An excerpt from The Last Conception by Gabriel Constans.
Savarna was the first to arrive at five that morning. She placed her bicycle in the storage room, washed and put on her scrubs. She checked all of the incubators, work surfaces and electronic readouts, to make sure everything was operating as close to body temperature as possible. The machines were on twenty-four seven and alarmed. After all, she and her colleagues literally held the possibility of new life in their hands day after day. If anything goes out of whack, emergency calls are automatically made until someone responds. They have backup systems for backup systems. So far, in her eight years of working at Conception Sciences, the alarm had gone off only once, and that turned out to be a faulty reading.
“Hey, Embryo Mama, how are our babies doing?”
Savarna had just started looking at the results from the previous day when her work partner Johnny Cranston walked in. She’d known Johnny for five years and trusted him completely. If she were ever in the position of their patients, she’d want Johnny to be her embryologist. He was very tech savvy and gave a damn. Personally, he’d been through the ringer, was divorced and had his adored teenage daughter living with him part-time. He’d recently moved to a nice neighborhood just twenty minutes from work. Johnny was handsome, and he knew it, but he never let his guard down, especially in front of beautiful women. He considered Savarna to fall in the category of beautiful, but she was an exception to his well-practiced defenses.
“Good morning Sperm Daddy,” she replied.
“Where we at, darling? Everything cooking at the right temp?”
“I was just checking yesterday’s records and laying out our schedule. Will you take a look and sign off?”
“It would be my pleasure.”
Savarna always noticed the contrasts between them when they stood side by side. He had big hands with long fingers, and his skin was darker than hers. She was brown, like a lightly baked brownie, and he was as black as dark chocolate. He stood a foot taller, had broad shoulders, a muscular chest and shaved head. She had long jet-black hair braided and tied up in a knot for work, a distinguished nose, and hips that seemed to trump everything else from the waist down.
“Looks like we’ve got a lot of D1 and D3s to switch out today,” Johnny said, as he signed the checklist.
“Yes, and two D5s. I really hope Mrs. Shcneider’s takes this time and her Inner Cell Mass doesn’t get screwed up like her last two attempts. She was so devastated.”
“You got that right. Nothing we could do though. Hear what I’m saying?”
“Yeah, yeah. I know the mantra. Don’t beat ourselves up for what’s out of our control.”
“Well, well. You actually remember your own advice.”
They both chuckled underneath their masks.
Everything in the laboratory had to be done perfectly and on schedule. Mistakes were not allowed, though inevitable.
Day zero, which they referred to as DO, was egg retrieval day. That was when they retrieved eggs from the woman and sperm from the man and put them together in a dish. On Day Two, which they called D1, they checked to see how many of the eggs were fertilized. They looked through the microscope to see if there were two pronuclei inside. If they couldn’t see any or what they saw consisted of only one or three pronuclei, that meant it was a wash and they couldn’t be used.
Day Two is when the embryos start to divide. A healthy embryo consists of two to four cells. That is when Savarna and Johnny would start to grade or evaluate the embryos on a scale of one to five, with one being perfect and five being poor. It takes about one minute to look at fifteen embryos. They had to do it quickly, so they were not outside of the incubator for long.
Day Three should be showing six to eight cells per embryo. If some of these are healthy, they can transfer them on the same day or put them into an extended culture for a Day Five transfer. If they go into extended cultures, they need to move them into a new growth medium that is made for the next stage of development.
On Day Five embryos have grown much bigger and gone from six to eight cells to fifty to one hundred cells. The coating around the egg is very thin at this stage and each embryo has two cell types – the inner cell mass, which becomes the baby and the trophectoderm, which becomes the placenta. This is the day when transfer usually takes place. One to two embryos are transferred to the patient’s uterus. Any extras are frozen or cultured to Day Six. On Day Six, anything that is left is either frozen or discarded.
“You can have the honor of icing any leftovers today,” Savarna told Johnny.
“Thank you, great ice queen. It will be an honor to preserve someone who may one day be our next Albert Einstein or Maya Angelou.”
“Or Charlie Manson or Hitler,” she said, half-joking.
“Not possible. These children are too wanted and adored to turn out like that.”
Freezing embryos is no minor task, though it may appear to be a simple procedure. When a healthy and viable embryo is frozen, it is placed into a computer- driven freezer in liquid nitrogen and is slowly brought down to minus thirty-five degrees centigrade. When cells are frozen, they are made up mostly of water and have to be dehydrated before freezing or ice cycles can destroy them. They are passed through solutions that by osmosis move in and out of a fluid buffer. Freezing takes about an hour and a half. When they are thawed, it is important to get rid of the ice crystals right away, so they are pulled out, held in the air for thirty counts and put in a thirty-degree water bath for forty-five seconds until they are thawed. They are then placed in solutions that reverse the process and put water back in. Within forty minutes of being de-thawed, an embryo can be transferred. Some patients successfully use an embryo that has been frozen for over ten years.
Savarna and Johnny sent out the morning report to all the physicians and case managers by 7:30, so they would know which patients to call to come in for their procedures or which ones needed to change their medications. Then they started working on egg retrievals, sperm analysis and triple-verification with each, to make sure they had the correct specimen for each individual. Retrievals started around 8:00 a.m. and continued every forty-five minutes, while transfers generally began at 10:00 and took place every thirty minutes. By noon, they were inseminating the eggs. Somewhere in the controlled chaos, they tried to make their way to the bathroom and catch a bite to eat. At 1:00 they made a break for the small lunchroom squeezed into the back corner of the two-story medical building.
“What?” she asked, looking up from her salad bowl.
“Come on. I’m about to burst. Did you tell them?” Savarna smiled, took a drink from her homemade chocolate smoothie and sheepishly looked down at her Greek salad. “You’ve got to be kidding?”
She shook her head. “My Mom was–”
“This is crazy… after all these years. They’re adults. They’ll understand.”
“Let me explain.”
“What’s there to explain? You chickened out again.”
“No, I didn’t. We were interrupted. My mother was trying to get me married off for the umpteenth time and just as I was about to tell her why I would never marry a man, the rest of the family burst in. There wasn’t any good time after that. It was her birthday after all, and I didn’t want to ruin it.”
“You don’t understand.”
“In Indian culture marriage is the biggest and most important celebration there is.”
“And you don’t think that’s true for other cultures?”
“Well, yes, of course,” she replied, taking a deep breath and looking him straight in the eyes. “But in India it can actually be a matter of life and death. Women are still defined by whom, when and if they marry. I don’t care if this is California and my parents have lived here for decades. I don’t think they even realize how deep this tradition is ingrained in their psyches.”
“So, its fair to keep them in the dark and keep hoping?”
“Of course not, but I’m not always as strong or as confident with my family, as I am with you. I don’t want to hurt them.”
“I think you’re hurting them more, let alone yourself, by not standing up and letting yourself be counted. They just want you to be happy, and they see marriage as the means to attain that happiness. We both know it’s not always what it’s cracked up to be, but I don’t see anything wrong with them hoping it’s the answer for their spinster daughter whose childbearing clock is ticking.”
“Spinster, my ass.”
“Tell them I’ll take you off their hands, but only for a good dowry.”
Savarna raised her glass, as if to throw it in Johnny’s face. He backed up his chair in mock surprise. Savarna’s phone rang. She put down her cup, laughing, and took the call.
“Hi, Magdalena. What’s up?”
“Tonight? It’s only Monday.”
Savarna closed her eyes for a moment as she listened.
She nodded, “OK. OK. Pick me up at nine.” She clicked her phone shut and put it on the table while Johnny went to the sink to put away his plate.
“She’s a wild woman,” he said upon returning to the table.
“It’s fun. Nothing serious.”
“Yeah, I know about fun, but is that all you want?”
Her phone rang again.
“Hey, Charley. How ya doing?” Johnny rolled his eyes. “This weekend? I don’t know, I’m usually pretty wiped out by then.”
She turned away slightly in her chair, as if to keep the conversation private.
“In that case, let’s do it. I’ll call you later. Take care.”
“Wish I had that many women calling me up,” Johnny wisecracked, as they stood and both prepared to re-gown and get back to work. “Where to this weekend?”
“Charley got a great deal on a bed and breakfast place in the redwoods over in Santa Cruz. She says it’s just what I need for some rest and relaxation.”
“So, you really prefer men after all.”
“You know Charley is–”
“I know, I know. Just goofing. You know my offer is always good. If you ever want to get turned around, I’ll show you what a real man is like.”
“Yeah.” They both laughed. “You and a thousand other men.”
“Hey, did you hear what one egg said to another when they saw millions of sperm on the horizon?”
“Only a zillion times,” she said. They made their way down the hall and entered the pressurized lab. “But if it floats your boat, go ahead and give me the punch line. I’ll act like I’ve never heard it before.”
“Now you’ve ruined it,” he said.
The automatic door opened and she went ahead. A cartoon they had taped on the door had two eggs and millions of sperm surrounding them. The caption next to the first egg read, “This doesn’t look good, I think the odds are against us.” The other egg said, “Looks good to me. It’s just what the doctor ordered.”
The Last conception:
Passionate embryologist, Savarna Sikand, is in a complicated relationship, with two different women, when she is told that she MUST have a baby. Her conservative East Indian American parents are desperate for her to conceive, in spite of her “not being married”. They insist that she is the last in line of a great spiritual lineage. In the process of choosing her lover and having doubts about her ability, or desire to conceive, Savarna begins to question the necessity of biology and lineage within her parents’ beliefs and becomes forever fascinated with the process of conception and the definition of family. Threads of Dan Brown (DaVinci Code), Chitra Banerjee Divakaruni (Sister of My Heart) and the film The Kids Are All Right, are tied together in this colorful tale of awakening, romance and mystery.