Thursday, 15 May 2014

Gender Benders

*This post discusses a very sensitive topic. Reader discretion is advised* 

Even though Husband is hoping that we have a girl if I ever manage to get pregnant again, he was reluctant to designate a gender preference with our PGD testing. "I think there are somethings you still have to leave to chance" he advocated. In theory, I concurred. If we had conceived spontaneously or even with an IUI, we were planning to keep the gender a surprise until the birth. However, we weren't in Kansas anymore, Toto. We were in the middle of our first IVF cycle with plans to go PGD testing for the primary purpose of avoiding the transfer of an aneuploid embryo. Advance knowledge of the gender would only be a secondary benefit. Yet, as I know my heart's desire for a girl, I felt I couldn't pass on the opportunity to make that dream come true. If we were having to go to such extremes to have a baby, then we might as well take advantage of the perks! I thought the process would amount to slipping the embryologist twenty bucks to get her to thaw a girl. Unfortunately, it doesn't work that way. We both had to sign the consent forms indicating a gender preference. Shamefully, I pulled the uterus card and coerced Husband into signing the forms.

Recently, my medical assistant was rooming my new OB patient, I started looking through her chart. She was 26 and this was her second pregnancy. I found a phone message she sent to her primary care provider; she just learned that she was pregnant and wanted to know how soon she could know the baby's gender. Oh, how nice when that's your primary thought process. No worries about whether or not this pregnancy will be viable or euploid... I bitterly acknowledged, as I once again reminded myself that these women live in a different world. My medical assistant emerged from the room. "She's ready." she announced. "She really is quite eager to know the baby's gender!" ...and I know why... I thought to myself.

Sure enough, the couple didn't say much during her interview or exam. Her ultrasound revealed a single viable intrauterine pregnancy measuring 9 weeks and 3 days. She didn't ask what her due date was. She didn't want to know the heart rate. They didn't inquire about the baby's size, as most couple tend to do; usually just after I've cleared the screen with the measurements. She only had one question: could I tell if it was a boy of girl? I replied that it was too early. I knew what was coming next. They wanted to know the gender as soon as possible as they plan to terminate the pregnancy if it were another girl.

My stomach flipped a bit as I looked at their absolutely gorgeous two year old daughter. She had perfect curls in her hair and her bright eyes were framed with long lashes. Due to my patient's age, she's not eligible for NIPT testing. The lab we use holds to the evidence that the test was only studied in high risk populations (Advanced Maternal Age, Personal history of a fetus with chromosomal abnormality, or abnormal serum screening or ultrasound findings) and will only perform the test for women who meet that criteria. Even if a couple is willing to plunk down a few grand in cash, they will be turned away if they're not appropriate candidates, which really makes me respect the integrity of the lab. The perinatologists in our area won't perform Chorionic Villi Sampling (CVS) or an Amniocentesis for a couple who only is looking for gender confirmation, unless they're carriers for an X-linked disorder such as haemophilia. Her best option was to do a 3-D gender scan, which could be performed before her anatomy scan at 18 weeks. "It's not covered by your insurance and would be an out of pocket expense." I informed them as I acknowledge that it sounded a touch bitchy.

When I worked at a reproductive options clinic, we would periodically engage in values clarification exercises. Various aspects surrounding abortion were proposed and participants would be divided into groups that would answer the questions either supporting or refuting the position statement. Then the groups would swap papers and would defend the other team's answer. The purpose of the exercise is to try to see things from someone else's point of view. Yet in all my time working at this clinic, the issue about doing an elective termination for gender selection was the one question that many struggled to argue for the supporting position. Even the most ardent pro-choice banner carriers admitted that gender selection made them feel a little uncomfortable.

Meanwhile, the consent forms for PGD testing were still sitting on our dinning room table. I was waiting until I had a department meeting in a few weeks, which would bring me in proximity to my RE's office and we wouldn't need to make a separate trip. I was also stalling as I had been re-thinking my intention for a gender preference. As Husband has a limited attention span and twice missed an initial and a signature on the forms for our first IVF cycle, my new tactic is to spread them out on the table and use 'sign here' stickers. I told them the latest batch was ready to sign. When he got to the question about whether or not we wanted to know the gender and if we had a preference, he dropped the pen when he saw my initials next to the option "I DO NOT want to know the gender" and came over to embrace me in his arms. "This is the right call Jane" he whispered to me. I know. We're not in Kansas anymore, but we've been in Oz long enough to understand what really matters.  

23 comments:

  1. Oh Jane, this is a beautiful post. Heartbreaking, but beautiful. Infertility robs us of many of the special "surprises" of normal pregnancies. Of course, you'll know the moment of transfer, you'll know at the earliest possible day if there's been implantation, but I hope you are able to keep this one area a mystery. Thinking of you!

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  2. Oh man that couple makes me furious. The fact that they are willing to terminate a healthy pregnancy just because they want a son? Ridonkulous. Not to mention the fact that sometimes the gender scans are WRONG.

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  3. I can not even imagine terminating a pregnancy because of the gender, that is crazy! I love the idea of a surprise!!

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  4. The story of this patient makes me really, really sad. To think there are so many people in the world hoping for A child, and this couple would consider terminating a healthy fetus because they already have that gender? Sickening. I can't even imagine all the things you see and hear in your profession.

    I know that gender selection is very controversial, and not for me, but I don't judge anyone, especially if they've gone through a battle to get there, that may be tempted to have the opportunity to choose from the start. Obviously you had to decide what is best for you, and I really hope you will have your successful cycle and find the element of surprise (either at anatomy scan or birth) refreshingly "normal" in a situation that is far from it.

    Thinking of you!

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  5. I still to this day have no idea how you cope with IF and your career, especially when dealing with a patient like this 26 year old woman! I know your decision was not an easy one. Good for you, Jane. It's really hard to give up control when we have so little to begin with!

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  6. Although I was hoping for a boy, we did not choose to do PGD for sex when we did IVF. However, if we go back for another baby I would be so tempted, but Andino doesn't agree with me.

    I agree with Eve, it still amazes me that you are able to do your job under your circumstances. I think I'd have a mental breakdown! You are a strong woman.

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  7. I love this story, Jane. While I understand people having a gender preference, I do think it's important to keep an open heart and mind.

    I always felt that my first pregnancy which I lost would have been a girl, so I had a strong preference for a girl when I got pregnant again. But did I feel disappointment when we found out from my Panorama screening that we had a chromosomally normal boy? Hell to the no! I was excited as I think I've ever been in my life. I don't say that to make myself sound noble, it's just the honest truth. If I were a "fertile" maybe it would have been different, but my heart was just so happy and grateful to have a healthy baby. I feel that's how it will be for you too--you'll be over the moon thrilled with a healthy pregnancy outcome, regardless of the gender.

    I'm glad you brought up this topic even though it's touchy. I don't have a problem with finding out the gender of embryos through PGD--to me that's entirely different than the case of your patient wanting to terminate an already established pregnancy on the basis of gender alone. But I think you made the right choice.

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  8. What a hard choice...it would be soooo tempting to be able to pick what you want in your heart but in the end I think I agree that some things are better left to fate. I am 1000% pro choice but the thought of aborting at 18 weeks because of gender makes me feel sick.

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  9. Boy that would be so hard to be in that ultrasound room. I would want to say a lot of things to that couple, as I am sure you did too.

    Xo

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  10. I also have a preference for a girl. I could be perfectly happy with just a single girl, but I would not be with just a boy. I know at this stage of the game, beggars can't be choosers, but if I get through my four embryos and none of them result in a female baby, I will have to adopt one. Or Thor forbid, do another cycle with sex selection. For now, I'll just cross my fingers for boy/girl twins and call it a day. But the idea of willful termination based on sex is sickening. It's Naziesque eugenics. Those employing ART are often accused of Brave New World type reproduction, when clearly, regular breeders can be far more guilty.

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  11. Oh, I can appreciate your temptation! While in some ways it's kind of cool to be able to select the gender, I would have had definite guilt if one embryo was selected for gender, no pregnancy resulted and then a second transfer with a different gender resulted in a successful pregnancy and baby. Would I consider this baby "less wanted"?

    Glad to hear that you are proceeding with the PGD for this cycle. Hopefully it will yield the information you need. As you told me once, perfect looking embryos aren't always chromosomally normal.

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  12. My hand flew to my mouth when I read about your patient. No way. No way could I have continued working with her. Whew. Props to you. And then I got teary reading the last paragraph. Wonderful post. I'm glad you are doing the PGD testing though.

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  13. As I was reading this, my heart sunk, as I was afraid of what was coming. And I was right. This post makes me cry. I always wanted a girl. I would have been very happy if our twins were two girls, but I have to admit I would have been a little disappointed if we had two boys (probably until I actually saw them and fell in love with them). Now that I have one of each, I can honestly say I am so glad I got a boy too. He is the happiest little baby and so cute. I cannot imagine terminating a pregnancy just because it wasn't the gender you were hoping for! Oh my goodness that breaks my heart. What if she's never able to get pregnant again? What if she keeps getting pregnant and they are girls EVERY TIME? Would they continue to abort their babies? I am not opposed to gender selection through PGD testing. I am not pro-choice, but it's not my place to judge and I don't hold it against anyone should they choose to terminate a baby. However, that couple really pisses me off.

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  14. This is so so sick that people would terminate due to the sex of the baby. I am so amazed at your ability to handle some of the situations you do! You are better than me.
    We also are getting ready to test our embryos and will take advantage of the gender selection; however, I will take whatever gender I can get at this point!
    Would you be able to email me or share with me how much it is costing you to test your embryos? Who you are using to test them?
    My email is jennitis28@gmail.com

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  15. I also have a preference for a girl, mainly I think because my only real experience with a baby is my niece and buying frilly pink things is so much damn fun. I remember joking with M that I wasn't sure if I wanted to do IVF if I knew in advance it would be a boy. But at this point, I think we all know that infertiles are more than happy to take what we can get! That said, I honestly don't have a problem with putting in an embryo of a preferred gender...but I have a HUGE issue with terminating one if it's not the gender you want. Such a small difference, but it just seems to me that if you want a child, you should be happy no matter what the sex.

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  16. I have to say, you are much better at keeping your mouth shut than I! I think I would have ripped that couple a new one. I think it will be wonderful for you both to have at least one surprise in all this. Everything else we do as infertiles is so planned out.

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  17. I just can't imagine what it's like for you to have to deal with people like this on a daily basis without wanting to just kick them in the face. Because just reading this made me want to do just that. And while its definitely tempting to be able to choose your child's gender, there are so few surprises in life, that i'm glad you are embracing this one!

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  18. Wow. This is a difficult post, but it's beautiful and I love how it ends. The beginning is so terribly sad :(. XO

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  19. Oh, my... well, this is as good a time as any to mention that I'm 100%, unequivocally pro-life... I have a post about it sitting in drafts that I keep neglecting because it's such a deep and important part of myself that I'm afraid to lay it bare. And then I feel ashamed for being scared of reactions. It's such a precarious place to be, especially in light of infertility and all the entails (though my beliefs pre-date my diagnosis by a lot).

    Anyway... this story of your patient made me cry real tears at work (which at this point they're all used to, so whatever. It really doesn't take much to set me off). I really, really, really, really, hope it's a boy. Really.

    And your own decision at the end of this post was beautiful. It is good to be surprised. As much as Eric wanted our baby to be a boy, I am really looking forward to his reaction the first time he sees her and holds her for the first time. A lot of mothers of girls say that their husbands were similarly skeptical and then did a complete reversal once they laid eyes upon their daughters. Boy, girl... either way, at this point in my journey, I can't imagine thinking of a healthy pregnancy as anything but a huge freaking miracle.

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  20. You are a super-human for dealing with all that you do because of your job. Major kudos to you. As my husband said, after I told him this story "Those people deserve to be terminated". Asshats.

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  21. The end of this post was so sweet. I love how touched your husband was.
    The couple with the little girl though... that is so sad. I didn't realize this was legal. And I agree with those above that my feelings about pre-transfer gender preference are rather different than those on termination.

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  22. I just don't even know what to say. I would have to punch that woman in the face and tell her how lucky she is to be pregnant with a healthy baby. Don't get me wrong, I am totally pro-choice and volunteer at planned parenthood, but, I can't even wrap my head around wanting to terminate over gender.
    I did hear from a friend that a mutual friend of ours did IVF and selected a girl. The friend made it sound like they did IVF for that sole purpose (they had 2 boys already) but then mentioned the husband had a vasectomy so I'm guessing there was more going on. But, knowing this mutual friend, I wouldn't be surprised if she did it purely for gender selection. I guess if you have the disposable income you can do things like that? I can see doing it (and I don't have a problem with it) if you are already having to do IVF, but choosing IVF when you don't have to? Seems icky.

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