Conceivability_What I Learned Exploring the Frontiers of Fertility

by Elizabeth L. Katkin

  All your eggs would be damaged. Could this be true? That’s all I could hear. After all I had been through, how could I not know this? Could the basic premise of five torturous, expensive, and sad years’ worth of IVF—the very cornerstone of Western medical reproductive orthodoxy—be wrong? I could still have good eggs? Or I could get them again?

  If it were true, in addition to increasing the chance of conception, her approach would also potentially increase the odds of keeping the pregnancy. Given that chromosomal abnormalities, which cause more miscarriages than all other known causes of miscarriage combined, most often result from an abnormal egg, could we have been doing something more effective all along not only to conceive but also to help prevent the miscarriages? These are the questions that would haunt me, and drive me, from that moment on.

  * * *

  Dr. Oxana explained that her detox plan—comprising a number of homeopathic remedies from a German company named Heel, together with the necessary daily multivitamins and the elimination of all plastics (bottles, containers, Tupperware) from my life—was designed to rid my body of its high level of toxins, creating a healthy environment for the growth of my eggs. The low dose hormone protocol was intended to minimize any damage from the current IVF cycle. Her goal: to stimulate healthy eggs using the least invasive means possible.

  We began a complex negotiation, the Russian doctor and the American lawyer.

  “Your eggs, use surrogate.”

  “Donor eggs, carry myself.”

  A standoff.

  Dr. Oxana was absolutely insistent that my own eggs would work with her regime. But I was skeptical of her plan—doctors I had trusted believed I had no good eggs left, and I had certainly never heard of improving egg quality—so I pushed to use donor eggs, despite my continued unease, as backup.

  As for my carrying the baby, however, Dr. Oxana had concerns. She was very worried about possible immunological and anatomical challenges to my carrying to term. She felt that my antiphospholipid syndrome and elevated natural killer cells posed significant risks, and she also worried about the unusual shape of my uterus. She explained that embryos would prefer to implant in a nicely shaped uterus with a smooth surface, and my arcuate or septate (irregularly shaped, almost bifurcated) uterus did not present the most welcoming environment. She seemed somewhat irritated that my file contained virtually no information on the shape of my uterus, the sole letter regarding my HSG test the only evidence they had ever looked at it. She said my uterus “did not make her feel good” about my prospects for implantation, and urged me to use a surrogate to protect against miscarriage.

  She admittedly had good points, especially with regard to my carrying. Yet she couldn’t sway me. Intoxicated with the idea that all my miscarriages may have been due to poor egg and therefore poor embryo quality, I felt there was no reason I shouldn’t be able to carry myself with good eggs—someone else’s good eggs, that is. And as much as I wanted to believe her and felt tantalized by the prospect of my own biological child, I just couldn’t get my head around the idea that she could find good eggs in me, at age forty, when every doctor, embryologist, nurse, ob-gyn, and article I had ever read assured me that my aging eggs were no longer viable.

  We compromised, agreeing to proceed, unusually, with a dual cycle: a donor and I would both go through the egg stimulation protocol at the same time, and we would select the best quality embryos to transfer to me to carry.

  Managing the cycle was, admittedly, a little more complex than the others, and believe me, I was used to complexity. Dr. Oxana was in Moscow, I lived in Dubai, and I had to obtain specialized products from Germany. She started out by requiring me to follow her detox plan for forty days, and we made an appointment for my return visit for blood tests. Fortunately, the flight from Dubai to Moscow was only three hours, and I could do it as an overnight trip, but it was a heck of a long way to go for a blood test. Seven weeks later, I was back in her office. The nurse drew my blood. I waited. I saw Dr. Oxana for about three minutes. She told me I wasn’t ready. Forty more days. I flew back home. Repeat.

  While on Dr. Oxana’s homeopathic detox protocol, I studied lists of potential egg donors: height, weight, hair color, eye color, face shape, blood type. Per Russian law, no photos were allowed. I presented the contenders to Richard. The trick was to try to imagine a girl in Russia who looked like me, which actually wasn’t too hard, since I am largely of Russian Jewish descent. The woman who managed the list at the clinic was outspoken and opinionated, but also helpful. I e-mailed Katya, the translator, to enquire about a few candidate numbers (the women were nameless, of course) and her answers never failed to crack a smile. “She is a fine donor, but looks nothing like you.” “She is a nice girl, but I am not sure if you would be happy.” That one intrigued me. She told me later that she wasn’t very bright, “certainly not suitable for a lawyer.”

  Selecting an egg donor is like holding a mirror up to yourself and wondering what you might choose to see if you had the power to change things. Did I want an egg donor who was taller? Or exactly my height? With my color eyes, or perhaps bright blue? Blond or brunette? Someone athletic? Well educated? Had a career? The choices never stop. The process forced me, somewhat uncomfortably, to confront what mattered to me in choosing the genetic material for my child. And then, it overwhelmed me. Uncomfortable with the role of creator, I simply deferred to my clinic, as Dr. Oxana had originally suggested we do. Katya e-mailed to tell me that a donor had come in who looked remarkably like me, and the coordinator thought she was a perfect fit. Done. Uncomfortable choices avoided.

  As luck would have it, by the time I was ready to begin the IVF cycle, I had found the perfect doctor in Dubai who was willing to work directly with Dr. Oxana. Dr. Nataliya, a Bulgarian ob-gyn who had recently moved to Dubai, came highly recommended from friends, and it was an unexpected blessing that she spoke Russian and was somewhat familiar with treatment there. We worked out an effective, albeit time-consuming, system. I went to the Cooper Health Clinic every other day, where I had acupuncture treatments from her Australian colleague Martine, and saw Dr. Nataliya for blood tests and ultrasound scans. She would then e-mail the results to Moscow, and I would go down to the sun-filled waiting room, get a cup of green tea, and happily begin my perusal of fashion and gossip magazines. At some point within the next hour or two, she would receive a return e-mail from AltraVita with our daily instructions, which she would relay to me in English.

  One sunny afternoon, much like all the others, Dr. Nataliya announced that there was good news. I was to go to Moscow the next day for egg retrieval. It happened to be my birthday, and so, rather than celebrating by going to the Coldplay concert in Dubai as originally planned, Richard and I gave the much coveted tickets to some delighted friends and flew to Moscow to see if Dr. Oxana’s theory about egg rejuvenation would bear fruit.

  As it turned out, Dr. Oxana was right about everything. After nearly three months of following her every instruction, she retrieved eight eggs (which she thought was too many, although I was thrilled), which in turn produced four embryos, two of which were normal (as revealed by preimplantation genetic testing). After several rounds of precisely zero normal embryos, and our earlier results of only one out of eight and three out of thirteen normals, I was both shocked and thrilled to have 50 percent of my embryos turn out to be chromosomally normal. Although she advised me that one of the two did not look good, I desperately wanted to use my own embryos, rather than those of the twenty-one-year-old donor I had been reluctantly relying on. With dwindling minutes for debate, the doctor pushed me into transferring one of each. An experienced hand at egg donation, she was sure I would get pregnant, and was also sure it wouldn’t matter to me at all in the end whose egg it was once I had a healthy baby in my arms. Filled with anxiety, I acquiesced. Or rather, I didn’t object as they swiftly rolled me away and she firmly instructed the team in Russian. In reality, it happened so quickly, I didn’t have much say in the matter.

&nb
sp; When I first found out I was pregnant, after transferring one of my own embryos and one of my donor’s, my initial reaction was shock. I was happy, of course, that we had two good embryos to transfer (both male, they revealed after the fact), and, unlike with my last several pregnancies, hopeful that I would finally keep one. At the same time, much to my surprise, I began to dwell on the fact that I had one of each inside me, and wondered if it was a mistake not to have transferred two of my own embryos. I realized only then that I hadn’t thought through the donor question as thoroughly as I should have, and hadn’t truly made my peace with using someone else’s egg. I found it ironic that the ethics committee at the Lister Fertility Clinic, which forbade surrogacy, a temporary relationship, had no problem whatsoever allowing for and facilitating egg donation, a very permanent one. It just seemed backward to me. As opposed to serving as a lovely, living breathing “oven,” this generous, anonymous woman would potentially provide the genetic basis of our child.

  In my panic, I tried to figure out how I got here. We had previously ruled out egg donation when we thought we needed a surrogate. Unlike the thousands of people who turn to egg donation each year in hopes of having a healthy child, for me, the idea of needing both an egg donor and a surrogate felt a step too far. If I couldn’t carry the baby, and the baby would not contain my genetic material, then I couldn’t see why we should go to all this trouble to create a baby when there were real, live babies who needed homes. But everything changed so swiftly when, at the ripe old age of forty, Dr. Oxana told me that she suspected I had good eggs. Excited about the chance of trying again to have my own child, and perhaps even carry the pregnancy this time, I had argued for the donor backup plan because I simply couldn’t face going through yet another IVF cycle only to come up empty-handed. But it was really just that: a plan I was trying to make as airtight as possible. My thought process went no further than the mechanics of ensuring that we had some good eggs to transfer. I certainly hadn’t contemplated the possibility of transferring a mixed batch.

  Despite our lack of a common language, Dr. Oxana always read my face.

  “Relax,” she reprimanded me, “it doesn’t matter.”

  “But I won’t know if the baby is genetically mine, or the donor’s.”

  “And it doesn’t matter. When you hold the baby in your arms, you will understand that it doesn’t matter.” I wanted to believe her, but I worried. Should we genetically test the baby and find out? Would it be strange if my daughter was genetically mine and my son was not? Would he be jealous? Closer to his father? What if, against the odds, both had implanted and we were having half-blood twins? Did it matter? Richard did not seem to think it mattered. Nor, clearly, did Dr. Oxana or Katya, the only other people who knew our unique situation.

  A few weeks later, when I lost our (one) baby, I was too sad for tears. My seventh miscarriage was no less devastating than the six that had been definitively “mine.”

  * * *

  Life continued on in Dubai, but I couldn’t stop thinking about our experience at AltraVita. Dr. Oxana had been right about the eggs. Why had I been so stubborn about carrying myself? If I hadn’t, we might be expecting another child now. I thought I had made my peace with having no more biological children, believing it was a closed door, but Dr. Oxana had cracked the door open and a sliver of light now shone in. I had produced two normal, healthy embryos. Surely she could get more? I knew I had to try. Dr. Oxana remained optimistic but insisted that we use a surrogate if we were to try again with her. This time, I didn’t argue.

  With Catherine, our “practically perfect” surrogate, as we had fondly come to call her, sadly out of the picture, I was back to square one. I met with a Russian law firm and surrogacy agency. I looked online again at the various surrogacy sites. I studied India and Ukraine as options, contacting clinics there and poring over their databases. I corresponded with several women. And then one evening, in Dubai, my phone rang. Catherine had news. She had broken up with Paul, her fiancé. She offered to try one last time for us. Our fairy godmother.

  The protocol remained much the same. In fact, even lower dose, as Dr. Oxana reduced the Gonal-f from 250 IU per day as used in the first cycle to 150 IU the second time because, ironically, she thought I had produced too many eggs. I was back to Dr. Nataliya and Martine for monitoring and acupuncture. I brushed up on my celebrity gossip in the lobby while awaiting my daily call.

  Richard and I went to Russia in July 2009. I took several days off work, promising to be available by phone, and we left Alexandra in Dubai in the care of dear friends. It was a frantically rushed trip. Despite my careful planning, I had failed to digest the key fact that it was illegal in Russia for a surrogate to be thirty-five or older, and Catherine’s thirty-fifth birthday was on July 11. If our embryos were not transferred to her by July 10, it was over. My eggs, thankfully, were retrieved on the Fourth of July. The procedure was smooth, and Dr. Oxana retrieved seven eggs, which were promptly fertilized and resulted in four embryos. His part done, Richard returned to Dubai, where work and Alexandra awaited.

  Catherine arrived a couple of days later, just as the embryologist was doing the embryo biopsy for PGS. I suppressed my anxiety about having good embryos to transfer, somewhat fearful that Catherine would be annoyed, at best, that we had dragged her to Moscow when we were uncertain of even having our own embryos to transfer; on top of that, I hadn’t dared broach the idea of her carrying a donor’s embryo. I think I had been hoping for the best and ignoring the worst. But now I was pacing around my hotel room wondering how I had let Dr. Oxana talk me into such a low dosage. I had never had so few eggs to start with. I convinced myself there would be nothing left.

  Finally, Katya, the translator, called. All four embryos were chromosomally normal. One hundred percent. I was speechless. Three boys and a girl. What a contrast to my last two attempts with the traditional protocol, which had yielded the devastating result of nice-looking embryos, all of which were chromosomally abnormal, many rife with complex abnormalities. Now, having crossed the dreaded forty-year-old milestone, I had virtually the same result as my fertile young donor!

  Remarkably, the sun shone down on us as we toured around Moscow, Red Square, the Kremlin, GUM. We dined at the elegant Café Pushkin, where I was allowed my first drink as Catherine had her last. I barely slept that night, tossing, turning, and praying my embryos would not arrest overnight.

  Catherine and I awoke on July 9, two days before her thirty-fifth birthday, and promptly got into a taxi to take us from the Golden Apple Boutique Hotel off Tverskaya in central Moscow out to the AltraVita clinic. The taxi picked up speed after we left the halting bustle of the city, and as we glided along the highway I turned to smile at Catherine. Despite having done this before, we were both nervous, but my excitement was mounting too. This might well be the time that we got it right. There was no reason to think otherwise. Suddenly, unbelievably, our taxi rammed into the truck ahead of us and jolted to a halt. I started speaking to the driver in panicked, halting Russian, which he could not understand. Despite our lack of communication, one thing was clear: his car was not going to AltraVita that morning. Standing in the tiny shoulder of the highway with tears in my eyes, I felt a crazy panic threatening to take over. The embryologist would be preparing the embryos now, and I needed to get to that clinic. I called my friend Olga, and in a mad jumble of words somehow managed to convey that I needed her to talk to the driver and ask him how we could get to the clinic. He told her there was no way, but he did manage to describe where we were. Olga agreed that she would send a car, but with Moscow traffic, it could take an hour for the car to get to us, let alone get to the clinic. Just as my heart was starting to slow down enough for me to realize that it had been racing, a taxi passed by and the driver shouted at me in Russian. I held out the cell phone and he hit the brakes. Olga must have explained where we needed to go, because next thing I knew, we were in the back of a filthy black tinted Lada. But it moved, and I was grateful. We arr
ived, frazzled, an hour late to the clinic.

  Rushing to get Catherine ready for the transfer, the Russian nurse whisked her away before I could speak to anyone. Dr. Oxana emerged eventually and spoke to me in English. “Congratulations,” she said. She had transferred the best-looking embryos, which happened to be two boys, to Catherine, and sent our healthy girl (the third boy didn’t make it), along with our donor embryos, to the freezer (where they remain to this day).

  “Good luck with the pregnancy,” she said with a smile.

  Katya then led me upstairs into a room where a cameraman and reporter awaited me. I was totally confused.

  “I thought they asked your permission,” Katya murmured, surprised by my reaction.

  “They did,” I replied. “In theory. I thought they might call me someday to be interviewed in a TV studio, with hair and makeup and lighting.”

  She laughed, but I wasn’t joking.

  “I am not only a mess, I am not prepared,” I protested, as a lawyer used to preparing for every meeting.

  “Not prepared?” Katya laughed. “You have been preparing for nine years.”

  Unkempt, exhausted, and nervous, I spoke to the CNN International crew. They had interviewed patients from all over the world who had come to Russia, virtually all of whom had had success, some after as many as a dozen miscarriages, but I was the first American they had an opportunity to meet. The show would air on CNN International, they informed me, on Connect the World with Becky Anderson, but they weren’t sure if they could get it onto CNN in America. In any event, they wanted others to hear the perspective of an American who sought treatment in Russia. It was a fraught, yet important ending to a fraught, yet important day.