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According to Quigley, the chances for pregnancy are best when the eggs are retrieved during the three-to four-hour period when they are fully mature. At Bourn Hall, women remain on the premises, waiting for that moment to occur. Each morning, Steptoe, now 71 and walking with a cane, arrives on the ward to check their charts. The husband of one patient describes the scene: "Looking at a woman like an astonished owl, he'll say, 'Your estrogen is rising nicely.' The diffidence is his means of defense against desperate women. They think he can get them pregnant just by looking at them."
When blood tests and ultrasound monitoring indicate that the ova are ripe, the eggs are extracted in a delicate operation performed under general anesthesia. The surgeons first insert a laparoscope, which is about ⅓ in. in diameter, so that they can see the target: the small, bluish pocket, or follicle, inside the ovary, where each egg is produced. Then, a long, hollow needle is inserted through a second incision, and the eggs and the surrounding fluid are gently suctioned up. Some clinics are beginning to use ultrasound imaging instead of a laparoscope to guide the needle into the follicles. This procedure can be done in a doctor's office under local anesthesia; it is less expensive than laparoscopy but may be less reliable.
Once extracted, the follicular fluid is rushed to an adjoining laboratory and examined under a microscope to confirm that it contains an egg (the ovum measures only four-thousandths of an inch across). The ova are carefully washed, placed in petri dishes containing a solution of nutrients and then deposited in an incubator for four to eight hours. The husband, meanwhile, has produced a sperm sample. It is hardly a romantic moment, recalls Cleveland Businessman Popela, who made four trips to Cambridgeshire with his wife, each time without success. "You have to take the jar and walk past a group of people as you go into the designated room, where there's an old brass bed and a couple of Playboy magazines. They all know what you're doing and they're watching the clock, because there are several people behind you waiting their turn."
The sperm is prepared in a solution and then added to the dishes where the eggs are waiting. The transcendent moment of union, when a new life begins, occurs some time during the next 24 hours, in the twilight of an incubator set at body heat. If all goes well, several of the eggs will be fertilized and start to divide. When the embryo is at least two to eight cells in size, it is placed in the woman's uterus. During this procedure, which requires no anesthetic, Steptoe likes to have the husband present talking to his wife. "The skill of the person doing the replacement is very important," he says. "The womb doesn't like things being put into it. It contracts and tries to push things out. We try to do it with as little disturbance as possible."