“Okay," I said. “But do you think you could do it instead? I can’t face her.”
“Why? You’re the one who knows her.”
“I’m too ashamed. Besides, you understand the cultural subtleties better than I do.
“Also," I added, “Maybe we should wait a little while. I feel so raw; I think I need a little more of a shell before I can move on.”
“We don’t have that kind of time," Steven said, the edge creeping back into his voice. “We have to move forward now if we ever want to do it.”
I nodded again. “But I don’t know if I can ever get past the regret that it took me so long to realize that I wanted to have a family with you," I said, my voice trembling.
“You have to, Peg," Steven said. “The only way to survive this is to be grateful for the two of us, for what we have together.”
Steven did call Koko the next day, but although she was understanding, she wasn’t encouraging. “She said she has no idea when she’ll get another baby," he reported. “It could be years. Also, there are four other couples ahead of us." He looked at me, accusingly. “It seems we missed the boat. We can’t count on this.”
He didn’t have to say any more; the facts were punishment enough.
I made a list of our complaints and read them off to Dan at our follow-up visit. “It seemed like there was no one at the helm during this cycle," I concluded, my voice level. “Like no one was making decisions. And the worst of it is we’ve lost the chance to have a baby with Jess. This was a unique situation, a special relationship that we’ll never be able to replicate. It’s a huge loss for us.”
Dan nodded sympathetically. “We can’t say for sure the cycle would’ve worked had things been different. But I agree that we bear partial responsibility for the failure." We said nothing, waited him out. “Let me talk to my partners about what we could do to make it right," he finally said. “I’ll get back to you in a week or so.”
“Thank you." My appreciation was genuine. His responsiveness hadn’t staunched my sorrow, but it had alleviated the rage—that was something.
While we waited we sought a second opinion from Marcelle Cedars, a friend of Risa’s, who a year earlier had been named director of the University of California at San Francisco’s infertility clinic. I liked Marcelle immediately. She had the same direct, sisterly style as Risa, the same feminist commitment to women’s health. “Look at this," she said, pointing at the records we’d brought her. “The semen analysis they ordered just before your second IVF came back with only four percent morphology.”
“What does that mean?” Steven asked.
“It’s the shape of the sperm. Fourteen percent is normal. This would indicate a low likelihood of fertilization.”
“I don’t remember anyone ever telling us that," I said. “So you’re saying they should’ve done ICSI this round, too?”
Marcelle nodded. “I would’ve. But I see a few other issues as well. Your uterus hadn’t been evaluated in four years. I would have done that. And personally, I would have had the donor take her shots in the muscle rather than under the skin—I find that the response to stimulation is better that way. I also would’ve had you use a skin patch rather than shots for the estrogen. A lot of people do the injections, but I think the patch is more effective.”
“How can two doctors have such different ideas?” I asked. “Does that mean his was wrong?”
“Well, this semen analysis would concern me," she said. “But a lot of the variation is about the art versus the science of medicine. It has to do with the lack of full data in this area—there are very few randomized trials in our field to let us know what works best so people develop their own preferences. The Europeans say it’s like the Wild West over here.”
Maybe if I’d had Marcelle as my doctor, I thought, I’d have a baby right now. She seemed to read my mind. “I could do a quick ultrasound to check your follicles and see if it might be worth trying another round of IVF," she offered as we got up to leave. “Or have you closed that door?”
“We have," I said, but I suddenly felt it creak open a crack. What if the problem had been Dan’s protocol, or merely the insensitivity of the clinic’s doctors? In a flash I was cobbling together the money, dismissing the emotional devastation that grew worse with each miscarriage, each failed medical intervention. It would be crazy to try again. But I felt that flutter: what if it worked?
“I suppose," I said, casually, “it wouldn’t hurt to look.”
I undressed and lay on the exam table, unsure what I was hoping for. Marcelle inserted the ultrasound probe, then shook her head. “You made the right decision," she said. “There are only two follicles developing here, and the best we could do is double that. Four follicles isn’t worth putting you through it again.”
Was I relieved? Sure. Was I sorry? Absolutely. I was also shocked that no one had suggested this simple, inexpensive test before. If we’d known way back before starting the first IVF that my production would be so paltry, would we have gone ahead? Would we have approached the process differently? I tried to push those thoughts aside—it was done. “But I am going to ovulate again, aren’t I?” I asked. It had been over a month since the donor cycle, and although I’d bled when I went off the shots, I had yet to get a natural period. That wasn’t unusual, but I was eager to get back to normal.
“Not for a while," she responded. “These follicles are very small.”
Two weeks went by with no word from Dan. I left him a voice mail reminding him of his promise, then e-mailed a few days later. In the brief reply I finally received, his tone seemed to have changed; instead of the concern he’d shown in his office, he seemed distant and self-protective. “We can offer you a repeat donor oocyte cycle at the rate of $3,500," he wrote. That would not, he continued, include “outside costs" such as a new donor, the medications, anesthesia, or what he referred to ambiguously as “etc." Adding that all up, our end cost would still run at least thirteen thousand dollars beyond the sixteen thousand dollars we’d already spent. That’s if we were interested in using an unknown donor—and if we were interested in working further with Dan. Neither, by now, was the case.
I felt like the high roller whose new friends disappeared when his stake was gone. The caring brochures, the chummy smiles, the warm affect of the clinic “team" seemed abruptly stripped away, revealing nothing more than a cold-blooded business. We had wanted so desperately to believe that we had ignored the sales pitch in the compassion, the coercion in the photographs of babies and sunflowers. But I finally got it—these guys may have been doctors, but they were also salesmen. I may have been a patient, but I was also a consumer. I was undergoing a procedure, but I was also making a deal—and they were making a buck.
Dan’s offer was an insult; what’s more, we felt he ignored our pain. We shot back a letter detailing what we’d learned from Marcelle, with a veiled threat of legal action if we didn’t get a full refund. I didn’t realize that fertility docs are pretty much bullet-proof. Back in 1978, when Louise Brown, the first “test tube baby" was born, IVF was as controversial as cloning is now. In her excellent book, Pandora’s Baby, Robin Marantz Henig writes that opponents—particularly antiabortion activists who considered the destruction of unused embryos akin to genocide—successfully lobbied to ban federal research funding on the procedure. Ironically, that, along with insurance companies’ refusal to pay for it, drove IVF into the private sector, where it has enjoyed minimal consumer regulation or ethical oversight.
In perhaps the most notorious subsequent scandal, the founders of one of the country’s top fertility clinics, at the University of California at Irvine, transferred fertilized eggs from as many as three hundred patients into other women’s wombs without their knowledge. Two of the doctors subsequently fled the country; a third was charged with mail fraud—there were no laws against using a woman’s eggs without her consent. And as recently as 2005, the medical license of one of San Francisco’s preeminent fertility specialists was
revoked after he transferred the wrong embryos into a patient, then covered up the mistake for over two years. The gestational mother is now embroiled in a custody battle with the couple whose embryo created her son. The embryologist involved, once again, saddled up and fled the country. Yee-haw.
The lawyer I consulted about our situation said it’s difficult to sue a doctor when there are no standard practices in the field. “One of the bedrocks of California law is that a doctor’s not liable for doing something another doctor might do, even if they’re in the minority," he said. “I wouldn’t waste your time and money. You’d never win.”
That was the year I returned to the synagogue on Yom Kippur, fasting and wearing white in search of a new beginning. I joined my new friend, Ayelet, and her husband, Michael, in the pews (which, given the holiday’s prohibition against bathing and deodorizing, lived up to the name). Like most of the women I gravitated toward then, Ayelet understood loss; she and Michael had terminated a fetus after amniocentesis revealed a chromosomal abnormality. Even now, several years later and pregnant with their fourth child, she hadn’t fully come to peace with that decision.
Before each segment of a Torah portion is chanted, someone has the honor of reciting a blessing, called an aliyah. At this temple, rather than singling out four or five individuals, aliyot were meted out by concept. So, for instance, the rabbi asked anyone who had worked for peace over the last year to come forward. People crowded the aisles to participate. Then he called up anyone who hoped in the next year to “create life, or bring something new into the world." Ayelet leaned toward me, looking like a Star Trek princess in her white caftan, round belly, and copper-colored hair. “Let’s go up," she said. “You stand next to Michael. I call him ‘The Sperminator.’ He can get anyone pregnant.”
The three of us stepped into the aisle, which was already jammed. Ayelet stood on one side of Michael, I stood on the other. He lifted up his woolen tallis so that it covered all three of us like a tent. I leaned in, holding Ayelet’s hand behind his back, my free hand touching the shoulder of the person in front of me, who was in turn touching the shoulder of the person in front of her, and so on until we were all connected to the person who actually touched the Torah scroll. Then I closed my eyes and chanted words I hadn’t sung for years but that always lived inside of me. I didn’t know if I would ever have faith, but perhaps I could find solace.
“This is Koko Kondo …” At the sound of that voice on our machine, Steven lunged for the phone. It was the last Thursday of October and we were packing for a long weekend in San Francisco. We thought a few days of playing tourist in the city would relax us, give us a chance to reconnect.
“She says there’s a high school girl in Hiroshima who’s pregnant with a baby boy and would like him adopted by an American couple," Steven told me, after hanging up. “The other couples on her list want girls. I told her it didn’t matter to us. He’ll be born next month. She wants to know if we’re interested.”
“Are we?” I stammered
“I told her we’d have to discuss it.”
“We still haven’t done any of the paperwork," I said, but my excitement was rising. Maybe my instinct upon seeing baby Kenji was right, and this was indeed our destiny—a child from Japan, from the country of Steven’s ancestors; a baby who came to us through a personal connection, through our joint good work in Hiroshima. That made sense to my writer’s brain, to its insistence on a narrative of fate.
“I still have the home study questionnaire,” I said. “I could bring it with us. We could get started on it over the weekend.”
But we didn’t. The paperwork sat on the desk in the hotel room just as it had sat on my desk at home. It wasn’t that we were unwilling at that point; we just needed time off. So we saw The Ring at the megaplex. We ate teppanyaki in the Tenderloin and house-made pasta in Union Square. And we shopped; we went to FAO Schwarz and bought early Christmas and Chanukah gifts for our nieces and nephews. I hadn’t bought clothes in over three years, convinced it was a waste since I was surely about to get pregnant. Now I indulged in retail therapy of the first order, splurging on a three-quarter-length leather jacket at Coach and a boiled wool blazer at Armani. I didn’t care what they cost—looking fabulous was my consolation prize for not having a baby.
On Saturday morning we strolled through the Farmer’s Market at the Ferry Building, snacking on organic strawberries and holding hands like the lovers we’d once been. We laughed. We had fun. We didn’t talk about babies. It had been a long, long time. That night Steven embraced me. I resisted at first, still estranged from my body; then consented, for his sake; and finally, gazing out at the city lights from our hotel room bed, I gave in to the feeling.
Steven was supposed to call Koko back that Monday, but didn’t get around to it for another two days. It was November 5,2002, barely a week since her last phone call. When he hung up, he looked pale.
“What is it?” I asked.
“She said the baby’s been born," he responded. “He’s been born and they need a name from us so he won’t go on the birth mother’s koseki!’ A koseki is a real-life version of the mythical “permanent record" so often invoked to keep American high school students in line: a set of official documents marking a family’s births, marriages, deaths, and other milestones. Although the information is supposed to be private, it’s readily accessible to potential employers and go-betweens arranging a marriage. An illegitimate birth could destroy a young woman’s future, but if we named the baby, giving him Steven’s last name instead of the biological mother’s, the child would never be recorded on her koseki, as if the pregnancy hadn’t happened. But we would have to act immediately.
Steven and I stood in the hallway, looking at each other in silence. “Well, Peg," he finally said. “What do you think we should do?”
11
KAI -CHAN ACROSS THE WATER
We named him Kai, of course. Kai for the ocean that separated us. Kai for the ocean that would bring us together. The few details Koko provided about his background were reassuring. His birth mother was a junior in high school. Her parents were divorced. She lived with her father, who hadn’t noticed the expanding bump she’d camouflaged with extra-baggy clothes. When she was seven months along, she confided in an aunt who took her to Dr. Miyoko Kohno, a female obstetrician in Hiroshima, who, coincidentally, was an outspoken advocate on behalf of troubled teenage girls. {More kismet, thought I!) The girl had never seen her baby—whether that was by choice or unfortunate custom Koko didn’t say. Kai had spent a few days on a maternity ward and was now being fostered by Koko’s mom and sister. He’d weighed a respectable seven and a half pounds at birth and was over twenty inches long. On the advice of a friend, we asked for his Apgar scores, whatever they were—some mark of responsiveness at birth, I gathered. At any rate, they were normal. We asked if the birth mother drank, if she did drugs, if there was mental illness in the family.
“Japanese only put healthy babies up for adoption abroad," Koko said, sounding slightly annoyed. “Although sometimes we send the other ones to someplace like New York." I couldn’t tell if she was joking.
There are so many children out there who need homes. That refrain had echoed in my mind throughout our infertility treatments, growing deafening during the donor egg cycle. Why were we going to such extremes to create a child when there are so many children out there who need homes? Why, as people would occasionally ask me, don’t you just adopt? I had my responses (including, “Why don’t you?”), but only now did I discover the most obvious one: adoption isn’t so easy. The children out there who need homes are older or have special needs; I wasn’t prepared to take on those challenges. Later I would learn that, domestically, as many as forty couples can vie for a healthy, white newborn (though a white child wouldn’t have been a priority for us). International adoption is uncertain, expensive—upward of twenty thousand dollars—and, where Americans benefit by others’ poverty and oppression, involves its own ethical complexities.
Then there’s the adoption process itself. We would have to open our lives to an agency’s scrutiny (paying thousands of dollars for the privilege), which involved three visits by a social worker to evaluate the fitness of our home. Our official “dossier"—an appropriate name for something so relentlessly nosy—had to include the questionnaire that I’d avoided for so long; tax returns and bank statements, a full reckoning of our finances and spending; multiple character references from old friends; copies of our birth certificates and marriage license; employment verification; and proof of housing and health insurance. We would also need medical exams; we were told by one agency that my cancer history could disqualify us, as could my visits to a shrink after my third miscarriage—thank heavens I hadn’t taken any psychotropic drugs. We’d need both state and FBI fingerprints to prove we weren’t child molesters. Various documents needed to be notarized, then brought elsewhere so the notarization could be authenticated. All of this, pursued diligently, typically took four months; it could take another five for the backlogged Immigration and Naturalization Services (INS, today renamed Citizenship Immigration Services) to approve the application.
Generally, prospective parents would wait up to another year to be matched with a specific child. But we already had a baby waiting. “There’s got to be a way to speed up the paperwork," I told Steven, grimly. At his urging, we bought tickets for a flight to Japan, leaving in three weeks. I planned to have powered through the red tape by then.
Strangely, there was no listing in the phone book for the San Francisco office of INS. The Web site said that we’d be denied entry to the building without an appointment, yet offered no way to schedule one with the adoption division. I called the Washington, D.C., office for help. A friendly (and apparently newly hired) agent promptly gave me the number for the local director of orphan petitions.
She didn’t even say hello. “How did you get this number?” she hissed.
Waiting for Daisy Page 17