVF).
More than a million babies have been born in the U.S. with the help of IVF and related treatments since 1985. But when I learned through some ill-advised, late-night Googling what we were in for, I almost threw up. First comes a week or more of shots to the abdomen, swelling the ovaries to the size of oranges and tricking them into producing more than one egg. Endless early-morning doctor’s appointments to monitor your progress culminate in an egg retrieval under anesthesia. Next, a lab technician will often play matchmaker, combining the eggs with sperm. Then you cross your fingers and hope like hell that those two take and grow together into an embryo suitable for transferring back into a waiting womb. Finally, there is the 10-day wait before the pregnancy test, punctuated (literally) by daily shots to the backside with a needle long enough to tranquilize an elephant.
IVF increases the chances of pregnancy but provides no guarantees. Roughly 30 percent of cycles in 2015, the most recent data available, resulted in a live birth. Each cycle would cost us more than $15,000, with insurance covering just a fraction. The budgeting we could handle (my Midwestern roots take a special kind of satisfaction in frugality). The needles I could not. Thankfully, I married a man with a much stronger constitution. Matt prepped the meds and administered the shots each night, pinching my belly fat—a necessary, unsexy step in a wildly unsexy process.
Matt also accompanied me to every doctor’s appointment, too many to count. It was a relief to have him by my side in the silent, stress-inducing waiting room on Manhattan’s Upper East Side. We weren’t going to make a baby with a Champagne-fueled, rose-petal-laden romantic evening. But we were making a baby together.
That first IVF cycle was almost ... exciting? My body responded well, yielding a veritable chicken coop’s worth of eggs. We transferred two of the four viable embryos we had ended up with after fertilization and—huzzah—one took. I was pregnant. Until I wasn’t. During a routine ultrasound at the end of my first trimester, my doctor squinted at the screen. My heart began to race as it became clear there was no heartbeat at all—the result of a chromosomal abnormality.
In our blind determination, we doubled down with dizzying back-to-back attempts. After a second unsuccessful transfer, a second full round of IVF, and then a third unsuccessful transfer, my body’s response tanked. After our third round of IVF, we had no suitable embryos left to transfer at all.
Our world grew very small. We distanced ourselves from friends with children and kept date nights to a minimum to pinch pennies. Adrift and despondent, we met with a counselor to talk about donor sperm and attended an adoption information session. We talked endlessly about what is known in the fertility world as “child-free living.”
We resolved to try a doctor at another clinic. He suggested a costly additional step: genetic testing. The lab would remove a single cell from a five-day-old embryo and ship it off to a lab for chromosomal testing. He also tweaked my meds, and my body bounced back. And at that cycle we had another four embryos reach the testing stage.
A nurse called with the results a few weeks later while we were staying at a friend’s house in the Hamptons. “Two!” I shouted at Matt, tears already welling in my eyes. Two viable embryos! We toasted the news with mimosas poolside before noon. Fear crept back in when my doctor called to discuss next steps and shared the gender. The news humanized the embryos and upped the ante in my mind.
On the brisk fall day when we transferred the first of those embryos, I lay anxious and alone on a frigid operating room table, my legs spread-eagle in stirrups. (Partners are not allowed in there, a policy I understand but don’t agree with.) Chicago’s “You’re the Inspiration” played overhead. I put my hands on my pelvis, said a little prayer, and began to plead. “Please, please, please,” I thought as the embryo entered my body. “Please stay.”
I sat for 10 minutes or so in the recovery room before the nurse told me I could go. “Shouldn’t I stay a little longer, just to be sure?” I asked. “You’re not a chicken,” she said, laughing. “It’s not going to fall out.” I tiptoed awkwardly into the waiting room and let Matt’s arms envelop me. Together we stared at the magnified portrait of the embryo given to us by the lab, studying the grainy image for hints of viability.
Nine months and 21 hours of labor later, our son Fitzgerald came into the world. Two years and 11 days after that, our second son, Oliver, was born. Hanging in our kitchen, alongside the ultrasound images from each pregnancy, are the pictures of those two viable embryos—two clumps of cells, our two little boys, Fitz and O. When the time comes to talk with them about how babies are made, I will take a deep breath, smile, and start with, “Not always how you’d expect.”