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emergency room for what she hoped was food poisoning, but sadly was another loss. Russell learned the news over the phone in a large room a long way from home. It was their wedding anniversary, which fell on Father’s Day that year. “All the other soldiers were showing off pictures of their kids and drawings their kids did for them,” Sarah said. “He felt so helpless.” When he returned, the couple underwent artificial insemination and in February got pregnant for a third time, armed with progesterone supplements and low-dose aspirin to counteract common causes for miscarriage. Eight weeks later, the news that Sarah had lost the baby was less than shocking. “I’d known something was wrong from the beginning,” she said. Sarah was convinced the problem lay in her own family history. Sarah’s mother has lupus, an auto-immune disorder that makes it difficult to carry children. “I had this tunnel vision,” she said. “I knew that somehow the tendency toward auto-immune disorders was affecting me and killing my pregnancies.” But fortunately for the Walters, Fort Bragg is home to one of the Army’s six infertility clinics. There, at Womack Army Medical Center, Sarah’s doctor, Lt. Col. Jason Parker, a physician and chief of the reproductive endocrinology and infertility clinic, urged Sarah and Russell to run genetic tests. Blood work turned up the answers Sarah was looking for, but not expecting. Sarah had a balanced translocation of chromosomes. When she was conceived, part of a chromosome broke off and swapped places with another chromosome; all of the genetic information needed to sustain life was there, just slightly reconfigured. Unless her children received both of her translocated chromosomes at conception, they would have either too little or too much genetic information. The Walters were referred to Patricia Devers, coordinator of genetic counseling services at the University of North Carolina at Chapel Hill, who gave them information on Sarah’s condition as well as preimplantaion genetic diagnosis, a controversial procedure that could greatly increase Sarah’s chance of a successful pregnancy. Frustration crept back in as Sarah realized she had some tough decisions to make. “Non-directive counseling is the credo of genetic counseling,” Devers said. “We present things in a factual manner and talk about the pros and cons of all different testing options and put the decision in the hands of the patient or family.” PGD is identical to in-vitro fertilization in every way save one – a single cell from each embryo is taken out and tested prior to implantation. “In Sarah’s case,” Devers said, “they would only implant the embryos with balanced genetic information.” Debates over PGD usually center on where to draw the line. Scientists and public interest groups are often at odds over which conditions should be tested – many chromosome abnormalities and certain mutations are tantamount to a diagnosis while others simply point to the susceptibility of a certain condition. As for media hype about creating “designer babies,” Devers says the science isn’t even close. For Sarah, it’s simple. “There are families enduring loss and sadness and heartache, and we have the technology to work around it,” she said. “I don’t have a problem with that right now.” Lori Farmer knows something about loss, too. After her own miscarriage, she spearheaded the effort to erect the Angel of Hope statue in Cross Creek Park downtown to honor parents who have lost children. Farmer now lives in Florida, but she still works as an assistant professor at the University of North Carolina at Pembroke. She is also an advanced practice nurse in genetics, a subject which recently became intensely personal. Farmer’s mother died two years ago after a battle with breast cancer. Lori’s own diagnosis followed. Her mother had been adopted, so Farmer could not look to family history for answers. Instead, she got tested for the BRCA 1 & BRCA 2 genes, mostly so she could Top | A breast cancer diagnosis led Lori Farmer to undero genetic testing. Above | Genetic testing has given Sarah Walter answers plus hope for a baby of her own. share the information with her two younger sisters and their daughters and granddaughters. The test ultimately came back negative just as Farmer was about to undergo bilateral mastectomies. If she had tested positive for the genes, Farmer says she would have been more aggressive and opted for a hysterectomy as well, wiping out any chance of ovarian cancer. That was this spring, and Farmer says her prognosis is good. It’s a double relief because she now knows the odds are decreased that the same thing will happen to her sisters and nieces. Most people who consult a genetic counselor are seeking just that, a sense of relief. At its heart, genetic counseling is a numbers game, and for many expectant mothers, the magic number CityViewNC.com | 55

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