Thursday, August 12, 2010

Why are young fertile women doing IVF ?


I saw a 28 year old business executive today , who had an unusual request. " Doctor, I want you to do IVF for me ! I know I am most probably fertile, but my husband and I are both very busy and are finding it hard to find the time to make a baby, because we both travel so much. I want to have a baby quickly and do not want to waste time. IVF is more efficient than natural sex , so I want to do this in this month. Can you do this for me ? I know that natural Human reproduction is a very inefficient enterprise - and the chances of a pregnancy in one month are about 25%. I checked my husband's diary and mine and compared it with the free online fertility calculator . It seems that the only time we will be together during my fertile time is in Nov 2010 and Feb 2011. I don't want to waste time and wait that long ! I want you to do an elective dET for me, and if you transfer 2 top grade blastocysts, my chances of having a baby are better than 56%. And if I have twins, this will be an added bonus, as I then get an instant family !"

I was a little taken aback. We've had requests like this in the past, but this one was much more direct . She was a very successful , well organised young professional, who obviously knew her own mind. She had done all her homework, and because she could not do the IVF herself, had come to me for help. ( Sometimes, I wish all my patients were as well-informed and decisive like she is ! )

While it's true that IVF was originally developed as a medical treatment option for infertile couples, we are now increasingly seeing couples who want to do IVF for social reasons.

While the initial reaction may be one of disapproval, I think we need to be a little more empathetic ! Just like birth control helped give women more control over their personal biology, IVF and other assisted reproductive technologies can also allow women more choices about their reproductive options. These are women who are used to making their own decisions and leading their own life on their own terms, so what's wrong with using assistance to expedite making a baby ?

Isn't all this very unnatural ? artificial ? These were exactly the same arguments which which were trotted out when birth control was first introduced. It was felt that birth control would mean that women would no longer want to have babies; and critics felt that it was dangerous to allow women the freedom to choose when to have babies ! Today,we can laugh at this antiquated attitude, because we take birth control so much for granted. Just like birth control can allow women to postpone childbearing, what's wrong with using technology to facilitate the process ? Isn't IVF a kind of positive birth control after all ?

The purpose of all technology is to allow women more control over their lives, so they can fulfill their personal reproductive desires. Is there anything wrong when women want instant gratification and do not want to waste time on inefficient natural methods ? For many, time is money - and they are happy to spend money to save time, by using IVF to accelerate and expedite the process.

She argued, " If I can use pills to postpone childbearing, why cannot I use IVF to accelerate it ? After all, it's my money and my body and my choice ! Why should someone stop me from exercising my right ? If you would agree to do IVF for me if I were 35, why should you say no to me just because I am 28 ? I want to have a child now when I am young and full of energy ! I enjoy having sex, but why should I be forced to have sex at a particular time just in order to have a baby, if there are alternative options available, which are more efficient ? "

Is there anything wrong with her approach ? I think it's fine, as long as women like her understand what is involved.

I remind them them it's much more fun to make a baby in their bedroom - but if they decide they want my assistance , I do not think it's fair on my part to refuse them. I am happy to help them , as long as this is a well-informed decision.

In fact, I think it would be unethical on my part to refuse to treat her ! Medical ethics teaches us to honour and respect patient autonomy, as long as the course of action is beneficial and does not because any harm.

Let her have the last words. " Doctor, if I can have my cake and eat it too, why can't I ? Thanks to technology, biology is no longer destiny - please respect and honour my wishes !"

What would you do if you were her doctor ?

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4 comments:

  1. Wow, it sounds like this woman might need a reality check, she sounds terribly naive and one of those who gives ART a bad name. Does she know what IVF entails? There is a reason why IVF is the last ditch effort of people dealing with infertility, a disease. It's not just something you schedule one day between work and yoga class. The expense, the drugs, the side effects (not to mention the potential long term effects), the drs./monitoring appts., the procedures, and the time sensitive nature of all of it. And to do it all and it may not work, when you could be trying on your own?
    If she is unable to find time to have relations with her husband within her fertile window, I have to wonder how they will manage pregnancy and a child (or two)?
    With all that said, I don't know that you have to refuse her, but possibly just educate her and her husband on something that they are clearly misinformed about. Maybe she would be a candidate for IUI w/frozen sperm or something...

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  2. Camille2:38 AM

    Thank you, doctor, for writing about this and thank you, kthappy76, for this profound comment: "If she is unable to find time to have relations with her husband within her fertile window, I have to wonder how they will manage pregnancy and a child (or two)?" Yours is a very important question to ask this female even if it is unanswered and simply invokes thought.

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  3. Anonymous4:06 AM

    Thank you doctor for posting this. I disagree with the previous comments, this young woman is not naive and she does not need a reality check. I find myself in the same situation, having been trying now for 9 months, all the fun of sex has gone out of the window and sex on demand is just horrid, with my husband feeling under pressure to perform, it's becoming a real issue in our relationship. It is true that in my case neither my husband or I have much time for intercourse as, like most people our age, we work full time and find work tiring and stressful, sex is the last thing on our minds and we'll often cuddle in front of the TV instead. That doesn't mean to say that we'll have issues with raising our child in the future!! I don't believe we are infertile, but for some reason it hasn't happened for us yet. However I am sure that the longer we go on without having made our baby, the more problems it will cause in our marriage. I can understand this young woman's perspective, she has come to her decision based on good judgement of the stresses and strains that baby making brings to a marriage and I do wish her well !!

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  4. I think we need to be empathetic - and provide couples with the information they need, so they can make the right decision for themselves.

    Yes, IVF can be expensive - but not having a baby can be costly too. Each couple needs to weigh the pros and cons and come to the decision which is right for them

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    My Facebook page is at www.facebook.com/Dr.Malpani

    You can follow me on twitter at http://twitter.com/#!/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

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