Fetal "Reduction"

After my visit to CCRM, I have much more thinking to do on this subject.

I am not a fan of euphemisms. I'm a call-it-what-it-is-girl. If it's too distasteful to say, then maybe you shouldn't do it. Euphemisms are so often used by hypocrites - a personality trait I abhor!

So let's call it what it is - a selective abortion. There ya go, I said it.

I've posted about this subject already but yesterday at CCRM I was asked by no less than 3 people to ponder the subject. My doctor, the nurse and the psychologist. Their policy on donor embryo transfers is pretty strict at two, at most. And what I really felt was mild influence from them to transfer only one embryo (given I have several high quality embryos) and that's okay, because I felt they had my interests in mind.

But here's the rub. The chance of one embryo becoming a viable pregnancy is around 60%. Two embryos is in the 85% range. That's a 25% spread - too much for me to ignore.

Now for the brutal news - the chance of two high quality embryos becoming a twin pregnancy is around 45%. And I don't remember the chance of one of those embryos splitting (giving me a triplet) but it was not some statistically low number like .001%.

I honestly do not know how to play this out. And at the end of the day, while I met with their psychologist, I was honest with her.

I said, "you know, I've thought about that many times this year and I'm no further today knowing what I'd do than I was the first day." I went on to tell her what I told my doctor - a single embryo transfer is not something I can consider without the facts in front of me on transfer day.

For example, consider this wonderful scenario that I hope befalls me. My doctor calls me on day 5 transfer morning and says "Sky, I have amazing news - you have 9 stellar embryos, it's hard to know which is better than the other, they're all top grade and I have two that are hatching. Right now we're going to freeze whatever you don't want to transfer. So, will it be one or two?" I would say, "one." Perfect. (and may that be EXACTLY what happens and turns into a beautiful little person for me!)

But here's an alternate scenario that I hope and pray does not happen. My doctor calls me on day 3 transfer morning and says "Sky, you have 3 good embryos - the rest don't look like they'll make it. One is excellent and the others are good." Frankly, my answer would be - TRANSFER THEM ALL. I wouldn't want to return for one final embryo transfer if two failed, aside from not feeling great about freezing/thawing - it is never as good as fresh.

But what if those 3 less-than-stellar embryos all implanted?! Well, I think a triplet pregnancy is out of the question for me - I would have to selectively abort one. But what about a twin pregnancy to a singleton? I mean, if I'm not ethically barred from selectively aborting a triplet to a twin, why not a twin to a singleton? What's the difference? It's still terminating one fetus, isn't it?

And what happens here is that I realize doctors and nurses form an enormous bias and impart their personal religious and moral ethics on patients - and that concerns me. I mean, if you're willing to support the selective abortion of 5 fetuses to 2, why not support the selective abortion of 2 fetuses to 1? After all, isn't it is lawful to abort 1 fetus to zero.

DISCLAIMER: I'm not saying I could selectively abort twins to a singleton because I just don't know. I don't even know for sure if I could selectively abort triplets to twins. How could I know? I'm not in that place! But I guess I have trouble with anyone in the IVF world making moral judgments around this. Aren't we are all guilty of having our hands in the life/death pool whereby we have a hand in creating multiple embryos and then actively discarding some?

I personally know two women who are as Catholic as the day is long - staunch pro-life ladies who've also had IVF and had remaining embryos. Neither could bring themselves to donate those embryos to another couple and both of them chose to discard the embryos. I mean, huh? If life starts at conception then how is tossing them down a sink or by way of an abortion any different? Doesn't it provide the same outcome - they're still dead.

Just some thoughts as I embark on a donor egg cycle in future. I know I'll be faced with some very difficult decisions for which no choice will be without risk and, ultimately, I may have to choose the lesser of two evils - whatever that is for me personally.

I can only trust that I'll make future decisions with the same level of honesty and integrity in which I strive to live my life.

Tonight, more than ever, all of my sisters in this IF journey are on my mind - I wish you all peace, happiness and the fulfillment dirty diapers brings.


Lorraine said...

I see that you have thought through EXACTLY the scenario versions that I have come up with.

And, like you, I still don't 100% know. Before IVF works, isn't everything weighted toward whatever it takes for success? It' just emotionally impossible to think about having too much pregnancy when you've spent years trying to have any at all.

I wish you the perfect version of the first scenario - along with the desired outcome, of course.

Kami said...

You bring up some good points. After having 36 embryos and one baby die, I was much more pragmatic about selective reduction - or as you say, selective abortion. I know it is killing a fetus, but I felt something for every single embryo.

I had 3 top grade blasts and 1 just a little bit behind. We transferred the top 3 and would have reduced to twins. As you know we had a singleton which was my preference. My RE also has an 80% success rate and normally only transfers 1 or two embryos - usually 2.

My reasoning is that twins are very likely to make it to term. Triplets almost never do. That doesn't mean they won't be healthy in the end, but I wasn't willing to take that chance.

Of course, if I was actually faced with it, I may have decided to try to have all three.

Me said...

I don't have a problem with selective abortion for the same reason I'm pro-choice and believe in stem cell research. I think "life" beings with a single cell. but I don't think a zygote a human makes. Or a morula. Or a blastocyst. So when? I'm not sure exactly but at the Bodies Exhibit I saw a bunch of fetii under glass and, in my mind, it's somewhere between the 9th and 13th week. People may judge me for drawing such an arbitrary line. I would contend that is what we're all doing, all the time, all throughout life, usually without even noticing we're doing it.