#so no hormonal treatment to force eggs (just collect them instead) | Explore Tumblr posts and blogs

aniray · 5 years ago

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Where You Least Expect It...

Here's the first part of my 5 part story.

It's Tommy x Lizzie. A Modern Surrogacy AU

~*~

“I’m so nervous, Thomas.”

Tommy looked over a Grace. Her golden hair was falling a bit out of the neat ponytail she had put it in that morning. She was fidgeting with the brochure from the clinic. If she twisted it anymore, Tommy was sure the thing would tear apart. But he didn’t say anything. He simply reached over and pulled the brochure out of her hand.

“Thanks,” she sighed. But two seconds later she was running her fingers along her brow. “God, Thomas, we tried so hard. And we’ve spent so much on all of this. Should we have gone with adoption?” They had had this same conversation the night before, and last week, and two months ago. But the answer was always the same. Grace sat up straighter, her head lifting a bit in determination. “No, this is what I want for us. A baby that’s at least part you, even if it can’t be part me as well.”

It had taken Grace a long time to accept the doctors’ verdict that she wouldn’t have children. After months and months of hormone treatments and strict dieting and far too many nights of his wife crying herself to sleep, Grace had let go of the idea of carrying her own child. And then there were even more months of trying to harvest her eggs. But when none of them were viable, Tommy had to step in before depression stole Grace away from him.

So they had turned to surrogacy. It wasn’t quite what Grace had wanted- having to use another woman’s egg as well as her body. But it was the closest to what Grace wanted and could actually get. So Tommy had gone to information seminars. He had read up on the different agencies. And when Grace had picked a place and a girl, Tommy didn’t voice his own worries. This was what Grace needed and he needed her, so this was what they would do.

The GPS told Tommy to take the next turn. But he’d already memorized how to reach the facility. Planning was what he did when he was unsure about things. Take control wherever he could had always been his way, but even more so since this whole fertility process had started. Polly was annoyed about it. Arthur was pulling at the leash. And John had gone and fucked his way into early fatherhood.

Something Grace wouldn’t admit she was hurt and bitter about.

Another turn and the facility came into view. It was nothing special, just a plain brick building. But it was clean and highly recommended. And mostly it was discreet- something Tommy had insisted on even if Grace hadn’t been concerned. Business was doing well and that always brought people who would rather Tommy or his loved ones not be breathing.

Pulling into a parking spot, Tommy turned the car off and turned to face Grace. “You ready?” He watched the emotions flit across her face. It was something not many people got to see. Grace had been raised to keep her emotions to herself. And then she had worked as a financial security investigator. Succeeding in that world meant not letting CEOs and their like see you anything other than calm and in control. So for her to show her fear and her anxiousness with him was just another thing to prove that they were supposed to be together.

“I don’t know. I just- I shouldn’t be nervous. It’s all been arranged. The papers have been signed.” She turned to look at him and Tommy felt a twinge in his chest at the tears in her eyes. “Its not even me who has to do anything. You’re the one about to…you know.” Tommy smiled. Always so proper. “But what if we do it and she changes her mind? Or you change your mind? What if-“

“I’m not changing my mind. She won’t change hers, either. And even if she does, this baby will be a Shelby. That’s why we got a lawyer for all of this, remember?” Tommy tucked a few strands of her hair back up into her ponytail. “Now, come on. It would look a bit bad if we were late because we took too long in the parking lot.”

Grace gave him a smile- the one that always seemed to make his world a bit brighter. “You’re right. I’m ready.” With a quick nod, Tommy got out of the car and went around to open the passenger door. Grace didn’t hesitate. She got out and took his hand as he closed the door. She was calm and strong and beautiful walking beside him.

And he’d be damned if this all went to shit.

~*~

The clinic was cold.

It always was, but today it bothered Lizzie a little bit more than the other times she’d come. They had her sitting in a small conference room, waiting for the couple she’d agreed to carry for- the Shelbys. Grace and Thomas Shelby. Wealthy, and from what Lizzie had heard from a staff member, trying this before settling for adoption. She didn’t like that word- settling. It reminded her of too many decisions she’d made in her life.

But that wasn’t really the point, was it? No, the point was, she was sitting in a cold room about to meet the people she’d be dealing with for the next ten months more or less. And she still wasn’t sure this was what she wanted. You already signed the damn papers, Lizzie. The thought didn’t make her feel any more ready for this. But she was a bit desperate.

Ryan, the asshole, had harassed her for years before she finally quit working for him. She had dealt with enough men putting their hands on her in her life. That’s why she had left her home town, club work and waitressing all behind her. And now she was leaving Ryan and his too small office and his too rough hands behind her, too.

“Don’t think about him. He doesn’t deserve it.” Standing up from the seat she was in, Lizzie paced the room. Everything was so…bright. The walls were white with framed pieces of abstract art to break up the monotony. The windows were frosted to let light in while keeping everything inside private. But stuck in the room alone Lizzie just felt like she had stepped into some Sci-fi horror movie. “Get a grip. It’s not that bad.”

She had just made her way to the far side of the room for the thirteenth time when she heard voices. Quickly, Lizzie went back to the seat she’d started in. Her heart was pounding suddenly. Her palms were sweating. This was it- there was no going back after those doors opened. A knock came half a second before the door opened. Dr. Stone came in with one of the office assistants right behind her.

And then she saw her- a well-dressed woman with her blond hair up in a high ponytail. This was the woman who would be raising the baby Lizzie was going to have. She looked so elegant. It made Lizzie a little self-conscious, honestly. But then a man stepped into the room and shut the door. He wore a very nice suit- obviously tailored for him. His expression was neutral, but Lizzie had a feeling it was an intimidation tactic more than lack of interest. She eyed the way he stood and realized that behind his respectable appearance, this man was dangerous.

Suddenly self-consciousness was replaced by trepidation. But Lizzie forced herself to smile. Dr. Stone motioned for the Shelby’s to take a seat and Lizzie watched as Thomas pulled out Grace’s chair for her. The two shared a quick smile and Lizzie looked away. It was barely anything, but it had felt intimate. She turned her attention to Dr. Stone. The woman stood at the head of the table as the assistant passed out three folders.

“Alright, let’s get started. First off, Ms. Stark,” she said turning to face Lizzie, “This is Thomas and Grace Shelby. They are the couple that we felt would be best for you.” Then she turned to the Shelbys. “Mr. and Mrs. Shelby, this is Elizabeth Stark. She will be your surrogate. We have done an extensive background check on both parties, the results of which are in your folders. The contract you signed is included as well, for your records.”

Lizzie shifted a bit in her seat at the mention of background checks. She’d told them about her past, she had agreed to the check, but it still made her nervous knowing these fancy people would see her entire life laid out on paper. Mr. Shelby lifted his head and caught Lizzie’s eye. She forced herself to be still and focus back in on what Dr. Stone was saying. “We have already collected Lizzie’s ovum and it is ready for fertilization. That process will happen today after we collect Mr. Shelby’s sperm. At the end of this I’ll have the three of you sign a document stating that we went over all of this. And then in about three to five days Ms. Stark will come back in to have the embryos implanted.”

It all sounded so clinical. She’d known that, of course. She’d done the homework and all the reading. She’d even gone to see a lawyer about what rights she did and didn’t have during the pregnancy. But sitting there in that white room with the frosted windows, Lizzie couldn’t help feeling… Honestly she didn’t know what she was feeling. She heard Dr. Stone ask if there were any questions and she shook her head. She knew what happened next.

“Alright then. Mr. Shelby you can follow Erin and she’ll take you to a private room. A nurse will give you instructions.” Lizzie felt an absurd bubble of laughter rising. The idea of a nurse having to tell a man how to handle himself seemed a bit hilarious for some reason. But she bit her tongue and kept her head down until the man was out of the room. “Now that it’s just us ladies,” Dr. Stone continued, “I think it would be good for you ladies to discuss things. I’ve found that the women have the hardest time figuring out their roles in each other’s lives during this process. So I’ll leave you two to chat.”

Then she was gone, and Lizzie was alone with Grace.

~*~

She’s pretty.

It was the first thing that had entered into Grace’s head as she walked into the conference room. The second was that this baby wouldn’t have any features that could be ‘from’ Grace. She hadn’t really thought about it before, but perhaps subconsciously she had assumed the clinic would find a blond woman. Or at least someone with the same eye color that Grace had. But no, instead here was this green eyed, raven-haired, beauty.

A sliver of insecurity had threatened to rise when she saw Elizabeth Stark. Thomas had always preferred dark-haired women. It was something that his family never seemed to let her forget. And every woman who had ever impressed Thomas, especially in business, had dark hair. Most times it didn’t bother her- this obvious inclination her husband had. Most of the time she simply reminded his family that she, and not these others, had been the one Thomas married. But today- the day she felt so lacking as a wife and a woman- all she could see was dark hair.

Of course, Thomas barely glanced at Ms. Stark. Grace knew that he had no interest in the woman. And to be fair, the woman kept her focus on Dr. Stone. But insecurity was not logical. So when Dr. Stone had left them alone to ‘chat’ Grace found herself trying desperately to keep all of the anxiety she felt from showing.

“So,” the other woman started. “Is there anything you want to ask me?” Grace fixed her eyes on the woman across from her. Her voice was soft, but her speech was more like Thomas’ when he was tired. Opening the folder, Grace skimmed the neatly printed words until she found what she was looking for. ‘Place of Birth: Small Heath, Birmingham.’ She preferred to be called Lizzie, the paper said. “I have a few for you, if that’s alright?”

Again Grace met Lizzie’s eyes. “Of course. What don’t you understand?” She could hear it- the ice that had crept into her voice. It was the tone she used in boardrooms and closed-door meetings with men who had too much power. And Lizzie didn’t like it. But for some reason Grace couldn’t bring herself to regret her tone.

“It says in the contract that I’ll be living in your guest house during the pregnancy.” Lizzie paused for a moment and Grace wondered if it was to collect her thoughts or to keep from running out of the room. “But it also said that if, once we met properly, either party wanted to renegotiate that…”

Grace arched a brow. “Are you suggesting that we let you live somewhere separate from us?” And she hated that she could hear her mother in her own voice. But it was a ridiculous idea. Surely Ms. Stark could see that. An incredulous smile came to Grace’s lips. “How would we know if something happened? This is not your child, Ms. Stark. This is mine and my husband’s child. Why would we allow a stranger to just go off with our baby?”

A flash of defiance showed in Lizzie’s eyes. She had sat up straighter in her chair, leaning forward a bit. “I understand your concern. But what exactly do you think I’m going to be doing at my place? Snorting blow and having orgies?” Grace’s nose crinkled at the mental image. “Listen, Mrs. Shelby, I’ll come by and visit every day. You’ll be at every appointment. But I don’t think it would be good to live so close together. I don’t want to get attached.”

She was trying to manipulate her. Grace could hear it. She could see it. But it didn’t make Lizzie’s point any less valid. And the last thing Grace needed was for Lizzie to decide that she wanted to fight for custody of this baby. Still, the idea of her not being just a walk across the lawn from her child… “No. I’m sorry, but no. Not this early. Maybe toward the third trimester-“

“I’ll be huge and tired and it’ll be too much trouble to move by then.”

But Grace didn’t back down. She couldn’t- not with this. She stared the other woman down, neither willing to give up their positions. But Grace had years of experience getting her way. And Lizzie Stark was not going to change that. “We’ll hire movers. You’ll never lift a finger except to get into the car when everything is finished.”

Lizzie lifted her chin and Grace prepared herself to fight whatever argument came next. Only one never came. Lizzie nodded slowly and leaned back in her seat. “Alright. No later than the start of the third trimester.” Then she stood up and walked out of the room. Grace sat at the table, heart pounding. She gave up too easily. She had put Grace on the backfoot, as Thomas would say, and she didn’t like it.

Mostly she wondered if she’d just ruined a chance at getting through this in peace.

~*~

Grace was alone when Tommy got back. And she was upset. He could tell by the stiffness of her shoulders and the tilt of her head as she stood at one of the windows. He had seen the doctor on his way back to the little conference room. She told him that Grace and the woman- Ms. Stark- were having a chat. It had sounded friendly enough, but still he’d picked up his pace. And now he was glad he had.

“What happened?”

Grace turned from the window to face him and Tommy could see the fear she’d pushed away was back. “I just-“ Grace took a deep breath. “I think I’ve started something. Between me and the surrogate.” Tommy tilted his head in confusion. Grace’s shoulders slumped and Tommy watched her blink back tears. “She wanted to stay at her own place. Simple enough, right? And I said no. No, Tommy, don’t look like that. I told her ‘no’ the way my mother told you she wouldn’t be able to come to the wedding.”

Tommy winced at that. Mrs. Burgess has made no effort to hide how much she hated Tommy and his family and the fact that he had married her daughter. She hadn’t come to the wedding. And when she announced as much, she had been cold and disdainful and the most well-spoken bitch that Tommy had ever dealt with. And now Grace was telling him she’d treated the surrogate that way?

“Alright. So you were a bit cold to her. Why? We said it would be fine if she didn’t live with us. It’s in the contract that living arrangements were negotiable.” He hadn’t wanted to have any new people on their property- not even in the guest house. And Grace hadn’t seemed so set on it either. “I read the file, there’s nothing in there that says she shouldn’t be on her own.”

Grace rolled her eyes in exasperation. It was something she didn’t do often. “I know, Thomas. But I just hate the idea of her having our baby so far from us. I mean, we don’t know her. What if she smokes? What if she drinks and the baby is born with Fetal Alcohol Syndrome.” Tommy held in a sigh. He knew Grace- she didn’t think any of those things would happen. She was just nervous and trying to keep as much control as possible. It was something he’d done far too often to not see the signs.

Coming around the table, Tommy set his hands on Grace’s shoulders. “Stop. I didn’t want her at the house to begin with. But you agreed, if she wanted to stay at her own place she could.” His arms went around his wife and Tommy held her tight. “We’ve got her number. We’ll call, invite her to lunch one day. You can apologize-“ Grace scoffed and Tommy shook his head with a smile. “You can apologize and then the three of us can figure out the living situation. No big deal. Alright?”

He pulled back to see Grace’s face. Her lips were set in a pout and her eyes were red-rimmed, but she was still beautiful. “Yes, that’s fine.” She lifted up and gave him a quick kiss. “Thank you for calming me down. Thank you for all of this. I love you, you know?”

“I know. Now come on. We’ve got reservations for dinner.”

~*~

Four Days Later

Lizzie had just walked in the front door when her phone rang. Fishing it out of her pocket, her brows scrunched together as she looked at the unfamiliar number. It had been a long day. She had taken the day to go to the library and read up on what to expect during the first three months of pregnancy. It had been information overload. And then she had gone to the clinic for them to implant the embryos. It had been fairly easy, but now she couldn’t’ stop thinking about the fact that this was all real now. More real than it had been when it was just talk and paperwork.

So she wasn’t really in the mood for a bill collector or one of those scam calls telling her she’d won a free vacation to Aruba. So she tossed her phone on the sofa and made her way to the kitchen. There wasn’t much in it- rent came first these days. But that would change soon. The clinic had given her a check as she left from the Shelbys. It was to cover her food, rent, and utilities for the month- until it was confirmed that a baby would be showing up in approximately nine months.

Standing at her mostly empty refrigerator, Lizzie pulled out the milk and a carton of strawberries. Turning to grab a glass from the cupboard, the sound of her ringtone came again. Setting the milk and berries on the counter she rushed back to the living room and snatched up her phone and answered. “Hello?”

“Is this Elizabeth Stark?” Lizzie tensed at the deep voice on the other end. It was the last voice she expected to hear. She pulled the phone from her ear and looked at the screen. The same number from a minute ago was on the display. Quickly she put the phone back to her ear. “Yes, this is she.”

There was a pause on the other end and she thought she heard someone else speaking in the background. “Good. This is Tommy Shelby. My wife and I were wondering if you’d like to join us for dinner one day this week.” Lizzie blinked, then blinked again. She hadn’t expected that. And she really couldn’t understand why Mrs. Shelby would want to see her. “Ms. Stark, are you there?” Mr. Shelby asked, a hint of impatience in his tone.

“Yes, sorry. I’m here. Um..” God, Lizzie, just fucking say no. Because she really didn’t want to see them before she’d gone back to the clinic. She wanted as much of her freedom as she could get before their lives became enmeshed. “Sure. I mean, that would be fine. Do you have a day in mind?” She hadn’t needed to read the file Dr. Stone had given her to know that the Shelbys had very busy lives. They might try to make it sound like this was all spur of the moment, but Lizzie knew better.

Another pause, then the click of someone typing. “Wednesday at six?” Lizzie got the feeling that she was not the one that question was being directed to. Not that it really mattered. She didn’t feel like she had much of a say in all of this anyway. Especially after how things had gone at the clinic with Grace. “So does six o’clock Wednesday work for you, Ms. Stark?”

“You can just call me Lizzie. And yes, that works fine. Where should I meet you?” She hoped it wasn’t anywhere too pricey. She didn’t want them to pay for her, but she also hated pretending she wasn’t hungry at places simply because she couldn’t afford more than water. So of course the place Mr. Shelby named was a fancy restaurant downtown. “Sounds good. See you then,” she replied, stomach twisting itself into knots.

“And Lizzie? Call me Tommy.”

Lizzie mumbled her assent and quickly got off the phone. She looked back at the screen, brain still processing the last…three minutes and twenty-six seconds. ‘Call me Tommy’ he’d said. Tommy- such an innocent sounding name. A name that made you think of little boys running after a ball or the shy kid in high-school who was always really sweet. But somehow when Mr. Shelby said it, all those thoughts disappeared. Instead you were left with that old school Mafia vibe. Darkness and danger wrapped up in every syllable.

“Great, Liz, just great. You’ve really stuck yourself with quite the pair, haven’t you?”

~*~

Tommy motioned for the waiter to bring him another whiskey.

So far dinner had been awful. Lizzie had arrived on time, dressed appropriately, if not quite up to the usual price standards for the place. She had been nervous, but tried to hide it. And Tommy had been sure that once they got settled at their table things would begin to smooth over.

He did not expect Grace to insult Lizzie’s dress. He didn’t expect to hear his wife- who had been completely apologetic before getting to the restaurant- turn into her mother the minute Lizzie arrived. And he didn’t expect to have to make small talk to cover the tension. He wasn’t good at small talk. It was always Grace who handled things like that when business required playing nice with people.

He’d given up two whiskeys ago. Instead he sat and watched as Grace ate her meal and Lizzie sipped at the lemonade she’d ordered. He’d told her he was paying- to order what she wanted. She’d refused. It’d been a while since Tommy had been broke. But not long enough that he forgot how fucking annoying it was to take handouts. So he didn’t push the issue.

But it had been almost an hour and the tension was starting to aggravate him. So, Tommy reached over and took Grace’s hand, ignoring his wife’s questioning look, before turning to Lizzie. “So, Lizzie, we asked you here because we wanted to get some things settled.” He felt Grace tense beside him while he watched Lizzie stiffen in her seat. Tommy didn’t miss the way her eyes slid to Grace for a moment. “I believe things may have gotten off to a bad start.”

“Yes,” Grace said, “I think there were misunderstandings on both sides.” There hadn’t been- not from what Grace had told Tommy. But he kept his thoughts to himself. “Ms. Stark, Lizzie, I hope you know that I wasn’t trying to force you into anything. I just feel so protective of my baby already.” Lizzie didn’t respond. “I hope you’ll forgive me.”

Lizzie reached for her glass and took a sip of her lemonade. Tommy could see her thinking. He knew she was trying to decide if Grace had meant what she said. Not that it really mattered. The papers were signed, she had gone to the clinic to have the embryos implanted. This was happening. But he didn’t want Grace upset. And he didn’t want to have to fight for custody of this baby. So he wanted the two women to play nicely.

Setting her glass back down Lizzie looked at Grace. “I’m glad you feel so protective. It’s nice, knowing that this baby will be taken care of. And I hope that we can get through this whole thing without any problems. So I will stay until the end of the second trimester.” She turned to Tommy. “But I still think it would be better if I stayed at my own place from the beginning. Like I told Mrs. Shelby, I’ll visit every day and you are going to be at the doctor’s appointments anyway. So I don’t see why I need to live on your property.”

“But,” Tommy turned to Grace. “As I explained to you, it’s a matter of safety and knowing what is happening with our child,” Grace said. “You obviously have financial issues. And in your background check it said that you’ve been in trouble a few times. I just need to know that you aren’t going to do anything that could harm my baby.”

Tommy stared at Grace. They had talked about this. They had gone over how things would go at the dinner. And she’d gone off course from the minute Lizzie arrived. He tossed back the rest of his whiskey and tried to think of a way to salvage this. But he could see it in his wife’s eyes- she’d dug in her heels. “Grace.” She turned to face him, eyes bright with defiance. “We agreed, yeah? We wouldn’t force anything.”

He felt Lizzie’s eyes on him. It made him uncomfortable- having someone see him and Grace like this. He didn’t like people seeing the inner workings of his marriage. But it couldn’t be helped. Not this time. “It’s fine. Alright? It’s fine. But I’m still going to need rent money. I’ll need to still have a place after this is all over with.” Tommy reluctantly looked away from Grace. The woman facing him had just as much defiance in her eyes as his wife, but her shoulders were slumped in defeat. It was an odd sight.

“Can you be ready to move by Wednesday after next?” It was two weeks, and Tommy didn’t think Grace would wait much longer. And he just wanted this whole thing to be over. He had business that needed his attention and he couldn’t referee between his wife and the surrogate. Lizzie tensed, but nodded. For the first time Tommy wondered just how bad off she was to be going through with all of this. “Movers will be at your apartment on the day, then.”

He saw the waiter and motioned for the bill.

~*~

“What the fuck was that?”

Grace winced. “I know. Thomas, I know. She just-“

“Just what? Showed up on time? Ordered a drink? Agreed to what you fucking wanted?” She bit her lip. She hated fighting with Tommy. It didn’t happen often. They understood each other too well for that, usually. But this whole thing was increasing Grace’s anxiety. “You were meant to apologize. The whole point was to smooth things over so we don’t have problems later.”

Grace felt a spike of fear at those words. It would be so easy for Ms. Stark to sue for custody. It would be so easy for her to terminate the contract- abort the baby. And Grace knew she wasn’t helping matters. If anything she was making things worse. But she couldn’t seem to help it. “I’m just scared, Thomas.”

Her husband looked over at her from the driver’s seat. But instead of the usual softness and love, Grace found Tommy’s face tight with annoyance and his eyes cooler than they’d been with her in a long time. “You can’t let that matter. You can’t let the fear get into your head and muck it up. We had a plan. You broke from the plan, Grace. And that- that shit that happened back there? That’ll be what fucks this whole thing up in the end.”

The rest of the drive was silent. It was excruciating, mainly because Grace knew Tommy was right. But that insecure part of her couldn’t let herself care. She couldn’t admit it, not to him. Not when he was defending that woman. It shouldn’t feel like this. None of this should feel the way it did. Grace should be happy. Tommy should be happy. They should be planning for a baby to arrive, not fighting over the woman who was carrying said baby.

But…She saw the way Lizzie had watched Thomas. Grace had seen something in her eyes that made her wonder. Something that made her want to hold him tighter, closer. And she’d seen the way Thomas had looked at Lizzie- there had been an understanding there. When Lizzie had only ordered lemonade, when she had politely declined to let Tommy pay for her meal- he’d looked at her like he recognized something in her. It was something Grace didn’t recognize and she hated it- that small thing that Thomas and this woman shared.

The car pulling to a stop brought Grace out of her troubling thoughts. They were home. The sun was just setting behind the house and it cast a golden glow over everything. It was beautiful- perfect. Thomas had picked it for her as a surprise and she had fallen in love with it immediately. And every time she returned, no matter how upset or scared or hurt she might be, seeing it always made Grace smile. But not this time. This time her eyes went to the guest house to the left of the property- almost out of sight.

“She’s going to live there, Thomas. She’d going to be right there.” She felt her husband’s eyes on her. It wasn’t comforting like she had grown accustomed to. This time his gaze was too heavy. “It feels too close. But I can’t stand the idea of her being a step farther away. God, I wish…” But it didn’t matter what she wished. Her wishes hadn’t come true even after all the money and the medicine and the tears.

Thomas got out and walked around to the passenger’s side. He opened her door like always, and gave her his hand to help her out of the car. But the warmth of his hand was gone as soon as she was securely on her feet. He closed the door and went into the house- without her. The only other time he’d done that was the night Ada had gone missing. He’d run in to make calls- to find his baby sister.

This time he just didn’t want to be near his wife.

#tommy shelby #lizzie stark #tommy x lizzie #peaky blinders fanfic

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nancygduarteus · 8 years ago

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Growing Cheaper Embryos for IVF Inside the Vagina

As the number of U.S. babies born as a result of fertility treatment tops 1 million—an all-time high—clinics are under pressure to keep up to date with pricey lab equipment that can create, develop, and test embryos. But some fertility doctors have started to offer a new low-tech device that enables a woman to incubate them in her own body.

The catch: She grows them inside her vagina.

A doctor places a mixture of surgically extracted eggs and sperm inside a device that looks like a tiny acrylic saltshaker and inserts it deep into a patient’s vaginal canal near her cervix. That’s where it will hover, like a thimble-sized satellite, for up to five days until the doctor retrieves it, removes the resulting embryos and transfers one or more to her uterus in the hopes of creating a pregnancy. “It’s like having a tampon in the vagina,” explains Kevin Doody, a Dallas reproductive endocrinologist who’s led studies on the device, called INVOcell, which was approved by the U.S. Food and Drug Administration in 2015. “It’s not going to come out.”

It’s a concept designed to appeal to patients who prefer a less tech-heavy approach to scientific baby-making. That could include Catholics who’ve rejected traditional in-vitro fertilization (IVF) treatment because it facilitates conception outside the body.

But INVOcell could be a game-changer for the $2 billion assisted reproductive technology market. The protocol calls for fewer eggs (and less hormonal medication) than traditional IVF, and only requires about one-third as many office visits. The vaginal incubator also costs one-third to half the price of regular IVF treatment.

That’s no small matter for the estimated 1 in 8 couples in the United States who have trouble getting pregnant or carrying a baby to term—three-fourths of whom don’t receive the care they need because they can’t afford it, according to the American Society for Reproductive Medicine. Although the average price range of regular IVF is quoted as between $10,000 and $15,000, the real-life costs are closer to $20,000 by the time medications, sperm injection, and genetic testing services are factored in, according to data from 3,200 IVF patients that was analyzed by the fertility doctor review site FertilityIQ for the personal finance website NerdWallet.

Insurance coverage for traditional IVF is sparse: About 26 percent of workplaces offer infertility benefits, according to the Society for Human Resource Management. Just 15 states mandate that employers provide any kind of infertility coverage, and only eight states require that to include IVF treatment. (Insurers have yet to start paying for INVOcell.) As a result, many patients blow through their savings, load up their credit cards—one survey of more than 200 women who’d gone through IVF found that 44 percent racked up at least $10,000 in debt—or beg for financial help on crowdfunding sites. More than 8,500 GoFundMe campaigns created to raise money for fertility treatments have collected $13.5 million in the last six years, according to figures provided by the company.

By contrast, INVOcell, which is manufactured by INVO Bioscience in Medford, Mass., costs about $6,800, including medication. “We can pay for this without going into debt,” says Katie Whited, 28, a nurse from Durham, N.C., who’s tried nearly every fertility treatment short of IVF, including ovulation induction drugs with timed intercourse, acupuncture, and intrauterine insemination in which a doctor injects sperm directly into a patient’s uterus. “We wouldn’t have been able to find $18,000 for IVF.”

Early numbers are promising: One randomized clinical trial of 40 women under 38 found no significant difference in success rates between traditional IVF and INVOcell. Although IVF produced more quality embryos overall, the birth rates were similar: Of the 20 women undergoing IVF, 12 got pregnant and delivered 15 babies, including three sets of twins. In the INVOcell group, 11 of 20 women gave birth to 16 babies, including five sets of twins.

“I see so many patients who can’t have kids because they can’t afford IVF. We’ve got to do better. It’s a matter of medical ethics,” says Doody, who has trained a couple dozen doctors on using the vaginal incubator for INVO Bioscience. “Now a greater number of people will be able to access care, and it’s going to open up the market.”

According to Doody, doctors who offer INVOcell can cut the number of office visits for one round of treatment from eight (for traditional IVF) to two or three, which is a big deal for patients in underserved areas, especially in the southeastern and southwestern United States, who often must drive several hours to reach fertility clinics. That means there’s less work for staff who administer blood draws and ultrasounds and play phone tag with patients with updates after each visit. “Patients take less medication, and we’ve gotten better at dosing and predicting how they will respond so we can do less monitoring,” says Doody, who is also the president of the Society for Assisted Reproductive Technology, the organization that reports fertility clinics’ data to the government. “We’re not trying to get 10 to 15 eggs like with regular IVF. We just need six to eight eggs to get one or two good embryos to transfer.” His rationale: More eggs aren’t always better, and doctors should aim for a handful of quality eggs, rather than the larger quantity typically generated during regular IVF.

And because the embryos are grown in the mother’s body, there’s no need for lab staff to run costly incubators with extensive security systems around the clock, which also brings down the price.

The fact that INVOcell preserves some of the mystery of baby-making was a big selling point for Brittney Koch-Dowell, since she and her wife are depending on help from science to conceive. (They each plan to take a turn carrying a baby.) “We’re already using donor sperm, so this helped it feel more real and natural,” says Koch-Dowell, 37, a restaurant manager from Elsberry, Mo., who’s scheduled to undergo the procedure this month. “I get to be the incubator. My body and my heat are producing the child.”

* * *

In some ways, the rationale behind INVOcell sounds so obvious. (“It’s like what’s old is new again,” quipped John Couvaras, a fertility doctor in Phoenix who’s helped four women conceive with the device.) Yet it took French embryologist Claude Ranoux nearly 30 years to fine-tune his invention, which has been available in Europe since 2008. Since the birth of the first “test-tube baby” in 1978, Ranoux had been fascinated by the idea of growing embryos inside the human body rather than in a petri dish. And he wasn’t impressed with the unreliable incubator at his workplace, the Cochin Hospital at Paris Descartes University. “I was forced to be an innovator because I had a bad machine,” says Ranoux.

So Ranoux rigged up a little portable incubator from plastic tubing. At first, he considered sewing it under the abdominal skin, but that would require two surgeries to implant and extract the device and risked causing an infection. Taping it under an armpit would provide a nice warm place, but he thought it would feel too uncomfortable over several days. He also considered securing it in the back of a patient’s mouth, but he didn’t want to risk shocking the embryos if she drank cold water or hot coffee. Besides, there was the chance she could accidentally swallow it.

Next he considered having a patient swallow the capsule and letting the embryos grow over the two to three days it would take the device to wind its way through the digestive tract. But he feared the intestinal environment would be too toxic. “Also, it would be a nightmare for the embryologist to retrieve the device later,” he says.

He came to the most logical place last. “I didn’t think about it initially because I worried the capsule could lead to infections or irritate the cervix and interfere with embryo transfers,” he says. Those concerns were unfounded; instead, he found that the vagina provided the best consistent temperature, pH, and oxygen balance and enabled easy insertion and removal of a device. He also believed that embryos would benefit from the slight temperature variations that women undergo throughout the day, which embryos that are created during natural conception experience as they grow in the uterus.

Although INVOcell is designed to stay in the vaginal canal on its own, doctors have the option of adding a diaphragm net to catch it, just in case. If it somehow works its way out completely, patients are advised to wash it off and push it back up.

* * *

In the meantime, patients still have to get used to the idea.

Anne Swart, 38, of Berkeley, California says she and her husband decided against using INVOcell to help them conceive their second child after enduring two miscarriages, even if it meant paying close to $25,000 out of pocket for IVF, including sperm injection and genetic testing. “It hasn’t been around in the U.S. for a long time and just felt risker,” she says. “We didn’t want to go through more heartbreak. We just wanted to do everything to give us the best chance.”

The main challenge with marketing INVOcell is that it’s recommended mostly for younger women with uncomplicated fertility issues and partners with normal sperm counts, says Fady Sharara, a fertility doctor from Reston, Va., who’s only treated one patient with INVOcell after advertising it for a year. “My patients are older, and they want to get the maximum amount of eggs with IVF, so they can do genetic testing to make sure they have a normal embryo to transfer,” he says. “They have a small pot of money. They say, ‘I can’t afford to try INVOcell and then IVF later.’”

The lab also provides important feedback on growing embryos that’s impossible with INVOcell’s “in the dark” approach, adds Michael Tucker, the director of IVF and embryology labs at Shady Grove Fertility, the largest fertility center in the U.S. He argues that modern lab technology, including time-lapse imaging of developing embryos, helps embryologists pick the best ones to transfer to the uterus. “The idea of INVOcell is clever, but in a diagnostic sense, you lose so much,” he says. “You have no idea what’s happening inside the body. You don’t know if fertilization was normal. There’s something to be said [for] following the entire process.”

It’s also unknown whether mainstream fertility medicine is ready to embrace an IVF alternative that might cut into clinic bottom lines. “When clinics don’t offer lab services, they strip out a major profit center,” says Jake Anderson-Bialis, co-founder of FertilityIQ.

Yet most clinics can afford to add INVOcell to their menu of treatment options, says Richard Paulson, a reproductive endocrinologist at University of Southern California Fertility and president of the American Society for Reproductive Medicine. “We have a very expensive heavy-handed approach to IVF in the U. S. There’s definitely room to bring the cost down,” says Paulson, who wrote a paper on ways to broaden access to reproductive care, such as offering minimal stimulation of eggs, retrieving immature eggs or embracing vaginal incubation, like INVOcell’s device. He says the pressure to report the best clinic pregnancy rates to attract patients has caused doctors to shy away from trying more cost-effective alternatives that have smaller chances of success.

The acceptance of INVOcell could make doctors more open to other innovative technologies that might bring down the cost of fertility medicine, adds Alan Penzias, a fertility doctor at Boston IVF and a professor at Harvard Medical School. Other inventions in the works include a portable ultrasound that IVF patients could use with their electronic tablets, a spit test to measure hormone levels that would replace blood draws, and an at-home semen analysis test that uses a smartphone app.

Or doctors could use INVOcell to extend the reach of clinics to underserved areas. “I might be able to put some equipment in a van and set up a temporary shop in a hospital a few times a year,” suggests Penzias. “It could provide another outlet to expand access to fertility care.”

So could a Catholic endorsement. The Vatican has long opposed IVF on the grounds that it enables creating babies outside the bounds of marital intercourse. “The rule of thumb is that you can assist reproduction but not replace reproduction,” explains Father Kevin FitzGerald, an oncologist who specializes in Catholic health-care ethics at Georgetown University. So reproductive scientists have tried to find creative solutions, such as a procedure invented in the late 1980s called gamete intrafallopian transfer (GIFT) involving shooting a mixture of sperm and egg directly into the fallopian tubes through a catheter. But multiple births were common with that procedure, and doctors eventually stopped using it as IVF success rates improved.

While the Church has yet to issue an opinion on INVOcell, experts say it’s a potentially Catholic-friendly alternative to traditional IVF because the device technically helps fertilization occur inside the body. By the time doctors insert the incubator containing the egg and sperm soup inside the vagina—about 15 to 30 minutes following egg retrieval—the sperm have just started to attach to the eggs’ outer layer and haven’t yet started to burrow inside. It takes at least 18 hours for the chromosomes to join together and fertilization to finish.

“INVOcell is a move in the right direction to a more natural assisted method,” explains FitzGerald. His ideas for making it even more acceptable to Catholics: Collecting the sperm during sex in a condom, rather than asking men to masturbate into a cup in a fertility clinic closet. It would also help if doctors only inserted the number of eggs they estimated might turn into embryos. “You must use what’s fertilized so you don’t discard embryos and destroy human life,” he says.

What’s appealing for some Catholic patients of Julie Rhee, a fertility doctor in St. Louis, is that INVOcell eliminates the role of the embryologist tinkering with sperm. “The part that makes them feel comfortable is that you’re not determining which sperm will be injected inside the egg or whether fertilization will even happen at all,” says Rhee, who just started offering the vaginal incubator in May and has 10 patients lined up for treatment.

Ranoux, the founder of INVO Bioscience, didn’t set out to appease the Vatican at first, yet he’s found a way to accommodate his Catholic patients. In addition to collecting the semen in a condom (there’s a special coitus room at his clinics), Ranoux also pricks the bottom of the condom, to leave open the possibility of a natural conception.

But still, unlike GIFT, which enabled embryos to travel to the womb on their own, INVOcell requires a doctor to take the embryos out of the device and manually insert them into the uterus. That interference in the baby-making process—plus the act of selecting embryos and potentially freezing the extras, which could later be destroyed—makes a Catholic endorsement less likely. “You’re interrupting the natural chain of events,” says Daniel Sulmasy, who studies clinical bioethics at Georgetown University.

What could be acceptable, he argues, is if someone invents an incubator that is placed directly in the uterus, and then dissolves. But it’s a tricky timing gamble. The device would have to self-destruct at the exact moment the embryos have developed and were capable of attaching to the uterine lining. Still, it might not be impossible. “I have some ideas,” says Ranoux.

from Health News And Updates https://www.theatlantic.com/health/archive/2017/07/growing-cheaper-embryos-for-ivf-inside-the-vagina/533205/?utm_source=feed

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ionecoffman · 8 years ago

Text

Growing Cheaper Embryos for IVF Inside the Vagina

The catch: She grows them inside her vagina.

And because the embryos are grown in the mother’s body, there’s no need for lab staff to run costly incubators with extensive security systems around the clock, which also brings down the price.

* * *

In the meantime, patients still have to get used to the idea.

Article source here:The Atlantic

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