Ava, page 13
“I’m ready. My therapist says I’m ready. She thinks I’ve made a lot of progress after seeing her for so long. I’ve been thinking about this for months, and it’s time.”
“But what if we get bad news again, Larkin? Do you think we can handle it?”
“I’m going to ask Aubrey to do my ultrasounds. If anything is wrong, she has other connections.”
“I’ll do whatever you want, Larkin. And I’m ready if you are. A baby would be wonderful.”
“No matter what happens, we can handle this.” She paused and then continued nervously. “I also had an interesting conversation with Dr. Davis this week that I’ve been thinking about.”
Larkin detailed Dr. Davis’s experiments and his motivation for pursuing his research, and she told Spencer she had volunteered to be his first test subject. Dumbfounded, Spencer looked at his wife.
“Why, Larkin? Why would you want to do this? It seems like something out of a sci-fi movie.”
“It is science, but it’s not fiction. This can work. But it’s not a decision I am making just for us. Well, it is in the short-term, but in the long-term, it’s for generations of women after us. This could be completely life-changing for so many women, including our future children.”
Spencer held the sides of his head and rubbed his temples as if the information was too much to be contained within his mind.
“Okay, okay, okay . . . let me think about this. This is a lot to process.”
“Thank you, Spencer. I need to talk to Aubrey as well. I’m going to need her help if we do this.”
* * *
Aubrey was known to her patients and colleagues at the Knoxville Fertility Clinic as Dr. Abrams. She was hired after completing her fellowship and was excited about living closer to her best friend. She was still estranged from her parents, so she didn’t feel compelled to live near them anymore. She had been declared cancer-free several years earlier, but her parents wouldn’t know that unless Lance had told them. They never called her to ask.
Prior to having chemotherapy, she’d frozen some of her eggs in case she decided to have children one day. She hadn’t yet met the right person to spend the rest of her life with, so they remained safely stored at a cryobank.
Not being able to carry a child herself made her more motivated to make it a reality for other couples who needed help. She knew she had chosen the right career path. Her office wall was covered with notes of profound gratitude and photos of parents holding their babies.
When her lifelong friend called to ask for her help with Dr. Davis’s experiment, Aubrey immediately agreed.
“Aubrey, I don’t think you’ve thought this through,” Larkin said earnestly.
“You’re right—I haven’t. But you are asking me for a favor, and I want to help. That’s all the thought I need to put into it.”
“Aren’t you putting yourself in jeopardy of losing your medical license? Ruining your whole career, which you’ve worked so hard for?”
“No one needs to know I helped you, Larkin. And I want to do it. Look, if I’d had access to an HPV vaccine, I wouldn’t have had cervical cancer and I’d still have a uterus. If you would have had access to a safe abortion, you wouldn’t have had to carry Maeve to term. Our lives have been changed forever by the decisions of others. It’s your turn. It’s our turn. I’m proud of you. And I think Dr. Davis’s idea is amazing.”
CHAPTER 23
January 22, 2041
The Tennessean
Hormonal birth control now banned in twenty-six states. US senators continue pushing for national ban led by Senator Jack Montgomery (R-Tenn).
It was close to midnight as Larkin lay on the procedure table at the fertility clinic with a paper drape over her legs, waiting for the Ativan to relax her prior to the egg retrieval. Spencer sat beside her, waiting for further instructions from Aubrey. The three of them had agreed to participate after weeks of discussion with Dr. Davis and Susan, but no one else knew what they had planned. The first experiments involving gene editing in human embryos had been performed in 2015, but they were strictly regulated after a lengthy moral and ethical regulatory process.
Dr. Parrish had removed Larkin’s IUD two months earlier, cautioning that she couldn’t offer any other type of birth control. Larkin reassured the doctor that she didn’t want birth control right now. Once Larkin started having periods again, Aubrey gave her injections for two weeks to stimulate egg production and control the timing of her ovulation.
If the laws hadn’t changed, Aubrey would have also been able to give Larkin oral contraceptives to help time the IVF process, but these were now considered a controlled substance and were only given under limited approval from a governing board after the physician submitted paperwork providing clear evidence that the contraceptives were being used to enhance fertility. Estrogen and progesterone were now as forbidden as OxyContin, fentanyl, and morphine.
Thirty-six hours prior, Aubrey had given Larkin a “trigger shot” of hCG, stimulating Larkin’s eggs to mature. Aubrey hoped to get multiple eggs for Dr. Davis to use.
As Larkin focused on relaxing, Aubrey started an IV and placed her on a monitor. Susan had volunteered to help and would watch Larkin’s vital signs during the thirty-minute procedure. Aubrey gave Larkin a short-acting sedative through the IV.
“How are you feeling, Larkin?” Aubrey asked as she squeezed her friend’s arm.
“Pretty chill,” Larkin mumbled sleepily.
“That’s what we want,” Aubrey said. “So, while you’re in here, I’m going to send your hubby off to a room across the hall with this little cup and instructions to watch some quality porn of his choosing, which I am sure he has never done in his life.” She looked at Spencer and winked. “He understands that this is for the greater good and is willing to make this sacrifice.”
“Thanks, Aubrey,” Spencer said awkwardly as he took the cup from her. Susan stared intently at the bare floor as Spencer walked past.
Aubrey and Susan then put on gowns, gloves, and masks. Aubrey sat at the foot of the exam table and inserted a long, thin tube with a suction device into Larkin’s vagina. The tube was attached to an ultrasound probe so Aubrey and Susan could visualize the eggs.
“You might feel a little pinch,” Aubrey said as the device punctured the vaginal wall and moved toward the ovary. Larkin didn’t seem to notice, so the mild sedative had been successful. Aubrey was able to suction twelve eggs from both ovaries. She placed them in test tubes and handed them to Susan.
“Nice job, Larkin. We’re all done for now.”
Spencer walked into the room as they were finishing up, holding the cup by its blue lid. Arm outstretched, he handed it to Aubrey without saying a word.
“Why, thank you! Come again!” Aubrey said cheerily, waving her hand as she took it from him. Spencer rolled his eyes and mumbled something under his breath. Susan failed to hold back a snort. She said she needed some water as she covered her mouth to unsuccessfully stifle a laugh. She handed the harvested eggs back to Aubrey and exited the room as fast as she could.
“Larkin will be a little drowsy for a bit. Please stay with her until she perks up, then help her get dressed. Make sure you tell her my hilarious joke when she wakes up,” Aubrey instructed Spencer.
“Sure. Hilarious,” he replied.
Aubrey took the eggs and the semen sample to a room at the end of the hall where Dr. Davis waited in the embryology lab with Susan, who had finally stopped laughing.
“Time to make a baby, Dr. Davis,” Aubrey said as she handed him the test tubes containing the eggs.
“Excellent. Thank you,” Dr. Davis said. He used a pipette to remove fluid from the tubes and placed it on a glass slide.
Dr. Davis examined the egg samples under the microscope and chose the ones of the appropriate maturity. He then injected them with modified genes that would bind to the gene segment he wanted to remove. The old gene would be spliced and replaced with the new genetic material. He was able to complete the process for nine of the twelve eggs.
While he prepared the eggs, Aubrey began processing the sperm sample. She used a special solution containing antibiotics and protein to “wash” the sperm and then placed it in a centrifuge in the corner of the lab to separate the healthy, motile sperm from the poor swimmers. She repeated the process several times to get the healthiest sperm for fertilization. The concentrated sample was then placed in a special medium to nourish it prior to being transferred to the egg.
Each egg was placed in a petri dish of culture medium along with a sample of sperm before being incubated.
“Don’t you need to inject the eggs directly with the sperm?” Susan asked Aubrey, recalling what she’d learned in medical school.
“Intracytoplasmic injection is another option to fertilize the egg, but since Spencer and Larkin don’t have fertility issues, we can use this more conventional method and expect the same success rate.”
Once the process was complete, Dr. Davis placed the petri dishes, labeled “Dr. A. Abrams,” in the lab incubator. Aubrey would check on them the following day.
After they had completed the process, Dr. Davis, Aubrey, and Susan walked back to the treatment room, where Larkin was now dressed and waiting with Spencer.
“So far, so good,” Dr. Davis reassured them. “We’ll monitor how they’re growing every day, and on day five, I’ll check to see if the gene transfer was a success.”
“And then we’ll place one of the eggs back into Larkin and hope for great news,” Aubrey added.
“That’s one small step for woman, one giant leap for womankind,” Larkin said softly.
Aubrey checked on the embryos’ development every day and was pleased that all the specimens were dividing well. On day five, she, Larkin, and Dr. Davis once again met in the fertility lab in the middle of the night. Dr. Davis removed a petri dish from the incubator and brought it to the IVF chamber, which looked like a clear plastic box with armholes on either side and a microscope in the middle. Humidified air inside the chamber kept the samples in the most ambient conditions. He placed the petri dish under the microscope and got the specimen into focus.
“Want to see how they’re coming along, Larkin?” Dr. Davis asked.
Larkin eagerly nodded, and he got up from the stool so she could see. Under the microscope, she saw a round cluster of about one hundred cells.
“It made it to the blastocyst stage. It’s perfect!” Larkin exclaimed.
They checked the other specimens, which had all divided and grown into blastocysts as well, some further along than the others. They would be ready for transfer tomorrow.
“You have a plethora of good specimens to choose from, Larkin. I’m going to take a small biopsy from one of the blastocysts to confirm that the transfer worked by fluorescing the desired segment. I’ll also be able to tell if the chromosomes are XX or XY. Do you want to know, or do you want to be surprised about whether it’s a girl or boy?” Dr. Davis asked.
“I want to know,” she replied without hesitation.
Dr. Davis sat back down in front of the microscope and used a small laser to puncture the trophectoderm, the blastocyst’s outer layer. He removed about eight cells, which would later form the placenta, and placed them in another petri dish. He then added the medium that would fluoresce the genes of interest.
He brought the specimen over to the fluorescent microscope he’d brought from his lab and placed it on the microscope stage.
“Can someone turn the lights off for me?” he asked.
Aubrey turned off the lights, and they waited while he examined the cells. Dr. Davis saw one of the chromosomes with a brightly lit section. He started laughing—a deep, exuberant laugh. “It worked. It worked!” he exclaimed, standing and clapping his hands. Then he looked up and, with clasped hands, said, “Mom. It worked. Thank you.” Looking at Larkin and Aubrey, he added, “And it worked because of both of you. Thank you. Thank you!” He turned to Larkin. “If this is the embryo you want to transfer, then I can also tell you the sex, if you would like.”
“Let me get Spencer on the phone so you can tell us together.” She dialed Spencer and put him on speakerphone. “Hi, Spence!” she said. “Are you ready to be a dad again?”
“Yes!”
Larkin nodded to Dr. Davis.
“Congratulations to you both! You’re going to have a baby girl.”
Larkin suddenly froze at the memory of Dr. Beyer flatly telling her, “Females tend to have a higher rate of anencephaly compared to males. About three to four times as high.” Her heart started racing, and she felt like she wanted to run. But run to where? She didn’t know, other than to get away from the thoughts in her head. So, she simply sat, unmoving.
“That’s fantastic news, Dr. Davis,” Spencer said over the speaker.
“Hi, Spencer. It’s Aubrey. Tomorrow will be the implantation, and then things will be much simpler after that.”
“Are you okay, Larkin?” Aubrey asked since her friend had been so quiet.
“What? Oh, yes. Just processing it all. It’s all very exciting.”
“Alright then. Get some rest. I’ll be all up in your nether regions again soon,” Aubrey teased.
Larkin had been taking Viagra to thicken the lining of her uterus and improve the chances of implantation. Progesterone had traditionally been used for this purpose, but acquiring it covertly had become an impossibility. Viagra, however, was easy for Spencer to obtain from his doctor with as many refills as he wanted. Numerous studies had shown that it was a successful alternative for improving the chances of embryonic transplantation. Larkin took his prescription under Aubrey’s instruction.
The other eight embryos were transferred to a cryopreservation unit Dr. Davis had bought for the lab, and they could be thawed for use later if needed. The ninth one would be implanted in Larkin the next day.
* * *
Larkin lay back on the fertility clinic’s exam table with the paper drape over her legs and held Spencer’s hand. Aubrey took a soft, flexible catheter containing the selected embryo and, with ultrasound guidance, located the desired spot in Larkin’s uterus and placed the embryo. The whole process took only a few minutes.
“That’s all there is to it,” Aubrey said as she helped Larkin sit up. “Now we wait two weeks and check a pregnancy test. You may have a little cramping and spotting, but that’s normal.”
Larkin remembered the first and only time she had taken a pregnancy test—in the bathroom at work. She recalled that she’d been in shock at first, but that feeling had quickly changed into excitement and a deep desire to have the baby that, just a short time before, she hadn’t even known existed. The feelings of pure want that washed over her in that moment had taken her by surprise, and she felt that wonderfully familiar way again.
* * *
Waiting two weeks was both exciting and excruciating for Spencer and Larkin. On the eleventh day, Larkin had some mild abdominal cramping and was bleeding lightly. She started to panic.
“Larkin, Aubrey told you this might happen, remember? I think she called it implantation bleeding. Text her if you’re worried,” he urged.
“I’m sure she’ll say everything is fine. And it probably is, but I’d feel better if I took a pregnancy test now. I won’t be able to think of anything else for the next few days if I don’t.”
Spencer agreed to drive her to the pharmacy. They looked in the family planning section for pregnancy tests. They were normally next to the feminine hygiene products, but they couldn’t find anything on the shelves.
Larkin walked up to the pharmacy window and saw several shelves housed behind a locked plastic box filled with decongestants and pregnancy tests. She asked the young tech who was standing at the register if she could purchase a test. She thought teenagers must have been stealing them.
“I’m going to need a photo ID, and the pharmacist will take down your information. The restroom is to the left. You can do your business in there and then bring it back in this.” The tech handed Larkin a small plastic biohazard bag. “We’ll call you back when we get the results.”
“What are you talking about? I want a pregnancy test, not the Sudafed. Why does the pharmacist need my ID? And why am I leaving the test here?” The request sounded absurd to Larkin.
“It’s the state law that passed recently. Or maybe an executive order or something.” The tech shrugged her shoulders.
“Another ridiculous law? And the pharmacist would call me? With my results? Why?”
“So we can make sure to have your result in the state database. If it’s positive, the health department will contact you tomorrow to schedule an appointment with an obstetrician. And I’m required to inform you that failure to appear for your obstetric appointment could result in fines or arrest. May I have your ID?” The tech extended her hand, palm up, and waited for Larkin to hand over her license.
“What the fuck? No, you can’t have my ID.”
“Please don’t curse at me. I don’t make the rules, ma’am.” The tech drew back her hand and tapped her fingers on the countertop.
“You may not make the rules, but she isn’t giving you her ID. This isn’t your business,” Spencer said angrily.
“Once you request a pregnancy test, it now legally makes it my business.”
“We don’t want one anymore,” Larkin stated, crossing her arms in front of her.
“Then I need to inform you that you both are on our security cameras, and we’ll have to report this incident to the state.” The tech pointed to the security camera that was positioned above her register.
Larkin looked at the camera, stretched her arm toward it, and extended her middle finger. Spencer grabbed her by the other arm, and they left the pharmacy with Larkin continuing her defiant gesture until they were out the automatic doors.
As they walked back to their car, she texted Aubrey and told her about the cramping, the spotting, and the pregnancy test. Aubrey came to their house a short time later and handed Larkin a pregnancy test from her office. Because every patient at the fertility clinic wanted to be pregnant, those tests weren’t monitored yet.
