If you were my wife," my gynecologist said to me, "I'd tell you I didn't think pregnancy was worth the risks."
My husband, John, and I, sitting in the doctor's office, were not shocked. We had, at least intellectually, accepted the notion weeks earlier. But the real-life bluntness of the doctor's words, the absence of clinical polysyllables, somehow made the notion feel more like a decision.
"But that would be a selfish thing for me to say," the gynecologist added. Doctors and husbands can discuss and suggest and enumerate their priorities, he said, but they can't decide. "It's your body. I don't know how much you're willing to risk, how important it is for you to give birth to your own child."
My own child. Our own child. Our gift, from one to the other. How many of us, female or male, can say we never imagined or yearned for such a child? How many can say we never cared whether we would have -- not simply raise, but actually create -- our own child?
"Having a baby" is more than a dream, more than an urge, more than even an expectation. It is, we come to believe, the ultimate birthright. That is, until real-life quirks and clinical kinks get in the way.
Technically, I am not completely unable to become pregnant or bear a child. But after two operations, the first of which was performed to increase my chance of conceiving normally, I am a poorer candidate than ever. Tests had shown that the ends of my fallopian tubes were blocked by adhesions, fibrous growths that form naturally after surgery or infection, both of which I'd had when I was in college 15 years ago.
For me to have any chance of conceiving normally, the adhesions, or scar tissue, would have to be removed, and the tubes repaired, in a surgical procedure called tuboplasty.
I went ahead with the operation at Johns Hopkins Hospital. The adhesions proved to be far more extensive and the tubes far more damaged than the tests had shown. But I recovered well -- until I'd been home a couple of days.
Suddenly I was violently ill, in terrible pain, and back in the hospital with a bowel obstruction, caused by an adhesion. After more than a week of attempts to clear the obstruction nonsurgically, I returned to in the operating room.
The end result was that the odds walloped me. I had been told that I might expect to have a 30 to 70 percent chance of normal conception after the tuboplasty. No such luck: Following that first operation, my doctor put my chance at 5 to 10 percent.
Moreover, because the severe damage to my fallopian tubes included destruction of cilia that move the egg from ovary to uterus, I am a relatively high-risk candidate for an ectopic pregnancy, the frighteningly dangerous outcome of fertilization occurring in the tube.
I might, the doctor suggested, ultimately want to consider in vitro fertilization. But following the second operation, my doctors -- there were several by then -- told me I should avoid at virtually all cost any future abdominal surgery. They said that after such surgery I would have a higher-than-average chance of getting another, potentially fatal, bowel obstruction.
This complicated the situation for several reasons beyond raw fear.
Ectopic pregnancies necessitate abdominal surgery. The most common in vitro fertilization technique involves retrieving eggs via a minor surgical procedure, although it is now possible to perform the retrieval nonsurgically via aspiration. But beyond that, in vitro fertilization occasionally results in ectopic pregnancy. And any pregnancy can ultimately result in delivery by cesarean section -- abdominal surgery again.
I heard all this news at what might be called a time of low resistance. I had been hospitalized at Hopkins for nearly a month. I had nothing to eat or drink for two weeks -- I was limited to intravenous feeding until the bowel obstruction was cleared -- and had lost more than 10 percent of my body weight, which had been at distance-running level to begin with.
Although I was managing, for the most part, to keep my spirits up and my attitude good -- figuring I would in no way benefit from doing otherwise -- I was flat-out scared of having to put my body through anything else. Logic and the self-preservation instinct told me, long before the gynecologist did, that pregnancy would not be wise and that, as the gynecologist suggested, "it would be a good idea to start adoption prodeedings immediately."
In the aftermath, my resolve has been firm -- if a bit shallower than I generally let on. "It's not worth it," I tell people, all calm reason, waving my hand dismissively. "Adoption is fine."
John agrees, our families agree, our friends agree. I have a great support system. But I began crying when I saw a film of a baby being born, and I have even asked John if he wishes he had married someone else so he could have his "own child."
There are, of course, other ways in which he and I could have a child at least partly "our own." Reproductive technology is racing along on dazzling, emotion-fraught, legally complicated paths, far ahead of the answers to the medical and ethical questions it raises.
John and I could hire a woman to bear us a child, through either artificial insemination with John's sperm or transfer of an embryo created from laboratory fertilization of my egg and John's sperm. As a friend said, "It would be your baby, just somebody else's toaster oven."
I don't have -- at least I don't think I have -- real moral objections to surrogate motherhood. But I am wary of legal complications and emotional snags, and -- more important but less amenable to explanation -- I am at gut level somehow uncomfortable with it. I'm certainly willing to discuss it, but, at least at this stage, I'd rather that we adopt.
That attitude is difficult for people to understand. A friend of ours, for example, has gone through operations and in vitro fertilization but has not become pregnant. The past several years, and particularly the months before, during and since the in vitro attempt, have been a time of intense emotional turmoil. Still, she may try in vitro again. She says she wants to rest assured, in later years, that she did everything within reason to bear a child.
Reason and reproduction are not natural allies. (If they were, there would be no unwanted children.) But for me -- and I can speak only for myself on something so profoundly personal -- it is more reasonable, and more important, to get on with other things.
The physical risks to me may make my decision easier, but I think some other people in my situation would decide to keep trying. By the same token, I'm not at all sure that, absent the physical risks, I'd want to pursue any further avenues to possible pregnancy.
Does that mean I'm lacking some psychological component, some sense of self-history or drive to reproduce? I prefer, of course, to think not. I prefer to think I have come to reasonable and honest terms with a reality that is no less real for being frustrating.
I don't like to think of this as a raw deal. For one thing, no one, as best as I can find out, is to blame; I'm not one to pin things on God's will. For another, I'm healthy again and it feels great.
Finally, most important, this whole experience has strenghtened John's and my apprecciation of each other and our marriage. The nurses at Hopkins told me that many infertility patients are bitter, their husbands resentful and hostile and their marriages in trouble because the woman's reproductive factory is not producing. I am infinitely luckier than those women will ever be, even if their biological conveyor belts do start working.
It is -- I cannot pretend otherwise -- a deep disappointment to put aside my expectation of childbearing. It seems maddeningly unfair, especially considering the number of women who don't have to think twice about getting pregnant and don't choose to think twice about their kids when they have them.
Perhaps John and I will adopt one of those children. We have a whole new world of family building ahead of us. We will, it appears, create our family without benefit of my pregnancy, but we will go on from there much like other people. I am looking forward to the benefits of having children; I am content to set aside the risks.