A Locked Chest

What problem does I.V.F. propose that it can fix? Parents enter the clinics looking for—at last!—a professional way of having children. There are experts everywhere, clad in white coats, and there is a clear language of timelines, probabilities, pricing. I.V.F. sells not just the promise of a child, but the hope of predictability and control. It cannot keep this promise, any more than any other route to parenthood can. And it asks parents to mortgage some of their children, the ones who are created, frozen, and ultimately thrown away, in exchange for this fairy gold.

The brochures and websites of I.V.F. clinics may try to make the service they sell sound simple, like one more high-end purchase. A quick search turns up one of the clinics closest to me, which promises that “our top reproductive endocrinologists are committed to you on your family-building journey.” One of the clinic’s testimonials makes one of its doctors sound like the S.A.T. coaches a high-achieving family might hope to hire in about sixteen years: he “does everything in his power to help them achieve their goal of having a child.”

But a family seeking I.V.F. isn’t on a thrilling family-building journey, and the would-be parents have already found that being “goal-oriented” and motivated wasn’t enough to cause a child to exist or to survive until birth. People who seek out I.V.F. often do so not because they have a strong consumerist or eugenicist instinct, but because the “natural” method of seeking to welcome children has left them empty-cradled and marked by grief. Entering the I.V.F. clinic is rarely a matter of embracing a simple, consumerist transaction—put fifteen thousand dollars into the vending machine, withdraw baby—and more an attempt at bargaining.

When aspiring parents find no obvious natural route to having a child, they are presented with an array of alternatives, some more licit than others. I.V.F., adoption, and egg freezing all share one part of their pitch in common: they’re intended to offer a kind of stability that was out of reach until now. Finally things will be fair and you can get what you deserve. But each method is ultimately a new trek through uncertainty and uncontrollability. There is no other path to parenthood.

Aspiring mothers line up the array of syringes and fill up their calendars with appointments in a spirit that is akin to that of the religious mothers who are told, “If you promise to name the baby ‘Gerald’ . . .” “If you drink the ground-up rocks from the milk grotto . . .” “If you do this never-failing novena . . . then this baby will live.” The greater the effort, the greater the physical suffering, the greater the hope that you have finally found the meritocratic door into parenthood. Here you can apply your capacity for suffering as currency.

A great deal of suffering, longing, and grieving has already led you here, but it was clearly not the correct kind of suffering, or you applied it at the wrong angle, losing the leverage it might have given you. The doctors have a method where your suffering will not be wasted, where it can be converted into cleaner probabilities.

But, as quickly becomes obvious, those probabilities are not certainties. Signing up for I.V.F. means, for most couples, signing up for more losses, ones which now come on a slightly more predictable schedule. Leave aside the uncertainty of egg harvesting, insemination, and the careful observation and ranking of children to see which should be first in line to be born. By the time the parents have cleared each hurdle and gotten to implantation, up to half of the time they will lose the child they took such care to craft and transfer.

The grief may not be entirely new to them, but it will have a different character than the miscarriages they may have suffered at home. An early loss comes as a mystery, with little you can know about your child. In my own cycle of losses, we hoped week by week to see and know our child a little more. Get to seven weeks to have the chance of seeing a heartbeat. Stretch to ten weeks and be able to glimpse the child’s sex by assaying my blood for free-floating Y chromosomes, even if the two-week wait for blood results might mean they come back after the baby is gone.

But in a clinical setting more is known, has to be known, before the baby is sent into the crucible of the womb. Parents choose from among the “good” children, seeking the best one. If they have multiple well-formed embryos, they face the possibility of authorship—choosing the sex of the child who is, at present, only about eight cells in toto (possibly down to seven after one cell was removed for destructive assessment).

I.V.F. parents, knowing their child’s sex, could choose a name much earlier than usual, but face the question of whether they are willing to “use up” this name on a baby who is so fragile, with an uncertain future. There is no side-stepping the fundamental loss of control that comes with being a parent, or even attempting to be one. I.V.F. cannot solve the risk of loving someone so small, and so vulnerable. But it makes it harder to fully acknowledge a child’s precarity, especially when the process divides children into keepers and failures.

There is no way for parents to avoid the close mingling of hope, fear, and grief when they open their hearts and their lives to a child. I.V.F. follows a pattern of seeming solutions which promise an impossible predictability or “satisfaction guaranteed.” Even family-expanding attempts that are licit often over-promise and mislead parents in this way.

For my own family’s part, I.V.F. was never a “solution” we entertained as we lost child after child to first-trimester miscarriages. Our Catholic doctor was clear with us that she would identify every medical issue she could licitly treat. She prayed with us and was diligent in her exploration of possible issues. In the end, we never uncovered a definitive explanation for why six of our children died and, subsequently, three of our children lived.

During that long desolation, we began exploring the possibility of adoption instead. We wanted to be open to life in whatever form we might be able to welcome it, and we both had adoption in our family. My husband’s sister was adopted from China, as was the only child of one of my mom’s closest friends.

The experience of adoption in our parents’ generation was very different from the landscape of choices we faced. For them, planning to adopt internationally, particularly from China, was a matter of assembling paperwork and getting in line. For as long as China maintained its hostility to its children, there would always be a supply of children relinquished to American families. They were orphaned not by the loss of their parents, but by their country’s cruelty to their families.

By our time of longing to be parents, China had realized it had erred, at least on a demographic level, even if the Communist Party was not willing to concede the point morally. The one-child policy had been lifted, and the nation urged marriage and having two, or even three, children. The surviving children of the stricken generation, now grown to adulthood, were mostly disinclined to trust their autocratic government’s volte-face. There were too few children to go around, and certainly almost no “extra” ones for adoption.

In America, there are many older children in the foster system, but very, very few infants who need to be adopted. Signing up to foster is a generous act, but one we felt unprepared for as young new parents. It certainly seemed easier to start by raising a baby, with his or her urgent but simple needs, than to assay the unpredictable demands of a preteen. We could grow as parents alongside our child.

But, much more than that, we knew that as parents who had lost the children we loved, we were unprepared for the key demand placed on foster parents: you have to root for the children you love to leave. The primary goal is family re-unification, and you can’t enter into a spirit of competition with the family whose custody is under investigation. The hope is to be a temporary safe harbor in a hard time. All parents must eventually let their children slip through their hands, but fostering means embracing that uncertainty at an unpredictable time—preparing for the school bus to one day return bearing every child but yours.

If we wanted to try to adopt an infant, our agency told us with admirable clarity, it might never happen. Very few women with crisis pregnancies choose adoption—they strongly prefer either to raise their children themselves, no matter how hard their circumstances or to accept the certainty of abortion rather than the mystery of surrender. Women who just miss their state’s cutoff for an intended abortion overwhelmingly chose to raise their children rather than, as the agency put it in boosterish language, “make an adoption plan.”

If we were matched with a mother we might receive a call with twenty-four hours’ notice and need to start driving to one of the four or five states where our agency was licensed in order to meet the baby at the hospital. If we’d left the country, lost our phones, disconnected in a national park, too bad. There was no line to wait in; all we could do was buy a lottery ticket with a cycle of hope and disappointment that was merely different from the natural one we’d been holding.

The agency left the adoption choice primarily in the mother’s hands. Families could put together an adoption profile for mothers to leaf through, but our main point of control was selecting what kind of baby we wanted to be eligible for. The adoption agency offered a very different menu than that of the I.V.F. clinic. While pre-implantation screening of embryos lets parents choose the sex of their child, the balance of their chromosomes, and, in some cases, a reweighted risk of breast cancer or brown eyes, our options were about which risks to embrace.

Were we willing to adopt a baby of a different race than our own? For which of the following drugs were we comfortable adopting a baby with significant in utero exposure? The adoption clinic ran a special online workshop for prospective parents, going over what post-birth detox from different drugs could look like, and what the long-term effects might be. What pattern of mental illness in the parent(s) might deter us from volunteering to adopt?

The enumeration of dangers and difficulties made clearer what the agency only occasionally alluded to. For many of the mothers “making an adoption plan” the choice was just about how they would lose their child. If they didn’t make a pro-active choice about an adoptive family, Child Protective Services might make a choice for them at the hospital. The baby would be airlifted out of the crisis, but the mother would continue on as she was.

Our job was to audition, taking photos, writing up a family narrative, making the case that we could raise her child. At one adoption class, a mother who had previously offered her child up came to answer questions, and all the prospective parents wanted to know how she’d chosen her child’s family from the stack of brochures. How could we distinguish ourselves, excel, or (an unspoken imperative) beat out our rivals in that room?

“I saw that the man was bald,” she said, “and my dad was bald, so they just felt like home to me.”

I managed to suppress a laugh, and her answer came as something of a relief to me. We could only open our arms, but we couldn’t summon a baby by any means. If we were given one, naturally or through adoption, it was likely to be without regard for any of the reasons we had hoped would prove our worthiness. No one is less impressed with your adult accomplishments than a baby is.

Shortly before we scheduled our home visit and would have had to deposit a (substantial) adoption retainer, we conceived again, for the seventh time, and that baby did not die. Our agency specifically prohibited prospective adoptive families from pursuing I.V.F. as a parallel track to adoption. You had to commit to just one lottery. But natural conception was allowed, and we quietly put our profile on hold and then removed it altogether.

Friends asked if we had finally found a cause for our miscarriages or a treatment that solved them, but I was on the same slightly speculative drug regime as I’d been for three losses in sequence. We made our escape as arbitrarily and unjustifiably as the family who won their child by virtue of baldness. We received the gift of a child alongside the knowledge of how unmerited the gift had been.

When Alabama ruled in favor of bereaved I.V.F. parents and said that clinics could be held liable for destroying people, not just property, if they failed to safeguard the frozen embryos in their care, the decision was both execrated and dismissed as naïve. Clinics claimed they couldn’t run a business if they were held to this standard of responsibility, and, more than that, the parents they served had nowhere else to go. Supporters of I.V.F. argued it was unfair to take one last chance away from good people who were struggling to become parents. If the industry needed special liability exemptions that no other medical service enjoyed in order to offer that last thread of hope, the trade was worth it.

I.V.F. depends on the same rhetoric that frames cancer patients as “fighters” who are expected to outwit and outlast their disease, until, eventually, they become losers instead. Children are, fundamentally, a risk, not a reward.

In another corner of the clinics, a similar set of syringes is lined up and sent home with women who come in for their appointments alone. Egg freezing is one further medical mitigation of the unfairness of life and fertility. Although companies such as Google offer to cover egg freezing for younger employees as a way to expand their choices (and lower the likelihood of choosing to marry and bear children), egg freezing is overwhelmingly used by older women, who find it is the last choice remaining to them.

In Motherhood on Ice, Marcia Inhorn’s ethnography of women freezing their eggs, the women she interviews at clinics are mostly in their late thirties or early forties. They are unmarried or dating men who have little intention of being fathers. Many of them will bank eggs only to find they do not find the hoped-for man who will make them children. Others will simply discover that none of their eggs thaw well when they return to try with donor sperm.

The clinics sell a kind of limitlessness: no need to mourn your lack of a marriage or a family. As long as you put a part of yourself on ice, you are as deathless as the Russian fairy-tale figure Koschei. Your potential for new life is hidden in an egg in a vial in a liquid nitrogen bath in a dewar; the thoroughly up-to-date successor to Koschei’s death, which is hidden in a needle within an egg within a duck within a locked chest at the bottom of the lake. Koschei aims to keep his death secret, but the women at the clinic hope to be found.

The only true part of the I.V.F. fairy tale is that the cost is larger than they tell you up front. And if they say there is no cost—not for someone as bold or as deserving as you—then the cost is likely even higher. Ultimately, there is no planned parenthood, and certainly no fully controllable child. Every child is cross, gift, death, grace wound up together, impossible to centrifuge into separate components.