By choosing not to decide, does that mean I’ve made a choice?

There’s an old Rush song that goes, “If you choose not to decide, you still have made a choice.”

I seem to be quite good at living my life like this. We didn’t choose to have Simon; he just kind of appeared in our lives. We hadn’t set out to buy a new house when we stumbled across this one back in 2003, but as soon as we saw it, we knew it would be ours. I didn’t even choose to be in this field, in this job… I just ended up here, somehow. Happily, on all three counts.

And so it goes. We got a call from our fertility clinic, reminding me that I had forgotten to fill out the consent forms for another year of frozen embryo storage (back in July. Oops.) So I was on the phone with the administrator, and we were talking about the move that the clinic will be making in the spring, from being part of the Ottawa Hospital to being a free-standing independent clinic. And I was asking, mostly out of curiousity, about how that would impact people who were planning to cycle this summer, and she said it probably wouldn’t have much impact at all, but I should check with my doctor to be sure – and did I want her to put me through to my doctor? And I shrugged and said, ‘Sure, I guess.’

And that’s how I ended up with an appointment. In April. To start a cycle that will ultimately resolve my greatest ongoing angst, what to do with our one little frosty.

I guess we’re going to go for it.


The rest of the (IVF) story

Yesterday, I told you the long and raw back-story to our infertility struggles. The good news is, today’s story is a lot less painful to read. And it has a happy ending!

Now that I’ve blown the suspense…

We started our first IVF cycle in May of 2001. In addition to ramping up the dose of follicle stimulating hormones, there was an additional week of self-injection to ‘suppress’ my own hormonal system, giving the clinic complete control over my body’s reproductive cues.

When we first considered artificial reproductive technologies, the idea of the self-injections terrified me. I’m not afraid of needles per se, but I was very squeamish at the idea of doing the injections myself. I never could work up the courage to inject into my belly, but I did become a pro at finding the perfect spot on my thigh to inject. To this day, the smell of alcohol wipes brings me instantly back to our treatment days.

And let me interrupt myself to explain that even beyond the emotional turmoil that goes with infertility treatments, it is nearly impossible to have a normal life during an IVF cycle. You have to be at the clinic first thing in the morning to get blood work and an ultrasound done. (Finding a parking spot is hell. Getting to work even remotely close to on time is impossible.) Then you are on tenterhooks all day, waiting for the results. (The nurses used to laugh at me. They’d call and say, “It looks good, we’ll see you in two days.” And I’d say, “How many follicles? What were their measurements? What was the exact estradiol count?” And I’d obsessively chart everything on an Excel spreadsheet saved in the same file as all my temperature charting from the old days.) You have to be home every day around dinner time to do your injections, or take them with you. (Post for another day = funny places you’ve done your injections. My winner? Bathroom stall of Taco Bell.) And you have no idea when your retrieval will actually be. Maybe in six days, maybe in eight. We’ll see. Probably in two days, but maybe three. As you can see, IVF is neither for the faint of heart nor for the control freak.

I figured that after two cycles of monitoring my response to injectible gonadotropins through the IUIs, the clinic would have a pretty good idea of what to expect from my ovaries. Apparently not. The ‘ideal’ cycle produces somewhere between four and eight high-quality eggs, according to our reproductive endocrinologist. As we got closer and closer to the date of egg retrieval, ultrasounds showed my ovaries filled to near-bursting with ten, then twenty, then thirty ova. I produced so many eggs that my estradiol (estrogen) levels skyrocketed and they had to ‘coast’ me for four days without stims, hoping the levels would drop a bit before retrieval.

When they finally did the retrieval in mid-June of 2001, I expected to be facing a surplus of embryos from my multitude of eggs. Due to the poor quality of Beloved’s sperm, the clinic employed the specialized technique known as ICSI, where one sperm is microinjected into an egg – which, of course, cost us an extra $1000 or two. I was badly shaken when we got the call later that day to tell us only ten eggs were viable and even more upset when we found out later only three embryos had survived to the end of the first day.

Three days later, we were back in the clinic to have the embryos transferred back to my uterus. Because of my relatively young age (almost 31) and fertility history, the clinic would only transfer two of the three embryos and agreed to cryo-preserve the third. With my two ‘babies’ tucked safely back where they belong, Beloved and I went out to lunch on our favourite patio and began the hellish time known in fertility circles as ‘the two week wait.’

In the time leading up to my cycle, I had become a regular on the IVF Connections bulletin boards. The mythology of the time advocated eating pineapple during the two-week wait, because the enzyme bromelain was supposed to improve the odds of implantation. (Other mythology revolved around the presence of bubbles in your urine, if I remember correctly. Only when you’ve been there can you imagine how desperate you become to find some order in the randomness that is infertility.) So, in those two weeks, I ate enough fresh pineapple to shred the inside of my mouth.

Ten days after my transfer, I woke up feeling loagy, like I had a flu. I ended up going back to bed, which was very rare for me. By late afternoon, I was feeling so bloated and uncomfortable that I was having trouble drawing a deep breath. I called the fertility clinic to check in and the doctor on call told me to meet him in the emergency room in half an hour.

I had developed ovarian hyperstimulation syndrome (OHSS), a common but potentially dangerous reaction to the extremely high levels of estradiol from the many follicles I produced. OHSS causes fluids from the bloodstream to leak into the abdominal cavity, which causes the bloating and breathing difficulties, and in severe cases can lead to kidney shut down and blood clotting. My case happened to be fairly mild (Nancy documented her hospital stay from OHSS on her blog) and I was told I could go home after a few hours, but would have to go back to the clinic every day for monitoring.

I was on my way out of the ER when the doctor stopped me and told me that in addition to the other blood tests he had ordered, he had requested a pregnancy test. He told me he was confident that the results would come back positive, but it may yet be several hours. Did we mind if the call came late in the evening to confirm? I’m surprised anybody but dogs could understand my supersonic squeal of assent.

Turns out not only was I pregnant, I was very pregnant. My levels of hCG, the ‘pregnancy hormone’, were very high for only nine days after transfer. So then came another hellish wait for the first ultrasound, populated by daily and then every-second-day visits to the clinic to monitor the OHSS. When we finally had our first ultrasound, I had been conditioned to expect more bad news. I was convinced the baby would either be lost, or ectopic. Turns out I was wrong.

Both babies were fine. Both. Both embryos had taken, and I was pregnant with twins.

I was in love with the idea of having twins. My father was a twin, his father was a twin, my mother’s father was a twin. Two babies, an instant family. I loved the idea.

Our elation was short-lived. Two and a half weeks later, we went back for a follow-up ultrasound, and they couldn’t find the heartbeat of the second baby. We had lost one of the babies at 9 1/2 weeks.

It was really a hellish ride. We still had one baby who seemed to be thriving and on target, and yet we had lost another. People didn’t seem to understand why I mourned this lost baby almost as deeply as the one I had miscarried the previous year. And of course, I was sick with worry for the surviving baby.

But don’t let me paint too morose a picture here. I was thrilled to be pregnant, and pregnancy treated me well. And through it all, I never really doubted that some way, some how, Beloved and I would be parents. I just knew it, in my soul, as I’ve never know anything before or since.

By the time we made it to our next ultrasound two weeks later, I was beyond anxious into the dark netherworld of neurotic. We saw a perfectly healthy baby growing right on schedule, and could actually see little arms and legs waving happily. I cried so long and so hard in sheer relief that the ultrasound technicians gave us free pictures and cried along with me. I was still crying when we got home nearly an hour later.

The final scare in that pregnancy was at the 18 week ultrasound. We found out beyond doubt that our little baby was a boy, and a healthy one, except for one concern. He had an echogenic cardiac foci , a bright spot of calcification on his heart that was thought at the time to be a possible indicator of Down’s syndrome. An amniocentisis would have confirmed or ruled out Down’s syndrome definitively, but the odds of miscarriage through amnio were the same as the odds of the baby having Down’s, one in 100. In the end, after a few sessions of genetic counselling, we opted to wait it out and hope for the best.

Tristan Louis was born three days after his due date on March 7, 2002. He weighed nine pounds and was 22 inches long. He was, and continues to be, perfect in every way.

The big infertility story

I’ve been thinking for a while about telling you our infertility and IVF story, and I figure now is as good a time as any. Most of you are busy eating leftover turkey and shopping for deals at the outlet stores, so we’re into light blogging mode.

It’s a long story, so much so that I’ve divided it into two posts, and even then decided to hide most of it beneath the fold. Like any good story, this one begins with heartache, but ends in joy. I mean, you already know how it comes out, and a lot of you know the details already. The trouble is knowing where to begin.

I remember Boxing Day 1998. Beloved and I were on the 401 heading back to Ottawa after spending Christmas in London and Windsor with our respective families. We were talking over some of the early details of our wedding, planned for July of the coming year. I don’t know how we got on to the topic, but I clearly remember talking seriously about when to have kids for the first time. There had never been any doubt about the ‘if’, but the ‘when’ had been a big question even though we’d been together for almost four years at the time. In that conversation, we officially decided to start trying for kids on our honeymoon.

I can still remember the feeling of elation, of expectation, of hope. Finally, finally, being a mother was within my grasp.

We almost waited for the honeymoon, but not quite. I remember being in Paris and not drinking much wine, because we had been busy and I was hoping I might be pregnant by a couple of days. When it turned out I wasn’t pregnant that July, I was only disappointed that I had given up a lot of indulgence in the name of a maybe-baby. Little did I know the road ahead.

Toward the fall and winter of that year, I started to buy the occasional pregnancy magazine. Every time I was a day or two late, which seemed to be every cycle that fall, I’d buy a pregnancy test and start imagining how I’d break the news to my family. First it was over Thanksgiving Dinner. Then as a birthday present for Beloved in December, and when not then, as a Christmas gift to my parents. I dreamed up elaborate ways to announce my pregnancy. When I was denied the chance to tell my mother I was pregnant for her birthday in February, I finally made an appointment to talk to my GP about fertility. That month, for the first time in my life, my cycle stretched out to six weeks, and I was crushed when my period finally came.

My GP listened to my story and referred me to the Fertility Centre at the Ottawa hospital. I was a little freaked out by the fact that she didn’t pat me on the head and tell me not to worry, but at the same time confident that whatever was wrong would soon be easily resolved by the ‘experts’.

In hindsight, our referral was processed in an impressively short period of time, but as each month came and went without a pregnancy, it seemed much longer. After a battery of blood tests, a semen analysis (Beloved’s, not mine) and a hysterosalpingogram (an x-ray of my reproductive plumbing), we had a consultation with a reproductive endrocrinologist. She told us that in fact there was nothing wrong with my physiology, but that Beloved’s sperm had such low morphology (poorly formed sperm) that she estimated our chances of conceiving a child naturally at less than three per cent. She said that the sperm were of such low quality and quantity that even lesser treatments like an intrauterine insemination were unlikely to work and that her best recommendation was for us to move directly to in vitro fertilization.

To say we were devastated would be an understatement. That afternoon, I had a prior ‘date’ with a friend planned to play a little catch. I was so blown away by the diagnosis that I couldn’t even tell her, one of my most cherished confidantes, throughout the three hours we were together. It was only when we were sitting in the car and I was about to go home that I finally found the words. And the tears. A river of tears.

I couldn’t cope with the concept of being infertile. Infertility is so much more than a clinical diagnosis. It means giving up on a dream you felt entitled to your whole life. It is standing on a precipice with a yawing future devoid of the children you already felt were a part of you. It is losing what you never had but always expected.

I was tormented by the fact that our infertility was ‘male factor’. I wished it were me, simply because didn’t want Beloved to be burdened by the guilt of responsibility. As much as the infertility was hurting me, I could only imagine how much worse Beloved must have felt.

In those early days, there were two main obstacles to pursing IVF. The first was money. Beloved had just barely finished his diploma and I was working in a mid-level government job. We were renting a townhouse, living paycheque to paycheque and had no money behind us whatsoever. The drugs would be reimbursed at a rate of 80%, but we’d have to pay the procedure out of pocket at around $7,000. On credit.

I remember the seminal conversation with my wise mother. She asked me, ‘What else are you going to spend your money on?’ And she was right. If anything was ‘worth it’, this was worth it.

Except, the other obstacle we were facing was the fact that even if we could scratch up the $7,000, there was only about a one in three chance it would succeed.

One in three.

All that money, all those needles (oh, how I feared the needles), all those hormones and all that disruption to our lives, and no guarantee of success.

And once again, we decided that if anything was worth it, this was worth it. We made an appointment to tell the clinic we wanted to go ahead in the early summer of 2000.

And then, on our first wedding anniversary, July 3, I peed on a stick because I was four days late and I never learn.

And I was pregnant.

For the summer of 2000, I felt like I was living in a dream. I felt tired but wonderful. My feet never really touched the ground. My due date was in March of 2001, and I found out one of my very best friends was due the very same month. It was fate.

Except fate is a cruel mistress. One afternoon in late August, three days before my first OB appointment, I went to the washroom and there was blood. Not a lot, but enough. I was scared. I managed to get an appointment at the after-hours clinic, and while I was in the waiting room, the cramping started. They tried to find the baby’s heartbeat, and when they couldn’t they told me it was probably too early. Lots of people had spotting. And, the nurse said with sympathy, even if it is the worst, there’s nothing we can do for you.

I cried all night long. I was still crying the next day when I asked Beloved to take me to the emergency clinic because I was in so much pain. Nobody told me that a miscarriage at 13 weeks would involve contractions, and I was terrified on top of being in pain and heartbroken. The emergency room staff were clinical and unmoved by my near-hysteria. They said the earliest ultrasound they could schedule was in five hours, and told me to go home and take some Tylenol and wait.

I passed the remains of the baby into my underwear, in my bathroom at home, alone. Trying hard not to look too closely at the lost little soul no bigger than half my fist, I scooped up what I could into a plastic container, because I had the idea that if I brought the fetus back to the doctors, they could tell me what happened. The only thing that kept me from a complete breakdown was the idea of protecting Beloved from my hysteria. I had to be strong for him.

Of course, the doctors had no answers for me. They said the baby was small for 13 weeks, so had either died some weeks before or had been falling behind in its growth. No matter, really. It was over.

We went back to the fertility clinic, and our reproductive endocrinologist opined that maybe we should try intrauterine insemination (IUI) after all, if I had managed to get pregnant given Beloved’s sperm counts. I imagined my ova like some giant Death Star in my fallopian tubes, gathering up wayward sperm.

By this point, getting pregnant was my all-consuming obsession. It was all I thought about. Each day, I would open my eyes and wonder how long until we could be parents. I would roll out of bed and dutifully chart my temperature, watching for that tell-tale dip in body temperature that indicated the beginning of monthly fertility. After sex (every two days, just like the books recommended) I would rest with my legs up the wall, a pillow under my hips, trying to coax lost sperm in the right direction. For two weeks I wouldn’t drink alcohol, ingest aspartame or deli meat or soft cheese, hoping that this was the month the miracle came back. And each month I would obsess over the toilet paper, watching for that first tell-tale smear of muddy blood, the dream dead for another two weeks.

I tried not to be bitter about other people’s pregnancies. I’ve never been the sort of person who begrudges someone else their rightful joy, but even seeing mothers out playing with their children was like rubbing salt into an open wound. The year in between our infertility diagnosis and the start of our IVF cycle was one of my darkest. The loss was hard to cope with, but the hope nearly killed me.

We opted for IUI with superovulation, meaning I would inject myself with follicle stimulating hormones to produce more than one egg, thus improving our chances for conception. Our first IUI ran through December of 2000. My period came, indicating the failure of the cycle, on Boxing Day at my sister-in-law’s house – two years to the day after our decision to have kids as soon as possible.

We tried another superovulated IUI in February of 2001. My anxiety was ratcheted even higher for that cycle, because I was desperate to be pregnant before facing the due date of the baby we lost to miscarriage. But, it didn’t work out that way. After that second IUI failed, we decided to stop piddling around with intermediary procedures and go big or go home.

We decided to spin the big wheel and try IVF in the spring of 2001. And I’ll tell you about it tomorrow.

Welcome IVF parents!

Hello, and welcome. Let me clear off a space on the floor and you can sit down and maybe stay for coffee. Say hello and stay a while, why don’t you?

Wondering what I’m talking about? Me too, kind of. Since about three in the afternoon yesterday, I’ve gotten almost 40 hits from an private message board. I got curious and tried to follow the link back, and it told me I wasn’t welcome and membership was by invitation only. It did say something about IVF parents, so I’m assuming this is maybe an off-shoot of the IVF Connections parenting boards where I used to spend all my time before blog. (If you ever need support or information about IVF or infertility, IVF Connections is the best place on the Web. I met some of my best friends there.) And speaking of best friends and IVF, you might want to drop by Nancy’s blog too – if you knew me, you’ll remember the inimitable Nancy99 and her adorable boys!

Anyway, all are welcome here, and if you are an old friend from IVFC, please do say hello. Heck, say hello anyway – we’re a friendly sort of crowd around here.

10-pages-in book review: The Bird Factory

I read a review of David Layton’s The Bird Factory in the newspaper, and managed to get a copy from the library in fairly short order. When I read the review, I knew it was something I’d have to read because it touches on a couple of themes dear to my heart.

First, the author is a 30-something Canadian, and Canadian-ness is often enough of a selection criteria to just get me to open a book. Second, he happens to be the son of one of the grand old men of Canadian poetry, Irving Layton. Third, the review was generally positive. Fourth, and foremost, was the subject matter: The Bird Factory is about a 30-something guy whose life starts to spin out of control when he and his wife have trouble procreating, and he finds out he has lazy sperm. Among other things, the novel is about going through in vitro fertilization (IVF) from a guy’s perspective.

For the same reasons I wanted to read this book, I wanted to dislike it. See, we Canadians have this deeply ingrained quirk that makes us want to see successful Canadians knocked down a notch or two. I had hoped I’d risen above this nasty little peccadillo, but I fear not.

By way of illustrating the point, let me retell this story of a friend’s first visit to the east coast. He was watching the men fish for lobsters. They’d haul up a trap and open it and shake the lobsters into a wide, shallow bin then they’d drop the open trap back into the water. (Pardon me if I gloss over the details. The lobster fishery is not something I’ve studied in any amount of detail.) The point is, the man watches the lobster fishermen (fisherpeople, I guess) for quite a while before his curiousity overcomes him.

“Excuse me,” he says, “but do you mind if I ask a question? That bin is so shallow, the lobsters should have no trouble climbing over the side. How are you keeping them from escaping?”

To which the lobster fisher person replies, (insert salty east coast accent here) “Well, me boy, these ‘ere are Canadian lobsters. Any one of them gets too close to the top of the pile, ‘tothers will just drag ‘im back down agin.”

More succinctly, as my dad recently put it, a Canadian is someone who will knock you down to size, then apologize for it.

So for reasons that are ingrained in me culturally, there’s an odd little piece of me that wanted this to be a bad book. Thinks he’s clever, does he? Writing about infertility? Thinks he has some insight, maybe some talent?

Turns out, he does have both insight and talent. It really is a good book. Layton’s wry humour, clean writing and genuine charm have me hooked. I’m a little more than 10 pages in – more like 60 – but just thinking about it as I’m typing makes me want to curl up and read another chapter to find out what happens next.

According to the review I read, Layton has gone through IVF himself, so he knows whereof he speaks. I found myself at various key points in the narrative thinking, “No, that’s not how it was for us,” then realized that he’s not narrating this from the woman’s perpective, he’s narrating it from the man’s – something to which I can’t really speak. I know what Beloved said and did, but I can’t claim to know how he felt. So when I was getting a little agitated with the protagonist’s laissez-faire attitude, it served as an interesting reminder that maybe my husband had a different way of experiencing that chapter in our lives.

I love a book filled with quirky characters, and this one has them to spare. Luke Gray, the protagonist, has a little lost boy quality that I would have found irrestible were I a literary character or he a real person. His wife Julia is a classic high-achiever who attacks the problem of infertility with a a single-minded focus that reminds me almost painfully of myself. Luke’s father, an erstwhile film-maker, builds a river in their suburban basement when Luke is a boy. Luke has made a business of constructing large decorative bird mobiles, and he seems to adopt employees like stray cats – odds and sods of societal rejects who seem even less engaged in their lives than Luke is in his.

You don’t have to have any experience in or even perspective on infertility to enjoy this book. It’s an insightful, darkly funny and poignant examination of one guy’s life and the forces that drag him through it.


Paying the price of indecision

Last week, I sent another cheque for $300 to our fertility clinic, and bought myself another year of indecision.

Tristan was conceived through in vitro fertilization (IVF) in the summer of 2001. At the time he was conceived, a total of three embryos were created. Because of my relative youth and reproductive health, the doctors advised us that they were only willing to put two of the three embryos back into my uterus, as twins was a more mitigable risk than triplets.

It was a hard decision for us to accept, at the time. We had gambled everything we had, financially and emotionally, on the success of IVF, and we had a hard time understanding how transferring three embryos wouldn’t improve our odds of success by 50% more than transferring two embryos. And it left us with the question of what to do with one lonely leftover embryo.

We followed the doctors’ advice, and transferred two embryos. The third was cryo-preserved – frozen in suspended animation at 3 days old. When I found out a little less than two weeks later that I was pregnant with twins (we lost one at 9 weeks), we were relieved that we hadn’t transferred all three.

Every year around the anniversary of our IVF treatment, we get another bill from the clinic for rent. Apparently freezer space is even more valuable real estate than downtown Manhattan, because we pay $300 a year for about a half a cubic centimetre of space. The embryo itself is nearly microscopic, and it is stored in a tiny glass pipette thinner than the ink stem in a bic pen. Friends of mine who have frozen embryos from more than one treatment cycle pay $300 for each tiny pipette of embryos. IVF is not for the financially faint of heart. (And despite the many praises of socialized medicine in Canada, we are on our own with the costs. Everything is out of pocket, and in five years of looking I have yet to come across a private health-care insurance company in Canada that covers any part of an IVF cycle, aside from the drugs.)

Our original plan was to go back to the clinic when Tristan was two or three and ask them to thaw and transfer our little “frosty”. The chances of the embryo surviving the thaw are somewhere around 30 per cent. The chances of the embryo successfully implanting and leading to a full-term pregnancy are about 30 to 40 per cent after that. But before we could put that plan in motion, out of the blue came my sure thing – Simon, the surprise baby.

So, each year I scratch out a cheque for $300 to keep our frosty on ice and buy another year to think about the future of our family. We had never really planned for three kids. Our finances are modest, as is our little townhouse. If we were blessed with a third child, we’d have to double kids up in a room and get a mini-van (this last being perhaps the most insurmountable hurdle. Me, driving a mini-van? Yikes.) I have serious concerns about the “middle child” dynamic, and about having the kids outnumbering the parents.

What really keeps me awake at night is the biggest “what if” of all – what if it’s a girl? A daughter. A mini-me. An XX ally in a house teeming with men. There is no way to find out the embryo’s gender, despite what many people seem to think about IVF. While it is possible to determine the embryo’s gender, that would only be done if you were already doing some heavy-duty genetic screening (at a wicked cost, by the way, and only at the prerogative of your clinic), but you can’t just order these tests à la carte for your family planning convenience. And if indeed we are blessed with another pregnancy, and it turns out to be a hat trick in my collection of boys, that would be okay, too.

There’s no real hurry. I read last month that a baby was born fully 13 years after she and her siblings were conceived. (It’s a fascinating story, although I almost didn’t want to add the link because of the bit about the clinic being shut down for taking people’s eggs. I expend a lot of effort fighting against those kinds of ideas when I talk to people about reproductive technology.)

So I scratch out my cheque each year, and think almost every day about our little totsicle, sleeping in a nitrogen bath. Although I am not in any way opposed to donating embryos to other families, or even to science, I don’t think that is the destiny of this little embryo. We can’t leave (him? her? it?) frozen forever, but each $300 buys us another year to think about it.


Things we never expected from IVF

As I’ve mentioned before, my eldest son Tristan was conceived via in vitro fertilization (IVF) and my youngest son Simon was a blissful surprise. I used to be a quite vocal advocate of IVF causes, but have been lucky enough to be too burdened with parenting to do much work on that front lately.

Just before we did our first (and thankfully, only) cycle of IVF, Beloved and I were interviewed on CBC about the ethics of IVF. In particular, they were interested in embryos created but not implanted, and what you do with “leftover” embryos when your family is complete. It’s a part of IVF that, when facing our first transfer, we really didn’t lose a lot of sleep over. By the time I had come to terms with the more immediate hurdles of the $7,000 to $9,000 out-of-pocket cost for a single cycle, the paltry 35 to 40% chance of success, and the fact that I would have to do my own injections, we were willing to sign off on just about anything to get our kick at the can. Leftover embryos? Sure, (touch wood) if we are ever so lucky (touch wood) we’d be happy to donate them, maybe to science or maybe to another infertile couple, sure, where do I sign, just please can we get on with it?

Our clinic requires you to sign off on the “disposal” of excess embryos before you do your cycle. (Note: I’m having a very hard time writing this post and using words like excess, leftover and dispose when I know I’m talking about little frozen babies-to-be. I’m not at all rabid about abortion or right to life or anything, but it seems so cavalier to be using these words and I thought in the interest of disclosure you should know.)

In the end, I think we agreed to donate excess embryos to science, but not to go so far as to donate them to an infertile couple. At the time, I admired the nobility of the idea of donating embryos to an infertile couple, but Beloved had strong reservations and we compromised. For now, our lone frosty waits in cryogenic slumber and we pay $400 a year for the luxury of not having to think about it yet.

And now, I am finally getting to my point today. A friend of mine has both an older child and twins conceived through IVF. When she and her husband knew their family was complete, they made the selfless, courageous and heroic decision to donate their embryos for adoption. Imagine their surprise, shock and dismay to recently open an e-mail from our mutual clinic to find a forwarded e-mail from the family who adopted one of the embryos – with a photograph of their newborn child. The clinic, showing in my opinion an appalling lack of consideration, had forwarded the birth announcement back to the donating biological parents.

I cannot imagine what it must have been like for them to open that e-mail. My friend said she and her husband couldn’t help but scan the baby’s features, looking for similarities to their own – their other? – three children. I have to wonder what on god’s green earth the reproductive endocrinologist who forwarded that e-mail was thinking. He has made a career dealing with infertility and its intricacies, and I cannot fathom what would justify his actions.

Perhaps a note to the donating family, advising them that the donated embryo had – again, I am struggling for the right phrasing – come to fruition would have been marginally acceptable. That would have been more than enough for me. But to forward a photograph? I am simply flummoxed that the clinic would do this.

As if this weren’t burden enough, my friends now wrestle with further dilemmas. Their son, conceived at the same time as the donated embryo, has a serious nut allergy. They now wonder whether they are obliged to relay that information back to the adoptive family, via the clinic.

Nothing concrete changed when my friends looked at that photograph. It didn’t change the decisions they had made, and I’m sure on some level they knew that of course there was a good chance that someday, somewhere, a baby would be born from the embryo they conceived. I know enough families who have suffered through infertility to know that that baby has been born into a family that went to the ends of the earth and back to bring him or her into the world, and that there is a very good chance he or she will lead a wonderful and priviledged life. But, I do think that it would be better for everyone if that baby’s face remained unknown to my friends, because it was not their choice to know.

When we committed ourselves to the idea of using IVF to complete our family, there were a lot of things we agonized over. The cost, the physical challenges, the fear of failure were all huge obstacles to overcome. We worried about long-term health implications for me, for the children conceived through reproductive technologies. And yes, we worried about what to do with any leftover embryos, should we be so lucky to face that choice.

The jury is still out on what we’ll do with our lone little frosty, but I think we’re leaning toward giving it a try. I never expected to have three kids, don’t have a whole lot of room for three kids in our house nor our budget, but I think we have more than enough love to go around and with that as a foundation we can make anything work. Maybe in a year or two.

Before I wrote this, I asked my friend if it would be okay if I told you her story, and she said she’d be interested in hearing feedback from others. I know a lot of you have struggled with infertility, and have used reproductive technologies. We’d both like to hear your thoughts, whether you have wandered down that road or not.