They sat quietly in a love seat at the N.C. Center for Reproductive Medicine, waiting for a nurse to call their names.
Lehman attempted a few jokes and tapped his sneaker on the carpet. Shanelle put her hand on her forehead.
On this chilly fall day, they were counting on Dr. Sameh Toma to get them pregnant.
They had already been through one cycle of in-vitro fertilization in their former home of Indianapolis. It hadn't worked.
This time, the Bests, as well as their doctor, were confident they would be welcoming a baby into their lives in nine months.
After all, they are both young and healthy -- he's 27, she's 28.
It used to be that young couples would try for years to conceive naturally before seeking fertility treatments. IVF was typically a last resort for infertile couples.
But more young couples are turning to IVF as one of their first options in treating infertility. Toma, who runs the Cary center, sees 130 new patients a month, he said.
"It has gone up year after year" since he opened the center in 1992, he said.
Of the roughly 62 million American women of reproductive age in 2002, 10 percent had had an infertility-related medical visit at some point, according to the Centers for Disease Control and Prevention.
The CDC also reports that in 2005, 134,242 fertility treatments were performed across the county and resulted in 52,041 infants. Many of the treatments produced multiple births.
At UNC-Chapel Hill's Reproductive Endocrinology and Fertility Clinic, more couples under 35 are seeking fertility treatments. In 2002, 37 percent of the patients there were under 35. In 2006, 51.4 percent were under 35, said Marc Fritz, who runs the clinic.
Infertility among younger people is not necessarily on the rise, Toma said. But the stigma of seeking infertility treatments is less than it used to be. And IVF is more readily available to couples at private clinics, not just major medical centers, said Bill Meyer, a doctor with Carolina Conceptions in Raleigh.
Also, Fritz said, the procedure is getting better results.
"The success rates with the technology legitimately make [IVF] an appropriate first line of treatment," he said. IVF has replaced surgery on reproductive organs, he added, because it is more effective.
Toma charges $5,500 for the procedure, plus $3,000 to $5,000 for the drugs the woman must take before and after the procedure. Duke's fertility clinic charges about $10,000 for the procedure and $1,500 to $3,000 for drugs, said Susannah Copland, a doctor in the clinic. Copland, whose clinic has not seen an increase in younger couples, said younger women save money on the drugs because they don't need as many as older women.
Some, like the Bests, have medical insurance that pays for IVF treatments. Toma offers a shared risk plan: After three unsuccessful IVF cycles, the patient gets her money back.
Typical problems
Most infertility issues in younger women tend to be related to problems with the uterus or obstructions in the fallopian tubes, Toma said.
Among the younger couples Toma sees, many cases involve problems with the male partner. Typically, the men have a low sperm count, he said. That means they have sperm but not at the numbers needed to get pregnant naturally. And that makes them excellent candidates for IVF, in which doctors implant the man's sperm directly into the woman's egg in a petri dish. Then the embryo or embryos are implanted into the woman's uterus or fallopian tubes.
As long as the egg is healthy, Toma says, it can overcome most problems with the sperm.
Most couples under 35 are told to try natural fertility for a year. But if the male partner has a low sperm count, the couple can get started on IVF much sooner, Toma said.
In the case of the Bests, Lehman has a low sperm count. He donated a kidney to his sister in 2005, and doctors suspect something happened during the procedure to affect his fertility.
Because of his condition, the Bests turned to IVF after they tried naturally for a year.
Toma said IVF has a 51 percent success rate with his female patients who are under 35. The rate falls to 37 percent for those 35 to 37. For his patients in their early 40s, only three of 14, or 21 percent, get pregnant using their own eggs and give birth.
The Bests, who have been married three years, went through one cycle with a doctor in Indianapolis. Then Lehman's job brought them to the Triangle. Their Indianapolis doctor referred them to Toma.
Fertilizing embryos
A smiling nurse called the Bests from the waiting room and walked them down a long hallway to a small office. There they met with Hugh Hensleigh, the embryologist who directs the center's lab.
He showed them pictures of her fertilized eggs, which were tiny cells. A few days before, Toma had surgically collected 17 eggs from Shanelle. For weeks before the procedure, she had taken shots of a stimulating hormone to increase her ovulation.
Ten of those eggs were successfully fertilized with Lehman's sperm in the lab. Then the embryos were allowed to grow for five days.
The Bests told Hensleigh they wanted to transfer three embryos to give them the best odds, especially because it didn't work last time. Hensleigh tried to persuade them to transfer only two.
"We shouldn't put back three because we don't want you to have triplets," he told them.
Multiple births can have more complications, such as premature delivery and low birth rates.
Hensleigh was confident the couple would get pregnant because of the quality of their embryos and their youth.
The Bests agreed to think about it after Shanelle received acupuncture. Toma offers the Chinese medical practice in his office to help patients relax before their embryo transfer.
She lay on a bed while David Peters, an acupuncturist, placed tiny needles all over her body. Lehman sat beside her. Shanelle held the picture of her embryos for good luck.
After about 45 minutes, the Bests headed to the embryo transfer room. First, they looked through a microscope at their embryos and checked the name on the petri dish to ensure they had the correct ones.
"Wow," they said.
Then Toma persuaded them to transfer only two embryos. The rest would be frozen.
Shanelle undressed and lay on a table with a sheet over the lower half of her body. Lehman sat beside her and held her hand.
"Y'all ready?" Toma asked as he sat on a stool near her feet.
"Let's do it," Shanelle said.
Toma washed Shanelle's cervix while a nurse prepared the embryos in a catheter. Then, guided by an ultrasound machine, Toma placed the catheter in Shanelle. He pushed the embryos into her uterus.
"I see his head," Lehman joked as he looked at the embryos on the ultrasound screen. "He's going to be a football player -- look at those long arms."
The nurse checked the catheter under the microscope to make sure the embryos made it out. They had.
Shanelle stayed on the table for 15 minutes.
Afterward, she had another round of acupuncture.
Then the couple checked into a nearby hotel for a few days of relaxation rather than drive back to their North Raleigh home.
They wanted to take all the precautions.
Awaiting the verdict
Two weeks later, the Bests went back to Toma's clinic for a pregnancy test. Shanelle's blood was sent to a lab. The Bests were sent home to wait by the phone for the next few hours for the results.
For two weeks, Shanelle had experienced chest pains and had not slept much. And she had cried a few times, convinced the procedure had not worked. She searched for any sign of pregnancy.
She had thrown up driving to Toma's office for a blood test. But she didn't know whether it was morning sickness, nerves or the progesterone she was taking to keep her hormone levels up.
It has been an emotional roller coaster, she said.
"Why us?" she said. "We're just a normal couple. Why can't we have a baby like normal people without needles?"
"I know it's going to work," Lehman said. "My only question is how many."
Pamela Richey, a Durham therapist who works with infertile couples, said couples who have a hard time getting pregnant go through increasingly difficult rounds of expectation, disappointment and sadness.
"It's a grieving process with each cycle," she said. "The longer it takes, the more issues couples have to deal with."
Each new phase of treatment brings a high expectation, she said, and it's very disappointing if it's unsuccessful.
"No matter how a couple prepares, if it doesn't work, it's devastating," she said.
Toma has a psychiatrist on his staff to help couples through the ups and downs that come with fertility treatments.
The Bests tried to stay optimistic, knowing that if this round of treatment did not work, they had eight embryos left. And if that happened, Shanelle said, she definitely wanted three transferred.
"That's my biggest fear is he didn't put in three, and that could have done it," she said.
While they waited for the call in their family room, they watched "Without a Trace." They ordered a pizza, too.
And Shanelle repeatedly checked the time on her cell phone.
"It's only 10:43," she said. The lab wouldn't be done until noon. Her friends sent text messages wishing her luck.
And several people called. Every time the phone rang, she jumped. First it was her godmother. Then a friend.
Finally, the nurse.
Shanelle listened in silence.
The pregnancy test was negative.
Shanelle broke down in tears. Lehman sat at her feet with his head in her lap.
"I love you," Lehman said.
"I know," she said.
A few minutes later, Shanelle said she wanted to start another cycle right away.
