Debating the Ethics of Egg Donation – The Atlantic

Readers share their struggles and successes with conceiving kids. To share your own story, please send us a note: [email protected].

After we published a story from a reader who had ethical qualms about using a donated egg that became her daughter, a bunch of readers in the TAD discussion group debated the question, “Is egg donation unethical?”—especially since thousands of dollars are typically given to the donor. Below are some of the best comments and personal stories from those readers, edited for concision. Here’s Terri:
My only real concern is compensation. Selling to the highest bidder for significant profit is risky and unseemly. It has to be regulated in a manner that protects both parties.
Another reader takes a more libertarian approach:
As long as all parties consent and the child created is loved and taken care of, then all is good. What’s unethical is bad parenting.
Jim compares egg donation to adoption:
The financial aspect of donation is no more fraught, to my mind, than adoption fees. The stickler is setting a fair price for the not inconsiderable pain and discomfort the donor experiences, as well as screening donors to make sure they are psychologically secure with the process.
Egg donation, fertilization, and implantation is essentially a rich person’s ethical problem, if that. Many women and their partners beggar themselves financially in an effort to become pregnant. If they can afford it and they want to, why not?
This next reader complicates Jim’s characterization that it’s “a rich person’s ethical problem”:
I am part of an IVF support group, with 10,000-plus members, and I’ve undergone IVF myself. The large majority of us are not affluent.
Also, it’s not fair for people who have never struggled with infertility to imply/demand that those of us who suffer from infertility settle with adoption, as if it’s an easy solution. We just want the same chance fertile people have—a chance they didn’t have to fight for or pay for, or suffer from.
Another reader also isn’t troubled by egg donation:
Is it less creepy than adoption? Prospective parents are also given dossiers of babies/kids they would like to consider. It shouldn’t be creepy to “choose” a child. We choose our mates, after all, and the initial attraction is mostly superficial there too. Is a child that arises from such a pairing not “chosen” as well?
It’s not uncommon in egg and sperm donations for people to search for donors who bear some similarity to them. Since the child will not have a genetic connection to the replaced parent, isn’t it better that they at least have some physical similarities? This is supposed to make life easier for the young kid, so they are not wondering why they look different or being teased as school for looking different (young kids can be merciless to their peers).
Finding physical similarities and other preferences is a big part of Gail Sexton Anderson’s job. She runs Donor Concierge, a service that matches intended parents with egg donors and surrogates.

Race and ethnicity is a big part of that process, which Gail addresses in this blog post:
For many intended parents having a sense of continuity within the family blood lines helps them to come to terms with going forward with an egg donor. I have had many intended parents tell me that they would like to find a donor who is Irish, Welsh, Italian etc. so that they can share stories of their heritage with their child and not feel they are being false to their child who shares their family but may not have similar ethnic heritage.  …
One problem that we run into over and over again as we search for our clients is how difficult it can to find the egg donor’s ethnic heritage. Too often egg donors and agencies confuse race with ethnic heritage and will just use race as a blanket answer to cover both. The trouble is they are not the same. One is a very broad category and the other defines the details of that category and for many intended parents it is an important distinction.
For example when I am looking for a Chinese donor I often find that all donors with any Asian heritage are listed as Asian. That is fine to a point if within the details of the egg donors profile her specific heritage is listed such as Chinese, Hmong, Japanese, Korean etc. Many programs have thought to include this information but many others still list the donor as just Asian. For a Chinese or Korean family this can be a real problem for many they feel strongly about their ethnic heritage and one is not interchangeable with the other.
Asian women, along with Jewish women, command the highest prices for their eggs—about $10,000 to $20,000 for Asian women, compared to about $6,000 for other ethnic groups:
Fertility industry experts say there are several reasons Asian eggs are in demand, including a cultural aversion to adoption. If a woman is infertile, they say, many Asian couples would prefer to use the husband’s sperm with a donor’s egg to conceive a child that carries at least half of the couple’s genetic identity than to adopt a baby from other parents.
Demand is also high among Jewish couples, many of whom put off having kids to pursue higher education or careers, clinic operators say. According to a report from the United Jewish Communities, half of Jewish American women have college degrees and 21% have graduate degrees. They tend to marry later, the survey says, and have lower fertility rates.  …
One reason for the lack of supply [of Asian eggs] is that Asian women are less likely to go through the discomfort of egg donations out of financial need. On average, Asian women earn higher salaries and are more likely to be college-educated than their counterparts in other racial groups, according to Labor Department statistics. Asian females out-earn white women by 13%, black women by 31% and Latinas by 52%, the agency said. “A lot of young women who elect to be egg donors do so for financial reasons,” Vorzimer said. “But many Asian and Jewish donors who are in such high demand are young ladies who do not need that financial compensation.”
Back to our readers:
I can see how the donation process could feel “designer baby” or “eugenics lite” and leave a bad taste in mouths, especially with the sadly inevitable preference for fair-complected donors. But it’s worth noting that 1) this has always been true of sperm donation and 2) the cost of entry, so to speak, for parents is too high for this to have a significant impact on population dynamics.
This next reader is on the same page:
I don’t think the eugenics comparison is fair at all. Even if every couple goes into the process looking for a baby that is similar in appearance to them, those are the babies they’d be conceiving naturally were they able/should they choose. Races are not being wiped out by egg donation and subsequent selection.
The eugenics angle isn’t just about aesthetics. As this reader illustrates, “My now-wife (we were dating at the time) looked into egg donation for financial reasons but was told she couldn’t due to some family medical history.” Another reader can relate:
My daughter looked into donating, to try to pay off student loans. She was turned down because her father is mentally ill and because she and both parents are nearsighted.
Setting aside the fact that I have reasons to believe that my ex-husband’s mental condition may be more a product of environment than heredity, can I just say I worry for the offspring of people who may come to believe that their high priced, perfect eggs will invariably yield perfect children.
This last reader can relate firsthand to donation:
As someone who has undergone IVF and has eight embryos waiting and who plans on donating any leftovers to a couple/person in need, I do not find it creepy in the slightest. I understand where people are coming from about adoption, and I have heard from so many people over the past eight years of TTC [trying to conceive]. And we do plan on adopting out of the foster program, which we have already been approved for, but not placed.
Unless you have gone through infertility, you just can’t possibly understand the heartache it causes. We have to watch over and over and over women have children who don’t appreciate the gift, or who abuse their child, abandon them and so much worse, so we cry and cry and wonder why me, why us. It’s awful. There is nothing wrong with a person/couple wanting a biological piece of them to exist in this world.
The following reader tells the story of her long battle with infertility that culminated with the successful use of donated eggs. But despite the happy ending, she struggles with uneasy questions about the ethics of the donor industry and the “massive resentment” she harbors toward her husband. She prefers to stay anonymous here “in order to protect my daughter’s privacy”:
I met the love of my life late, at age 36. Two years later, we were married and trying for a baby. In retrospect I wish we had started to try as soon as we decided to spend our lives together, but hindsight is 20/20. I had several friends conceive without difficulty in their late 30s, so I was confident that we still had time and that it would happen.
But it didn’t. For three years we did the usual fertility treatments, including three rounds of IVF, with one heartbreaking early miscarriage. The treatments just didn’t work.
Early on we had discussed backup plans, though we weren’t crazy about any of them. Adoption was potentially just as expensive, difficult, and heartbreaking as fertility treatments and it could take years, particularly if we wanted infant adoption. The thought of starting from scratch with a whole new cycle of hope and disappointment was daunting. But we didn’t much like to face the prospect of childlessness either, since both of us had long dreamed of having a family and desperately wanted to raise children together.
A friend in her mid-40s told us about donor egg programs. She had a successful pregnancy using donor eggs and strongly recommended it. Our initial reaction was “no way, no how.” We wanted our own genetic child, and my husband balked at the idea of “having a child with another woman.”
But as the years wore on, and after our final disastrous round of IVF, we weren’t ready to give up yet, so we faced a choice: start from scratch with the long complicated process of adoption, or go with donor-egg IVF.
The upside of donor eggs was a massively increased chance of success, since the donor would be under 30. So long story short, we went with donor eggs. It held the highest chance of success with the least chance for heartbreak (a huge consideration given that we were already worn out by the stress of the previous attempts). It would allow our child to have a genetic relationship to one parent. And, I would be able to have the hoped-for experiences of pregnancy, childbirth, and breastfeeding.
We now have a beautiful daughter who gives us joy every day. I wouldn’t trade her for anything. But at the same time, I still have very mixed feelings about the process:
I still sometimes grieve the ideal of parenthood I thought I would have. But I am also grateful every day that my daughter exists. It’s an astonishing thing to bring a life into the world and see her become more and more herself. And if this is what it took for this unique little person to exist, I can make peace with that.
For more reading on the ethical quandaries of egg donation, check out this 2015 Atlantic piece by Jacoba Urist. She addresses a key question: How much money do donors typically get—and how much should they get?
In the [American Society of Reproductive Medicine] guidelines, issued in 2007, the organization’s ethics committee considered—and then rejected—a pricing structure based on an outright comparison to sperm donation. If the average payment for sperm donation was $75 for an hour’s worth of work, the committee members reasoned, then a woman paid the same hourly rate should get $4,200 for the 56 hours it typically takes to donate eggs—but “because oocyte donation entails more discomfort, risk, and physical intrusion than sperm donation,” they wrote, “sperm-donor reimbursement rates are reasonably considered to underestimate the amount that is appropriate for women providing oocytes.”
The committee members also argued, however, that the space between too little money and too much is a narrow one. The ideal payment is up to $5,000, the ASRM believes; higher fees “require justification,” while more than $10,000 is always inappropriate. The possibility of more money, the guidelines say, could create an opportunity for donor exploitation in the egg market: Women may provide eggs “in response to financial need,” leading them “to conceal medical information relevant to their own health or that of their biological offspring.” […]
Is the money for a donor’s eggs, or her services, or her discomfort? It’s virtually impossible to decide how much a woman should be paid for the process, and how open the egg market should be, without confronting the underlying issue of what she’s being paid for in the first place.    
Urist also mentions the documentary The Perfect Donor, whose trailer is below. It begins with a young woman relaying what an agency told her about her prospects for donating: “You’ll probably get picked pretty fast, because you’re blonde, you’re blue-eyed, and you’re white”:

Catherine Lacey sounded a similar note in a personal essay for The Atlantic:
Dr. Greene [at the donor agency] asked about my parents’ and siblings’ bodies: average-height, average-weight, fair skin, and blue eyes, and she makes an approving expression at the last fact. This is like a sunroof on a car you might buy or a washer-dryer in a potential apartment. Grad school is a leather interior, a pool in the backyard.
Lacey was compensated $8,000 for her eggs. Jessica Cohen, while an undergraduate at Yale, responded to an ad in her college paper to donate her eggs for a whopping $25,000. From her 2002 Atlantic account:
Beyond their desire for an Ivy League donor, they wanted a young woman over five feet five, of Jewish heritage, athletic, with a minimum combined SAT score of 1500, and attractive. I was curious—and I fit all the criteria except the SAT score. So I e-mailed Michelle and David (not their real names) and asked for more information about the process and how much the SAT minimum really meant to them. Then I waited for a reply. […]
David responded to my e-mail a few hours after I’d sent it. He told me nothing about himself, and only briefly alluded to the many questions I had asked about the egg-donation process. He spent the bulk of the e-mail describing a cartoon, and then requested photos of me. The cartoon was a scene with a “couple that is just getting married, he a nerd and she a beauty,” he wrote. “They are kvelling about how wonderful their offspring will be with his brains and her looks.” He went on to describe the punch line: the next panel showed a nerdy-looking baby thinking empty thoughts.
The following paragraph was more direct. David let me know that he and his wife were flexible on most criteria but that Michelle was “a real Nazi” about “donor looks and donor health history.” […]
After I’d brooded about these matters, I received the shortest e-mail of the correspondence. The verdict on my pictures was in: “I showed the pictures to [my wife] this AM. Personally, I think you look great. She said ho-hum.”
A reader revives our series with a rare perspective we haven’t heard from yet—a lesbian couple struggling to conceive:
I’ve read many, many of the stories you have posted regarding infertility, deciding to have children, and adoption—mostly to find answers to my own questions. The stories seem to be consistently from heterosexual relationships, and while I can relate to these on some level (infertility, financial strain, marriage), I am at the same time seeing them at such a distance. My experiences are not the same and I have many of the same options, but they are altogether different.
My wife and I have been married for three years. We decided to have children, and, as lesbians, were sent directly to a reproductive endocrinologist. We kept trying to tell the doctors and nurses (and each other) that we weren’t infertile … we just didn’t have sperm!
Except it appears we are somewhat infertile. After four failed IUI cycles using my uterus and donor sperm, we reached the point at which we were told, “If it was going to happen this way, it would have already.” Our 20 percent chance was knocked down to 10 percent for further IUI, and they suggested IVF—or, to change tracks and let my wife become pregnant.
My wife is somewhat gender nonconforming, and her view of becoming pregnant herself is that she would do it if it were necessary for us to have a child—something we both want. But she is uncomfortable with the idea of being pregnant. I can understand her feelings and empathize with the choice. As her wife, I don’t want her to do something she isn’t excited about.
Our doctors can’t seem to get the language right; they talk about “her” baby and “my” baby, as if any baby we had wouldn’t simply be our baby. One doctor even told my wife that if later she “wanted her own baby,” then we could use embryos from my IVF for her to be pregnant. We understand at face value they are concerned with the biology of making this baby, but it’s hurtful.
Everyone says we’re lucky: We have two wombs, and sperm is inexpensive compared to surrogacy. Some people suggest we “just adopt” (we would if we could afford it!) or simply tell us to let my wife become pregnant.
The choice isn’t that simple. IVF is expensive, giving up the hope of being pregnant is difficult, and spending money on infertility is hard when it’s just taking away money we could use to raise the child. Having my wife go through IUI and spend another $6,000 on three or four chances at 20 percent sounds like bad odds …
Some days it seems as if every other lesbian is just throwing around sperm and getting pregnant. Why should it be so difficult?
I never thought I would deal with infertility, and I am devastated at the thought of never being pregnant. I don’t even care about the baby’s genetics being mine; I simply want the experience of being pregnant with our child.
Thanks for letting me write it all down.
If you’d like to write down your own experience to share, please send us a note.
Meanwhile, for more reading on the subject of lesbian mothers-to-be, here’s Alana Semuels back in December 2014:
Increasingly, lesbian couples who want to have children are turning to men they know for genetic material, and are sometimes asking him to share some parenting responsibilities. It’s possible that gay men who use a surrogate to have a child are involving the mother in the child’s life too—at least if you believe the premise of the failed 2012 NBC comedy The New Normal.
“We are seeing a growing trend of a female, same-sex-couple parenting with the man who provides the genetic material but does not relinquish his rights as a sperm donor,” said Diana Adams, a New York lawyer who advises families on issues like these.
To be sure, this new type of family can create a minefield of legal issues. A Florida judge last year allowed the names of three parents on a birth certificate after a sperm donor sued a lesbian couple, who had been his friends, after they asked him to cede parental rights. Last October, California amended its family code to provide that a child can have more than two parents. And the case of Jason Patric, who donated sperm to his ex-girlfriend on the condition he wouldn’t be involved in the child’s life, and then changed his mind and sued for custody, got widespread media attention in 2012 after Patric started lobbying for more rights for sperm donors.
“Three-parent families will be one of the next major legal issues for the LBGTQ community,” Adams said.
But in the future, a sperm donor might not be necessary at all. In the June 2014 issue of The Atlantic, Alexis Madrigal sketched out “Five predictions about the future of reproduction”—the fourth claiming that “synthetic sperm will save the nuclear family”:
Researchers may ultimately be able to take a cell from an adult man or woman, turn it into a stem cell, then change that stem cell into a sperm or an egg. Doctors have already succeeded in breeding same-sex laboratory animals in this way.
Timothy Murphy is a philosophy professor at the University of Illinois College of Medicine at Chicago whose work focuses on the bioethical implications of reproductive technologies for gay, lesbian, and transgender people. He points out that creating artificial sperm and eggs could, rather than leading to radical social change, actually preserve a normative family structure. “For gay and lesbian couples, the synthetic gametes would eliminate the need for a third party,” Murphy notes. This kind of assisted reproductive technology—“unnatural” as it might be—would allow same-sex couples to keep reproduction solely within the family.
Here’s a very rare experience we haven’t seen in our reader series yet: embryo adoption. It’s a middle ground between having your own biological child and adopting one: You adopt an embryo created from a donor egg and sperm and bring the fetus to term in your own body, thus experiencing the biological aspect of motherhood when it comes to pregnancy and childbirth. But let our reader tell it:
My husband is infertile and didn’t know it when he married his first wife (college sweetheart). Her sadness/bitterness was a leading cause of her leaving him after 13 years of marriage.
When we met several years later, he told me early on about his infertility “in case it’s a deal breaker.” I said it wasn’t, given our ages (36 and 45). Fast forward five years to today, married four years now, and we have a beautiful son born of “embryo adoption.” We met our son’s genetic parents through friends of friends and have an open adoption relationship (even though legally, it was just an embryo “donation”). They had leftover embryos from their own IVF and we adopted all three (and we’ll give our last one a chance at life next year). The four of us have become good friends and are like an extended family. We are ALL thrilled with this arrangement.
Success factors: (1) Embryo adoption/frozen embryo transfer is much less expensive than full IVF because the embryos already exist. (2) Neither my husband nor I are genetically related to our son, so it feels like “equal footing.” (3) We got to experience pregnancy, birth, and breastfeeding like genetic parents. (4) It aligned with our ethical beliefs that embryos are humans; we didn’t create more to be discarded. (5) We are not overly enchanted with our own genes; we were happy to adopt others.
More stories of embryo adoption, and donation, are here.

The beginning of our reader’s note mentions how her husband’s first wife ended the marriage due to his sterility. We’ve previously heard from readers on how infertility has variously ruined marriages and strengthened them. Below are three more readers along those lines. The first one attests to how struggling to have a child forged an even stronger bond with her husband—partly because both of them have infertility issues:
I take strong issue with the urban legend that IVF can destroy a marriage. IVF is simply one of those major life events that will test the depth of a relationship and the maturity of the people involved in that relationship.
My husband and I feel that we were both very lucky but also very smart in our IVF process. When we started trying to conceive, because I was in my 30s and my husband in his 40s, my OB-GYN told me that if nothing was happening after four months of trying, get into a fertility clinic and have tests done. I also had an amazing herbalist/acupuncturist whom I worked with to regulate my cycles who gave the same advice. Furthermore, I had watched several friends struggle through IVF, and I knew that it was better to be proactive rather than waiting and trying and waiting and trying for years.
(By the way, it is infuriating when someone flippantly suggests, “Have you thought about adoption?” Adoption is not the panacea, and it is not a simple—or cheap—process, and IVF is usually cheaper. Adoption is simply a different means by which to have a child with its own particular challenges that may be different or similar to the challenges of going through IVF.)
After eight months of trying, we had fertility tests done. It turned out that we both had issues, which, honestly, was a relief in the sense that neither one of us could feel like it was our “fault.” We were even, and in it together.
Our issues mean that it is extremely unlikely that we will ever conceive naturally. I think that diagnosis was a blessing, because I know of other couples who don’t have a clear diagnosis and who go through IVF but secretly hope to conceive naturally. That is not a possibility for us, and it was a relief to be able to return to having sex as a form of relational intimacy and to let go of the pressure on sex to make a baby.
Because of our particular issues, we skipped over IUI and IVF and started straight away with ICSI [intracytoplasmic sperm injection]. I was grateful for this, because it would have been very hard (and expensive) to go through so many failed rounds. Our first round of ICSI worked, and we are expecting a baby girl in only a few more weeks.
Throughout the process, IVF brought my husband and I closer to each other. Going through IVF is a very intentional process. There’s no “magic” in it, like you see in the movies where getting pregnant seems to happen so effortlessly and is often used as a cheap plot device. Our process of having a child forced us to talk about things that some couples never talk about. We had hard conversations. These conversations can, yes, test a marriage, but our marriage was strong to start, and making these choices together only made our marriage stronger.
We also continuously reminded ourselves that we are a family with or without children. We told ourselves that if IVF didn’t work, then we would buy a scooter.  Stupid, maybe, but it helped keep our perspective clear that our family and our life together is about more than having children, no matter how badly we want a child.
My husband administered all of the shots to me, and we went to every single appointment together. Actually, we didn’t do that once, and there was bad news, and we learned after that just how serious and vulnerable the process of fertility treatments is, and we made sure to do everything together from that point on.
Even if we hadn’t gotten pregnant through IVF treatments, the process was still very positive for us. It opened our eyes to a world of medical professionals who do incredible work everyday. It also gave us an appreciation for how unique each person’s experience with fertility is.
Finally, it forced us to get very clear about what our marriage means to us and what it means to have a family together. It made us acutely aware that if we want something in life, we have to go out and try to get it. There is nothing passive about IVF. Everyone’s experience is different, but for us, it was a very good experience, and I remember the closeness that we felt as we were preparing for the treatment as a time of deep love and togetherness.
This next reader’s marriage also survived infertility issues, but their infertility nevertheless had a powerful ripple effect on her extended family:
I was 25 when I married and we tried starting a family right away. I had normal periods but never could get pregnant. When I saw my gyne a year later, she found my FSH [follicle stimulating hormones] to be slightly elevated and sent us to a RE [reproductive endocrinologist] right away. That led to numerous IUI attempts and two IVF attempts, lab draws, and lots of tears and heartbreak. I remember getting up one night just sobbing so hard I could hardly walk at the thought of never being pregnant, giving birth, looking at a copy of me and my husband.  
It is now 12 years later, we have since given up, but we are better emotionally now. Our marriage was in a rut for a long time, and needs of all kinds were not being met. We both stuck through it and have a stronger marriage now.  
Along with my own heartbreak though, my sister also dealt with infertility and IVF treatments. Nothing worked for her either, and her husband expressed a desire to have “his own kids.” Sadly, their marriage did not survive. This is doubly hard on our family because my parents will never have biological grandchildren, so they are struggling with acceptance as well. My dad’s family ends with my sister and me.
Infertility affects more than just the infertile couple; it really affects a whole family. We are all still grieving over all the losses infertility caused and will one day, hopefully, move on.  
Another reader also reconciled with being childless:
My wife and I pursued increasingly aggressive treatment for infertility necessitated primarily by what we eventually discovered to be my azoospermia [low sperm count]. We faced the feelings many couples experience of stress, personal failure, loss, jealousy, worry about the future, concern about the financial burden, questions about the consequences of donor sperm, and horror stories about adoption. It was a very difficult time in our lives, but we worked extremely hard to keep communicating our feelings with each other and to be supportive of those feelings, no matter how complex or mixed.
In the end, after receiving treatment for more than a year, we decided to remain childless, and we’re not sorry at all. What got us through dealing with infertility—communication, respect, and mutual support—has made our marriage stronger. We also feel that we tried as much treatment as we were comfortable with, and therefore that our choice not to have children is just that: our choice, made deliberately. Lastly, infertility treatment diagnosed a separate health issue I didn’t know I had, and treatment for that problem has improved my quality of life.
Two years later, our marriage is stronger than ever, and we’ve found a world of opportunities and experiences that fill whatever hole may have been left by the lack of children. I’m saddened by how many of your readers and others have had overwhelmingly negative experiences that destroyed those relationships. I know it’s a very hard situation, but not all experiences with infertility lead to the end of relationships.
Update from a reader:
I’ve been reading your series on infertility and am having a really hard time with these entries. Why? Because I am an adoptee. I was born in 1971 to a young woman who struggled with drug use, and after a month in foster care, I was adopted by a family who has given me everything in the world.
So when I hear language from your readers like “… her husband expressed a desire to have ‘his own kids’”; “This is doubly hard on our family because my parents will never have biological grandchildren, so they are struggling with acceptance”; and “my dad’s family ends with my sister and me”—well, perhaps you can’t imagine how hateful and hurtful that feels to someone who is adopted.
My grandparents were thrilled to have a new grandbaby, no matter how I got there. My parents definitely thought of me as their “own” kid, and their family line did not die out simply because they couldn’t have biological children.
I would never say to a couple “just adopt,” because it’s a long and challenging process. But being a parent is about a lot more than just having a baby. It is utterly insulting to adoptees to imply that we are not a “real” part of our families. I heard this stuff a lot when I was a kid; I really didn’t think I’d still be hearing it into middle age.
For dozens of personal stories from readers on adoption, check out this Notes thread. For quick reference, here’s a chronological list of entries:
Yesterday we heard from a reader with uterus didelphys, a genetic condition that forms two vaginas, two cervixes, and two uteri—each linked to an ovary through its own fallopian tube. It’s difficult to determine exactly how common the condition is, but it’s between one in every 2,000 to 3,000 women, including the following reader. Her uterus didelphys went undetected for many years—and nine months:
I have wanted to share my story since it happened to me, to let other women know it’s OK to have uterus didelphys and that you can successfully carry a baby to term even with the condition.
This spring I was 36 weeks pregnant when my doctor came in with some very scary news. My baby was slowing down on the growth curve and they didn’t know why. There were many possibilities, from genetic disorders to the more probable explanation that my placenta was not giving my baby the nutrients he/she needed. We ran tests and monitored the baby, and the whole while I knew something was different about my pregnancy.
I only ever felt the baby kick on my right side, and we could only ever find the heart beat on the right side.
I shared this with my friends and family, asking questions about their pregnancies and wanting to relate to their stories of the baby kicking their ribs one minute and their bladder the next, but I never shared it with my doctors. I think I thought that I was crazy and was just imagining it; certainly there was no way my baby was just on one side of my stomach.
The next four weeks were scary and we were worried. We didn’t know what was to come. My doctors wanted me to carry the baby as long as possible and were ok with me going into labor on my own. That didn’t happen, and I was brought in for an induction during my 40th week. For 48 hours we tried to get my body to go into labor on its own, but I never felt a contraction, even though I was supposedly going through them like clock work. I went in for a c-section on my second night in the hospital and had a healthy baby boy delivered not even an hour later.
During the C-section, my doctor discovered I had uterus didelphys. I have two sides to my uterus, which explained the baby only kicking on my right side, and I also have two cervices and two openings in my vagina. All of this came as a shock, but I was also so happy there was an explanation.
I was able to carry a healthy baby to term without even knowing that it was a high-risk pregnancy. My husband and I hadn’t been trying to have a baby, though we wanted kids eventually, and I am so glad it happened the way it did. If I knew what I know now, I, like the previous woman who wrote in, might not have wanted to try due to the risks.
The more I read about uterus didelphys and the struggles such women have had to get pregnant, the more I am so grateful for our little guy. He was born small (5lbs, 12oz) and had to be kept in the hospital nursery for about 24 hours, but I would do it over again any day to have him. I hope that other women who have this same condition hold on to some hope that they can have a healthy pregnancy and delivery.
A reader writes:
I have uterus didelphys—a.k.a. having two uteri, two cervixes, and two vaginas. (On top of that I have a hormonal imbalance, which one doctor said was PCOS [polycystic ovary syndrome]—I had a trans-vaginal ultrasound done and my ovaries are riddled with cysts—but a second doctor said it’s not PCOS.) Each of my uteri is smaller than a normal-sized one. But my menstrual cycle is like clockwork, and there are no other downsides besides high-risk pregnancy.
The doctor told me that the organs of the female reproductive system are duplicated at one point during development, but eventually the organs merge and become one. For mine to have not merged is like a mutation! I’ve thought of it like the X-Men. It’s pretty cool, IMO, because I can break the ice by telling people I have two vaginas.
I’ve read about women with uterus didelphys who have successfully become pregnant and carried almost to term, successfully delivering via C-section. I recall reading that one woman carried twins in one uterus and a single child in her other uterus simultaneously and they were all delivered successfully. [Our reader is likely referring to Hannah Kersey’s story. And here’s the story of  Sarah Reinfelder, who also had twins—one in each uterus. That occurs in one in 25,000 women with uterus didelphys, making the overall likelihood one in 50 million women.]
The doctor said that my uterus that looked more developed was on the side with the smaller vagina. It’s too small for a penis, let alone a baby to come through, so if I ever got pregnant, they would likely do a C-section. I really wanted to give birth naturally, but it would be impossible.
Though to be honest, I’d rather not try to conceive. I’ve always been extremely squeamish and quick to faint (while having blood drawn, for example). I’m honestly glad about my malformation, so I see it as a sign to not try. I would be risking my life. I’ve never been on birth control or used protection with my husband and I’ve never become pregnant. (I wonder if my hormonal imbalance may be contributing to my luck.) I’ve never tried to get pregnant and I can’t afford any other options [e.g. in vitro fertilization]. Adoption would be nice. Until then, I have animals.
Among the many emails we’ve received from readers struggling with infertility, one of the emotions that keeps coming up is envy—unspoken envy toward people who seem to have no trouble conceiving and giving birth to healthy children. As one of our previous readers put it:
I also struggle with jealousy. “Oh! We weren’t even trying to get pregnant!” Even a good friend of mine at age 42 is about to have a baby girl via IVF. I think of her every day and hope I am so lucky.
Another reader can relate:
I am in my late forties. I have not been on birth control since my early twenties and have been married 17 years. We have been through IVF three times.  I would have thought the next step was adoption, but my husband said that was a deal breaker. I was not willing to get a divorce over it, so I just suppress my feelings of wanting to be a mother and channel them into caring for three dogs and a horse.
Everyone automatically assumes you can just get pregnant whenever you want. People even say to me they got pregnant just by talking to their husband. It’s very hard to hear that as someone who has tried so hard and has been through so much. I can’t even tell you how many pregnancy tests I have peed on—a ridiculous amount of hope each time, only to have a huge amount of disappointment and tears after. Not to mention the money we have poured in.  
I gave up in my late 30s. Having a family should have just been easy—something everyone assumes will happen if you want it. I do feel I have been successful in other areas in my life, but it still is hard seeing all of my friends and their happy families.
This next reader’s excitement over being an aunt was clouded by her feelings of jealousy:
In five days, I’ll have my second FET (frozen embryo transfer) and I feel I like I should be excited, but I’m just numb.
My husband and I have been struggling with infertility for almost three years—about the same amount of time we’ve been married.  I wouldn’t say this issue has been hard on our marriage [unlike these readers], because he’s been more than supportive. It’s definitely affected me more than him. My heart aches for a child.
We got pregnant right after our wedding and were thrilled to see the tiny heartbeat at our eight-week appointment. But the joy was short-lived, as I miscarried right after. We had already told friends and family that we were expecting. I was so naive about miscarriages, as I had only known one other person who had gone through one. But after mine, I heard from friends who had also had a miscarriage, which made me feel better that we had told people. [Read many more stories of miscarriage here.] I also learned that most women who have a miscarriage go on to have healthy children soon after, so I was hopeful.
Then, just a month after the miscarriage, my younger brother and sister-in-law announced they were having a baby. I was devastated. It’s irrational, I know, but it felt like something of mine was stolen: a due date close to our baby’s, our parent’s first grandchild, and just the joy I once had was now theirs. I kept up appearances around them, but inside I ached. I had difficulty being around her pregnancy, but once my niece arrived, I couldn’t help but have joy in being her aunt.
It took about six months before I got pregnant again. That one only lasted maybe five weeks. I went on to get two more positive pregnancy tests and yet two more rounds of disappointing news.
That’s when we saw a fertility doctor and decided to go with IVF and genetic testing on the embryos, since miscarriages are usually caused by genetic abnormalities. My husband and I both were tested for about everything that could affect pregnancy. Nothing was found. We had unexplained infertility.
After two egg retrievals, we had five healthy embryos. In August, we had our transfer of one embryo. I was so excited for the pregnancy test, thinking that this would be it. Our chances of success after genetic testing were even higher. We had eliminated the major factor causing miscarriages, so how could this not work?
It didn’t, and I didn’t even get a positive pregnancy test.
Around this time, my brother and his wife announced they were pregnant with their second child. Of course they were. Them and everyone I know on Facebook.
All of this is why infertility has made me numb. I protect myself from pain, because I’m afraid to put too much hope into it. I brace myself for disappointment. All I know is I won’t give up. I will have a child one day, however that may come.
Even if this isn’t shared, it was definitely cathartic to write this out. So thanks.
If you have any words of support or advice for either of these readers, please send us a note and I’ll update.

Below are two very different reactions to our previous note, “When Infertility Threatens Marriage,” which featured a reader expressing anger toward her husband for persuading her to wait until 35 to try for a baby; another woman who broached—with studies to back it up—how infertility can ruin a couple’s sex life, and marriage overall; and another reader describing how infertility led to her friend’s divorce. The second reader featured below is outraged over that note—“disgusted” even—because she believes it perpetuates myths about infertility.
This first reader, however, exclaims, “OMG that note is exactly right; infertility is brutal on marriage.” She elaborates:
My husband had an undescended testicle at birth and testicular cancer when he was an adult. Despite those issues (should have been red flags), we didn’t get tested until well over a year after we started trying to have a baby.
I had turned down several good career opportunities to conceive. When my tests were fine, but his weren’t (they were all over the map), he blamed it on me, saying I stressed him out. He also flatly refused to see a specialist, so I left and took a job I loved far from our home.
We did see a specialist in the city I was working in and he was optimistic about IVF-ICSI, since my numbers were fine and age was on my side. Then I had an HSG (x-ray to see how the tubes and uterus are) and I got what was later confirmed to be a false positive. My husband was weirdly satisfied, but IVF was still on the table. I ended up leaving my job for a job where I would travel to work and back home, week on, week off. He was paying for the flights. While I loved my job again, the cost was insane. So I moved back.
In hindsight, I should have just called it quits and got my dog, moving on. After all, I had a husband who would not support fertility treatment or my career.
I did get naturally pregnant twice. The first was a missed miscarriage [a.k.a. silent miscarriage] and the second miscarriage was just before a trip to the fertility clinic. The first was just bad luck—a trisomy incompatible with life. After the second, a battery of tests were done and I had an autoimmune disease that should have been obvious as the symptoms were so classic.
We actually did do IVF-ICSI with a lot of backup from a fertility psychologist and the doctors pushing my husband along. They said they’ve never seen anyone so stubborn and resistant. At one point the psychologist said my mental state had deteriorated so much that it was cruel to not do treatment.
The first round worked and we have a beautiful, healthy child (after a terrible pregnancy and emergency C-section). Now we are trying again, but I still feel so much resentment towards my husband. It’s been eight years! I started off being a young wannabe mom and now I’m the dreaded advanced maternal age.
I have felt completely unsupported and alone in both the quest to have a family and in my marriage. No support for infertility or my career. Meanwhile, my husband has gone from strength to strength in his career.
Here’s the passionate dissent from our second reader—a “long-standing facilitator of an online infertility support group”:
Let me preface my comments by saying that The Atlantic online is my most favorite print media outlet.  Your feature pieces are so engaging I have even used them inside my classrooms. So, when I saw Resolve [the National Infertility Association] post about an Atlantic piece on infertility in the Notes section, you can imagine how excited I was to see the topic finally generate some real discussion in a serious online magazine. Being infertile these last eight years, well, I’ve been around the infertility block and I think this topic is one that should no longer be whispered about.
I was completely disappointed. I realize what I read was a rough-ish first take on a story that might not even make it to print, but I was disgusted by it, because it simply perpetuates every misguided stereotype of infertile men and women that exists. It’s unfortunate stories like this that are the very reason why infertility is not considered a legitimate health problem deserving of medical treatment covered under health insurance, just like every other disease.
I don’t have a lot of time to go through your piece point by point, because I don’t even know if a live human will be reading this. But you should know:
If someone really does read these emails, I’m more than happy to continue this discussion.
If you’d like to ask that reader a question about her experience, about infertility more generally, or if you’d like to discuss your own difficulty with fertility and how it affected your relationship, for good or for ill, please send us a note: [email protected]. All views welcome.
(The joyous video above is from a reader, Kacy, who blogged about her “bumpy ride” through infertility with her husband, Jack.)
Update from another reader who struggled with both infertility and marriage:
This article could not have hit any closer to home. Infertility has almost ruined my marriage. My husband and I are 34 and 35 and have been trying for a child for five years and have had five reoccurring pregnancy losses at six weeks each time. Each loss is devastating.
We did all the testing and seeking options from three fertility specialists and no cause can be identified. They say it’s likely genetic and recommend in vitro, but when you don’t have $15,000 to spare and no guarantee the next pregnancy will take, it adds financial stress to an already emotionally stressful situation. When no cause can be found, you start think irrationally, and unknowingly anxiety and depression start to develop. If there is not a scientific explanation, then there must be a divine force making a statement that we shouldn’t have children together.
This stress compounded over five losses and many years made me weak and vulnerable, and I allowed someone outside my marriage into my life for distraction and understanding of these new feelings. I fortunately determined that it’s not another man I need. I need clarification to accept that we may not have a child, but my husband is my family and he is everything to me.
This next reader shows a lot of self-awareness and self-reflection over the trying process he put his wife through, and what they endured together:
I have a genetic abnormality which results in the absence of the vas deferens (the duct which conveys sperm from the testicle to the urethra). This means that IVF—via medical extraction of sperm directly from the testicles—was the only way for my partner to get pregnant with our child. It also meant, ironically, that many prior years of contraception to avoid getting pregnant was pointless.
I still feel guilty about the IVF process my partner had to go through, which was entirely because of me. Lots of time consuming and distracting medical appointments. Lots of effectively voluntary medical procedures. Increased risk of various forms of cancer.
All I needed done was an extraction needle-gun shot into my testicles every now and then, to get the sperm out. (Although yes, that was as painful as it sounds—give me a basketball or a football to the groin any day.)
The IVF treatments became an obsession. Everything else —jobs, friends—took a back seat. We were initially cautious and put back one embryo each cycle, but it kept not working. Time was getting away from us (my partner was approaching 35), so we started putting two embryos in each cycle.
After half a dozen cycles—voila—boy/girl twins. We were grinning ear-to-ear coming out of that ultrasound room. It was a stressful, high-risk pregnancy, but in the end they were healthy babies born close to full term in the end.
But there was another thing to feel guilty about: That twin pregnancy did a lot of damage to my partner’s body. Fortunately only muscles and no internal organs or spine or anything, but still.
Again, because time was still running out, we crazily decided to go a few more times (my partner was approaching 40), but we were clever this time; we only put one embryo back each cycle. After a few cycles, the signs were good.
Then it was time for another IVF pregnancy ultrasound. You have never seen a couple so devastated by one of those ultrasound confirming a pregnancy—identical boy twins. (IVF increases the risk of embryos splitting, result in identical twin pregnancies.) Our existing twins were about to turn three.
More guilt, but this time for being disappointed when anyone else without children trying to fall pregnant would have been elated. It was a more stressful and even higher-risk pregnancy, but again we were fortunate to have healthy babies born close to full term in the end.
***
One thing which amazed us about the whole IVF process was how uneducated society in general was about fertility decreasing with age. Some well-educated friends of ours told us the first they heard of it was when they first told their doctor their intention to get pregnant and universally, the doctor’s response was something along the lines of “better get a move along then!”
IVF can be seen as an excuse delay pregnancy, but it shouldn’t be viewed like that at all. It should be viewed as a last resort. It is expensive, invasive and stressful. There are no guarantees it will work. We made some bad decisions (delaying having children; putting back multiple embryos; trying for a third baby) and had some very lucky outcomes. Not everyone is so fortunate.
***
My partner would have considered adoption, but I only wanted to have genetic children. But the moral dilemma of potentially passing on my genetic abnormality to any male children was an interesting one: When do you get a boy tested for the absence of the vas deferens? Do you really want an 18 year old running around thinking they’re bulletproof because they can’t get anyone pregnant? On the flip side, do you want an 18 year old having a masculinity crisis of confidence for the same reason?
We still haven’t decided when to tell our boys and/or get them tested, but we continued on regardless because we thought that at least IVF will improve in 20 years time, so our sons would always have it to fall back on, just in case.
This story from a 39-year-old reader is utterly heartbreaking. He and his wife not only struggled for years to conceive—suffering a miscarriage along the way—but also struggled to adopt. (Perhaps they can find some helpful insight from our reader series on adoption or the one on miscarriage.) Our reader begins his story plaintively: “Being a father was always the thing I wanted the most, from childhood on up.”
I was an only child to an only son from my grandfather who had lost a courageous battle of MS over ten years before I was born. My nuclear family connections were important and I wanted to have a good job, but not a great job because I wanted to have the freedom to be there for my kids when they needed me, like my family had been for me.
I got married pretty much straight out of college and my wife wanted a professional career that required a master’s. We put off starting a family until she was done, after we’d been married three years. We were both 26 when she went off birth control.
The following January we were pregnant. The following March we were not.
The product of our conception slipped away, and we were excoriated for not visiting the emergency room instead of urgent care. We knew that miscarriage was common, so we chose not to tell anyone (or nearly anyone) that we were trying, nor that we were unlucky.
We were told that our miscarriage meant our clock started over, but six months later there were no positive results. Meanwhile, the parade of friends, family and co-workers getting pregnant started to get bigger and bigger. I became more and more desperate and my wife, obligingly, went along—beyond things that she thought were appropriate: Clomid, IUI, laparoscopy, injectables, IVF.
All the while the costs mounted—both the cost of the treatment and the cost on our marriage. I took each drip of bad news as a personal failing, and both of us were more and more separated from family, friends and each other. Instead we felt trapped, bitter, and unfairly persecuted for something that wasn’t out fault.
When our second round of IVF failed to produce nearly enough eggs, the doctor (who worked for a clinic that had said they could make my wife’s ovaries do anything) reported that there was no chance we would ever have a child biologically. My life was basically over at that point. There was no more writing on the pages in the book of my life. All I saw was blankness.
My wife tried to convince me to leave her. She wanted me to have what I wanted, and since she couldn’t give it to me, she’d release me. Like I could be happy with someone I didn’t love.
After pausing for several months, we elected to pursue domestic infant adoption —infant because I wanted as clean a slate as possible, and domestic because international made us both feel icky. Both of us are fastidious book learnin’ types, so we started to read and take the necessary classes. We got into an adoptive pool and waited … and waited … and waited. Many times we were told that we were the last couple that a birth mother was looking at, but every time she chose someone else. (And once we even got trapped in CPR class with a couple that had been chosen ahead of us.)
The march of negative pregnancy tests and, later, rejection e-mails from our social worker left a mark. We had become failures of both biology and the judgment of birth mothers. We more distant from one another than ever.
And my wife, who had been in school or trying to have a baby for all but 24 months of the 12 years I had been with her, discovered alcohol—and, just behind it, alcoholism. I was too blinded by my need to be a father to see it. So, as were trying to re-up for another year of being judged by birth mothers, my wife took a water bottle full of vodka on an errand in our car, got lost, and hit a telephone pole.
Let’s just say: we didn’t end up adopting.  The empty book returned and we both headed into recovery programs. The good news is they worked. The bad news is neither one of us feels that adding the stressors of adoption would be healthy.  Indeed, I was addicted to becoming a father so much that I was willing to throw almost everything away for it.
There isn’t a day I don’t wish I were a daddy. That child we miscarried would be 12 today.
I still don’t talk about this with anyone. What can they say? They have their kids and their lives and here I am stuck. A failure. I built my whole life around something basic and I have nothing to show for it.
I reel when parents complain about their kids being monsters or burdens.  I worry for my lonely future when no one will be there to help take care of me when I am old. I resent childcare tax credits when IVF is prohibitively expensive. I resent abortion warriors who think I am the reason that other mothers should be required to carry their children to term. I just wish things were different for me.
But I try to live one day at a time now. I try to think about whether we could be foster parents, as if that would somehow be easier. I try to see what the point of all the suffering and anguish was. I have the heart of a parent and I want to do something with it. As I approach 40 next year, I recognize that it would take a Powerball-level miracle for me to ever really be called someone’s daddy, so my job today is to learn to accept that, tears notwithstanding.
Thank you so much for the opportunity to share. I have been looking for more ways to advocate for this community I’m a part of, and telling my story is a way to do that.
If you have any words of support for our reader, especially if you’ve experienced something similar, please send him a note. Update: Here’s one from Leila:
I read your story with tears. When a door to personal life is closed, it can mean we are meant to act on a universal stage. You mention fostering a child, which would be a kindly act. Of course I don’t know what your circumstances are, but you sound like someone who would be a great help in any number of countries, setting up or working with an orphanage to rescue abandoned children from the streets. You could find yourself a Dad to hundreds of children over the years.
I wish you peace in finding your purpose. I am sure it is a different path than most others.
Here’s another note, from Peggy, who addresses another option for our reader:
I am not sure why you and your wife feel “icky” when you contemplate international adoption. But if that possibility remains, do it!
Sure, the process is exhausting, time consuming, and at times painful. But like any pregnancy, the rewards are never ending. Our infant daughters came to us from China. One, who spent many early months in an orphanage, has some anxieties, but then she is a teen now, so I suppose that comes with the territory.
Our 11 and 14-year-old girls are straight-A students with kind hearts and wise minds. And, of course, I think they are as pretty as daisies in a field. My husband and I would not trade them for any other, even children born to us biologically. These are our forever children,  and we are so grateful to have them.
Don’t dismiss this possibility. Please.
One more note of encouragement, from Don:
KNOW THIS: YOU ARE NOT A FAILURE BY ANY MEANS! Life doesn’t always follow the script we develop in our minds and hearts.
I too have wanted to be a Father since I was very young. In my first marriage my wife became pregnant in both of her tubes and they were removed. At that point we reassessed and considered adoption. As time wore on, we focussed more on her three children from a previous marriage and adoption never occurred. In my second long-term marriage, I fully expected to have a child, and after a few years I broached the subject and learned that my wife did not feel the same. I was frustrated and disappointed.
I have spent my life trying to be the best “Uncle Don” I could be to the children of all of my family and friends. Not having my own child will always be the biggest regret of my life, but there is much more to life. You sound like an amazing person and brought your partner through a very trying time. It may be time to rewrite your “script.” I wish you well.
A reader writes:
I’m 36 and I’ve been struggling with infertility for a bit over a year now. I say “I” because from my point of view, this is much more my problem than my husband’s (yes, he’s had tests done and all is normal). I know many men are as heartbroken as their partners over trying to conceive, but that hasn’t been my experience, nor my friends’. My husband loves me and wants me to be happy, but it’s very simple for him to say “we’ll adopt” or “we’ll have a baby some way; you’ll be a mother.” It’s very different to be the one who feels that her body doesn’t work; who doesn’t feel like a woman; who feels as if life is passing her by every day that passes without a baby.
I feel guilt and anger every day about waiting so long to try to get pregnant; anger at my husband for persuading me to wait until we were 35 to start trying; anger at myself for listening to him when having a family is my life’s goal.
I also struggle with jealousy. “Oh! We weren’t even trying to get pregnant!” Even a good friend of mine at age 42 is about to have a baby girl via IVF. I think of her every day and hope I am so lucky.
That reader’s marriage doesn’t seem to be imperiled, but we’ve heard from other readers about the damage that infertility can inflict on a couple. Rachel has seen it secondhand:
I’ve known a few people who have done IVF. What people don’t talk about much is the high level of divorce correlated with the procedure. Couples are three times more likely to divorce [at least according to this 2014 study of Danish couples]. The impact of the hormones often leads women to have harder time moderating feelings, and feeling out of control is compounded with an impact on sex drive that reduces the sexual relationship to mechanics. [This 2010 study from Stanford backs up that last assertion.]
It’s an interesting choice: your marriage or a child.
The high cost of IFV—for example, one of our readers spent $15,000 on it and related measures—undoubtedly strains a marriage as well. Has infertility ruined, or nearly ruined, your marriage? If so, and if you’d like to talk about it anonymously, please send us a note: [email protected].
Here’s another reader who witnessed the detrimental effects of infertility on marriage:
My only story on this subject is not a happy one. My friend was not conceiving, and after the full battery of testing the problem ended up being on her husband’s end. She was ecstatic with that answer (donor sperm is a lot less expensive and taxing then if the problem had been her) but he balked. He was on board with the idea of IVF, but not donor sperm and not adoption. Biological or nothing.
She left him over it, since “nothing” wasn’t an answer she was willing to entertain. He tried to get her back after about six months of separation, but she was already living with someone else by then. She’s married with two kids now, but I always think of her first husband and feel bad for the guy when I see her. She could’ve given him a little more time to come around, you know? That’s a pretty big thing to accept. Infertility has a devastating impact on a lot of lives.
Update from a sympathetic reader, Jill:
I just read the story from the 36-year-old woman struggling with infertility for over a year. I struggled too, for years, and it was only my fertility doctor that actually helped me. He said at one point, you have to know you’re more than a vessel to carry a child. It may not sound like it was kind, but it was. He did not want my entire life ruined because I felt inadequate if I did not have a child.
To that reader: Don’t ruin your entire life with anger and resentment or ruin your relationship with your husband. You did what you thought was right at the time. I did end up having one pregnancy and I am fortunate for that. I’ll keep you in my thoughts.

The first story in our new reader series comes from a 33-year-old woman who has struggled to conceive for more than two years. “As I write this, I have one hard-won blastocyst on ice, waiting to be transferred to my uterus.” She looks back to the beginning:
From my early twenties, I often told my doctor at annual exams that I was concerned about my fertility because of irregular, scant, light periods and a history of eating disorders in adolescence. I was written off as young, healthy, and too anxious for my own good.
When we started trying for a family at 30, I brought it up again and was told to come back after one year of trying. After spending almost $2,000 on acupuncture, hundreds of dollars on vitamins, thousands more on counseling and mindfulness and relaxation, seed cycling, supplements, and ketogenic diets, I was finally referred to a specialist. After an invasive and painful procedure to open a blocked fallopian tube, we spent a year on medications and HCG injections to force ovulation, awkward timed intercourse, and bouts on birth control to suppress the cysts that kept developing.
After over a year with a specialist, our infertility is still unexplained.
My recent IVF cycle results were surprising and devastating. After 11 days of stressful and uncomfortable injections, the dozen good follicles I had left yielded only three eggs—well below average, especially for someone under 35. Only two of those eggs fertilized. Only one survived to blastocyst.
I made a $15,000 bet on my body and feel like I lost. I am hopeful my upcoming transfer will bring me a positive pregnancy test, but I don’t believe it will. Without any other blasts in the freezer, I’ll have to start all over again.
Infertility is isolating, painful, and discouraging. We watch as others around us build their families and move forward with their lives while ours remain stalled. Vacations, career changes, moves, and even dinner plans revolve around cycles and medications and often can’t be planned at all. We live two weeks at time, for years at a time, always treading the line between the hope that keeps us going and the despair that month after month of failure brings.
It becomes hard to remember to picture a child at the end of the process, and even doing so can be a painful reminder that we may not get there.
Not everyone in our tribe of infertiles will become parents. Some will find motherhood (or fatherhood) in other ways—by fostering, adopting, or something else that works for them. But we all hope we beat the odds and come out with more than just a mountain of debt in the end. Until that time, I’ll keep living two weeks at time and cling to the hope that my single frozen blastocyst might one day be my baby.
American and European leaders’ profound lack of imagination has brought the world to the brink of war.
Oh, how I envy Liz Truss her opportunity! Oh, how I regret her utter failure to make use of it! For those who have never heard of her, Truss is the lightweight British foreign secretary who went to Moscow this week to tell her Russian counterpart, Sergey Lavrov, that his country should not invade Ukraine. This trip was not a success. At a glacial press conference he likened their conversation to “the mute” speaking with “the deaf”; later, he leaked the fact that she had confused some Russian regions with Ukrainian regions, to add a little insult to the general injury.
Lavrov has done this many times before. He was vile to the European Union’s foreign-policy chief, Josep Borrell, last year. He has been unpleasant at international conferences and rude to journalists. His behavior is not an accident. Lavrov, like Russian President Vladimir Putin, uses aggression and sarcasm as tools to demonstrate his scorn for his interlocutor, to frame negotiations as useless even before they begin, to create dread and apathy. The point is to put other diplomats on the defensive, or else to cause them to give up in disgust.
The older we get, the more we need our friends—and the harder it is to keep them
It is an insolent cliché, almost, to note that our culture lacks the proper script for ending friendships. We have no rituals to observe, no paperwork to do, no boilerplate dialogue to crib from.
Yet when Elisa Albert and Rebecca Wolff were in the final throes of their friendship, they managed, entirely by accident, to leave behind just such a script. The problem was that it read like an Edward Albee play—tart, unsparing, fluorescent with rage.
I met Elisa one evening in 2008, after an old friend’s book reading. She was such mesmerizing company that I rushed out to buy her debut novel, The Book of Dahlia, which had been published a few months earlier. I was instantly struck by how unafraid of darkness and emotional chaos she was. The same articulate fury suffused After Birth, her follow-up; her next book, Human Blues (her “monster,” as she likes to say), comes out in July.
How the wealthy have learned to live with the pandemic
At the start of the pandemic, COVID-19 was often depicted as an agent of random chaos, a disease that affected everyone irrespective of their race, gender, or socioeconomic status. On virtually every count, this assumption has proved to be false. Although the coronavirus managed to disrupt how human beings live and work, it didn’t do so proportionally. The crisis hit an unequal world and, when it did, exacerbated those inequalities. By and large, living through the worst of the pandemic has been easier for the wealthy, many of whom could afford to maintain a certain semblance of normalcy while mitigating health risks. The superrich got even richer.
To get a glimpse into the world of the affluent during the pandemic, I reached out to many of the businesses that flourished off them. Private jets, superyachts, personal catering, concierge medicine—these industries have not only survived but thrived during the pandemic, in large part because they could provide their customers with all the things that COVID-19 had rendered in short supply, like safety, seclusion, and, above all, a sense of control. The wealthy have already learned how to live with COVID-19 (albeit at a very high cost). Now the rest of the world must figure out how to do the same, on a budget.
The secret to satisfaction has nothing to do with achievement, money, or stuff.
I glanced into my teenage daughter’s bedroom one spring afternoon last year, expecting to find her staring absentmindedly at the Zoom screen that passed for high school during the pandemic. Instead, she was laughing uproariously at a video she had found. I asked her what she was looking at. “It’s an old man dancing like a chicken and singing,” she told me.
I came over to her laptop, not being above watching someone making an idiot of himself for 15 seconds of social-media fame. What I found instead was the septuagenarian rock star Mick Jagger, in a fairly recent concert, croaking out the Rolling Stones’ megahit “(I Can’t Get No) Satisfaction”—a song that debuted on the charts when I was a year old—for probably the millionth time. An audience of tens of thousands of what looked to be mostly Baby Boomers and Gen Xers sang along rapturously.
The results were mixed.
One morning last summer, I woke up and announced, to no one in particular: “I choose to be happy today!” Next I journaled about the things I was grateful for and tried to think more positively about my enemies and myself. When someone later criticized me on Twitter, I suppressed my rage and tried to sympathize with my hater. Then, to loosen up and expand my social skills, I headed to an improv class.
I was midway through an experiment—sample size: 1—to see whether I could change my personality. Because these activities were supposed to make me happier, I approached them with the desperate hope of a supplicant kneeling at a shrine.
Psychologists say that personality is made up of five traits: extroversion, or how sociable you are; conscientiousness, or how self-disciplined and organized you are; agreeableness, or how warm and empathetic you are; openness, or how receptive you are to new ideas and activities; and neuroticism, or how depressed or anxious you are. People tend to be happier and healthier when they score higher on the first four traits and lower on neuroticism. I’m pretty open and conscientious, but I’m low on extroversion, middling on agreeableness, and off the charts on neuroticism.
Scientific research alone cannot address the challenges that Americans with mental illness face.
During my last year as director of the National Institute of Mental Health (NIMH), I was in Oregon, giving a presentation to a roomful of mental-health advocates, mostly family members of young people with a serious mental illness. During my tenure as the “nation’s psychiatrist,” the nickname for my role, I oversaw more than $20 billion for mental-health research, and I was eager to share evidence of the agency’s scientific success.
I clicked through my standard PowerPoint deck featuring high-resolution scans of brain changes in people with depression, stem cells from children with schizophrenia showing abnormal branching of neurons, and epigenetic changes as markers of stress in laboratory mice. We had learned so much! We were making so much progress!
He is threatening to invade Ukraine because he wants democracy to fail—and not just in that country.
There are questions about troop numbers, questions about diplomacy. There are questions about the Ukrainian military, its weapons, and its soldiers. There are questions about Germany and France: How will they react? There are questions about America, and how it has come to be a central player in a conflict not of its making. But of all the questions that repeatedly arise about a possible Russian invasion of Ukraine, the one that gets the least satisfactory answers is this one: Why?
Why would Russia’s president, Vladimir Putin, attack a neighboring country that has not provoked him? Why would he risk the blood of his own soldiers? Why would he risk sanctions, and perhaps an economic crisis, as a result? And if he is not really willing to risk these things, then why is he playing this elaborate game?
America’s chaotic withdrawal from Afghanistan added moral injury to military failure. But a group of soldiers, veterans, and ordinary citizens came together to try to save Afghan lives and salvage some American honor.

Updated at 5:15 p.m. ET on February 9, 2022
It took four presidencies for America to finish abandoning Afghanistan. George W. Bush’s attention wandered off soon after American Special Forces rode horseback through the northern mountains and the first schoolgirls gathered in freezing classrooms. Barack Obama, after studying the problem for months, poured in troops and pulled them out in a single ambivalent gesture whose goal was to keep the war on page A13. Donald Trump cut a deal with the Taliban that left the future of the Afghan government, Afghan women, and al‑Qaeda to fate. By then most Americans were barely aware that the war was still going on. It fell to Joe Biden to complete the task.
Like it or not, the way we work has already evolved.
In 2019, Steven Spielberg called for a ban on Oscar eligibility for streaming films, claiming that “movie theaters need to be around forever” and that audiences had to be given “the motion picture theatrical experience” for a movie to be a movie. Spielberg’s fury was about not only the threat that streaming posed to the in-person viewing experience but the ways in which the streaming giant Netflix reported theatrical grosses and budgets, despite these not being the ways in which one evaluates whether a movie is good or not. Netflix held firm, saying that it stood for “everyone, everywhere [enjoying] releases at the same time,” and for “giving filmmakers more ways to share art.” Ultimately, Spielberg balked, and last month his company even signed a deal with Netflix, likely because he now sees the writing on the wall: Modern audiences enjoy watching movies at home.
Most public activity on the platform comes from a tiny, hyperactive group of abusive users. Facebook relies on them to decide what everyone sees.
If you want to understand why Facebook too often is a cesspool of hate and disinformation, a good place to start is with users such as John, Michelle, and Calvin.  
John, a caps-lock devotee from upstate New York, calls House Speaker Nancy Pelosi “PIGLOSI,” uses the term negro, and says that the right response to Democrats with whom they disagree is to “SHOOT all of them.” Michelle rails against the “plandemic.” Calvin uses gay as a slur and declares that Black neighborhoods are always “SHITHOLES.” You’ve almost certainly encountered people like these on the internet. What you may not realize, though, is just how powerful they are.
For more than a year, we’ve been analyzing a massive new data set that we designed to study public behavior on the 500 U.S. Facebook pages that get the most engagement from users. Our research, part of which will be submitted for peer review later this year, aims to better understand the people who spread hate and misinformation on Facebook. We hoped to learn how they use the platform and, crucially, how Facebook responds. Based on prior reporting, we expected it would be ugly. What we found was much worse.
American and European leaders’ profound lack of imagination has brought the world to the brink of war.
Oh, how I envy Liz Truss her opportunity! Oh, how I regret her utter failure to make use of it! For those who have never heard of her, Truss is the lightweight British foreign secretary who went to Moscow this week to tell her Russian counterpart, Sergey Lavrov, that his country should not invade Ukraine. This trip was not a success. At a glacial press conference he likened their conversation to “the mute” speaking with “the deaf”; later, he leaked the fact that she had confused some Russian regions with Ukrainian regions, to add a little insult to the general injury.
Lavrov has done this many times before. He was vile to the European Union’s foreign-policy chief, Josep Borrell, last year. He has been unpleasant at international conferences and rude to journalists. His behavior is not an accident. Lavrov, like Russian President Vladimir Putin, uses aggression and sarcasm as tools to demonstrate his scorn for his interlocutor, to frame negotiations as useless even before they begin, to create dread and apathy. The point is to put other diplomats on the defensive, or else to cause them to give up in disgust.
The older we get, the more we need our friends—and the harder it is to keep them
It is an insolent cliché, almost, to note that our culture lacks the proper script for ending friendships. We have no rituals to observe, no paperwork to do, no boilerplate dialogue to crib from.
Yet when Elisa Albert and Rebecca Wolff were in the final throes of their friendship, they managed, entirely by accident, to leave behind just such a script. The problem was that it read like an Edward Albee play—tart, unsparing, fluorescent with rage.
I met Elisa one evening in 2008, after an old friend’s book reading. She was such mesmerizing company that I rushed out to buy her debut novel, The Book of Dahlia, which had been published a few months earlier. I was instantly struck by how unafraid of darkness and emotional chaos she was. The same articulate fury suffused After Birth, her follow-up; her next book, Human Blues (her “monster,” as she likes to say), comes out in July.
How the wealthy have learned to live with the pandemic
At the start of the pandemic, COVID-19 was often depicted as an agent of random chaos, a disease that affected everyone irrespective of their race, gender, or socioeconomic status. On virtually every count, this assumption has proved to be false. Although the coronavirus managed to disrupt how human beings live and work, it didn’t do so proportionally. The crisis hit an unequal world and, when it did, exacerbated those inequalities. By and large, living through the worst of the pandemic has been easier for the wealthy, many of whom could afford to maintain a certain semblance of normalcy while mitigating health risks. The superrich got even richer.
To get a glimpse into the world of the affluent during the pandemic, I reached out to many of the businesses that flourished off them. Private jets, superyachts, personal catering, concierge medicine—these industries have not only survived but thrived during the pandemic, in large part because they could provide their customers with all the things that COVID-19 had rendered in short supply, like safety, seclusion, and, above all, a sense of control. The wealthy have already learned how to live with COVID-19 (albeit at a very high cost). Now the rest of the world must figure out how to do the same, on a budget.
The secret to satisfaction has nothing to do with achievement, money, or stuff.
I glanced into my teenage daughter’s bedroom one spring afternoon last year, expecting to find her staring absentmindedly at the Zoom screen that passed for high school during the pandemic. Instead, she was laughing uproariously at a video she had found. I asked her what she was looking at. “It’s an old man dancing like a chicken and singing,” she told me.
I came over to her laptop, not being above watching someone making an idiot of himself for 15 seconds of social-media fame. What I found instead was the septuagenarian rock star Mick Jagger, in a fairly recent concert, croaking out the Rolling Stones’ megahit “(I Can’t Get No) Satisfaction”—a song that debuted on the charts when I was a year old—for probably the millionth time. An audience of tens of thousands of what looked to be mostly Baby Boomers and Gen Xers sang along rapturously.
The results were mixed.
One morning last summer, I woke up and announced, to no one in particular: “I choose to be happy today!” Next I journaled about the things I was grateful for and tried to think more positively about my enemies and myself. When someone later criticized me on Twitter, I suppressed my rage and tried to sympathize with my hater. Then, to loosen up and expand my social skills, I headed to an improv class.
I was midway through an experiment—sample size: 1—to see whether I could change my personality. Because these activities were supposed to make me happier, I approached them with the desperate hope of a supplicant kneeling at a shrine.
Psychologists say that personality is made up of five traits: extroversion, or how sociable you are; conscientiousness, or how self-disciplined and organized you are; agreeableness, or how warm and empathetic you are; openness, or how receptive you are to new ideas and activities; and neuroticism, or how depressed or anxious you are. People tend to be happier and healthier when they score higher on the first four traits and lower on neuroticism. I’m pretty open and conscientious, but I’m low on extroversion, middling on agreeableness, and off the charts on neuroticism.
Scientific research alone cannot address the challenges that Americans with mental illness face.
During my last year as director of the National Institute of Mental Health (NIMH), I was in Oregon, giving a presentation to a roomful of mental-health advocates, mostly family members of young people with a serious mental illness. During my tenure as the “nation’s psychiatrist,” the nickname for my role, I oversaw more than $20 billion for mental-health research, and I was eager to share evidence of the agency’s scientific success.
I clicked through my standard PowerPoint deck featuring high-resolution scans of brain changes in people with depression, stem cells from children with schizophrenia showing abnormal branching of neurons, and epigenetic changes as markers of stress in laboratory mice. We had learned so much! We were making so much progress!
He is threatening to invade Ukraine because he wants democracy to fail—and not just in that country.
There are questions about troop numbers, questions about diplomacy. There are questions about the Ukrainian military, its weapons, and its soldiers. There are questions about Germany and France: How will they react? There are questions about America, and how it has come to be a central player in a conflict not of its making. But of all the questions that repeatedly arise about a possible Russian invasion of Ukraine, the one that gets the least satisfactory answers is this one: Why?
Why would Russia’s president, Vladimir Putin, attack a neighboring country that has not provoked him? Why would he risk the blood of his own soldiers? Why would he risk sanctions, and perhaps an economic crisis, as a result? And if he is not really willing to risk these things, then why is he playing this elaborate game?
America’s chaotic withdrawal from Afghanistan added moral injury to military failure. But a group of soldiers, veterans, and ordinary citizens came together to try to save Afghan lives and salvage some American honor.

Updated at 5:15 p.m. ET on February 9, 2022
It took four presidencies for America to finish abandoning Afghanistan. George W. Bush’s attention wandered off soon after American Special Forces rode horseback through the northern mountains and the first schoolgirls gathered in freezing classrooms. Barack Obama, after studying the problem for months, poured in troops and pulled them out in a single ambivalent gesture whose goal was to keep the war on page A13. Donald Trump cut a deal with the Taliban that left the future of the Afghan government, Afghan women, and al‑Qaeda to fate. By then most Americans were barely aware that the war was still going on. It fell to Joe Biden to complete the task.
Like it or not, the way we work has already evolved.
In 2019, Steven Spielberg called for a ban on Oscar eligibility for streaming films, claiming that “movie theaters need to be around forever” and that audiences had to be given “the motion picture theatrical experience” for a movie to be a movie. Spielberg’s fury was about not only the threat that streaming posed to the in-person viewing experience but the ways in which the streaming giant Netflix reported theatrical grosses and budgets, despite these not being the ways in which one evaluates whether a movie is good or not. Netflix held firm, saying that it stood for “everyone, everywhere [enjoying] releases at the same time,” and for “giving filmmakers more ways to share art.” Ultimately, Spielberg balked, and last month his company even signed a deal with Netflix, likely because he now sees the writing on the wall: Modern audiences enjoy watching movies at home.
Most public activity on the platform comes from a tiny, hyperactive group of abusive users. Facebook relies on them to decide what everyone sees.
If you want to understand why Facebook too often is a cesspool of hate and disinformation, a good place to start is with users such as John, Michelle, and Calvin.  
John, a caps-lock devotee from upstate New York, calls House Speaker Nancy Pelosi “PIGLOSI,” uses the term negro, and says that the right response to Democrats with whom they disagree is to “SHOOT all of them.” Michelle rails against the “plandemic.” Calvin uses gay as a slur and declares that Black neighborhoods are always “SHITHOLES.” You’ve almost certainly encountered people like these on the internet. What you may not realize, though, is just how powerful they are.
For more than a year, we’ve been analyzing a massive new data set that we designed to study public behavior on the 500 U.S. Facebook pages that get the most engagement from users. Our research, part of which will be submitted for peer review later this year, aims to better understand the people who spread hate and misinformation on Facebook. We hoped to learn how they use the platform and, crucially, how Facebook responds. Based on prior reporting, we expected it would be ugly. What we found was much worse.
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