How to Make a Family: The Blog

More Than a Uterus

They've got a point. May not be one that a lot of folks in the TTC world are concerned with, but maybe we should be. It's not a point that has passed me by, but like Tara Parker-Pope, I'm a tad stunned at the unleashed fury springing forth about reports on prescription drug sharing (a common sense 'no no'.) The reports were honing in on women 'of childbearing age', causing some (many?) women to cry "bikini medicine!"

Read some of the so-far-425 comments on her blog, Well.

Do Doctors View Women as Pre-Pregnant? - Well - Tara Parker-Pope - Health - New York Times Blog.

Same-Sex Couples, Baby-Making, Insurance, and Philosophy

The California State Supreme Court has ruled unanimously that gays and lesbians have the same rights as anyone to be treated by a physician. (Here's a related article from the San Francisco Chronicle.)

Encouraging news. Another battle down in the world's growth toward valuing all folks with inherent (as opposed to earned) worth.

I have a bit of a problem, though, and it's one I may have mentioned before here. Forgive me if I'm repetitive. It's about lumping infertility, its diagnosis and treatment, in with other maladies.

First, for the record, some disclaimers: I have nary a qualm about the sexuality of people who want to become parents. I'll argue with the best of them that what kids need from parents has nothing to do with which gender/s their parents love.

I think the ART that helps people have babies, regardless of whether a couple or individual or whether the partners are of the same sex or not, is inspiring and miraculous. I think in a perfect world that anyone who really wanted to have a baby could do so.

I also think that physicians who let their personal beliefs stand in the way of healing and practicing medicine have forgotten their oath. That said, I know that humans are just that: human. I'm not sure what I would do if presented with a situation wherein my service would be in direct conflict with strong inner stances. I think I know, but I don't really until I'm there.

But is fertility treatment always a therapy for a malady, an ailment, a disorder, a disease?

That's the question that bugs me endlessly, and especially in discussions about insurance coverage.

And the California story is as much about insurance as it is about the rights of gay and lesbian people. Guadalupe Benitez was referred by the refusing physician to a practice that would happily treat her, but her insurance wouldn't cover service at that venue. Possibly if she'd had insurance coverage for the required intrauterine insemination, there would be no suit.

So did Benitez, who now has three children, have an ailment in need of medical attention?

I suppose if we expand our concept of healing, broaden it to include rendering aid to cure the emotional duress, spiritual suffering, and social stigma of being childless, then yes, Benitez was afflicted and should have every right to expect proper treatment.

But that concept would encompass so many more people than just gay and lesbian patients who want to have children.

This story is less about the rights of gays and lesbians than it is about the definitions of infertility and medicine.

Have You Heard? Baby-Making Is Back!

Many of you long ago signed up to receive notifications of updates to this blog, innocently and understandably expecting tips on getting and staying pregnant in this day and age of assisted reproductive technology. Now, after two long years of waiting, those of you whose interests are primarily in the personal baby-making arena will be happy to learn about our new blog.

The name is tres clever.

You'll find How to Make a Family: Baby-Making at http://howtomakeafamily.typepad.com/babymaking/

I am painstakingly (or with my eyes glazed over and half-closed, depending on the time of day) moving the content from our old How to Make a Family website into the blog -- one page at a time. Be patient. I know you already have been, but please continue. If there's one thing I know about how to make a family, it's that you gotta be flexible, understanding, and forgiving. I really appreciate the hanging-in-there, out there.

And if your interest was more along the lines of after the baby is made, then you'll enjoy our other new blog, All There Is To It, at http://howtomakeafamily.typepad.com/all_there_is_to_it/.

For Our Baby-Making Readers

We're finally -- albeit slowly -- migrating content from the 'old' How to Make a Family site over to blog format. You will now see appearing over at our 'sister blogs' (Baby-Making and All There Is To It) the stuff you were probably looking for when you stumbled upon us.

Some of you have gotten pretty tired of waiting. Thanks for your patience while I move almost a decade's worth of material from there to here. One page at a time.

More to Penelope & Friends

From Penelope Trunk's Brazen Careerist:

"Get Married First Then Focus on Career"

But the article ignores one of the most pressing issues facing Generation X: Infertility. No generation of women has had more trouble with fertility than this generation who received the terrible advice, “Wait. You have time. Focus on your career first.”

and from her Boston Globe column:

Women who want to have children should make it a priority in their twenties to find a partner. That's because one of the most dramatic issues facing Generation X is infertility.

and finally, from me:

I'm a freelance health writer. I write for lots of different publication venues, online and off. Not as many as I'd like, but I digress.

Most of this blog's readers know that my long-time mainstay (i.e. has fed my own personal product of the fertility industry) is writing about fertility, infertility, getting pregnant, staying pregnant, and the bells and whistles that go toward those ends.

Over the years, I've had a few editorial superiors who request I devote my attention (thereby subjecting my readers) to topics that are mostly crucial to them (the editors) and theirs. Just because a health topic is hot in your household doesn't mean that millions of other eyeballs will care. That sounds so reasonable as to be trite, but it's the truth.

Until the day comes when whatever I say about any topic of my own conjuring up is not only warmly received and read but looked forward to with anticipation... I gotta make my living writing about things that interest other people.

Sometimes that's not the same thing as my editor's Aunt Mildred's current pressing ailment.

Whether you're writing about infertility or cancer or infected toenails, it's imperative to avoid sounding the alarm -- even about things that are personally alarming.

The Difference Between Girlfriends & Facts

Penelope -- please.

Boston Globe columnist Penelope Trunk, in typical finger-in-your-face style, comes right out and says that women should aim for getting pregnant in their 20's because "... one of the most dramatic issues facing Generation X is infertility. No generation of women has had more trouble with fertility than this generation... "

I'm not going to even touch the debate here -- though everyone knows that I'll gladly handle it at more convenient times -- about when in their lives women should try to have babies.

But try as I might, I can't find an expert or source for her claim about Generation X. In this column, she refers to a sociologist. She refers to a fertility testing company. She refers to a WSJ article that uses Extend Fertility as its source.

I hear what she's trying to say. Trust me, I do. But making claims about an entire generation's fertility as compared to other generations' is not only pointless without the right data, it's downright inappropriate.

It's one thing to use hyperbole when talking about work lives and careers. If you're going to start making pointed claims and aiming direct hits in the medical and health arena without solid footing, you're in the wrong field.

Update: Dozing Through Tyra Banks' Show

Lucky me. Little did I know when I posted yesterday about the recent taping of an infertility-treatment-related Tyra Banks Show, the show was slated to air today. Thanks to the Conceive Magazine maillist, I was alerted to this last-minute "news" because the mag's founder, Kim Hahn, was a scheduled guest.

That's an interesting piece of the puzzle - the involvement of Conceive Mag - that I hadn't heard already from the folks at American Fertility Association or RESOLVE. So, now - knowing that Kim Hahn and group are in thick with the Sher Institute, the group of clinics led by Geoffrey Sher (who, I daresay, was one of the first repro med pros to realize the enormous value in boldly waking up the general public via carefully positioned statements to the mass media) - I just had to watch Tyra.

You have to know this -- I don't do much TV. Really. I find myself woefully in the dark during any conversation about the latest whatever-it-is that "people are watching," and contentedly so.

That goes triple for "talk shows."

So this was a painful time in my day, an hour made even more boring by way of the fact that I saw nothing related to what the AFA had fretted about based on reports from audience participants. First, we had to slog through a Happy Celebrity Baby story featuring The Bachelorette. That fascinating quarter of the hour sent me right out the door to run a quick errand. The show followed with a story that got the most gasps of "OH!" from the audience -- a 22 year old woman who felt so desperate to have a family that she's deceiving her fiance by not taking birth control pills on schedule. After that completely-un-infertility-related and predictable scenario, the rest was Snooze-ville. 

One young woman who had determined to have a baby as a single mom because of her dim hubby prospects was spoken to - she certainly didn't seem surprised - by a tearful cousin who worried about the whole "single mother hardships" angle for her relative. I didn't discern any animosity. Another couple told their story of treatment and two miscarriages, ending with the happy announcement that she just learned she's conceived again. No rebuttal or comment from the audience there.

I think the real blasphemy of the show was presented by Kim Hahn and Tyra, and it had nothing to do with infertile guests being confronted by dismayed and frustrated relatives in the audience.

During one of the show's first teaser breaks -- where you're intrigued by the mention of what's to come following this commercial! -- Tyra said we would also be hearing about some of the latest methods to try and get pregnant.

Apparently, those "latest methods" amount to the home-testing kits that I won't bother to name here (nor did they on the show, specifically... but you can certainly find it out on the show website.)

In her defense, I'll assume that Kim's hands were tied on that front, that she was literally told what products to parade out there - by either the show's producers or her own magazine's bottom line. I know how it works. Time is of the essence in those shows, and they're not about educating the public -- they're about getting the public's eyeballs to focus long enough to make a sale by the folks who pay the bills.

So, I'm baffled. Who told the AFA about the "public humiliation" of guests at the show's taping? Did, in fact, the show's producers edit out related offensive material? Or was someone's subjective judgement of 'humiliation' so very different from mine?

On a related note -- I tried, by clicking on every link I could at the Conceive website, to discern any relationship between the mag and either the AFA or RESOLVE, virtually the only patient advocacy groups for infertile people in America. I found nothing. Neither group is listed anywhere on the site, whether as paid advertiser or resource.

So if women are unlucky enough to rely solely on what Conceive magazine has to offer in the way of getting-pregnant advice, the range of options seems to swing from placing expensive curvy pillows under their butts at just the right time to one of the country's more controversial reproductive specialists, with scarcely a 'word to the wise' from experienced fertility consumers in between.

I think the Tyra Banks Show is an appropriate spot for them to hawk their wares. I vote from here on out, patient advocacy groups turn a deaf ear to pleas for assistance from the entertainment media. They're on no one's side.

Mama-Wannabe's Gone Wild

Like a lot of folks on the same maillists I endure, I was a recent recipient of emails from the American Fertility Association about a recent taping of The Tyra Banks Show. The AFA was up in arms and in full advocacy mode after feeling duped by the show's producers into soliciting willing participants who were then customarily trampled by plants in the audience.

When I happened upon this recent news item (here on Revolution Health's website) about a fertility treatment cost analysis published in January's Fertility & Sterility, I couldn't help but think about the "Tyra Banks Show incident."

The study says that when using a woman's age and her FSH levels to calculate the probability of a live birth following ART, the calculated cost of that baby gets higher and higher. Astronomically. If the woman's predicted delivery rate is less than 10% using that formula, she's going to pay a lot more for a baby from her own egg cells than she would for one from donor eggs.

Word on the street (to date, no one's heard from the Tyra Banks Show producers, nor has the show been aired) is that the invited guests were women who were continuing forward with assisted reproductive technology long after what some think are reasonable attempts. Rather than it being a tear-jerking, empathy-gleaning feel-good event, it turned into a finger-pointing affair compleat with frustrated relatives of the patients who were led into confronting their loved ones with the heat of the moment.

Years ago, when I spoke by way of Internet day and night with thousands of people who were sad, mad, dismayed, and downhearted about not being able to get and stay pregnant, the vast majority of us knew -- even if it was too painful to openly discuss -- that in the end, something would have to give. I daresay that for most of us, the biggest straw breaking camels' backs was the financial one. We all knew, either directly or through the grapevine, of women who had spent hundreds of thousands of dollars and many, many years, not to mention the emotional and physical stress involved, on IVF procedures that numbered in the double-digits.

Physicians walk a very fine line with this issue. I applaud those who come right out and tell women that their best chances are donor eggs at some point, and suggest the patient might be better off either stopping treatment altogether or making that tough choice to use someone else's genetic material. On the other hand, I am impressed with the attempts made by so many older women (and younger ones who have wacky FSH for little to no discernible reason) who refuse to see their fertility strictly in medical terms, choosing instead to incorporate existential and even spiritual themes into their baby-making efforts.

As for Tyra Banks' show and producers -- that's just showbiz, folks.

Link: News - Revolution Health.

ASRM: Press Releases

Autumn, even down here in the too-warm South, distracts me.

So the entire month of October has come and gone, and with it, the annual meeting of the ASRM. This year it was held in Washington DC. I chose not to attend this year, preferring to scrounge my freelance pennies toward the trip to 2008's soiree in my favorite city, San Francisco.

But -- you can catch up with some of the research that was presented at this year's meeting, on the handy-dandy press release webpage at the ASRM site. Keep in mind that this is only a smidge of the stuff that came out of the gathering, specifically, the stuff that the ASRM Media Folks found especially interesting.

Link: ASRM: Press Releases.

Multiple Congenital Defects? I'll Take Em!

Similarly along the lines about using reason in making baby-making choices... this small study found that women expressed a readiness to accept a number of chronic disabilities associated with multiple pregnancy as opposed to the risk of not having a child at all.

That the study only surveyed 74 participants is its saving grace. I think.

Link: Safety Versus Success In Elective Single Embryo Transfer: Women's Preferences For Outcomes Of In Vitro Fertilisation.