May 3, 2007

Slate: Everything You Didn't Know You Wanted To Know About The Fertility Industry Because You Were Too Emotionally Involved To Ask

Slate has short reviews of two books that deal with the unspoken or unregulated implications of fertility treatments: Liza Mundy's Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World and Peggy Orenstein's more experiential Waiting For Daisy, which has a subtitle too long to print here. Even if I keep typing randomly right here, it still takes up less room than the subtitle. Still. Even still. Eve- anyway.

The gist of Mundy's book seems to be regulation, research, and objective, informed counselling are needed in the IVF industry. Orenstein, meanwhile, sheds light on the distorting effects of the TTC process:

(One doctor tells Mundy that fertility patients are more motivated than cancer patients.) Therein lies the complication: It's not easy to be clearheaded about life-altering decisions—and ask hard-nosed questions of your doctors—when the emotional stakes are so high. Then there's the financial calculus, which pushes patients toward wringing the most out of every fertility treatment. IVF cycles typically cost about $12,000, and only a handful of states mandate insurance coverage. So, when a doctor asks a patient, 10 minutes before the embryo transfer, whether she wants to implant two or three or four embryos—and she's recently taken out a second mortgage to fund her pregnancy attempts—it's pretty tempting to choose the greatest number of embryos, thereby upping the odds of pregnancy, but also the risk of twins, triplets, and quadruplets.
Hmm. If that's the way these things really go down, then there's a huge problem. But it would seem to me that a lot/most people who pursue fertility treatments would discuss it for months and do piles of research and thinking about it beforehand. And that decisions about harvesting and transfer [not implanting, Slate, that's different] don't happen on the fly. And what decision would you take anyway? To NOT increase your chances of implantation? Especially if the next step is deciding about selective embryo culling.

Where was that article about the mom going ahead with triplets, who said that she saw twinges of regret in the eyes of every parent of twins who looked at her because they went the easy way and culled, but she'd toughed it out and kept all the embryos? Maybe what needs more counselling is the fertility industry book industry.

The Fertility Maze: Two new books chart the ever-present pitfalls of assisted reproduction. [slate]


I'm 46 and currently entering my seventh month of pregnancy. After a couple of rounds of unsuccessful IUI, my husband and I opted to go the IVF/donor egg route with an anonymous, 21-year-old donor. These procedures are covered by insurance in CT (which, good on them), where we live, but only if you're under 40. Despite the fact that we live in Fairfield County, we live on a combined income of under $30,000; the procedures combined cost over $50,000. (No, the math doesn't add up; an unexpected windfall allowed us to go forward and end up basically back at broke.)

The cost was the downside. Our clinic was the upside. They very firmly suggested transfering only two eggs, even at my age. I don't know what they would've done if we'd asked for more; we'd done extensive research online and would never have transferred more than two. The conversations with the doctors re. the number of embryos transferred happened early and more than once. I did, in fact, conceive twins but had "vanishing twin" which, though tinged with sadness, was actually a huge relief.

What really amazed me were the posts I read on an online support chat room for older women while I was trying to get pregnant, where women were happily forging ahead with multiple transfers, and then suffering through all manner of complications, this before they even gave birth. Almost never was there any mention of "selective reduction," but rather joy in the number of implantations, no matter how many, as if they'd never read any other information or heard the warnings. It may be that the possible stigma attached kept women from writing openly re. their real feelings about possibly reducing the embryos, but that only made the danger of these large transfers all the more disturbing. It seemed clear to me that the fact that these women seemed incapable of even writing about reduction, meant that they were unlikely to consider it a viable option.

Yes, the technology can be frightening and the possibility of abuse by unscrupulous doctors is great, but I am hugely thankful the technology exists, for obvious reasons. But there definitely needs to be much greater oversight and more regulation of a relatively new medical field.

[wow, thanks for sharing your experience and POV. The articles about reduction I've read seem to have centered largely on NYC/Manhattan and seemed to imply reduction discussions were standard operating procedure. That said, I've never heard or read anyone actually discussing her/their own decisions about it directly, either. Go figure. -ed.]

I know of one message board on which selective reduction is openly and honestly discussed- but it is a support board so there is no debate on that board. I won't name the board here because it is a place for women in a very emotional state and they need some privacy.
I am one of those women who had to seek the support of that board when I fell pregnant with triplets on my first IVF cycle with my own eggs at the age of 41.
I was encouraged to accept the aggressive stance of having a lot more than 2 embryos implanted because of my age. It may be a surprise- but no- there wasn't a whole heck of a lot of discussion before I was laying on the table about to undergo the transfer- partly because it was my first cycle and until that day you have no idea how many embryos there are to work with.

I suspect that Caitlin's experience of her clinic insisting on limiting a transfer to two, more than anything reflects the age of egg donor. In Australia the number of embryos transferred is limited to two in all cases and there is no selective reduction available. The end result being that a woman in her 40s has very limited options for IVF and for pursuing a HOM pregnancy. The results were so low because of the combination of age and the limit, that many clinics now refuse to treat women over 40- a catch 22 that has arisen because IVF is 80% covered by government insurance. Where the cycles have such a low rate of success the public does not want to fund them. And it was with this background that I chose to agree to an aggressive approach- I have too many Aussie friends who have undergone many failed IVF cycles and who have given up.

So here is one Aussie grateful to be living in NJ at the present time.

And yes I do feel something when I see a mother of triplets but it is not regret over having chosen to "cull". When I see a mother with triplets I do experience a confusing mix of feelings and thoughts. One of them is that there aren't medals for giving birth to the most number of children for a reason- because it isn't a competition. Having said that- go John & Kate!!!
Your website ROCKS-I read it everyday.

In addition to better counseling/education, my biggest complaint about the whole IVF thing is the industries push of putting in more than one embryo at a time. We had twins the first time after putting two huge deal and we did happen to know the risks.

But the second time, we told the Dr. that he was only putting one in at a time. He said that's fine, but when they put the future babies in frozen storage, they store them in pairs. When they thaw them, they have to be thawed in pairs. So each transfer, we ended up wasting one of our chances of getting pregnant. That's just stupid. Fortunately, we got pregnant with exactly one frozen baby left.

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