VOGUE
INCONCEIVABLE CONCEPTION
December 1994
Photographer: Mary Ellen Mark

When Pam's husband, Manny, was killed in a car crash, she thought her world was over. Then there was hope: A new solution to male infertility might enable her to bear his child. Steve Fishman reports on the intersection of medical technology and human tragedy.

Pam Williams knew that she and her boyfriend, Manny Maresca, were scheduled to take the same three days off from waiting tables the following week -Wednesday, Thursday, and Friday. And Friday night they had tickets to the Pink Floyd concert. So when Manny nudged her out of a nap before a double shift and proposed to her, Pam thought, OK, we can get married Wednesday night, May 4, relax Thursday, go to Pink Floyd as a kind of honeymoon on Friday, and be back at the restaurant on Saturday morning.
 
So what if they were only 22 and had met at the restaurant only eight months before? ("Why so soon?" Manny's mother blurted out. Pam was glad that Manny piped up, "I just love Pam, and I just want to be married to her." No, Pam wasn't pregnant. She felt certain. Months before, she'd called her mother in upstate New York. "I've been seeing this guy for a week, and already I'm head over heels in love with him," Pam had said from Orlando.

It wasn't for lack of options. Pam is pretty, smart, fun. Other boyfriends, though, hadn't been affectionate, or even really attentive. Manny seemed to study her. If she wore perfume, he'd say, "You smell really nice." He wasn't cheesy. He genuinely meant it. He picked flowers for her, wrote her poems. In a past romance, Pam and her boyfriend had gone out separately, each with his or her own friends. Manny and Pam did everything together. They cut each other's hair. They even got the same tattoo -a Japanese symbol that means "to love." ("They were one of those couples you just know are really, really in love," a friend says. "Every time you saw them they were laughing, smiling, holding hands, or kissing.")

And if Pam dreamed something up, then Manny fell in line, maybe went even further. "Wouldn't it be nice if we had a Jacuzzi to kick back in, pop open a bottle of champagne, and just chill?" Pam said one hot Florida night after work.

"Put a bathing suit on," Manny said.

"What do you mean?" she said.

Manny insisted. Then he led her to an apartment complex where they sneaked into a Jacuzzi, drank the champagne Manny had brought along and enjoyed the stars.

Pam had pretty much earned her own way since she was seventeen. She'd moved out of her parents' house when she was eighteen, traveling to Florida because of the awful New York winters and an idea she had about vast opportunities there. "I hated where I lived," she says. She didn't know anyone but the friend she moved down with. "I develop friendships quickly," she says. She enrolled in a community college, got two jobs. "I'm not afraid to get my hands dirty," she says. She was proud to be self- sufficient. If someone was 26 or 27 and still lived at home, she suspected laziness. Pam was ready to plunge in. One week's engagement was plenty, she thought. Manny's mother, a notary public, could marry them. Pam's family wouldn't be able to travel from New York to Florida on such short notice, so she'd have to find someone else to give her away. She asked a friend, the bartender at work.

"Really?" he said. "But I've got school."

"Miss school," Pam said.

Tuesday, the day before the wedding, so much preparation was still needed that Pam got someone to cover her shift at the restaurant. She and Manny bought groceries, the flowers, the rings. They picked up the marriage license. Tuesday night Pam got a great antique-white-colored slip dress. Her blond hair was cut in a bob and buzzed in the back -Manny did that part- and everyone said she looked beautiful. (Her only regret was that the dress was cut so low that the tattoo on her left breast peeked out.) Wednesday, the day of the wedding, they bought Manny's suit. He was a six-footer with curly red hair, which for a while he patiently straightened with a blow dryer. He wore suspenders and shaved his sideburns so they curved toward the corners of his mouth. When he smiled, his broad features fell into place, and he turned handsome. Pam's brother was able to make it down from New York. Manny's aunts were there, most of them, it seemed, wearing flowered dresses. The ceremony was held in the yard of Manny's parents' house. A portable CD player was brought out. "The Rose" played in the background. Then Manny, an honors student in creative writing at the University of Central Florida, read aloud a speech he'd written to let everyone know just how much he loved Pam. "It astounds and amazes me that you are human, for in my eyes you are everything that has ever been and everything that will ever be," he said. "You are everything. That is really the only way I can explain it. You should have been a planet or the sun or the moon, or something, anything huge and heavenly that everybody should look at."

In his office, decorated with silk flowers and brochures entitled "Infertility, the Emotional Roller Coaster," reproductive endocrinologist Mark Jutras, 39 and gray haired, wears Top-Siders and goes tieless. Someday, he says, he's going to have a motto done up in Latin: LOVE IS DANGEROUS. He means that people go merrily along until they fall in love. Then they start asking the doctor to do unusual things. What he doesn't mention is that he loves those requests. They keep his practice -helping couples conceive using in vitro fertilization and other high-tech methods- from becoming routine. Not too long ago, for instance, a lesbian couple called. Could he fertilize both of their eggs with sperm from the same man, then put each woman's egg into the other's body, so they could carry each other's genetically related babies?

"That's a great idea!" Jutras responded with excitement. "That would really work!" (Eventually he declined. He could never get it through the ethics committee.) He can, though, cite other out-of-the-ordinary solutions. A 23-year-old woman had tumors on her uterus. Other doctors had recommended hysterectomy, but she wanted a baby. Jutras removed 20 tumors, leaving her uterus intact. Three months later she was pregnant.

For Jutras, the body is capable of endless manipulation and, through manipulation, repair. What he asks himself is this: "Can I get what she wants done, done?" Usually, Jutras says, "I look at it and say, 'Yeah, I can get that done."

Recently Jutras had begun to work on men with extremely dysfunctional sperm-delivery systems. Urologists weren't much interested, but Jutras figured it was a means of learning more about severe cases of male infertility. (About 40 percent of the couples who can't get pregnant easily can trace their problems to deficiencies in the man's reproductive system -either in his ability to produce numerous, good-quality sperm or in his ability to deliver them.) Jutras concentrated on paralyzing injuries of the spinal cord. The medical challenge is to make these men deliverers of usable sperm.

One promising approach involves an electro-ejaculation unit -essentially a modified cattle prod-designed by a vet. The unit fits into the rectum, pushes up against the prostate, and delivers an electric shock to the pelvic muscles, tapping into the reflex pathway that produces ejaculation. It's approved by the government for experimental use only. Jutras also had a $2,500 vibrator that fit into the palm of his hand. He could place it under the head of the penis, where its tiny jackhammers might trigger the ejaculatory reflex. On Thursday, May 19, Jutras had his first success with the vibrator. The patient was a 38-year-old man who'd broken his neck in a motorcycle accident nineteen years earlier. "He was like a 16-year-old," says Jutras. "Five seconds and then an ejaculation." Jutras lent the man and his wife the vibrator to take home for the weekend.

On the next afternoon, when a call came asking whether he could harvest sperm from a dead man, Jutras understood the request as only a fertility doctor could: an extreme case of male infertility. (Obviously, a dead man can't produce healthy sperm, nor can he deliver the sperm his body has produced and stored.) Jutras was told that the widow not only wanted a sample of sperm, but wanted enough so that she could have her dead husband's child, something that had never been done before and as recently as two years ago would have been out of the question. But radical improvements in standard in vitro fertilization techniques-the "test tube baby" procedures that once seemed so stunning-were permitting doctors to fertilize a woman's egg in the lab with nothing more than a handful of sperm or, in some cases, just a single sperm. Jutras thought there was a chance he could help.

As he put it, "I would be willing to stay all Friday night to get it done."

In the case of the dead man, of course, the first challenge was how to
extract even one sperm. And a sperm bank would be needed to store a recovered sample, another hurdle on a Friday afternoon.


221M-032-009
Manny Maresca’s mother, Leslie, pictured here with her two-and-a-half-year-old daughter, Maia, says that even though her firstborn left no will, she’s sure he would have wanted a child with Pam.

On May 9, five days after Pam and Manny's wedding, a sperm bank opened in a drab strip of offices in a suburb of Orlando. United States Cryobanks is owned by Dwight Brunoehler, a former spokesman for Southern Bell Telephone Company, former sales manager for the Yellow Pages, former jewelry store owner. "My philosophy is," says Brunoehler, "if you can turn something for a profit, turn it, and then do something else. There's a lot of other fun things to do out there." In this venture, he'd been inspired by his fiancée, the office manager of a local fertility clinic. "You know, every day we get calls for sperm-storage facilities," she'd told him, "and every day we send them out of state because there's nobody around here."

Brunoehler, 44, has a deeply tanned face, an unwrinkled forehead, and an easy manner. He knew nothing about sperm banks, but he'd been an entrepreneur in the watch and the weapons businesses. And he is a salesman. A little research at the local library revealed that with fewer than two dozen independent commercial cryo-banks in the country-and none in Florida-sperm storage was a business opportunity. Say a guy is going to have a vasectomy and wants to store some sperm, just in case. (Or, as with another case that came Brunoehler's way, say a guy is in prison and wants to store sperm so his wife can have a baby.) The nearest commercial sperm-storage facility was in Atlanta. Brunoehler figured he could charge $300 to $500 for the first year and $125 for every year after that. Customers would save the $100 cost of overnight shipping to Atlanta.

Brunoehler found an investor, put in $100,000 of his own money, hired a lab manager, outfitted an office suite with soundproof "collection rooms" (featuring leather divans and porn videos), and started buying equipment. He purchased a Thermadyne Locator 4, a waist-high, two-foot-wide container that looks like an industrial vacuum cleaner on wheels. Inside is liquid nitrogen, 198 degrees below zero. Open it, and nitrogen vapors slowly drift out. Legend has it that if you drop in one of the rubbery lizards that scamper over Florida's sidewalks-as nitrogen-delivery guys sometimes do-it freezes midstride. The real kick, though, comes when the lizard thaws: It will scurry off. The tank could store 3,000 vials of sperm, preserving their potency, theoretically, for several hundred years. So far, one baby was produced sixteen years after sperm was frozen.

Thursday, May 19, was one of Pam and Manny's scheduled days off. They always took their days off together. Someone, though, had gone on vacation and Manny had picked up the Thursday shift to earn extra cash. Then a waitress offered to swap with Pam.

"Manny," Pam said, "we'll have Friday and Saturday night to do something together."

"That's awesome," Manny said.

"Oh, my God, what are we gonna do?"

Manny had an idea. "We'll go out to dinner with these friends of mine I haven't seen in a while."

"OK, cool."

They couldn't wait to get out of the restaurant that night, but Manny had one table that had pitched a tent. None of the other waiters or waitresses could vacuum their stations. Eventually the manager decided not to hold everyone up. "You all go home, and Manny and Pam will vacuum your stations," he said.

"Well, thank you," Pam thought.

When they got out at 11:30 P.M., it was raining. In May in central Florida, it pours briefly and frequently. They drove Pam's 1994 Honda Civic-a repo with 17,000 miles on it that they'd purchased the night before- across the street to a 7-Eleven and bought banana-flavored milk and fresh-baked cookies for the 45-minute ride home.

In the car, Pain said, "We can pay this car off in five years and then keep it long enough to teach our kids how to drive." They talked about starting a family the next year, after they bought a house. They planned to start looking in six months. They had it all worked out -house, kids. Pam could return to school to study wildlife ecology. She had two years of credits; she wanted to finish.


221M-041-004
Dwight Brunoehler, president of United States Cryobanks, a sperm-storage facility in Orlando, was the Maresca’s only hope for preserving Manny’s sperm.

Pam read the instructions in the owner's manual to preset the radio stations. She switched on classical music.

"What are you doing listening to this classical shit?" Manny joked.

"Isn't it relaxing?" Pam said.

Pam put the manual back in the glove compartment and dropped something. Manny glanced at her. The car was headed around a curve. The road was slick from rain.

"Oh, shit," Manny said. The car crossed into the oncoming lane of State Road 426. Manny slammed on the brakes and tried to swerve back into the right lane. The car fishtailed. Pam heard scraping, glass and metal, a tearing sound that seemed to go on forever until the car crashed into a telephone pole on Manny's side, turned over, and came to rest on Pam's side. The airbags hadn't inflated. For an instant, they hung from their seat belts. Manny seemed to lean toward Pam, his arm draped loosely across her lap. Pam wasn't hurt. She called to Manny; there was a gurgle in his throat. She pushed her way up, crawled out a window, and called for help.

It was perhaps easy to believe that Manny had just bumped his head and would be out of it for a little while and then back with Pam. Overnight at Orlando Regional Medical Center, the number of family and friends feeding off that hope grew to 30, including a good chunk of the wedding party. By noon the next day, however, Manny's body had started to swell. His face turned a bruised purple. The doctors said they'd run a few more tests, though it sounded to Pam as if they already knew the results. Pam thought, "He isn't coming back to us."

"Too bad you're not pregnant," Pam's mother-in-law remarked. Pam lay on the couch staring blankly. Hours later Pam approached her sister-in-law, just ten months younger than Manny. She'd been considering something: She and Manny had both loved kids so much and both loved each other so much. Pam said to her sister-in-law, "I don't want anybody to get offended. I don't want anybody to think that I'm not thinking positive, but I really want to, before it gets too late, I want to see if I can get some sperm frozen."

"Oh, my gosh, what a good idea."

A couple of neurologists reported that they'd done a few more tests and were going on and on when Pam interrupted them. The family had already agreed to donate his organs. Now Pam wanted to know: "Do you think it would be possible to get a sperm sample taken?"

The doctors looked at each other. "No one's ever asked that question before," one said, "but I'll find out."

Pam had heard of people freezing sperm all the time. "I didn't know it was a big deal," she said.

At 1:55 P.M. on Friday, May 20, Manny Maresca was declared dead. Soon after, Jutras got the call from TransLife, an outfit that arranges organ transplants, asking whether there was a way to save Manny's sperm. Jutras wished he could try the electro-ejaculator, but without government approval that wasn't possible. He did have the vibrator, though -or at least he knew where it was. The vibrator had worked only once, the day before. The quadriplegic man he'd lent it to lived an hour away. A messenger was sent.

Shortly after 5:00 P.M. in an intensive care room at Orlando Regional Medical Center, Jutras held the vibrator under the tip of Manny's penis. A worried nurse shot around the room. "Are we going to retrieval or not? Come on," she said. If a body goes too long without oxygen, its organs become useless. A respirator was still pumping the heart, lungs, liver, and kidneys with oxygen, but it was getting more difficult to support him. Jutras capped the vibrator to the penis. There was perhaps a slight stiffening. A few drops of liquid emerged. Jutras put them on a glass slide and sent them off to the pathology lab. A few minutes later they sent back their report: The sample contained no sperm.

Sperm might be retrieved from the epididymis, a tube that looks like a three-foot-long strand of spaghetti wound into a ball. (Sperm are stored there for up to six months.) A microneedle might suck sperm out of the coiled tubing. This procedure, though, was complicated to set up and delicate to execute. In a dead man, it was unnecessary. During a fellowship year in the lab, Jutras had removed the epididymides of rats, put them in a lab dish, chopped up the tubes, and let the sperm swim out-and found mature sperm capable of fertilizing an egg. Jutras thought, "We can cut the epididymis. That will work." He made his way to the operating room.

United States Cryobanks' Brunoehler agreed to send his office manager to the hospital to collect the sample, which was supposed to be a straightforward one. Stick the sperm in a centrifuge, separate out the impurities, plunk the filtered sample into the liquid nitrogen like any of the other 3,000 samples the Locator 4 could hold. That was supposed to be the procedure. When Brunoehler heard that he would instead receive a chopped-up epididymis, he thought, "We've never dealt with that before. We don't know what to do." Brunoehler didn't even really want to be in the sperm-storage business. ("Believe me, there's no money in storage," he says. "The donor business"-selling sperm and eggs from donors-"that's where we see the money being made.")On the other hand, he'd already agreed to keep the lab open. He knew that without storage, retrieving the sperm was a waste of time. And Orlando had only one commercial storage facility. "We were the Marescas' only alternative," he said. And he realized something else. Getting name recognition for a new venture was often a long, slow process. "This does bring some attention to the business," acknowledged the former PR man.

"You go last," Jutras was told. The general surgeons moved Manny's body onto the table for retrieval: the valves of the heart, the corneas, the pancreas. Jutras paced, warming his tiny glass specimen vials in his pocket. Four hours later, at about 10:30 P.M., the surgical team prepared to head home.

"Hey, guys, I'm still here," Jutras said. "We've got to do this part."

"Oh, yeah," said a general surgeon. "What do you want?"

He told the surgeon to make an incision in the scrotum and remove the contents -the fat, the connective tissue, the testes, the epididymis- and hand them to Jutras in a bowl. Jutras removed the connective tissue. Blood will destroy sperm, so Jutras worked to get the sample free of traumatized tissue. He snipped out the epididymis and let the ball of tubing fall into his little jar. With scissors and then a scalpel he minced the epididymis.

Something, he noticed, was in his light. Jutras looked up. A half dozen people were standing around him. "We've never seen anything like this before," said a doctor.

"Neither have I," said Jutras.

On Monday, May 23, Pam attended the funeral; so did 300 others. Every flag in Titusville, Manny's hometown of 50,000, was at half-mast. His parents have an auto-repair shop there. The town had watched Manny and his five siblings grow up. Pam thought about the headstone. Manny had always wanted their song to be "The Rose." Pam would have the last lines engraved. It would say, here "lies the seed that with the sun's love in the spring becomes the rose." The day was exhausting, and when she was finally able to get through to Brunoehler, he began explaining about the first sample that they'd tried to get with the vibrator, and then about the new procedure they'd tried with the epididymis.

I don't care, Pam thought, and then she said, "Did you get a good sample? Can I use it?"

"Yeah."

"Oh, God, thank you. This is just what I needed to hear."

Brunoehler wanted to talk a little longer; perhaps he wanted to share his excitement. But Pam was anxious to hang up.

Gathering her friends and in-laws into the living room of the house where she'd been married nineteen days before, Pam told them everything Brunoehler had said.

"We've got a chance for Manny to live on," she said. "It's going to happen and it's going to work." Everyone cheered and clapped.

Weeks later, Jutras learned that fifteen years before, another doctor had published a short case report on the same epididymis removal. The 30-year-old donor had also died in a car accident. He wasn't married, had no fiancée, but his family had asked to harvest sperm. "Lessening grief and offering alternatives remain my priorities," the doctor wrote. Back then, any argument about how the sperm should be used was moot. Infertility treatment was in its infancy. As the editor of the journal Fertility and Sterility pointed out, this was "an interesting exercise."

By the time Jutras repeated the exercise, the state of affairs had dramatically changed. Since the first test-tube baby was born in 1978, 40,578 kids around the world have been conceived through in vitro fertilization techniques -the oldest are in high school. (To date, more than 25,000 births have been recorded of babies conceived in a U.S. lab.)

The logic of in vitro fertilization is simple: Reduce the work of the sperm and the egg. During intercourse, sperm must whip their tails in order to swim perhaps eight inches to the waiting egg. It's a great distance for a sperm, which is one five-hundredth of an inch long. If the sperm were a person, this journey would be like swimming more than four miles. And the swim takes place in an inhospitable environment; the sperm are threatened by acids, currents flowing in the wrong direction, the woman's immune defenses. Neither are sperm favored by chance, since half will swim into the fallopian tube without the egg, or by time, since they are potent for only 48 hours. Of the hundreds of millions of sperm that set off, perhaps only hundreds find the egg.

In vitro fertilization techniques remove this process from the work-intensive environment of the body and place it instead in the calm, controlled atmosphere of the lab. In standard in vitro fertilization, eggs surgically retrieved from the woman's body are placed in glass dishes, and healthily swimming sperm -50,000 to 250,000 per dish- are dumped in. Thousands of sperm penetrate the gel-like casing of the egg, called the zona pellucida. One, it is hoped, will wiggle all the way through the egg's inner membrane to the cytoplasm, in whose nucleus the genetic information is stored. If all goes well and the egg is fertilized, it's put back into the woman's uterus. If it implants in the uterine wall (only 10 to 15 percent do, which is why doctors work with multiple embryos), pregnancy begins.

This approach works about half the time. But if the sperm population is reduced or if they are less than vigorous swimmers, this standard technique is virtually hope1ess. And the cost is nearly prohibitive at $7,500 to $10,000 a try. Only in the past few years have doctors been able to up the chance of pregnancy in cases of extremely deficient sperm count. The strategy builds on the straightforward logic of previous techniques: Do the tiresome physical work of the sperm for them. "One procedure has been a bridge to the next," says Carolyn Givens, a reproductive endocrinologist at the University of California at San Francisco, a leading fertility center.

An early idea was, working under a microscope, to simply create a slit in the zona pellucida with a glass needle. Another idea, called zonal drilling, involved squirting an acidified solution on the zona, which actually made holes in it, little entrances for sperm. The next thought was to inject sperm under the zona. Four to ten sperm were sucked, tail first, into an extremely thin glass needle. The doctor chose the sperm that seemed, to the microscopically aided eye, the most normal in shape. (They didn't, for instance, have two tails or two heads.)Piercing the zona with the sharp, angled end of the tube, the sperm were deposited just under the zona, next to the egg's membrane. It was hoped that one sperm would wiggle through the membrane and into the egg's cytoplasm. This was called SUZI, or subzonal insemination, and by 1988 it had produced its first baby. By 1993 Gianpiero Palermo of Cornell Medical Center reported that he'd fertilized 18 percent of the eggs into which he had subzonally injected sperm.

Clearly the next reasonable step was to inject a sperm directly into the cytoplasm. There was only one problem. It didn't work. In 1988 intracytoplasmic sperm injection, or ICSI, was reported to be unable to fertilize an egg. Palermo changed that. "It was an accident," he says today. He was fertilizing eggs with SUZI. In one egg, he happened to inject just one sperm, and he happened to get it into the cytoplasm. It fertilized the egg. "It aroused a suspicion," he says, "so then you try to do more eggs." Palermo suggests that the difference may have been a couple ten-thousandths of an inch in the glass needles he employs. His are extremely narrow: The opening is 0.00020 of an inch wide; the head of the sperm is 0.00014 of an inch wide, a difference of about six hundred-thousandths of an inch. (A human hair is huge by comparison, ten times wider than the opening of the needle.) Soon Palermo was able to fertilize about 60 percent of the eggs he injected using ICSI, a vast improvement over SUZI, which it has now virtually replaced.

A team at the University of California at San Francisco reported its first pregnancy using ICSI this summer. At Cornell, Palermo has achieved 22 births by ICSI. "It certainly opens the possibility to men who couldn't even hope to become fathers," Palermo says. Even, it would seem, to dead men.

Only 30,000 to 40,000 sperm were retrieved from Manny. ICSI is Pam's only hope. In September, Jutras attempted an ICSI procedure for the first time. The patient had 2O moving sperm, virtually nothing. Still, his sperm were able to fertilize five eggs. "ICSI is the great equalizer," says Jutras.

Pam, when I finally meet her in August, is living in an Orlando apartment complex not far from the airport. Along the road are other developments: Wimbledon Park, Winding Creek, bucolic names for arrangements of standardized units you have to search for by number. Pam is settled in with three roommates, young women who politely cross a large living room coming from or going to work. The furnishings are sparse, mainly electronics. Pam sits on a small pillow on a futon frame-the futon has been dragged into a bedroom. She appears to be wearing two outfits, white shorts and a black tank top and, over that, a lime-green tunic that she proudly bargained $5 off of in Oswego, New York, her hometown. As she pulls her knees up, her tunic tents. The edge of her tattoo peeks out. She smokes -took it up again the night of the accident.

She's back waitressing at the restaurant, which has been the stable element in her life for the past year. She's not weepy or out of control all the time now; she's been through that, she says. She hopes to make another life for herself and is kicking it off with junior college this fall. She even thinks she'll be with someone else someday. "I hope so! I mean, honestly, I don't want to spend the rest of my life alone," she says. Clearly, though, the center of her emotional life is still Manny, the man she was married to for sixteen days. "I know it's going to take a long time to find anyone to even compare," she says. "Right now I can't imagine myself with anybody else."

She lives near her mother-in-law. "Normally she calls me every day," Pam says. "It's weird if I don't talk to her. We're really close."

Her mother-in-law, Leslie, who recently turned 42 (one day before Pam turned 23), agrees. "At first," says Leslie, "Pam was the only one I wanted to be around. I felt compelled to spend all my free time with her. We're very, very alike. She truly adored my son. That's all I wanted for him. It's been really hard. It's been a blessing having her."

Manny is a strong bond between them, as is, of course, the thought of Manny's child.

A medical ethicist might argue that one person can't decide to bring someone else's child into the world -even if that one person is a dearly beloved wife or mother- without express consent. "Is he, dead, simply bits and pieces that can be used to fulfill others' rational desires?" asked ethicist Judith Wilson Ross of University of California, Irvine's School of Medicine, about a similar case. "Surely not."

Legally, there are few precedents. "This is basically uncharted territory" is the cheery summary of Susan M. Wolf, associate professor of law and medicine at the University of Minnesota Law School. This area of law has recently gotten a title-posthumous reproduction, or, as Wolf says, 'making babies after you're dead." But so far only one case has ended up in court. A California man died and willed his stored sperm to his girlfriend. His ex-wife contested the will-she had heirs to protect. The court ruled in favor of the man's will, and thus for the girlfriend.

Manny left no will. What did he want done with his sperm?

"My son loved Pam and he loved children," says Leslie. "This is what he would have wanted. I know it." Leslie's expression has an equation's solidity. Is it enough? There is more. Leslie had six kids who ranged in age from 2 to 22, and Emanuele was her firstborn. They talked every day. Everyone said he was her favorite. She believed in him. "He had it all," Leslie says, which leads her to say, "It's so important that this intelligence and humor are carried on. That's why it is so important that this baby is born." It is possible to wonder, though, whom it's important for. The world? The family? Pam? Or as consolation for a mother's grief in having, as she says, "lost the greatest gift we've ever been given"? What if Pam decides she does not want to have the baby of a man she'd only had a chance to love for eight months?

Manny's mother is conflicted. She loves Pam but knows, too, she'd be devastated if Pam backed away. "We want this baby born at all costs. It would be upsetting if she didn't; that was the game plan. If Pam decides never, we will support her. It doesn't rest on her shoulders. I'm not telling her one way or the other." Then she adds, "We're hoping she has his baby."

Nothing, of course, gets done without the cooperation of the sperm bank and the doctor. Brunoehler has no ambivalence about this. "Sperm is a piece of real property, like a car or a house," he says. And Pam, as far as he is concerned, is the owner. Jutras points out that single women already qualify for fertility-treatment programs. "The way I look at Pam's case," he says, "she'd just be a single woman with an unusual source of sperm."

"I would not have a child to make someone else happy," Pam says staunchly. It seems reasonable to wonder, though, how rational a choice she can make. "We have a chance to make Manny live again": Those words -Pam's words the day of the funeral-must ring in her ears, along with the applause.

"I can't wait," Pam says from the bare futon. Her eyebrows purse. "I love kids. I want a kid. I want kids," Pam says with the rhythm of a train building speed, "and I wanted kids with my husband, and l wanted to raise them with him, but if that's not going to be a possibility, then I can still have his kids and raise them knowing who their father was and what a wonderful person he was. And I think that's great." She says she's not afraid to be a single mom, not worried about how that might affect her chances of marrying again, which she clearly wants. She says that sometimes she simply wants to bring this part of her life to a conclusion.

For Pam, the greatest hindrance now seems to be money. She says she wants to wait until she feels financially stable enough to support herself and a child, which includes, of course, being able to foot the exorbitant cost of having a high-tech baby. Pam doesn't have health insurance. She’ll have to come up with $lO,OOO to $20,000 and that's with Jutras offering his services for free.

Ironically, it may be more financially advantageous to have a kid soon. Pam has already had offers for the foreign rights to the baby pictures. And the possibility of a TV movie would be enhanced if she were a mother -she's been approached by several companies. And she's in debt. She owes for the funeral and $4,500 on the Honda she owned for one day. She also owes Brunoehler, who charged $2,125 -four times the normal fee.

"By 25," the 23-year-old Pam says, she'll get pregnant. Jutras, for one, is happy to wait. "As long as the sperm is in the freezer," he says, "we always have the potential for getting a pregnancy." You can't refreeze a specimen. "If we pull it out and don't get a pregnancy, the potential is lost." By spring the hormone Pam used for birth control, Depo-Provera, will be flushed out of her system. Then Jutras could, if Pam wants, trick her ovaries into superovulating -producing perhaps 20 eggs at once- and attempt to fertilize her eggs with her late husband's sperm. There are many hurdles here. Pam has never been pregnant and has never had her own fertility evaluated. Who knows how many eggs can be harvested from her body, how many fertilized, how many implanted? But if it works, it will be the first time sperm retrieved from a dead man have enabled a woman to conceive a child, which sounds strange, but isn't, not in the realm of the many strange things reproductive endocrinology is now making possible.

Leslie, for instance, has considered that if Pam decides not to "help Manny live on," for whatever reason, then, worse comes to worst, using donor eggs, she says, "I could carry it" -a mother carrying her son's baby. Pam thinks perhaps this is just Leslie's grief talking. But maybe this is the trouble with technology. It could make life out of a mother's grief, a newlywed's loss, feelings that might more appropriately be talked out on a psychiatrist's couch. Maybe love in an age of assisted reproduction is dangerous.

END