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.)