When There Is No Heartbeat

A Quiet Conversation About What Comes Next

For many intended parents, this moment comes before the answer.

I had a call last month with a father who was about to make a payment, and he paused. He didn’t say it right away. After a few minutes it came out. He was afraid. Not of the money. He was afraid he would send it, the ultrasound would happen, and there would be no heartbeat. Then what. He asked me that in a voice I’ve heard a lot of times over the last twenty-five years, and I tend to slow down when I hear it.

Here’s the thing. Nobody really controls whether a heartbeat shows up on that screen. Not me, not the clinic, not the embryologist. This is biology. It isn’t a contract or a schedule anyone can actually promise. I know saying that out loud can sound scary, but I think once you sit with it, it’s closer to a relief. You stop trying to control the part that was never yours to control in the first place.

What people are really paying for when they come to us isn’t a heartbeat on the first try. I know that sounds strange, so stay with me. They’re paying for a team that knows what to do whether the first transfer works or it doesn’t. They’re paying for the fact that the surrogate has been screened carefully, that the embryos were handled by a clinic that actually knows what it’s doing, that the legal side was handled by real reproductive attorneys and not someone figuring it out on the fly. What you’re paying for is a path forward.

The first transfer is a starting point. Sometimes it takes. Sometimes it doesn’t. The percentages shift depending on the embryo, the surrogate, the cycle, a lot of small things. The clinics we work with are pretty open about this. The good ones don’t sugarcoat it and they don’t make it sound like a disaster either. They just tell you what they’re seeing and what they’d do next.

I remember a couple a few years back. They had waited a long time to even get to the point of transfer. When the first one didn’t work, the wife called me from her kitchen, and she wasn’t crying, she was just quiet. I told her the same thing I’m telling you. The process doesn’t stop. We look at what happened. The doctor reviews the cycle. We talk to the surrogate. We plan the next transfer. Six months later, they had their son. That’s usually how this actually goes. Not always in one step, but generally forward if the team around you is steady.

What I try to explain to intended parents, especially the ones standing at the edge of that first payment, is that the whole reason this process is built the way it is, is because biology doesn’t always cooperate. If everything worked perfectly the first time, every time, you wouldn’t really need experienced people around you. You need them because you don’t know what cycle you’re going to have. You don’t know what that first scan is going to show. And when something doesn’t go the way you hoped, it helps to have people next to you who have been through this many times and know what comes next.

I don’t want to pretend that a transfer without a heartbeat is a small thing. It isn’t. It’s hard, and I respect that. But feeling disappointed isn’t the same as being stuck. You can feel all of it and still have a clear next step, and that’s usually what separates doing this with a good team from doing it alone.

When the father I mentioned at the start finally moved forward, he said something that stayed with me. He said, I think I was trying to buy a guarantee, and now I understand I’m buying a process. That’s close enough to the truth. He wasn’t wrong to be scared. He was just looking at the wrong piece of it.

So if you’re reading this and you’re sitting at that same pause, before the payment, before the transfer, before the scan, I want you to know that fear is pretty normal. I’ve sat with a lot of people through it, on phone calls, across tables, in waiting rooms. It doesn’t mean anything is wrong. It usually means this really matters to you. And the way through it isn’t chasing a certainty that biology can’t give you. It’s picking people who know how to keep moving, calmly, whatever that first appointment ends up showing. Most of the families I’ve worked with do end up holding their baby. Not always on the timeline they pictured, and not always on the first try, but they get there. That’s the part I keep coming back to after all these years, and it’s the part I’d want you to hold onto too.

I don’t usually write about this part of the process, but after enough conversations like that one, it felt worth saying out loud.

— Parham