We Wanted a Test Tube Baby
The doctors warned us that it wouldn’t be easy. We didn’t know how right they were.
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They did. Kellogg found one follicle on the right at 18mm and one on the left at 17.5mm. Three others were visible, two at 14mm and one at 11mm. The radiologist couldn’t believe that the follicles on the left had grown so much. Dr. Vaughn was pleased. He planned to go ahead with surgery in two days, even though the large one on the left might not be accessible. He said he would try to remove three eggs from the right ovary and any he could get from the left. The only barrier to surgery would be the estrogen level, which needed to be at least 800.
At eleven-thirty Sarah went to Ruby’s office to await the estrogen results. Her level was 1350. Ruby and Sarah dashed across the courtyard to the lab for the LH blood draw. The technician drew three extra tubes of blood for Repp to process for the embryo culture medium in which her eggs and my sperm would fertilize.
Because of the high estrogen level, Sarah won another reprieve from her Pergonal injection. All that remained were the blood draws at three-thirty and seven-fifteen.
We had an early dinner before the last blood draw. If the tests showed an LH surge, Sarah would be scheduled for surgery the next day. To cover that contingency she was to begin fasting at midnight. I figured Sarah’s last meal might as well be a good one. We went to Ruth’s Chris Steak House and ordered a banquet. I kept the scotches coming, but Sarah wasn’t up to it. The emotional and physical demands of the day had exhausted her. We still weren’t sure whether she would make it to surgery or what Vaughn would be able to find or get. And if she did make it to surgery, there was still a month and a half left before we would find out whether any of this had been worth a damn.
We were awakened the next day by a call from Ruby, who told us that the LH hadn’t surged. If it had, that would have meant that Sarah was about to ovulate and we would have gone to surgery early. That was if we were lucky. For some IVF patients the LH surged either too late at night or too early in the morning for surgery to be scheduled. They would be canceled at the last minute. But Sarah’s didn’t surge, which meant the HCG, the LH surrogate, would kick in and cause her to ovulate on time. Ruby set Sarah’s surgery for Friday morning.
At three-thirty Ruby called. We were to report to St. David’s Day Surgery Center at five-thirty in the morning. Sarah could eat light foods, but she would have to start fasting at midnight before surgery. Also, Ruby was going on vacation for a week the day of our surgery. I joked that she had abandoned us to the capricious whims of strangers; Sarah wasn’t so lighthearted about it. She had come to rely on Ruby for more than shots. Ruby was the conduit for the immediate good or bad news.
When we got up at four-thirty, Sarah’s sides were sore from the swelling of the ovaries in preparation for ovulation. As we drove to St. David’s, Sarah said she was concerned that there wouldn’t be any eggs. We had no guarantee that each follicle contained an egg; the ultrasound couldn’t show what was inside a follicle.
At day surgery, a nurse gave Sarah a drab gown while I made coffee for myself and others just arriving. John Repp showed up. He would take the eggs that Dr. Vaughn hoped to remove. I went to the room where Sarah was filling out surgery releases. The anesthesiologist, Dr. Gary Mihm, came in. He ran down a list of “have you had this or that?” questions. Spotting cough medicine on the nightstand, he asked about it. Sarah had had sinus congestion all week. Mihm listened to her chest. Vaughn then entered and asked about her health and also listened to her chest. The doctors discussed Sarah’s congestion, then Mihm left. Vaughn explained that because Sarah was not in perfect health, the anesthesia presented a greater risk. He suggested that we might wait for the next cycle, in July.
I asked Vaughn whether Sarah’s condition warranted grave concern about the surgery and recovery. No, not grave, just enough to mention the risks. Sarah and I looked at each other. She was sitting on the bed in her surgical gown and leaning forward, her feet in paper slippers tapping at the floor. There was no hesitation in either of our expressions. I knew damn well that she wanted to go ahead. She knew I did too. We hadn’t gone through thirteen days of shots and pain and chemicals for nothing. There was no need for us to talk it over. I told Vaughn we both wanted to proceed. He left. It was only six-fifteen and still too dark to see anything outside. Sarah chuckled at the drama, but she was concerned that there was still a chance of being canceled at the last minute.
Vaughn came back in. “Let’s go,” he said. I wished him luck. A nurse entered and gave Sarah a blanket. It was cold in day surgery. The nurse told me to kiss Sarah good-bye and then led her away.
I did my best to read Leon Hale’s Easy Going while Sarah was in surgery. I wandered, made some phone calls, bought a pack of cigarettes, smoked one. During my listless peregrinations, the IVF team worked.
Mihm put an IV into Sarah’s arm and injected the anesthesia while a nurse put life monitors on her chest. As Sarah was getting drowsy, Vaughn asked her if she was ready. She said yes, wished him luck, then fell asleep. Vaughn got to work.
He made four small incisions, about half an inch each. One, in the navel, was for the laparoscope, an internal telescope about the thickness of a golf club shaft. Below that incision, one was made for the hypodermic needle that would collect the follicles on the right ovary. Another incision was made for a grasping instrument to hold the ovary in place. The last incision was needed for a grasping instrument to push the colon out of the way. This was delicate surgery, and it took place in an area the size of a soup bowl.
Dr. Vaughn slipped the laparoscope into the abdominal cavity. The light attached to it enabled him to see the lemon-shaped ovaries. He searched the right one for the blisterlike follicles on its surface. When he saw a follicle he wanted, he stuck the long large-gauge hypodermic needle inside the blister and drew fluid through the needle and into a test tube. In the fluid, he hoped, was an egg—smaller than the dot over an i.
John Repp took the tube to the lab to look for the egg under the microscope. Meanwhile, Vaughn was seeking out another follicle. Each time he opened one, a tube was taken to the lab for Repp to examine. That kept the nurses busy—assisting the doctor, delivering tubes to the lab, taking notes on where the follicles were so if Repp didn’t’ see an egg, Vaughn could go back to the notes to help him find the follicle in question and maybe retrieve the egg. As it turned out, Vaughn entered twelve follicles and found three eggs. Within an hour Sarah’s incisions were stitched up and she was in recovery.
I was on the bed reading when he came to tell me about the three eggs. They were from the right ovary and were very mature. The left ovary, though, was badly damaged. It bled every time he touched it. I asked if he had had a chance to look at the left fallopian tube. Maybe it was no longer damaged, and we would have another chance of natural conception. He said there was little hope of the tube’s ever working, but he was pleased with the surgery. Repp then came to the door with a look of expectation on his face. It was time for me to perform the one duty expected of husbands in the IVF program. I had come prepared.
The Playboys placed in the masturbatorium to gratify someone’s conception of what every male wants were much too lame for a real man like me. So I had borrowed a dirty magazine from my friend Kevin—another real man not intimidated by prurient exploitative trash. I sneaked Party Pieces #1 into the room in a manila folder beneath a United Way agency’s board report and Stephens’ Incidents of Travel in Central America, Chiapas, and Yucatan. No one suspected a thing.
After I dropped the sperm off at Repp’s office I called our folks and friends to let them know about the three eggs. Everyone was excited. Sarah came out of the anesthesia clearheaded. I told her about the eggs and that Vaughn was pleased. She was happy—she had done a good job.
The eggs still needed to be fertilized and divide, transfer and adhere to the uterus. Sarah’s body would still be manipulated with hormones. But Sarah felt good, we were happy, and John Repp had three very mature eggs to work with.
What followed was, to me, the most fascinating aspect of IVF. Repp would take my living sperm and Sarah’s living egg and allow them to conjugate to produce a new life. He would be there at the incipient stages of human life, at the initial formation of human beings, Sarah’s and my human beings.
Perhaps for many, the primordial embryonic stew was not of real consequence. Perhaps to them a matter of choice was more important than a matter of life. For us, however, fate decreed that viscous, spittle-size blob a matter of the utmost importance. St. David’s agreed. A normal, healthy fertilized egg was sacrosanct. It was not that it could be transferred, it was that it had to be. It was life.
Certainly Repp’s job took on a moral and ethical burden, but it was mainly one of technical, not philosophical, expertise. He took my sperm and washed it to separate the gametes (the reproductive cells) from the fluid, which he didn’t need. While washing, he concentrated the sperm into a small amount of fluid by centrifuging it so that he could draw the sperm into an eyedropperlike pipette. He introduced the pipette into a test tube about half filled with a solution of salts, vitamins, minerals, sodium bicarbonate, and 10 per cent serum from Sarah’s blood. This procedure was a sperm “rise” or “swim up,” so called because the sperm moves in one direction, working its way to the top. That eliminated all the non-motile sperm. It also reduced any abnormal sperm by 90 per cent.
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