With Great Power, Comes Great Responsibility

My Colleague had a long standing patient who had three boys and was desperate to have a girl. She scoured the internet and created a particular formula; she would eat a particular diet, they would copulate in a certain position and she requested a prescription for Clomid so she could control exactly when she ovulated. Sure enough, she became pregnant on that occasion, and during her first visit with me, she openly announced that she planned to terminate if the baby were a boy. "So..." I asked my Colleague, "Is it really inappropriate that I am hoping this baby is a girl and that she'll be a total little bitch?" "Not at all." she replied "I've had the same thoughts."

She went on to deliver a healthy baby girl and recently she ran into Co-worker at Whole Foods. "I've been thinking about coming in to talk with [My Colleague] about having another baby!" she announced. (because she needs to ask her permission?) She never made it in for that appointment before she called to report a positive pregnancy test. Apparently, fertility is hers to command.

When my RE called with my PGD results, it never crossed my mind to ask about the gender of the embryos. According to the formula predicted by the XYZ Fertility Centre, it takes 10 eggs to produce 1-2 euploid embryos. I was expecting to have only 2-3 keepers. I would have been devastated if there were none, and very disappointed if there was only one. I never dreamed that my 20 oocytes would yield the upper end of their prediction with four. My most fucked up embryo would have been a female phenotype, Turner's Syndrome with trisomy 1 and trisomy 8. Despite the fact that Turner's Syndrome is highly compatible with life, approximately 90% of 45 X- foetuses will spontaneously miscarry.  

Okay, I admit I am curious to know what the genders could be; I just don't want to actually hear the results. Of course, in my ideal world, all would be female and I'd have four chances to get exactly what I want. How would I feel if we were to learn that they were all male? Would I have less of an incentive to transfer? I don't know. Perhaps, I do know the answer and that's why I never asked the question. Performing a fresh stimming cycle just to obtain a female embryo is simply out of the question.

It's just hard to ignore that this option is available. We signed the consent forms declaring that we did not want to select a particular gender prior to the start of the cycle. At that time, we didn't know if we'd have any embryos progress to the blast and biopsy stage. Yet, it's still not a guarantee. Earlier this year I saw a patient who bore a daughter with her first pregnancy. They really wanted a son, so they travelled to LA to do IVF for the purpose of gender selection. She became pregnant with twin boys after her first transfer, but lost them both at nine weeks. A few months later, she spontaneous conceived -a rainbow baby boy. She was now unintentionally pregnant again, this time with another girl.

If I were to request to transfer a female embryo, and the result were a BFN; my disappointment would contain an additional layer of guilt. Yet, as I have little confidence in embryo grading, selecting based on gender seems as random as any other method. What if we were to exhaust all our female embryos and then succeed after transferring a male? Would that pregnancy feel less desired? However, if our first transfer with an unknown embryo is successful and turns out of be a boy, would I regret not expressing my desire for a girl? I suppose, if that situation were to occur, we could always consider attempting a second transfer if we have any remaining female embryos. Although, this goes against my plans to only have one child and not to have a baby after the age of 40. Of course, my original plans were to not have kids and to never do IVF.

Ultimately, I am hoping that that statistics finally weigh in our favour.  I am primarily referring to the data that shows a 75% implantation rate when an euploid embryo is employed. Yet, while some studies show that traditional IVF produces a higher ratio of males compared to the spontaneous conception population, when ICSI is utilised, there seem to be higher rates of females. I polled our own blogging community. There is definitely a trend toward performing ICSI. In the traditional IVF group there were 5 of 7 boys (71%) and in the ICSI batch, there have been 17 of 20 girls (85%). This does include my second miscarriage. I requested not to know what the gender would have been, and my RE obliged. However,  the lab copied the results to my Primary Care Physician, who divulged that detail. I can't help to wonder if that were my only chance to have a girl.

Of course, the looming question is to ask if that were my last opportunity to have a baby. I am still so skeptical. I am still so dubious that this could actually work. Although, I am convinced that my shitty first cycle produced a tainted batch of embryos; logically, I just can't accept that all four were abnormal. It just doesn't feel that we've gained any ground, except eliminating one aspect of the unknown. We're merely operating under the 'more shit you throw against the wall [uterus], the more that's bound to stick' principle. This is still not mine to command. Not a single aspect; including gender selection.

I'm sure there will be people who will wonder why we didn't indicate our preference. It's an easy question for an outsider to ask, and it's tough to provide a coherent explanation. I suppose it's the remaining detail from our original plan that is still available to us. To learn the gender, not from a piece of paper or an ultrasound image, but during the very first time we hold our baby, if that moment ever comes our way.