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Or take Patricia and Isaac, another young and highly educated couple who couldn’t conceive a child. [40] Patricia’s two sisters and mother had given birth in their late thirties, so she and Isaac had presumed that becoming pregnant would not be a problem. In the early years of their marriage, therefore, they focused on education and jobs, trying only after several years to have a child. When Patricia did not become pregnant, the couple underwent scores of tests and then rounds of fertility treatments. After three cycles of Clomid, Patricia turned to IVF and became pregnant after her second round of treatment. Sadly, though, the embryos—twins—implanted in her fallopian tubes, and the pregnancy had to be terminated. Soon after, Patricia was diagnosed with early-stage breast cancer and underwent a bilateral mastectomy. Throughout this ordeal, she stuck persistently by her doctors at a leading fertility clinic, even though she worried that she was becoming “deprioritized.” As of March 2005, she was planning to pursue one or two more cycles. She was nearing forty at the time and had been trying to conceive for three years.

And finally, consider Katherine and Noah—also young, well educated, and trying desperately to create a child. [41] Because Katherine had several aunts who had struggled to conceive, she and Noah had wasted no time. “From our wedding night,” Katherine recalls, “I was trying to get pregnant.” When nature didn’t work as they had hoped, Katherine went to a local fertility clinic, where she had three rounds of IUI. Then the couple moved to a new city, where she jumped to IVF treatment. She had three rounds in rapid succession but achieved only a brief pregnancy, which soon ended in miscarriage. So Katherine underwent surgery for endometriosis, tried IUI again, and enrolled in a class for stress management. When the juggling became too much to handle she quit her job but continued treatment at the same fertility center with the same specialist. The doctor, Katherine said, remained positive. “He seems to think,” she recalled, “that we have no reason to stop what we’re doing.”

Notice what all these cases have in common. The clients’ demand for the “product” is exceedingly strong. They are willing to try anything—repeated rounds of hormones, multiple surgeries, pregnancy right after cancer—and they are essentially unwilling to give up. Or as Katherine laments, “This whole process has a twenty-four-seven hold on my life. I cannot just forget.” Each of the couples is determined to produce a child from their own gametes— “After all this,” notes Patricia, “it’s really hard to give up having a genetic child”—and price is simply not a critical constraint.