Child Development

How our IVF Journey Began

I’ll try to use my personal journal to proceed in chronological order — we began knowing little about IVF, and research took some time.

I haven’t made much of it here, but my husband of 15 years is a guy, which I think, unless the PC terminology has changed recently, makes us a gay couple having children. Our new neighborhood of 60 or so houses has two other gay couples with children already in residence, so we’re not unusual. This street has many children already and more on the way since the schools are considered top-notch and we’re within easy commuting distance of San Diego’s high-tech employers.

The first reason we started to think about kids was the experience of raising two puppies. I haven’t had a pet since I was five, and the sense of taking care of and training a young animal is similar enough to raising children that I realized we would enjoy it (after the initial unpleasantness!). We had both had some desire for kids earlier in our lives, but the hurdles then seemed insurmountable and of course we were busy with work.

First entry from my personal journal, June 5, 2019:

I checked again to see if it’s too late for us to have a kid of our own. No *outright* reason not to, except the $150-200K to order up a donor egg, IVF, and surrogate mother, *and* I’d be feeble long before the child left for college. Not that upper class families shrunk from sending their kids to boarding school at 12. If you’re not independent enough by then, you soon will be. 🙂 Kid would get a nice trust fund and of course lots of attention. I can’t get anything done anyway, might as well nurture, no?

As of two years ago, we were both retired from normal full-time work, so it now seemed practical to handle the baby years. Half the stamina, but two people home most of the time!

I found some online sources, and a surrogacy agency supportive of gay couples (and run by two gay dads.) Near enough, in LA, so I talked to them and they referred us to a West LA IVF doctor to get started.

July 2 2019:

I was going to write something about our Skype meeting with the LA baby consultants coming up later, but running out of time. We’re far from designer babies, but the current crude technology and regulation does let you 1) seek out and pay a premium for the egg donor with rare characteristics (it’s a hoot that Ivy League Asian women are the gold standard for certain seekers and so get the highest payments), and 2) you can’t do gene tests of the eggs yet without damaging them, but you can test embryos by removing a few pre-placental cells early, seemingly doing no harm at that stage. By choosing those without gross abnormalities you can reduce miscarriages and select for sex. We might try for twins, actually, for that 1.5x the costs for 1 and the sibling experience….

[Husband] is onboard. Which suddenly changes our plans for later life. Sort of like a Hail Mary pass on your last down, I’m starting to downgrade my expectations for my own work to put effort into the fresh new entrants in the race. They, at least, won’t be crippled by a lack of early support.

We found out later that multi-embryo surrogacy (hoping to improve chances of having one, but often ending up with twins) is no longer considered wise; this is partly because the technology has improved so 50-60% of screened and well-timed implantations result in a healthy birth, just as high as for multi-embryo attempts which risk twins and complications. Our meticulous IVF doctor won’t do multis anymore. This became the consensus in the last five years or so. Other changes in the technology made it just as safe to freeze embryos after 5-7 days of development, which allows the implantation at the perfect time for success. So our process was 1) freeze sperm, 2) have the egg donor provide eggs, and 3) fertilize eggs with sperm via ICSI (which is now standard for late-in-life IVF — ICSI is “intracytoplasmic sperm injection,” where the lucky sperm is injected into the egg by a very fine needle.) The resulting zygotes are cultured and observed for 5-7 days, graded on an A-F scale for viability, and genetically tested to improve likelihood of a successful birth.

micorphoto of needle injecting egg with a spermatozoa]

Needle injecting a single spermatozoa into an egg.

In hindsight, the natural process for prime-aged young people is error-prone and hit-or-miss, resulting in early miscarriages and other bad things. Nature’s Way includes Nature’s Punishments. Typically the natural way is to try many times and succeed enough to keep the species going, and the winnowing process sifts out most”tries” — either the4 egg doesn’t get fertilized, or if fertilized doesn’t implant, or if implanted doesn’t develop properly, and is expelled via silent miscarriage before the mother is even aware of being pregnant, or develops long enough for underlying defects to cause a later miscarriage. The latter feel like tragic losses, but it’s part of the natural process and no one’s fault.

We had both done sperm tests. [Husband] did fine, I did not — my test report was stamped “azoospermia,” which means zero spermatozoa in the sample. Turns out my decade of testosterone supplementation (“exogenous testosterone”) was the cause; complex feedback loops shut down both endogenous production of T and sperm production, which made drug companies run studies of such sufferers hoping to find the male Pill. No such drugs were found, but the cause and recovery are thoroughly documented in medical journals.

So I was hoping I could catch up with time and treatment — younger men in the same boat can have fertility restored in 3-6 months, but as the doctor warned me, that doesn’t mean an old man can recover as quickly, or at all.

[Husband] went ahead and started the process by driving to LA to deposit his contribution.

Aug 8 2019:

Project stall: [Husband] drove all the way to West LA (2+ hours) to make a 10:30 AM appointment to give a sperm sample for freezing. Two hours later, he’s told “we need more than that, could you come back next week?” The legally-required FDA paperwork only lasts 7 days so you can’t wait longer or you have to pay for it again (several hundred dollars?) So he goes back Tuesday leaving here at 6 AM. At least the doc complimented him on his youthful motility.

Meanwhile, I’m just working on producing a gamete or two. Tap tap tap.

[to be continued: “How We Did It,” in installments.]

August, 2019 – Deciding to try IVF

We did a lot of research before starting the IVF process. The difficulty of adoption in the US in this era is comparable to or worse than IVF, and it’s almost as expensive, so we didn’t go that route — and besides, no one in my family is carrying on the family name, so we’d prefer to have my ancestor’s genetic threads continue.

We searched online for an egg donor. This is still an unregulated business, with some effort made to provide a code of conduct from a nonprofit organization of donation agents, but couples looking for Only The Best eggs clamor for Ivy League, Asian, accomplished concert pianist donors; which means a donor with those desirable characteristics can charge far more for her donation. Some agencies advertise “$50-100 thousand dollars for your eggs,” which is well beyond the guidelines.

We found a great donor but at one of the more mercenary agencies; she’s a graduate of a great but not Ivy League science-oriented college, she has a high IQ, and she was not that expensive as a first-time donor. “Proven” donors (after at least one successful donation) can charge more, but this was her first time. We had the agency’s help and did Skype calls to see if we liked her and vice-versa. Contracts had to be drawn up (there are lawyers for both sides at every stage of the process!) and signed.

Recognize that this isn’t easy for donors — they have to put up with medical, psychological, and genetic screening, making many visits to clinics, taking precisely-timed drugs to mature their egg follicles in abnormal numbers for a carefully-timed harvest. Our donor had to fly cross-country twice. The harvesting procedure can be painful and the wrenching-around of body chemistry can result in bad reactions. Fortunately, none of that happened and she was very successful. (And we had to have her back for a second donation when only one embryo came of the first, for reasons that I’ll describe in a later post.)

Our IVF doctor is semi-famous: “IVF doctor to the Stars,” kinda, with past clients like [redacted] and numerous Hollywood types. His office is in West LA on Wilshire, almost to the Santa Monica border, so we visited several times.

Genetic screening is a big part of the matching process. Both egg donor and sperm donor are screened for genetic abnormalities; many people harbor genes that can produce syndromes or diseases that would cause miscarriage if combined with similar genes from the other parent.

My Counsyl gene tests showed three more-or-less damaging flaws; fortunately, none of these overlapped with similar flaws in the egg donor, so we were cleared. I had two recessive conditions, plus a third which apparently is held back from the report for laypeople because it’s too diffuse a danger (sufferers live long enough to reproduce but are extra-susceptible to emphysema and liver failure.) I carry one copy of the good gene and one half-good gene (S) which means it would be wise to avoid hooking up with another carrier (and even wiser to splice it out for good, but we don’t do that yet.) https://ghr.nlm.nih.gov/…/alpha-1-antitrypsin…

Then I got my first sperm count of zero! That will be the subject of a later post — male factor infertility and remedies.

Driving to IVF clinic

Downtown LA as seen from highway

Having Children – Progress Report

I generally write on attachment theory and relationship topics to report on research results and the personal experiences of others. I try not to let my own personal experiences show too much because I’m trying for a neutral, nonjudgmental view. I have been too busy with other projects to keep up the writing and reporting here — but in a few years there will be enough new research to do another book on attachment. But for now I have more important projects!

It’s perhaps slightly embarrassing that I have weighed in on child-rearing topics but never had children until now. So we’re almost too old to undertake such a project, but we have the time and the space for it now.

The first few minutes of Idiocracy humorously cover the modern issue of long-delayed (and often foregone) children amongst the highly-educated, well-off young people of today, who may well stay in academia and avoid commitment until they are in their 30s and 40s, thinking “we must have stable jobs and resources before we have a child.” This is biologically risky since women’s eggs begin to slowly decline in quality after 25, and drastically after 40. Males, too, decline in sperm quality with age, though not as quickly (since sperm are generated from stem cells on demand, rather than being stored as buds from birth as eggs are.) Couples who want to have children but find their fertility has waned sometimes use IVF. A would-be mother whose eggs are too dicey can use a donated egg, and if unable to carry, a gestational carrier (the modern term for surrogate.) Anonymous male sperm donations are (compared to eggs) relatively cheap if it’s the male who has the issue with fertility. IVF procedures have improved greatly in this decade, and it’s a good thing because women are tending to postpone children for careers and men’s sperm is rapidly declining in potency. In a few generations perhaps most children will be IVF babies — presuming the price declines from the current $40-100K per child.

So I’m going to write more about these much more personal topics. We have (as mentioned elsewhere) embarked on our first child; we started in August of 2019, and our first is due in April of 2021 (21 months after our decision, delayed by COVID-19 shutdowns and other snags.) We found a great egg donor and have a second (and perhaps third) frozen embryo ready to start this month. The embryos have been screened and graded, and PGT-A genetic tests (not completely reliable) say they are all healthy boys.

20 Week Ultrasound

Ultrasound at 20 weeks

We moved from a comfortable home on a golf course in the Palm Springs area because public schools weren’t very good there, and since there were no children in miles (the average age of our neighbors being 70), we moved to Carmel Valley in San Diego, which has fantastic schools and a neighborhood that will have hundreds of children within walking distance. We want them to grow up like we did, free to roam the suburban area by bike and walking, to build peer relationships with a wide variety of other children.

I’m planning to post the history of our IVF experience before the first baby arrives. The initial 6 months of caring for an infant are pretty much all-absorbing, so I won’t have time to post much until after that.

Avoidant: How to Love (or Leave) a Dismissive Partner

Negative Reactions to “Avoidant” and “Bad Boyfriends”

Most of the reviews of Avoidant and Bad Boyfriends are positive, some embarrassingly so (“You saved my life / marriage /sanity!”) — I read the reviews and the few really negative ones I ignore because they are vastly outweighed by 5-star reviews. But there are some common themes, so I’ll address the three latest one-star reviews here.

1.0 out of 5 stars
Reader Use Discretion and vet the author!
Reviewed in the United States on January 9, 2020
Format: Kindle Edition

I am a Licensed Therapist specializing in Attachment Injuries and Trauma this book can be damaging for anyone dealing with an attachment injury. Use discernment when reading.

It’s threatening for a professional (licensed!) therapist to have possible patients reading the truth and starting to heal themselves. In her world, each patient is to be swaddled in bubble wrap and gently coaxed back into healthy attachment patterns through her no-doubt-caring therapy. I get a lot of fan mail from therapists and marriage counsellors who direct their patients to my books to get a head start on understanding their issues, but perhaps they recommend it for only their most robust clients. This theme (Appeal to Authority) appears frequently. I can imagine there might be people triggered by some parts of the books, but it’s not nearly as triggering as real life in a relationship with a dismissive partner. Therapy is great for those who can afford the time end expense. My books are cheap and can be read anywhere.

Other outraged reviews go after the chapter on abusive relationships (see an early version here), citing the discussion of combative relationships where (typically) the unexpressive male strikes out physically while the female is psychologically and verbally goading him. Today’s presumption that the male is entirely at fault fails to consider all of the dynamics of these troubled couples. Would you rather be shoved or slapped in anger, or continuously sniped at and undermined by your partner? The stereotype of the abusive husband and the suffering victim is common but not every angry male is entirely in the wrong, or every battered wife a completely innocent victim. Abuse comes in all types, sizes, and sexes. The belief that only women are abused is semi-sacred, and the effort to squelch any contrary voices (“cancel culture”) is similar to the search for heretics.

Reactions from dismissives in denial (or their partners who want a cotton-candy solution to their problems) are also common. Our next one-star review is an example.

Facebook "I'm in this photo and I don't like it" text box.

You’re coming too close to describing how I contribute to my relationship problems…

1.0 out of 5 stars
Skip this one, not worth the read or money. Very biased and inaccurate.
Reviewed in the United States on January 6, 2020
Format: Paperback Verified Purchase

Not worth the read. I would give it no stars if that was an option. It condemns avoidant attachment style people. It’s another “opinion” based dating book, which I should have realized by the name. I thought it would give more constructive insight to the underlying wounds which produce the avoidant attachment types and understanding of triggers for this attachment style. It’s very narrow minded and shames anyone with this attachment style. The author never guided his subjects to working with their own insecurities and understanding that any attachment dynamic is a result of their own inner needs of attachment that of which stem from the developmental stages in early childhood. He essentially said avoidant style people are hopeless and abusive. Which is in fact not a fact or truth at all. My opinion is you can chalk this one up to another bad advice book that is not based in any actual research or fact and dangerously compartmentalizes humans into a this or that category while damning them to a negative life sentence behavior. I wish I could return this book.

On the contrary, being partly dismissive myself, I understand and sympathize with those people who can’t form good attachment bonds in later life because their earlier experiences forced them to develop a defense mechanism to save themselves. This is described in great detail in the books, but this reader demands a presentation so tactful that avoidants will feel righteous in continuing to devalue and dismiss significant others to stay safe. Avoidant is a splash of cold water and describes the harm this defense mechanism does along with some practical methods for coping with it and learning to feel more secure with intimacy.

Our next one-star review is of the “I have my guru and you’re not as good!” variety. There are people emotionally invested in attachment books they’ve already read who find my presentation jarring. A book that is quite good and presented largely to soothe the anxious-preoccupied, Attached, is often cited as better, by those same people enabled by such kid-gloves treatment to avoid looking at their own need to become more secure in themselves. As for Gottman’s books, I plug them and excerpt from them a lot because they are very good. Gottman built on academic attachment experts and my books were substantially complete before I had read any of his books. He’s got a good cottage industry going, and I view his work as especially accessible and valuable for couples with problems. Avoidant is directed to the seeker of self-knowledge and the partner who is feeling alone in his/her concerns about living with an avoidant.

1.0 out of 5 stars
Reviewed in the United States on December 20, 2019

This book labels people and limits the mind of being open to possibility. HEAVILY referenced Gotman and inappropriately and without sound evidence attempts to build on Gotmans work.

Just read Gotman’s work which is based on sound evidence.

Lordy, lordy. These people can’t even spell the names of their gurus correctly. Attachment issues are complex and every individual is a different mix of reflexes and habits, a fact I made clear at several points. Everyone has modes of reaction that mimic the more extreme kinds of insecurity, but only in specific situations or with specific people that trigger them. But I discuss them as types because it’s fair to say most people exhibit a preferred attachment style under most conditions, and it’s very useful to recognize this.