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 ?