Thursday, December 02, 2004

Selective Reduction: The background

I wanted to write something thoughtful, even philosophical, about our decision not to reduce. It turns out that even an account of the bare facts mires me in the online equivalent of stuttering. Nevertheless, at some point, I need to get the subject behind me. This is part I, in which I lay out our rejection of SR before the fact. Soon, I'll take on the job of explaining how our entire world view shifted once we knew it wasn't a theoretical position.

But right at the outset, I reluctantly concede to myself that I'm duty-bound to declare the reason why I've been so reluctant, so unhappy, about writing about SR. It would be intellectually dishonest to do otherwise.

I think people who reduce from triplets to twins have made a huge mistake.

Every time I read the selective reduction boards, every time someone advocates reducing triplets in the comments section of some blog, I feel this visceral outrage, and a horror in my gut. As easy as it is for me to understand and emphathize with the entire gamut of family-building practices (and it's really easy, I think any and all routes are great, I'll get excited for you to the exact appropriate degree without becoming condescending and beginning to believe my opinion actually matters*), that's how hard it is for me to understand how people could reduce from triplets to twins. To some extent, the disconnect unnerves me. To feel so judgemental and pissed off doesn't fit my idea of myself.

SR in the case of quads and more, I understand. I ache for families facing the statistics on quad+ pregnancies, and I'm grateful I was spared that decision. We certainly never predicted triplets based on my estradiol or follicle measurements, so it could probably just as easily have been quads, or even quints. I'm exceedingly grateful it wasn't, because once you're carrying quads or more, the statistics are indeed stacked in favor of SR. And I would have hated facing that decision.

But to reduce from triplets to twins? Neither the statistics on medical outcome nor the realities of triplet family life justify reduction (at least not the various non-financial scenarios of triplet life I've seen invoked on-line, most of which are pure media-invention fantasy) . And it drives me a little nuts to find myself believing this so strongly. I should be a lot more tolerant, I think. I'll be looking for tolerance when I compose the second half of this story.

We ruled out SR at our first RE appointment. Saying we ruled out SR, though, was simply one way of saying that we refused to pursue any protocol in which it might become an issue.** I don't think either Calder or I ever ruled out SR simply on the basis of its mechanics. In general, we're pro-choice in our politics, and I grant no scientific arguments against abortion in the first 16-18 weeks. I do know that I had a gut instinct that making that decision -- to abort one fetus in the midst of an otherwise-wanted pregnancy -- would cause me extreme emotional distress. But I also knew that most women who choose abortion express contentment with their decision--they report feeling that whatever grief they experience is appropriate and not debilitating, or even terribly long-lasting -- and I knew in the abstract that SR could be the humane choice under certain circumstances. It simply wasn't right for us.

At this point, I'm duty-bound to disclose that Calder and I are church-going Lutherans. I embrace every truth revealed and celebrated in Psalm 139. But wait, wait! Before you hightail it out of here, it's on the basis of that same Psalm that we'd like to see the church normalize the status of gays: ordain homosexuals regardless of whether and when they last had sex, provide a marriage ceremony for homosexual Lutherans (the current one references God creating us male and female for each other, but most of the liturgy requires no amendment or alteration), welcome homosexual parents at the baptismal font, etc. I'm pro-choice, anti-voucher, anti-prayer in schools. Just consider me a Lutheran in the old-fashioned progressive "live and let live, hard to say what's right, you betcha" Garrison Keillor sense of the word (but not so inhibited, obviously).

Nevertheless, I never felt that my opposition to SR was based on religion. If you had asked Calder and I to explain why SR was off the table in January 2000, we would not have quoted the Bible. We would simply have said that it felt wrong. We certainly did not express, to ourselves or others, the sentiment that Julie finds so dominant in HOM stories, that "whatever happens is meant to be, that God will give and take away according to his wisdom." On the contrary, I spent a fair number of Sunday mornings raging against God, because if you sneak into service late after an "early"-morning appointment with your clinic nurses, you will find yourself stuck worshipping with all the families with small children. This is unpleasant, even if not ironic.

No, our oppositions felt rooted in behavioral ethics, not religious scruples. Most of what Calder and I knew in 2000 about SR came from the stories about the sex- and septuplets in the media. We tended to talk about the procedure between ourselves as a "cheap escape" for couples who pursued blatantly irresponsible ART protocols. Of course, I know a hell of a lot more about SR now, and I would never label it a cheap escape. But there's no denying that it struck us that way then. To consider or embrace SR, it seemed to us, entailed considering or embracing irresponsible treatment options. We were determined to do neither.

This was the background to our discovery that we were carrying triplets: we had ruled out SR, but not for especially well-thought-out reasons. It was simply a gut instinct, and one of several lines in the sand that we had felt called upon to draw before entering the process. We had seen too many people plunge further and further down the rabbit hole of infertility treatment, forgetting their way back home, changing into all sorts of unwieldy new sizes, psychological as well as physical--maybe good choices for them, but not for us. Calder and I made some promises to each other right at the beginning, and we intended to stick with them. No SR was one of those promises. But never forget that "No SR" was really a promise about protocols -- rejecting it helped define our outer limits.

* I simply adore Gaudy Night and there's a great passage in the latter half of the book that's entirely on-point. Peter Wimsey comes to dinner at Shrewesbury College and advises one of the dons (maybe even the Head) that she should not ask him "that tired old question, whether I approve of women's education or not." (I'm paraphrasing.) And when the Don asks, why not? Wimsey replies, "you should not imply that my opinion in any way alters the rightness of the case." Or words to that effect. Dorothy Sayers is a much better author than I am. Obviously sexist, but still.

** In retrospect, our RE should have explained in simple, direct language that the only protocol in which high-order multiples are 99% guaranteed not to occur is single-embryo IVF. Where that would have left us, I don't know--we were dealing with a separate set of issues regarding IVF, and had ruled it out. I've always suspected that we would have plunged down the rabbit-hole ourselves, given enough time. In retrospect, we were sidling over toward that direction during the cycle in which we conceived the babies.


Moxie said...

Jody, I just wanted to tell you how much I appreciate your blog. I'm not infertile and have never done ART, but your perspective is so interesting and analytical. It intrigues me.

As I was reading your first few paragraphs about SR, I was nodding my head. I'm also pro-choice, and could imagine myself aborting a pregnancy under certain circumstances. But SR just seems so wrong to me, in the way that the premise of the movie "Sophie's Choice" horrifies me. "A child or not" is one thing, but "choose which one" is completely different.

So then I read on and discovered that you are Lutheran. I am, too. I wonder if it's something about the Lutheran upbringing and way of relating to thought about God and the world (in that Lake Wobegon kind of way) that leads me (us) to that feeling.

At any rate, I'll be interested to read your next installment.

Cricket said...

Although I've gone over to the athiest side, I still have a soft place in my heart for the Lutheran church. I wasn't raised Lutheran, but I embraced it completely as an adult. Some folks would say, "Too bad it didn't stick." (I am still as pragmatic as any Lutheran out there :)

I really appreciate your thoroughness in your step-by-step eval if your decision-making process regarding your children. I do have a question which might be included in your follow up.

I understand your idea of not going from 3 to 2 and the idea of SF for 4 or more. What sort of number is an optimal goal for 4 or more to get to? (I'm not studied up on the topic, so I appreciate your blog for both the facts and feelings.)

If you say the goal would be 2, then how is that different than going from 3 to 2 as if the higher order started out as 3? With the risks of carrying 3 (and I'll admit I'm assuming) being greater than 2, wouldn't 2 be optimal for all?

(I hope this line doesn't rate with the ignorant masses that you're blogging about. If so, visit my blog and flame me, if I deserve it. Infamiliar with current trends [that before or even after 2000], I'm curious about your learned opinions and I hope that's okay. I am a multiples virgin, but I enjoy your blog and your opinionatedness.)

Anonymous said...

Yes, this is why I chose single embryo transfer IVF.

I didn't even do one IUI, for fear of multiples (twins).

To me, the increased risks of a twin pregnancy were unacceptible.

This is not uncommon, in most countries other than America, it is the norm to only transfer one embryo in the first few cycles in the under 35's.

Mel said...

Very well written. I'm so glad I found your site! I look forward to getting caught up on your blog.