Friday, March 21, 2008


Much to our surprise, considering both the history and how much the test took out of her, JF passed the "long program" glucose test yesterday. Yay!

Tuesday, March 18, 2008


I flunked the short glucose challenge test on Friday so will be performing the long program on Thursday. It involves three days of a high carb diet, three hours of sitting in the blood lab, a triple salchow and sequins. Except the last part.

I probably shouldn't have been surprised that the levels came back elevated; after all, it's not like the insulin resistance part is actually a surprise. I'm just afraid it will make them tell me I can't have the fruit I've been going crazy for (or the summer fruits I've been craving -- I'm counting the days until they hit their seasons ... strawberries ... blueberries ... peaches ...)

Tuesday, March 11, 2008

We Now Return You To Your Irregularly Scheduled Blogging

Yesterday was our first ob/gyn appointment in nearly four weeks. Everything was fine, with a lovely fast heartbeat. This means we have successfully made it out of the first trimester.

Friday, March 7, 2008

But Wait, There's More

Discussing the previous two posts with JF, we came up with the rich man's way of skirting around restrictions against screening embryos. Simply line up enough surrogate mothers to handle every possible embryo generated -- and once you have a pretty good idea N children are likely to be born, line up N-1 adoptive parents. Then once they're born, you do the screening process (genetic testing should work just as well on a live kid as on an embryo), keep the best kid for yourself, and give the others up to the adoptive parents.

Now, if you're anything like me, your first reaction to that is "Yuck!"

But think about it. If you take the "no screening embryos" exception as given, where is the downside here? The rich guy gets the kid he wants. N-1 other families get kids they desperately want. The surrogate mothers pocket a nice chunk of change that they apparently wanted. As long as no one is coerced, this is a win-win-win situation.

If there was some medical reason for the screening (risk of a terrible disease, perhaps), you can argue that you are more likely to get a kid who actually has the disease this way; but each individual embryo's chance of having the disease is exactly the same as before. And the judgment that every embryo is inviolable rests soundly on the notion it is better to be born with the terrible disease than not born at all, so I cannot see that as an argument against doing this.

Nonsense on Stilts

The Nancy Gibbs article JF talks about is a good example of how to wrap extremist BS in a nice-sounding package -- and how to call for government intervention based on hypotheticals that produce a "Yuck!" reaction.

She starts by invoking a bunch of over-the-top scary examples, then cites both conservative and liberal objections to make herself sound balanced and moderate. Then she jumps straight into a radical, hard core position without examining what its implications. As JF points out, the first effect is radically decreasing the odds of IVF working -- there would only be a 50% chance of transferring even a single viable embryo! Mind you, we're talking about an expensive, emotionally consuming procedure that only has about a 50% success rate starting from the best possible embryos.

But that's just the tip of the iceberg. Because if you think it out, the next step is to say, well, why not transfer a bunch of embryos and then selectively reduce if too many implant. This is far less safe than the way they do it now (and strikes me as bordering on morally reprehensible), but it seems to fit with the rules printed in the article. But not the spirit. So clearly their program will require outlawing this form of abortion. (It seems like it also would require outlawing any timed-intercourse cycle which routinely produces many eggs, as they always have a scary chance of producing dangerous numbers of embryos.)

If they take the principles they state seriously, the logical conclusion is you have to outlaw abortion altogether for all couples, not just IVF patients. (Well, I suppose they might allow a rape exception.) There's just no sane way you can hold that embryos are inviolable, but fetuses are disposable.

Notice the way this works: in two short paragraphs, Gibbs jumps straight from the freakshow example of trying to give birth to an entire softball team at once to outlawing abortion and preventing couples from using the best available assisted techniques to help them get one or two healthy children. There's no chain of logic there; just two examples of something that could hypothetically be done via IVF, one normal and sensible, one ridiculous and completely imaginary to the best of my knowledge.

In the next paragraph she jumps to European countries that limit the number of embryos that can be implemented -- for financial reasons! Of course, this is allowing the law to overrule your doctor's good judgment of the best treatment for your issues to save a few bucks. And it's completely unrelated to the idea of not allowing screening -- you can bet that these let you make more than embryo and choose the best possible.

Let me point out "reproductive tourists" show the complete insanity of trying to ban this sort of thing. Unless that ban is enforced across the entire globe, it's just going to make couples head for greener pastures. On average, the ban would add about $30,000 (and loads of extra heartbreak) to the cost of a successful IVF cycle. That makes plane tickets to India seem like a bargain.

Then another freakshow "Yuck!" example, apparently of what might happen if you only partially enacted the suggestions in the third paragraph (all embryos must be transfered, but at least you get to screen them). Also note that this touches on some deep philosophical issues -- is Gibbs implying those embryos would be better off not being created than being raised by adoptive parents?

The final paragraph attempts to scare us with the specter of screening. It skips right past how the unambiguously positive screening for major diseases would be outlawed under the paragraph three rules. (Nothing like doing your best to add to the sorrow in the world, while patting yourself on the back about how ethical you are being.) Then it presents screening choices that are at worst crass, and concludes that the government has to intervene -- even though the major parties that are harmed if they don't are embryos that are not used. It's moving past "We're doing it for the children!" to "We're doing it for the embryos!"

SF says issues like this will make a libertarian of me yet ...

In "Wanted: Someone to Play God" in the March 3 issue of Time, Nancy Gibbs expresses her opinion on your medical life.

There is much worth discussing in this column, even moving past that it is yet another instance of a journalist using "implanted" when she should use "transferred."

-- Gibbs claims that there is "nothing to stop [doctors] from implanting[sic] 10 embryos in a woman hoping to give birth to a softball team."

This assertion introduces the tone for Gibbs' column, which paints an extremely unflattering and offensive picture of infertile people as having lost their moral guides in their desperation to reproduce. It assumes that people undergoing ART do not weigh the options presented to them by any measure other than how likely the options are to give them what they (selfishly and desperately) want.

If legislators feel that they have to start making laws to limit everything doctors might do that is against conventional wisdom (and against the health of their patients), then we're really in trouble.

-- Discussing the book Embryo: A Defense of Human Life: "Their defense, less theological than biological, is that the embryo is a whole, living member of the human species in its earliest stage of development, not just a potential one or a part of one--and if destroyed, that particular individual has perished."

After having miscarried three times, I have a different view of whether every embryo is a "whole living member of the human species." They are so fragile -- I have an extremely hard time seeing them as fully-footed in this world during the "earliest stage of development." Even under the best of circumstances, natural or assisted, they don't all survive ... so, in that sense, they are still only potential.

-- "From that conviction arise their rules for both research and reproduction: Don't create more embryos than you will implant. No freezing, no choosing, no storing for future use and no experimenting on them.

This approach would all but end IVF as a practical treatment (not to mention, as SF points out, abortion at any time during pregnancy as well as the morning-after pill). At each stage of IVF treatment, there is a relatively high average failure rate. It would be perfect if you could retrieve one egg, fertilize it, have it grow to a perfect day-5 blastocyst, transfer it and have it implant perfectly and grow to a full-term baby. But that's not the way it works, even in unassisted cycles. In my case,

we retrieved 17 eggs.
10 fertilized.
3 of those were genetically abnormal.
2 stopped growing.
We transferred 2.
One implanted.

Three more are waiting for us, so that we can try again without my having to undergo another painful egg retrieval and possibly have my eggs have deteriorated to the point where they are unusable. So: from the 10 fertilized eggs, we got 5 potentially viable embryos. My doctor and nurses indicated that this was a relatively good outcome: lots of eggs, decent fertilization rate, a choice of which blastocysts looked promising -- NOT, I would point out, which had blue eyes, high IQs or musical talent -- and a few left for another try.

The column goes on to say:

"Adopting these rules would mean that America is catching up with Europe, where governments subsidize more of the costs and so control some of the risks."

One of the ways Gibbs suggests we might "catch up" with Europe is to allow the transfer of only one or two embryos at a time. If you are only allowed to create as many embryos as you will transfer, and you can only transfer one or two embryos, then you really could only try fertilizing two of those eggs. To try more would be to risk creating "too many" embryos.

Given the numbers I had -- which I was led to believe were a relatively good outcome -- that approach would have cut our chances of success drastically. 42% of my eggs didn't fertilize AT ALL. So you first would have needed the luck of having chosen your two eggs from the lucky 58%. Then they would have to be two of the five that continued growing and were healthy.

Picture it this way: you have a bag with 5 red marbles and 12 black ones. You get to pull two; red represents the eggs that produced viable embryos. My mathematician husband worked out an 8.6% chance that you would get two of the "winners" -- and a 49.8% chance that you would get none at all. And, as I said before, transferring two "winners" doesn't equal two babies; it might not even result in one.

--"Could patients create as many embryos as they like and pick the best, as long as they line up couples to adopt the rest--or sell the extras to offset the costs? This is no wild plan; in the U.K. researchers offer women reduced rates on fertility treatment if they agree to donate half their harvested eggs for research.

Here we have a cognitive jump from embryos, genetic engineering and "designer babies" to research done on gametes. I wouldn't be surprised to find people saying that research on "harvested eggs" is morally wrong who would never consider saying the same thing about research on sperm. Eggs and sperm are not people. We produce tens of thousands/millions more of each than will ever become "whole, living member[s] of the human species." I don't see how doing research on gametes is somehow a special case requiring legislation.

--"This is a moral wilderness, full of hope and traps. I don't expect aspiring parents to bring order to it when all they want is to survive the journey and make a family. That job is surely one for policymakers, to monitor the immense social and scientific experiment we've been conducting in private and make sure that we weigh the risks before we embrace the promise."

If the policymakers' science and logic are as bad as that in this column, we are all of us in trouble.