My IVF story: conclusions

This is the fourth and final post on my experience with IVF and pregnancy, and my thinking on its broader meaning to the public and to anthropology. Find the first post here, the second here, the third here.

While I spent a lot of time reflecting on my IVF experience, pregnancy and childbirth while they were happening, I didn’t think much about how others viewed my reproductive decisions. Maybe it’s because I’m from Massachusetts, which is a pretty liberal place, where gay marriage is legal and I had my choice of two different birth centers within an hour of my home. I had a supportive family who was delighted at the prospect of a grandchild, and friends who were rooting for me every step of the way. Friends in particular helped me maintain a rational perspective, and keep emotion and desperation from coloring my decisions.

I think that’s why I was so surprised at how vitriolic the comment thread got over at my CNN.com interview last week. Most of the nastiest comments have been removed (flagged by me and my husband), but I remember them just the same. Some commenters thought I should have let my brother in law “have a bit of fun” with me to get me pregnant (some put it worse than that, I won’t print it here). I thought this was interesting because to them, this had nothing to do with me or my choice. This explicitly reduced me to breeder status, and implicitly, to someone it was okay to rape.

Then there were the comments about the Catholic church condemning IVF. I’m not Catholic so I moved on. I also saw a lot about “bad genetics” and that it’s too bad we don’t have better mechanisms to weed out people with them anymore. I don’t even need to address that one.

Then there were the comments about all the babies who are waiting to be adopted. While commenters soundly took that one apart, I’ll also point you to this recent post in Feministe about the ways in which adoption is more expensive, more time-consuming, and potentially more exploitative than IVF.

And then there were two other threads: first, the folks who thought the whole thing was unnatural, messing with God’s plan, disrupting natural selection, and so on. Second, the folks who thought women who undergo IVF were evil, angry feminist career women who just waited too long to have babies and it was their fault they had old, dried up wombs.

Let’s focus on these two, shall we? Turns out I have a little expertise to offer.

IVF is unnatural

Let’s start with what I teach my students: the naturalistic fallacy. The naturalistic fallacy is committed when someone tries to equate “good” with “natural.” Hurricanes are natural, and yet can damage homes and cities, and are responsible for the loss of human life. Body odor is natural, and yet I shower and put on deodorant each day. Infanticide and sexual coercion in primates are quite natural phenomena too. So why is it a criticism of something to call it “unnatural?” That person is committing the naturalistic fallacy.

Those who asked “whatever happened to natural selection?” are committing another error. You could say we disrupt natural selection with the use of vaccines, prenatal care, chemotherapy, and many other medical treatments, but only a few people refuse these things, not because they wish to be weeded out by the selection pressures that made them sick, but for religious reasons. So really, the “natural selection” argument is another way of committing the naturalistic fallacy. I would argue that medical treatments are another environmental variable, rather than a disruption of natural selection. Besides, we have a wealth of evidence to suggest that natural selection is continuing to shape human evolution, and human health, in a number of ways (Byars et al. 2010).

Evil, angry, old feminists

Figure 1. Ellison et al (1993) Figure 5D of midluteal
progesterone concentrations across three
populations. Notice the highest concentrations
are between 25-35 years of age.

The average age for most studies I have read on IVF have an average maternal age of 29-34 years – even though, as you might expect, women get to the point of using IVF often after exhausting many other options and trying for years (for a completely random smattering that I pulled from Endnote, see Amir et al. 2007; McWilliams and Frattarelli 2007; Menezo and Barak 2000). That means that the many women undergoing IVF are within the 25-35 year range of maximal fecundity (Figure 1, Ellison et al. 1993). That’s right, folks, women are not maximally fecund when they’re eighteen, not even when they are twenty. The highest hormone concentrations and most consistent ovulatory cycles are in the 25-35 year range (Ellison et al. 1993). It’s true that this range isn’t necessarily ideal for most professions, including my own. But it just so happens that evil, angry feminists such as myself are taking our reproductive health and careers both into account when making reproductive choices.

I was twenty eight years old when I got pregnant (I turned twenty nine days later). The timing was not ideal for me professionally, as it meant I had a five month old while starting my first tenure-track position, the one I now hold here at Illinois. But I wanted to do my best to control for any factors on my end that could reduce the probability of conception, since the fertility issue was my husband’s, due not to his cancer, but his cancer treatment.

Something else I have noticed is that most of the criticisms, in the story’s comments and in wider circulation, are launched at infertile (or older) women. Nowhere have I read criticisms of men dealing with infertility. When we think of reproductive choice, we tend to launch all of our feelings – good and bad – at women. This leads to an overrepresentation in our minds of people who seek IVF as being pathological women.

For diagnostic purposes, medicine lumps people into two categories: healthy, or diseased (we could quibble over subclinical, or pre-diabetic, etc, bins, but bear with me a moment – I am talking not about the nuances of what a doctor understands, but the effect institutionally on patients). This is a very smart thing for a large number of diseases. You usually have a cold, or you do not. You have chicken pox, or not. Unfortunately this model of disease fits poorly on female reproductive functioning. Both the female and male bodies are responsive to environment, from psychosocial or immune or energetic stress to behavior. But the variation produced by these features in women is enormous, and simply more obvious. Cycle length, menses length, hormone concentrations, conception rates, ovulation: these things are easy to measure, and many are easy to observe without special technical equipment. They change over the course of a woman’s life and even fluctuate based on environment from cycle to cycle. We can’t really draw a line, where on one side they are healthy and the other pathological, and yet this is done every day when women reporting irregular cycles are given hormonal contraceptives without a thorough workup to determine the cause of the irregularity. For some women it may relate to marathon training combined with stress at home, for others a diagnosis of polycystic ovarian syndrome is necessary.

Further, the medical definition of normal is very difficult to achieve. How many women experience a twenty-eight day, ovulatory, symptom-free menstrual cycle month after month? Likely not many, if the data from my lab are any indication. This puts most women in the pathological category for huge chunks of their lives… even if nothing is actually wrong with them aside from having bodies that adaptively respond to environment.

I would suggest that this has led to a general perception – in the media, among the lay population, and elsewhere – that women’s bodies can go wrong easily (as opposed to vary naturally and adaptively), and that we should look to women when there is an issue getting pregnant. This is even though I am guessing medical doctors have a much more nuanced understanding of reproductive functioning than the model I described above. Because most laypeople don’t actually know how bodies work, and in particular how and why bodies vary – it is easy for subconscious sexism to seep in. So this model gets mixed up in the sexism in our culture, and this is part of what has led to demonizing users of IVF, pathologizing female athletes, encouraging young teens to take hormonal contraceptives to stabilize their cycles, and placing severe cultural limits on food and activity in pregnant women that are not evidence-based, to name a few.

Reproductive choice

It seems to me like we have a long way to go before we can appreciate and think well about the complexity of reproductive choice. The CNN.com story’s comments, and others (Pharyngula has a very nice takedown of another article where IVF babies' personhood is questioned), demonstrate that a lot of fear comes up when women have a say over their bodies. With more flexibility in terms of our reproductive decisions, we can have children at a later age or not at all, we can terminate pregnancies, we can enter into spaces and professions where normally only men have exercised choice. These are dangerous ideas to some. But we need to continue to talk about them, and think about what it would take, from all perspectives, to move away from an emotional standpoint, and towards a rational one.

References

AMIR, W., MICHA, B., ARIEL, H., LIAT, L., JEHOSHUA, D., & ADRIAN, S. (2007). Predicting factors for endometrial thickness during treatment with assisted reproductive technology Fertility and Sterility, 87 (4), 799-804 DOI: 10.1016/j.fertnstert.2006.11.002

Byars, S., Ewbank, D., Govindaraju, D., & Stearns, S. (2009). Natural selection in a contemporary human population Proceedings of the National Academy of Sciences, 107 (suppl_1), 1787-1792 DOI: 10.1073/pnas.0906199106

Ellison PT, Panter-Brick C, Lipson SF, & O'Rourke MT (1993). The ecological context of human ovarian function. Human reproduction (Oxford, England), 8 (12), 2248-58 PMID: 8150934

McWilliams GD, & Frattarelli JL (2007). Changes in measured endometrial thickness predict in vitro fertilization success. Fertility and sterility, 88 (1), 74-81 PMID: 17239871

Menezo, Y. (2000). Comparison between day-2 embryos obtained either from ICSI or resulting from short insemination IVF: influence of maternal age Human Reproduction, 15 (8), 1776-1780 DOI: 10.1093/humrep/15.8.1776