Why Not IVF?

I am writing this post in response to some things that have been said to us, and also to explain why we are going almost against probably what most of the general public would do who has a similar situation with infertility and the financial means to consider fertility assistance - and definitely the field of medicine - in choosing how to expand our family, in light of our struggle with infertility, and the specific diagnosis of infertility that we have (meaning that we could likely "benefit" from fertility assistance). Also, read on if you don't know a whole lot about different measures of fertility assistance - I won't go into great detail here, but I will include links so you can read up on your own if you want.

We have heard the following comments or some sort of variation of them:

"Are you sure you don't want to try IVF - I know someone it worked for and..."

"Are you sure you aren't going to someday regret not ever trying harder to have your own child?"

"What will you do with your adopted child if you happen to get pregnant someday?"

"Are you sure you're not disappointing (Narasimha or Kristina) by not trying harder?" - asked to one of us about the other.

"Is this something your religion won't let you do?"

Yeah, I'm not kidding - people really say this stuff.

Western medicine has come a long way in helping people live longer and better lives, from transplants, to medical management, to things that aren't necessary but make people happy and "improve" lives (here I am thinking anything from liposuction to fertility assistance measures, etc.). With any perceived benefit, there is always a cost, whether it is physical, financial, or even moral.

Infertility is a somewhat flaky diagnosis, and is basically characterized by a couple who has tried to get pregnant for 1 year with no success. There is always more to it than that though - the real question is what is causing the infertility? Sometimes it is a physical problem that the man has, sometimes a physical problem that the woman has, and sometimes, both parties have problems that contribute. As you can imagine, there are many MANY things that could go wrong (or even just not quite right) with either the man or the woman making pregnancy unachievable. For a brief overview of infertility or a list of some of the most common causes of infertility, click here. Sometimes, there is nothing that can be found that is wrong with either person that would indicate why a couple is unable to conceive. Sometimes, conception is possible, but for whatever reason, the pregnancy is spontaneously (accidentally) terminated early and doesn't result in a live birth. The couple may or may not know there was ever even a pregnancy, depending on how and how early the pregnancy ended. My point here is that this subject is no simple matter.

We (one of us actually) were diagnosed with a physical problem very early in our effort to become pregnant. We looked at the facts regarding the treatment, and the risks and benefits, and decided that the affected person would have surgery to attempt to correct the problem. We decided that in our situation, we were ok with fixing our bodies to see if that would make us able to spontaneously conceive without the help of actual "fertility assistance measures." The problem that was fixed was something that was physically painful before the surgery, and is a problem that people have fixed even if they aren't having problems conceiving as a result of it (it doesn't only cause problems in aspects of fertility). The surgery was likely successful, although we don't know how successful (read here and here for a little more on our specific situation). The surgery took place over a year ago, and to date we have still not been able to get pregnant.

So there's the problem. What can medicine do for us?

There are many options, ranging a lot in how physically invasive they are, how many "moral" issues are potentially attached, and how much they cost financially.

Here's a list of some of the things we could pursue (click on the word for detailed description or read my sort-of layman's description):

Medication-Induced Hyper-Ovulation
Sometimes the woman doesn't ovulate regularly, so they give medications to make her ovulate. Sometimes they give the medications to make her ovulate more, so that each month, instead of releasing one egg, she could release several, which would hypothetically increase the odds of fertilizing an egg and then having one implant. This also increases the chance of multiple embryo implantation. There would be no way to know how many embryos would possibly implant, but it could be very many. This is likely what happened when the woman from Carlisle, Iowa, had 7 babies at one time (septuplets). This may seem obvious, but any pregnancy with more than 1 baby has increased risk, and with each additional baby, the risk increase is exponential. This leads some to consider Selective Reduction. This means aborting some of the babies. The thought is that the ones who are left will have a better chance of survival and health. It is still abortion - still the killing of babies you supposedly worked so hard to make. This also can get more morally messy when the parents do genetic testing, or find out the gender of the babies, before they decide who to get rid of. Sometimes people choose to abort the babies with problems, or by gender, and sometimes it could be random, or where the baby is attached to the uterus, etc. This medication therapy when used alone is probably the cheapest fertility assistance a person could try. I guess it could also be considered "fixing one's body" if the woman isn't ovulating (under the precept used above for my justification of the surgery we were ok with doing). However, the risks are still there, even in the "fixing one's body" scenario, to have a multiple pregnancy, which could then lead to a moral decision.

Artificial Insemination (AI) or Intra-Uterine Insemination (IUI)
Sometimes used in combination with the Hyper-Ovulation medication (above) - sometimes not. This is often used as a first-line therapy, and is quite a bit financially cheaper, and less physically painful, than IVF which I will talk about next. This is where the doctors have some of the man's sperm, and they will often "wash" it to get the good ones out, and they put the good sperm directly into the woman's uterus. The timing with the woman's monthly cycle is precise, and it gets the sperm closer to where it needs to get to for the couple to become pregnant. There are still downfalls to the process. I would still consider the pregnancy to have been achieved in the doctor's office, but there is more left to nature, like the union of the sperm and the egg, and the embryo's growth, survival and implantation in the uterus.

In-Vitro Fertilization (IVF) with embryo transfer
This is a very complex process, and quite invasive and expensive. Not to mention often full of moral questions. This process starts with the woman giving herself daily injections to induce hyper-ovulation which can be timed very precisely. Kind-of the same as the medications listed above, but I think different in some aspects that I don't know. Then the woman has to go to the doctor's office and they put her to sleep and pull the eggs out of her ovaries with a long needle before they are released into the fallopian tubes. Then they take the man's sperm and mix the eggs and the sperm together, and hope that some of them will hook up and form embryos. This is in the lab - and where they get the term "test tube baby." Then they "grow" the embryos that result out for a few days, to see which ones survive. After that, they pick the healthiest one(s) (and they can even do genetic testing on these embryos to find problems/gender), and finally, they put these little week-or-so old embryos straight into the woman's uterus, where they will hopefully latch on and grow to be babies. This process, as it would seem, has moral issues everywhere. First, the doctors take from the woman as many eggs as they can, which could probably be anywhere from several to 30 or even sometimes 40+. Then, they basically try to fertilize all of them, and see what happens. It is feasible that half of those could fertilize, so now you have 25-20 embryos (early stage babies). Now it is likely that some of them will die in the growing out process, and often they have to freeze them to wait for the right time in the woman's cycle to transfer to the uterus, and some will probably die then or in the unfreezing process too. But say somehow after growing and freezing/thawing you still have 10 viable embryos (which is potentially very realistic and possible, and could be more or less depending on each situation). The doctors won't put any more than 2-3 in at a time, and then you could still end up with twins/triplets if they all latch on (we know or know of people who have had singles, twins, and triplets with this process). So even if you put 3 in, you still have 7 left from your 10. Now what to do with those leftover embryos? Well, you can keep having babies until yours are all used up (and then you have to pay for the freezer space in a lab to keep your frozen babies until you are ready for them) and potentially end up with lots and lots of kids. You could dump them in the trash can, which as far as I'm concerned is no better than abortion. You could adopt them out, which is becoming more popular and is called Snowflake Babies. Now sometimes you don't have so many embryos to think about - I know of a couple who by the time the growing out and unfreezing was finished, they had 2 (and only 2) very healthy embryos that they implanted and ended up having twins 9 months later (actually like 8 months because the babies were premature which is the most common complication of pregnancy with multiples). But, this extra embryo situation does happen often enough that you have to have a plan that you have to tell your doctors before they will even start the process of IVF with you.

Intracytoplasmic Sperm Implantation (ICSI) - See link for IVF
Even farther on the spectrum of IVF, and more expensive. This is when your sperm and eggs won't unite on their own for whatever reason when they mix them together in the test tube, so the doctors actually pick a single sperm and shove it into the egg to get the embryo.

Donors
People also have the option of using donors for almost any part of the process - anywhere from donor eggs, to donor sperm, to borrowed uterus (also called a surrogate). This can get very morally sticky, and in the case of using a surrogate, even legally sticky by means of custody, etc. The potential for problems and miscommunications are endless. Not to mention expensive and risky, based on your personal preferences as a parent.

There is so so so much more - this is hardly the tip of the iceberg. But hopefully it gives you an idea of the scope of what's possible, and what those who are interested in pursuing the options have to consider.

Now that we know the options, lets get personal - why not fertility assistance for us?

If my dramatic portrayal of the risks involved didn't indicate well enough how I feel, here it is: I don't think that the potential risks are worth the potential benefits. Said again: the things that could go wrong, and how much that would cost (physically, emotionally, financially, morally) do not outweigh the benefits in my mind.

Another reason: A fellow (Christian) blogger who also suffers from infertility said it this way (not a direct quote, but this is the gist of it): "I don't want to take something that is beautiful and natural and created by God (the act of making a baby) and turn it into a sterile lab procedure." I couldn't have said it better myself.

Another reason: Why does adoption have to be a last resort? "Oh, I tried EVERYTHING and nothing worked, so I guess we have to adopt to get a child." I don't want to look at my adopted child and think "We could have done better." I bet if you ask those who have adopted children, no matter their reason for the adoption, (a group I soon hope to be a part of) they would say that they love and own that child as much as anyone who physically births a baby. I will choose to take a proactive and positive approach to loving my child, no matter how God chooses to give him or her to me. Adoption is a special way of making people into a family, and in my mind is something to be embraced and celebrated. Love is a choice, not a feeling - ask anyone who is happily married. Although not a concept endorsed by our society, I firmly believe that the Bible teaches this.

Another reason: I have said this before, and will say it again. If God wants us to be pregnant, we will be. He doesn't need the help of medical professionals for us to add to our family. There is a child (or hopefully children) out there who God has intended for our family. Whether sitting in an orphanage in India, or in our bodies waiting to be conceived, or waiting to be conceived through someone else that we could someday adopt - I don't care who or where - if God allows the process, whatever it entails, for us to acquire children, then I will feel blessed and be thankful for it.

Another reason: Though these fertility assistance methods have been tested and improved upon over the years, there is certainly never a guarantee. Financially speaking, these can be anywhere from kind-of expensive to you-only-have-enough-money-to-do-this-once-and-even-then-you-just-drained-your-retirement-account expensive. And even then, you could end up with no baby. I have heard countless stories where people spend every dime they have, and put second mortgages on their houses, etc., and at the end of the day, they are still not mommies and daddies. I am much too cheap to take that kind of a risk. Also of note: people who choose to pursue these things get little or no help from insurance, so somehow have to come up with the funds for this on their own. In my mind, money spent here could just as well be invested for a future college tab, or a bunch of trips to India, or any number of other things.

If I haven't somehow answered the questions above yet, I will do so now.

"Are you sure you don't want to try IVF - I know someone it worked for and..."
IVF is an amazing thing, and I am sure it has made countless families very happy. I am happy for those who are happy because of it. I personally know people who have done this, and who it worked for, and they have the most precious and beautiful children as a result. It is still not something I am willing to do. To clarify: we are not saying our choice is right for everyone. At the end of the day, each person has to be able to accept decisions they have made. We all have different ways of looking at things.

"Are you sure you aren't going to someday regret not ever trying harder to have your own child?"
Two answers to this one. First, we aren't going to stop trying to have a biological baby. We will keep doing everything we can do - 2 people in the confines of a bedroom - to become pregnant. I still hope and pray that this will happen for us someday. If it doesn't, I will be thankful for whatever (whomever) God provides. And second, any adopted child we have is OUR child. As much as any biological child we may someday have.

"What will you do with your adopted child if you happen to get pregnant someday?"
Um, duh, love it, and care for it, and punish it, and teach it, and buy it stuff, and play with it, and make it mad, and make it happy, and let it make me mad, and let it make me happy, and laugh with it, and cry with it, and dream about it's future, and celebrate with it, and celebrate its part in our family, and hopefully one day lead it to Christ...I'm sure there's more. And, tell it to say that "At least Mom and Dad chose me - they got stuck with you!" if the biological child ever gave the adopted child grief about being adopted. :)

"Are you sure you're not disappointing (Narasimha or Kristina) by not trying harder?"
We are 2 adults who are happily married and very much want the best for each other before ourselves individually. This is a decision that has been made to be the best, not for either of us individually, but for both of us together and as a family. This decision has not been made without much conversation and prayer, and many moments of sadness and tears about our missing children, and many moments of hope and happiness looking forward to what lies ahead for our family. This is no small decision and we do not take it lightly. May I encourage you that unless you have been "there" (whether "there" is infertility, dealing with sick family members, personal problems, financial difficulties, etc.) don't give advice to people who are dealing with "there" - just be encouraging. And if you can't do that, don't say anything at all. I am not saying that you are not allowed to lovingly raise important issues that may not have been considered/discussed. But if the people directly involved say "Yup, I've thought of that and I'm willing to deal with it," then believe them and let it go.

"Is this something your religion won't let you do?"
My religion isn't Baptist (although that's what it says on the church we attend) - my religion is being a follower of Jesus Christ, or "Christian." The Christian handbook is the Bible, and no, it doesn't say anywhere in the Bible that "Thou shall not do IVF." You can look - it's not in there. Through the Bible, however, we can learn Christian principles, and learn to know God better, and through those things we can feel like we are making decisions that would best please God. Though I don't think that fertility assistance measures necessarily fall under the category of black and white "sin" I think there are a lot of issues in fertility assistance that do count as "sin" and then a lot of gray area. I personally try to look at Christian living on a good-better-best continuum. Maybe before "good" would be not necessarily sin, but not good. That is where I would personally, especially for my life, place IVF. And then you have to be careful, because there are so many things that could push you into the "sin" category. I don't know why, with so many homeless children out there, I would make myself face these tough choices when I can get a child without doing so. I know from the Bible that God loves me and wants me to be happy, as a child of His. I also know He wants me to trust Him unconditionally for everything I want and need. I also know that if I wait and do things His way rather than try on my own, I will be much happier and more at peace with any outcome that happens (interesting Biblical parallel - read in Genesis 16 about Abraham and Sarah's infertility, and what they did about it, and how that turned out). I will choose to wait. Waiting doesn't mean doing nothing, and it doesn't necessarily mean not exploring options. I believe that adoption is in a sense taking things in our own hands. The difference here is that there isn't really anything about it that is "sin," and if we approach it prayerfully and still asking for God's blessing, we can have peace that this is what He intends for our family. My God is a God of love, and He wants us to manifest His love unconditionally, and adoption is one way I believe we can do that, and make Him happy and still get what we want, which is a family.

Yikes, that's a lot of info for one post. This will probably be about the last time I talk about fertility assistance - I just wanted to set the record straight. My identity will continue to be defined by infertility, and also now as an (potential) adoptive parent. I know this is long - I hope it was helpful for you, no matter how much you know about infertility or issues surrounding it.

May Narasimha and I continue to want to please our God more than anyone else, and may God be honored by this issue of infertility/adoption in our lives.