The Radical Freedom Of IVF

The day my partner and I affirmed via DocuSign that we wished to destroy 12 vials of frozen sperm and donate our three remaining embryos for research, we were 1,144 miles from the cryobank where they were stored. I sat working at the long table where my family eats and does homework and holds family meetings and plays Monopoly on Saturday nights, in the cramped living room of the house we rent in St. Paul. My children were at school and day care, hours when being a parent of four feels most manageable.

Anna and I bought the giant table because we wanted to make our living room feel like a coffee shop. Our kids were 5, 7, and 8 — and we wanted the table to lure them as they got bigger and had more reasons to retreat to their rooms. I envisioned the future that is now: notebooks and novels thrown all over, cups of tea and hot cocoa, conversations getting more adult at our rowdy family dinners. Who has a crush on whom? Which curse words are the best and worst ones? When Anna clicked the purchase button on the table and chairs and a couch, we agreed: It was a very good idea to get new furniture, our first furniture not from Ikea, now that we were done having babies.

But then we changed our minds. Anna has said that the thing she likes most about me is how willing I am to change my mind.

The night of the appointment at which we saw a flicker of cardiac activity on a screen in our fertility clinic, we decided to tell our older kids about the fourth baby. They sat around the table after dinner. I opened a box of fancy cupcakes and halved them, so everyone could try two flavors. I started filming. In the video, Anna hands my oldest son the ultrasound photo, and at first, he does not know what he is looking at. And then it sinks in. The Baby!? Our other son chimes in: “I thought it was the moon at first.” I guess I can see it: my grooves and craters, a spot of stark white. Future sister.

The baby was one of four embryos. Our clinic told us that we had an extremely high chance of having a baby with the luck we’d had during the embryonic stage. And it worked. Our daughter is the first one we tried, the best embryo regardless of sex, as I selected before transfer, and we decided that we would relinquish the rights to the others when she turned 1.

About two years later, we both wanted to sign the documents, but neither wanted to go first. I’m not sure why, exactly, the clinic sent them to Anna. Maybe because they considered our embryos hers primarily: her eggs, donor sperm, for what would be my uterus. We have been told that which one of us is our daughter’s “real” parent varies state to state, some recognizing her biological bond, others my gestational. Before we clicked Finish, a meaningless text loop: Are you sure? Are you really sure? What is sure? Did we hope to provoke something other than yes? Anna was sitting in the break room of a NICU a few miles away. She signed, then I did. And then it was over.

What is an embryo? Of course, I know in a literal sense: In our case, a reproductive endocrinologist retrieved Anna’s eggs on New Year’s Day 2021. It was a gray day, and I wasn’t allowed in the building, so I sat outside in the car staring blankly into the parking lot fog. Soon after the procedure, an embryologist injected a single sperm from a thawed vial of known donor sperm into each of 14 eggs. Of those 14 fertilized eggs, seven survived long enough to biopsy for preimplantation genetic testing, and four were deemed suitable for implantation. Those four were then cryogenically frozen. The other three were discarded, with the thought that if we transferred them, and they implanted, my body would likely miscarry soon after.

We joke that our daughter is “double frozen” since the sperm that made her had been in a tank for a decade before the embryologist thawed it to make her. When we asked our friend to bank his sperm for us in 2011, none of us thought very far or hard into the future. Anna and I weren’t actually married, because my legal sex was still female and that wasn’t a thing we could do. Being a closeted trans guy had always made planning anything hard for me. Anna and I were in our mid-20s and we jumped into parenting without thinking much about it, as both our sets of parents had in the ’80s. I was unhappy in my job teaching high school, artistically unproductive, and ready for a new phase to begin. Parenting was something I knew I wanted, and doing it as fast as I could gave me a way to avoid looking hard at my relationship to work, to gender, and to my body, among other things.

We lived in a chaotic apartment cut into the back of an old Victorian that shared a corner in West Philadelphia with a thunderous bar. One of our friends was a dorm resident adviser who would ride through campus on his bicycle, scavenging snacks from university events to bring to our house: an open bag of pistachios, half a sleeve of crackers. This was the genetic father of our future children.

And so I had three children in rapid succession: one at 25 (she carried), one at 26 (I carried), and one at 28 (her turn again). The daily labor of parenting young children eclipsed everything else for years.

Nothing radicalized me about abortion like having children.

For every person alive, the decision to have children or not is affected by many factors: desire, age, availability of viable sperm and egg inside or outside the context of a relationship, the cooperation of the carrier’s body, the cost to treat any issues that arise, the health or abnormality of the embryo that becomes the fetus that becomes the child, and, of course, the way the law circumscribes our options to manipulate circumstance.

For two people who didn’t produce sperm, we had it very easy the first three rounds: a willing donor, a queer-friendly fertility doc, few interventions needed, good insurance, easy out-of-hospital births. When I learned that an own-egg baby was unlikely when it was my turn again for one last round, my insurance, it turns out, covered the golden egg of queer fertility: the medical costs associated with egg donation, as a treatment option for my infertility. It was, we were told by the incredulous billing department, the first time our large urban clinic had worked within the context of this coverage.

And, of course, all along, we had Roe. Nothing radicalized me about abortion like having children. We always talked about having a big family, and I grew up in one, but still, nothing prepares you for the labor and the anguish that come alongside the joy and fulfillment. My body and my emotional landscape are forever changed by my wanted experiences of gestation and birth, and throughout both pregnancies, I was haunted by the thought of the many people who do this because they have to, not because they want to.

During my pregnancy with our last baby, Anna and I would have the most endlessly specific conversations about the things that can go wrong. We didn’t always agree, and that was scary, though I knew she would support my decisions. We talked openly about the urgent need to unpack our ableism and prepare to parent disabled children, since every person who isn’t born disabled is, either quickly or slowly, moving toward disability in their own way. We also, especially during this last pregnancy, talked about abortion: under what circumstances each of us would get one, where we would go at different stages of pregnancy, and what that might mean for us, for our family-building project. Would I want to get pregnant again, would I want Anna to try an embryo transfer, or would we give up?

Anna was an experienced labor and delivery nurse who had worked on a unit specifically for parents carrying children with severe fetal anomalies, and I was two years into working as an educator in a pediatric oncology clinic, where many of the patients had genetic conditions I had to help their families explain to their teachers and school counselors.

I have to admit that, though Anna does not agree with me, I do think that what is depicted in the picture the nurse handed me is human life. It’s the earliest picture I have of my beautiful child.

But we never thought we couldn’t get one, if we wanted — and wanting, to me, is the same thing as needing. Our last baby was born five months after Dobbs in a state that still has legal abortion. At my anatomy ultrasound, something that many people find fun or exciting, Anna and I nervously scanned different parts of her body for the conditions we most feared. Instead of looking for hands and feet, Anna asked to be shown that her diaphragm wasn’t herniated.

During the second half of my pregnancy, there was, even more than before, an endless supply of urgent writing about abortion. Women wrote about abortions that changed or saved their lives, about abortions they had wanted, and about abortions they’d had because of the conditions Anna and I feared. They performed their grief in print, their longing for dignified treatment, their despair at seeing other people go through pregnancies they could not, but had to, continue. I channeled a lot of my own sadness about the medicalization of my own pregnancy, and what that meant in terms of interacting with providers as a trans guy, into rage on behalf of the women who wrote these essays. I was mad at the laws and mad at what we demand from birthing people: that we constantly disclose the stakes we face to get the care.

The real answer to what an embryo is, is part science, part context, part feeling. Our daughter is blond and has, as of this writing, eight teeth. She can spot her own polka-dotted coat among the pile of family coats and brings it to me when she wants to go outside. She likes lemon yogurt and the song “Skinnamarink.” She has baby-fat hands, soft and white and domed. In the minutes before she was put inside me, I sat in a plastic chair in a hospital gown and shower cap. It was so cold outside the surgical theater in the waiting area, and I was alone and unsure where to look, what to think. They were preparing the room for me. A nurse came through the double doors and handed me a picture of her: a cluster of black and gray and white. I have to admit that, though Anna does not agree with me, I do think that what is depicted in the picture the nurse handed me is human life. It’s the earliest picture I have of my beautiful child.

In the book In Vitro: On Longing and Transformation (translated by Robin Myers), Isabel Zapata writes deftly about the depersonalization she experiences going through in vitro fertilization (IVF). The lab where her husband’s sperm is collected and analyzed is an “immaculately white-walled laboratory that looks like the inside of an abandoned spaceship.” Having to rely on doctors to get pregnant challenges Zapata’s basic beliefs. She muses that for her, “It’s best not to use the word life when thinking about this process,” because imagining life beginning in the laboratory “would radically transform the world [she’s] built.”

There’s a similar level of depersonalization attached to fertility in Aisha Sabatini Sloan’s Borealis. She recalls when she was a child and her friend’s mom was pregnant, “I was convinced she was going to give birth to a lizard.” This reverberates into her present trying to conceive in a queer relationship: “When the cause of ‘infertility’ on your medical chart reads ‘male problem,’ everything can feel very lizard baby, very Gattaca.”

I see myself so clearly in some of the literature about infertility that I read in the period surrounding my own experience. It’s a strange, hard, otherworldly experience. Most of us both want to and don’t want to be in the clinics we find ourselves in. Either we’re infertile, or we’re sick, or we have a worrisome genetic condition, or we’re queer and this is the way that makes sense to navigate making a family. In this setting particularly — places that are part medical arena, part business, and part worship space, there’s a way in which you’re everything at once: a patient, a customer, a prayerful beggar, the one with the power to decide the course of treatment, the one being given constant commands.

I feel the most kinship with how Shira Spector writes associatively about the time she spent trying to get pregnant in her graphic memoir Red Rock Baby Candy — “Bread that took all day to bake burns/the cookies were made with salt instead of sugar, the cake never rises ... The time I wore Scarlet lingerie and lipstick and prayed to the color red. I don’t know what gets people pregnant.” Images of babies and baked goods are collaged, and the section ends with a self-portrait of Spector lying on the floor, holding a blond toddler.

In art made about (in)fertility there is a tension between the constraints of the medical, financial, and legal systems in which we operate and the freedom we have to take those experiences and turn them into art. Each of the writers above had choice, but with constraint: The clinic represented both the barriers to parenthood and the possibility of scaling them. Lying in the surgical theater, with a nurse pressing an ultrasound wand down on my abdomen and a doctor threading a catheter, with my daughter inside, into my uterus, I sucked in air at the discomfort. My doctor looked at me. She said she was sorry.

“It’s OK,” I said. “I want to be here.”

It’s a strange, hard, otherworldly experience.

During this time, I turned to art, but I also turned to Reddit. In the space of the clinic, I struggled to focus on the words my doctor and nurse practitioner said, on the handouts and the slideshows and the emailed consents. Reddit wasn’t artistic or beautiful. I logged on to see the numbers, the stats. I logged on to read others’ understandings and experiences of the procedures I faced, and also, honestly, because a large part of me felt selfish for undergoing IVF when I already had rad kids at home. I tried to limit the degree to which I processed with people who weren’t behind an avatar: who knows what my friends had not told me about their own fertility, and I had three living children.

As a trans person, I’ve long known the power of social media, its way of connecting people who have the same niche health care needs. When my own IVF worked, and I no longer needed supplement brand recommendations or coping strategies for daily progesterone injections, I stayed on some subreddits, anonymously answering questions about my experiences, especially happy to spread optimism about low early human chorionic gonadotropin (hCG) blood levels had led to a successful term pregnancy for me and my ideas about what queer-friendly health care looked like.

The grumblings about IVF being outlawed started the minute the Dobbs Supreme Court decision was leaked. Posters from conservative states in the United States wanted to know: Should they ship their embryos to California or someplace else to protect them? Should they plan for IVF tourism instead of relying on their home clinics?

Within hours, group administrators started to weigh in: These conversations were allowed. They were reasonable. On the Internet, as in my real life, people who need reproductive care understand that IVF and abortion are intimately linked. They’re at their core about our ability to make hard, empowered choices to steer the course of our own lives. Redditors who commented implying people were being hysterical or alarmist were ruthlessly downvoted, dozens and dozens of furious, anguished thumbs down.

My own IVF journey was full of crying, more in the span of a few months than in the decade before, especially since I was off of the testosterone that suppresses it for me. I cried most often in the evening, on my kitchen floor, after a day of tension, when I had finally gotten my three children to bed. The tension of those visits to the clinic multiple times a week: my sneakered feet on the sidewalk walking in the dark to the subway, sitting staring out the greasy car window, the elevator to the eighth floor fertility office at 7 a.m. Vial after vial of blood. The neat pile on the chair in the corner: jeans, boxer shorts, sneakers. My feet on stirrups in Room 1 and Room 2 and Room 3. Faces of fellows and med students and my doctor, pushing the ultrasound wand into me again. The numbers: follicle count; lining width; estrogen level. The picture of my family I showed to my nurse practitioner when she asked, all of us dressed up for my brother’s wedding. Anna wears a sequined romper. I am in the middle, wearing a tuxedo and an impossibly big smile. The emails that same NP sent when I asked how likely it was my pregnancy would continue a few weeks in:

Krys

50/50 at this time

I have seen it work out

I have seen it not work out

Hang in I am sending good vibes to you all

In the end, the time spent worrying that my desire wasn’t a good enough reason for all the health care was wasted. Eventually, if you’re one of the lucky ones who get a living child out of your care, you get to do what I’ve spent the last year doing: moving on. The embryos belonged to me, and they were my potential children, but I don’t want seven children, so now they’re gone. Other memories have started to edge for space in front of my memories of the clinic. My new, better memories: my older daughter’s gloved hands reaching out to help catch the baby in a birthing tub in my bedroom. The pies Anna’s boss brought us after the baby was born. The way my baby’s day care teachers kept cheering for her to walk across the room to me, until the day she did. My daughter is like all children, like all of us: She didn’t ask to be here, but here she is.

It matters because reproductive freedom belongs to all of us, is all of our responsibility.

The case in Alabama that may undo the beautiful, complicated, harrowing, Earth-changing science that is IVF does not shock me. The lawsuit was initiated by intended parents who wanted to sue the person who walked into their fertility clinic and destroyed their cryopreserved embryos. That families would want to send their agony over this loss somewhere, even somewhere misguided, comes as no surprise. But the court’s decision, which cites the Bible and declares embryos “children,” has catastrophic implications for folks in Alabama who, like me, find themselves at the clinic door. The only thing that separates us is two years and about the same number of miles that separated me from the embryos we relinquished.

Most of the pictures in my “IVF” album are of Anna injecting ovary-stimulating medications. She started on Christmas Day and, for a week and a half, injected mind-bogglingly expensive injections into her stomach fat. She injects wearing an ugly Christmas sweater. (It’s royal blue, with bells, and says “Fa La La La Llama.”) She injects wearing cobalt scrubs. She injects in a worn heather sweatshirt. She looks happy, then tired, then happy again. Each time she is in the kitchen and I am photographing her because I love her and because she is giving me the biggest gift: the chance to have one more baby, even though there isn’t language to describe why after all these years I feel called to try. There are people in Alabama right now in the middle of this cycle, some of whom have no living children, having spent their life savings on a basket of vials and needles, being turned away just as their body is ready to give. It’s a tragedy you can only fathom if you’ve lived in a house that, for a few weeks, is filled with that particular blend of longing, that hesitant excitement.

It matters because reproductive freedom belongs to all of us, is all of our responsibility. When I started thinking about the children I’ve carried, I was primarily focused on the way my experiences as a trans guy affected how I was treated, the way I moved through the world, and what I thought about all of it. In the end, though, even the worst stuff I’ve experienced only felt bad, only made me feel awkward or small or erased. Those experiences matter; I know that. But my material reality, this radical degree of choice, matters far more.

These days, as I sit around the big wooden table with my four kids and their incredible appetites, I feel an uncomplicated acceptance. Our family is what it is. It’s done, and now Anna and I get to figure out what to do now that our babymaking years are over. There was a day before the baby when I sat them down here and explained my infertility to them as simply as I could. I told them that even though I was still young and luckily very healthy, my body had far fewer eggs than most people my age. I explained why I had to go to the doctor so often, and what would happen as I continued to go there. I don’t remember exactly what I said, but I do remember using the word “lucky,” not to describe my circumstance but rather what I was able to do in the face of it.

The last few days, I’ve been thinking about the way my chest would swell with a corny, earnest, heartbreaking hope on some of those subway rides to the fertility clinic, the way, during the months or years of IVF treatment, you can sometimes see the shape and fill of your uterus, empty or not, on a screen as you fall asleep. Giving the embryos we didn’t want to carry to research was rooted in an optimism that is becoming increasingly hard to access, and with it came the hope that this daughter I brought onto the Earth will have at least the freedom Anna and I have, if not more. It was a decision born from the hope that if she uses her one body to make other people, we’ll know more about how to keep her safe, about how to keep her baby safe. I know from experience that embracing that freedom means embracing the messiness of it all: how saying goodbye to this period of my life, to these embryos, came with a small dose of hesitancy and regret over the loss of potential lives, of theirs and mine. Anna, for her part, says that what she gave me was not human life but “more like a sourdough starter.” And though my own view is more complicated, being an IVF patient has only made me more adamant that we all deserve the full spectrum of reproductive options. Because it was my precious choice to let go, to move on. It was harder than I thought it would be, but I’m so grateful we made them, that it worked. I know I’m lucky. I’m ready for what’s next in my life. I want that for all of us.

Krys Malcolm Belc is the author of The Natural Mother of the Child: A Memoir of Nonbinary Parenthood. He is the Edelstein-Keller Writer in Residence at the University of Minnesota and lives in St. Paul with his partner and their four young children.