When It Comes to Becoming a Mother, Sometimes Less Really Is More
I tried to get pregnant for months. But when my fertility treatments worked too well, I faced an unexpected moral quandary.
In the Orthodox community in which I was raised, getting married and having children were generally a one-two punch. The time to have a baby didn’t necessarily correlate with the age of the woman but with how long she’d been married. In my case, when three years had passed since my wedding—even though I was just 23—people around me started getting concerned. “I know you’re probably feeling embarrassed,” one of my closest friends whispered to me. “But you can talk to me about your fertility problems. You must have been trying already for a long time.”
Truthfully, we hadn’t even been trying to get pregnant yet. I got married while still in college, and I wanted to finish up school and work for a few years before I had a baby. But the social pressure was building from our friends who all seemed to be having children, and around our fourth anniversary, my husband and I decided to join the parent club. But getting in, it turned out, wasn’t so easy.
After an unsuccessful year of trying to get pregnant naturally, I met with a reproductive endocrinologist. He thought I had a classic ovulation problem that could easily be solved with fertility injections. Every night I would give myself a shot of an ovary-stimulating hormone in my stomach, and every morning I would come in for a sonogram and blood work to determine how much medication I would need that evening. Everything would be “precisely measured,” he said, “so we won’t have to deal with a ‘multiples’ situation.” Fertility doctors were in the precarious situation of trying to help women get pregnant, but not pregnant with too many babies at once (“multiples”), which could cause a difficult pregnancy for the mother or a danger to the babies. Reproductive medicine wasn’t an exact science because there was no way to guarantee that a fertilized egg would actually develop into a fetus or not. That part was still up to God.
My doctor told me to practice giving myself a shot by injecting oranges because “the give is the same.” I went to the market that night and bought a big mesh bag of navel oranges—stomachs, navels, it seemed to make sense—then fretted the whole way home that maybe Valencias would have been better.
The doctor’s office was a baby factory of sorts, located in a posh Upper East Side brownstone just off Park Avenue. When a patient was “active,” there were no appointments necessary. Women began lining up outside the door a half hour before it opened at 7 a.m. For the next two hours, they were poked and prodded. The fertility problems ran the gamut from lack of ovulation to “hostile uterine environment,” but in practical terms most women needed some kind of medication nightly, whatever their ultimate treatment might be, and needed to come in daily because the shelf life of an egg ready to be fertilized (and hopefully become a fetus) is quite short. With all the scientific jargon and timing, the making of a baby here certainly wasn’t a romantic, candlelit rendezvous. In fact, the men rarely were needed. Some came for emotional support, but their real role as baby-makers was relegated to a cup, kept at body temperature, and brought in within four hours of deposit. Regardless of the medical need, most women (including me) had intra-uterine inseminations in the office because the turkey baster was apparently more effective than the male organ, and after weeks of treatment, the doctors wanted to increase the chances of success as much as they could, even if it made the conception extremely unromantic.
Most of the women there were typical New York City upper-crust: late 30s, perfectly blown hair, nicely tailored outfits. Most of the ones who looked more my age—24 by that time—were clearly Orthodox, their skirts carefully covering their knees, their wigs hiding their natural hair. I wasn’t like these women; I classified myself as Orthodox because of most of my religious practices, but I didn’t dress the way they did. And I was willing to bet that most of them had been trying to get pregnant since their first anniversary—the date most rabbis withdraw their heter, or permission to use birth control. My husband and I hadn’t asked for such an exemption, nor did we stick to a timetable for family planning. We were married very young and didn’t feel ready to have children right away. We were more concerned with building a strong foundation to our marriage than we were about a religious issue with birth control.
I felt a twinge of doubt about being so self-reliant when the initial treatments didn’t do anything but cause blurry vision, mood swings, and a bloated stomach. Month after month, we increased the dosage of the ovary-stimulating medication, switched brands, and still no pregnancy. I hoped God wasn’t trying to send me a message.
Fast-forward many months to one blustery day in March, three weeks into yet another fertility cycle with a new, more powerful medication. I came for my daily observation. The doctor did an ultrasound and frowned. After not responding to the injections for months, my ovaries were now hyper-stimulated. I had produced eight large follicles, which could eventually become eggs that could then be fertilized and potentially develop into fetuses. We wouldn’t know if these follicles would develop into fetuses until later, when we might see as many as eight beating hearts on another ultrasound.
“We won’t let that happen, of course,” the doctor said brusquely, as I lay on the examining table. “Either you’ll have to reduce or we’ll have to abort this cycle—no pun intended.” He snorted softly.
I knew only minimal information about selective reduction: that it was a nicer phrase than abortion, but it was a way to get rid of a fetus. The doctor would “reduce” the pregnancy from a big number (like eight) to a small number (like two) so as to better increase the chances of the babies being born healthy, at full term, and to lessen the health impact on the mother. The problem is that the reduction could only be done later, after the follicles had become eggs and been successfully fertilized, because the “reducing” process was to arrest a live fetus’s heart. In a patient who did in-vitro fertilization (IVF), where eggs are fertilized in a laboratory and then implanted into her uterus, the doctor could minimize chances of multiples by only implanting a certain number of eggs from the outset—one or two at most—but with the less-invasive, less-expensive treatment that I had opted for (ovulation-stimulating injections), it was impossible to know how many eggs would be fertilized until they were already tiny fetuses in the uterus.
I had two choices: I could discontinue treatment for the rest of this cycle, which would mean the follicles would shrink and never turn into eggs, and I would have wasted yet another month of my life and still not be pregnant. Or I could proceed with the remaining injections and insemination and take a chance that all eight follicles could actually become fertilized eggs—meaning I would be pregnant with octuplets. If that were the case, the doctor was insisting I could not deliver that many babies and I would have to do “selective reduction.” Even though reduction was only a possibility that was still weeks down the road, I’d need to make the decision in advance—now.
I closed my eyes and tried to breathe deeply. I should have told the doctor that I couldn’t make such an important decision in haste and that I also needed to discuss the situation with my husband. I should have admitted to the doctor that I didn’t even really understand what he was asking me to do. I probably should have talked to my rabbi. But I was so tired of the injections and the hormonally induced pimples and mood swings, and I just wanted to be pregnant. I knew if I didn’t agree to reduce, the doctor would not continue with this cycle.
“Yes, sure, of course,” I answered. “Definitely—we’ll reduce.”
The doctor peered at me from beneath his wire-framed glasses and nodded his head. “OK then. Let’s give you the ovulation shot, tomorrow you’ll do the insemination, and I’ll see you in two weeks for a pregnancy test.”
A few hours later, I logged on to one of the infertility websites I’d been visiting and posted an anonymous question about selective reduction. The responses were swift and harsh.
“This is not the place to be asking this! Don’t you realize we are all trying to get pregnant here?!”
“Are you actually planning to inject potassium chloride into your baby’s beating heart and KILL HIM?!”
I sat at my computer and cried for hours. I didn’t think I could go through with the reduction after all. We had tried for so long to have a baby. I called my husband, still crying, and begged him to understand. I had gone ahead and plunged us into a terrifying situation without even consulting him. He was silent and said we’d talk when he got home from work.
Overseas, I sought out ways to connect to the community, but when I came home, my old sense of alienation would quickly return