Monday, 11 August 2014

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.


  1. I think most people have a hidden or not-so-hidden preference for one sex or the other. I really want a boy and if hubby would let me, I'd adopt and specifically request a boy. I wouldn't be surprised if you conceive a boy and you are tempted to try once more for a girl... First& foremost you want a baby. It's only afterwards you start to think about the sex.

  2. I think you have every right to not choose the gender, if that is your preference. You pay enough for testing and procedures, you deserve to do as much as you can the way you and your husband feel is best.

    We recently did PGD testing. Four came back normal. All four are boys. I was sad that my dreams of having a girl were pretty much squashed. It is hard sometimes when I see little girl things and such, but I know when/if that little boy gets here, he will be so loved and perfect for our family! Like the person says above- we just want a baby at this pint!

    For me, I think it is good to know now, so if we do hopefully get pregnant, I'm not in tears when I find out it's not a girl through an ultrasound.

    That woman who would terminate the pregnancy if it wasn't a girl is sick and I wish she never ever was allowed to get pregnant.
    Hopefully your best embryos are girls and this won't be a dilemma for you in the future :) Good luck!

  3. I wouldn't want to choose gender of the embryo--but you are definitely in the minority for not wanting to know until the delivery! The odds are in your favor and I expect you to be expecting soon. XO

  4. I'm always curious to hear about others' reproductive stories. What did they picture happening one day? What did they have to compromise on? What dream did they kiss goodbye?

    We did PGD on our embryos and came back with an even number of both male and female. Before we knew this, DH and I weighed up finding out vs not finding out. There was a part of me that liked the idea of leaving it up to chance, and finding out at the anatomy scan, if we made it that far. DH felt that, with everything else we'd controlled (ours were conceived via egg donation), why let the embryologist decide? I conceded he had a point. I wanted to transfer one of each, anyway. For all sorts of reasons, mainly choosing to not choose, in a way... And that's what we decided to do -- one of each, as long as they were the two best embryos. And that's what happened. Our two best happened to be male and female. Only one made it, and we learned the sex at the anatomy scan. A controlled surprise, if you will.

    I sometimes think it would be a special to learn of the sex at the moment of birth. I just never had that vision when I dreamed about the family I would one day have. That wasn't written into my reproductive story, so I could have gone either way.

    May you find yourself delivering a healthy baby girl in 2015!

  5. I always wanted to try to make any potential pregnancies as normal as possible, and that meant not selecting the gender or knowing what was transferred and waiting until the anatomy scan to find out the gender. Good luck with your decision!

  6. I honestly had not thought about that aspect of PGD. We are supposed to do a cycle in the next few months and embryo bank for PGD and of all of the things I had thought about, that wasn't it!
    If pushed I would like a girl, but ultimately just a baby will do, regardless of gender.
    I know my stepmother desperately wanted a girl, had multiple IVF cycles and at least one miscarriage, but what she ended up with was a boy. I don't think she would change it now.

    Good luck!

  7. As I mentioned on my blog, I was scared shitless of the prospect of either gender so we didn't find out the gender until Izzy was born! We didn't do PGD but only put in one embryo during our transfer so we just transferred the best embryo we had (in the end, we only had two anyway). I think that it's fine to choose the sex or to not choose the sex- it's a personal decision that I don't think that you have to explain to anyone.

  8. This comment has been removed by the author.

  9. The idea of gender selection has intrigued me since before we started our IVF cycle. My husband and I agreed long ago that if we ever got pregnant, we'd wait until that magical moment at birth to know the gender. Love seeing when other people feel similarily!

    Our RE didn't recommend PGD for our first cycle, so we knew we were leaving it up to him and the lab to select the best embryo for transfer. Turns out we only had one to choose from, so fate was indeed in control of the outcome, similarly to how we'd experience with old fashioned natural conception (though technically the lab tech that selected that sperm was ultimately in control). But 'we' didn't pick one or the other, which is part of the beauty that we see in the whole thing.

    I can see the appeal in selecting a gender from the start, especially for people in this community that struggle so hard to have just one child. But it does weigh on my morals a bit, and I know it's something I'd never do myself. Nonetheless, everyone should make whatever choice is best for them. Good for you for sticking with what you feel is best for you.

    Oh and that patient who would have aborted if it wasn't the gender she wanted? Breaks my heart to pieces. I can only imagine your strength you have to have in your line of work, especially for those of us on this side of reality.

    Am hoping and praying your dream will come true in the coming year!

  10. Thanks for another thought provoking post, Jane. I have commented on this topic before, but this debate is interesting to me because I used to think I had a strong gender preference. Going through pregnancy after a loss, it has amazed me how many things are different than I expected them to be, and the gender preference is one of those.

    I really, really wanted a girl and had a girl name picked out that husband and I were both set on. When we found out that we were having a genetically normal boy through our Panorama screening, our primary reaction was simply joy at having a healthy baby. But eventually I did go through the thought process of wondering how I would feel if this is our only baby and we never have a girl (or if we are able to have a second baby who also happens to be a boy). It's funny how your heart, which you think you know so well, can surprise you sometimes, because as the months passed, I fell more and more in love with the idea of having a son, or even two sons one day. I no longer feel a strong desire for a daughter, although I know I would adore her too of course if we had one.

    The amazing thing about love is that it's strong enough to not only change your heart in the present and for the future, but to retroactively alter what you thought you felt and believed and wanted.

    The journey that I bitterly hated now seems beautiful looking back; the son I never knew I longed for is now the center of my world and the strongest desire of my heart. And now that he's mine, it's as though he was always mine, always the one I truly wanted most. Always the only one who was ever meant to be right here, right now.

    I guess all this is to say that when it comes to the gender question, keep an open heart and mind--they just might surprise you :)

  11. I never had a gender preference exactly, but when I imagined myself with a baby, I usually imagined a boy for some reason. I guess I just had to imagine something. When we found out we were having a girl, I had to change my mental picture, but I found that easy to do. Once I got used to the idea of a girl, I would sometimes wonder what it would be like if we found out the U/S tech got it wrong and we were really having a boy. I thought that would make me sad (at least for a while) because now I had started to "know" my baby as a girl. (The latest scan unequivocally showed girl parts). I honestly don't know what I would do if I had the chance to choose the sex of the embryo. Sometimes you don't really know until you are in that position, and one can't judge another's decision. I imagine there are so many feelings involved, and going through IF and fertility treatments brings up feelings you may not have ever known you could. Well, except I do judge that woman who would abort if it wasn't the sex she wanted - that's horrid and I would support mandatory sterilization for anyone who would do such a thing, grrrr. But in my optimistic view, I still think the most important thing - regardless of treatments, assuming they are done ethically - is to love one's children. I believe that love can make everything right. Like Annie said, love can change your heart for the present, future, and even what you thought you believed.

  12. Gender selection is so interesting to me... I never really even THOUGHT about it until recently as I've read some posts of people whose doctor allows them to choose the gender after having down genetic testing on the embryos. My doctors were against this and would only share the gender once I was released from their care (so really only a few weeks earlier than the anatomy scan). I've thought a lot recently about whether or not I'd want to choose and I think I'm still on the side of the fence that wouldn't want to choose... but... wow... that must be a tough decision!

  13. Yup. 2 girls with ICSI. I didn't have enough embryos to do any testing and find out before hand and I'm not sure what I would have done. My preference for a boy or a girl were constantly changing. My husband really wants a boy and I wonder if he would have chosen or left it up to fate if we had the chance.

  14. I think I've said this before - I always wanted a girl. I'm pretty sure I would have been (temporarily) disappointed if we ended up with two boys. But now that we have one of each, I can't help to think what I would have been missing out on if we didn't have our son Ayden! And I wouldn't have even known what I was missing.

    I think it's an amazing decision you made to not find out the sex, even though you had the opportunity. Willpower!!! I want so much for you to get your baby at the end of all this. I want that happy ending for you! Whether that be boy or girl, it will be perfect no matter what. Life has a funny way of happening that way.