In this new column, Jean Hannah Edelstein starts the complicated journey to conceive using in-vitro fertilization – and takes readers with her

Don’t make jokes, I say to E.

We pause outside the hospital classroom. It’s 9.30am on a sunny morning in Manhattan and we’re about to enter a roomful of people who are here for an introduction to IVF treatment.

E is a very funny man, which is why I have to tell him not to make jokes: because that’s how he lightens the mood. I love him for it. I do it, too. But this is not the time or the place.

OK, E says.

Many of the people in the room have had a very difficult time, I tell him. They will have suffered losses or tried to have conceived for years before reaching this point. It’s very sensitive. Not like it is for us.

I know, E says.

E and I have been married for two weeks when we arrive at the classroom, but I’ve known for three years that I’d need IVF. We married for love, but also because he needed to get on my health insurance for us to begin the long process of starting a family.

I was lucky: when I learned that IVF would be advised if I wanted a biological child, I started looking for a job at a large tech company that advertised its coverage of fertility treatment as part of its benefits package. The job that I found writing marketing emails was not my dream job, but that did not matter. The health insurance that the company gave me meant that one major obstacle to IVF – the huge cost – was, if not eliminated, much reduced.

Planning ahead like this is the exception, not the rule: most people come to IVF after many years of trying to get pregnant, after miscarriages, after being told that their reproductive systems don’t function. Changing jobs then is often not easy or feasible. People say that infertility is as stressful as cancer, as grief-causing as death, and I don’t doubt it.

E and I are not infertile; at least not as far as we know. We haven’t tried to get pregnant because I have Lynch syndrome. Lynch is a genetic cancer syndrome that vastly increases my chances of developing certain kinds of cancer – colon cancer especially, and endometrial cancer as well. Lynch is passed through an autosomal dominant gene, which means that if one of your parents has it, there’s a 50% chance that you’ll have it, too – unlike recessive genetic disorders, like cystic fibrosis, which require a gene from each parent. I inherited Lynch from my dad, who died from lung cancer in 2014, six months before I was diagnosed.

The good news about my diagnosis was that there is power in knowledge: there is much that I can do to help prevent cancer. Many people don’t find out they have Lynch until they are already very ill, but I’m so far cancer-free and able to have regular screenings that mean my life expectancy is normal, though I also expect it to be much more medicalized. I see three to four specialists twice a year, have frequent colonoscopies, biopsies, ultrasounds, MRIs.

Once I’ve completed my family, I’ll have a prophylactic hysterectomy – a prospect that makes the question of children feel even more pressing. But having Lynch means that any child of mine conceived naturally would have a 50% chance of getting it too.

When I was diagnosed with Lynch – I had a blood test – the doctor cheerfully told me that I could use IVF to eliminate it in my children. Good thing my parents didn’t have that option! I thought. At the time I was single, but I still took that as a sign that I should find that IVF-supporting job.

Later, when it was clear that E and I would marry, we discussed the possibilities. We could have conceived naturally, crossed our fingers and gotten the kid tested once they were a young adult. We could have had a fetus tested for Lynch in utero, but I knew that I wouldn’t see it as grounds for termination – and then that child would live with the burden of knowing about the Lynch gene from the first day of their life. I enjoyed 33 years of ignorance.

Or we could do IVF.

That’s why we’ve come to the classroom: to learn about the process and the cost. We’ll be doing pre-implantation genetic diagnosis (PGD), wherein embryos are biopsied on the fifth day of development and their DNA is examined for an offending dominant gene. Embryos that inherit the normal gene from E, rather than the faulty one from me, will be selected.

Making the embryos requires the same initial process as egg freezing: injections to stimulate my ovaries, a surgical retrieval of the eggs. Egg freezing stops there; for embryos, the eggs are immediately fertilized in a lab with a fresh or frozen sperm sample.

In the classroom, a nurse explains the process with the aid of a PowerPoint presentation and some YouTube videos that show a well-toned woman in a sports bra giving herself abdominal injections. There are about 25 people in the room, taking the class with us: some are couples. Some are women on their own. We all watch in silence.

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E makes it nearly to the end of the presentation without any jokes, but then the nurse brings out the fake ass. It’s a disembodied torso: Caucasian in hue, made of some kind of foam, it starts at the waist and ends mid-thigh. The nurse solemnly carried it around the classroom so that people can practice the “trigger” shot, which involves a bigger and scarier needle than the other injections, and is intramuscular, which is to say – it goes in the buttocks.

Would anyone like to practice a trigger shot? the nurse says, and E’s hand shoots up.

Stop being so enthusiastic, I whisper.

When the fake ass comes around to us, we can see that the spot where the shot is meant to go has been worn away by hundreds of other first-timers and their shaky hands. I also have to suppress a giggle when I plunge the needle in.

When I sit back down I look over at E’s papers. He’s drawing the fake ass and a large needle. He labels the picture: Jean.

I told you not to make jokes! I say.

I’m not making jokes, he says, I’m taking notes.

This week I learned: “Live births” is the data point that medicine uses to measure the success of IVF treatment.

Jean Hannah Edelstein is the author of the forthcoming This Really Isn’t About You

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