The first transfer I saw was in a delivery room, although the woman was not pregnant. Her position reminded me of somebody giving birth, but instead her belly was full of urine. She had been drinking water all morning to expand her bladder, straighten her uterus and allow for a better view. How uncomfortable! Her husband stood by her holding her hand. In a room a few doors down the hall, the embryologist prepared two embryos, which were now a few days-old. I thought of everything she did to get herself here.
I did not know the extent that women must go to seek ART (Assisted Reproductive Technologies). First, in order to diagnose the reason for infertility, both the man and woman must undergo testing, like uncomfortable imaging of the uterus, blood draws and sperm analysis. Then, most of the medications prescribed are injected and require ultimate compliance, which can involve alarms during the night.
Finally, in order to assure the timing of ovulation perfectly, women undergo vaginal ultrasounds every 48 hours as their ovaries begin to respond to the drugs. So a woman might come for 10 vaginal ultrasounds before her procedure is scheduled. It requires serious commitment to come to the doctor early in the morning to have a probe inserted inside you. Most women came alone, and had to disclose this very private and sensitive issue to their workplaces.
If the cycle failed (no pregnancy), they would start all over again. Meanwhile, the treatments were expensive, and the medications made many women feel depressed or emotional. I wanted these patients to have children dearly, but I was surprised by what they endured to reach their goals. These women were some of the strongest I have met with hidden stories of trauma, multiple miscarriages, unexplained infertility and rare diseases.
The woman in the bed was undergoing IVF (In Vitro Fertilization), the most successful, but also the most invasive and expensive of all the treatments. A few days earlier I had helped her when she went under general anesthesia to have her eggs retrieved. Her husband had been present that day to donate fresh sperm, but he had to leave for work immediately afterwards, leaving her alone in our care. The fertilization occurred in a plastic dish about 2 inches in diameter.
Now the embryos appeared to be tiny clusters of cells, too small to reveal their genetic content. The doctor took several minutes to carefully insert a practice catheter (without embryos) into the uterus through the cervix. A nurse pressed constantly on the patient’s bladder with the ultrasound probe, so we could visualize the placement of the catheter. When the doctor was satisfied, she was ready for the real catheter with embryos.
We all were quiet as she injected the embryos into the uterus, a process that took only a few seconds. And then, she sent the catheter back down the hall for a microscopic check to make sure all the embryos were emptied. We waited.
“It’s clear,” the embryologist announced after a few seconds. And then, we were done. It would take about 2 weeks to know whether these embryos resulted in a pregnancy. I wondered what was going through the woman’s mind. I imagined babies being made in a loving sexual partnership, but here we were trying to make a baby in a sterile field with uncomfortable probes and catheters. Yet, I felt warm, and noticed that she glowed with hope.
While many of our patients did get pregnant, this first transfer patient did not. Two weeks later I saw her, tearfully waiting in the office for a follow-up visit. I knew instantly the procedure had failed, and I felt a wave of sadness for her loss. And more importantly I felt her anger and fear that despite all she endured, she may never experience biological motherhood. I left with a new appreciation for the uncontrollable aspects of pregnancy, a powerful miracle that so many take for granted.
I wonder why these women are so intent on having a child in their own womb. There are already so many people, babies especially, who don’t have good loving parents; and adoption would be much easier, and cheeper(?) (I really don’t know the cost for either so I’m guessing here). I know they both come with complications; It just seem like it should be easier to adopt.