It’s too late, baby

12 01 2015

Not only am I lazy, I am also a bossy broad.

Bossy and lazy: and I wonder why I don’t date!

Anyway, Amy Klein writes in aeon about her reluctance to tell her 42-year-old friend that it’s too late to begin thinking about freezing her eggs:

What I really want to tell my friend is that if she is serious about having a baby, her best bet would be to go out to the nearest bar and hook up with a stranger – during her 36-hour ovulation window, of course. But I won’t tell her to sleep with a random guy, I won’t ask if she ovulates regularly, nor will I say anything else about the state of her ticking – nearly stopped – biological clock: it’s too delicate a subject.

To which I can only say: if someone brings up her ovaries to me, then I’ma gonna go ahead and tell her that thinking and freezing are not going to get the job done—although I’d recommend a sperm bank rather than the local pub.

Will I also tell her that chances are she’s already infertile? That would depend on the course of the conversation, and, in any case, I’d tell her to talk to her OB-GYN.

Klein is right, however, that most women don’t know that, for most of them, the fertility window is closed by the early forties, and that it begins closing in the late-twenties/early-thirties. Fertility rates do decline throughout the thirties (entering a period of greater variability in the late thirties), but, again after 40 the decline is precipitous.

And IVF won’t help—not if you didn’t create embryos before entering your fifth decade. Yes, some women do conceive their own children throughout their forties, but, as Klein points out, all of those well-known women birthin’ babies at 48 or 50 are either using embryos frozen some time ago or someone else’s eggs. Liza Mundy has more about this in her terrific book, Everything Conceivable:

Studies show that among ART [assisted reproductive technologies] patients who are forty years old and using their own eggs, there is a 25 percent chance of pregnancy over the course of three IVF cycles. The chances diminish to around 18 percent at forty-one and forty-two, 10 percent at forty three, and zero at forty-six.

In 2005, a group of doctors at Cornell surveyed IVF patients over forty-five who had attempted to conceive using their own eggs. Among women between forty-six and forty-nine, not one get pregnant using her own eggs. (p. 42)

And, it should be noted, the odds are even worse for poorer and non-insured women of every age, who may have had untreated medical problems which interfere with or nullify their fertility.

Mundy and Klein both note that a previous attempt by the American Society for Reproductive Medicine to raise awareness that the biological clock only has so many ticks in its tocks caused controversy among (hangs her head in sorrow) some feminist groups (well, the National Organization for Women), for the “pressure” such information would place on women, making them “anxious about their bodies and guilty about their choices”.

(Do I mention here that loooooong ago I was a member of the Sheboygan chapter of NOW? Those women, who fought to bring Planned Parenthood to the county, who had been harassed and threatened, would have hooted then-prez Kim Gandy out of the room for thinking they would have been afraid of a little information.)

Klein quotes Naomi Cahn, author of Test Tube Families, who notes that

‘the politics of reproductive technology are deeply intertwined with the politics of reproduction’ but ‘although the reproductive rights issue has a long feminist genealogy, infertility does not’. Discussion of infertility is threatening to feminists on two levels, she contends: ‘First, it reinforces the importance of motherhood in women’s lives, and second, the spectre of infertility reinforces the difficulty of women’s “having it all”.’

That is not any reason, however, not to spread the word as far and wide as possible:

‘Shunning that information about the relationship between fertility and age, however, ignores biological facts and, ultimately, does a disservice to women both in terms of approaching their own fertility and in providing the legal structure necessary to provide meaning to reproductive choice,’ writes Cahn.

. . .

‘It is only with this information that reproductive choice becomes a meaningful concept,’ Cahn writes. ‘Choice cannot mean only legal control over the means not to have a baby, but must include legal control over the means to have a baby.’

Exactamundo.

It is sometimes pointed out that it is unfair that men have no legal say in whether a women chooses to continue or to end a pregnancy—and maybe it is, but it’s also how it is. Similarly, maybe it’s unfair that men remain fertile throughout their lives but women do not—and maybe it is, but it’s also how it is.

So better to say how it is (and the earlier the better) than pretend otherwise, so women have the knowledge, and the time, to make the choices that make sense for them.

And if we’ve got to be a little bossy to get the word out, well, then that’s how it is, too.





American idiot

16 02 2012

This just passed the Virginia House of Delegates by a vote of 66-32:

HOUSE BILL NO. 1 Offered January 11, 2012Prefiled November 21, 2011A BILL to construe the word “person” under Virginia law, including but not limited to § 8.01-50 of the Code of Virginia, to include unborn children.

———-Patrons– Marshall, R.G. and Cline; Senators: Colgan and Garrett———-Referred to Committee for Courts of Justice———-Be it enacted by the General Assembly of Virginia:

1.  § 1. The life of each human being begins at conception.

§ 2. Unborn children have protectable interests in life, health, and well-being.

§ 3. The natural parents of unborn children have protectable interests in the life, health, and well-being of their unborn child.

§ 4. The laws of this Commonwealth shall be interpreted and construed to acknowledge on behalf of the unborn child at every stage of development all the rights, privileges, and immunities available to other persons, citizens, and residents of this Commonwealth, subject only to the Constitution of the United States and decisional interpretations thereof by the United States Supreme Court and specific provisions to the contrary in the statutes and constitution of this Commonwealth.

§ 5. As used in this section, the term “unborn children” or “unborn child” shall include any unborn child or children or the offspring of human beings from the moment of conception until birth at every stage of biological development.

§ 6. Nothing in this section shall be interpreted as creating a cause of action against a woman for indirectly harming her unborn child by failing to properly care for herself or by failing to follow any particular program of prenatal care.

§ 7. Nothing in this section shall be interpreted as affecting lawful assisted conception.

§ 8. Nothing in this section shall be interpreted as affecting lawful contraception.

That’s right: the proposed amendment protecting contraception was stripped out of the final bill.

As for “affecting lawful assisted conception”, does Delegate Robert G. Marshall know that the process of culturing, testing, freezing, and thawing embryos carries the non-negligible risk of embryo death? Or that this bill would require those who created the embryos in vitro either to transfer said embryos to a willing woman or to keep them in a deep freeze forever?

Does he know that as of 2009 Virginia contained 12 fertility clinics, which performed over 2000 cycles using fresh non-donor eggs? Is he aware that many, many more than 2000 fertilized eggs were transferred which never took? Is he aware that during these IVF cycles that many eggs were fertilized that never developed beyond a few cleavage stages—that is, that these eggs died in the dish?

Maybe he does, and he just doesn’t care.

But no, let’s not give him the benefit of the doubt—especially since he couldn’t be bothered to agree to the contraception-protection amendment—and let’s denounce his double-idiocy. Why double?

1. He does not understand conception.

To begin with, fertilization is a process, not a single event. The zygote is not formed until the last stage of fertilization, that is, after the sperm has penetrated into the ooplasm it takes some time before the 23 pairs of chromosomes are sorted and arranged. Furthermore, the early pregnancy factor protein—the presence of which in the first 10 days after fertilization indicates a pregnancy—is not secreted into the woman’s bloodstream until 24-48 hours post-fertilization.

And of course, pregnancy is not considered to have begun until 6 days or so post-fertilization, when the blastocyst attaches itself to the endometrium epithelium of the uterine wall.

Given that neither Marshall nor any of the rest of the 65 delegates could be bothered even to define what is “conception”—is it that magic moment when a single sperm pushes its way through the zona pellucida surrounded the ooplasm? after the formation of the two pronuclei? the fusion of said pronuclei?—-it’s easy to conclude they don’t give a damn about biological reality.

Which matters because it is the biological reality that 60-80 percent of all fertilized eggs will never result in a live birth, which in turn would indicate that “nature” or “biology” doesn’t give a damn about Marshall’s definition of personhood.

2. This biological reality also matters because these majority of failed fertilizations could potential open a woman up to legal liability.

Yes, the bill states that “Nothing in this section shall be interpreted as creating a cause of action against a woman for indirectly harming her unborn child by failing to properly care for herself or by failing to follow any particular program of prenatal care” —but it doesn’t prevent such creation, either. In other words, the legislators, in attempting to get around the legal reality that it would be impossible to investigate every single instance of failed fertilization, nonetheless leave open the possibility (via § 4) that a woman could be held liable.

Admittedly, I could be reaching here, but it does seem as if sections 4 and 6 are in potential conflict with one another, and it is by no means certain how a court would resolve such a conflict.

More to the point, this is a piece of bullshit boilerplate designed both to get the state off the hook for not providing adequate prenatal care to poor and uninsured women and to reinforce the notion that women aren’t responsible enough to make decisions about their own health.

And, of course, this bill leaves the status of in vitro-created zygotes in limbo: what happens if they don’t develop? Could clinicians be held liable?

Who knows. Answers to these questions would require some recognition of the messiness and complexity of human life, something which these reality-challenged delegates are clearly unable to do.

The bill now goes to the Senate.