By Miriam Zoll

Excerpts from Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies (Interlink, 2013).

One Egg, Please, and Make It Easy

I am an official member of the Late Boomer Generation. We grew up after the Pill and the Baby Boomers, in the socially transformative 1970s and '80s, watching with wide eyes while millions of American women - some with children and some not - infiltrated formerly closed-to-females professions like medicine, law, and politics. This exodus from the kitchen into the boardroom created a thrilling, radical shift in home and office politics, in the economy, and in relations between the sexes.

"Shoot for the stars," some of the more thoughtful women advised us, "but don't forget about the kids."

We are the generation that also came of age at a time of burgeoning reproductive technologies. We grew up with dazzling front-page stories heralding the marvels of test-tube babies, frozen sperm, surrogates and egg donors; stories that helped paint the illusion that we could forget about our biological clocks and have a happy family life after - not necessarily before or during - the workplace promotions.

Each week newsstands brimmed with stories about older celebrities becoming mothers with the help of miraculous fertility treatments. A few years ago, photographer Annie Leibovitz birthed her first child at the age of 52, while actress Geena Davis delivered at 48 and supermodel Christy Brinkley at 44. More recently we read about singers Mariah Carey and Celine Dion delivering twins at 41 and 42, and actresses Courtney Cox and Marcia Cross became mothers at 43 and 45, respectively. From where we stood, science and technology was the New God, giving women once considered over the hill a chance to start a family in middle age. Whether we knew it or not, we comforted ourselves in a security blanket of medical and media reassurances that age and motherhood no longer mattered.

* * *

On the morning of our first appointment at the fertility clinic, Michael and I were nervous and excited. The clinic literature cited studies claiming, "Well over two-thirds of all couples seeking treatment for fertility- related problems become parents." It didn't occur to us then to ask if this statistic meant that two-thirds of parents birthed their own babies or a donor egg or embryo baby, or if they became parents through adoption or surrogacy. We were as green as could be about what to expect and what to ask, and we were eager to hear how the doctors thought they might help us.

The world's first test-tube baby had been born in Britain in 1978. Data from the European Society for Human Reproduction and Embryology indicates that globally in 2012, approximately 1.5 million assisted reproductive technology (ART) cycles were performed and roughly 1.1 million failed (77 percent). In the United States, the Fertility Clinic Success Rate and Certification Act of 1992 requires the Centers for Disease Control (CDC) to publish self-reported ART pregnancy "success rates" from almost 500 fertility clinics scattered throughout the country. In 2010, the most recent data available, there was an overall failure rate of 68 percent. With no standardized reporting mechanism, the rates are based on cycles that require manipulation of egg and sperm outside of a woman's body. They do not take into account success or failure rates of intrauterine insemination (IUI), hormone treatments alone, or donor egg cycles that are cancelled.

That first day, my husband and I met with two health care professionals, one who examined my female interior and another who walked us through the ins and outs of the medical aspects of fertility treatments. A marble egg sat on a little pedestal on both staff members' desks, and at one point during our meetings they each held it between their thumb and index fingers. In the spirit of Vanna White, the former Wheel of Fortune hostess, they smiled and said, verbatim: "Like we say here at the clinic, it only takes one good egg to make a baby." It was obviously the clinic's mission statement. I immediately thought that, if all we had to do was find one good egg, we were certainly the right candidates for the job. How hard could that be, really? We had the best of modern science and medicine at our fingertips. I was in great mental and physical health. I exercised and practiced yoga regularly. I ate well. What more could a doctor ask from a patient? Little did I know that the process of finding one good egg would be a bit like panning for gold in a mine that had already been stripped of much of its bullion.

A few weeks later, we met with a veteran physician I like to refer to as the Silver Fox. He greeted us with a warm handshake and a smile, and gave us time to look at his marble egg and photos of ferocious sperm fertilizing healthy eggs. Once he read through our medical records, he sighed very dramatically, clasped his hands together on top of his desk and looked me straight in the eye.

"The first thing I want to say is that you're old."

I winced as his words cut through me like a razor-sharp sword, and then within a split second I found myself in a serious state of denial, fighting back the urge to tell him that he was the one with the white hair, not me. He was the old geezer in the room, not me. No sir, not me. All my life I had to convince people that I wasn't as young as I appeared. I knew I was teetering on the brink of officially entering middle age, but I didn't think I was there - yet.

"Women your age have a harder time conceiving, especially if they have endometriosis, like you," he continued. "You should have come to see me when you were thirty."

Why thirty? My friend Sarah became pregnant the first time she tried at the age of forty, and Tracy got pregnant the first time she tried at forty, and then again at forty-three. Susan and Stephanie, my colleagues at the United Nations where I was working, both delivered without IVF at forty-two and forty-three. I was a little shocked by the doctor's recommendation, but I quickly learned that, after witnessing the failure of the technology time and time again, a growing number of fertility specialists around the world were now advising women to have their children in their twenties.

Welcome to Casino Fertile

...I was confident that, since my mother had birthed me later in life, I would have no trouble doing the same thing. During that first meeting with the Silver Fox, I proudly told him that my mother had been thirty-nine years old when I was born.

"Just because your mother did it doesn't mean you will too," he replied. "Do you think there's a gene for birthing in middle age that your mother passed onto you?"         

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