The NYT ran an Op Ed titled “Selling the Fantasy of Fertility” by Miriam Zoll and Pamela Tsigdinos. I waited to write a blog about their
Op Ed because I wanted to really think through the points raised, and not be in auto-react mode. This well written and thought provoking article deserves that pause. I haven’t read Miriam’s book (Cracked Open: Liberty, Fertility and the Pursuit of High-Tech Babies), but I loved Pamela’s book (Silent Sorority: A Barren Woman Gets Busy, Angry, Lost and Found) and interviewed her on the Creating a Family show on Deciding to Live Child-Free (highlights here).
Where I Agree
Tsigdinos and Zoll are so right that “the refusal to accept physical limitations, when applied to infertility, can have disturbing consequences.” I have written before about my concerns for women who go through cycle after cycle of in vitro fertilization with the hope that somehow the next one will work. Infertility medications are powerful drugs, and I suspect that we will someday find there are health consequences for those who overuse them.
While there is no magic number of IVF procedures a woman should go through before she moves to a different option, doctors on many Creating a Family shows have said that chances of success after 3-4 cycles are slim. Unfortunately, as this article points out, it is sometimes hard to stop.
It’s no wonder that, fueled by magical thinking, the glorification of parenthood and a cultural narrative that relentlessly endorses assisted reproductive technology, those of us going through treatments often turn into “fertility junkies.” Even among the patient-led infertility community, the prevailing belief is that those who walk away from treatments without a baby are simply not strong enough to run the gantlet of artificial conception. Those who quit are, in a word, weak.
Ending our treatments was one of the bravest decisions we ever made, and we did it to preserve what little remained of our shattered selves, our strained relationships and our depleted bank accounts. No longer under the spell of the industry’s seductive powers, we study its marketing tactics with eagle eyes, and understand how, like McDonald’s, the fertility industry works to keep people coming back for more.
Where I Disagree
If parenting a biological child is important to a couple, or if they crave the experience of pregnancy or breastfeeding, why shouldn’t they seek treatment for their disease? There are downsides to most medical treatments, but we balance the risk and rewards and most often decide in favor of treatment. The key is knowing continued treatment is futile and it’s time to stop.
Who’s to Blame
Zoll and Tsigdinos’s blames the infertility industry’s seductive marketing tactics for making it hard for women to quit fertility treatment. Infertility clinics provide treatment for a disease, but they are also a business and as with most businesses, they market. But even with this “seductive” marketing, from my perspective, not many women become “addicted” to fertility treatment. Most women try a reasonable number of cycles and then start considering other options. The Creating a Family Facebook Support Group is full of these women.
In my experience, the women who go back for IVF process after IVF process well past the recommended three to four cycles share certain characteristics–they are successful, competent, and fairly wealthy Type-A people who are usually able to conquer any obstacle with enough work and money.
I really like this type of woman. They are movers and shakers. They get things done. When they hit a wall, they look for ways around, over, or through regardless if the wall is a business challenge or infertility. Defeat is not an option. I don’t know Tsigdinos or Zoll personally, but I have to wonder if they fall into this category. They seem like women I’d like, so I’m guessing they are.
Is the infertility industry to blame for supporting their obsession? Well, maybe, but don’t they also share the blame? No doubt some infertility clinics and doctors gladly keep feeding the fire and make a pretty penny doing so, but I talk with plenty of infertility doctors who are frustrated by some women’s inability to stop treatment. They encourage counseling, they are happy to provide resources on other options such as adoption. In fact, they support nonprofits such as Creating a Family because they want to support all family building options.
Chances of Success
Unlike in many industries, success rates for infertility clinics are readily and publicly available for all to see. While these statistics aren’t perfect (we did a recent show on How to Interpret IVF Clinic Success Statistics) they exist for anyone to see. They are even broken down by age and type of treatment to help women assess their personal chances of success.
I don’t think it is lack of information that keeps the IVF junkies going. Infertility industry hype doesn’t help, but honestly, even without the marketing and the pictures of adorable babies and besotted parents, some women will keep trying because that’s who they are and how they approach life.
A Time to Pause
I agree with Tsigdinos and Zoll that “[o]nce inside the surreal world of reproductive medicine, there is no obvious off-ramp.” Creating a Family has long advocated for a time to pause in fertility treatment. This pause needs to happen, in my opinion, before pursuing in vitro round 5, 6, or 7. It also needs to happen before a patient moves to non-genetic parenting through donor egg or sperm. I’d love to see every clinic require a break at these times with counseling with a qualified therapist.
Now, it’s your turn–do you think infertility clinics are selling a fantasy?
I don’t think they are selling a fantasy, at least not the one I used to get pregnant. My doctor and nurses were always extremely clear with me on their opinion of my chances of success and how to proceed. I know they would have told me if they didn’t think a procedure would work (and in fact they did, but we had to go ahead with 6 IUIs from an insurance standpoint in order to get coverage for IVF). I also know a number of women who’ve conceived well past the suggested 3-4 cycles… so sometimes perseverance does pay off. I think it’s impossible to paint a broad picture on the issue because every woman’s or couple’s situation is different.
They are absolutely selling a fantasy, esp when you have been pregnant before. We did about 8 IUIs and 1 IVF “because you are old” when my FSH was 6.6 when we started when in reality all we needed was a Krueger semen analysis which is only used for IVF. I had gotten a small inheritance and with a 50% copay, they designed a way to use all of it. That was clinic #1 (Sacramento, Ca). Clinic #2 was for the IVF and wasn’t interested in getting to the root of DH’s bad morphology and oh, btw, we’ll book IVF #2 for you. (Oklahoma City – found out later that Dr has a real rep for being a bully and an ass).
My suggestion is to NOT trust them blindly. Become your own advocate. I learned more than I ever wanted to about female fertility. Once I had an HSG to determine my tubes weren’t blocked and I used OPKs monthly and had textbook cycles and EWCM for what turned into years, I suspected we were being played and preyed upon…. but who am I? I don’t have MD behind my name… and I am the one who suspected DH’s IF (as well as diabetes, another thing that would’ve been revealed if clinic #2 had cared to get to the root of the IF). Overweight women can ave hormone issues, so it stood to reason that men could too and OMG, I was RIGHT.
I would implore anyone to demand a KRUEGER analysis. $200 vs the over $10,000 and 3 years we wasted (from age 36 to 39, burning daylight!!!!). It was unconscionable. Krueger analysis revealed the bad morphology and BLOODWORK, not semen revealed extremely low testosterone, also an easy fix.
lots of other ways too TTC before resorting to ivf if needed, some natural ways, or lots of vits etc, chiropractic or acupuncture etc can also help.
One of the most freeing things I did when I knew we were moving out of state and would never see our doctor again was to make a final appt and confront him with everything he’d lied to me about. Yes, endo can be genetic (I had to threaten a lawsuit to even get a lap done and SHOCKER, one ovary was adhesed to intestinal wall. That poop pain wasn’t in my head!) Yes, it releases an irritant that makes the uterus hostile to sperm. Yes, bacterial vaginosis is a real problem and not just something Mr. Massengill invented a fix for and yes, it can cause a PH imbalance in the vagina which can be inhospitable to sperm (and made me absolutely miserable so I was able to dx and treat myself to get relief since he told me I didn’t have a problem)
Thanks for your response, Dawn. Those of us who have been dealing with treatments for awhile learn to be more realistic about the chances of it working and when we express our realistic expectations, are often met with comments of, “You need to be more positive!’, and “I just KNOW it will work next time.” No one knows if it will work next time and while we understand that our family members and friends have the best intentions, it’s hard to hear that when we are struggling with so many conflicting emotions ourselves. We are hopeful it will work but also need to guard our hearts and be realistic about the statistical probability we are faced with given our specific circumstances. It’s all a balancing act and the bottom line is that each person dealing with this has a right to feel the emotions they are feeling at the time they are feeling them and we shouldn’t criticize each other for being where we are when we are. We should only reach out to support each other wherever we are in the journey.
Dawn:
Thanks for the great, thoughtful commentary. I, too, have been pondering a response to this. I spoke at the Fertility PlanIt conference that the op-ed authors were objecting to. While they wrote their piece perhaps partly to market their own books — and I found doctors in attendance at the event very interested in talking about ways to improve on success rates by sharing new research, similar to what happens at ASRM and other informed industry gatherings — I do certainly understand and agree with their concern that there is such a desire to believe in “fertility magic” that patients can fall victim to marketing hype of less customer-focused doctors and clinics.
Thankfully, I also think those dollar-oriented doctors are an exception in this industry, not the rule.
I agree with you, Dawn, that so many doctors — and many Choice Moms on our discussion boards — wish science and data about age factors in particular could be understood by more women earlier in the process. Yet juggling “hopeful and trying” versus “cautious and giving up” is an incredibly emotional tightrope, and it is sometimes hard to know when to jump off.
I have read Miriam Zoll’s excellent book, and have her permission to excerpt from it in the new version of the “Choice Mom E-Guide to Fertility.” She offers an important and personal wake-up call to the fact that in too many cases, IVF does NOT work.
As many women offer to each other in support, “it only takes one” healthy embryo, or merger of sperm and egg — and success stories do happen at various ages. But I also know that the #1 regret expressed by many women on the Choice Mom boards and workshops is that they wish they had started earlier because in hindsight, the challenges of age and unexplained fertility were too great. That is a very hard lesson.
Well said Mikki! And to everyone else, if you are a single woman considering or doing single motherhood, you simply must check out http://www.choicemoms.org.
My fertility doctor was terrific. She was realistic and said that the odds are not in my favor. She broke it down to a percentage based on my diagnosis (POF) and allowed my husband and I to ask as many questions as we needed. She wasn’t trying to sell us on fertility treatments, even though I wanted to try. She told me it was a slim to none chance. While that may be devastating, I found closure and I think it helped me move on and look for other ways to become a parent. Like Egg Donors or Adoption. I am thankful I have a doctor who is honest with me and my chances. It was the kindest thing she could have done.
Hi, Dawn: Thanks for your thoughtful response. I think it is very difficult to walk away from any type of treatment — not just infertility — when there is a sliver of hope that something else might work. I’ve encountered this many times professionally in other areas of health care and, unfortunately, personally as well. But my point is that this sensibility is pervasive in our health care system, not just in the infertility field.
Though I usually don’t comment on a lot of the media frenzies that seem overtake the infertility field (as well as many other aspects of our life), I felt compelled to respond to this critique because it goes to the heart of what I do for a living. Here is the link to my blog if you are interested in reading it:
http://terridavidsoncommunications.com/the-responsibility-of-a-new-york-times-op-ed-piece-2/
Your response was thoughtful. For those wanting more details, including links to other critiques, I recommend reading Terri’s blog that she links to.
I really appreciated this article and didn’t take it at all the way that it seems many people are taking it based on some blog posts I’ve seen. I didn’t see it as making fertility clinics and other fertility services the bad guy, but rather calling to attention the fact that while we’ve made some amazing advancements, fertility treatment isn’t a cure all. It seems that many people in the general public view ART as an instant solution and, while it is for some, it takes years for others and there are some people for who it never works. That doesn’t mean it isn’t worth trying but with so many options for treatment, there’s a never ending array of possibilities, making it difficult to determine a time to jump off the train, so to speak.
It seems that in our society, we’re always hearing the message that if you try hard enough, you will achieve your dreams and I think that there are many people struggling with Infertility who feel pressured to keep going longer than they might otherwise based on this mantra. In the end, it is up to the individual or couple to determine what is best for them as an individual and as a family but there are many difficult decisions along the way and there are many people who have a vested interest in the fertility treatment working. Extended family members, REs, etc. that add to that pressure as well. Yes, the general consensus is that if something doesn’t work after 3 or 4 times, it should be time to move on but what if you aren’t able or willing to try IVF 3 or 4 times for whatever reason. Does that mean you didn’t try hard enough and you’re giving up to soon? What if you never try IVF at all? Does that mean that you didn’t want a baby enough? What if you decide for whatever reason not to adopt and to live Child Free? Does that mean that you obviously didn’t want to be a parent badly enough and all of your previous attempts were in vain and that it should be assumed that biology was too important a factor to you to consider adopting?
For me, the article called to attention the fact that fertility treatments don’t guarantee a baby and that they’re hard and that there’s a problem with society putting the blame on fertility patients when they don’t try hard or long enough. I think that most fertility professionals are up front with their statistics and as you mentioned, they are posted for all to see but there is a fine, blurry line between being hopeful and being realistic. I also think we need to broaden our vocabulary to find a word or term that make deciding to discontinue treatment sound less negative. You could “choose another path” to building your family, “come the the resolution” to do something other than parent. I’d love to hear any other suggestions people may have as well. Thanks, Dawn, for keeping the discussion going through your blog posts as always!
Elizabeth, I totally see your point. I also should have mentioned that I appreciated the article for highlighting what many outside of the Infertility World don’t realize–fertility treatment is not a guarantee. It doesn’t always work. I also agree completely with your point that there “a fine, blurry line between being hopeful and being realistic.” (Wish I had said it.)