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.