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In Vitro Fertilization


Articles

Blogging Infertility

Cheryl Miller on the lively and fractious community of “infertiles”

Eugenics—Sacred and Profane

Christine Rosen on Orthodox matchmakers, IVF clinics, and genetic testing

My Mother, the Embryo

IVF's Latest: She-Males, Fetal Eggs, and Children of the Unborn

Fertility Gone Mad

Pregnancy After Menopause, IVF Birth defects, & More

Hollywood’s Fertile Imagination

Baby-Making Goes Prime Time

‘An Unknowable Atom of Human Flesh’

Henry Hyde and Joe Barton on the Ethics of Stem Cell Research

The Embryo Wars

The U.N., Mitt Romney, and California Corruption

The Bioethics Agenda and the Bush Second Term

Acorns and Embryos

Robert P. George and Patrick Lee on moral standing and bad metaphors

Getting Serious About IVF

Adam Wolfson on the new report from the President’s Council on Bioethics

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Blog Posts

ART in the News

Y-guys, the loneliest kind of infertility, Dara Torres, and more

Donated Generation

The summer issue of The New Atlantis is now online. As always, there are some terrific articles, including Rita Koganzon's foray into the world of Second Life and James Bowman look at the "dumbest generation."

Your humble blogger also has an article in the issue--it's on donor-conceived children and the rise of open-donor programs. Many, many thanks are in order to DI-Dad blogger Eric Schwartzman and Circle Surrogacy's John Weltman for sharing their stories. Joanna Scheib and Elizabeth Marquardt were both incredibly helpful and generous with their time and knowledge.

An excerpt:

When Eric Schwartzman went in for a medical exam six months before his wedding, he didn't expect to hear he was infertile. After the examination, the doctor suggested Schwartzman have a sperm-count test. Schwartzman thought nothing of it. Then the results came in. He was diagnosed with azoospermia, a condition in which the man produces virtually no sperm. "Don't plan on having kids naturally," his doctor told him. "You can just adopt."

Schwartzman and his wife were devastated. He offered to call off the wedding, but she refused. Instead, they went to a fertility clinic, where Schwartzman underwent two testicular biopsies to retrieve sperm for in vitro fertilization (IVF). As a backup, his doctor suggested the couple select a sperm donor, and they agreed without really taking the possibility seriously. But when two IVF cycles failed, he and his wife reconsidered.

Schwartzman is now the father of two "half-adopted" children, as he calls them, both conceived through donor insemination. Most of the time, he says, he focuses on day-to-day life--"getting them potty trained" and the like. But he sometimes wonders what effect their unusual beginnings will have on them. 

Still More on 30 Years of IVF (And Britain's Donor Shortage)

The London Telegraph has a series of articles on ART today, including a number of first-hand accounts from patients and donors. There are some great stories, but since I'm working on a piece about donor registries, I was most interested in the ones about the effect of the anonymity ban on donor recruitment. 

The answer is not good — as this U.K. government report recently attested.

Sophie Turner and her partner Karen Harvey have spent two years trying to conceive a child. After learning about the waiting list for sperm donors, the couple turned to a Danish cryobank. The trips did not result in a baby, so the couple returned to the U.K. where they are still waiting for a donor:

After two failed attempts, she's being treated at Barts, where there's a three-month waiting list for British sperm. Any child we have will be able to contact the sperm donor when he or she is 18; I think it's a good thing that children know where they come from, but I'm not sure of the effect it will have on us as a family.

Sue Adlam is a school teacher. She waited a year for an egg donor to conceive her first child, and is now searching for another donor to conceive a sibling:

I feel as if I've spent half my life waiting, but as anyone who's ever suffered from infertility knows, what keeps you going through all the sadness is the prospect of the amazing miracle of a baby at the end of it all. Many women are faced with the prospect of a wait of at least two years, but my hope is that things will begin to improve in the long term.

In Vitro We Trust

Nature is not the only one looking back on the birth of Louise Brown. In the New York Times, Peggy Orenstein reflects on the history of IVF and the challenges ahead:

Louise Brown turns 30 on Friday. These days, her name elicits little more than a mystified head shake. Who was she again? Let me refresh your memory: Little Louise was the world’s first “test-tube baby,” what we now refer to as an I.V.F. kid, or simply “the twins down the block.”

Brown’s life today is as unremarkable as the circumstances of her conception have become: she’s worked as an administrative assistant in Bristol, England, and is married with a naturally conceived toddler of her own. It’s hard to imagine that she begat one of the major revolutions of the 20th century: since her debut, more than three million babies have been born worldwide using I.V.F. or other reproductive technologies.

[I]t’s easy to forget the disturbing questions about I.V.F. — its practices, ethics and impact on public health — that do remain and are left largely subject to a physician’s conscience and a patient’s desires. The trouble is, doctors who do I.V.F. are selling a product and their patients are so vulnerable, their experience with infertility so fraught, that they’re not always willing or even able to act in what seems like their own best interest.

IVF: The Next 30 Years

Nature magazine's July issue has a special feature on the 30th anniversary of IVF. After discussing the legacy of IVF (subscrip. req'd), Nature asked a group of scientists what the next 30 years of IVF research will look like. Among the predictions:

  • Scientists will be able to create sperm and egg cells for anyone. Using sperm and egg cells derived from induced pluripotent stem cells, scientists will end infertility. Newborns and hundred-year-olds could become parents.
  • Embryo research will become a "fact of life": "They would become objects and would be used as objects...Maybe 20–30 years from now we'll read in newspapers that someone made 20,000 embryos and studied their development, and we'll decide it's OK."
  • IVF for less than $100: Cheap IVF will soon be made available in developing countries.
  • Healthy babies will be assured with the use of "genetic cassettes." Scientists will insert the cassettes into embryos to correct for diseases like Huntington's.
  • But people will still have sex: "IVF is expensive and uncomfortable. The old-fashioned way is cheaper and more fun and that won't change in 30 years."
  • Artificial wombs will change the abortion debate: "If an artificial womb were developed, the government could pass a law that requires people who have a termination of pregnancy to put the fetus into one of these wombs."
  • Alert the trial lawyers: There will be litigation over the health of IVF babies. "With the increasing availability of IVF, there will be more emphasis on safety. Not enough is known about the long-term health of the Louise Browns of this world — if there is a problem, it will be unexpected."

Two Takes on Living With Infertility

Melissa at Stirrup Queens has two great posts up. The first is about Jenna Nadeau Currier's infertility memoir, The Empty Picture Frame. (Read more about Jenna in my article, "Blogging Infertility.") Here's Melissa discussing Jenna's idea of  parenthood as a "calling":

I felt strongly drawn to the idea of parenthood and I wanted to experience it very badly. I was willing to try multiple paths to get there. I made life choices/career choices based on the idea of motherhood and what type of mother I wanted to be. I'm lucky that this worked out for me because I made a lot of choices that I probably would have regretted since I gambled making them.

The second post is an interview with Kim Hahn, CEO of Conceive magazine:

Melissa: You are the founder and CEO of Conceive magazine. What gave you the idea to start the magazine?

Kim: While my husband and I were trying to start our family, I was frustrated by the lack of positive, consumer-friendly information about fertility. Specifically, I longed for a magazine as beautiful, upbeat, and informative as the many pregnancy and parenting magazines on the market. I saw a hole in the market for women trying to conceive. There are magazines for brides, pregnancy, and parenting, but there was a gap between the bridal and pregnancy magazines.
 

ART in the News

Affordable IVF, Older Dads, and The World's Oldest Mother

Eugenics Watch: I, For One, Welcome Our New Genetic Overlords

What happens, if after pre-genetic screening, no unaffected embryos are found? Should they be transferred? And if so, who gets to decide?

That's the subject of a talk by Dr. Wybo Dondorp, a senior research fellow at the Department of Health, Ethics and Society at Maastricht University (The Netherlands), at the 24th annual meeting of the European Society of Human Reproduction and Embryology in Barcelona. If you read this Reuters article, you might think that the patients get to decide about the disposition of their affected embryos. You'd also be wrong.

According to Dr. Dondorp, decision-making about affected embryos must be "shared" between parents and doctor--except, that is, when the doctor disagrees with the parents. Then, the doctor gets to decide that it's not in the interest of the future child to be born:

"The present consensus is that where the classical indications for PGD are concerned, doctors should, as a general rule, not transfer affected embryos where no non-affected ones are available.

[...] The welfare of the child is closely connected to the classical indication for PGD: a serious disease caused by a single gene mutation for which there are no, or limited, treatments, and, in most cases, presenting early in life. An example is an embryo that is homozygous for cystic fibrosis, where the child will definitely have the disease. In such cases it is inconceivable that doctors would agree to transfer these embryos as it would be at odds with their professional responsibilities.

[...] It must be made clear that there may be, with conditions, room for shared decision-making about transferring affected embryos. But that does not amount to leaving it to the parents, as doctors cannot avoid their professional responsibility for the welfare of the future child."

Just to be clear, people with cystic fibrosis can live into "their 30s, 40s, and beyond." But no, their lives aren't worth living! For now, Dr. Dondorp hasn't yet ruled on the fates of people with genes for hereditary cancers or other chronic conditions. Those will be decided by a "case-sensitive evaluation of aspects relevant to the 'high risk of serious harm' criterion." Again, not by you, the potential parent!

So what if your doctor decides you shouldn't transfer your embryos? Dr. Dondorp has some helpful advice: 

In pre-test counselling it should be explained that if no non-affected embryos are available, the only options are trying a new cycle or being advised to reconsider one's reproductive plans such as refraining from reproduction, using donor eggs or sperm, or adoption.

But don't worry, the doctors won't immediately dismiss your views about the fate of your embryos. They'll pretend to listen first, and then do whatever they've already decided on. 

"Parental requests for transferring affected embryos should not be dismissed beforehand as a sign of irresponsible capriciousness. As the couple's primary wish may be for a child, they may reason that if a non-affected, healthy child is not what they can get, they will also be happy with, and good parents for, a child with a condition they at first intended to avoid. Respect for autonomy at least requires taking such requests seriously, even if, in view of all other considerations, doctors decide not agree to the requests."

ART in the News

IVF is not so easy, fertility coaching, and more

John D. Gordon, Internet Doctor

Part Two: On being a man in a woman’s world, when things go wrong, and more

100 Questions and Answers About Infertility

John D. Gordon

Part Two of my interview with Dr. John D. Gordon. For Part One, click here.

When patients ask you for advice on the web, how do you typically respond?

JDG: If they don’t tell me how old they are, I ask how old they are. I’ll ask if there’s a sperm issue sometimes. Usually they lay out in their little shorthand exactly what they’ve been through. I’ll get these six-paragraph descriptions of everything they’re doing.

It’s hard. There’s this old joke: What’s the difference between God and a reproductive endocrinologist? The answer is: At least God knows he’s not a reproductive endocrinologist.

There is a feeling that there’s nothing you can’t accomplish with modern science, and there are certainly some physicians who play into that. That’s not always true. Sometimes things defy explanation; we don’t understand why things haven’t worked. The patient has been through an awful lot, spent $100,000, and has nothing to show.

At that point, it’s incumbent upon somebody to say, “This is about being a parent. Your goal is to become a parent. Obviously, your goal was to be genetically the parent, biologically the parent. But maybe that won’t happen. Therefore you might have to consider what does it mean to be biologically the parent, but genetically not the parent with donor egg or donor sperm? Or to be neither genetically nor biologically the parent and to pursue adoption? Or not to have a family and have a different life?”

Those are important things to present to couples. We’ve all seen patients who ended up broke, divorced, and unhappy at the end of this road. That’s not what we want to see. It’s a terrible outcome.

How did you choose fertility as your specialty?

JDG: My father and my brother are general surgeons, and general surgeons have a different view of the world. The old adage: “A chance to cut is a chance to cure.” Why would you want to be anything else except a surgeon?

I thought I wouldn’t go to medical school because I didn’t see myself as a surgeon. Then I came to the conclusion that I really like science and helping people so maybe medicine would be a good career.

I went to medical school, and thought maybe I’d be a pediatrician. I went on my first rotation and it was a disaster. I didn’t get along well with the residents, and I found it too traumatizing to deal with the sick children—it just broke my heart.

Then I did a rotation in Internal Medicine at the VA Hospital in Durham. That was really sad because all these guys were coming in with multiple medical problems and they’re constantly being admitted. They didn’t get better that quickly. It was depressing.

I went right from there to OB/GYN. I didn’t really know anything about women’s health, except that my father said the OB/GYN guys never slept because they were up all night delivering babies. I did the rotation; I loved it. There was medicine; there was surgery. The women were generally compliant patients. They listen to what the doctor has to say and don’t ignore medical advice--not like men. Men are terrible patients. And delivering babies is really exciting.

Then I did an elective in reproductive endocrinology. It was emotionally charged, but it was very goal-directed. You knew if you accomplished the goal or not, which I liked.

What’s it like being a man in a “women’s field”?

JDG: In the mid-Atlantic and the South, there are some women who prefer to have a male physician. Rarely do you find this in California. The default mode is “I want to go to a female physician because she understands me better.” I can’t argue with that: I can’t say what labor feels like; I can’t say what it’s like to have a bad period or an ovarian cyst.

At times, it would go in the other direction where male physicians were almost demonized: “Why are you in this profession? You shouldn’t be here.” There was a paucity of men in the program, and nationwide that’s continued where there are very few men going into obstetrics and gynecology.

You were immediately suspect. I remember one night being on obstetrics call at Kaiser. A woman was in labor, and I went in and introduced myself. She said, “I want a woman.” I told her, “It’s August. The only woman I have has been an intern for three weeks and she’s only done a handful of deliveries.” She said, “That’s who I want.” I’ve delivered like a thousand babies at this point. Fortunately, things went fine.

The good thing is in a subspecialty, you have patients who say, “I want the best doctor. I don’t care--male or female.” You’re somewhat protected in a subspecialty.

My wife had a female obstetrician for her first pregnancy and said she would never have one again. She felt all her symptoms were ignored or dismissed; she felt no one really was listening to her. It’s true a woman has experience of these things, but if a woman says, “This hurts,” I’m not going to say, “No, it doesn’t.” If she says “Every time you do a pap smear my cervix hurts,” I’m not going to say that’s impossible, because I don’t have a cervix. If you tell me it hurts, I’ll believe you.

What should patients look for in a physician?

JDG: There are a couple of things. The first thing is: What is the experience of the physician? Where did they train? Are they board-certified? What has been their reputation, and what are people’s experience with them and their practice?

The second thing is with IVF, it’s very important to have a good IVF lab. If you don’t have a good IVF lab, you could be the best, most caring physician in the universe and you’re not going to get people pregnant the way you should. That’s something the patients never see. They have to evaluate it based on statistics. The problem is there’s that old adage: There’s lies, there’s damned lies, and there’s statistics.

The problem with comparing practices based on statistics is that there’s a patient selection phenomenon going on as well. What I’ve always told patients is if you’re looking to compare two practices, look at their donor egg pregnancy rates because they should be a level playing field. Everyone has young donors, and everyone has older women who need donor eggs. Their donor egg pregnancy rates should be a yardstick by which you can compare practices--apples to apples and oranges to oranges.

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