Things I have learnt from and about IVF

by Maria on February 18, 2012

Encouraged by Belle & Tedra’s recent posts, and just loving Jim Henley’s recent comment:

“I’d just like to say that all the ladyblogging about ladyparts and ladyissues only of interest to ladies around here lately has been awesome. I’m learning a lot from it”;

I’m going to share some observations as I near the end of my third round of IVF.

Embryos are not babies
You might think someone so eager to have children as to undergo months of difficult and expensive treatment would have a hard-core view on embryos and babies. You’d be right.

Twice now, I’ve had two embryos placed in my uterus. I have pictures of the precise moment they were ‘put back’. None of them stuck. The fact is, most don’t.

Despite what we went through to create these embryos, I am left with the cold conviction that they were opening gambits, and no more. Certainly, I would have loved them if they’d turned into babies and mourned them if I’d lost them farther along, and I was very, very sad to not get pregnant. But I felt as if the embryos were simply sets of ultimately flawed operating instructions that de-compiled within hours or days. Most embryos are only that. They may succeed, or they may not. They may be carried to term, or they may not. Human agency may intervene in any of these moments, or it may not. This makes me a bad Catholic, but I find it strangely comforting nonetheless.

I believe more firmly now that an embryo is a step along the way to becoming a human, but it’s not a human. It’s a possibility. And a real, live human woman in all her flaws and situational complexity is infinitely more important and deserving of consideration than the mere possibility of one.

Trans-vaginal ultrasounds are really quite invasive
This is a live issue in the US, where legislators are trying to force women who want abortions to undergo ‘just an ultrasound’ to see their babies. The idea is that once women see the fetus, they won’t want to kill it. Religious conservatives can’t seem to conceive that a woman can understand her pregnancy is real and still choose to end it.

During IVF, women have frequent trans-vaginal ultrasounds to see how their ovarian follicles are developing and to measure the lining of the uterus. I have them two or three times a week. It was a big deal for me when I started as it’s basically a dildo with a camera in it, wrapped in a condom, smeared with very cold lubricant, pushing quite hard against the cervix. Towards the end of the cycle it’s quite painful. At any point along, it’s awkward. Even though I can now chat happily about the weather or point out a missed follicle on the screen, the nurse and doctor are still incredibly solicitous of my comfort. They do this scan every day but they appreciate it’s not a normal or comfortable situation for the person being scanned, and they act accordingly.

I want to have these scans. They are getting me somewhere I want to be, and they are administered by professionals I know and trust and who are on part of that journey with me. I believe this invasive scan being forced on pregnant women seeking an abortion would be a violation of their bodies. As someone who gets this scan all the time, I truly cannot imagine the interaction in the room or the doctor/radiographer – patient relationship that would be involved in a woman unwillingly undergoing it from a professional intent on forcing her into something she doesn’t want. I also wonder how there can possibly be consent, when the women are forced to submit in order to be allowed medical care.

Most people are statistically illiterate – probably by choice
The odds in my case are 70 – 80% for failure. That’s unfortunate but normal for my age. Most people I talk to are irrationally optimistic about their chances. The likelihood is expressed as; ‘We have a 20 – 30% chance of success? That’s great!’ And it is great, of course, compared to people a decade or two ago whose chance of having a baby was precisely zero. But if a doctor said you had a 70-80% of dying in the next six months, wouldn’t you start writing your will and marking off that bucket list? The numbers are not kind, but I find it helps to be honest with myself about the glass being less than a quarter full.

Then there’s the Monte Carlo fallacy, which you hear often in IVF circles; ‘I have a one in three chance of getting pregnant each cycle, so if I do three cycles, I’m bound to get lucky’. Again, wishful thinking. Each cycle re-sets the likelihood back to a third. I don’t like to imagine how many cycles I would have to do before my numbers revert to the mean!

There is really very little you can do
It’s good that some women find cutting out alcohol and coffee helps, or doing post-embryo transfer meditation, having acupuncture, giving up work, or any number of things that make them feel better from one minute to the next. (Giving up coffee may possibly help with implantation, but the improvement is vanishingly small.) But none of these things improves outcomes as much as not being fat, not being old, not being poor, living in the right local authority area, picking the right clinic, or, sometimes, just using a different drug or protocol.

Women receive an endless stream of unsolicited advice – largely from other women – that amounts to an implicit and unintentional blaming when assisted conception doesn’t work. It pains me to be ungracious about help so generously offered, but I’ve read too many discussion threads of women torturing themselves for not lying down for long enough afterwards, for drinking that cup of black tea or not making it to yoga, that one time. Or the worst; not relaxing!!

There is only one thing a woman on IVF can do to improve her chances of getting pregnant: be born with a lot of good quality eggs and don’t spit them out too soon. Massages and detox diets have zero effect on the ovarian reserve. Zero. It is hard to accept, but the level of agency involved once you’ve surrendered to IVF is almost nil. Take your shots at the right time, and get enough food and sleep. That’s it.

As a feminist, I believe that irrationally constraining my lifestyle in ways that don’t demonstrably help, just so I can say ‘I did everything I could’, is just another way of staying small and quiet so no one can blame me if, as the numbers so cruelly indicate, it doesn’t work out.

So yes, do all the scented candles, evening primrose oil, positive thinking and lovely long walks you like. They help with peace of mind and overall wellbeing, and can be essential to just getting through it. But they won’t demonstrably help to start a pregnancy, and not doing them doesn’t mean you didn’t want it enough.

IVF clinics (in the UK) are choke points for everyone’s pet public health priority
If I were amongst the lucky majority who fall pregnant by simply having sex, I wouldn’t have to submit to endless checklists imposed by well-meaning public health busy-bodies. But I am not allowed to proceed unless my smear is up to date, my vaccinations can be proven, and I undertake to swallow extra folic acid daily. There are lots more I can’t remember, and they all involve providing the clinic with paperwork in case there’s an inspection. Some of these requirements have to do with pregnancy, but many are simply unrelated trip-switches that shut off IVF to anyone who doesn’t comply.

It’s classic bureaucratic irrationality. Almost anyone can get pregnant without permission, but once you fall into the trap of needing help, you must prove again and again that you are worthy of it.

Practically, it doesn’t make sense. The IVF demographic is a small one, but, I’ll hazard, on the whole a lot healthier than the general child-bearing populace. Chances are you’ve tried a lot of lifestyle improvements before you start on the Gonal-F. So why should I have to satisfy expensive and time-consuming box-ticking exercises to get permission for motherhood?

But the current hot button issue in the UK is single embryo transfers. There’s no possibility of an Octomom scenario in Britain. Doctors here can only transfer one embryo at a time unless there’s a good reason to transfer two, such as the woman being older than thirty seven. Three embryos can be transferred to women in their forties, but this is rare. When two embryos are transferred, the likelihood of a twin pregnancy can be up to 25%. (That’s 25% of the successful 10 – 20% of transfers in the >37 age group.) But the UK fertility regulator, the HFEA, has just told fertility clinics they must bring multiple birth rates down even further, to 10%.This means more pressure on women or couples to transfer a single embryo, no matter what their situation is. If they don’t, they are selfishly risking multiple births and burdening the system.

Like most public discussion of IVF, there is a lot of cant that tries to disguise the unpalatable truth. Hardly anyone wants to carry twins, but we only have a couple of shots at getting pregnant, so the risk/reward calculus is different to that of most people. To support its directive, the HFEA insists that single embryo transfers result only in slightly lower pregnancy rates. But this is only part of the story. (And given what women are already told to do to only marginally increase their success rates, it is striking that the same differentials can be completely dismissed when it suits.)

If you don’t transfer the second embryo, you have to freeze it. When you freeze it, the odds of successfully thawing it drop to around 60%, depending on the facility. So by insisting on freezing the second embryo instead of giving it a chance in utero, the authorities are effectively destroying anywhere between a quarter and a half of them.

This issue tends to be misrepresented as ‘Well, it’s difficult for clinics to say no to pushy couples who are paying for a service / only get one or two cycles on the NHS’. The truth is that individuals opting for double embryo transfers have gone through a lot to create a small number of embryos, and are making sensible decisions based on the full range of relevant information, not just the statistics that serve the HFEA’s case.

What’s at issue is the relative risk calculus of the individual couple versus that of a national health provider, but with the added dimension of time. We are comparing the risk of failure today versus risk down the road with multiple births. Most people get about a two-year window to succeed or fail with IVF. Improving thawing rates of embryos or pre-implantation identification of successful ones are, for anyone undergoing IVF today, merely interesting hypotheticals. Our timeline is by necessity shorter than that of the regulator, and none the less compelling for that.

In short, these are complex and difficult questions that deserve an honest debate based on the full range of available information, and not the patronizing partial truths coming out of the HFEA.

Blaming IVF multiple births for hoovering up scarce public health resources may or not be fair, but it’s probably inaccurate. NICUs are not full of IVF multiples. The NICU population comes from a range of groups, including babies with genetic disorders and the premature children of very young mothers with chaotic lives who would never pass the bureaucratic scrutiny required to darken the door of an IVF clinic. I don’t believe the state has a right to prevent these women conceiving, so why should it be allowed to stop me?

Everyone has a story
Many, many people have had tricky or unhappy times, not just with infertility, but with miscarriage, and the moment you hint you might be one of them, stories just come tumbling out. Infertility is a great leveler, and another lens through which to see that the reality of life is unpredictable, painful but also richer than the happily ever after I would have chosen for myself.

But ‘everyone has a story’ works in another way, too. If many media commentators are to be believed, IVF is a quick fix for sharp-elbowed women who ‘want it all’ but ‘left it too late’ and, let’s be honest, were probably ‘asking for it’. This doesn’t happen to be my story, but I don’t generally volunteer that because a) it’s nobody’s business, and b) if it was my story, would I be somehow deserve this? And would my husband?

It’s horribly commercialized, but if it wasn’t we wouldn’t have it
There is a whole medical/commercial infrastructure that seems to determine that no matter what the cause of infertility, IVF is nearly always the answer. This makes sense for many patients, but the incentive structures for large-scale provision of just one type of treatment may crowd out others.

However, as pretty run of the mill, middle class people living in a provincial city, we would not be able to access IVF without the scaling made possible by the financial rewards of a somewhat industrialised process. So I’m fairly sanguine about becoming grist to the mill of the fertility industrial complex. And, as I hope I’ve indicated, my clinic and the people who work in it are lovely and very, very good at their jobs.

IVF is not all that bad
I won’t generalize my own, relatively easy, experience to those of all women undergoing IVF. But I will share that, even with the bone-tired exhaustion, endless appointments, and recovery from minor surgery every couple of months, I’ve found it all surprisingly ok. It’s human nature that we probably don’t hear as much about the many IVF experiences that are really quite tolerable. But for everyone, IVF is also an emotional rollercoaster, albeit one which defies the laws of gravity with a lot more downs than ups.

IVF is a lot of things. It’s highly political, as I’ve tried to illustrate. It’s unpleasant, tiring and time-consuming. It’s bloody expensive. In all these respects, it’s perhaps not bad practice for the down-sides of parenthood. It’s also a timely counter to the downward supply curve of adoption.

But if I had to sum up all I’ve learnt, particularly for those considering it, I’d say ‘It’s actually not all that bad, considering. And at least it gives us a chance.’

***

A word to the wise, I’ve edited out my thoughts on adoption in the UK, but suffice to say it is difficult, if not impossible, for people in my situation to adopt, and I will zap any comments along the lines of ‘There are loads of needy children out there. Why don’t you just get one?’

***
P.P.S. My belated thanks to the many commenters below for such a generous and informative discussion.

{ 80 comments }

1

Anonymous 02.18.12 at 4:17 pm

I can see that it promotes discussion to edit thoughts on adoption out of this post, I’m sure that another day they might find an interested audience.

2

bob mcmanus 02.18.12 at 4:20 pm

Excellent post.

3

Orange 02.18.12 at 4:48 pm

Brilliant post. I’m a friend of Tedra’s and not an academic, so I came to CT mainly for her posts. Now I’m also reading Belle and Maria’s posts.

I like the IVFer’s perspective on embryo “personhood” and those horrible compulsory transvaginal ultrasounds. I had my share of those (fully consensual but still awkward and uncomfortable) ultrasounds back in my fertility-treatment days and agree with Belle.

4

bemused 02.18.12 at 4:49 pm

I very much hope you are successful. I married late and tried for several years to conceive, and finally was lucky enough to do so without IVF, but I clearly remember the the sadness seeing all the babies and pregnant women around me, the mechanistic “trying” with thermometers and schedules. In the meantime my husband and I tried to adopt one of the “loads of needy children out there”. I confirm that that is an impractical alternative in the US as well. A separate post on that would be informative to many.

5

Maria 02.18.12 at 4:50 pm

I’ll certainly give it some thought, Anonymous.

6

another anonymous 02.18.12 at 5:25 pm

All of this is much the same in the US. And I think one of the reasons people overestimate how bad IVF will feel is that they underestimate how bad it feels to get to the point where you turn to it. Statistical illiteracy works similarly, too: people are bad at reasoning about less-than-50% chances vs much smaller less-than-50% chances.

My wife and I tried for several years to conceive without success, using the various commonly available interventions short of IVF (drugs + IUI etc). *That* was a long monthly emotional roller coaster and a real strain on our relationship. The odds per cycle of IVF, especially considering the possibility of one extraction providing embryos for multiple transfers, were so much better than all the other stuff we’d done that we finally decided we had to give it a shot (or rather quite a lot of shots, ha ha). And it just wasn’t that bad, except for a couple of very painful days after the extraction.

Now surely part of this impression is retrospective rose-colored glasses: we were very lucky; the coin came up heads for us quickly. But the relief at “bringing out the big guns” was palpable and came before we knew whether it’d work.

I wish you the very best of luck.

7

Maria 02.18.12 at 5:42 pm

Thanks, another anonymous. It occurs to me on reading your post that a lot of how we’ve been able to take several rounds of IVF more less in stride is that we came to it pretty fresh. For various diagnostic reasons, it was clear from day 1 that there was no point trying anything else. So we’d not had the pain and strain of years of trying.

OTOH, I’ve also heard, like what you say, that if you’ve come to it via the scenic route, IVF feels quite definitive and as if you can finally ‘really do something’. I’m really glad it worked out for you.

8

Maria 02.18.12 at 5:43 pm

Many thanks, Bob & orange.

9

Jim Henley 02.18.12 at 5:51 pm

Great post. The transvaginal ultrasound section is especially timely for us American readers, but the whole thing was informative across many dimensions.

10

piglet 02.18.12 at 6:05 pm

“It’s human nature that we probably don’t hear as much about the many IVF experiences that are really quite tolerable.”

My impression is that we hear a lot about how great and easy IVF is nowadays and very little about the suffering that it causes to the vast majority of those who try it. That must be different when you are in that group yourself but I don’t see that much media coverage of the high failure rate.

11

Henri Vieuxtemps 02.18.12 at 6:26 pm

‘I have a one in three chance of getting pregnant each cycle, so if I do three cycles, I’m bound to get lucky’. Again, wishful thinking. Each cycle re-sets the likelihood back to a third.

Well, it seems to me that in three cycles you have a better than 70% chance.

12

Scott Martens 02.18.12 at 6:45 pm

The failures are a real blow. If you’ve come to IVF, you already feel like a failure. You get there already wondering if you’re too old to be a parent, your mom wants to be a grandmother before she’s too old to enjoy it, and the truth is, it’s quite likely your life choices that got you here. At 20, you sure wouldn’t have needed medical intervention to get pregnant – you took all the measures you could to keep that from happening. You could have led a life that involved early parenthood. It would have killed your career and made a mess of your plans, but you could have done it. Maybe you should have. Maybe it would have been worth it, because it sure sucks now.

And now… you have to go through this. And it’s failed and there’s every chance it won’t work next time or at all. And you’re powerless to do anything about it. All you can do is be the supportive partner for a woman who’s been much more intimately involved in the process than you have and feels worse than you do.

You look back and wonder if you screwed up to get here. You’re *so* grateful that Belgium offers IVF as part of its national health plan, and despite being insured by the Catholic insurance plan and going to the Catholic university hospital for it, you can have it. But it doesn’t change that you made choices to get here and now they’re costing you. And even when you’d never imagine, in a million years, criticizing anyone else’s choice to not have children young, you can’t avoid that ugly critique of yourself.

And, since the majority of infertile couples have two members with diminished fertility, the failures hit you pretty hard even if you don’t face facing the invasive procedures (though the mandatory prostate exam should not be forgotten!), and even when your physical contribution is just jacking off into a cup in a hospital clinic that’s too uptight to keep porn magazines in the room intended for the purpose. It’s your baby that’s not happening too. It’s not less your fault and not less your failure.

I wish you better luck than we had, Maria.

13

NomadUK 02.18.12 at 7:19 pm

I’ll admit to having had this vague, niggling irritation at the idea that IVF is available at all on the NHS, when things that are arguably more important (to basic health and well-being) like dental work and eyeglasses are not as well funded as I’d like (I have to pay for my dental cleaning and it still costs me about £200 every time I have to update my eyeglass prescription). But the budget for the NHS is something like £100 billion, and IVF costs something like £90 million, so it’s really pretty much a drop in the bucket of the grand scheme of things, and it makes people happy, and your writeup (as usual) makes a lot of sense out of something that, honestly I hadn’t really given a lot of thought to — so what the hell. Good luck.

14

Sherri 02.18.12 at 7:45 pm

We did a couple of rounds of IVF after having a child via Clomid and IUI the first time. Managing IVF with a toddler made it even more tricky. IVF is an emotional rollercoaster, the drugs did not do good things to my moods, and dashing off to the doctor’s office for all the regular blood tests and yes, transvaginal ultrasounds meant constantly juggling childcare. (Out of respect to the other patients in the practice, you do not want to bring a child to an infertility clinic!)

Then there’s the sudden childcare dilemma of egg harvesting, since you don’t have much advance warning of when you’ll have to drop everything and go in for a minor surgical procedure because your eggs are finally ready. Of course, by then if the drugs had done their work, I was so uncomfortable and bloated from softball sized ovaries (not an exaggeration), that I just wanted it done.

At the end of the second round of IVF, I discovered that it was possible to be a little pregnant. That is, I tested above threshold, but barely. On the repeat test two days later, my beta hCG rose, but didn’t double. I was in limbo. I probably didn’t have a viable pregnancy, but my husband had to keep injecting me with progesterone just in case for a few weeks until it would be possible to use a transvaginal ultrasound to see if there was a fetus in the uterus. As we all expected, there wasn’t, but I still fell apart. It was just too much.

I had to keep coming back for a while after I stopped the progesterone so they could monitor the beta hCG to make sure that it dropped back below threshold levels, so that it was clear that I didn’t have an ectopic pregnancy. Then I was done. I was lucky; I have a wonderful daughter, who’s now 17. I don’t regret any of it, but I wouldn’t wish it on my worst enemy.

Embryos are not people any more than lottery tickets are fortunes. I feel even more strongly after my experience that women should have control over their reproductive choices, and that includes abortion.

15

Anonymous 02.18.12 at 7:47 pm

Thank you for this painful insight, Maria, into your world at the moment. Thank you for talking about it in such a down to earth way. I’m sure that by doing so you will help many women: those going through IVF, or contemplating it, and the rest of us who think we might be helping with advice and tips, but actually compassion and understanding is the only help you can give, right?

16

Anonymous 02.18.12 at 7:47 pm

Thank you for this painful insight, Maria, into your world at the moment. Thank you for talking about it in such a down to earth way. I’m sure that by doing so you will help many women: those going through IVF, or contemplating it, and the rest of us who think we might be helping with advice and tips, but actually compassion and understanding is the only help you can give, right?

17

piglet 02.18.12 at 8:00 pm

“If you’ve come to IVF, you already feel like a failure.”

What is it about our society that makes childless people feel like a failure? Still in 2012? I have decided against children. I understand most people wouldn’t make that choice but I also wonder how much of a choice it is when it is (at least to some extent) social expectations that drive you to the IVF clinic.

18

Emma in Sydney 02.18.12 at 8:12 pm

Great post, Maria. Having watched sisters and friends go through this grinding process I can’t help thinking that your grounded, practical attitude will help you survive it, and also make you a better parent if you succeed. You will be in my thoughts.

As someone who had the opposite fertility problem, I think you are right about an embryo being a possibility, not a baby, and I think that should be true whether or not it implants itself. Pregnancy needs active and explicit consent, not rolled up in consent to sex as the forced birthers would have it, but part of the complex process of becoming a parent. Or not.

19

Tehanu 02.18.12 at 8:31 pm

Wonderful post and I so much appreciate the paragraph:

I believe more firmly now that an embryo is a step along the way to becoming a human, but it’s not a human. It’s a possibility. And a real, live human woman in all her flaws and situational complexity is infinitely more important and deserving of consideration than the mere possibility of one.

We tried for 9 years to have a second child after having no trouble at all with the 1st one. This was in the 1980s and involved several operations and months and months of pills and tests and other things, most of which I’ve mercifully forgotten. Eventually I decided that the emotional roller coaster and the sadness every month were just not worth it any more. Like Sherri above, I’m grateful for the child I did have. But I don’t fault myself or anyone else for trying — or for not trying, if they really don’t want kids — and no matter if you quit next week or keep trying for the rest of your life, I hope you find the support you need. Thanks again for this terrific post.

20

Tom T. 02.18.12 at 8:50 pm

Hopefully you’ll be successful with IVF and never have to consider donor egg, but that procedure really does push the odds of success up sharply, in cases where the limiting factor is egg-related. The attenuation of the genetic connection is an unacceptable trade-off for some, of course. It’s perhaps also worth noting that the regulators have sharply restricted its availability in the UK, by capping payments very low and forbidding anonymous donation.

21

Matt McIrvin 02.18.12 at 9:12 pm

Blaming IVF multiple births for hoovering up scarce public health resources may or not be fair, but it’s probably inaccurate.

The Octomom media circus drove me up the wall for this reason. All these people were treating this extraordinarily rare situation as if it were indicative of massive social problems, as if Octomoms were in somehow danger of overrunning the earth.

22

chris y 02.18.12 at 10:26 pm

Otherwise rational people completely lose it when it comes to multiple births. A former colleague’s wife had quads (I don’t know whether through IVF or not and I don’t care); he asked his employer for compassionate leave to be on hand when she came home ans was turned down “in case it set a precedent”.

He doesn’t work there any more.

23

Alan 02.18.12 at 11:33 pm

The most honest, insightful, reflective blogpost on this subject I’ve read. I’m childless by choice (which I sometimes regret, I admit), but I’ve dear friends who have gone through the agony and near-bank-rupting expense of IVF with results of in one case a heart-breaking mid-term miscarriage of twins that ended her attempts, and another with triplet girls after several attempts. The uncertainty, pain, and joy I’ve witnessed in their lives lends at least some amount of appreciation and perspective on what you’re going through. Please accept my best wishes and thanks for generously allowing a glimpse into your life.

24

piglet 02.18.12 at 11:41 pm

“as if Octomoms were in somehow danger of overrunning the earth”

You think that is what people think? Any evidence for it?

wikipedia: “Public reaction turned negative when it was discovered that the single mother already had six other young children and was unemployed and on public assistance programs. She denies ever having used public assistance. She conceived the octuplets and her six older children via in vitro fertilization (IVF).”

Leaving the public assistance part aside, in what universe is the behavior of that doctor considered ethical? IVF-induced multiplicity may be rare but it does cause real suffering to real humans. Is it the opinion that that suffering is a worthwhile price to pay for society’s obsession with motherhood (because that’s what it is – nobody cares about fatherhood)?
http://www.nytimes.com/2008/02/19/health/19mult.html

For a couple in Brooklyn who asked that just the woman’s first name be used to protect their privacy, six years of infertility and several failed procedures was enough. When the woman, Marie, was 28, they requested that three embryos be transferred, even though their doctor advised transferring two.
“I wanted a set of twins,” Marie said. “It is such a complicated and sometimes painful thing to go through I.V.F., and to have to go through it all again for a second child was just a waste for me.” In the third in vitro cycle, last June, Marie became pregnant, with triplets. At four weeks, she lost a fetus. At four and a half months, she lost the entire pregnancy. She was devastated, she said, but she added, “I don’t regret my decision.”

“She was devastated”, and “I don’t regret my decision”, those tow statements come up a lot in those reports. I guess motherhood and self-denying braveness still go together.

25

Chris Williams 02.19.12 at 12:09 am

Thanks for this post, Maria. I have no ladybits, but an early brush with bladder cancer has led to me spending some time staring at the ceiling while nurses make polite and friendly conversation about the weather and holidays, and other nurses stick things into my manbits. My point: what _is_ it with the cold lube already? Can’t they get some kind of heater to knock it closer to body temperature? Tensing up because of cold things is not what anyone wants to do in these circumstances.

26

Bruce Baugh 02.19.12 at 12:19 am

Thank you very much for writing this, Maria. I may have some questions later, but for now, just appreciating and mulling.

27

Steve LaBonne 02.19.12 at 12:44 am

I have nothing to contribute, but just want to wish Maria good luck.

28

Number Three 02.19.12 at 1:34 am

Wife and I had a miracle baby, 3.5 years ago–no assisted fertility, despite earlier efforts (IUI). And trust me, daddy appreciates every day how unlikely a person she is. I don’t believe in a deity, but if I did, she would be all the proof I need. The docs were clear that we couldn’t conceive, but then we did.

In 2010, we decided that we wanted to try for another baby. Multiple rounds of IUI and IVF . . . no luck, and some heartbreak (I won’t go into details, but sometimes a positive test is not a viable pregnancy, as we know from more than one occasion). We had great insurance (U.S.) for the first three IVF rounds, and even the 4th round, which was out-of-pocket, we had pharmaceutical coverage (worth at least $6k).

This is a hard road to walk. Good luck! Wish you the best.

29

Daniel 02.19.12 at 1:41 am

>>Then there’s the Monte Carlo fallacy, which you hear often in IVF circles; ‘I have a one in three chance of getting pregnant each cycle, so if I do three cycles, I’m bound to get lucky’. Again, wishful thinking.

I think that your probability is off, but I might be wrong.

Let’s say the chance of getting pregnant in one cycle is 1/3. Let’s consider 4 cycles. Let’s say the chance of getting pregnant in any one cycle is completely independent of getting pregnant in any other cycle, then the probability of NOT getting pregnant in any of the 4 cycles, is (2/3)^4, which equals 0.1975 and the probability of getting pregnant in at least one of the four cycles is 1-0.1975 which equals .8025. So the chance of getting pregnant in at least one of the 4 cycles is approximately %80.

Under the assumptions you described the more cycles you undergo IVF the more likely you will become pregnant.

30

jim 02.19.12 at 2:06 am

@28: The wheel has no memory.

The 80% includes success on the first try, which, the first try having been done with, didn’t happen.

31

Antti Nannimus 02.19.12 at 3:06 am

Hi Maria,

Yours is one of the most informative and insightful posts I’ve seen on the Internet, but more than that, it is surely the bravest! Even if you are a “bad Catholic” by some moronic definition, you are clearly a very great human being to make up for it.

Thanks for this, your courageous and most personal insight, into these difficult painful issues!

Best regards,
Antti

32

Katina 02.19.12 at 4:01 am

After such a frustrating couple of weeks where women’s rights are concerned, I want to express my appreciation for such a thoughtful and personal post. Your reflections on IVF and embryos are particularly compelling, given the far-reaching implications of the deeply troubling “personhood” bills in Oklahoma and elsewhere.

33

Meredith 02.19.12 at 5:36 am

Maria, thank you. I wish I could find the words. Godspeed.

34

bad Jim 02.19.12 at 6:11 am

My eldest niece and her husband were happily childless by choice for years until her siblings started to have children. She changed her mind. Eventually, her husband did too, but since he’d had a vasectomy, IVF was the only feasible option.

Three embryos were introduced on the first try, two survived, and now they have a matched set of two-year-olds, boy and girl.

I can’t comment about what the parents endured during the process, but it doesn’t seem to have been horrific. I did spend a few days with my niece in the last month of pregnancy and she was faring better carrying two heavy parasites than some of the women I’ve known with only one, probably because she’s pretty big and generally healthy.

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Tedra Osell 02.19.12 at 6:28 am

Piglet @16: I’m pretty sure that what makes couples who start trying IVF feel like failures is not social pressure, but the fact that they have been trying–deliberately–to have a child for presumably quite a long time before they start down that road. I absolutely and unreservedly 100% support women who don’t want kids resisting the pressure that they often feel to do so, but honestly, isn’t a post and comments about and by people who clearly do want kids very badly kind of the wrong place to complain about how unfair the world is to people who are childless by choice?

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Tedra Osell 02.19.12 at 6:37 am

Maria, one of the things that always strikes me when I hear friends and acquaintances talk about this sort of thing is how universal the experience of having everyone and their dog tell women what we “should” be doing with/about our reproductive organs. Don’t have multiple embryos implanted, do relax, don’t drink coffee, do this, don’t do that. It really is quite amazing how very much we, socially speaking, want to pretend that women’s fertility is somehow something women can and do consciously control, whether we’re telling women not to get pregnant by “just saying no” or how to get pregnant by eating yams or “just relaxing” or that they should have more or fewer children, or time them differently, or have them under different circumstances, or even the “why don’t you just adopt” stuff.

I don’t know what to make of it, except that it sucks and I hate it.

And I wish you the best of luck getting pregnant, and am sorry you are having to go through so much in trying to do so.

37

e julius drivingstorm 02.19.12 at 8:25 am

Thank you and best wishes, Maria.

38

anon 02.19.12 at 9:00 am

Third round worked for us, Maria. They will just have to up or fine-tune the doses. And yes you are right: it is in the end all about hoping and believing and dealing with statistics. I believe IVF should be part of the public health care system and be for free but that’s maybe another discussion, also depending on the country you live in.

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Tim Wilkinson 02.19.12 at 10:55 am

The formula for the probability of a success occurring before one has exhausted n attempts, where the independent probability of success on any one attempt is p, is 1 -[ (1-p)^n].

Daniel (I hadn’t initially noticed it was a Daniel, and don’t know if it’s the Davies variety) is correct to take the probability of failure in all attempts as the easiest approach to the problem (that’s what the outer “1-” is for, to convert that into the probability of at least one success: of course here one success means the process ends, so there would never actually be more than one).

So you get the chance of failure (1-p), which is 70% or 0.7, and raise it to the power of the number of attempts (n), which here is 3, and you get 0.343, which is the probability of 3 failures. Take the complement of that, i.e. difference from 1, and you have 0.657 or 66% which is the probability of success from a three-attempt course of treatment. From 4 attempts, it’s almost exactly 76%.

Daniel’s calculations were probably correct, but for some reason he changed the probability, and went for 4 rather than three attempts.

To get the probability over 95%, just out of interest, assuming 30% success, it takes (a plan which contemplates making as many as) 9 attempts.

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Tim Wilkinson 02.19.12 at 11:04 am

Maria is of course also correct to point out that these are ex ante probabilities for the whole course, and so on the last attempt of any course (for those unlucky enough still to be trying), the probility of success will always have resolved back to the single-try value of 0.3.

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Dan 02.19.12 at 12:07 pm

Heartbreaking post. I wish you the best of luck, and frankly, I’m impressed by your realistic stoicism. Still, that makes me feel for you all the more.

On the trans-vaginal ultrasounds… I read with some amazement what they’re trying to pass in Virginia, and frankly, I can’t believe that it’s even potentially legal. I live in Connecticut, and mostly I consider the US to be a civilized country, but how on Earth can anyone defend forced invasive procedures and/or our current debate on the merits of contraceptive coverage? What a weird world we suddenly live in.

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Erin 02.19.12 at 1:46 pm

I’m deeply grateful to the online community of (mostly) women who are brave enough to talk openly about the often-excruciating experience of IF. I used to have “views” about things like IVF (unnatural! expensive! multiples!) but then I actually sat down at an on line forum and read about the experiences and emotions of couples going through treatments. It unraveled all of my ignorant assumptions and left me a more knowledgeable and kinder person. We tend to associate (in the US ) good health and good health outcomes with moral virtue. Sometimes this happens on such a deeply subconscious level people aren’t even aware of it. (Good things happen to good people/If you live the “right” kind of life, you aren’t supposed to get cancer, even though we know this happens all the time.) So there’s a moral overlay to all these questions, and x100 if you’re a woman and it involves your ladyparts, as Tedra said above. Everything you do or don’t do and everything that happens to you is your *fault* – so as a result people going through IF often hide it because the amount of misunderstanding, a$$vice, and people’s “views” they get is revolting, really. The ability to want to have a baby and to end up with a healthy live birth? Sheer luck. Yes, there are things you can do to help along the way, but most of it comes down to luck. Realizing this about my own ability to conceive easily has made me more compassionate and passionate about advocating for ALL reproductive rights, including the right to have infertility treatments covered by insurance.

Telling people to relax is the worst. Seriously.

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bianca steele 02.19.12 at 1:47 pm

I myself was very lucky, both with my doctors and with IVF itself (and techs who warm the lubricant!), but what struck me was how little the doctors still know. There are a handful of things that might be wrong, but they don’t have a way of knowing which one. They don’t know how a woman will respond to the medication until they see how she responds to their first guess at a dose. And you only get so many tries, especially if you’re over 40 already. For me, insurance required a certain number of attempts at IUI before IVF, which in some ways was good—I got used to the easy injections before I had to worry about the big needles, and it just generally seemed much easier and less invasive—but which didn’t work right for me, and which resulted in a couple of scary times. We need more research to make the procedure more precise and to find new, less invasive ways of helping.

Good luck, Maria.

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piglet 02.19.12 at 4:08 pm

Tedra 34: “to complain about how unfair the world is to people who are childless by choice?”

Not my intention at all. What I was trying to express was dismay ta the idea that motherhood is still defined as the essence of women’s role and those who don’t fulfill it are made to feel as failures.

“I’m pretty sure that what makes couples who start trying IVF feel like failures is not social pressure”

Maybe you are right. Maybe when bronze age Rachel felt like a failure when she didn’t become pregnant, that had nothing to do with social pressures. It was just in her personality to want that child so badly.

I am astonished. Astonished to hear that kind of claim from social scientists trained in feminist theory. Are we to assume that among all the social structures associated with gender roles, motherhood, etc., IVF is the one area free of social pressures? The utopian place where people (in fact, women) assert their free autonomous will over their bodies, gain full “control over their reproductive choices”?
I am astonished at the unquestioning acceptance if not glorification of IVF as a liberating technology, brushing aside all the human suffering that it undeniably creates as a price worth paying.

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Harold 02.19.12 at 4:42 pm

Men want babies too — it seems that all the physical aspects of existence are still projected as being a concern only of women. From the point of view of nature it is better to have offspring while in one’s twenties — men and women — while one’s genetic material is pretty fresh. Perhaps –in a future Aldous Huxleyan world — ambitious people who have the means will freeze their eggs and sperm “for later” when they have advanced degrees and/or have made their first millions.

What surprises me is how many people take for granted that everything must turn out perfectly at every stage. Life doesn’t work that way.

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Scott Martens 02.19.12 at 5:17 pm

piglet@43: I couldn’t claim that no woman has ever been pressured into IVF when they didn’t want children. I can tell you that was not the case for us. Neither me nor my wife wanted children when we met. At the time, we were both very strongly against it *ever*. I carry a rather nasty partially heritable condition that can’t be tested for and where the chance of passing it on is almost impossible to predict. (So do most people – I just happen to know exactly what mine is and what it does because it’s so prevalent in my family, intensely destructive, and impossible to miss.) She had the kind of childhood experiences that meant she wouldn’t even get married until we needed it for immigration (and even then only after a couple years of nagging) much less have children.

But eventually, we had stable lives and “never” turned into “maybe” which turned into “we’re not getting younger”, which turned into “why am I not getting pregnant?” which turned into seeing a doctor and finding out that a combination of factors in both of us – related in part but not entirely to age, made it difficult to conceive.

I suspect the majority of IVF falls into the same category we were in.

Even if you don’t want children, knowing you can makes a big difference. Knowing you can’t is not pleasant. I suppose there is some social involvement in that, but look at it this way: men who have erectile dysfunction feel pretty awful, even if they didn’t have much sex life to lose. It’s hard to blame socially determined gender roles for that. The loss of capability is very real.

In the same way, the loss of capability involved in infertility is not free of social factors, but represents a real loss just the same and not merely a failure to fill a social role. The point of feminism – at least as I understand it – is empowerment. Not being able to conceive is genuinely disempowering. I don’t think men and women are very different in that respect.

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Tedra Osell 02.19.12 at 6:15 pm

Piglet @43: I didn’t say that there was no such thing as social norms and expectations for folks trying for IVF. What I said is that people feel like failures because of a deeply personal sense of loss. Whether or not that sense of loss is partly the result of social norms? Sure, but it seems to me that you are rushing right past the deeply personal sense of loss to hop on a hobbyhorse, which strikes me as in bad taste.

For the record, I’m not a social scientist. My doctorate was in English. Needless to say, this means that I know nothing about anything.

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Ray 02.19.12 at 6:43 pm

Great post. Good luck.

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piglet 02.19.12 at 7:08 pm

“Perhaps—in a future Aldous Huxleyan world—ambitious people who have the means will freeze their eggs and sperm “for later” when they have advanced degrees and/or have made their first millions.”

This is already happening. Empowerment? Liberation? Control over reproductive choices? Brave New World? I expected there to be at least some debate on CT whether these are desirable developments. I am not that old but these questions used to be debated, back in the 1980s and 1990s. There was a strong feminist resistance movement against the encroachment of the biotech industry on women’s reproduction. Have we now all swallowed the libertarian fairy tale of empowerment through technological control over bodily functions?

Tedra, sorry to mislabel you as a social scientist. But feminist theory is a fair description is it not?

50

Zippy Cat 02.19.12 at 7:58 pm

Thank you for your post, Maria. It was honest and thoughtful. I am mom to a 2-year-old daughter through IVF (in the U.S.). It was hard for us — I didn’t mind the ultrasounds, but I didn’t like the egg retrieval or the thrice daily injections, and we weren’t prepared for the emotional ups and downs that go along with IVF. Don’t give up hope — we only had one frozen embryo (after a miscarriage of twins), and she is now our beautiful and healthy little girl. (and, fwiw, I am now pregnant with a miraculous au naturel baby after being told IVF was the only way we could conceive due to issues on both sides).
I am also frustrated with the narrative of the “woman who wants to have it all.” I started trying to conceive when I was 28, hardly an old lady.
Anyway, good luck, and I will be hoping all the best on this round.

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Tedra Osell 02.19.12 at 8:04 pm

Nope! I’m a practical, real-world feminist who has never read most of the major academic feminist theorists. My academic work was musty and archival and historicist in nature.

52

Scott Martens 02.19.12 at 8:40 pm

piglet@48:

I expected there to be at least some debate on CT whether these are desirable developments. [...] Have we now all swallowed the libertarian fairy tale of empowerment through technological control over bodily functions?

I wasn’t aware that particular fairytale was libertarian. I think it was socialist first and started with the introduction of the pill. Alas, my PhD is in linguistics, which means unlike Tedra I don’t even know English.

In some ways, that debate is dead. We have IVF and the world didn’t come to an end. Test-tube babies are just babies, not mutant technofreaks. On the other hand, some of it is what Steward Brand used to say: “We are as gods and might as well get good at it.” We can exercise significant power over reproduction. We can’t ignore that and we can’t pretend it will go away. Better to make good choices about it. I have a personal sob story about that too, but it doesn’t make a good blog comment.

It’s like a lot of other technologies that didn’t really change the world.

53

Dutchmarbel 02.19.12 at 11:51 pm

Only met the spouse when I was almost 32. Fertility problems, no obvious cause so in the Dutch healthcare system you have to try for 3 years before they will do any treatment. Was fortunate that (after IUI’s) the first IVF worked and had my oldest son when I was 36 (ha, no longer an idiopathic infertile, now I was a senile gravida…).

I recognize all that Maria said. The testing and procedures are invasive. I mean; the first test to check compatibility between partners is to check for live semen in the vagina within 24 hours of having sex. The next few years were spent with keeping temperature charts every day and having obligatory sex in the fertile week – followed by 2 weeks of continues checking of own body for probable pregnancy signs. So by the time we were up for IUI and later IVF I felt that however invasive the procedure was it at least ment we didn’t have the stress and obligations in our own sexual relationship anymore.

When I finally got pregnant I was totally insecure and uncertain because my only certainty was that I couldn’t trust my own body with basic functions surrounding pregnancy. When my son was finally born I cried for months, all the stress and scares and hurts of the years before had to come out.

Having children means that you sacrifice part of your life. It’s hard and the costs are pretty high. So I can totally understand friends who do not want children. However, spouse and I *did* want children. And having children is part of society for a number of reasons. If you want them and you cannot have them you are continuesly reminded of the fact that you ‘failed’ at having them. In talks with others, in discussing effects of political measurements, in having others relive their nice childhood memories via their children, in exchanging pictures. You will be reminded of your infertility for the rest of your life – because even when you are older people will start exchanging stories about grandchildren.

Stress doesn’t cause infertility, infertility causes stress. And everybody should just recognize that fact and try to support people who probably spent years focussing on preventing pregnancies and now have to mourn the loss of an ability everybody is supposed to have.

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Meredith 02.20.12 at 12:01 am

I wouldn’t want to live in a world where most men and most women didn’t want to make babies together, and then nourish them together (whether in conventional marriages or otherwise). I’ll be bold and brave and assert that there is something profoundly good in that desire.

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Emma in Sydney 02.20.12 at 12:30 am

Piglet @ 48 I expected there to be at least some debate on CT whether these are desirable developments. I am not that old but these questions used to be debated, back in the 1980s and 1990s. There was a strong feminist resistance movement against the encroachment of the biotech industry on women’s reproduction.

I am that old, and I used to take a radical feminist position that reproductive technology was just a way of subjugating women and reducing them to incubators yadda yadda. Then I (a) got old enough to want children of my own, and (b) wrote a feminist PhD thesis about how second wave feminism, as a product of its time and culture, systematically devalued ‘womanly’ pursuits from quilting to breastfeeding, because it unfortunately shared a patriarchal framing of which human activities were important and empowering. Like many other feminists, I began to see that revaluing some of the human pursuits which happened to be overwhelmingly done by women might be important in a feminist understanding of the world.

And then I saw the joy of real people I loved having babies they had thought would be impossible, and I changed my mind. I also read a lot of infertility blogs and learned to keep my mouth shut and listen when people were telling their personal stories, because I might learn something and avoid saying things that are hurtful and rude. You should try it, piglet.

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piglet 02.20.12 at 2:06 am

I wasn’t aware that particular fairytale was libertarian. I think it was socialist first and started with the introduction of the pill.

I don’t want this to get off topic but the quest for technological control over reproduction is much older than the pill. Not that I know anything either.

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Harold 02.20.12 at 4:01 am

People aren’t told the truth about IVF because it an incredibly lucrative business for fertility doctors. The truth is that even now, people are much much more fertile when in their twenties. (Though things have improved considerably, since the failure rate used to be something more like 90 percent than 70 percent). IVF is much more convenient for doctors than delivering babies. It’s nine to five. Not that I am condemning people who have the wherewithal to try it. I am in favor of babies and children. Not so much of the medical industry.

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Avid Reader 02.20.12 at 4:20 am

Thank you for bringing up the subject, Maria. I feel safer commenting anonymously — I’m just not interested in subjecting us to people’s judgements.

I’m in the U.S., we have two wonderful children, both through IVF. We’re lucky to live in a state that mandates coverage for infertility treatments. We have friends who live in another state who will have to do it all out of their own pockets. To have had to pay that much money ourselves would have been a real strain on our marriage, I think.

I wasn’t the one doing it but I think it was pretty bad. Like others, we had a couple of rounds of IUI before we got approval to try IVF. IUI is pretty tame and IVF feels like the “big guns” in more way than one. We had a couple of trips to the emergency room (casualty ward on your side of the pond). I vividly remember when the emergency docs told my wife she was pregnant — uhm no, that was just the fertility drugs, no embryos had been transplanted. It took much longer than we bargained for and it demanded a lot, particularly for my wife (I merely played a supporting role).

On our last round, we had four viable embryos of… marginal quality. My wife was getting close to forty and so eggs were not going to get more plentiful. We had used up all the frozen embryos from attempt number one in the previous round, to no avail. We followed our doctor’s advice, swallowed hard and had all four transferred. I know a bit about probability and statistics but at that point we were just praying (not that I’m religious, but it’s the closest description I can think of). Given the outcome (one successful baby), I’m glad we had the chance to do it that way. We are now, very firmly, finished with the business of making babies.

One last comment: I’m still surprised at how common this has been among our circle of friends. And the infertility problems are at least as likely to be on the male side in my (limited, anecdotal) experience.

59

Joshua W. Burton 02.20.12 at 4:57 am

IVF is . . . highly political . . . bloody expensive.

Not everywhere, of course.

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Helen 02.20.12 at 5:05 am

Thanks for explaining that to us, Harold.

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soren 02.20.12 at 5:52 am

“Embryos are not babies”

Whether embryos are baby’s are not is contingent of that embryo actually becoming a baby. It is “already but not yet”. It’s a paradox but it’s a true one everyone unconsciously acknowledges when the mother talks about the “baby” during and after the pregnancy.

“There is really very little you can do”

For most women they could have tried not waiting so long to have a child.

“IVF clinics (in the UK) are choke points for everyone’s pet public health priority”

Do you want nationalized health care or not?

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Emma in Sydney 02.20.12 at 8:21 am

Um, Harold? IVF babies still have to be delivered. And they come at all hours of the night. I think doctors who want a quiet orderly life become radiologists or pathologists, at least in Australia, not reproductive endocrinologists or obstetricians.

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Pete 02.20.12 at 10:51 am

“the premature children of very young mothers with chaotic lives who would never pass the bureaucratic scrutiny required to darken the door of an IVF clinic. I don’t believe the state has a right to prevent these women conceiving, so why should it be allowed to stop me?”

I think there are quite a lot of people who would like to find some way of preventing people from having children unless they are “responsible”, whether from vicious motives or a genuine desire to reduce the number of “Baby P” incidents, but no way has been found of doing this that isn’t horrendous and the entire discussion is behind the nailed-shut door labelled “Hitler”.

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OlderThanDirt 02.20.12 at 1:02 pm

Harold, I could have had a baby in my twenties with my abusive partner. Or I could have waited (what I did) until I got out of that relationship, and into my current relationship. I married again at 30 and was lucky enough to be able to have a child at 33 and another at 36 on my own. Was I selfish and stupid not to have a child with an abusive partner? It was the fear of delivering a defenseless child to his reach that finally got me out.

I know if you think about this, you can think of several situations a woman could find herself in that would mean that her twenties were not the best time for childbearing. There is a persistent narrative that the only reason that women don’t have children early is that they’re trying too hard to “have it all” but this narrative is just another instance of not trusting women to know what’s best for their own lives.

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Amanda 02.20.12 at 1:21 pm

It is so refreshing to read a simultaneously accurate and personal discussion of IVF, not just the stuff dished up by mummy bloggers all too often. My son was conceived “naturally” under the influence of a cocktail of fertility drugs preparing for a last-ditch IVF cycle after a couple of failures and our specialist pretty much telling us we would never even conceive with IVF. I was absolutely astounded during our couple of years of infertility treatment at some of the things people around me would say, often very critical, but you’ve mentioned them too so I guess it is the same in both hemispheres. On the adoption issue I can add that it is virtually impossible in Australia. There are in effect NO Australian babies to be adopted, and overseas adoptions are increasingly rare and limited by all kinds of regulations, and my husband at 41 (with a minimum 2 year adoption process ahead of us) was deemed too old to join the system (I was 33).

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Brussel Sprout 02.20.12 at 1:44 pm

Re adoption, I’d just like to add that even if you can successfully negotiate the bureaucratic hurdles to adopting, the long-term psychological consequences on everyone involved (birth parents, adoptive parents, adopted child(ren) and any birth children of the adoptive parents can be complex and painful to work through. I can think of five families off the top of my head in my circle of family and friends where the adopted children are now in the 35-50 range and the issues are coming thick and fast. It’s certainly no quick-fix to the whole issue of infertility and those people who glibly suggest otherwise are probably doing so from a position of deep ignorance.

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PSC 02.20.12 at 2:55 pm

My partner and I are on our 3rd round of IVF with no success as yet; it’s an emotional spiral. I hate the whole process.

On the probability; I don’t think it’s meaningful to say “20% success rate so if you try 3 times you’ve a 50% chance of pregnancy”. Along the way you’re bombarded with a lot of semi-relevant information, which might be meaningful but probably isn’t. What are your FSH levels? How many follicles did you get? How many eggs got collected? How many fertilised? How many grew out to 3 and/or 5 days? All of this has a bearing on the final question; how many implanted?

For any couple ultimately the probability of a pregnancy is either 0 or 1, as a participant you’re not interested in the behaviour of a population of 1000s, you’re interested in the selfish question: will we ever have a child?

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bianca steele 02.20.12 at 4:51 pm

Harold, this is off-topic, but infertility does exist. People have different hormone levels, they are carriers of genetic defects that make some embryos unviable, they were over-exposed to radiation, their mothers were given DES.

If someone starts trying at 33, and doesn’t go to a medical specialist for three years, they are now as was mentioned above considered “elderly” for fertility purposes. Are you going to find a sin to blame infertility at 32 on, too? Or is “younger” supposed to mean “under 25,” which many now do not think is the idea age to start a family?

I’m going to reiterate that we need better information and more research.

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me 02.20.12 at 5:14 pm

Zygote not embryo.

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Lobster 02.20.12 at 5:47 pm

Thanks for writing this. I’m not contemplating baby-making anytime soon but I like hearing stories about it, and I particularly appreciate the part about IVF clinics accumulating pet public health priorities. Pregnancy tends to do that in general.

@Helen, don’t you mean mansplaining?

@Tim Wilkinson et al: the problem with the statistical formulation is that for individuals, the draw is not from the aggregate distribution. There’s some individual probability of getting pregnant using whatever particular IVF methods are involved — for example, my friends whose infertility comes from sperm troubles were told their odds of success are substantially higher than the average. Probably the best way to think about it is using Bayesian updating. So actually by the time you reach the 9th round the best guess about its effectiveness is much lower. I think a rough and ready version of this is one reason (in addition to cost) that people will eventually stop trying IVF.

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Emma in Sydney 02.20.12 at 7:45 pm

The IVF mother I know best had her natural fertility destroyed by successful treatment for cancer during her late twenties and early thirties. This is increasingly common. Some of the parents of the miracle babies are miracles themselves.

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Avid Reader 02.20.12 at 9:18 pm

Point of information: government adds extra requirements for couples wanting to do IVF too. There’s no national health service or even any public funds involved at all. It’s just that, unlike the usual way of getting pregnant, IVF is regulated, hence the “choke points”. I remember the compulsory blood tests in particular — checking for AIDS and other STDs. I understand the motive but I still think they do that kind of thing in part because they can. Prospective IVF patients are not in a good place to argue.

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Avid Reader 02.20.12 at 9:24 pm

Aargh. I left out important words. Government adds extra requirements in the U.S. too.

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Richard B 02.20.12 at 9:47 pm

1. This is quite the most thoughtful and balanced piece on the subject I have yet read.
2. As a primer to any future discussion on adoption, I am old enough to have visited, as a professional, the old-style mother-and-baby homes which provided so many of the adoptable newborns. They were disgusting: they saw themselves as moral enforcers, and made the lives of the baffled pregnant girls and women a regimented misery. I also acted as guardian ad litem in adoption cases. The idea that there was once upon a time a golden age of abundant newborns, all of course preferably white and in perfect health, is one of the sicker fantasies of the anti-abortionists.
3. I did end up as a father, twice over, though I was well into my 30s and my partner had been told by a doctor that she was unlikely to be able to bear children, so I certainly can remember the prolonged inner questioning – “How much does this matter to us? What would we be prepared to do?” – and I can only feel very lucky indeed.

From long experience, my questions about allocating either IVF or adoption would not be about about the cruder measures of suitability – all that jumping through bureaucratic hoops in both cases – but simply about “Do you want a child so that you can get love from a child, or so that you can give love?” So many lousy parents of all kinds are in the first group, all the good ones are in the second. Telling them apart is vital.

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Dejla 02.20.12 at 11:49 pm

This was a fascinating article. You’re very courageous to struggle so hard and I hope with all my heart you succeed.

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Kieren McCarthy 02.21.12 at 7:10 am

A wonderful post Maria. So sad that it has to be about the struggle to get something that most take for granted.

There were a lot of points that registered strongly. This was one: “Almost anyone can get pregnant without permission, but once you fall into the trap of needing help, you must prove again and again that you are worthy of it.”

Part cowardice on my part – I am more comfortable talking about broader, policy, implications in public than personal emotion – but I think you have really hit on something bigger here. How people, by seeking help, are made to feel bad about it.

You have some idea how nuts it is here in the US. But I do think the sign of an advanced civilisation will be when people have *more* sympathy for people that wish to have what many take for granted, rather than less.

Anyway, lots of love.

Kieren

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A neuroscientist 02.21.12 at 2:38 pm

Thanks for the post. Hope it works. It did for us.

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absurdbeats 02.21.12 at 5:53 pm

I’m late to the conversation, but I’d like to recommend Liza Mundy’s Everything Conceivable. It’s a well-sourced journalistic account of a variety of assisted reproductive technologies and their consequences.

I’ve used it in my 300-level undergraduate course on bioethics, and even without a midterm or final exam, the students read it!

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Emma Jane 02.21.12 at 7:33 pm

Thanks, Maria, for posting something so reasonable in such a visible forum.

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Antti Nannimus 02.22.12 at 12:11 am

Hi,

If every conversation on the Internet could have as much information and so little noise as this one, we might finally have some hope to rise out of the primordial swamp of ignorance we have lived in for so many millennium. Where could this have happened just now, especially concerning a subject so controversial as the process of our human reproduction? Only on Crooked Timber, is my guess!

Have a nice day,
Antti

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