Fertile Ground (10 page)

There had been few men in her life. She could barely remember the college senior to whom she’d given her virginity (this was soon after Asher; she’d been rebellious, hurt, angry, desperate for affection). She dated more and more sporadically and became increasingly reluctant to become physical. She enjoyed sex, but found that sex

without love left her dissatisfied and uneasy (she’d moved out of her parents’ Orthodox world, she realized now, but hadn’t rid herself of its values). And until Matthew, she hadn’t had time for love. Lately she wondered whether it hadn’t been the other way around—whether her single minded focus on her career had been an excuse to prevent her from entering the risky world of relationships.

“Was it worth it?” the reporter asked. “All that hard work?”

“I love what I do.” Lisa lifted the porcelain cup and, inhaling the fragrant steam, realized she hadn’t really answered the question. She took a tentative sip.

“Me, too.” Gina smiled again. “I don’t know if Mr. Fisk explained, but we’ve been planning a piece on fertility clinics for a while. I’m not here to do a hatchet job. I want to get background for an in-depth piece. And I’d like to come back with a film crew.” She cocked her head. “I will be asking some tough questions about your clinic in light of yesterday’s allegation. Fair enough?”

“Fair enough.” If the woman was telling the truth.

“Okay.” She flipped open her pad. “Percentagewise, how many couples who come here to the clinic achieve a live birth?”

“I don’t have our latest statistics, but I’d say between twenty-five to thirty-two percent. There are many variables—the age of the woman, any physiological abnormalities or diseases, the sperm quality and quantity.”

“Good rates.” Gina looked at her with interest. “Newsweek did an explosive piece on fertility clinics a while back. Based on data submitted to the American Society for Reproductive Medicine, the national success rate is twenty-one-point-two percent. How do you account for this clinic’s superior rates?”

Lisa was familiar with the Newsweek piece. So was everyone in the field of assisted reproduction. Edmond should be handling this, she thought with a flash of irritation, but he hadn’t come in, wasn’t expected to be in.

She put the cup on the coaster. “We have a superior staff of physicians and lab technicians who have perfected the assisted-reproduction techniques we use. We also

have unique methods of dealing with male infertility and problems related to the woman’s immune system.”

“That’s what your brochure says. Mr. Fisk messengered all the literature to me yesterday.” Gina paused. “It doesn’t really explain all that much, though. You mentioned you don’t have the latest statistics. Are they forthcoming?”

“The new brochures are at the printers’.”

“As the clinic’s founder and one of its directors. Dr. Gordon would know the statistics. But he’s not available?”

There was no mistaking the innuendo in the reporter’s tone. Lisa hoped her own face was impassive. “That’s correct.”

She’d barely slept last night. She’d phoned Sam as soon as she’d stepped inside her apartment, still shaking, even though she’d realized that no one had been following her, that her imagination had invented menace. She hadn’t mentioned the car or the “Notes” file, but she’d told him that Matthew was missing, that Barone thought his disappearance might be linked to Chelsea Wright’s murder. She’d heard Sam’s shock when he finally spoke. “I’m coming over,” he’d told her. “You shouldn’t be alone.” She’d turned down his offer—it was late, and she hadn’t wanted to take advantage of his friendship—but they’d talked for a while, and she’d taken solace in the warmth and caring his voice offered.

Edmond had phoned, too. She’d repeated what she’d told Sam but hadn’t mentioned the missing luggage and clothes; she’d told him she’d tried to file a missing persons report and would try again in the morning. She’d done so on the way to work and had been pestering Se lena, who was too kind to show annoyance, asking her every half hour for news.

“You have no idea where Dr. Gordon is?” the reporter pressed.

“No.” Lisa made a point of looking at her watch, as if time were her problem. Normally, it was—the clinic saw over five hundred patients a year, and the pace was grueling. But today she had too much free time. She’d

been busy till now with patient procedures, all of which were scheduled for the early morning. Interviews with prospective patients took place later in the morning or in the afternoon. Many of today’s appointments had canceled. She was certain the reporter had noticed the relatively empty waiting room.

“Since you’re interested in assisted reproduction, Gina, I thought we’d start with the retrieval of the patient’s eggs. This is after the patient has taken fertility drugs, like Pergonal.”

“The retrieval’s done here, in the clinic?”

Lisa nodded. “In an operating room, under what we call conscious sedation. The patient is in a light state of sleep and needs no assisted breathing, just an oxygen mask.”

Gina wrote on her pad. “How do you remove the eggs?”

This was the kind of question Lisa felt comfortable answering. “Using an ultrasound screen as a guide, I insert a needle attached to a transvaginal probe into the ovaries and puncture each of the mature follicles. The needle has a suction tip that aspirates the egg from the follicle into a tube attached to the needle.”

“Just a sec.” The reporter was scribbling quickly. “How do you activate the suction apparatus?” “With a foot pedal. On the ultrasound screen you can see the follicle collapse when it’s empty.”

“Neat.” Gina nodded. “It would be great if we could get that on film. Do you always find an egg?” “We don’t do a retrieval unless there are at least four follicles, sixteen millimeters or larger. The ultrasound shows the size and quantity of the follicles. Blood tests show the hormone levels that indicate the probability of eggs being present.” Lisa drank more coffee and watched Gina write.

“So each egg is aspirated into a separate test tube?” “Usually. Sometimes the needle punctures two follicles at once. In that case, both eggs will be aspirated into one tube.”

Gina nodded again and nipped a page of her pad.

“How many eggs do you typically aspirate during a retrieval process?”

Lisa shrugged. “There is no’ typical Harvesting can yield from one to thirty eggs.”

Gina raised her brows. “Thirty eggs! That’s a tribe. Imagine Thanksgiving dinner.” She shuddered.

“Thirty eggs is a lot.” Lisa smiled. “We’re pleased with twelve to fourteen.”

“What happens next?”

“A lab technician checks the contents of each test tube through a microscope. The tech tells me whether an egg is present or not and rates the egg as mature or immature.”

“I guess it’s true what they say, that society labels its young early, huh?” The reporter’s laugh was low and throaty.

Lisa laughed, too. “I guess.” She lifted her cup and drained its contents. “The lab tech labels each test tube, of course. We’re scrupulous about proper labeling. It’s imperative that the records are complete and accurate.”

“But mistakes are possible, aren’t they?”

Here it comes. Lisa felt her stomach muscles tensing. “I don’t see how. The labels for each patient are typed the night before the egg retrieval. The lab tech makes sure the labels correspond with the patient’s name.”

“Okay. So the test tubes are labeled. Then what?”

Lisa relaxed in her chair. “They’re stored in a lab incubator at womb temperature. Meanwhile, the partner’s sperm has been collected, prepared, and labeled. The ratio is one egg to about two hundred thousand sperm, by the way.”

“Talk about overkill.” Gina smiled and shook her head.

“Uh-huh. Sometimes, if the sperm is sluggish, a caffeine like booster is added.”

Another lift of the finely arched brows. “No kidding! A little espresso to get them going?” She inclined her head toward Lisa’s cup.

“Something like that.” Lisa was beginning to like Gina Franco. She reminded herself not to mistake charm

and humor for sincerity. “Two to three hours after the retrieval, the eggs are fertilized with the sperm in labeled petri dishes and incubated.”

“How many eggs are successfully fertilized?”

“The national statistic is eighty-six percent. We do somewhat better. Three days later the fertilized eggs are transferred into a catheter, which is inserted into the patient. The eggs float into the uterus. This time there’s no anesthesia.”

Gina crossed her legs. “How many eggs?” “We do a maximum of four. Some clinics implant five or six, sometimes more. That’s because the chances for conception increase with the number of implanted embryos.”

Gina frowned. “So why does your clinic do only four?”

“More embryos can result in multiple gestations. Multiples are more difficult to sustain than singletons, especially when you’re talking triplets and higher. Prenatal and postnatal care is far more expensive. The mother faces greater risks, and there are often serious birth defects and complications—blindness, brain damage, learning disorders. There’s also a high incidence of cerebral palsy. Sometimes the complications are fatal.”

She hoped the reporter would include that in her piece;

she’d seen heartbreaking examples of permanently handicapped newborns. The images still haunted her. “Some specialists prefer to increase the chance of conception by using more eggs. Then, if there are three or more embryos, they encourage selective reduction.” That was what Ted wanted to do. “We have to be competitive,” he’d insisted angrily at the last staff meeting. Lisa and Sam had voted him down.

“That’s a euphemism for abortion, isn’t it?” Gina tapped her pen against her pad. “I’ll bet the pro-lifers aren’t happy.”

“They aren’t. And many patients refuse to do it. It’s a complicated, controversial issue.” The Hoffmans, Lisa recalled, had discussed the possibility of multiples before Naomi conceived. A rabbinic authority had advised them

that to save the remaining fetuses and protect the health of the mother, selective reduction was permissible, but should be done as early in the pregnancy as possible, preferably before the fetus was forty days old. The Hoffmans had decided against selective reduction and were thrilled when Lisa told them Naomi was carrying twins.

“What happens to the fertilized eggs that aren’t implanted?”

“They’re labeled and frozen in liquid nitrogen for later use, just as sperm are. Approximately seventy-five percent of thawed embryos survive intact.”

“And the unfertilized eggs?” Gina asked, hunching forward. “The ones from donors, for instance? Are they frozen, too?”

“They’re too fragile to withstand the freezing and thawing. Researchers are working on finding a solution.” Including Matthew. She thought again about the “data lies!?” he’d scribbled yesterday morning, and the “Notes” file.

“Well.” Gina looked as if she’d swallowed sour milk. “I thought I’d have my eggs frozen now, while I’m relatively young. I read that a woman’s chances of conceiving drop significantly after she’s thirty-five. I guess that gives me one more year. huh? And all the good men are taken.”

Lisa smiled reassuringly. “Those are just statistics, Gina. I wouldn’t panic.”

“Off the record? You’re three years younger, and I assume from your engagement ring that you don’t need a sperm donor. But are you at all worried that you’ll have trouble getting pregnant?”

Lisa glanced automatically at her ring and felt her chest tighten as she thought about Matthew. “I think every woman worries until she is pregnant. Off the record? Yes, I worry. But I know assisted reproduction provides me with numerous options.”

“And if none of them work, that would make some ironic story, huh? “Fertility eludes infertility specialist.” “

“Highly ironic.” The possibility had crossed her mind more than once.

She and Matthew had talked about starting a family as soon as possible—at least three children, they’d agreed. As an only child himself, he’d understood the loneliness she’d felt growing up. Why can’t I have a brother or sister like everyone else? she’d often pleaded when she was a little girl, not realizing the pain her questions must have caused her parents.

“Back to the eggs,” Gina said, turning another page of her notepad. “What happens if the patient decides she no longer wants them?”

Lisa was relieved to switch to a less personal discussion. “It depends on what arrangements are made.”

“And if there are no arrangements? If patients move and lose contact with the clinic? What happens then?”

Lisa hesitated. “Generally, we dispose of them. That’s standard procedure in fertility clinics around the world.”

“And the pro-lifers are unhappy about that, too, right? Another controversy?” Gina’s eyes gleamed with interest.

Lisa wondered if the reporter was going to make these issues the focus of her piece. “There are numerous ethical questions regarding assisted reproduction. It’s a new field, and we’re encountering different issues as we discover new techniques. We don’t have all the answers yet.”

“Why can’t you give the donor eggs to other patients? I mean, why chuck them when they could benefit someone else?”

Was this a trick question? “Not without the donor’s written consent. That would be unethical, and illegal. California made it a felony to steal eggs.” Punishable by up to five years in prison and a fifty-thousand-dollar fine.

“But it could happen accidentally?”

From a desk drawer Lisa pulled out a blank form, then walked around the desk and sat next to the reporter.” “This is a lab form. Across the top we list the surgery date, the names of the patient, partner, retrieval physician, and lab tech. Underneath that we list the number of follicles and eggs retrieved.”

She pointed to the middle section. “In these columns we grade the eggs and note the date and time of the insemination and embryo transfer.” Her finger moved to the bottom of the page. “The sperm specimen is dated

and graded and purified—the partner’s or donor’s name is listed, as is the tech’s. Below that is information regarding the transfer. Again, the tech’s name is listed.

“Now look here.” Lisa indicated a box at the bottom right-hand corner of the page. “We check whether the embryos were frozen or not. If they were, we indicate the date and time, the number frozen, the number of vials frozen, the stage at which they were frozen. As always, the tech’s name. We keep accurate cryologs on all frozen embryos, and we use a separate form for the embryo transfer. There’s a clear line of accountability and origin all the way through.”