A Perilous Conception

by Larry Karp

  James had a history of borderline paranoid schizophrenia, had been doing well for years on psychotherapy and medication, but he’d gotten himself fired from several retail clerk jobs after customers complained about what they took as insults or smart-alecky comments. This translated into endless bouts of relapsing financial pins and needles.

  Joyce, a biology teacher at Emerald Community College, had the anatomy, physiology, and biochemistry of conception down pat, which made the couple’s failure—her word, not mine—all the more galling. She’d tried a bunch of dietary manipulations and folk remedies, none of which were any more effective than traditional approaches.

  I brought up the possibility of adoption, but the two of them shot that down in a hurry. Joyce insisted she was going to have “my own baby,” no ifs, ands, or buts. “And it’s going to be my baby, too,” James barked. “No way some other guy’s sperm is going to get her pregnant, not if I have anything to say about it.”

  Joyce rested a hand on his arm, something I’d seen her do before when he looked like he might be about to lose it.

  Once I saw his muscles relax, I reviewed the past eleven months of investigations and treatments, and was about to launch into an explanation of a journey through the terra incognita of infertility, when Joyce gave James a look that brought me up short. It asked, “Are you ready?”

  He nodded.

  Joyce turned back to me. “We’ve decided to go to the University.”

  Like a slap in the face. I was stunned. “Why?”

  “We thought it would be a good idea to see one of the infertility specialists there.”

  I shook my head. “I guess you can do that, but they don’t know anything I don’t know. I read the same journals they do, and attend all kinds of conferences at the U and around the country.”

  James pulled at the back of his collar. Joyce sat a little straighter in her chair. “They work in this field all the time, but it’s only a part of your practice,” she said. “Maybe there’s some new research that isn’t even published yet.”

  They were going, no question. Infertility patients are like trains with disabled brakes. They wanted the benefit of new research. Were they thinking of in vitro fertilization? They weren’t about to get that at the U, though, were they?

  But they couldn’t get it from me, either. I swallowed bile, got up, and extended my hand. “I wish you luck,” I said. “Keep in touch. If they help you conceive, I’ll certainly want to know the details.”

  James nearly fell over his feet, thanking me for trying to help. He pumped my hand as if he expected to see water gush out of my mouth. Joyce was cooler, but still cordial. “I’ll definitely let you know,” she said. “And if we’re successful, I’d like to come back and have you take care of my pregnancy and delivery.”

  Knickknack, paddywhack, toss the dog a bone. “It would be my pleasure,” I said.

  ***

  For the rest of the afternoon, I had to force myself to keep my mind on business at hand. After the office closed and I’d written up the charts for the day, I walked across the skybridge to the University Medical Complex, stopped by the cafeteria, grabbed some dinner, and picked at it. This was my personal Pearl Harbor, and I was not about to lie down and let those hypocritical University bastards wipe out my practice. I had an idea, which, I’ll admit, made me more than a little nervous. If it didn’t work out, things could get ugly.

  But what if it did work out?

  I left my tray with most of the food uneaten, no great loss, hustled out of the cafeteria, and down the hall to the Med Center Library.

  The library closed at midnight, and that’s when I left, stepping lively, carrying a fistful of copied journal articles from medical centers around the world. The papers described the scientific and clinical procedures which one day might produce babies through in vitro fertilization, and discussed the ethical and religious arguments that swirled around those procedures. Catholics were opposed, no surprise, but the secular ethicists were split into two camps. One group was as strongly opposed as the Catholics, claiming that since there was no way to tell in advance whether the procedure was safe and would produce normal children, it constituted unethical experimentation on the unborn, or even on the unconceived. The other group insisted the work was right and proper, because it might both alleviate the human misery of infertility, and give life to individuals who otherwise never would exist.

  It was clear a race was on to be first to the finish line, and that the leaders were a team in England, consisting of Robert Edwards, a physiologist who’d spent some time doing research at Johns Hopkins, and Patrick Steptoe, a clinical gynecologist. Edwards seemed to have gotten a good handle on the protocol for fertilizing human eggs and culturing embryos. Steptoe’s expertise? He was a leading laparoscopist who’d published a book, “Laparoscopy in Gynaecology,” which I’d read hot off the press in 1967. In the journal articles, he’d described his approach to recovering human eggs from ovaries just before ovulation, and I had no trouble seeing that with a little practice, it would be a piece of cake for me. The question was whether Giselle Hearn could pick up on Edwards’ reports, and do the laboratory side of the work as well as I could do the clinical.

  ***

  Once I set my mind to an idea, I never waste time. Next day, after I finished with my morning patients, I hustled across the skybridge to the Department of Obstetrics and Gynecology, then down the hallway to the research wing, and into Dr. Hearn’s lab area. Hearn was standing in a corridor, talking to a young woman in a white coat, probably a tech. I waited until the girl smiled, nodded, and walked away; then, before her boss could move on to whatever she had in mind to do next, I walked up to her. “Dr. Hearn.”

  She had no idea who I was. “I’m Colin Sanford. I practice OBGYN at Puget Community.”

  Her face said, “Then why don’t you go off and practice a little OBGYN?”

  “I need to talk to you,” I said.

  “About what?”

  “I have an idea I’m pretty sure will interest you.” Then, I added, “I was at your conference last week.” I looked around to make sure no one was close. “Gerry Camnitz is not only a pompous ass, he’s a stupid man. You should be able to extend your work to humans, and I know how you can do it.”

  She didn’t know what to make of me, and I couldn’t blame her.

  “We can’t talk about it here,” I said. “Let me take you to dinner tonight.”

  That earned me a world-class fish eye.

  “Dr. Hearn, I’m not trying to mash on you, and I’m not playing games. I’m as serious as I’ve ever been. I don’t think you’ll want to walk away from my proposal. Meet me at Charley’s Boathouse, seven o’clock, and I’ll tell you about it.”

  She didn’t say yes, she didn’t say no. Just stood there, trying to sort me out.

  “What can you lose?” I added. As it turned out, only her life, but how could I know?

  ***

  Charley’s is a posh seafood house in the Sunset Bluff neighborhood, out on a pier over the edge of Puget Sound. As I sat at a prime window table, waiting for Dr. Hearn, I could hear waves breaking against the shore. By ten past seven, I was beginning to wonder whether she was going to stand me up, but then the hostess brought her over. I stood to help her into the chair. “I’m sorry to be late,” she said. “Parking was awful.”

  “They’ve got valet parking.”

  “Not to be offensive, Dr. Sanford, but PhDs don’t have quite the discretionary cash MDs do. We tend to cut corners when we can.”

  I let the hostess move out of earshot, then said, “What I want to talk to you about will take care of that.”

  For the first time, she smiled, but it wasn’t a smile of amusement. It was pure skepticism. I handed her a menu. “The halibut stuffed with crabmeat is terrific. Let’s order. Then, I’ll start filling yo
u in.”

  ***

  When the waitress walked away, Dr. Hearn nodded in my direction. “All right. I’ve got to admit, I’m curious to hear what you have in mind.”

  “Let me ask you a question first,” I said. “About Gerry Camnitz. Why is he so set against your doing any work on human gametes?”

  She reached for her water glass, sipped, didn’t take her eyes off me. “How do I know Gerry didn’t put you up to this, and you’re not going to go back and tell him what I say?”

  “It’s that bad, huh? Look, Dr. Hearn. I’m just a humble downtown doctor. Do I seem like someone Herr Professor Camnitz would send out on a spy mission?”

  I’m good at using a preposterous little remark to loosen up a nervous patient, and the technique worked on Hearn. She laughed. “No, I’ve got to say, you don’t,” she said. “I guess if I’m wrong, fine. You can tell Gerry to shove my job up his ass. I don’t really want to leave Emerald, but I’ve got to get out of his department. I’ve already sent feelers to a few places.”

  “When we get done with Camnitz, you won’t have to move anywhere but into a bigger house,” I said. “Tell me where he’s coming from. What’s his problem with having you do human research?”

  She sighed. “That idiot. He’s exactly what you said this afternoon, pompous and stupid. He’s afraid of the heat he might get from religious and conservative groups, and worries that if the wrong people manage to get onto National Institutes of Health research committees and find he’s been allowing work on human eggs or embryos, he might get blacklisted for federal grants.”

  “Is that likely?”

  “I’d say no. But Gerry always wants to play the safe hand. And God forbid he should take any chances with his social standing. Do you know Horace Bancroft?”

  “Big-time lawyer. Very Republican. Wasn’t he chummy with Goldwater?”

  “One of Barry’s biggest contributors. He also keeps the Catholic church in Emerald in pocket change, and for good measure, he’s on the University Medical Center’s Board of Directors. Roe v. Wade damn near gave him a stroke. Let his son-in-law permit experimentation on human eggs and sperm, especially if there’s any kind of public controversy, and Gerry’d be selling apples on a street corner.”

  I smiled. “That’s an interesting image.”

  The waitress set salads in front of us. The smell of hot sourdough bread rose from a napkin-covered basket she set at the center of the table. Giselle’s stomach gurgled; she went red. I laughed. “Good. You’re hungry.”

  I broke off a piece of bread, slathered on butter. Then I used the bread as a pointer. “So you’re going to be left at the gate, gnashing your teeth, when Edwards and Steptoe make their big announcement about the first in vitro fertilization baby.”

  Halfway to her mouth, Giselle reversed course, and set her forkful of lettuce back onto her plate.

  “Right,” I said. “You’ve been fertilizing mouse eggs and culturing the embryos. If you had permission, how soon could you be doing human work?”

  “I could start tomorrow,” she snapped. “Not that I’d expect to have much success right off the bat. I keep up with the literature, and I’ve got friends in a couple of labs I could talk to. But there are always intangibles. What works in one place may not work in another.” She narrowed her eyes. “How is it you’re so familiar with human embryo culture?”

  “Since I’m a commonplace clinical doc?”

  She didn’t back down. “If you want to put it that way. I don’t expect a clinician to know any more about embryo culture than I know about delivering babies.”

  “I know how to read journals,” I said. “Not that I’d understand nearly the details you would, but I can get the gist well enough. Including that it takes two highly-skilled people to pull it off, a scientist with enough dedication and know-how to fertilize eggs and grow embryos, and a doctor with unusual laparoscopic skill who can get preovulatory oocytes in good condition to that lab worker. And those two people are sitting at this table.”

  She took a cautious mouthful of salad, not taking her eyes off me. “Why?”

  “Because I know what’s out there for the winners of this race. Names in history books. Magazine interviews, newspaper articles, TV shows. Lectureships. For me, a line of patients outside my office door and halfway down the block. For you, grant agencies lined up outside your office and halfway down the block, begging you to relieve them of their research funds. And the joy of being able to tell Gerry Camnitz where to get off. I’m betting if Hearn and Sanford go to work, they’ve got a damn good chance of beating out Edwards and Steptoe. But every day we wait lowers our odds. Wouldn’t you like to jump right into a full professorship? And give your car to the valet at Charley’s Boathouse?”

  “A full professorship, huh?” Her eyes couldn’t carry off the skepticism she tried to put into her voice. “I have about as much hope of that, being a PhD and a woman, as I have of waving my arms and flying.”

  “True right now,” I said. “But as half of the first team to get an IVF baby, it’d be a whole new ball game for you.”

  The waitress took our salad plates and set the crabmeat-stuffed halibut before us. Giselle didn’t even look at hers. “Nitty-gritty time,” she said. “How is all this supposed to happen? Where do I get the equipment and supplies I’d need?”

  “Whatever you can’t free up from what’s already in your lab, I’ll subsidize. And then I’ll get ova for you from my laparoscopy patients. I’ll tell them it’s for infertility investigations, true enough, and to compensate them for the inconvenience of needing hormone shots to time ovulation to their procedures, I’ll write off any of my professional charges not covered by insurance.”

  She frowned. “Is that ethical?”

  “What’s wrong with it? Everyone comes out ahead. I’m not going to coerce anyone, just give them a choice. I’ll get sperm from med students, the same as I do for artificial inseminations. Then, you’ll do the fertilizations and cultures on the QT. When we’ve got it all down pat, we’ll start doing it for real. If we’re careful, Gerry Camnitz won’t know a thing until we announce success, and at that point, with pictures of that beautiful little baby in every newspaper on earth, whatever complaint he’d make would be like pissing into the wind.”

  A smile spread across her face, then faded. “The schedule of ovum maturation, fertilization, and embryo development is pretty rigid and unforgiving. Working on my own, I’d have to put in some long and odd hours.”

  “You expect sympathy from me? With what I do for a living?”

  She laughed. “Touché. But you’d better know how much money you’d be laying out. I’d need a sterile hood with a heat plate, a temperature-controlled CO2 incubator, a centrifuge, a phase-contrast microscope, and a good dissecting microscope. All together, that’s probably twenty to twenty-five thousand dollars.”

  “I’ll put every cent where my mouth is,” I said. “It’ll be the best investment I’ve ever made. Give me the specs on the equipment, tell me where to get it, and I’ll have it for you inside a week.” I motioned toward her plate. “Eat up. Then we’ll sort out details.”

  ***

  I was right. It came off like gangbusters. Giselle appropriated an alcove in her lab complex where she could work privately, and then, late one night, I came in and helped her set up the hood, microscope, centrifuge, and incubator, and move in supplies, everything from sterile gloves to petri dishes to pipets. The next day, I made my first arrangement with a patient: in exchange for her having a series of hormone injections prior to her upcoming laparoscopy twelve days later, I would waive my professional fee, no small consideration since the procedure was being done as part of an infertility workup, and medical insurance companies notoriously do not pay for infertility work.

  For the first month or so, I did struggle a bit with the ovum recoveries, and Giselle h
ad to fiddle with modifications of the standard Biggers, Whitten, and Whittenham culture medium, but by the time we’d done twenty retrieval and culture attempts, the work was going smoothly. Three of the patients ovulated before their scheduled procedures, and in another two, there were no eggs in the fluid I aspirated from their ovaries. But seventy-five percent recovery seemed pretty much in line with the rates I’d seen in journal articles, so I was satisfied.

  For her part, Giselle got half of the eggs fertilized and developed to the stage of four- to eight-cell embryos, at which point it would have been time to introduce them into the uterus and hope they’d take root. She called me over there to see the first one, and it was something I’ll never forget, peering through the microscope at that little clump of cells, shimmering in the culture medium. My heart actually skipped a couple of beats. It killed me to see Giselle pull the embryo out of culture and stain its cells to make sure its chromosomes were normal. But we had to be certain we weren’t going to turn out malformed babies.

  By the end of June, we’d had twenty-two successful retrievals, fertilizations, and cultures. Giselle was a little reluctant when I told her I thought we should go ahead and replace an embryo. I asked what she was waiting for. “Our success rates are as good as any in the published literature, and we don’t really know how far along Edwards and Steptoe are, do we? If they happen to beat us to the finish line, we stand to lose a lot. First in the USA would be good, but nothing like first in the world.”

  So the next afternoon, I got Joyce Kennett on the phone, and asked how things were going at the U. I was more than pleased to hear the super-specialist professors had been no more successful than I’d been. I told Joyce there were some new developments in the field, and that if she’d like, she and James could come in and hear about them. She liked. We set up a meeting for the next afternoon.

  They’d looked nervous six months before, but that was nothing compared to their appearance now. James shifted constantly in his chair, kept wiping the back of a hand across his mouth. Joyce was practically twitching. “I’ve got an interesting possibility for you,” I said. “But before I say anything about it, I’m going to ask for your promise that you won’t discuss it with anyone, even if you decide against it.”