Elizabeth (greyautumnrain) wrote,

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Infertility and Choice

I've been pro-choice for a long time. I took me a while to work out exactly how I felt about it, but I eventually reached the conclusion that the science pointed to there being this huge grey area between conception and viability, and I think that when there is a grey area those directly affected should get to make the decisions, not the government.

One might think that now that I'm having so much trouble getting pregnant that my views might change. One might think my frustrated ambition to motherhood would have me thinking that women who managed to get pregnant shouldn't terminate. That's certainly not the case. While my views have been affected, I'd say that if anything I am more firmly pro-choice now than I ever was before.

Partly its about having choices. If you're in the happy majority without fertility issues you get to have kids if you want them (assuming you have a willing partner of the opposite gender). I had it planned out. Find a suitable mate: check. Get married: check. Spend a couple of years together just being a couple so as to work any kinks out of the marriage gig: check. Have three kids reasonably spaced apart: um.... Suddenly my entire agenda was derailed, and while there are steps I am taking to address that, the whole business is very, very dicey. I can do treatments until I run out of insurance and personaly credit and still there is no guarentee that I'll get even one baby out of the deal, much less the three in my plan. Its not a hard leap from there to empathy with someone who has a plan that includes going to college and starting a career who sees the entire plan ready to crumble over an 'oops' pregnancy. Its about getting to have those kids when you want them, at the opportune time in your life.

Wrapped up in the having choices issue is the happy childhood issue. I will never forget my mother telling me, "You and Margaret were both planned occurances." It was a big deal to her that we were both planned. We were wanted children, and she wanted us to know it. I want that for my children, and heck, I'd like that for all children everywhere. It was especially compelling for me because after that statement my mom went on to explain about her own childhood. Her older brother had been a very difficult delivery, and her mother had been told not to have any more children. Her mother was a devout Catholic, though, and wouldn't use birth control, so 14 months later she had my mom. My mom told me how she grew up hearing "I wasn't supposed to have you" every time her mother was upset with her. I wouldn't wish that on anyone. At the time I heard the story I was in my teens and took it to be a good anecdote about being responsible and using birth control until you were ready to have children. When I was in college and one of my friends had an 'oops' while on the pill I was reminded of it, and while some might argue that living unwanted is better than never living at all, I'm not convinced.

That of course brings us to the biology. I haven't have formal biology since AP bio is high school, but being a nerd I did a fair bit of reading up, especially once the whole infertility issue reared its ugly head. Of course I have long known that birth control is not fool-proof. When I started using the stuff I read the labels, and did not find the fact that no method was 100% effective reassuring. Now that I am having difficulty conceiving I can no longer be confidant that it was my dilligent use of multiple methods that was behind my perfect record on that front. These days I have a whole new appreciation of just how chancy both conception and contraception are. You can try to regulate what is going on in that system, but its all a very delicate balancing act.

The more compelling thing about the biology is my increased awarness that a fertilized egg is a long, long way from being a baby. Embryos sometimes just give it up at two or four or eight cells, or maybe they don't implant. A lot of embryos don't implant. One of the things I suspect is going wrong with me is that stuff is not implanting for whatever reason. For all I know I could have had a dozen embryos by now that just didn't take. If life begins at fertilization there are a whole lot of people that last less than two weeks. Say you make it to implantation, though. With over the counter pregnacy tests there are a lot of women these days who are seeing those two pink lines, celebrating, and then getting their period two days later. I think its roughly one in four. Thirty years ago people didn't realize these were essentially miscarriages because the didn't have the tests and it just looks like the woman's period was a couple of days late. There are also pleny of people who make it to six, eight or ten weeks only to have the pregnancy fail. There is a reason why you don't generally tell your friends about a pregnancy until the second trimester: its awkward to tell people the good news only to tell them the bad news a week later. Things are safer after that, but still not certain. The more I learn about it the more I realize just what an uncertain gray zone pregnancy is.

That brings me to the issue of thereputic abortions. When you start reading the infertility websites you hear a lot about these and people who are infertile seem to be at higher risk. Ectopic pregnancies, fatal genetic defects, no heartbeat on the ultrasound... there's a long list of things that can go wrong that would call for a pregnancy to be terminated even if it was desperately wanted. My impression is that most anti-abortion legislation is not terribly intelligent about this. A good example would be the law that was passed in South Dakota, which makes it illegal to have an abortion unless the mother's life (but not health) is in danger. I'm guessing the people who passed that have never heard of pre-eclampsia. Either that or they don't care if women go into seizures and suffer permanent damage as long as they don't have an abortion. Late term abortions generally happen because they are necessary. Worrying about dubious regulations is not the kind of burden a woman needs when faced with having to terminate a wanted pregnancy.

Then there are the abortion issues that are really specific to people doing ART. Selective reduction happen, and its the prudent thing to do if you find out you are carrying four or more babies. A single pregnancy is the goal of ART. A single baby in there is the lowest risk. Twins is an acceptable level of risk for most people. Triplets are tricky -- high risk, but not sheer folley. Anything more than that and you're looking at very tiny and very premature babies as the best case scenario. You have the choice between risking them all, or sacrificing some to give the others a better chance. I don't think people should go into ART unless they are willing to make that choice and understand it. Any reputable clinic will of course do everything to make sure that high order multiples don't happen in the first place, or course, but the risk is always there. Of course while the clinic is making sure you don't have a litter in the first place, there may be left over embryos that aren't transferred. These are usually frozen as a backup. The extreme pro-lifers have a field day with this. To them, these are babies, being sorely mistreated by being kept in cryogenic storage. I just can't agree with them on that one, given that I know their low odds of making it to undeniable person-hood even given the best possible chance.

I hope some day soon I'll have the extra insight into the whole thing that comes from getting pregnant and carrying a baby to term. That would be nice. I'll certainly continue to think about the issue whatever happens. I just had to write about it now because these thoughts had been bouncing around my head for a while and they needed to be put down somewhere.
Tags: the world according to elizabeth, ttc
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