All language subtitles for NOVA.S48E08.Fighting.for.Fertility.1080p.x265-ZMNT_track3_[eng]

♪

♪

This is what I.V.F. looks like.

Wow.

This is what my life is going to
be consumed of.

All these meds in 20 days,

thousands of dollars.

This is I.V.F.

(birds chirping)

ERIN LEVIN:
Infertility just feels like
a special little corner of hell

that just goes on and on and on.

TIFFANY HARPER:
Every community has that
taboo subject,

that thing they just don't talk
about at the dinner table,

and fertility is ours.

STACEY EDWARDS-DUNN:
Black women are struggling
with infertility

at almost two times the rate as

our Caucasian brothers
and sisters.

AIMEE EYVAZZADEH:
I think there's an
infertility pandemic.

And I think it's getting worse.

Infertility rates are quoted as
one in eight

but I think it's much higher.

SHANNA SWAN:
Men from the general population,
we found that their sperm counts

had dropped 50% in 40 years.

JAMES GRIFO:
There's no embryo that has all
normal cells.

Mother Nature's all
about spectrum.

If you want to see the belly,

I'm actually wearing a whole,
like, belt underneath my shirt.

One thing that people would
always say

is that two men can't make
a baby.

And so, I'm sort of like,

"Watch us."

(laughs)

CINDY DUKE:
No one likes hearing

that you take Black women
from America,

put them in other countries that
are supposedly

lower resourced,
and they do better.

That is shocking.

♪

I don't like to say that
it's a miracle.

Because that doesn't have the
smack of truth to it.

She is the spoils of war.

♪

(baby fussing)

♪

♪

CASSIE JOSEPH:
I met Zack and he was a guy

that I just found myself falling
in love with.

And he brought out the best
of me.

ZACK JOSEPH:
You just get excited

about the prospect of having
a family

and you meet the girl
of your dreams

and then you decide,
you know, to get married.

And you hope that kids are
the next step.

♪

CASSIE JOSEPH:
In my family, my sisters got
pregnant right away,

my mom got pregnant right away.

So, I never thought that
infertility would be a word

that I would have to use in my
own personal life.

ZACK:
And we tried for years.

Everybody gave us advice...

"Well, you just need to relax

"and, you know, it'll happen.

Just... you guys are just
too stressed."

And we kept trying

and eventually we both
reached a point

where we said something's wrong.

CASSIE:
After a year,
I went in to the doctor.

They took my labs, a few days
later they called me back

and said you know,
"You ovulate regularly,

all your labs, hormonal-wise,
are in check."

And so the next step would
have Zack go in.

Of course,

my husband did not want to go in

to the doctor.
(both chuckle)

So, he waited for about
six more months.

So, I thought there's
nothing wrong.

There can't be anything wrong.

That would be crazy that
something was wrong.

♪

CASSIE:
The doctor called me and
he told me the news

that Zack had zero sperm in
his semen analysis.

And that was the first time...

(voice breaking):
we heard it.

♪

AARON MILBANK:
Having no sperm

is not very uncommon.

But most of the time there's an
obvious cause...

a man who's had a vasectomy,

men who are taking testosterone.

So, in Zack's case,

unexplained no sperm with
no blockage

is relatively uncommon.

Sometimes, we find genetic
reasons.

That's not the case in
Zack's case.

When you're told you
don't have sperm,

you feel like you're
less of a man.

You feel like, "Well,
why am I different

"than all the other guys
that are out there?

And how am I
less qualified?"

Dr. Milbank,
you're in good hands.
I know.

I just have to have faith that
everything is going to work out.

(voiceover):
I was diagnosed with
non-obstructive azoospermia,

which by definition means that
there are zero sperm.

The doctor proposed that we go
in surgically

and look in the testicle and
see if there is sperm there.

♪

KARINE CHUNG:
In a patient who has
non-obstructive azoospermia,

what that means is that
the sperm production

is likely very compromised.

And so, in order to get sperm,

the urologist is making an
incision in the testes

and pulling out some of
the little tubules

that will contain small
amounts of sperm.

NARRATOR:
Contrary to popular belief,

male infertility is as common
as female infertility,

and has many causes, including
abnormal sperm production,

chronic illness, injury,

or lifestyle choices.

DR. AARON MILBANK:
Very good.

All right, Jeff,
find something good.

TECH:
Okay.

So, we want sperm that has

a normal shape to it.

The sperm that has the
most normal shape

is usually going to have a
better chance for fertilization

than sperm that has
abnormal shapes.

MILBANK:
Found one?

TECH:
Yeah, there's a few sperm
in here.

MILBANK:
Nice!

This is a sperm that really has
a nice head, midpiece, and tail.

You can see it right kind of
here at the center.

♪

MILBANK:
So, if you think in terms
of what

Zack's chances are of having
a child

without any intervention,
it's zero.

We have moved him from zero
percent success to,

at this point with sperm in
the lab,

probably about a 50% chance

of having a child that is
genetically his.

I love you.

I love you, too.

ZACK:
I'm of course happy that they
did find sperm.

But you still have all those
questions about what is next.

♪

SHANNA SWAN:
If we take an average man today,

and look at his sperm,
his father's sperm,

his grandfather's sperm...

we see that he has on average

about half the number of sperm
as his grandfather.

So, what we found when we looked
in Western countries...

That is men from
the general population

who didn't know whether or not
they were fertile...

we found that their sperm counts
had dropped 50% in 40 years.

Because it's not likely to
be genetic.

Why? Because it's too fast.

It's too fast a decline for
a genetic change.

So then it's environmental.

(lighter clicks)

Lifestyle factors like smoking
too much,

binge drinking, stress.

A man's body weight, his obesity

is directly related to
his semen quality.

Another is the chemicals in
our daily life

that have the ability to
interfere

with the production,
distribution,

and utilization of testosterone.

And they are part

of a category called
endocrine disruptors.

Endocrine means hormone.

Testosterone is a hormone.

So, chemicals in plastic,

soft plastic in particular,

have the ability to decrease
testosterone.

We know that the chemicals in
personal care products

include many endocrine
disruptors.

The chemicals come into the
mother's body,

they get to the fetus,

there's no question that they
get to the fetus.

So, this is a really critical
link to the picture.

♪

NARRATOR:
These chemicals can reduce
testosterone

in the developing fetus...

and that can affect males'
sperm production

and health later in life.

SWAN:
The consequences,

one of which is lowered
sperm count,

and we see a lot of that in...
all over the United States.

It's not just the number of
sperm that we care about.

We also care about the shape
of the sperm,

which has gone downhill as well.

It's got to swim straight.

Circles won't do.

It's got to get to the target.

So, what we're seeing is

that the sperm are failing
the test,

in lots of ways.

NARRATOR:
But healthy sperm are just
one piece

of the fertility puzzle when it
comes to making a baby.

In order for natural conception
to occur,

there are actually a lot of
things that need to go right.

So, the very first thing that
needs to happen

is there needs to be ovulation,

which means that one mature egg

is released from the ovary.

That egg then needs to be picked
up by the Fallopian tube

and it lives there for
about 24 hours.

If there's sperm around,

the sperm needs to find the egg
in the Fallopian tube

and then they join together,
which we call fertilization.

The egg now transforms and
becomes an embryo.

CINDY DUKE:
Reproduction is really exciting

because it's the best example of
multiplication you'll ever see.

So, the embryo goes from
one cell

to two to four

and it just keeps doubling.

So that by the time the embryo
gets into the womb,

it's hundreds of cells.

KARINE CHUNG:
Once it's in the uterus,

that blastocyst needs to send
signals to the uterus

and the uterus needs to send
signals back

until there's a connection,
which we call implantation.

Even when a couple has no
fertility issues whatsoever,

the chances that all of that
will go right in a given month

is only about 25% to 30%.

Here we are.
Yeah, here we are.

My turn.

♪

CHUNG:
Approximately one in
eight couples

suffer from infertility in
the United States.

I think it's a private issue

where a lot of people who are
struggling with fertility issues

don't really talk about it.

But I think it's important that
we all acknowledge,

one in eight is a lot of people.

♪

NARRATOR:
Each year, about 160,000
Americans

turn to in vitro fertilization,
or I.V.F.

In the coming weeks, Cassie will
take drugs

to stimulate the development of
multiple eggs

in hopes that they can be
fertilized

with Zack's sperm in the lab.

This is what I.V.F. looks like.

These are all the meds

and they come in a package,
a big box.

And you open it up and
you're like, wow!

This is what the next 20 days
of my life

is going to be consumed of.

All of these meds

in 20 days.

Thousands of dollars.

This is I.V.F.

♪

EDWARDS-DUNN:
"It hurts to give yourself
shots.

"It hurts when your spouse has
male factor infertility.

"It hurts when you and your
spouse don't see eye to eye.

"It hurts because no one knows
the silent tears

"that you cry at night.

"It hurts because you don't have
insurance or money

"to cover treatment or
adoption services.

"It hurts!

"Because it seems like God
is silent.

"It hurts because of the crazy
comments people say to you like,

"'Just relax.'

"It hurts because the baby
you've always dreamed of

"seems like a distant reality

that may not ever happen."

♪

In the African-American
community, what I would hear

is that we were fertile,

that we were hyper-fertile.

Much of this is steeped in
a number of breeding myths,

particularly during slavery.

Black women in particular...

we didn't struggle with
infertility.

That's what we were told.

♪

And for those women

that were experiencing fertility
challenges,

it was a secret, you know?

No one was talking about it.

NARRATOR:
Reverend Stacey Edwards-Dunn
was 37 years old

when she married her
husband Earl.

They planned to have a child
right away

but were unable to,
and turned to I.V.F.

EARL DUNN:
I think one of the key issues

with a lot of couples,

especially minority couples,
is financial.

It's financial, it's expensive.

WANDA BARFIELD:
Assisted Reproductive
Technologies, or A.R.T.

does relate to
socioeconomic status

because fertility treatments are
relatively expensive.

DUKE:
I.V.F. could cost anywhere
between $10,000

and as high as $25,000,
if using your own eggs.

In terms of who gets to
have a baby,

it's whether you can afford it,
whether you have access to it.

We know that, unfortunately,

just simply looking at
geographics in terms of

locations of fertility clinics,

they tend to be located in the
more affluent neighborhoods.

For many people, it's cost
prohibitive.

HANK GREELY:
I.V.F. is usually not covered

by either private insurance

or by the state health care
program for the poor,

the state federal program
Medicaid.

We're one of the few rich
countries

that doesn't think of it as part
of basic health coverage.

DUKE:
The good news is more and
more states in the United States

now provide what we call
mandated coverage,

which is a strong requirement or
recommendation

that employers and other
insurers

provide fertility coverage.

NARRATOR:
For six years, Stacey and
Earl poured their life savings

into multiple I.V.F. treatments.

Finally, a doctor alerted Stacey
that she had a rare condition

that no one had ever told
her about.

EDWARDS-DUNN:
So, I went to go see the doctor.

She said, "Had anyone ever
told you

that you had one
Fallopian tube?"

I said, "Absolutely not."

"Has anyone ever told you that
you have a unicornuate uterus?

That your uterus is much smaller
than the average uterus?"

I said, "Absolutely not."

Now although I had been
diagnosed

with unexplained infertility,

they still never told me that
I had one Fallopian tube

or had a unicornuate uterus.

Which could have been a,
you know,

a major game-changer for every
doctor that had seen me.

BARFIELD:
For African American women,
there has been

a long-standing history of
reproductive coercion,

of sterilization that we know
that's gone on

in the history of the
United States,

and there is a concern
about trust.

CHUNG:
Across the board,
there are disparities.

Clearly disparities in the
medical system for the treatment

of African American men
and women.

And I think that's true in the
world of infertility as well.

EDWARDS-DUNN:
In our community,
I hear it all the time.

When we go to doctors,

many doctors do not take
us seriously.

Many doctors have provided
diagnosis

oftentimes that's incorrect.

(lighter clicks)

♪

NARRATOR:
Reverend Stacey came to see
the first six years

of her private fight for
fertility

as her season of delay.

EDWARDS-DUNN:
A lot of people struggle with
this idea of delay.

And you wonder
when your time is coming.

And so I had to get to the point
that, you know,

each time I got a negative
pregnancy test

or that the I.V.F. wasn't
successful,

I had to eventually arrive to
the point

that delay didn't mean denial.

NARRATOR:
Believing she would become
a mother,

Reverend Stacey decided to
break her silence.

EDWARDS-DUNN:
The moment that I was willing
to open up

and publicly share about
my story,

what happened is that
women and couples

began to come out the woodworks.

Because they were like,

"My God, she gets it.

She, she's going through what
I... what I'm going through."

Or "She's now been through, you
know, what I'm going through."

♪

Black women are struggling with
infertility

at almost two times the rate

as our Caucasian brothers and
sisters.

TIFFANY HARPER:
I knew when I was about
25 years old

what they kept telling me... "You
have a uterus full of fibroids."

And so, I didn't know if

that was going to impact
my fertility.

I had just graduated from
law school.

I wasn't interested in having
a baby at that point.

And so I kind of...
I didn't have symptoms.

I kind of let it go on and
go on and go on.

NARRATOR:
Fibroids are benign tumors
of muscular and fibrous tissue

that typically develop in
the walls of the uterus.

EYVAZZADEH:
Fibroids cause a disruption
inside the uterus

such that it becomes not only
hard to get pregnant,

it also becomes harder to
stay pregnant.

Black women experience
miscarriages

at a much higher rate.

And I think it's almost always
due to fibroids.

♪

NARRATOR:
When Tiffany married

and was ready to start a family,

she struggled to get pregnant,

but did not know where to turn
for help.

(mouse clicks)

HARPER:
I think every community has
that taboo subject,

that thing they just don't talk
about at the dinner table,

and fertility is ours.

I didn't have a voice.

I was just struggling.

I'm a lawyer by trade and so I'm
used to advocating for people.

But in this, I couldn't advocate
for myself.

I didn't know how and I had,

I had too much pain,
too much shame,

and that's when I came across
Fertility for Colored Girls.

It's so difficult...
WOMAN:
Yeah.

And it's very difficult to be,
like,

told this basic lie
your whole life,

that it's just... everything's
going to work out

and it really isn't.

EDWARDS-DUNN:
I do believe that God called me

to start Fertility for
Colored Girls,

to create this safe space
for women,

particularly African American
women who were struggling

at insurmountable rates

because there was no place for
them to go.

♪

HARPER:
I went to the meeting and
I was shocked

because there were so many
Black and brown women there,

like me, who were struggling.

And it was the first time that I
didn't feel alone.

We're believing and
we're cheering you on

till the end.
Yes.

Black women in particular,

we have experienced generations
of oppression.

We carry generations of stress.

Someone says that,

you know, this stress and this
trauma is also cellular,

and it particularly impacts us
on this infertility journey.

♪

BARFIELD:
Women, particularly
African American women,

have experienced long-standing

social, economic, and
environmental stress

that has really placed a burden
on their bodies

in a way that translates

into more adverse reproductive
health outcomes.

And that term is called
weathering,

that this weathering in a way
prematurely ages Black women.

Your stress hormones, cortisol,
your fight-or-flight hormones

known as catecholamines or
epinephrine, norepinephrine,

those hormones actually should
only be present

at low doses overall in
your general day-to-day

and only spike when you
truly have

a new, short-term scare
or anxiety.

For people who find themselves
in societies where there's maybe

institutional racism,
structural racism,

their catecholamines and
their cortisol levels

are way higher than
they should be.

And so if someone is constantly
under stress

where their body is weathering,

that has a lot of long-term
impacts

on all your organ systems.

And over time, we see
that manifesting

in earlier ages of diagnosis
with disease,

earlier ages of diagnosis in
terms of high blood pressure,

diabetes, stress-related
tension,

and even birth outcomes
in women.

(gospel singing)

HARPER:
The Black community is often
described as

the most religious community
in America.

And there's a big push to just
pray about it.

Rev. Stacey,
because she's a reverend,

really kind of demystified that
and said,

"God made the science too."

I had gone through one round
of I.V.F.

and when they went in to
retrieve the eggs,

they could not really get to
my ovaries

because they've got these
fibroids all over the place.

And upwards of 80% of
Black women

suffer from fibroids.

And we don't do anything about
it unless it's life-threatening.

And Rev. Stacey just really gave
me the push I needed and,

and the permission to, to
remove the fibroids

and move forward on my path to,
to motherhood.

NARRATOR:
After surgery to remove her
fibroids,

Tiffany embarked on more rounds
of I.V.F.

GREELY:
I.V.F. doesn't seem to be

any more efficient than nature.

Still, most I.V.F. embryos do
not become babies,

just as most embryos that are
produced the old-fashioned way

don't become babies.

But if you've got blocked
Fallopian tubes,

or if your sperm for some reason
won't fertilize an egg,

for a variety of other reasons

there are a lot of people out
there for whom

the old-fashioned way
just won't work.

And for them, I.V.F. amazingly
outperforms nature.

NARRATOR:
This is the second time
Cassie and Zack have tried

to conceive a child through
I.V.F.

using sperm extracted from Zack.

Their first attempt did not
produce viable embryos.

♪

Within 24 hours of
Zack's procedure,

Dr. April Batcheller will
attempt

to collect eggs from both of
Cassie's ovaries.

BATCHELLER:
We give women like Cassie

extra follicle stimulating
hormone.

So that instead of just growing
one egg,

maybe we can get 15 or 20 eggs
from the ovary.

♪

The goal is going to be

to place a needle into each one
of these follicles here

and aspirate all of these
beautiful eggs

that Cassie spent the past
two weeks growing.

NARRATOR:
Follicles are the tiny sacs
inside the ovaries

that nurture and release
a woman's eggs.

EYVAZZADEH:
During an egg retrieval,

a doctor will place a probe
inside the vagina

and through a needle-guided
procedure,

follicles are drained of
follicular fluid.

24.

NARRATOR:
In the room next door,

the embryologist will isolate
Cassie's eggs

and try to fertilize them
with Zack's sperm.

BATCHELLER:
Fertilization is probably

our biggest hurdle
that we have here

because of Zacks's sperm
challenge.

♪

In this case, because Zach's
sperm were surgically extracted,

they lack the ability to swim.

And so, we have to give them a
bit of a boost

by injecting
the non-swimming sperm

into the egg with a needle,
called a ICSI needle...

intracytoplasmic sperm
injection.

NARRATOR:
This revolutionary technology
was developed

to assist fertilization for men
with weak or few sperm.

Today, it is widely used in
I.V.F. laboratories.

Oh...
All right.

Okay, I know, right?

NARRATOR:
Within 18 hours,
Zack's sperm and Cassie's eggs

create three embryos.

From there, it is
an anxiety-provoking

five or six days while we wait
for the embryos

to grow and divide.

♪

CASSIE:
I think being faced with
infertility

is extremely hard.

It's emotional.

You have the steps of grieving.

You're trying to accept and
you're trying to, you know,

predict what's going to happen.

Everybody has such a
unique story.

And when you have a
child of your own

and you say,
"Why not adopt?"

that's their opinion, you know.

They decided to be
parents themselves,

they have biological children.

And it's really hard to
hear that.

You look into your future.

What does that look like for us?

Who's going to be with us for
our family Christmases?

(chuckles)

Like, who's going to be with us,

like, when we're saying
our last words?

I think, like...

we want to have
the joys of children.

DUKE:
There are a lot of causes
for infertility.

So big items are male factor,

where there's something going on
with the sperm.

Tubal factor, where there's
something going on

with the Fallopian tube,

and anovulation where there's an
issue relating to...

ability to release an egg
from the ovary.

NARRATOR:
One condition that affects
a woman's ability

to ovulate regularly

is polycystic ovary syndrome,
or PCOS,

a hormonal disorder that if
left untreated,

can have long-term consequences.

DUKE:
We know that people

with P.C.O.S.,
because of insulin resistance,

also struggle with their weight.

And so, in the United States,

where we're facing an
obesity epidemic,

and thus a diabetes crisis
as well,

it's really important to
diagnose PCOS even in teenagers.

NARRATOR:
An even more common illness

affecting a woman's fertility
is endometriosis,

an inflammatory disease of
the reproductive system,

that can begin in puberty.

It afflicts at least ten percent
of women

and takes an average of
six to eight years to diagnose.

One of the biggest downsides

to endometriosis progressing
without diagnosis or treatment

is that it can cause really bad
scarring of the Fallopian tubes.

But it also can cause the eggs
to die.

Some women may stop ovulating
regularly.

And some may even go
into menopause prematurely

as a result.

♪

NARRATOR:
But one of the major challenges
for women

who are struggling to conceive
is the age of their eggs.

GRIFO:
We as a society

all need to know that there are
issues with having babies

when we're older

and we need to be thoughtful
about planning our fertility.

It's not a popular message,

and it does create anxiety,
which no one wants to do.

But, on the other hand,
you know,

I can't tell you the number of
women who have said,

"No one told me this stuff,
I can't believe I'm 44

"and thinking it's easy to
get pregnant.

And now you're telling me
I almost have no chance."

NARRATOR:
As a woman ages,
not only does the quantity

of her eggs decline,

but so does the health of
her eggs.

There's a crucial moment during
fertilization,

when the egg needs to eject

exactly half of its
chromosomes...

with perfect precision.

GRIFO:
Eggs are aging as you get older.

And they don't release
the chromosomes

until they're ovulated and
fertilized.

And that's, you know,
this graphic here...

which shows a sperm and an egg.

This is the egg kicking out half
the chromosomes.

When this egg is 25, it's moving
the chromosomes around

with 25-year-old machinery

versus 40-year-old machinery,

you're going to see
more mistakes

where a chromosome goes where
it shouldn't.

And, for instance,
Chromosome 21,

there should be one copy here
and one copy there.

NARRATOR:
But sometimes an egg,
especially an older egg,

fails to eject its extra copy.

GRIFO:
Now all of a sudden,
you've got an embryo

that has three copies of
Chromosome 21,

trisomy 21, that's
Down Syndrome.

NARRATOR:
In the last decade, egg freezing
has become increasingly popular

for women interested in
delaying childbirth

or who are going to
undergo chemotherapy.

CHUNG:
I'm asked all the time

what is the ideal age
to freeze eggs.

And I think that somewhere
between 28 and 34.

That's because in that window,

the quality of the eggs and
the quantity of the eggs

is still optimal.

After 35, it is possible to
freeze eggs

but the outcomes are not quite
as successful.

EYVAZZADEH:
Egg freezing is one of the
greatest discoveries

in modern times.

It is a huge game-changer.

It allows women to donate eggs
to themselves

at a time when they may not have
as many options.

It allows women to choose
partners

based on things that are
not related

to their biological clock.

♪

TRYSTAN REESE:
When I first saw him in
the hospital

and everyone's screaming at me
to push,

and they're screaming at me
to slow down.

And then everything goes
completely silent.

And I hear him come out

and then they lift him up in
the light

and I get to see him for
the first time.

♪

And he opens his mouth,
and he just starts to cry,

which was the most amazing sound
I've ever heard.

♪

NARRATOR:
Creating a baby was the
last thing on Trystan's mind

as he searched for his identity.

I, like many people,
always did feel

there was something different
about me.

And I think, tragically,

I actually felt that there was
something wrong with me,

that I was broken.

For me it was just excruciating
and it came to the point

where I didn't believe that I
could continue

to live a kind of life
that I was living.

And it really wasn't until
I was 18 or 19

when I realized, "Oh, my God,
I'm not broken at all,

I'm just transgender."

When I finally did tell my mom
specifically,

you know, "I'm transgender.
I'm going to be transitioning,"

you know, I just watched her
face fall.

And it's not that she's
transphobic,

she just truly believed that
it meant choosing

an unhappy life for myself.

CHUNG:
For people who have
gender dysphoria,

what that means is that

they have a really distressing
discomfort

because there's a discrepancy
in their gender identity

and how they appear on
the outside

or the sex they were assigned
at birth.

So, by matching their physical
appearance

to their gender identity,

that allows the world to
perceive them

as they already perceive
themselves.

NARRATOR:
Trying to match his
appearance to his identity,

Trystan turned to testosterone.

TRYSTAN:
Looking back on it now,

I'm like, "Oh, I took
testosterone

from the black market."

And that is a really, really,
really dumb idea.

Because your whole endocrine
system

is a very delicate
constellation.

It's like a spiderweb.

You know, you pull on one piece
and everything else goes.

There's a complex signaling

that occurs naturally in men
and women,

where there's hormone signals
that come from your brain

that speak to the ovaries and
speak to the testes.

When you take testosterone or
you take estrogen,

those hormones then take over
the signaling

that would normally be driven
by the brain.

And that can have implications
for reproductive health.

For example, testosterone
therapy

can lead to increased risks
of stroke,

heart attacks, blood clots.

You should really be under
doctor supervision,

or if not a doctor but a nurse
or a naturopathic doctor,

but someone who has advanced
training in hormone management.

But a lot of L.G.B.T.Q. people
take risks with their health

because they're scared.

(birds singing)

(bee buzzing)

NARRATOR:
Discrimination towards
the L.G.B.T.Q.+ community

has hindered access to
healthcare

and led to misperceptions.

BIFF CHAPLOW:
The message has always been
that, like,

gay people are dangerous to
children,

that gay people shouldn't
raise children.

That, like, we are the opposite
of family.

We destroy family.

♪

When it became clear that
Lucas and Haley,

my biological niece and nephew,
were going to need a home,

it was pretty clear that we were

going to be the only people
that could take them.

Or they would need to go
into foster care.

And so,

you know we had a discussion

and Trystan was, like,
very supportive.

Was like yes, let's do this,
let's take them.

Did you concentrate?

Concentrate means
you work very hard...

TRYSTAN:
It never occurred to me
until I met Biff,

I started thinking,

you know, I would love to have
a family with him.

And seeing him with kids
I was just like,

that door could open for us.

We could have a physical
manifestation of this, you know,

profound and true experience of
love we have for each other.

BIFF:
Many people like me

don't ever have the opportunity

to have a kid that is
biologically connected to them,

either because the reproductive
systems don't match up

or they don't have the
resources.

And in many cases I think people

don't even imagine.

That was one thing that
people would always say,

is, like, two men can't
make a baby.

And so, I'm sort of like,

"Watch us."
(laughs)

♪

NARRATOR:
How do two men make a baby?

CHUNG:
Hormone treatment can suppress
the reproductive system.

So, for example, a transgender
man who is taking testosterone

will experience a cessation
of menses.

So, periods will stop coming.

And that's actually an intended
consequence of the treatment.

But in addition, it will
suppress the ovaries

so that he is no longer
ovulating.

When they come off of
testosterone,

there are reports that the
menses will return.

Testosterone really acts to
the ovulatory system

the same way that any
hormonal birth control

that stops ovulation and
menstruation impacts the system.

It just hits pause

on the sort of
egg maturing factory.

And when you go off
testosterone, as I did

it takes a few months,

and then the egg maturing
factory

kicks back into gear and
you ovulate and menstruate

just as you had before.

CHUNG:
There have been reports
of pregnancies.

But what we don't know is
if a person has been

on testosterone for
a long period of time,

is that return of ovarian
function

going to actually occur.

If you want to see the belly,
I'm actually wearing a whole...

NARRATOR:
Trystan had been taking
testosterone for 12 years

before trying to get pregnant.

After experiencing a
miscarriage,

he soon became pregnant
with Leo.

... gigantic giant.
(laughter)

Leo looks so much
like you that people just assume

that I wasn't involved at all.

(laughs)

They do assume that we
had a surrogate

and just used my sperm for that.

We did have a surrogate

and we did use my sperm.

It was me, I was my
own surrogate.

Trystan was the surrogate.

TRYSTAN:
How do you navigate pregnancy

as a transgender man?

Maybe you feel conflicted about

or even negative about
having breasts.

But now, that's being used to
nourish a human.

Maybe you felt conflicted about
having a uterus to begin with,

now it's being used to grow a
person...

you're building a family.

NARRATOR:
Trystan felt grateful that
he was able

to become pregnant and
give birth.

But for patients about to
transition,

there are steps they can take to
preserve their fertility.

In patients who are undergoing
gender-affirming therapy,

I think it's important that they
are presented with the option

to either freeze eggs or
freeze sperm

before they start those
treatments.

TRYSTAN:
Fertility preservation
is invasive.

It is very expensive.

And it takes a long time.

It can take weeks or
even months,

depending on how successful the
first retrieval is.

And a majority of trans adults

who say they wish they'd
preserved their fertility,

they said that they were
not counseled,

they didn't think about it.

CHUNG:
Counseling the younger group

about fertility preservation

before gender-affirming therapy
is particularly challenging

because these are teenagers.

And many times,
they're so distraught

by their gender dysphoria,

that they're really eager
to start

their gender-affirming
treatments.

Honestly if you had told me
at age 22,

you know, you have to choose
between transitioning

and ever having a
biological child,

it would not have taken me one
second to make that decision.

I would have chosen transition.

I thought I was choosing
transition

over ever having a family,

ever falling in love,
ever having community support,

ever getting married.

CHUNG:
What the research has shown
is that

at least 50% of transgender men
and women

do wish to have children or
have a family in the future.

Okay, Leo...

TRYSTAN:
Change comes from moving into
the place that's hard

and looking for the light.

Often when you say like, "Well,
why don't you just adopt?"

It's rooted in this belief that
we shouldn't have access

to the same things as
everyone else.

I don't want to be like men who
are not transgender.

I feel like what I am is unique.

It's powerful, it's a gift.

(Leo chattering)

If I had been assigned male
at birth,

I never would have had Leo.

♪

So when I look at me pregnant,

you know, I'm just one of
the many men

who happen to be unique
in that we can create life.

And I think that's pretty cool.

♪

♪

BATCHELLER (on phone):
Hi Cassie, it's Dr. Batcheller
calling,

I was just calling you with some
excellent news this morning.

I wanted to call and
let you know

that we have your CCS
results back

and that both of these embryos
are normal

and available for transfer,
which is pretty exciting.

CASSIE:
We got that call

and it was two embryos

and they're both normal,

and they're both baby girls.

So, we're super excited,
at least I am

about the girl part.

NARRATOR:
Both of Cassie and Zack's
embryos

were frozen and one has been
thawed out

to be transferred today.

Our embryo today is a 5BB,
that's the grade of it,

and frozen embryo transfer
and it's a baby girl.

And then Jos... baby Joseph,
January 2020.

So today's the day,

we waited four years for this,
so we're over the moon excited.

Are you guys ready?

Yes.
Yes.

All right, I'm ready too.

So, we're here today doing
Cassie and Zack's transfer

after a long road of
going through

several I.V.F. cycles
to get here.

So, we warmed up their embryo
a few hours ago

and then transferred it
successfully.

Everything went very
smoothly today.

So now we are just in
the nine-day waiting period.

♪

It's been five years,
four embryos,

three transfers,
zero pregnancies, for me.

And then one mosaic embryo,
one surrogate, and our baby.

♪

Infertility just feels like

a special little corner of hell
that just goes on and on and on.

And you can keep throwing money
into it

and time and sadness and blood
and sweat and tears,

and you may end up with nothing.

(bird singing, water trickling,
Erin shushing)

I don't like to say
that it's a miracle

because that doesn't have the
smack of truth to it.

She is the spoils of war.

(chuckles)
She is the result

of many years of battle.

And she is our victory.

NARRATOR:
After four years and
three failed cycles of I.V.F.,

Erin was diagnosed with
recurrent implantation failure...

meaning her embryos were unable
to embed themselves

into the wall of her uterus.

EYVAZZADEH:
Erin came to me.

She was frustrated,
she wanted answers,

she didn't have a diagnosis.

NARRATOR:
Testing pointed to an issue
with Erin's immune system...

it was identifying her embryos
as foreign.

EYVAZZADEH:
That's why

we decided as a team to consider
using a gestational carrier.

NARRATOR:
Before transferring any of
Erin's embryos

to the gestational carrier,
or surrogate,

Dr. Aimee Evyazzadeh used

pre-implantation genetic
testing, or P.G.T.,

to make sure they had the
correct number of chromosomes.

Offered at most I.V.F. clinics,

the test is used by about 35%
of patients

and can cost between $1,500
to $5,500.

This test is typically done when
an embryo is about five days old

and has divided to roughly
300 cells.

The inner cell mass is what
could develop into a fetus.

The outer layer of cells...
Called the trophectoderm...

is what could develop into
the placenta.

An embryologist plucks just a
few cells from this outer layer

and a lab performs a genetic
test on them

to count how many chromosomes
each cell contains.

Based on this test, the embryos
are generally classified

as "abnormal" or "normal."

But if the sample contains
a mixture

of genetically normal and
abnormal cells,

then the embryo is considered
"mosaic."

ERIN:
We had four embryos left.

One of them was abnormal,

two of them were normal,

and one of them was mosaic.

So, you think, I want to get
my best chance.

And so I want to use the embryo
that looks the best,

that has the highest grade,

and that has really good genetic
testing results.

And I don't want to use these
garbage embryos

that have tested abnormal

or partially abnormal
like a mosaic.

NARRATOR:
One of the normal embryos did,
not survive the thaw

so Erin and her husband Gary
considered transferring

the mosaic embryo with the
remaining normal one.

GARY LEVIN:
We knew we would transfer

this one healthy one
that we had left

but then the question was,

what do we do

with the mosaic embryo
that's left?

We also didn't want
to discard it.
Right.

Because there was a certain
percentage chance

that it could result
in a healthy pregnancy.

NARRATOR:
In the end, one normal embryo
and one mosaic embryo

were transferred into
the surrogate.

Soon after, Erin and Gary got
good news.

ERIN:
Fortunately, we got
positive pregnancy results.

So, we knew our surrogate
was pregnant.

The two embryos were
different sexes.

So, the healthy one was
a male embryo

and the mosaic embryo was
a female.

When we were told there
was just one

and that it had implanted,

we assumed that we were
having a boy.

(baby heartbeat)

NARRATOR:
A blood test revealed a girl.

The mosaic embryo had implanted.

CHUNG:
In discussing the risks
associated

with transferring a potentially
abnormal embryo,

we talk about
three possible scenarios.

One is that the embryo just
wouldn't implant.

The second scenario is that
that embryo would implant

and it would result in
a miscarriage.

The third possible scenario
though is that

if the embryo truly is abnormal
and implants,

it could result in a baby with
genetic abnormalities

due to abnormal cells
being present.

Before we will transfer a mosaic
embryo in any patient,

they need to have
genetic counseling.

That throws you into a
whole other world

that you have to
get expertise in

to decide if that's going
be a viable pregnancy

and how do you find out if it is

and will we need to look at
early termination

or what are the odds that this

is a miscarriage.

And if it's not,
what are the odds

that this is a baby who will be
born with special needs.

CHUNG:
There have been several case
reports of patients

who have had pregnancies from
transfer of mosaic embryos.

And I think it's too early to
say whether any of these embryos

actually translate into
birth defects for the baby.

Maybe later in life as we follow
these babies as they grow older,

there might be something that's
identified

that's related to the mosaicism.

♪

GARY:
We're in this world of
testing everything

and going through I.V.F.,

we're getting all this
information that most couples

that have natural pregnancies

never even have to face.

♪

CHUNG:
What we really care about is
whether the baby

is going to have the proper
amount of genetic material.

But what we're testing

is a small portion of
the trophectoderm,

which we know is the portion of
the embryo

that's destined to become
the placenta.

So, there is some controversy
over how accurate this test is

and whether we are at the point
where we should be doing it

for all of our patients.

Yes, go, go!

GRIFO:
Mother Nature's all about
spectrum, all about continuum.

So, there's no embryo that has
all normal cells.

If 70% of the cells
are abnormal,

those are called
high-level mosaic.

♪

If only 30% of the cells
are abnormal,

those are low-level mosaics.

NARRATOR:
When fewer abnormal cells
are present,

miscarriage rates are
predicted to go down

and the chances for
a live birth increase.

There seems to be
a better outcome

with the lower level mosaics
over the high-level mosaics,

but we're still learning that.

CHUNG:
There is actually a lot of
research that suggests that

the embryo may be capable of
correcting itself

once it's inside.

NARRATOR:
But how?

Researchers... including
Dr. Shawn Chavez...

have found evidence that
suggests that on day four,

the embryo performs a
self-inspection.

I like to liken it to
a card game.

So that you can actually share
information with your neighbor.

And so you can start to decide,
based on your card game,

who looks good to become
a placental cell,

part of the placenta,
and who looks good

to become part of
the inner cell mass,

which is going to become
an embryo.

♪

NARRATOR:
At this developmental stage,

Dr. Chavez has noticed embryos
discarding cells

or fragments of cells that are
chromosomally damaged.

CHAVEZ:
They have a significant amount
of DNA damage.

And we think that the embryo
actually knows that it's there

and basically has a signal to
it that says,

"You are not going to divide

"because you're chromosomally
abnormal

and your DNA is highly damaged."

I really like to point out
your attention

is this large excluded cell.

So, you can see based on
its size,

it probably came from very, very
early in development.

Besides being excluded,

it is never allowed to
divide again.

NARRATOR:
More needs to be understood
about mosaic embryos,

but some couples...

especially those who are running
out of options...

are deciding that the prospect
of having a healthy child

is worth the risks.

If a woman only produces
mosaic embryos,

most clinics don't want
that liability.

I think the tide is turning.

I think they're finally starting
to realize

if that's the only thing a woman
has is a mosaic embryo,

that they should give it a shot.

And so, I'm hoping that
more clinics

are going to accept that
responsibility.

♪

EYVAZZADEH:
Finally, in August of 2020,

American Society for
Reproduction Medicine

came out with a
committee opinion

saying that every single clinic

needs to have a policy in place
for mosaic embryos

and patients need to be told
about it as well.

♪

ERIN:
Don't let a clinic
or a testing lab

tell you you shouldn't use
these embryos.

Keep them and maybe if you are
more comfortable,

use them as a lower priority.

But they really could be
a real baby.

(baby fussing)

♪

CASSIE:
We transferred baby girl
a few weeks ago.

We got a positive
pregnancy test,

which we were over
the moon about.

And a few days later,

my HCG level,

which is the indicator of
your pregnancy, went down.

And then it was
confirmed that I...

we had a miscarriage.

♪

One in four women of
reproductive age will experience

a pregnancy loss

at some point
in her reproductive lifetime.

That means 25% of women.

It is quite natural and
very common

for women to blame themselves.

And the first way to help
someone understand

it's not their fault

is to let them know how
common this is.

Through this journey we've come
closer and closer and closer

to being able to actually
have a child.

And it feels like it's
within reach.

It's just, just barely out
of reach.

Are you sleeping...

NARRATOR:
Cassie and Zack have one
remaining embryo to transfer.

CASSIE:
For the next frozen embryo
transfer, I'm nervous.

I have one more embryo left.

ZACK:
This needs to work.

And if this doesn't work,
what's next?

We haven't talked about
what's next,

if this doesn't work,

because we're just praying
that it does.

NARRATOR:
I.V.F. succeeds only about half
the time for couples.

♪

Cassie and Zack's last embryo
resulted in another miscarriage.

They plan to try again
with I.V.F.,

starting with another
surgery for Zack.

♪

EDWARDS-DUNN:
To hold onto hope means to
look beyond

what might be negative or
what might not be working out

in a way that you desire to
happen in that time

and know that something better
is going to come.

♪

HARPER:
I went through my third round of
I.V.F. in May of 2018.

They retrieved two eggs,
they fertilized.

My doctor came into the room and
I'll never forget she said,

"Tiffany, they look great!"

(voice breaking):
And I remember thinking,
you know...

no one's ever said that to me.

No one's ever said they
look great.

Like this is... I have a shot.

And so, we put them both back in
and the rest is history.

I gave birth to my son
nine months later.

And he is everything that I
prayed for,

everything that I've been
waiting for,

everything that, like,
I didn't know I needed.

♪

NARRATOR:
Reverend Stacey Edwards-Dunn and
her husband Earl

decided to try one last time.

EARL DUNN:
After seven years,
I just told her,

I said, "Let's try one
more time,"

because I think I had a
good feeling.

Our bonding together,
our faiths together,

that, that whole collectiveness.

♪

EDWARDS-DUNN:
On January 2,
we received the call

from the doctor around 2:30.

Everything, like the world
seemed to stop.

The doctor, the nurses,
everybody was on the phone,

saying, "We call with good news.

We want you to know that you
are pregnant."

(laughter and giggling)

♪

Our daughter that...
Shiloh,

that was born on September 11...

She is she's a gift to so many.

Whether your path is becoming
pregnant naturally

or becoming a parent
through I.V.F.,

donor eggs, donor sperm,

surrogacy, embryo adoption,
or adoption...

there is a plan or
a path for you.

That's what you hold onto and
know at the end of the path,

there is a miracle waiting
for you.

And whatever path that is,
the path isn't deficient,

it's just different.

♪

♪

ANNOUNCER:
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Episodes of "NOVA" are available
with Passport.

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Amazon Prime Video.

♪