When he pushed the graph across the table to me, I wasn't sure why the fertility doctor had scheduled all those tests for us. There it was, in black and white clarity, the stark relationship between age and fertility. I was 42, and even the quickest glance at the chart showed I had about as much chance of getting pregnant -- even if I could afford the medical intervention that my insurance plan wouldn't cover -- as getting hit by lightening. Twice. On Sundays.

in addition to my age, my medical history provided yet another strike. Since my mid-30's, occastional pains in my right side bothered me. When I was 35, and still relatively fertile, I had consulted a doctor about those pains, convinced by that point that I had ovarian cancer. The young internist sent me for CT scans, which revealed a completely different problem: an unidentifed lump in my spleen, which resides on the left side of the body. On a Friday afternoon, the internist's office called to tell me that she wanted to see me; it wasn't until Monday, after a weekend's worth of worrying, that I heard her diagnosis.

"I've consulted with a surgeon. We don't know what the lump is, but we think you should have your spleen removed." The news stunned me. Immediately the pain on the right side of my body was forgotten, and a sudden, previously unknown pain in my spleen materialized. I've always been proud of the way I replied. "Who are the specialists who deal with the spleen? I want to see a specialist before I make a decision."

A little research told me that, while the spleen's function wasn't well understood, having one was better than not having one. The hematologist agreed, and took a more cautious approach. After ordering studies at 3 months, six months, and a year, he concluded that the lump may have been with me from birth, and posed no harm.

Meanwhile, the twinge in my right side continued on and off, feeling very much like a stitch you get after exercising too hard, but was ignored. Years later, I realize that this was the feeling of my overies being squeezed by the lumps growing in my uterus.

By age 40, though, I was experiencing other symptoms: heavy periods that lasted far longer than they should have. I thought that these periods were a sign that I was fertile. In reality, the opposite was true, The heavy periods, and the lumps that now protruded in my belly were fibroids. Again, the first consultation with a physician -- a gynacologist this time -- resulted in a similar recommendation: let's do some surgery. But the surgeon couldn't promise whether the surgery could remove just the fibroids, or whether my entire uterus would have to come out. Again, I found a way to be a proactive consumer, and found a less invasive procedure that would stop the blood flow to those huge fibroids without major surgery.

By this time, I'd met the man who would become my husband. Adam, and the trip to the fertility specialist who wasted no time in giving me the bad news.

There were lots of tears, of course. Then acceptance that the path to having children would take a different form. Adam and I weren't even married at that point, so we settled into life --getting officially engaged, planning a wedding, moving half-way accross the country. By the time we got to the point of trying to figure out the kid thing again, two years had passed.

We considered adoption, but I found the decisions overwhelming. Which agency, which homestudy group, which country did we qualify for? Which would offer us the best hope of healthy children. I loved the idea of adoption -- the ultimate in recycling, as I thought of it. But the options for international adoption were getting fewer and fewer, and the wait times longer and longer, and domestic adoption seemed very risky as well. It felt very difficult.

Then I remembered something I had read while my head was still spinning in wedding programs and party favors --surrogacy in India. We'd outsource our pregnancy to India, for the same reason call centers do. We'd have a newborn, who we could care for and shape from its earliest days.