San Diego Reader

Like many newly married couples, Cristen and Jeffry Hays wanted to get pregnant soon after their wedding in 1992 but felt it best to wait.

They used birth control until Jeffry finished three years of chiropractic school, passed his preceptorship, and established a practice in San Diego. Then, in their mid-30s, with “it’s now or never” nagging them, they dropped their protective shields and went at it, a pleasure as often as it was a duty.

For a year, nothing happened. Something was wrong, and the Bakersfield natives suspected the problem was inside Cristen. An insulin-dependent diabetic since 12, Cristen wears an insulin pump, monitors her intake by pricking her finger and testing her blood-sugar level ten times a day, and lives at times emotionally weakened by the high maintenance her illness requires. Tests suggested that either the diabetes or scar tissue from the disease was blocking her fallopian tubes. She was ovulating regularly, but the incoming sperm couldn’t find an egg. They considered laparoscopy, a “roto-rooter,” Cristen calls it, to open up the tubes. But the operation guaranteed nothing, except another invasive procedure.

Diabetics do have healthy babies every day, Cristen tells me on a warm evening in January when she and her husband are lounging at the dining room table in drawstring shorts and cotton T-shirts at their Scripps Ranch home. Cristen is 37, athletic and fit, able to work, but weary of her daily regimen. Jeffry, a year older and a former personal trainer, possesses (literally) a hands-on grasp of anatomy as well as empathy for his wife’s condition. “Yes, [pregnancy] is doable,” he says. “But Cristen had had complications with her eyes, some stages of kidney dysfunction. Throw a pregnancy in there, throw some hormones in there, throw all that together and try to manage your blood sugar. If the blood sugars get out of control, it can wreak havoc. Some higher power was saying that this was not meant to be.” So they gave up on getting pregnant and turned to the higher power of science.

In vitro fertilization, it’s called. The now-22-year-old technique whereby conception can occur outside the body is routinely performed at seven San Diego fertility clinics. Cristen and Jeffry met Dr. David Smotrich at his Smotrich Center for Reproductive Enhancement. A soft-spoken, impartial man, as much scholar as physician, Smotrich was trained at Tel Aviv University. He told me recently, “In Israel, there’s a push for people to get pregnant.” As a “disease,” infertility is covered under Israel’s socialized medicine system, while in the United States the procedure is still elective. In any event, Smotrich didn’t need to present the Hayses with the idea of surrogacy, that is, a carrier for the couple’s fetus who gives birth to the child and gives the child to the parents. The Hayses had already stumbled on the procedure through a friend whose sister had been a surrogate. Suddenly an idea lit up in Cristen; she thought of her older sister Candace, who had three children and who, according to Cristen, gets “pregnant so easily.” Candace wasn’t sure. She hemmed and hawed for months. Antsy, Jeffry called her one afternoon and said, “I appreciate that this is a big decision, but we have to know.” After a half-year of reading, classes, and reflection, Candace agreed.

In vitro with a surrogate requires pit-stop coordination. Candace took drugs to ready her uterus to receive the embryo; Cristen was put on Pergonal to stimulate her egg production; Jeffry kept his calendar open: He would have to arrive at the clinic to supply the sperm on the same day as implantation. Which, good trooper, that’s just what he did — running a stop sign or two on his way to the clinic bathroom when the great day finally arrived.

On Pergonal, Cristen had created 14 eggs, and Smotrich, once he’d removed them from her ovary, fertilized 10 of them. (The odds of fertilization are pretty good, what with 40,000 to 50,000 fresh motile sperm after one egg on the bottom of a petri dish.) He watched the eggs closely, “grading them subjectively,” as he says, on their number of divisions, symmetry, and clarity. He determined that 6 of the 10 were viable. Smotrich and the Hayses decided then to implant 3 in Candace and freeze the other 3 for a (possible) later cycle. Raising high the roof beams, Jeffry and Cristen’s Christmas card showed a picture of an embryo, a one-day-old, six-cell floating clover leaf in its preimplantation petri-dish exile.

Fertilization begins when the pronucleus of the male gamete disperses its material into the pronucleus of the female gamete. With in vitro, it may be necessary to surgically inject a single sperm through the egg’s membrane with a needle. Consummation occurs once 23 chromosomes of each male and female gamete are combined into a single cell, the zygote. The zygote then begins cleavage, dividing many times over the next four days. At day five, the zygote forms a blastocyst, a hollow membrane of primitive cells, some external, but more colonizing internally in a tight clump. Seen under a microscope, the round blastocyst, about as thick as a human hair, or 0.008 inch, resembles an inverted wedding ring with the diamond on the inside of the circle. That diamond is the inner cell clump, elliptically formed and pulsating with switched-on genome joy. The hope is that the blastocyst will keep enlarging and, after seven and a half days, implant its sticky outer cell mass (eventually the placenta) onto and into the uterine wall. The cells forming on the inside of the blastocyst are called stem cells, that is, the undifferentiated master cells from which all other cells in our body stem.

(It is these cells and their medical possibilities that I have come to talk with the Hayses about, though I admit to being circuitous. Stem cells have been touted, just in the last two years, as the greatest medical miracle since antibiotics, because these cells, in their blastocyst stage, have unlimited potential for treating and curing almost all diseases as well as for growing organs from scratch. I hope to discover how Cristen and Jeffry feel about this potential, which, as they know, resides within the embryos they have created, and are keeping, in vitro.)

Back at the clinic, Dr. Smotrich placed three embryos in Candace. Jeffry and Cristen knew their chances were less than 50-50, but they were hopeful. Just one or, perhaps, all three will stick. High hopes, indeed, but the rule is otherwise. The best guesstimate is that only one of ten implanted embryos stays for the full term. We’ve all heard of the exhausted mother with as many as seven embryos implanted, resulting in a multiple birth after which telethons are organized and the neighborhood volunteers in shifts to change diapers. Couples and clinics want pregnancies. That can mean upping the ante with fertility drugs and the questionable practice of putting in a dozen embryos to enhance the odds (in England the law limits the number to four). But the “success rate” of in vitro remains dicey: Only 40 percent of couples who do three cycles or more (each cycle is one implantation of embryos) will get a baby.

Dicey, indeed, for Cristen and Jeffry and Candace, now an even closer triumvirate. But, sadly, none of the three implanted; Candace’s body absorbed them. After consultation, the group decided to unthaw the other three embryos and try again. A month later, that too was a bust. It was “all downhill on the emotional roller coaster,” Cristen recalls. Either they’d start once more from scratch, meaning another $10,000 cycle and the coordinated labor of the female tag team, or quit. Cristen, a fighter, says, “I wasn’t ready to give up,” even after the second failure. Jeffry adds, “We felt the odds increase every time because the doctor learns a little bit more about what he can change to make our chances greater.”

On the third cycle, they created five embryos and Smotrich placed four in Candace. Jeffry calls it “getting more aggressive,” while Cristen acknowledges some desperation. Candace agreed that if all four, or three or two, stuck, she would carry the lot to term. The lone leftover embryo they froze. Though the Hayses and Candace knew about “selective reduction,” whereby they could reduce the number inside Candace if there were complications, in principle the three decided against it. Doing so remained hypothetical: One of the four clung to Candace’s uterus and buried itself in the lining. The embryo-cum-fetus had few problems as it grew to term. In March 1999, Jayden Marie Hays was born, pudgy and healthy, a saucer-eyed charmer who by the time I meet her at age nine months cadges me to pick her up and hold her just so she can push my tape recorder off the table.

Though Cristen and Jeffry and Candace came to a perfect end with Jayden’s birth, which is also the perfect beginning of this little girl’s life, there is another “being” or “life” left to consider. That other frozen, and as yet unused, embryo. And the Hayses have considered it.

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