Monday, August 22, 2011

Hypocrisy and Choice

I know, I know. I haven’t blogged properly in forever. The intent is there, but between work stress, financial stress, minor, but cumulative physical stuff, and a very active toddler, when I have free time in front of the computer I just sort of space out and read. I fully intend to write a real update, with photos and video (although that would involve getting the files off the camera’s memory card), but this topic has been rattling around in my brain since I read Mel’s and Julie’s posts about the twin reduction article in the New York Times Magazine. I started writing comments in my head to both posts, but shortly realized I had quite a lot to say. I debated whether to post this or not, and probably will be debating with myself until I click on “Post.” I write this knowing I may lose readers. (Even though I know I haven’t been writing much for anyone to read, it’s nice to know there are a bunch of people who check in and are pleased to see something new here.) 

As to what I thought of the article, meh. Jjiraffe’s post about the NYT and infertility nails it quite well. I know that people have very strong feelings about selective reduction, particularly twin to singleton reductions. I was a little surprised by the comments on Mel’s and Julie’s posts saying they didn’t understand why someone would transfer more than one embryo if they were not willing to parent multiples. I was glad to see others speak up about the long infertility/loss journey and the desperation that led to their decision about how many embryos to transfer.

In my own case, the decision was made based on the questionable quality of the donor embryos that were frozen on day two, and was made after discussions with my RE and the embryologist. My RE transferred three embryos on my first FET and I did not get pregnant. After further discussions, the decision was made to transfer four at my second transfer. All throughout my journey to get pregnant I considered and researched possible scenarios. I knew that if I needed to reduce for any reason, Dr. Evans and Dr. Stone (referred to and quoted in the article) were my best choices for a safe outcome. I believe I saw Dr. Stone bring a patient into the recovery room when I was there after my polypectomy. I assume it was a complicated reduction, as it was in the hospital, and the woman was somewhat sedated. The woman was wheeled in on a gurney and once settled, looked up at her doctor and said, “Thank you for not being judgmental.” In my own haze from the lovely IV pain meds, I thought to myself, that must be Dr. Stone. I’m not going to say what I would have done if I’d become pregnant with more than one. No matter how much one has thought about and researched something, I think it’s impossible to know for sure until you move from theoretical to reality. Let’s just say I was very happy to see one heartbeat on my first ultrasound. There was a second sac visible, but it was empty. My OB referred to it as a vanishing twin at my first appointment.

So why do I feel I need to write about this article? First of all, as I’ve written before, I am staunchly pro choice. I also personally know three women who’ve undergone twin to singleton reductions. One was due to dire medical necessity, one was for a combination of medical and social reasons, and one was for social reasons. I kind of feel “social” should be in quotes, as it can encompass so much. Financial considerations, physical considerations (i.e., older parents), lack of support system (i.e., single mom without nearby family), etc. I support these women in their decisions. I know they were not made glibly. It stings when I hear damning judgment of their choice. It stings because I could have easily been in their shoes. It stings because I know their reductions shredded them emotionally. They will have a raw spot in their hearts for the rest of their lives. Yet, I know each of them believes they made the right decision for their families.

I spent a lot of time talking on the phone, emailing and texting with my friend who reduced for “social” reasons when she was deciding what to do. She’s a single mom by choice in her mid forties. Oh, and she’s a twin herself. I told her several times during her decision making process that whatever she decided, it would be the right decision. I pointed her to the blog of a friend who wrote about reducing her twin pregnancy. I pointed her to twin mama blogs. I listened to her go back and forth. I answered questions about the challenges and joys of single motherhood. I told her that, according to my research, she and her remaining child would be in good hands with either Evans or Stone. I offered to accompany her to the procedure, but she opted to go alone. I hope I was a comfort when she called me, tearful, from the waiting room before the procedure.

I was thinking the other night about how I’m bothered by the judgment about this. There is more than enough judgment to go around regarding ART. Many judge IVF as wrong, donor gametes as wrong, gestational surrogacy as wrong, certainly many would judge me negatively for having a child on my own. Then I realized I’m a hypocrite. I have plenty of judgment for Nadya Suleman. I know I’m not the only one who knew she was lying when she said she had six embryos transferred and two split during an FET. (In case you haven’t heard, it came out during the investigation of her RE that it was actually a fresh IVF cycle and TWELVE embryos were transferred.)

But my bottom line is that the choice to reduce is very, very personal and needs to be available and safe. The NYT article was sensational, as usual. The women sounded callous about their decision. But we don’t know what their thought process was like when they were making it. And how many tears were shed. We don’t know what quotes the writer didn’t use or were edited out. I choose to give them the benefit of doubt and believe they love their children as much as I love mine.

Bless doctors like Joanne Stone and Mark Evans who believe that women are capable of deciding what’s right for their families. These doctors don’t hate babies, they care for women. For mothers.