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Authors: Natalie Angier

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BOOK: Woman: An Intimate Geography
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mammalian egg, is built for darkness, for spinning stories in visceral privacy and you can thank that trait, in part, for your smart, fat, amply convoluted brain. An internally conceived and gestated fetus is a protected fetus, and a protected fetus is a fetus freed to loll about long enough to bloom a giant brain. So we lend new meaning to the term
egghead:
from the cloistered egg is born the bulging frontal lobe.
How different is the status of the sperm. A sperm cell may be tinier than an egg, measuring only a small fraction of the volume, so it is not exactly a form of billboard art either. Nevertheless, because it is designed to be externalized, publicly consumed, sperm lends itself to easy technovoyeurism. One of the first things Anton van Leeuwenhoek did after inventing a prototype of the microscope three hundred years ago was to smear a sample of human ejaculate onto a glass slide and slip it under his magic lens. And men, I will set aside my zygotic bias here to say that your sperm are indeed magnificent when magnified, vigorous, slaphappy, whip-tailed tears, darting, whirling, waggling, heading nowhere and everywhere at once, living proof of our primordial flagellar past. For mesmerizing adventures in microscopy, a dribble of semen will far outperform the more scholastically familiar drop of pond scum.
A woman's body may taketh eggs away by apoptosis, but it giveth not without a fight. How then to see an egg? One way is to find an egg donor: a woman who is part saint, part lunatic, part romantic, part mercenary, and all parts about to be put under the anesthesia that Bustillo calls the "milk of amnesia," so she will not feel her body crying bloody hell on the battlefield.
Beth Derochea pats her belly and booms, "Bloated! I'm full of hormones! I tell my husband, Stay away!" She is twenty-eight but looks a good five years younger. She is an administrative assistant at a publishing company who hopes to work her way up to an editing position. Her hair is long, dark, parted on the side, casual, and her smile is slightly gappy and toothy. "I hope nobody inherits my teeth!" she says. "Anything but that I've got really weak teeth.'' Derochea is a woman of gleeful, elaborated extroversion; even being in a flimsy hospital gown doesn't make her act shy or tentative. She bounces; she laughs; she gestures. "She's so good!" a nurse in the room exclaims. "I'm so broke," Derochea says. "I'm a little ashamed to admit it, but I'm in debt." That's

 

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one of the reasons she's here, at Mount Sinai, to donate eggs, her pelvis tender, her ovaries swollen to the size of walnuts when normally they would be almonds, tubing about to be slipped into her nostrils to bathe her in milky amnesia.
If somebody were to design a line of fertility fetishes, Beth Derochea could be the model. Clips of her hair or fingernails could be incorporated into the amulets as saints' parts are encased in reliquaries. This is her third time at playing egg donor. She gave eggs twice during graduate school, and each time she yielded up a bumper crop of twenty-nine or so. Now she is back, in part for the fee of $2,500. But only in part. There are other reasons that she doesn't mind, even enjoys, donating eggs. She and her husband don't yet have children of their own, but she told me she likes playing mama. She mothers her friends; she urges them to dress warmly in the winter and to eat their fruits and vegetables. She likes changing diapers on other people's babies and rocking the infants to sleep. She likes the idea of her seed seeding other people's joy. She doesn't feel proprietary about her gametes. A fan of science fiction of the eggheaded variety, she tells me about something that Robert A. Heinlein once wrote. "'Your genes don't belong to you,' he said. 'They belong to all humanity.' I really believe that. My eggs, my genes, they're not even something that's me, they're something I'm sharing. It's like donating blood!"
By this generous, almost communistic imagery, we are all aswim in the same great gene pool, or fishers from the river of human perpetuity. If my line comes up empty, perhaps you will share your catch with me. For such reasons of heart and rightness, Derochea said she would donate eggs even if she weren't paid. "I might not have done it three times, but I definitely would have done it at least once," she says.
Her sentiment is rare. In many European countries, where it is illegal to pay a woman for donating eggs, almost nobody does it. Bustillo said that when she attended a conference on bioethics recently, the audience of doctors, scientists, lawmakers, and professional ponderers was asked, just out of curiosity, whether anybody there would donate eggs. "Nobody raised her hand," Bustillo said. "Though two people later said they'd consider doing it for a relative or good friend." Derochea is not donating eggs for relatives or friends. She never meets the couples who receive her eggs, she will never see any progeny that might come of

 

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them, and she doesn't care. She doesn't moon over sequelae, she doesn't fantasize about her mystery children. "I've managed to disengage myself from any sense of investment," she says, as calm as a Renaissance madonna.
I say to Bustillo that it's a good thing the best egg donors women at the peak of their fertility, in their early thirties or younger are at a point in life when they are likeliest to need the cash. An egg donor earns every dime of her blood money. Three weeks before I met her, Derochea had begun injecting herself with Lupron, a synthetic version of gonadotropin-releasing hormone, a potent chemical bred in the brain that begins the entire cycle of egg-dropping. For a week she injected herself nightly in the thigh with a narrow needle of the type diabetics use. No big deal, she said. Barely noticeable. Uh-huh, I said, thinking, Oh, sure, sure, anybody could do it, anybody except me, who's always thought the worst thing about heroin addiction is not the way it ruins your life or may give you AIDS but that you have to inject
yourself
with a
needle
.
After the Lupron came the hard stuff. She had to switch to a double-barreled shot of Pergonal and Metrodin, a mix of ovulatory hormones designed to spur the ovaries into a state of hyperactivity. (Pergonal, incidentally, is isolated from the urine of postmenopausal women, whose bodies have become so accustomed to the menstrual cycle that they generate ovulatory hormones in extremely high concentrations because of a lack of feedback from the ovaries.) Preparing this sweet brew demanded concentration, to assure that as she pulled the fluid into the hypodermic syringe, no potentially embolizing bubbles were pulled up with it. She also needed to use a much heavier-gauge needle than she did for the Lupron, which means a bigger and more painful shot. This time Derochea had to aim for the rear part of her hip, every night for about two weeks. Not terrible, not an ordeal, but something she admitted she wouldn't want to do each month. Toward the end of this non-ordeal, to stimulate the final stage of ovulation, Derochea gave herself a single shot of human chorionic gonadotropin, again through an ominously large hypodermic.
All the while, between nightly inoculations, she had to return repeatedly to the hospital for sonograms, to check on the expansion of her ovaries. She thickened with excess fluid and jested about her snappish-

 

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ness. When I talked to her, she was more than ready to give up her grams of flesh. Her two ovaries were like overstuffed sacks of oranges, each orange an egg ripened with unnatural haste by three weeks of hormone treatments. In a normal cycle, only one egg would be pushing its way from its ovarian pocket. But at the moment Derochea was an Olympic cycler, and two or three years' worth of oocytic offerings had been condensed into a single month. There's no evidence that she has lost those years that her childbearing potential has in any way been compromised or truncated. We are, after all, overbudgeted with eggs, and think of what management does at the end of the fiscal period to budgets that don't get used: ka-
ping!
So the medical Demeters of the world simply cannibalize what otherwise would apoptose into the void.
In any event, fertility fetishism runs in Derochea's family: all of her siblings have already reproduced repeatedly. "Having babies is just something we do," she says. Derochea also doesn't worry about the risk of ovarian cancer, which some experts have proposed is heightened by the use of fertility drugs. The data on this question remain inconclusive, and in any case are more associated with the drug Clomid than with any of the follicular stimulants that Derochea has received. "If my family had a history of ovarian cancer, I'd be more concerned about it" she says. "But at this point, I'm not worried. Maybe that's stupid, but I'm not worried."
She lies down on the operating table. They pump her first with oxygen, then with anesthesia. They ask her if she's sleepy yet. "Mrrph!" she mumbles. A moment later she's as limp as a Dali clock. The surgical assistants stick her legs in stirrups and douse her genitals with iodine, which looks like menstrual blood as it dribbles along the inner folds of her thighs and onto the table. Bustillo barrels into the room, washes her hands, and jokes about crap and vaginas but no matter, she scrubs. She sits down at the end of the table, at the gynecologist's stirrup-side post, ready for one of the easier breaches of the body's barrier. Her assistants wheel a portable ultrasound machine over to the table and hand her the ultrasound probe, an instrument shaped like a dildo. She slips a stretchy latex casing over the probe "the condom!" she says and threads a needle through the device that will suck the readied eggs from their pockets.
Bustillo inserts the wand into Derochea's vagina and up into one of

 

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the two fornices, the culs-de-sac of the vaginal canal that pouch up around either side of the cervix. The needle pierces the fornix wall, moves across the pelvic peritoneum the oily membrane that surrounds most of the abdominal viscera and finally perforates the ovary. Bustillo does the entire extraction procedure by watching the ultrasound screen, where the image of the ovary looms in black and white, made visible by bouncing high-frequency sound waves. Coming in on the top lefthand side of the screen is the needle. The ovary looks like a giant beehive honeycombed with dark bloated egg pockets, or follicles, each measuring two millimeters across. These are all the follicles that were matured by Derochea's diligent nocturnal injections. The sonogram screen is full of them. Manipulating the needle-headed probe with her eyes fixed on the sonogram, Bustillo punctures every dark honeycomb and sucks all the fluid out of the follicle. The fluid travels down the tube of the probe and into a catchment beaker. You can't see the egg suspended in that fluid, but it's there. Immediately after the fluid has been extracted from the follicle, the pocket collapses in on itself and disappears from the screen. A few moments later it slightly distends again, this time with blood.
Prick! Prick! Prick! Bustillo pierces and vacuums out every follicle so quickly that the honeycomb seems alive with accordion motion: pockets fall in, reengorge with blood. Prick! Prick! Prick! It hurts vicariously to watch; I want to cross my legs in discomfort except that I'm standing up. One of the surgical assistants tells me that sometimes the women who have this procedure done demand that it be performed without anesthesia. They regret their choice. At some point they start screaming.
When the left ovary is picked clean of ripe eggs, Bustillo moves the probe over to the other vaginal fornix and repeats the maneuver on the right ovary. The entire bilateral pricking and sucking takes ten minutes or so. "Okay, that's it," Bustillo says as she withdraws the probe. A stream of blood flows from Derochea's vagina like a fire set by a departing army. The nurses clean her up and start calling her name and shaking her arm to wake her. Beth! Beth! You're done, we're done, we've plucked you clean. Your genes are now floating in the communal pool in which another woman soon will immerse herself, seeking baptism with baby.

 

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Back in the lab, Carol-Ann Cook, an embryologist, separates and counts the day's plunder: twenty-nine eggs, the same number harvested from Beth Derochea twice before. This woman's vineyards are fruitful! Cook prepares the eggs, these grapes of Beth, for fertilization with the sperm of another woman's husband, a woman who lacks viable eggs of her own.
The use of donor eggs for in vitro fertilization is one of the few promising things that have happened to the technique since its introduction in the 1970s. Most women who attempt IVF are nearing the end of their patience and fecundity. They are in their late thirties, early forties. For reasons that remain entirely opaque, the eggs of an "older" woman and it annoys me to use that term for anybody under eighty, let alone
my peers
have lost some of their plasticity and robustness. They don't ripen as readily, they don't fertilize as well, and once fertilized, they don't implant in the womb as firmly as the eggs of a younger woman do. Older women usually start by trying IVF with their own eggs. They are partial to their particular genomes, their molecular ancestry, and why not? There's little difference between a baby and a book, and it's usually best to write about what you know. So they go through what Beth Derochea went through, weeks of preparatory hormonal injections. At the other end, though, they give forth not dozens of eggs but perhaps three or four, and some of those may be barely breathing. The fertility gods do their best. They join the healthiest-looking eggs and a partner's sperm in a petri dish to form embryos. After two days or so, they deliver the embryos back to the woman by squirting the clusters of cells, afloat in liquid, through a thin tube inserted into the vagina, across the cervix, and into the uterus. No big deal: blink and you miss it. Alas, for the women too it's a case of blink and you lose it. In the vast majority of patients, the technique fails. The chance of an older woman giving birth to a baby conceived from her eggs through IVF is maybe 12 to 18 percent. If you heard that these were your odds of surviving cancer, you'd feel very, very depressed.
An older woman may try IVF once or twice, even a third time, but if by then she hasn't conceived with her own harvest of DNA, she probably never will. At that point a doctor may recommend donor eggs, combining the seeds of a younger woman with the sperm of the older woman's husband (or lover or male donor) and then implanting the

 

BOOK: Woman: An Intimate Geography
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