Just inside the automatic sliding doors of Spring Valley Hospital Medical Center, an oversized baby bottle beckons visitors from atop a folding table. One by one, 140 men and women approach the table in the hospital lobby. Before scouting a seat, they rip a raffle ticket from a tightly coiled roll on the table, sign the back and toss it into the bottle. If all goes as planned, the ticket to a free baby could be inside it.
Cars fill the parking lot outside, but hope drove these people here tonight. In approximately 1½ hours, someone will shake the bottle and pluck from it one ticket. Fingers will cross and breaths will deepen. When the name is read aloud, one of these people will discover the feeling of restored faith.
Each of them longs for the same thing: a baby. They've entered a lottery to help them get one.
The Sher Fertility Institute held its first drawing for a free in vitro fertilization treatment, valued at $10,000, in 2010, after the economy proved that even the desire for a pregnancy can fiscally tap out. Through its lottery system, Sher has awarded six free in vitro procedures, three of which produced pregnancies, two of which delivered babies.
Most of the people in attendance on this spring evening are couples. Some women arrived alone. A lot of arms are folded. A lot of heads point downward. It's not your typical raffle. No one wants to be here, but everyone wants the grand prize.
Couples typically seek out IVF treatments when all else has failed. It's an arduous process that starts with hormone injections for about two weeks preceding ovulation to produce the release of more than one egg. The eggs are then retrieved surgically and fertilized with sperm in a lab.
Doctors monitor the fertilized eggs to determine the prime embryos, which get implanted in the patient's uterus. From there, doctors exit the picture and fate enters.
After the crowd is seated, tonight's audience will wait through a 90-minute seminar about Sher's services. Then, they'll wait for the drawing. If they don't hear their name called, they'll go home and wait for a miracle.
Just in case any of them consider quitting, Leslie Carlisle has quite a carrot to dangle in front of them. She won the drawing last year.
The 30-year-old woman in jeans and a stretchy black top stands at the podium and shares her story. She and her husband, Ray, spent 2½ years and in excess of $10,000 trying to get pregnant before winning Sher's lottery.
"We kind of accepted the fact that we couldn't" - she stops to compose herself - "complete our family."
Her IVF treatment collected 15 eggs, she tells the crowd. Eight were fertilized. Only one made an embryo, which now goes by the name Brayden. She and Ray welcomed their son into the world just weeks ago.
With odds like that, Carlisle has the ideal "If it could happen to me ..." story. Between sobs, she urges the audience not to give up.
Jonquil, 39, and Erik Nelson, 40, appreciate the pep talk, but don't need it. They're far from calling it quits, which is why they're far from home. The couple flew in from Montana after reading about the raffle on Sher's website.
It's not the longest they've traveled in their three-year effort for a baby . Last fall they flew to New York for "a really good deal" on an IVF treatment. They'll share that much, but they try not to think about the cost of it all.
"Don't make us add it up," Erik says.
When Dr. Jeffrey Fisch, medical director for the Sher Fertility Institute Las Vegas, begins the seminar, couples are still trickling in. The additional arrivals could mean more business for Sher. For the folks in attendance, however, it means a slimmer chance of going home a winner.
"Ironic that this is happening in a town built around gambling," Erik notes.
He and Jonquil plan to test their luck at the slot machines after doing so here.
Making a baby in itself comes down to odds. According to Fisch, a healthy couple has only a 20 percent chance of conception each month. After that, they have a 10 percent to 12 percent chance of delivering a baby. Depending on patients' ages and diagnosis, IVF treatments typically improve the odds of pregnancy to 50-50. Chances for delivery increase to 40 percent.
But, with credentials like Sher's, confidence increases exponentially.
Dr. Geoffrey Sher founded the Sher Institute for Reproductive Medicine in Las Vegas and its seven other clinics across the country.
He was the first in the United States to establish a private IVF program in 1982; he was the first to present "prolonged coasting" in 1993, which eliminated IVF cycle cancellations; the first to implement a new means of ovarian stimulation in 2000; the first to form a CGH-tested frozen egg bank in 2009 to be used by IVF patients. And, for the parents of more than 16,000 babies, the first doctor to get this IVF thing right.
That's just part of the numbers game that brought each of the hopefuls here tonight. The other part comes attached to dollar signs.
Kristi, 32, and Greg Governale, 33, have exhausted their savings trying to have a baby. They wanted to use it to buy a house, but more than a house, they want a nursery.
In their 1½ years of trying to procreate, the Governales say they have visited every fertility specialist in Las Vegas. They have already had one IVF treatment.
"A month ago today," says Kristi, her voice cracking, "we found out we had a miscarriage."
The ordeal has brought Kristi and Greg closer, posing the first event from which they've had to "heal" together. But they've only been at it 18 months.
Several rows behind them tonight sits Liberty Hoskins. The 35-year-old tried nine years for a baby. She grew so fixated on becoming a mother that she lost her wife status in the process. She blames her divorce on the stress her infertility issues caused. Hoskins has a hormonal disorder that results in cysts on her ovary's edges, also known as polycistic ovarian syndrome.
"I just didn't feel like a complete woman," she says.
When you couple deep desire with a deadline, it's easy to end up with a fixation. Dr. Markie Blumer, assistant professor of marriage and family therapy at the University of Nevada, Las Vegas, says it comes down to societal ideas of "normal."
"We grow up with the default setting that (procreation) is a biological privilege," she says. "When we don't have that given ability, we realize it's a privilege for some and not for others."
She likens dealing with infertility to the grieving process. It starts with denial, which leads to anger. Bargaining is next - "We'll promise to be these kinds of parents, if only we can get pregnant" - followed by depression. Acceptance is last. For some, this means looking into an egg or sperm donor. For others, it means adoption.
Hoskins never reached the "acceptance" step. She's now remarried and the proud mother to 9-month-old Ylexa, who arrived after one IVF treatment through Sher. The new mom would like to win the raffle tonight to give her daughter a sibling. This time she's looking into gender selection for an additional $3,000. Hoskins doesn't just want another baby. She wants a boy.
As long as women at a reproductive age aren't at risk for ovarian or breast cancer, they can have as many IVF treatments as they want without damaging their health.
"There are no links associated to any other risk factors," says Dr. Glenn Schattman, president of the Society for Assisted Reproductive Technology. "The number of cycles isn't at all relevant."
But the prognosis is. For some doctors, a particularly dismal one can trigger a stop sign. The Ethics Committee of the American Society for Reproductive Medicine refers to this as a "very poor" or "futile" chance of achieving a live birth. The former is anywhere between a 1 percent and 5 percent chance. The latter is less than or equal to 1 percent.
Some patients actually see that as encouragement, which is why Jennifer Lahl has a problem with this raffle.
"These couples are desperate and will go to desperate measures. Doctors have a responsibility not to prey on people's hopes. They're feeding into that desperation," says Lahl, president of the Center for Bioethics and Culture Network. "It's unethical to raffle off health care. At its most base level, it's a corruption of how medicine is supposed to operate."
As Fisch speaks, his PowerPoint presentation behind him, the interest level fluctuates in the Spring Valley Hospital lobby. Some people listen intently and scribble notes. One woman yawns and scrolls through her Blackberry.
Fisch cites case studies for the crowd. Case study one is a woman he calls "Hope." Case study two gets the moniker "Faith." The significance isn't lost on anyone, especially not 28-year-old Ana Nicolas.
She had the Japanese symbols for "hope" and "faith" tattooed on her inside wrists during a vacation to Hawaii last year. They represent her now three-year pursuit to have a baby with her husband, Mark Nicolas, who had a vasectomy reversed after they married five years ago. They've artificially inseminated Ana twice. Their last attempt, in October, didn't produce a pregnancy.
Mark had to drag his wife here today. The only hope and faith Ana has left are those two taunting tattoos.
Couples who attend raffles of this nature usually do so as a last-ditch effort. With IVF treatments running $12,000 to $15,000, it's a nonoption for most. It's not the quest for dumb luck that motivates them to put their names on tickets and watch a stranger shake up their fate. It's hopelessness.
"The reason people are desperate is because this country doesn't provide proper coverage for infertility care," says Sean Tipton, director of public affairs for the American Society for Reproductive Medicine.
Until that happens, he sees nothing wrong with Sher's lottery: "We are not going to call someone unethical for providing access."
Laura Moore is thankful for the 1-in-140 chance at a free IVF. She is a nurse; her husband is a full-time student. The 25-year-old wants four children, but infertility runs in her family. She says her failed attempts to have a child have caused her to "hate pregnant women."
Moore's genes and financial situation have her counting on hearing her name called at the end of the night. She sincerely believes it will be.
Shamaya Woodard is also 25. She doubts she'll win the raffle, but it sure would be nice. Woodard, who is standing for the seminar because she couldn't find a seat, has been in a domestic partnership for three years. She and her partner have saved $12,000 for an IVF. Reproductive medicine is all they have.
"I cry every time I see people with kids," she says.
On cue, the only baby in tonight's audience begins to coo a few feet away. Woodard's eyes well up. She smiles and shrugs: "I'm always in tears."
Before concluding his seminar, Fisch takes questions from the audience. So many hands raise, he reminds people he will stay past the raffle to answer them all.
With that, the hands drop. It's time.
Arms wrap around shoulders and holding hands squeeze tight.
Leslie Carlisle, Sher's lottery poster girl, walks to the front of the crowd. Painfully familiar with the waiting game, last year's winner reaches right into the oversized baby bottle and draws the lucky ticket. Fingers cross and breaths deepen. Carlisle calls out the winner's name.
Like that, 138 people experience yet another defeat.
Kristi and Greg Governale will hold out for that nursery. Liberty Hoskins' daughter will have to wait a while longer for her little brother. Laura Moore will keep resenting pregnant women. Shamaya Woodard and her partner will continue saving. And Jonquil and Erik Nelson will return for Sher's next IVF raffle in the fall to gamble once again. "Baby on red," Erik jokes.
As the winner makes her way to the podium area, shock and joy take turns cartwheeling across her face.
When she shakes his hand, Fisch gives the audience a nudge. "I'm sure you're all very happy for her, right?"
Silence turns to applause.
The long-awaited event lasts a matter of seconds.
The packed lobby quickly empties. The folding table, oversized baby bottle and a few hangers-on remain. In a corner, the winner celebrates with her husband.
She still has her hands to her mouth in disbelief. Ink peeks out from inside her wrists. Ana and Mark Nicolas won this evening's raffle. What they won exactly - a free IVF or a baby - will be determined in time. One thing is certain. Without hope and faith, they wouldn't have won a thing.
Contact Xazmin Garza at firstname.lastname@example.org or 702-383-0477. Follow her on Twitter @startswithanx.