A Perilous Conception

by Larry Karp

  They turned puzzled faces to each other, then to me.

  “It’s a controversial procedure,” I said. “Perfectly legal, but there are people who object to it on religious grounds, or on the basis of their own system of morals or ethics. I suspect they’d try to make life uncomfortable for any couple who decided to give it a go.”

  Joyce got it. “You’re talking about in vitro fertilization, aren’t you?”

  “I need a promise,” I said.

  Another look at each other, then they both nodded.

  “All right. Yes, I am talking about in vitro fertilization. I believe it’s a good procedure, and eventually it’s going to be routine. Right now, doctors all over the world are trying to get it done. An English team at Cambridge seems to have the inside track, but I’ve been working quietly with a very knowledgeable embryologist here. She’s at the point now where she gets fertilization and embryo development in about half the eggs I recover.”

  Joyce was nearly off the edge of her seat. “How many embryos has she cultured?”

  “Successfully? Twenty-two.”

  “And how is it you’re involved? Why isn’t this a University research project?”

  I didn’t try to hide my grin. “I could give you the stock answer, that I just don’t know, but I’ve always been honest with you. I do know. Dr. Hearn, the embryologist at the U, is the equal of any scientist anywhere at doing these procedures, but the department chairman is as conservative as they come, so Dr. Hearn’s been doing her work in private. The other half of the equation is the need for a doctor who’s especially good at laparoscopy. That’s where I come in, and I have no institutional rules to hold me back.”

  “But hey, wait a minute. Aren’t you worried about what’ll happen when that chairman at the U finds out?” The first words out of James.

  “When the world looks at your smiling face and Joyce’s, and the gorgeous baby in her arms, nothing Dr. Camnitz might say would mean a thing.”

  “If the baby is gorgeous,” Joyce said. “What if I miscarry? Or worse, what if it has a terrible birth defect?”

  “If you miscarry, no one will know anything,” I said. “Women miscarry every day. And if there’s a birth defect, well, about three percent of all babies conceived naturally have significant birth defects. The important question is whether the rate of abnormalities is higher after conception in a plastic dish, and there are two reasons to think not. One is that Dr. Hearn’s cultured embryos have looked normal and had normal chromosomes. And second, all evidence indicates that when a very early embryo isn’t developing right, it’s miscarried.”

  Joyce nodded. “Of course. That’s true in all animals. But, Dr. Sanford, what would this work cost us? You know we’re not—”

  I held up a hand. “The only cost you’ll have will be hospital bills for the laparoscopy when I retrieve the eggs. No charges for my work, or Dr. Hearn’s. But while we’re talking about money, here’s something to think about. The parents of the world’s first IVF baby will be in a position to earn a bundle from endorsements of everything from baby food to diapers, never mind all the magazine and TV interviews. Remember the Dionne quintuplets, back in the ‘thirties? Those little girls made their family’s fortune. The first in vitro baby will get at least that much attention.”

  The longer I spoke, the more James frowned. “I wouldn’t feature living in a fishbowl.”

  Joyce put a hand to his arm. “That would be our choice,” she said. “I’m sure Dr. Sanford wouldn’t release our names unless we agreed to it.”

  “No, I wouldn’t,” I said. “But the truth is, if I don’t announce who you are, some reporter is almost certainly going to get into the hospital records and find out. On the other hand, a new house, an unlisted phone, and an agent should take care of the worst of it, and still keep money coming in.”

  “We should think about that,” Joyce said.

  “It sounds like you’ve already made up your mind.”

  James didn’t sound as if he’d made up his mind. “You can go home and talk,” I said.

  Joyce waved me off. “I have made up my mind. I know enough as a biology teacher to be comfortable that there really shouldn’t be any major risk to either the baby or me. And if I turn down the opportunity, what am I going to think when I read about some other woman who had more courage and ended up with a baby? I’m thirty-one, James. We’ve been married two years, and been through every investigation and treatment available. I’m at the end of my rope. If Dr. Sanford can do what they won’t try at the University, more power to him. If he succeeds, I’ll have the thing I want most in the world, and he’ll make his career, fair enough. And as far as money’s concerned, wouldn’t it be nice to have that kind of security? I’m not going to let anyone else raise my child, which means I’d need to stop working.”

  James was a bright enough guy, but he had a good dose of the quirkiness you often see in paranoid schizophrenics. He picked at a fingernail. “Well, if that’s what you want, Joyce…but I guess I’m nervous about you being a guinea pig.” He turned to me. “You’re sure this Dr. Hearn of yours has had enough experience? I sure wouldn’t want her screwing up on my wife and baby.”

  More of James’ schizophrenia. Suspiciousness, and a short fuse. Again, Joyce reached a hand to his arm.

  I talked fast. “James, there are never guarantees any time a woman gets pregnant. But Joyce isn’t going to be a guinea pig. The experimental work’s all been done, and it’s gone beautifully. And replacing the embryo is straightforward. We push a little fluid with the embryo in it up into the uterus through a tiny plastic catheter. Like giving an injection.”

  Again, Joyce and James looked at each other, and as couples seem to do, came silently to agreement. Joyce looked back at me. “When can we start?”

  “When was your last period?”

  She sagged in her chair. “I started three days ago.”

  “That’s all right. While you go through this cycle, I’ll keep Dr. Hearn in practice. Call me when you start your next period. We’ll set up a schedule for the hormone shots to prime your ovaries, and arrange for the laparoscopy at the best possible time. Sound all right?”

  Joyce smiled. “Yes.”

  James chewed his lip, and nodded.

  ***

  I can’t say it went entirely like clockwork. As uptight as Giselle was, I figured I might have to untie a knot or two in her knickers, and in fact, I did need to steer her around one bump in the road. But in my line of work, I’m used to anticipating and dealing with complications, and if I say so myself, I’m good at it. Six weeks after my talk with the Kennetts, I retrieved five ova from Joyce’s bulging ovaries. Giselle took them from the operating room to her lab, and three days later, she had three apparently-normal embryos, two eight-cell, one four-cell. I got Joyce and James right in, and suggested we put all three into her uterus. That way, there would be three times the chance of an implantation, worth the risks of a multiple pregnancy. It took Joyce exactly no time to say, “Go ahead.”

  James chose not to watch the procedure, which was fine with me. I told Ruth Ellen, my nurse, that Dr. Hearn had developed a new procedure for treating sperm so as to make them more effective at attaching to eggs and penetrating them. She got Joyce into one of my exam rooms while I called Giselle, who came over the skybridge with a cart holding her dissecting microscope and a small incubator. While she set up at the side of the room, Ruth Ellen helped Joyce onto the table and into stirrups. I did a quick manual pelvic exam, then slipped in a vaginal speculum, checked the cervix, and gave silent thanks that it was perfectly straight. If it weren’t, I’d have had to grip it with a tenaculum, a surgical instrument with two sharp points, not only uncomfortable for the patient, but also a stimulus that might produce a uterine cramp which could push the embryos right back out.

  Ruth Ellen handed me a thin plasti
c catheter, the kind we use for intrauterine insemination. Slowly, gently, I passed it through the cervix. No resistance whatever, bingo. “All good, Joyce,” I said. “Practice run perfect. Ready for the show?”

  “Let’s do it.”

  “She’s a trouper,” Ruth Ellen chirped, and patted Joyce’s hand.

  While I was doing the preliminaries, Giselle got the embryos ready for delivery. The night before, we’d gone into her lab, and I’d watched her rehearse the procedure. It involved attaching a one-c.c. syringe to a catheter, then drawing the embryos in five to ten microliters of fluid from the culture dish into the end of the catheter, and leaving a minute air bubble at the catheter tip. Straightforward, but delicate.

  I’d thought I might feel nervous, but I was cool as a Popsicle as I took the syringe and catheter from Giselle’s trembly hand. Still, I slid the catheter through Joyce’s cervix as if it might explode under less-than-meticulous attention. As I pushed the plunger, I surprised myself by breathing out a huge “whoof.” We’d pulled it off, done all we could. Now it was up to biological chance.

  I left Joyce with Ruth Ellen while I walked Giselle out of the office and to the elevator. As I came back through the waiting room, James flew out of his chair, nearly knocked me over. “Did it go all right, Dr. Sanford? Is Joyce okay?”

  “It went fine, and she’s fine,” I said. “Come on, I’ll take you in. I’m going to admit her to the hospital overnight to keep her at strict bed rest with her head lower than her rear end. Let’s give those little guys every chance to implant.” Not that I really believed topside-down bed rest would do anything useful, but I was of a mind to dot i’s and cross t’s.

  ***

  The next four weeks seemed like four months, waiting to do a definitive pregnancy test. I ordered weekly serum tests, the kind we used to help diagnose an ectopic pregnancy, and they were promising, very promising. But I didn’t want to set Joyce and myself up for a massive disappointment. Finally, on September 8, 1976—I’ll never forget the day—I ordered both a blood and a urine sample, check and double-check. Joyce was as bubbly as she was twitchy. “I know they’re going to be positive,” she said. “The last three days, I’ve been really green around the gills.”

  Could be just nerves, I thought, but my own stomach did a back-flip. I smiled. “Fingers crossed.” A couple of hours later, the results were back: “Both serum and urine HCG levels consistent with normal pregnancy at six weeks menstrual age.” That evening, Giselle and I had lobsters and champagne at Charley’s Boathouse.

  ***

  Next morning, after rounds, as I walked down the corridor to my office, a woman stepped into my path from the little nook outside the rest rooms. “Dr. Sanford, I need to talk to you.”

  She looked familiar.

  “You don’t know who I am,” she said.

  “I’ve seen you—”

  “I’m Alma Wanego, the supervisor in Dr. Hearn’s laboratory.”

  “Oh, sure. Of course. Sorry.”

  “That’s all right. No reason you should have noticed me. I need a few minutes of your time.”

  I checked my watch. “I don’t want to be late to my patient appointments. Can we talk later? Over lunch?”

  “I think we’d do best to talk now, Doctor. I won’t take more than twenty minutes.” She gestured with her head toward the elevators. “Let’s go down to the coffee shop.”

  Everything about her was severe. Her face looked chiseled out of marble, thin lips, tightly drawn, not a hint of a smile. Blue eyes cut from a glacier. Long blonde hair, waved down over her right forehead, every hair strictly in place. Poker-straight posture. Sharply cut gray suit with thin white stripes. Her tone and manner said she was someone not used to being contradicted or corrected. I was caught off guard by a feeling of strong sexual attraction, one that carried a warning: take on the Ice Queen if you dare, but if you fail, you die.

  I nodded. “All right.”

  Once at our table, steaming cups of coffee between us, Ms. Wanego turned those twin blue jets of frost on me. “I’ll be direct and clear, Dr. Sanford. To save you the time of playing what’s-all-this about, I know what you and Dr. Hearn are up to. Remember that little incident in the lab on August 9? I saw all of it, including you rushing over and into Dr. Hearn’s office, then off double-time to the supplies room, and then down the hall. I also happened to be standing outside the men’s room a short while later. Are you with me?”

  “I’m listening.”

  “So after everyone else left that afternoon, I found the project log in Dr. Hearn’s desk. The patient for that day was coded as JK, so it was no problem to check the Puget Community Surgery Unit records and see you’d done a laparoscopy for lysis of adhesions on a Joyce Kennett. I kept my eye on Dr. Hearn, and three days later, when she ducked off into her alcove, wouldn’t talk to anyone, then went rushing out with a wheeled incubator and a microscope, I followed her.”

  “You followed her?”

  For the first time, I got a smile, but not one you’d want to see on the face of somebody who had the goods on you. “Yes, I followed her. Right to your office. And then I counted ahead on the calendar. When Dr. Hearn got a phone call yesterday, and practically floated around the lab like a helium balloon, I called the hospital laboratory, told them I was your receptionist, and I needed the result of a pregnancy test on Joyce Kennett. She said she’d already given the result to someone, so I said we were a little uncoordinated right then, and could she please give it to me one more time.” Another smile. “Congratulations, Dr. Sanford. The first IVF baby in the world.”

  She flicked the tip of her tongue across her lips. “That should be worth a lot to you and Dr. Hearn, not to mention Mr. and Mrs. Kennett. But a few words from me to Dr. Camnitz, and that would be the end of this collaboration, and probably also the end of Giselle Hearn’s career. I imagine your reputation would also take a pretty substantial hit, especially considering that little accident you thought you’d covered over. But I know how to keep a secret. For ten thousand dollars, cash, my lips will be sealed.”

  The oddest thing. The way she was looking at me right then should’ve made me want to smack her in the face, but what I really wanted was to throw her to the floor, jump on top of her, and start tearing at her clothes. Her expression was an invitation to go at it, very hot and very heavy. Her modus operandi, I thought, and figured it must have won her a ton of arguments and negotiations. But I was not about to let this discussion go past the talking stage. The frying pan wasn’t comfortable, but that would be one ugly fire to jump into.

  I tried to play for a little time, shot my cuff and looked at my watch. “You said not more than twenty minutes, and—”

  “That was for talking. Now, look. Don’t even try telling me you have no idea where you’d come up with ten thousand dollars. That’s ice-cream cone money to you, Doctor. You have two choices. Come across with the money, now, or I go straight to Dr. Camnitz’s office. This is not negotiable. What’s your decision?”

  “Sorry,” I said. “But I do have a couple of questions. When’s the next time you’ll be knocking on my door with your hand out?”

  She clearly didn’t like to be on the receiving end. “I said I want ten thousand dollars, and that’s what I’ll take. I keep my bargains. What’s your other question?”

  “What are you demanding from Dr. Hearn?”

  “Nothing. I need to work with Dr. Hearn, and I’m not a stupid enough bird to foul my own nest. This matter will be entirely between you and me. Do you have any more questions?”

  I pushed my chair away from the table. “There’s a phone booth at the corner. I’ll call my office and tell them I have an emergency.”

  ***

  I didn’t want to risk phoning Giselle at the lab, so I waited till evening, and called her apartment. “We’ve got a problem,” I said. “With that,
uh, complication we had on the way to getting Joyce Kennett pregnant.”

  I heard a gasp. “Oh, no. Look, Colin, I’ll take the blame for that. I’ll apologize to the Kennetts. I really should have done that when it happened.”

  “Wait, there’s more. But let’s not talk over the phone. I’ll come right by.”

  ***

  Giselle’s apartment was only a few blocks from mine. She rang me in, then had the door open before I got up to her floor. “I made some coffee,” she said.

  I almost said we might want something stronger, but no need to get her more upset than she already was. “Good. Bring it on.”

  She listened quietly to my story. I thought just as well to spare her the sexual component of the exchange, but told her everything else. When I finished, she blew. “Oh, that snotty little creature. Sometimes it takes all I have to keep from giving it to her, bang, right in her arrogant, condescending kisser. Ten thousand dollars? I could kill her.”

  “But it’s your lab, isn’t it? Why don’t you can her?”

  “Hah. Good question. Look for the fine hand of Chairman Camnitz. When the job opened up, Gerry told me he wanted Alma appointed. He said he thought she had what it took to keep a bunch of techs in line and working efficiently. She’d been a good tech, but I had real reservations about her management skills. Gerry wouldn’t budge, though. The techs hate her, all of them. They file complaints, they threaten to leave, and one of them actually did quit. I spend way too much time trying to pacify them and bitching to Gerry, but he sticks to his guns. If he tells me one more time about cracking eggs and making omelets, I may kill him.” She made a wry face.

  “What do you think? Wanego said she keeps her bargains, and this would be a one-time payoff. Do you see that happening?”

  “In a word, no. She’ll be back, but not necessarily the next time she wants to buy something. With Alma, I don’t think money is really the thing. She seems to get off on winning when she can rub the loser’s nose in it, the harder, the better.”