COUNTDOWN TO A BABY.(personal experience with in vitro fertilization)

WEEK ONE

I have been telling my friends that what I am injecting into my wife, Doreen, this week is crushed, powdered Chinese hamster ovaries. This is not quite the truth. I am injecting her with cells from Chinese hamster ovaries that have been genetically reengineered to help develop multiple eggs and, in thirty-three per cent of the live births that result, multiple babies: twins, triplets, quadruplets, and up. It's called Gonal-F, and it costs $3,674.50 for a full course of treatment--one injection a day for twelve days during the first half of the menstrual cycle. This is just one element of the in-vitro treatment that Doreen and I hope will give us a baby.

The Gonal-F powder comes in glass ampules, six of them per injection, in Doreen's case, since her follicle-stimulating hormone (FSH) level is high--which means that her body must work very hard to produce eggs. A woman's chances of conceiving drop slightly at the age of twenty-seven, significantly at thirty-five, and precipitately at forty; her FSH level measures what's called her "ovarian reserve"--the number and quality of eggs remaining of the one to two million egg cells she is born with. The higher the FSH level, the fewer the eggs, and the less likely they can be fertilized, until a point is reached at which a woman cannot be a biological mother no matter how much Gonal-F is pumped into her blood.

Doreen is thirty-seven. She is in excellent health, she has never had a miscarriage, and her menstrual cycle is as regular as a lunar calendar. Nor does she have any tubal damage, pelvic infections, sexually transmitted diseases, etc. So we had no reason to suspect that her FSH level was high until we met with Dr. Lawrence Werlin, our fertility specialist. Photo collages of babies and cheery cards of appreciation covered his office walls, and stuffed animals spilled out of his antique rolltop desk. It was clear from his tone that what he was saying was not good news: Doreen's FSH level was above the range in which ovaries can be stimulated. But it had never been tested before, so he didn't want us to be alarmed; it could drop within range next month. Afterward, while Doreen was in the rest room, I asked Werlin's head nurse, Janet, a thin woman in her late thirties, what the cutoff FSH level was for in-vitro fertilization. "Thirteen," she said. Doreen's was sixteen. I asked Janet what it would mean if Doreen's level was sixteen when we tested it again. She said, "It means you might have to consider an egg donor." This flattened me. I was not about to find out what it would do to Doreen. I did not tell her about my conversation with Janet until after the next FSH test results came in: twelve. One point inside the ovaries-can-be-stimulated range. One point inside the hope that we may still have our own biological child.

Like most couples who one day find themselves in a doctor's office discussing assisted reproductive technology (unironically known as A.R.T.), Doreen and I had always thought that all we had to do in order for her to get pregnant was stop trying not to. Wrong. Doreen did everything but stand on her head afterward. She would jam a pillow under her butt and lie immobile for thirty minutes with her knees tucked and her pelvis tipped up. She used ovulation-predictor kits. "Does this look blue to you?" she'd ask me, holding the plastic stick in front of my nose. She bought a ninety-eight-dollar thermometer to measure the minute spike in body temperature that accompanies ovulation. We also tried: Forget-about-it-and-relax romantic weekends. Herbs. God-awful teas. Diet and exercise. No diet, no exercise. Doing it a lot, doing it a little, this way or that way. Early in mid-cycle. Late in mid-cycle. Exactly at mid-cycle. Abstaining beforehand for two days, three days, four days, five days, one week--a Rubik's cube of permutations.

None of them worked.

So we tried assisted reproductive technology. Our H.M.O. would cover six intrauterine inseminations (or IUIs, in which the sperm is deposited by catheter into the uterus at ovulation), provided that our primary-care doctor would testify that we had been trying on our own for at least two years. We had actually been trying for four years--almost as long as we had been married. Doreen was thirty-one when we started; she had just turned thirty-five when we began the IUIs. The look on her face when she saw someone else's baby was an unfailing reminder that she felt time running out. She never said anything more than "What a darling little girl." But I knew what she felt. It wasn't that she didn't have a baby. It was that she might never have one.