by Emma Brockes
I wish I could say that after this consultation, I suspend my moratorium on research and self-educate to Ph.D. standard, like Nick Nolte in Lorenzo’s Oil. At the very least, I should be feverishly Googling “hysteroscopy” and its related terms. But every time I think about researching the operation, I am overcome with inertia and something else, a primitive sense that by focusing on the bad things I will increase the chances of them happening. The most I can bring myself to do is to Google “blocked fallopian tubes,” a search that brings up a lot of testimony from desperately unhappy women at the tail end of multiyear fights to get pregnant. Blocked tubes, I read, account for some 20 percent of infertility.
And yet I’m reluctant to go in for elective surgery. The operation, said Dr. B, can be conducted only under general anesthetic and taking even the tiny risks associated with that seems obscene. My mind ranges back to the chemo unit. Bravery in the face of cancer is admirable; bravery in the face of an avoidable operation feels like a parody of those with real problems.
I do something then that is more emotional than practical: I look to see how doctors would be handling my situation if I still lived in Britain. If the hysteroscopy is considered all right at home, under a health-care system so strapped for cash that most NHS managers would rather die than green-light an “unnecessary procedure,” then I tell myself I have nothing to worry about. If the Brits don’t go for it, then neither will I.
It takes two minutes at my computer to find what I’m looking for: guidelines issued to doctors by the Royal College of Obstetricians and Gynaecologists. Just reading those words soothes me. Here we go, the royal standard, the firm hand of authority from a world-class health system that doesn’t ask you, the least qualified person in the room, to make clinical decisions, but instead tells you what’s good for you and you can either like it or move to America.
The advice laid down to British doctors by the RCOG is that the hysteroscopy is a “successful, safe and well-tolerated” operation, albeit one associated with “significant pain, anxiety and embarrassment” on the part of the woman. In spite of that last bit, the governing body recommends that doctors conduct it under local anesthetic, because, to paraphrase, buck up ladies, that’s life. (One wonders if it was a man or a woman who wrote these guidelines.) It is hard not to laugh at this, the difference in the two cultures’ ideas of pain management. In Britain, whether it hurts or not, it is assumed you will take it on the chin and be grateful that anyone bothered with you in the first place. Years before moving to America, I’d gone for minor eye surgery at Moorfields in London, and when I inquired, timorously, of the consultant, “Is it going to hurt?” he gave me a flat yes and a spiky look just for asking.
In America, by contrast, any degree of pain, like any degree of heat or cold in a poorly temperature-controlled house, is considered less a fact of life than a failure on the part of the service provider. In my biased view, this makes pain as a concept harder to control, although this is, I understand, as much a hangover from my mother’s parenting as a function of cultural difference. In the chemo unit, at home with her back pain, throughout her entire life, it was my mother’s core belief that something will hurt in proportion to the fuss that one makes about it. As a result, in very limited circumstances—blood tests, immunizations, minor operations—I can enjoy pain; it makes me feel important. My eye operation hurt like hell, but it gave me something to kick against and allowed me to congratulate myself for being my mother’s brave little soldier.
After reading the RCOG guidelines I decide I’ll have the operation. But bristling with my mother’s machismo and something like patriotic pride, I call the clinic to request it under local anesthetic. Twenty minutes later the nurse calls back and says under no circumstances will Dr. B operate without a general anesthetic and doubts any doctor in Manhattan will; it is simply too painful.
Something occurs to me then. If I had been with a male partner trying to conceive the regular way, I would in all likelihood have been trying and failing to get pregnant for months or even years by now, my two blocked tubes undiagnosed and untreated. I would, potentially, already have become That Woman, whose inability to conceive overshadows every other aspect of her life. By doing it the artificial way, I have shrunk the agony down to less than a week. Fear gives way to relief and then to euphoria. A third self-image presents itself: I am immensely lucky! This is all for the best! Thank god I’m half single, half in a same-sex relationship and not in a conventional marriage! Four days later, I go in for the procedure.
L has a meeting that morning and offers to cancel and come with me, but it gives me a small sense of victory to renounce my own needs and so I turn her down, then get the added buzz of resenting her for not overriding me. (She knows I am doing this, and won’t override me partly in retaliation for not stating my needs plainly. I tell myself this is completely unjust given that we can’t change our natures and there’s a minuscule chance I might DIE here.) Oliver, with whom I do not play these games, travels up from Park Slope for an eight a.m. start and sits with me in the prep room, where he spends thirty minutes trying to get Wi-Fi and communicate to the anesthetist that he isn’t my husband—unsuccessfully on both counts. Just before I’m wheeled in, my phone buzzes; it’s L, texting me a photo from the summer of me holding the baby in an orchard. We are both smiling at the camera. I send her back kisses.
When I wake up, Oliver is at my bedside. “You’re not making any sense,” he says.
“Huh?”
“You’re talking an amazing amount of shit.”
I still occasionally worry about this. Given that I emigrated on the strength of the drugs for three fillings, I can’t imagine what unfiltered junk flew out from my subconscious after being out cold. With Oliver’s help, I get off the gurney and, after retreating behind a screen to get dressed and thanking the anesthetist—“Good luck to you both,” he says, and we blush—we make our way upstairs to reception. Depending on what Dr. B found down those tunnels—space debris? Scar tissue? Cobwebs?—it is possible I am about to hit the end of the road, in which case, I decide, I will simply push it to the back of my mind along with all the other things I put off indefinitely, like figuring out what I think about life after death and finding an alternative to Time Warner Cable. Eventually, I have to believe, I’ll come to terms with it.
Dr. B appears and beckons me to follow him into his office.
“A buildup of matter,” he says genially. “Quite normal, very common and I’ve cleared both tubes out.”
“What kind of matter? What’s it made of?” He says some words I don’t catch—some sort of tissue, possibly beginning with F. Anyway, “Water is flowing in both directions,” he says. “We’re good to go.”
This is great news. There are no further preliminaries. I gulp; now I will actually have to go through with it.
FIVE
Sperm
MY GRANDFATHER on my mother’s side was a convicted murderer and child molester who abused all eight of his children. He was an alcoholic, a drug addict and almost certainly a psychopath, and was released after serving six years in prison for murder—of an old man during a robbery—two years before my mother was born. Most of us understand intuitively that the sins of the father don’t transfer down the generations in any measurable way, but I understand this more keenly than most. This man, my mother’s father, killed, robbed, cheated, beat his wife, raped his children and went on mad rampages with an ax, before keeling over from a brain hemorrhage brought on by the substance abuse that runs rampant in the family. And yet my mother was good, kind, just and loving, funny, cheerful and sane.
A few weeks after my dinner with William in London, he sent me a long, thoughtful e-mail telling me he had taken my request very seriously, calling his mother in Spain and discussing it at length, before coming to the conclusion that it would simply be too hard for him to father a child and not be involved in its life. To my surprise I was overwhelmed by r
elief. William supported what I was doing and wished me all the love and luck in the world and I was very touched by this, by both the lengths he had gone to and the concern of his e-mail. Now, with the clear conscience of having explored some alternatives, I was free to do as I pleased.
This is a tricky part of the story for me. Characterizing my relationship with L is hard, but in some ways characterizing the donor process is harder. It is the place where, in casual conversation with others, I’m most likely to feel curiosity lean toward prurient interest, where I find the question of navigating the line between being transparent and being gross the most difficult to call. There may come a day when it is as regular as milk to share details of one’s sperm donor—when there is a language less alienating to describe it than this, and that feels less compromising of one’s child’s essential privacy. But we are not there yet, and as I begin searching, I realize I have no idea how to calibrate this choice. Is it the biggest of my life, or one that is essentially meaningless? Underplay the donor and you risk turning the guy into the elephant in the room; go on about him too much and you risk pathologizing your child’s background. No matter how often I tell myself it doesn’t work like this, the fear of doing it wrong—of making the wrong decisions, with generation-deep consequences—is there from the outset.
At my desk, scrolling through profiles, I look for characteristics that align with my own. I want someone clever, which in this context means educated. I want someone with dark hair. I want someone whose favorite film isn’t Once Upon a Time in America or Titanic. In the absence of a metric for gauging a man’s humor or internal beauty or moral worth, I want someone tall and basically symmetrical. A choice is superficial only if it is made at the expense of deeper considerations and so, although I reject sperm donors on criteria that would outrage me if applied in real life by men, to women, I tell myself I’m not doing anything wrong. I want someone with a background similar to my own, to minimize the possibility of my child glamorizing the donor and also to lessen the number of items on my to-do list—take her to Peru; teach her Mandarin—to fill in the missing parts of her identity. This means a white, Anglo-Saxon (or, at a pinch, Catholic) American with western European origins, educated to the same or higher standard that I was—but not a writer, because I know writers and they’re messed up and I don’t want a journalist, either, in case I know him, or he’s a bad one and I dilute my good journalist’s genes with shoddy ones. I want someone with talents different from my own but that I think of as equally interesting (but not too interesting), i.e., not a marketing executive or a mime artist.
It strikes me that neither L, nor most of my male friends, nor I myself, in fact, would clear these filters, L on the basis of her job and religion, my male friends, who are funny and intelligent and most of whom can’t throw a ball, for reasons of height or athletic ability. And when I look at my own genetic heritage I can only laugh. If there is a single scenario in which having a murderer and a pedophile in the family tree is an advantage, it is here, now, as I sit at my desk trying to parse donor profiles for signs of degeneracy. Imagine the profile if I was an egg donor: five foot eight, 135 pounds, good liberal arts education and two generations out from your worst nightmare.
As for the narrowness of my selection criteria, all I can think is that it’s a mistake to see this exercise as equivalent to friendship or dating. I keep reading magazine pieces about “sperm donor parties,” or “egg-freezing parties,” as if having a child this way were not a series of sober, unnerving decisions but some mad version of a hen party. The donor banks are just as bad. They’re all called things like “Infertility Solutions,” making them sound as if they have a sideline in targeted killings, but when you visit the Web sites, most are set up to look like quasi dating services, their grammar and architecture reinforcing the lie that you are choosing a husband, a coparent and the progenitor of exactly 50 percent of your child’s face and personality. They go to great lengths to avoid the word “catalog,” but that’s what it is, pages of donor profiles with vital statistics, photos and numbers attached. Some of the Web sites even have a little shopping basket icon in the right-hand corner of the home page and an option to “check out”—both entirely for show, given that you can’t do any of this without making at least one phone call. Still, in the early stages of the search, you might be forgiven for thinking you were browsing online for a bath mat at Target.
Everything is extra. Thirty-five dollars for the guy’s baby photos. (Guidelines vary from state to state, but in New York, you can see only photos of the donor as a child.) Fifty dollars for an audio file. Some donor banks offer a “silhouette” of the donor as an adult, which would be hilarious if it wasn’t so creepy. What next—his breath in a jar to rule out halitosis? Handwritten personal profiles that delineate tastes, preferences and motivations for donating cost extra, too, although “impressions from the desk staff” are free of charge and also free of content. For example, “attractive, with a friendly manner” and “seemed quiet, but kind,” assessments it is impossible not to scrutinize as code.
It feels, simultaneously, like a deeply personal choice and like a parody of choice, one in which each further detail only adds to the sense of how shallow the data pool. And yet it is almost impossible not to invest it with meaning.
“You know,” says Oliver over a beer one night, “there’s a philosophical argument to be made for blind sperm allocation, where you can’t find out anything at all.”
He is needling me and it works. “Genes matter,” I say fiercely, then realize I don’t know to what extent I believe this. Sperm banks trade on the bogus idea that if you buy enough extras, you can filter your way to the ideal child—a claim, by the way, with a guaranteed 100 percent success rate, given that once a woman is pregnant, she is inclined to consider her baby not only ideal but inevitable. So I see the logic of “random selection.” It states, quite clearly, that we have no control over the genetic makeup of the child we produce; that all we can do is act in love and blind faith and hope for the best.
Still, I resist the idea of blind allocation. It seems monstrously impertinent, seeming to hold me and other women in my position to higher existential standards—that is, standards governed by rationalism rather than the gloopy emotional swamp out of which most of our motivations emerge—than women having kids with a husband’s sperm. The choice of donor may be meaningless in terms of a controllable outcome, but there is still huge emotional value to be had from making it.
* * *
• • •
HOW, THEN, to make the choice? For a single afternoon, I wonder if cost should be one of the factors.
There are, it turns out, as in every other consumer goods sector, cheap sperm banks and expensive sperm banks. The cheap ones have chaotic Web sites and no apparent door policy in terms of who can donate—the equivalent of Match.com but for sperm—where the cost is a couple of hundred dollars cheaper than the average and no one edits the profiles. I see one in which the donor, an unemployed twenty-two-year-old, answers the question “Why do you want to be a sperm donor?” with the answer “Need the money,” and wonder if this is the most honest man I will find.
Out of curiosity one day, I click on the catalog of egg donors and it is then that I notice a startling disparity. Brains come from the dad and looks from the mum, right? And so, while male donors at the expensive banks are almost all educated to at least the level of a master’s degree, female egg donors of equivalent value are by and large indifferently educated. They have high school diplomas and degrees in sports science. But they all to a woman look like Ukrainian models.
“You know it’s probably all Dr. B’s, right?” says L.
“That’s gross.”
“Think about it. I bet every kid conceived in this place comes from his sperm.”
Variations on this theme become a running joke. “For all I know, it could be the janitor’s!” I say to friends and it raises a laugh, as
if this were the most hilariously terrible fate that could befall an educated woman—janitor’s sperm! Imagine! Then we sober up and acknowledge that, of course, there is nothing wrong with being a janitor and the act of choosing a sperm donor sadly flushes out the fascist in all of us. It formalizes the worst aspects of human nature. It makes us mean. It turns us all into John Galliano. Legitimize these impulses and before you know it we will be trading babies on eBay, classified by height, weight, IQ and color, for anyone to buy and return.
This is ostensibly what the legislation is for; to save us from ourselves and prevent the advent of “designer” babies. In reality, of course, a lot of the legislation around fertility treatment is based on religious principles designed not to rule out eugenics but to prevent the “wrong” kind of people from having children. In Italy, use of sperm or egg donors was banned across the board until the high court overturned the law in early 2014, but the right to assisted reproduction is still restricted for “single parents, same-sex couples and women beyond childbearing age.” An estimated four thousand Italians a year go abroad seeking help, mostly to Spain.
In Switzerland, donor sperm can be used only by heterosexual married couples who have been married for at least a year before treatment. (It’s a shame they don’t transfer some of this moral zeal to their banking laws.)
The UK has among the most progressive laws in Europe. There are no restrictions on who can be treated, but to prevent accidental inbreeding, there are limitations on the number of families to which an individual donor can contribute; in this case, ten. In Norway it’s eight, in Sweden it’s six. In New Zealand, it is a maximum of ten kids among a maximum of four families. In France, there are no restrictions on sibling numbers within a single (heterosexual) family, but no more than six families may be helped by a single donor.
And then there is America. Guidelines issued by the American Society for Reproductive Medicine recommend that each donor be limited to no more than twenty-five births per 850,000 of population and most responsible sperm banks impose narrower restrictions than this. But in terms of actual inviolable laws, there are none. There is no central tracking system for children born of sperm or egg donors and no legal obligation for the clinics to submit records. It is completely and utterly unregulated.