After my 20th shot of hormones, I texted my boyfriend, only half kidding, “I’m dying.” We had decided to freeze embryos, but after more than a week of drugs that made me feel like an overinflated balloon and forced me to take several secret naps a day, I no longer cared whether we froze anything. I was not doing this again.

In order to maximize the number of eggs that can be harvested from the human body, most women who undergo an egg retrieval spend two weeks, give or take, injecting themselves at home with a cocktail of drugs. The medications send the reproductive system into overdrive, encouraging the maximum number of egg-containing follicles to grow and mature at once. They can also cause itchiness, nausea, fatigue, sadness, headaches, moodiness, and severe bloating as your ovaries swell to the size of juicy lemons. Some people experience ovarian hyperstimulation, which can lead in rare cases to hospitalization. Studies have found the stress of fertility treatment to be a primary reason people stop pursuing it, even if they have insurance coverage.

Many people who continue with IVF feel that, if they want a child, they have no other choice. “Right now our treatment options are pretty binary,” Pietro Bortoletto, the director of reproductive surgery and a co-director of oncofertility at Boston IVF, told me. “Either you just put sperm inside the uterus. Or you do IVF, the full-fledged Cadillac of treatment.” But a third option is emerging, one that could reduce the cost and time that fertility patients spend at the doctor’s office and mitigate the side effects. It’s called in vitro maturation, or IVM. Whereas IVF relies on hormone injections to ripen a crop of eggs inside the body, IVM involves collecting immature eggs from the ovaries and maturing them in the lab. The first IVM baby was born in Korea in 1991, and since then, the method has generally yielded lower birth rates than IVF. Decades later, new scientific techniques are raising the possibility that IVM could be a viable alternative to IVF—at least for some patients—and free thousands of aspiring mothers from brutal protocols.

The challenge of IVM is to figure out how to make fragile, finicky human eggs mature in a dish as well as they do within the ovaries. The handful of researchers and companies leading the push to make IVM more mainstream are taking different approaches. One Texas-based company, Gameto, uses stem cells to produce something akin to an ovary in a dish, mimicking the chemical signals an egg would receive in the body. Last month, for the first time, a baby was born who was created using Gameto’s stem-cell medium, Fertilo. The fertility clinic at the University of Medicine and Pharmacy at Ho Chi Minh City, in Vietnam, uses a technique that involves first allowing the retrieved eggs to rest, then ripening them. Lavima Fertility, a company that spun out of research at the Free University of Brussels, is working on commercializing that technique.

[Read: They were made without eggs or sperm. Are they human?]

For now, these new treatments aren’t commercially available in the United States. The Food and Drug Administration hasn’t historically weighed in on the media that human embryos grow in, but it asked Gameto to seek approval to market Fertilo. Gameto is now preparing for Phase 3 clinical trials. Lavima could face similar hurdles. Older IVM methods are available in the U.S., but not widely used. Meanwhile, more than a dozen women in countries where Fertilo has been cleared for use, which include Australia, Mexico, Peru, and Argentina, are carrying Fertilo-assisted pregnancies, according to the company.

Compared with IVF, IVM is far more gentle. Harvesting immature follicles requires only one or two days of hormonal injections, or skips the process altogether. Reducing the hormone doses necessarily means fewer side effects and cases of ovarian hyperstimulation syndrome. (It may also curtail any possible long-term health effects of repeated exposure to these hormones, which have not been well studied.) Skipping or reducing the drugs can also save women thousands of dollars and many visits to a provider for blood work and monitoring. For women who live far from fertility clinics, or can’t commit to so many visits for other reasons, this protocol could make the difference between undergoing treatment and not, Bortoletto said.

Historically, IVM has generated fewer mature eggs and embryos compared with IVF. The stats are improving, but even if IVM maintains an overall lower success rate than IVF, it still could be the better option for several groups of patients. Egg donors, many of whom undergo multiple retrieval cycles, could be good candidates. So could hyper-responders—patients whose ovaries naturally develop more follicles each month, thanks to their young age or conditions such as PCOS. IVM clinicians could gather enough eggs from hyper-responders that even if a smaller number mature in the lab than might have in the ovaries, a patient would still have a good chance of pregnancy. These patients are also at the highest risk for uncomfortable or dangerous IVF side effects. IVM could be a safer choice, and an effective one. In a 2021 committee opinion, the American Society for Reproductive Medicine concluded that IVM reduced the burden of fertility treatment for these groups of patients. Some studies of hyper-responders have found a live birth rate of 40 percent or higher per IVM cycle, a number on par with that of IVF.

Many women seek IVF because they are approaching their 40s and have few eggs left; they will likely never be good IVM candidates. But IVM might work just fine for patients with blocked fallopian tubes, single and LGBTQ people, and young women who want to freeze their eggs. It could also be useful to cancer patients, many of whom don’t have time to undergo a lengthy IVF cycle before beginning cancer treatment that threatens their fertility. The University of Medicine and Pharmacy in Vietnam primarily offers IVM to women with PCOS, women who appear to have a significant reserve of eggs, and women with a condition that mutes their response to hormonal stimulation. Lan Vuong, who heads the department of obstetrics and gynecology, told me the live-birth rate with IVM there is about 35 percent.

IVM could go far in helping to reduce the physical and emotional toll that fertility treatment takes on women at a time when more people than ever are seeking it out. In some ways, IVF’s burden on women has increased: In an effort to improve birth rates, new drugs, with their attendant side effects, have been added to the standard protocols in the decades since 1978, when the first IVF baby was born. Beyond IVM, some companies are exploring new ways to reduce pain points, for instance by replacing needle injections with oral medications, some of which aim to have gentler side-effect profiles, or by having patients monitor a cycle at home instead of schlepping to the doctor every other day. Dina Radenkovic, the CEO of Gameto, told me that, within the fertility industry, there is a “growing recognition that fertility treatments must be not only effective but also more humane.”

[Read: Aspiring parents have a new DNA test to obsess over]

Knowing all this, I can’t help imagining how my own experience could have been different. My doctor eventually told me that part of the reason my cycle was so painful was that I was a hyper-responder, even at the advanced age of 37. If a gentler option had been available, I would have been a prime candidate.

But then, one tried to get in the bed w Paddington.  😳And then another.  I knew what was coming so I quickly grabbed Paddington.  He was very content in my lap. 

 

We go through a lot of pickles around here - my wife and I, and both of our kids when they're here. They grew up that way, and regard their occasional contacts with people who dislike pickles (or are just indifferent to them) with puzzlement and pity. We always have store-bought ones around, but the fridge generally has home-made varieties in it, and I thought I'd pass some of those along. 

These range from "Extremely easy, nay, downright cheating" all the way to real fermentation. I'll take them in that order, so the first one is a home version of the giardiniera vegetable pickle mix that you can buy jarred at the store. You get to choose what goes in there this way - we generally have carrots, cauliflower, onion, celery, and bell pepper, and make some jars with a sliced-up garlic clove and some without. Your choice! You'll want to wash these and cut them into useful-sized pieces since you'll be fishing them out of the jar and eating them later on. Pack the mixture pretty firmly into jars with lids - you won't be canning these per se, but the Mason-type jars used for that work great. Failing that, you can use plastic containers or even sturdy zip-closure plastic bags if you like living on the edge. The finished pickles will need to be kept in a refrigerator until eaten.

Now you'll make a vinegar brine. I use 2 1/2 cups (590 mL) of water and 2 1/2 cups of white vinegar, with 1 tablespoon of Morton's kosher salt. The salt is always the finicky part in such recipes, because (1) a lot of home/traditional recipes in the US measure it by volume the way I just did and (2) there sure are a lot of varieties of salt out there. You're better off with weight if you have a kitchen scale - that tablespoon of Morton's is 16g, and that of course means 16 grams of whatever salt you're using yourself (although I will say that iodized table salt can give an off flavor for some people - I'm pro-iodine in table salt, but not necessarily for this application). If you have Diamond Crystal, the other big brand of kosher salt, a tablespoon of that is only 10 grams, while a tablespoon of "regular" table salt is 23! So by volume that one tablespoon of Morton's kosher would be 1.5 tablespoons of Diamond Crystal or just under two teaspoons of table salt.

I heat up the vinegar-water-salt mixture to dissolve the salt, and I pour that over the vegetables in their jars while it's still warm (in the theory that it softens them up a bit). You'll want to cover all the vegetable pieces as much as you can. But you'll be fine if you don't heat anything up - remember, these are being stored in the fridge. I do leave them standing covered with their lids overnight before transferring into the cold, and that's no problem. I like to leave them in there a week or two before starting in on them - they will get softer with time, as would any of us if we were immersed in dilute acetic acid, to be fair. So make what you'll eat in a reasonable amount of time (two or three months).

The second variation is cucumber bread and butter pickles. This recipe is also not canned, and needs to be stored in the refrigerator. Where I grew up, "bread and butter" referred to "simultaneously vinegary and sweet" pickles, but the ratio varies a lot from place to place. Some bread-and-butter mixtures are just too syrupy for me; the recipe below is a bit more bracing, and you can adjust for taste when you see how it goes. It should be noted that this one may be more of a summer recipe, because it'll work best with fresh cucumbers. I do this one with a mixture of small (pickling/Kirby) cucumbers and sliced white onions, packing these into glass jars like the gardiniera mixture above. But feel free to extend the recipe to other vegetables and experiment! In this case, the brine I use is 2 cups of water (about 235 mL) and 2 cups of white vinegar (same 1:1 ratio as before), and this one has 4 tablespoons (1/4 cup) of Morton's kosher salts (aka 64 grams salt - I actually go a bit scant on that quarter cup, so you should be fine with 50 to 60 grams of salt) along with 1/2 cup white sugar (100g). You'll probably have to heat this one up to dissolve it relatively quickly - I let it cool a bit but again I pour it over the vegetables while it's still warm. Store them in the cold, and again, I give them at least a week before starting to eat them. But see what works for you!

Now for some fermentation, with half-sour cucumber pickles. This is the sort of pickle you'll get at delis in the greater NYC area and throughout the urban Northeast, and they are very tasty, but I don't make them as much because they are a bit of a moving target due to the natural fermentation. Note that these are also stored cold. You'll start out with pickling cucumbers again (so again, this may be more of a summer recipe because of the availability of good ones). Leave them whole (you can slice a bit off the blossom end, which is said to improve them during pickling, but I've done it both ways). These are traditionally seasoned with garlic at the very least (about four cloves for a one-quart jar), and generally with fresh dill as well (several good-sized sprigs of it). A few black peppercorns are a good addition, and you can add some coriander seeds (which also show up in a lot of recipes). For this one, the brine is 20g of salt in four cups (470 mL) of water. That salt would be two tablespoons of Diamond Crystal, a fairly scant tablespoon of table salt, or a tablespoon plus a teaspoon of Morton's kosher. You see why weight is preferable! Pour this over the whole cucumbers in the jars, but leave some room at the top, and don't tighten the lids down! That's because these guys are going to start real fermentation with real lactobacilli (present on the surfaces of all real cucumbers!) Put them in the fridge for at least four or five days before eating them. They'll be good at least up to a month in there, but they will get less bright green, a bit softer, and more sour as time goes on. If you get some white stuff on the surface of the liquid, fear not - that's some adventitious yeast and will do no harm.

The last on the list is outright sauerkraut, which is ridiculously easy (outside of finding a good kraut-weight; see below). I never liked it as a kid, but developed a taste for it later on, and the home-made stuff is superior to most of the stuff you can buy. You also again have your choice of when to eat it, but I find that it changes much less rapidly than the half-sour pickles can. Start with some green/white cabbage and shred it finely, with an eye to what you can firmly pack into jars (but definitely not all the way up to the top!) and also to how much sauerkraut you're up to eating in the next weeks or months. The only other key ingredient is salt, and the best way to do it (again) is by weight. I use 2% salt by weight to the cabbage. You can mix this up in a bowl and pack it into jars then, or layer cabbage into the jars with repeated salt sprinklings from your pre-weighed amount (just be sure to use the whole 2%). Other additions can include caraway seeds, a couple of juniper berries (if you have 'em), perhaps even a couple of garlic cloves. But try it plain the first time. At this point you'll want to put something in the jar to keep the cabbage below the level of the liquid that will develop - I do this is wide-mouth pickling jars, and we I use a tiny "gift-sized" jam jar that will just fit through the opening. I weigh that one down with water or salt and screw down its lid, then put it in a small plastic bag to reduce the possible mess, and lower that down onto the top of the cabbage. There are plenty of other ways to do it, and you can even buy thick glass discs to drop into the jars. You'll want to store the fresh kraut prep somewhere cooler than room temperature, but not really at refrigerator levels, either (in my case, our basement works well).

Sometimes your cabbage will be fresh enough to release enough liquid to cover itself; often (in my experience) it won't. In that case, you can add some more brine after a day or two, about 4 or 5 grams of salt per cup of water, to fill it more and cover the cabbage. The idea behind that weight is to keep the packed cabbage under the liquid level. That's one reason I say not to pack it all the way up to the top, because you need some head space of liquid (and weight) up there. The other reason is that in the first week or so you will get some vigorous lactobacilli fermentation with the formation of plenty of carbon dioxide bubbles within the shredded cabbage, which tends to expand its volume. You can see this effect in the photo. Prepare for possible spillovers! After about a week you'll be at the crunchy-but-definitely-fermented "fresh kraut" stage, and as time goes on it will get softer and a bit more transparent. You'll be able to see that commercial sauerkraut is generally heavily aged by home standards. If you want to extend any particular stage you reach, put the jar in the fridge and things will slow down dramatically. Enjoy!

Magoo lives in Italy.  He was one of the Potomac 6, rescued in NC.  He was sick earlier this year, but he’s doing great now. 
He gets to go so many places w his mom and dad. I hope his mom posts more Christmas pictures of him.  I’m sure they will be on some new adventures.  There may be more places he needs to visit. I think he’s making plans.  Merry Christmas Magoo! 
 

I love Zeke’s bed. 
It’s very Christmassy. 🎄He’s been helping decorate Joy’s Christmas House.  He has his own little tree. 🎄There are so many trees in Joy’s house. And a giant Santa. 
Helping Mom has been tiring. I guess he’s exhausted. 💤💤😜
 

I was given some puppy pictures of him, complete w a lipstick kiss. 
He was an adorable puppy.  
Smooches “Smoo-Chee” has settled into his foster home.  He has completed his medical care.  We did find out he can see a little bit.  We originally thought he was blind. He has the prettiest markings.  
Smooches has lots of beds to choose from.  His foster dad’s pillow is perfect.  He’s resting after playing. For a 12 year old, he’s very active.  
Smoo-Chee learned to use the ramp and he climbed up on the bed during the night.  He’s just precious.