This story is part of the series Expecting worse: Giving birth on a planet in crisis, a collaboration between Grist, Vox, and The 19th that investigates how climate change impacts reproductive health — from menstruation to conception to birth.
On their very first date, Kirsti and Justin Mahon talked about wanting kids. They met on a dating app in 2016, nine months after Kirsti moved from Texas to Florida. Almost immediately, they fell in love. A little over two years later, they got married. Six months after that, they started trying for a baby. To their surprise, they got pregnant right away. But just as quickly, they had an early miscarriage. At 27, Kirsti didn’t have any reason to suspect fertility problems, and her obstetrician was quick to reassure her: Kirsti’s blood work looked normal, and getting pregnant after a month of trying is a good sign of fertility. Conceiving again, she was told, would be easy.
Over the next two years, Kirsti got pregnant three more times. None of her pregnancies lasted beyond the first trimester. “It felt like we were hitting a brick wall,” Kirsti said. In January 2022, the couple went to see a fertility specialist who conducted a series of intensive tests that uncovered what was really going on. Kirsti was only 29 years old at the time, but the specialist told her that her egg quality was that of a 40-year-old’s. In vitro fertilization, or IVF, the specialist said, was Kirsti and Justin’s best hope.
It didn’t take the couple long to decide to take the plunge. “With every loss that we had it was like I was watching Kirsti lose a piece of herself,” said Justin. “It became obvious with the consultation that the IVF process was really the only way to guarantee that this really brutal cycle wouldn’t continue.”
So they drained their savings, cashed in an old retirement account, and took out two loans to pay for the treatment. They live in Florida, a state where coverage isn’t mandated, so most of the procedures would be out of pocket. Justin estimates it cost between $25,000 and $30,000. The couple hammered out the minutiae of IVF with their specialist, down to the timing of every hormone shot. They felt ready.
But Kirsti and Justin hadn’t accounted for hurricane season. If the process of getting pregnant naturally feels murky and unpredictable, in vitro fertilization turns conception into a science — every menstrual phase, reproductive hormone and embryo carefully screened, tested, and optimized.
First, patients inject themselves with fertility hormones aimed at stimulating ovarian follicles and bringing as many eggs as possible to maturity. An IVF cycle can fail right then and there, with the bad news showing up on an ultrasound screen or on the printed pages of a laboratory test before the eggs are even collected. Often, too few follicles develop. Ovulation can happen prematurely, or the ovaries can become hyperstimulated, causing pain, nausea, or more serious health problems. Everything can go wrong, and everything — down to the timing of each hormone shot — needs to go right.
If it does, the patient’s eggs are removed for fertilization in an outpatient procedure called an egg retrieval. The eggs must be harvested 34 to 36 hours after the “trigger shot,” a final hormone injection which prompts the eggs to finish maturing, but before the ovary releases them into the fallopian tubes. Patients are administered a painkiller, then the doctor guides a needle through the vagina or stomach and into the ovaries, aiming to suction all the eggs from their follicles. Mature eggs — there can be dozens, just one, or none at all — are fertilized with sperm in vitro, Latin for “in the glass,” or in this case in a petri dish. There, the embryos mature for three to six days. Not all of them survive, or develop correctly. The ones that make it can be reinserted into the uterus right away or, more commonly, frozen for later use.
Two time-sensitive procedures bookend the most stressful and critical weeks of the IVF process. The first is the egg retrieval. Once the trigger shot has been administered, there’s no turning back. If the procedure doesn’t take place approximately 36 hours after the injection, the patient’s follicles rupture, casting the precious eggs irretrievably into the fallopian tubes. A missed alarm, a traffic jam, or a delayed flight can wreck an enormous financial and emotional investment. The second is the embryo transfer. A patient’s uterine lining must be sufficiently thick when an embryo is reinserted — otherwise, the embryo won’t implant, and the patient won’t get pregnant. Doctors often prescribe additional hormone injections for up to 12 weeks to boost estrogen levels and thicken the uterine lining before a frozen embryo is thawed and transferred.
Fertility clinics typically require patients to come in regularly for ultrasounds to determine the optimal day for the transfer.
These windows of opportunity are narrow, and it doesn’t take much to slam them shut. For a growing number of would-be parents living in the coastal areas of the United States, where climate change is making hurricanes faster-moving and more intense, all it takes is a single storm. In September 2022, the Mahons were preparing for the final stage of IVF: the embryo transfer.
Kirsti had already undergone the grueling egg stimulation and retrieval process, which produced 23 eggs. Four had turned into embryos, and three were genetically tested. Two came back healthy and had been frozen.
Her transfer had initially been scheduled for August, but it got canceled when Kirsti contracted COVID-19 that July. Now, as summer turned to fall, Kirsti spent five weeks injecting herself with hormones at their home on the outskirts of Naples, Florida, where she worked as an animal supervisor at the area zoo.
On Wednesday morning, Justin injected Kirsti with the last dose of her medication. Southwest Florida was flooding, and parts of the state were losing power, but they hadn’t heard anything from the clinic. Their appointment was supposed to be the next day. As far as Kirsti knew, the procedure was still on track. Since the beginning of the 2000s, climate change researchers have warned that a warmer planet produces stronger and more damaging hurricanes. In 2020, 30 named storms developed in the Atlantic, setting a record. University of Pennsylvania researchers recently predicted…
