FAIRFAX, Va. — Chad and David Craig fidgeted in the waiting room like expectant fathers, which is, after all, what they were.
Just down the hall, in a sterile surgical suite, a young woman they had met only once had her legs up in stirrups. Dr. Suheil J. Muasher, a fertility specialist, gripped a long silver needle between his right thumb and forefinger and twirled it gently as he guided it through her vaginal wall and into her right ovary.
"It's full of follicles," he said approvingly, glancing at an ultrasound monitor to track the needle's path.
The follicles showed up on the screen as black blobs. Each contained an egg the size of a dust particle. As Muasher punctured the first sac, he stepped on a foot pump and suctioned it until it collapsed and disappeared. Fluid the color of fruit punch streamed through a catheter attached to the needle and into a test tube.
The fluid was spirited into an adjoining lab, decanted into a dish, and examined under high magnification by one of Muasher's embryologists.
"Do you have anything?" the doctor called.
"I have a first egg," his assistant announced. She transmitted an image resembling a star cluster onto a monitor in the operating room. The anesthesiologist, Dr. David C. Yarnall, couldn't resist. "Looks like it's sunny side up," he said.
The date was Oct. 9, 2004, and Chad and David had been awaiting this moment for nearly two years. It was the first significant medical step in their unconventional quest to become fathers, an undertaking that would have been inconceivable a few years earlier.
As gay men trying to produce genetic offspring through a gestational surrogacy arrangement, Chad and David had invested their hopes and their savings in the primacy of technology over biology.
They knew from years of research into assisted reproduction that success was never guaranteed. And their process would have more moving parts than most. They were paying one woman to provide her eggs, and another to carry their artificially inseminated embryos to term. To make it all happen, they had assembled a team of doctors, nurses, embryologists, technicians and lawyers. Things could go wrong at any stage, and Chad and David would have little control over events beyond playing the odds.
At the moment, none of that mattered. After months of planning and anticipation, it felt to them like Christmas morning.
"We are absolutely on the edge of our seats," said Chad. "The process is such a test of patience. Tons of waiting and then quick and short bouts of intense progress. I am guessing it will just hit me all at once that we are finally about to be pregnant."
Their fate now depended on the intricate choreography Muasher had directed by prescribing various fertility drugs to stimulate the egg donor's production, synchronize her reproductive cycle with that of the surrogate, and prepare the surrogate's uterus to accept an embryo.
They knew their egg donor only as Jessica, but their dreams of building a family relied heavily on this near total stranger. She was single and 25, in her egg-producing prime, but she had never been pregnant or donated eggs before.
For the previous three weeks, at Muasher's direction, Jessica had injected herself daily with hormones. Each morning, she numbed one of her hips with an icepack and jabbed it with Lupron, a synthetic formulation that prevented her from ovulating until the desired moment.
At night, she gave herself two shots that stimulated egg production — Follistim (derived from the ovarian cells of Chinese hamsters) and Repronex (extracted from the urine of postmenopausal women). In addition to bruising from the injections, Jessica suffered side effects like sleeplessness, headaches and bloating that sometimes forced her to unbutton her jeans.
Muasher carefully monitored her hormone levels and follicle development through regular blood tests and sonograms, and tweaked the dosages accordingly. The adjustments were critical to warding off a rare but dangerous condition known as hyperstimulation, which could lead to renal failure or blood clots.
"It's more of an art than a science," Muasher explained, "because people respond differently to the medications." Indeed, he had tried to treat Jessica conservatively, but based on her sonograms he projected she would yield at least 20 eggs, well above average.
Precisely 35 hours before Muasher planned to retrieve the eggs, Jessica gave herself a final "trigger shot" of yet another hormone that would prepare her follicles for ovulation. The timing of the procedures was calculated so that the peak of her egg maturation would dovetail with the priming of the surrogate's uterus for maximum receptivity.