The Open Laboratory 2010: for sale now!

Looking for once place to read the best science writing of 2010? Want a peer-reviewed resource that you can show your colleagues that are social media naysayers to demonstrate the power of science blogs? Look no more: Open Lab 2010 is now available for purchase at Lulu.com!

Two of my posts on IVF were selected for Open Lab (to be put into one essay). I'm brushing shoulders with some very fancy writers. I do hope you'll buy it.

ResearchBlogging Editor's Selections: PMDD

Just a quick note to let you all know that my PMDD post was chosen by both Krystal D'Kosta and Jason Goldman for their Editor's Selections this week over at ResearchBlogging.org.

An embarrassment of riches

I have been quite the fancypants lately. In addition to the flood of new traffic from Science Online 2011, and in particular my post on the women scienceblogging panel, folks have been heading here to talk about broader issues of underrepresentation and racism, and, of course, iron-deficiency and the ladybusiness.

Then, because of a happy accident and the fact that Laura Weisskopf Bleill of Chambanamoms.com wanted to help me promote some focus groups I am running for a study on doctor-patient relationships around hormonal contraceptives,* I became a Chambana Mom to Know. At the same time I was recruited by the ever-clever John Hawks to do a bloggingheads.tv diavlog where we discuss women in science, blogging in academia, my fieldwork, the ladybusiness, #aaafail, and lots of other stuff.

I am feeling quite overwhelmed by the fact that I have a lot of new readers, and this is no longer the intimate space it once was (usually when I write, I imagine myself to be talking to a group of female friends while we sit on the couch and hang out - it now feels like giving a seminar to a medium-sized room full of people, where we are somehow still able to manage cool sidebar conversations). This is new and exciting, and while there is a part of me that will grieve for that little space where I knew most of the people who read me, I am delighted to bring anthropology to more people and keep pushing myself to write more accessibly for more people.

So, I am trying to think of next steps in terms of my writing. I still owe you all a summary of the survey I did on my readers a few weeks ago: given my day job commitments, that is the plan for what will probably be my single big post of the week.

However, I also want to continue to do two things: shorter researchblogging posts on articles I find interesting, and longer posts on specific issues around women's health, anthropology and medicine. So if there are particular papers you want me to read, particular topics you want me to cover... say so in the comments!


*I need to double-check with the IRB about whether I have approval to advertise this on the blog. If it turns out I do, expect a post on it this week!

ResearchBlogging Editor's Selections this week

Krystal D'Kosta, the new social sciences editor at ResearchBlogging.org, shares her Editor's Selections this week, and I'm one of them for my iron-deficiency post! Check them all out here.

Crowdsourcing revisions to my OpenLab piece

On January 7th, Jason Goldman of the Thoughtful Animal and this year's Open Lab Editor, announced the finalists for Open Lab 2010, a yearly anthology of about fifty of the best pieces of online science writing.

Magically, out of 900 posts, two of my IVF posts made it: My IVF story: pregnancy and My IVF story: conclusions, to be made into a single essay.

I know. Holy crap! I'm excited, pleased, proud, and surprised. I was a reviewer for this year's edition,* so I know it was time-consuming work -- I can only imagine how much more work for Jason himself. I really appreciate how this anthology is produced by the community, and reflects the best thinking of a large group of people, and how many selfless volunteers put in work.

Unfortunately, I'm also a little harried right now. The deadline to turn in my revision is January 21st, but on the 20th I have an NSF proposal due, as well as the papers for my probationary review (that's the review tenure-track folks get every year). I'll be away this weekend for Science Online 2010, with my kid, and classes start next week.

I want to combine these two posts as thoughtfully, and seamlessly, as possible. I have a few different ideas about how to do this in a way that reduces the total size of the essay, rather than lengthens it, but I also thought: why not ask my readers? Maybe you read the posts and had questions or felt like things were missing from the original version; maybe you felt elements of it were redundant. I'd like to hear what you think! This will help me when I carve out time to revise the two posts into an essay.

To sweeten the pot, I'll send a little present to each person whose comments I use when I make my revisions. Maybe some origami sticky notes or a titanium spork? I'll also make sure to acknowledge each of you on the blog.



*Obviously I didn't review any of my own stuff -- each reviewer only got a small portion of posts to read each round and I didn't even know who the other reviewers were until the end.

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

My IVF story: pregnancy

A few things have made me decide to tell my conception, pregnancy and birth stories, and provide some broader context, on my blog. Of course one thing is the CNN.com story that came out on Monday. Then I was struck by how the criticisms being launched by opponents of IVF – to me personally on the CNN.com story’s comments, and broadly in the media coming off of Edwards’ Nobel Prize win – are so overtly sexist and are so related to the way I frame my research. And, earlier this semester I also had a student leave me a note in my Question Box. (The Question Box is a box I leave out for students to submit anonymous questions. Sometimes serious, sometimes ranting, often clever, it’s an interesting part of Anth 143.) This student asked whether my understanding of reproduction, as someone who studies it, affected how I viewed pregnancy and childbirth when I went through it myself.

So this post chronicles how I got to be pregnant. Later posts will discuss my pregnancy, my childbirth, and how sexism and the pathologization of women’s bodies are damaging and incorrect.

The beginning of my family

Brendan and I met in college, at Nerd School. I knew Brendan had had leukemia just a few years before, and I remember thinking that it made him calmer, more mature. I valued his thinking above the other young men I knew. Thankfully, he felt the same way about me. It took us six or seven months to start dating, and a few months after that for me to discover he was infertile. I just asked him one night, he told me he was, and that was that.

I remember feeling as though the chance to have children was slipping away, because of who I had fallen in love with. I remember seeing how Brendan turned inward a bit, in that moment, I think expecting rejection from me. He talked about how much he wanted to be a dad one day, and I thought, I fucking hate cancer. And then I figured, science will take care of this by the time we actually want kids. Either that or we’ll adopt. So I tried not to think about it. And of course, over several years, we fell more in love, and we got engaged, and we got married.

Over this period, we were both going to graduate school. I was doing dissertation fieldwork in Poland until two weeks before we got married. After a year of lab work (undiluted spit and piss stink more than you might expect) and I was in the writing stage, I moved back up to Cambridge and, for the first time since we started dating, we lived together.

Brendan, being a year ahead, finished his doctorate before me and went on to an amazing post-doc position at Children’s Hospital. I was a lecturer at Yale, and then preceptor faculty in the Harvard Expository Writing Program while finishing my dissertation. But while writing in coffee shops and libraries, I found myself intensely, painfully jealous of pregnant women. I wanted to hold little babies and smell their hair. So I started talking to Brendan about it, and it was something he wanted too. He looked into his healthcare, and it was amazing. In vitro fertilization would be totally covered. Totally covered. As in, cough up the occasional co-pay and you can try to have a baby. It made me feel almost like a normal person.

Going for it

We made an appointment with a fertility specialist. We figured it made sense to try while I was young and not a limiting factor, seeing as we already had one in Brendan. Poor Brendan had to submit to a number of tests, because it was decided that there was a very, very small chance that maybe there were some sperm in there somewhere. There weren’t, but let’s say he found out the hard way. Then there was a chance that Brendan had a single vial stored somewhere that was taken between chemo treatments. Chances were nothing was alive inside it, but our doctor was excited by this news and recommended we try IVF to see if we could use this sample.

Then it was time to figure out a backup plan. Neither of us wanted to use a stranger’s sperm. So then it was a matter of deciding who to ask.

Of course, privately, years ago, we had already discussed Brendan’s youngest brother. You see, his middle brother was his bone marrow donor when he had leukemia. We always felt it would be fitting to have his other brother be our sperm donor. But how the heck do you ask someone to be your sperm donor, especially a twenty two year old someone who, understandably, doesn’t exactly have babymaking on his mind?

We needn’t have worried. We called, we chatted, we nervously explained, and Brendan’s brother was beside himself with delight. I suspect he had always been disappointed to be the brother who wasn’t a bone marrow match. As a fifth grader with his oldest brother battling cancer and his middle brother getting holes punctured in his hip to donate bone marrow, he got his class to sit down and make paper cranes. They didn’t quite get to one thousand, but they got close.

With Plans A and B all set in terms of the sperm, it was time to figure out the eggs (I’ll spare you what turned out to be insane details scheduling and timing Brendan’s brother’s trip to coincide with my treatment). I had to undergo a battery of tests including a hysterosalpingogram and vials and vials of blood to make sure I was fertile and wasn’t harboring any nasty diseases or genetic proclivities to nasty diseases. Brendan and I also had to go to a therapy session. I felt like all my spare time went to phone calls and doctors’ waiting rooms. I understood why I had to go through it all, but resented what I had to go through when other people could just have sex and get pregnant. Once we were cleared, we couldn’t even get started with the stimulation protocol, because we had to be fit into the embryologist’s schedule: they don’t want too many embryos to watch at one time. As rational as all this was, it was hard to feel rational when I wanted to move forward.

IVF in accord with our lifestyle and environment

Our doctor was exceptional. She was hopeful in a measured way, she listened well, she was not condescending, and she appreciated the fact that I was a scholar in women’s reproduction and had a few opinions of my own. We discussed going for a very mild protocol to avoid hyperstimulation, because a higher dose would be unnecessary for someone like me: healthy, young, athletic, fecund. I said I would rather have this all not work then feel like I was so desperate to have a baby that I would risk my or my child’s health.

So we went for a lower dose. Birth control pills, then little needles in my leg, more appointments to count follicles and measure my endometrial thickness, a perfectly timed hCG shot to mature my eggs.

Fourteen eggs were aspirated in an outpatient procedure. Brendan’s sample was thawed. The sample was essentially empty. Brendan’s brother’s sample was used. My heart broke just a tiny bit when I was told that part. But then I remember thinking to myself, rather fiercely, of the incredibly strong baby that will come out of all this, and call Brendan Daddy, and how the bonds of our family would knit even closer in the wonderful blend of genes and environment that would be our child.

We risked a five day protocol before blastocyst transfer. In IVF, the most typical protocols are to transfer a three day embryo, or a five day blastocyst, back into the mother. The three day was more common in the past, but you risk the mother’s endometrium not really being receptive yet. The five day transfer would mean a few more risky days of being cultured in vitro, but a greater chance of there being an alignment with the receptivity of the endometrium. The other decision we had to make was whether to transfer more than one blastocyst. Continuing with our decision to not take risks with my or potentially a baby’s health, we wanted to reduce the chance for having multiples, so we opted for a single embryo transfer.

These were a panicked few days, waiting for the embryos to culture, hoping some would actually be left by the time we got to the fifth day. I had trouble maintaining a rational perspective, that the way we were doing this was best. But we got there. We went in for our outpatient procedure to have the embryo transferred to my body. I had to take a Valium and drink an enormous glass of water: the Valium was actually more to keep my muscles, including the muscle of my uterus, from contracting, and the water was to get my bladder as full as possible to make it easier to image my uterus using abdominal ultrasound while they implanted the embryo.

Our "textbook" blastocyst.

The ultrasound and embryo transfer were excruciating, not because it was painful, but because I needed to pee so badly that I wanted to scream. You try drinking an enormous glass of water and then have someone pressing an abdominal transducer down on your bladder while someone else is making you stay still while they put an embryo in you. Then, continue to lie still there for a while before you can get up and pee.

The second the doctors left the room, I turned to Brendan and burst into tears. At least for that moment, I was pregnant. There was a blastocyst inside me, and I was so absolutely happy and terrified that I could barely contain myself. We grinned at each other like fools, clutching our picture of our “textbook perfect blastocyst” and when I finally got to go to the bathroom I hoped that I wasn’t flushing anything else down the toilet.

A new beginning

A week later while on a family vacation in Maine, I was exhausted all the time, wanting to go to sleep early, and writing it off as wishful thinking or aftereffects of the stimulation protocol. We still had another week before our official pregnancy test. So of course on the drive home from vacation Brendan and I went to the store and bought three.

The first one came up immediately and unequivocally positive.

We had our official test soon after, and it told us what we already knew. I fell to the floor of our apartment as the nurse on the phone, accustomed to such a reaction, waited for me to stop crying.

I was pregnant.



* * *
Tomorrow, I go all meta on my pregnancy.