Midway on our life’s journey, I found myself in dark woods, the right road lost. I’ve actually never read “The Inferno,” but I found that line in my mind every morning when I woke to do my hormone injection and especially on the darkest mornings — the ones when I went into the clinic to have my unpregnant blood drawn to confirm another I.V.F. cycle’s failure. Of course, I had considered my life ruined many times before — other medical and romantic crises — but I was always wrong. This issue, though — childlessness — really did seem different. My two closest girlfriends chose not to have children and didn’t regret it, and I envied them, but I didn’t know how to feel as they did. No one gets everything they want in life, but to be childless felt like being deprived of something essential: the primal human experience. When I was 39 and single, I was in northern Uganda, and a woman there asked about my children. I said I didn’t have any, and she solemnly told me that she would pray to God to remove my curse. Instead of shrugging it off, I thanked her.
I was 41 when, after a gazillion not-quite-right relationships and a broken engagement, I met Michael, the man I would marry. He was five years younger; socially, it didn’t seem like an important age difference, but in terms of fertility, it turned out to be. I was haunted by the thought that if we didn’t have children — even though he loved me and even though that love might blind him to the truth — in some sense marrying me would have turned out to be a mistake. Raising children was a crucial part of his vision of what he wanted to do with his life, and if he had married someone his age, she probably would have been fertile.
“I’m not comfortable with it,” our doctor said when I begged him to let us do a fifth round of I.V.F. “When a doctor offers you a treatment, there is an expectation that that treatment could work.”
“It could work,” I said. “I don’t mind doing the treatments. I just want to keep trying.”
“Realistically, you need to consider other ways to have a family,” he said.
But it seemed to me that there were no other good options. I had friends who spent all of their money trying to adopt, only to have things fall through again and again — birth mothers who changed their minds, foreign programs that were discontinued. I researched adoption in China but discovered that the criteria excluded us. When Michael’s parents adopted his sister in the 1970s, there was an abundance of babies in the United States in need of homes, but the widespread use of birth control and abortion, among other factors, has caused the supply of infants available for adoption in the subsequent three decades to plummet to a fraction of what it was then. Knowing that, I was still taken aback by how discouraging one adoption agency was about our prospects for “competing” against other couples. “Most birth mothers do prefer younger women,” the woman informed me. “But you’ll get a letter from your doctor, certifying you are in excellent health for the social worker anyway.”
“Right,” I said, thinking about the arthritic condition that caused the chronic pain I had been struggling with for many years.
I found another doctor and persuaded him to let us try a fifth round. All you have to do is not die, I told the embryos once again, but once again they all did. After a failed sixth round, I was told I had a new medical problem that would pose risks to a fetus’s health, and I began to consider whether the embryos might have been right about the merits of my body as their greenhouse. Should I scrap my problem-ridden body entirely and try third-party reproduction? I felt a pang at the idea of excluding myself — of having no role at all in gestating or creating the child. But that pang was checked by disappointment in my body and a longing not to be limited by its limitations.
I consulted with a perinatologist, a high-risk pregnancy specialist. “Is your goal to have the experience of being pregnant or is your goal to have the best chance of having a healthy baby?” he asked. “If you really want a healthy baby, get a surrogate and an egg donor.” In that instant, I made up my mind. Of course that was my goal — and compared with that goal, all other desires seemed not only secondary, but also trivial, even narcissistic.
I began researching surrogacy and egg donation — corresponding with gestational carriers on surrogacy Web sites and talking to agencies. The process seemed so daunting and alienating — inviting all these strangers into our bedroom, creating relationships with unknown conventions and risks, giving others extraordinary power. In the story of what happens when a man and a woman love each other very much, they don’t need strangers to lend them their gametes. Having children was one of life’s great acts of self-definition. How could we turn the most intimate thing a couple could do — coupling — into a ménage à trois, let alone à quatre orcinq?
There were so many ways the journey could go astray. The Internet was filled with stories of predatory egg-donation and surrogacy agencies. The legal status of surrogacy is varied. In a number of states, the status is unclear or surrogacy is prohibited. There were several cases of surrogacy in recent years in which the surrogate succeeded in keeping the baby despite an absence of any genetic connection. Even if everything went perfectly, it was hugely expensive. Of course, the cost of surrogacy is dwarfed by the cost of actually raising a child, to say nothing, for example, of a college education, but considering what baby-making usually costs — nothing — it took our breath away. We were able to afford it because of a financial deus ex machina. Just when the I.V.F. bills were mounting, the software company that Michael co-founded was acquired by a large company. But there was still something disquieting about choosing to spend so much — and having an option that many infertile people did not have.
We were also unsettled to discover how many people disapprove of surrogacy and egg donation. There are objections to it on the right, on religious grounds, as violating the natural order and the trinity of father-mother-baby, or as being part of a slippery slope that would lead to abominations like human cloning. There are objections on the left by those who say that surrogacy is exploitative and degrading for the women, irrespective of what the women who become surrogates say about it. (Some people believe only paid surrogacy is exploitative but unpaid surrogacy is fine.) I read articles and court decisions and took notes on the arguments, but in the end they mainly seemed to boil down to the fact that it is new. Because of the central social importance of the family, changes that affect it are often initially condemned as strange, unnatural, evil or dangerous. Using anesthesia in childbirth was controversial after anesthesia’s invention. Had not God condemned Eve to bring forth children in pain? Birth control was once condemned, but it is now widely accepted. Once outlawed, abortion is now legal and supported by a majority of Americans within certain limits.
Reproductive technology fills an important — and growing — need. Gay couples are increasingly choosing to have families. Eight percent of women between 40 and 44 identify themselves as involuntarily childless or hoping to become pregnant, according to a Pew report. Most women in that age bracket will be able to become pregnant only by using donor eggs. Although we could handle negative reactions, it was upsetting to think that our children would have to deal with them. Still, we didn’t want fear of other people’s opinions to influence such an important and personal decision, and we hoped we would raise children who could stand up for themselves.
'But that would be crazy...'
Throughout our fertility treatment, our hope was that I would become pregnant with twins. We wanted to complete our family and not face future treatment, and we loved the idea that our children would be same-age companions for each other as they grew up. But in my consultation with the perinatologist, he discouraged the idea of twins.
“The fertility industry has convinced themselves that twins are safe and only triplets are high-risk, but they’re not,” he said. “They don’t see the babies after they’re born. Take a look at a NICU sometime.”
When conceived naturally, 11 pregnancies in 1,000 produce twins. Over all in the United States today, principally as a result of fertility treatments, 32 in 1,000 pregnancies result in twins. The majority of twins are fine, but because 60 percent are premature, twins are more than twice as likely to have disabilities that require ongoing medical treatment or special education. Twins have a fourfold-to-sixfold increased risk of cerebral palsy compared with singletons, a fivefold increased risk of fetal death and a sevenfold increased risk of neonatal death. And most of the high medical costs are, of course, passed on to society, which gives fuel to critics of reproductive technology.
We scrapped the idea of trying to have twins and decided we would have a baby with an egg donor and a gestational carrier and then try to have another the following year, with as small an interval as possible between the two births.
“If we really want our children to be the same age, we can try to find two carriers now and do the pregnancies in parallel,” Michael said.
“But that would be crazy,” I said. It sounded crazy, anyway. Although it was logical, and it would give us a better chance of having at least one viable pregnancy, it sounded weird and somehow hubristic, as if having children were a vanity project or a movie we were producing or a manufacturing job to be outsourced. What if trying for one child was reasonable but trying to go from an empty nest to a full house was greedy and would turn our tale into Icarus’s and irritate Fate, Mother Nature or any of the powers Michael definitely doesn’t believe in and I basically don’t, either, but I still fret about?
For many couples, the most crushing aspect of fertility treatment is not all the early morning blood-draws but the haunting feeling that the universe is telling them that their union is not — in a spiritual, as well as a biological, sense — fruitful. But I knew Michael and I were a great couple — I had pined so long for the elusive feeling of rightness, and now that I finally had it, I was damned if I was going to let biology unbless us. And I knew if we let biology become Mother Nature, we actually would be damned.
We forged ahead. I wanted to find carriers who would be like female relatives — women with whom it was fun to shop for baby things and who would give us advice on actually caring for the babies and make it all seem doable. While this desire seemed natural to me, I was surprised by how differently other people saw it.
“You won’t have anything in common with the carriers,” a director of a Los Angeles agency (which we decided not to work with) insisted dismissively. The gestational carriers at their agency were mainly white, working-class women, often evangelical Christians — “the kind of girls you went to high school with,” he said, managing to give “high school” an ominous intonation. He waved his hand. “You may think you want to stay in touch now, but trust me, once you have your baby, you’re barely going to remember her name. I call it surrogacy amnesia.”
Many intended parents do feel uneasy at the idea of too much intimacy with their carriers and are willing to pay the hefty agency fees to “manage” the surrogacy and maintain distance between them. But for us, the idea of not being close to the carriers seemed much more alarming, like something from “The Handmaid’s Tale.” Moreover, the only true safety in surrogacy lies in trust. What real remedy could there be if, for example, your baby was born with fetal alcohol syndrome?
“If it’s a boy, we can give it to them, but if it’s a girl we can keep it,” Olivia decided. Fie explained that the baby would belong to Michael and me, even if she was a girl.
Olivia didn’t respond, but a bit later she tugged on Fie’s sleeve and said, “Mom, we should help the lady with the broken belly.”
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