It's that time again.

Mel's Book Tour has hit again, and this time it was with the book Embryo Culture. If you don't know Mel, she's like the Den Mother of the fertility treatment world, and is so amazingly organized I want to bury my head in shame.

The book was more of an auto-biography-meets-National-Geographic. It was about an author's experience with IVF treatments and a whole lotta' science in between. Nothing wrong with science, now. Don't get me wrong. I like science, birds and the bees, Darwinism and Punnett Squares, but this was scary science, science of the negative. 60% of IVF babies will have x. 82% of IVF twins will suffer from y. 0.4% of you will get paper cuts reading this book. That kind of thing.

So, on to my questions.

1) The author also talks about how many embryos should be transferred at any given cycle. Should there be a limit?

Purely my opinion here, but - yes. Yes yes yes yes yes. In the EU they're moving towards single embryo transfer for women under a certain age or with no history of IVF, and two embryos for those over 40 or those with repeated failed IVF cycles. I remember in Sweden I didn't get a choice on one of my cycles, I was only allowed to put one back. In the UK you can only have max two put back unless you're over 40, then it's a max 3. I support a max of 3. The statistics here show that your success rates do not go up with increased numbers of embryos being transferred, and the theory is that the embryos must "compete" for all the goods at the uterine snack bar.

My clinic was a very, very conservative clinic. They hate multiple births because of the high risks involved in them. On my 5th IVF cycle they recommended both embryos be put back because they weren't great quality and I had had many failures at IVF prior to that round. And boom! I have twins and my RE was not happy.

Multiples are hard. They're hard on the health system, which almost always gets to welcome infants into special care or the mother into L&D a number of times before the arrival. They're hard on the mother's body and mind. Multiples are very hard on the finances. The risks involved with multiples are huge - premature labor (ding!), pre-eclampsia (ding!), small birth weights (ding!), developmentally behind (ding!), higher risk of in utero infant mortality (thankfully we skipped that one). Carrying multiples is very hard on the body as well, and I'm talking about my kidneys and bladder here, not about my attractive stomach apron. Not to mention that dividing your time and attention between multiple babies is not only exhausting, but also makes you feel like you're neglecting whichever child isn't getting your focus.

I wouldn't give up my babies for anything, but I feel we should be more realistic about what to do if we have more than one. I hear stories of women putting back 8 embryos, 9 embryos, and saying that should they all take they'll "just reduce". As I've said before, there's no "just" about reducing. It's a hard choice to make, just as having quints is a hard choice to make.

2) [The author] Beth Kohl discusses her fears about how IVF may lead to increased health problems for her children, and she thinks about this in the context of her daughter's surgeries for cysts on her bladder. Do you ever worry that IVF or other ART could compromise the health of your children created through the process? How has that affected your decision to pursue treatment?

I worry that the pursuit of IVF has marked my children in terms of development to some extent - because they were early they are behind, although I am assured that by 12 months old they'll have caught up with the rest of the pack. Gestationally they're about to be 18 weeks old, 22 weeks old from date of birth, but size-wise they're the same as a 12 week old, and about there developmentally too.

But I honestly never worry that they'll develop a heart condition as a result of being created in a petri dish, or that one arm will grow longer than the other because their cells were exposed to air instead of being bounced along a fallopian tube. Maybe I'm naive, I just think that at only 4-cells not a whole lot could've impacted them at that stage. I do worry about genetics in general - skin cancer runs in my family, I worry that they'll get that and vow to protect them against the sun, but I don't worry that anything might impact them due to the nature of their creation.

3) Beth likens Dr. Frankfurth's [her IVF doctor] office to one that "should have belonged to a family doctor in Anchorage, circa 1950, and not to a late twentieth century endocrinologist." How much do appearances matter? What were your first impressions of your RE's office? Did/does that color your interactions with the RE himself or herself?

My RE - while a medical genius and an excellent physician - was not a sparkling personality, and his office reflected this. We met him at his NHS office, even though we pursued treatment privately, as we are ineligible for NHS treatment for fertility. His office was a typical NHS office - boring desk, boring chair, boring view. His private office was no different, and the waiting room of the clinic where we pursued treatment was littered with ancient Hello! magazines and pamphlets from the HFEA. There was at least a coffee machine with drinkable coffee, but his office was cold and depressing. The transfer room was also a boring, run-of-the-mill NHS style room. Don't get me wrong, I love the NHS, but NHS decoration is something out of the 70's. So if I'd been going on looks I would've done a runner. As it was, we went based on their success rates, and I'm glad we went where we did, even if we never exactly had a warm and huggy relationship with the RE.

The only decoration that he had really were massive picture frames, each containing many photos of babies he'd helped to create. They lined almost every wall of the clinic and I remember being both unable to look at them and being unable to draw my eyes away from them. I sent in a photo of Nick and Nora, I sometimes wonder if they're in a frame and someone going through the process looks at them and can't bear them, just as I did.

Hop along to another stop on this blog tour by visiting the main list at http://stirrup-queens.blogspot.com/. You can also sign up for the next book on this online book club: The Mistress's Daughter by A.M. Homes (with author participation!)

-H.

Posted by: Everydaystranger at 01:52 PM | Comments (9) | Add Comment
Post contains 1162 words, total size 7 kb.

1 We put back three embryos for our IVF cycle as well as our FET (prior to that, I had only done injectable cycles, which HELLO. I could have theoretically had my own Discovery health show, and it's very scary to think about) and honestly, I don't think I ever really worried about multiples. Obviously the first time it didn't work, and that was with our valedictorian embryos. The FET, we were with Dr. Pompy who made us sign a waiver stating that we were on the same page in regards to selective reduction. I know there's no just about it, and I'm sure I would have had a hard time with the decision, but thankfully, we hit the baby lottery. As for doctors, it's not government regulated here, so finding a doctor is kind of like trying to find a used car salesman without a bad rug and a plaid suit. Obviously, we hated our first doctor (i still need to write him a nice fuck off letter) and landed with Dr. Pompy, who we actually did have a huggable relationship with. There are few people I miss in CA, and he's one of them.

Posted by: statia at March 02, 2008 03:26 PM (lHsKN)

2 I feel I really have no opinion here, since I have never undergone IVF, but I think you make some very valid points-along with Statia below- as two women who have been through it all. As far as the office and the doctors, I agree it should be as warm and personal as possible, and it is a shame it isn't always like that. I remember very well when I was pregnant with Veronica an incident at my OBGYN. It was a high risk office, and because I was so overdue they sent me there. Many of the woman were receiving IVF or undergoing difficult pregnancies, and I felt guilty the minute I walked in there with my giant belly and all those eyes were on me. A young women and her husband were called back for their ultrasound, and when they emerged a little later she was in tears and he was holding her, and as the nurse walked her out she said "again, I am so sorry." I just wanted to melt into the floor. I thought it was extremely cruel to make her not only walk out in front of everyone, but it just seemed to add insult to injury that was I sitting there 9+ months pregnant. At that moment I truly realized just how unfair it all seemed. As a side note, when Scottie was in the NICU his nurses were some of the bitchiest and coldest I have ever encountered. Lord knows I am not saying that this is the case with all NICU nurses, but the ones assigned to Scott were awful. I remember my mom commenting on how you think that they would be a little more supportive and caring, but I guess taking care of the babies and their delicate conditions trumps worrying about the parent's feelings. However, it seemed like cold comfort at the time and I just dreaded going down there and seeing those nurses. Can't complain now though, because he is a healthy six year old. It is wonderful when you find a doctor that you love, it is just too bad when you have to deal with the ones you don't.

Posted by: Teresa at March 02, 2008 04:37 PM (b+8pB)

3 I almost peed my pants with this one: "0.4% of you will get paper cuts reading this book. That kind of thing." I worry about the premature birth thing--though mine were IUGR and it's likely that a singleton would have been IUGR too. At 3 1/2, they still haven't caught up size-wise. But yes, when you talk about quints and the promise that they'll be early and you know what prematurity is like...well...you gulp. I think three is reasonable. One would only be reasonable if it was a shifting one that took into account other factors.

Posted by: Mel at March 03, 2008 10:24 PM (mu6zx)

4 Thank you for sharing your experiences with us. I have similar thoughts about limits. Interesting thought about the health impact of the creation method.

Posted by: Deb at March 04, 2008 12:43 AM (4xfg0)

5 Thanks for sharing your experiences. I have similar thoughts on the limit issue. Interesting thought on the health impact of creation method. Good answers!

Posted by: Deb at March 04, 2008 12:46 AM (4xfg0)

6 Thanks for sharing your experiences. I have similar thoughts on limits. Interesting thought on the health of the baby based on conception method... hadn't thought about it that way.

Posted by: Deb at March 04, 2008 02:12 AM (4xfg0)

7 Okay... If you can, please delete one or two those. It was giving me an error message about spammers and DUH... I didn't look at the top of the list, only the bottom. It has been one of those days-- Thanks!

Posted by: Deb at March 04, 2008 02:20 AM (4xfg0)

8 Tried commenting yesterday without success -- let's see how this goes! Just wanted to say I appreciated your comments, especially re: multiples. I'm not sure people have a realistic view of what's involved in carrying them, let alone bringing them up. We need more voices like yours.

Posted by: loribeth at March 04, 2008 01:21 PM (pYHpB)

9 I was scared of being pregnant with twins because I knew what it could mean (NICU stays, bedrest, etc), but I also was scared of not being pregnant at all after all those shots and all that medicine in my body. I took the risk of having a twin pregnancy because the twin fear was so much less of having to go through IVF again. I love my babies and am so glad we did what we did. However, I would never have transferred more than 2. More than that seems like too much - at least, for my situation. I can't understand people who say they will "just" selectively reduce. How do you do that? How do you decide? Thank you so much for your comments. I enjoyed reading them!

Posted by: Heather at March 05, 2008 11:11 PM (nXacA)

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