All the Little Unborn Babies

neither God nor nature is pro life

They call it a “vanishing twin.”

We’ve had an unusual number of ultrasounds, during this pregnancy, gotten to see our little guy more than most do. They always do a lot at the fertility center, which is part of their usual package - and, given how much I’ve paid, I’d be pissed if they didn’t - and also the pregnancy is considered high risk. IVF in general involves watching every stage of a process that nature wisely decided to hide away behind closed doors, so that we don’t spend too much time worrying over what we can’t control. On transfer day we were piled into a little room with more monitors than mission control at NASA and a disconcerting number of personnel for a procedure that, we were and have been reassured, is perfectly routine. Still I worried. I worried while I watched them shoot the little dot into the uterus and I worried as I said “godspeed, little guy,” and I worried on the drive home and I worried as we waited for the next sonogram to take a look and have an opportunity to worry again. My wife did all of that plus took an endless amount of hormones and endured daily injections and experienced the relentless indignity that comes with an army of strangers casually invading every inch of your privacy.

You shouldn’t get too invested in any one attempt. A majority of IVF blastocysts don’t implant, after all, meaning that they never successfully burrow into the endometrium and establish a placenta. It takes days to know if implantation has happened and success can only be established with an HCG test, which looks for one of the core pregnancy hormones. The clinic or OBGYN will schedule a blood test for a week to ten days after the implantation procedure to determine if you’re pregnant; they say not to preempt this by taking home urine tests, but everybody does anyway. This leads to endless anxious posts on various online forums, women sharing pictures of pregnancy test sticks, looking for “squinters,” desperate to be told that there’s a line there somewhere when very often there isn’t. I find it all very human and very sad. They say that a couple with three viable embryos has a 95% chance of turning one of them into a pregnancy. You get that a lot, in fertility - people talking about a woman enduring multiple failed implantations the way a carnival barker talks while pressing you to play ring toss. I’m afraid that not everybody gets a prize.

Of course implantation is only the first part. Once implanted, the embryo actually has to develop and grow, and very very often they don’t. As time has gone on, science’s perception of the estimated percentage of fertilized eggs that turn into live births has trended down; that is, we are more and more aware that miscarriage is even more common than we once knew. For much of human history we didn’t have the technology to reliably know someone was pregnant until quite a bit into the process. Combined with the fact that many miscarriages happen so early that there are no physical symptoms, or result only in what appears to be a heavy period, this means that women have historically been miscarrying at significantly higher rates than they were aware. We now know that it’s remarkably common for a women’s egg to be fertilized without leading to a live birth, without her ever knowing. A lot of teenaged boys have had their prayers answered a little later in the process than they thought.

This all has consequences. The most obvious of those is the relentless heart-in-throat period of early pregnancy, when any woman can lose their embryo at any time. Most early miscarriages are the result of chromosomal abnormalities, transcription errors or the like where the karyogamic process somehow goes wrong and produces a pregnancy that would never lead to a viable human baby. Despite that fact, miscarriage remains stigmatized in many contexts, and prospective mothers tend to blame themselves. Obviously, losing a pregnancy is very hard regardless of the circumstances. It’s not harder, with IVF, just harder to ignore, because you know exactly when transfer is happening and you know as early as possible if you’ve become pregnant, so you’re always aware that a fertilized embryo has failed to turn into a viable pregnancy; people doing it the old fashioned way don’t know if fertilization has actually happened and often won’t know they’re pregnant until months into the process, meaning that they will sometimes lose pregnancies without knowing it. There’s obviously pain to go around. But they do tell you to shrug off failed implantation and early miscarriages as best you can, the fertility people, because IVF is a numbers game. There is a cold wisdom there, and also the advice is fruitless because we don’t get to decide when we hurt. Add in the fact that egg retrieval produces a finite number of eggs and that a finite number of those eggs fertilize and that a finite number of the fertilized eggs gestate into viable embryos and that a finite number of the embryos implant and that a finite number of the implanted embryos survive the first trimester…. Well, you get it.

Another way you might put all of this is that IVF casts light on a broader reality: pregnancies are precious to parents but nothing to nature. Miscarriage is no more a mistake to nature than an acorn trying to germinate in concrete.

Anyway, the twin. We went through those anxious first weeks, which did not cease to be anxious after they did the blood test and told us we were pregnant. We were all too well aware that such tests are often only a prelude to a later bitter failure. My wife took a couple dozen urine tests in those early days, keeping careful notes as the line darkened, another thing they tell you not to do. You can’t really assess anything once you’ve known implantation has happened, and HCG can stay high for days after a miscarriage, so it’s a seductive and flawed indicator. But it’s too early to see anything on ultrasound and not doing anything while you wait for trips to the clinic is just too hard. It’s too hard. You have to have something, and that little line looks like something. You also can’t tell anyone too early, given the miscarriage risk - we waited until week ten to tell close friends and family and until week twelve to go public - and that’s a very weird thing, having an experience that’s dominating your emotional life which you must studiously avoid talking about with the people closest to you. Pregnant women are granted a little accommodation, in our society, though not nearly enough. But in the first couple months they can’t even ask for that, for fear of losing the baby, for fear of making the pregnancy real and thus vulnerable to reality. Well. Over time everything went according to plan, and the baby grew, and eventually we got to see the little bean on ultrasounds. And that’s when they discovered Twin B.

We were doing an early ultrasound and the tech at the fertility clinic went “Oh!” And there was a second gestational sac, in which a second baby might go. That there was a second sac was actually better than the alternative - “multiples” increase miscarriage risk and complications in general, and those risks are particularly high when twins share the same gestational sac. (A loss of one of the embryos can trigger a response that disposes of the other one too, which feels like another level of biological cruelty to me.) But it looked like there was nothing in that gestational sac, making it an “anembryonic” second pregnancy. We were told it would break apart and be reabsorbed in time, nothing to get attached to, nothing to be worried about. But then, another ultrasound, and there was definitely a little embryo inside, looking quite like its sibling, just small. Unlike with its twin, though, there was no detectable heartbeat. Probably not viable, probably not, probably not. Probably no second baby, probably not, probably not. We were told it would break apart and be reabsorbed in time, nothing to get attached to, nothing to be worried about. Like a parent telling their child not to expect snow on Christmas. They got firmer the more time went on in which we shared the Earth with Twin B: don’t get invested. Don’t expect this child to survive. And then there was another ultrasound, and look there, a heartbeat, a little uneven, but strong. The people at Yale were surprised and started hedging their bets, but their company line didn’t change much. It could survive, maybe, impossible to say there was no chance, but still - they stressed that it would very likely break apart and be reabsorbed in time, nothing to get attached to, nothing to be worried about. Don’t get attached. Don’t get attached.

And we said all the right things and listened to the fertility center people and resolved not to get attached. Eventually they moved us from the swanky brushed-steel-and-glass campus of the fertility center to the competent-but-humble industrial baby factory at the Maternal Fetal Medicine center. (Guess you can’t fund buildings that look like an Apple Fertility Store with what Medicaid pays.) We had told the Yale people the same thing we told ourselves, that we wouldn’t get invested, we just wanted one healthy baby, just one baby. I joked that Twin B stood for Twin Bonus, pointed out that I’d only paid for ten fingers and ten toes and wouldn’t expect to get double for my money, yuk yuk yuk…. One odd little twist: they said that it was possible that the twin was the result of a simultaneous natural pregnancy; that is, that while we had been doing IVF, my wife might have gotten pregnant naturally. (As is standard procedure now, we had done a single-embryo transfer.) There was no way to know, and as they kept dissuading us from getting invested I didn’t ask too many questions. Still, interesting to wonder if they were fraternal or identical twins, and the genetic questions are a little loaded too - we have been unable to do traditional testing to look for chromosomal abnormalities and determine the sex, thanks to Twin B, as the genetic material of one might have contaminated that of the other. It was impossible not to be struck by the possibility that, after three years of trying, a second pregnancy had spontaneously occurred the old-fashioned way in the middle of IVF, particularly considering that I had paid the clinic instead of paying the taxes.

Anyway. They did warn us. But I must confess that I have never rooted for anything in my life as hard as I rooted for Twin B.

And then it was gone. No heartbeat. Routine ultrasound. Nothing to worry about. It would be reabsorbed. And we both went “aww” and the nurse said “Sad!” and we chuckled and moved on and I said “ten fingers ten toes” again, like some sort of moron, and we only confessed to each other to being upset later on that day and then went on about our separate days to nurse our separate griefs. The clinic said not to get attached. We told each other we wouldn’t get invested. And then you find that you are, in the middle of this larger joy, and you don’t want to be greedy or to be the one who violated the doctor’s commandment or to be the one to bring more sadness into a process in which you pay very competent people to sift through that sadness and try to pull out that one essential happiness, cell by cell. Anyway, I never would’ve confessed to how hurt I was to lose Twin B. But my wife, who is wise and has none of my attachment to self-aggrandizing stoicism, was direct and uncomplicated and honest: it hurt. She was brave enough to say so.

I suppose this might sound like the setup for a conversion narrative, that I lost Twin B and learned about the true value of a human life and resolved to burn every drop of mifepristone in a giant vat in St. Peter’s Square. In fact the influence has run in the opposite direction. Before I saw abortion rights as merely a matter of individual autonomy, which of course is still the core issue; the only question one must answer, to know where they stand on abortion, is “Who owns the human body?” But now I also think that abortion is, ultimately, a reflection of nature, of the nature God made. It’s a reminder that there is something fickle at the heart of our most basic animal reality, and the chaos of human desires is not some unfortunate mistake but rather a reflection of the fact that we are nature and are in nature. And part of being nature is accepting nature’s profligate disdain for our plans, which very much includes our designs on when to have babies and when not to. I apologize for the visuals, but that’s human creation - in three years of pitched physical labor, my wife and I expended the material of life at frightening speeds, to no effect, to no effect, to no effect but late night tears, waiting for a thin blue line that would never come. And then there were the three clinics and the Clomid and the IUI and the Lupron and the “Have you considered PRP?, we think you should, it’s experimental and costs $7,000, but you want to give your baby the best possible chance, now don’t you?” No, I’m over it, the mystique of pregnancy, the sanctity of life before life. To me it’s all just chemistry, indifferent chemistry, and the chemist is either the doctors or else it’s nature or, if you prefer, that baby-loving Jesus of yours. We become rights-bearing, emotion-laden baby humans at birth; the alternative is to assign a “right to life” to a primordial soup that, I assure you, very often doesn’t want to live, seems to want to do anything but live. Take it up with your god. He made those rules.

Nature is the most ruthless abortionist; those who talk about a right to life must face up to that plain truth. Nature takes babies by the bushel, sending decent and vulnerable career women to the bathroom at work, bleeding, weeping and inconsolable, telling themselves they’ve got five minutes to get it together and head back to their desks so that no one knows. Once you understand that you live in a world where atoms make up cells that make up tissues that make up organs that make up embryos that end up as clots in the toilets of people who desperately, desperately want to have children, you can’t take the idea of a “right to life” seriously anymore. A right to life? Babies are born addicted to fentanyl, babies are born with cancer. What are you talking about, a right to life? Whose job is it to enforce this right, if not the very celestial being that invented Trisomy 13, placenta previa, and ectopic pregnancy? He made the woman that was raped and He made the rapist and He made the resulting pregnancy that, we’re told, must not be ended with the medical science He allowed into His universe because that’s not what He wants. Mysterious ways, indeed.

They try to make secular pro-life arguments, try to take God out of the anti-abortion case; it reminds me of those YouTube videos where they take the laugh track out of episodes of Friends, an absence that makes the fundamental absurdity of what we’re watching more plain. Even without a god, you’re still left in the same basic pickle: what you call some sort of violation of the natural order is simply the ordinary expression of corporeal biology. Our ecosystem is a profligate baby killer. Miscarriage is an essential part of sexual reproduction, a cleansing mechanism that is a necessary antecedent to the entire process of zygotic production; that miscarriage breaks our hearts is just one of those things. You can Google about how pelican mothers will favor one chick over another until the unlucky one has grown sickly and emaciated and the mother finally pushes it out of the nest without ceremony. I don’t recommend you do, though, as it’s grim business. We would have done anything to have saved Twin B, and while we were busily not getting attached and practicing mature and self-defensive obstetric realism I was coming up with names and trying to figure out how hard it would be to carry around two babies and a shopping bag at the grocery store. In the end, though, the outcome for Twin B was the same as for the unwanted pelican chick. That’s what it means to be alive, and I think you should factor that into your views on abortion.

Some people badly want to be pregnant and can’t get what they want. Medical progress in that direction has been remarkable, but trust me, a lot of people don’t get what they’re looking for when they go to the fertility clinic, no matter how large the checks they cut, and that heartbreak is of an order I can’t describe. Some people badly want to not be pregnant when they are, and whatever our medical system’s deficiencies, whatever the limits of our knowledge, that is something we know how to do very well: to make a woman not-pregnant, reliably, safely. Increasingly this is an at-home procedure. And I am asking you to wonder why you might want to punish the women who don’t want to be pregnant while you worship a God that gives babies to those who don’t want them even as he holds the idea of a baby right above the grasp of people who want nothing else, dangling that relief above them like a cruel child withholding a treat from a dog. If you’re religious, you believe in the deity that created women who just can’t get pregnant. So who are you mad at, exactly, and why? His will is done, right? So why don’t you see that will in the hands of the ordinary human abortionist? And what does it say that the God you worship forbade ending pregnancies while he slaughters babies himself, born and unborn, by the billions? Who is he to tell some panicked woman that she has to keep a child she doesn’t want?

There’s some more embryos of ours sitting in a freezer somewhere. Because, yes, as the more zealous anti-abortion people will tell you, IVF requires an assembly-line approach to the creation of human life. The dirty little secret is that modern science is not a handful of white-clad scientists working efficiently in impeccably minimalist labs but rather the slow grinding of hundreds, working in spaces that are factories in all but name. To get babies - you know, more little children of God - you need a lot of embryos, more than you ever intend to give birth to. Because of nature. Because of God. We might decide to implant another of our embryos in the future, we might not. The plan is for the ones we never implant to be donated to infertile couples, and I hope every one turns into a little pair of feet padding along on someone’s carpet. But if they instead end up in some medical waste bin somewhere, that’s OK too. Because that’s what it took to make the pregnancy we have that we hope turns into the child we want. That’s what it took to make life! And the idea that those embryos are somehow entitled to more than God and nature give to all those potential babies out there, destined to be loved, that instead miscarry…. It just doesn’t make any sense to me. If you’re angry that zygotes become something other than living creatures, take it up with the universe that made them so disposable, and if you don’t like abortion, don’t have one. I wish Twin B had made it. But theoretical people have no rights; whether or not they should is irrelevant in the face of the knowledge that reality does not afford them the opportunity to have rights. Nature sees to that.

The battle, in this process, is to protect your heart without covering it in so many layers of ice that you can’t feel anything when the joy comes. You make a plan, a defense plan for your heart, and you try not to swerve. But you do fail. I was over the vanishing twin and then I wasn’t. I was fine and then I found a picture of my sister and myself as a baby, in a shoebox full of yellowing Fotomat prints in a cardboard box that sits on a shelf in my living room. It’s one of many boxes of photos and documents that I’ve always meant to digitize but haven’t, which means that any day they could go up in flames as suddenly and finally as the family those pictures depict did. But life goes on, if we make it go on. Someday I will take our son and place him on my lap and go through those pictures one by one and explain to him why the 1980s came in different colors than the years he will occupy, in a future that is already his and not mine. To see my siblings in golden emulsion like that, though, made me think of what my unborn child might have had in Twin B, a sibling and friend and irreplaceable companion, and for a moment I lost myself in a beautiful and bitter nostalgia, every moment of my youth that was cast in those particular colors that can be seen only by the innocent and the unafraid. For that uncertain moment I thought of all the things a child is - another set of little gloves to fish around for in the pockets of another little coat - and for awhile I let myself hurt, my only swerving, then pushed Twin B out of my mind forever.