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While Lori was in the operating room, Bill was picking up his sperm at the Repository and bringing it to the fertility center. "All I had to do was take my sperm over in a little suitcase," Bill later cracks. "She did all the work."
Lab technician Fred Miller slowly thawed Wetzel's sperm in stages, in the same way the sperm bank froze it in stages. At the same time, Graubert handed the eggs to Miller through a window in the operating room. It was time for the Big Moment.
In standard IVF the eggs and sperm mix together on a petri dish, and nature takes its course: The sperm swims to the egg and penetrates the outer core. But in the Wetzels' case, because the sperm count was low, the couple decided to use a five-year-old procedure called ICSI (intracytoplasmic sperm injection), which cost an extra $2000. In this procedure doctors help nature along a little.
Miller sat in front of a large microscope atop a 1000-pound table to ward against potential vibrations and began his lengthy "video game." Joysticks attached to motorized robotic arms stick out of the sides of the microscope. One robotic arm has a miniature needle attached; both have suction. Miller stuck the petri dish containing the eggs and sperm under the microscope's magnifying glasses. With the left joystick, he suctioned the egg to keep it in place. Then he located the fastest-moving sperm and used the other joystick to suck up those sprinting sperm and push them over to the egg. Pushing a button on the joystick, Miller injected the sperm inside the egg wall. He repeated this process 14 times, for each of Lori's 14 eggs. It took an hour and a half.
Over the five years Miller has been using this apparatus, he has grown quite adept, says Graubert. "He's probably very good at pinball games now," the doctor laughed.
Miller then stuck the petri dish in an incubator, where it was kept at body temperature -- 37 degrees Celsius -- and humid, as in a uterus. He left the dish overnight so the sperm and eggs could get acquainted in peace. Upon arriving at work the next morning, the first thing Miller did was check the petri dish to see if the cells had divided -- the sign that fertilization had occurred.
He's been working in IVF for 18 years, practically since the beginning, but Miller still calls the process "a miracle" and revels in his godlike role as an eyewitness to the most wondrous event in the history of the world: the creation of human life.
"When I see a one-celled thing and then a woman walks in with her baby nine months later, that's the greatest high," he says.
Lori, sore after the egg retrieval and home from work, got a call from Graubert the next day. "The eggs are splitting," he said.
The couple decided to push the technological boundaries even further by using a procedure called blastocyst transfer. The method is brand new; the couple was the first in South Florida to use it. In traditional IVF, when the embryo reaches three days and has eight cells, it is ready to be implanted in the woman. In blastocyst transfer embryologists add a sugary solution to the petri dish and wait until the embryo is five days old and has 50 cells. At that point the embryo's genes have been "turned on" -- it is now a separate entity with DNA and protein, an amalgamation of the egg and sperm. These advanced embryos have a much better chance of lasting the full term. For that reason doctors have to insert only one embryo in the woman, whereas in standard IVF doctors would typically insert many more to ensure that at least one reaches full term. An added benefit of blastocyst transfer: It eliminates the possibility of triplets or quadruplets.
Lori did well; seven of her embryos survived to the fifth day. Graubert implanted two in her uterus, using a five-inch catheter in a simple and painless procedure. Why two? Most patients find twins acceptable, and -- as calculating as it sounds -- they get more bang for their buck: two kids for the price of one. Five embryos were left over, which Graubert froze for future use. The embryos are safe in his liquid nitrogen mini-freezer forever, insists Graubert -- what happened at the University of Miami cannot happen to him. There, something went wrong with a freezer and an undisclosed number of embryos were ruined. A Weston couple filed suit against the university in June, claiming the school stole their last chance to have a biological child. But Graubert has a newfangled alarm system built into the unit that is hooked up to a computer and actually beeps him when the temperature rises.
After the implantation Bill and Lori played a horrible waiting game for 11 days, waiting for a blood test that would confirm that Lori was pregnant. The couple could have bought a home pregnancy test but Lori decided, "I'm going to leave this in the doctor's hands." She told Graubert to call her and her husband together at 5 p.m., when Bill would get home from work. But she couldn't wait, she was about to burst. So she called the doctor back and said, "Call as soon as you know." At 10:30 a.m. Graubert, with his entire staff on speakerphone, called. They all played a part in the pregnancy of their first patient, all knew Wetzel's courageous story, and all wanted to share the good news with Lori.