IVF, The Nobel Prize, & Sexuality

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Robert Edwards has won the 2010 Nobel Prize in Medicine for his development of in vitro fertilization. The procedure takes one or more eggs from a woman, mates them with sperm in a petri dish outside the body, and then inserts the fertilized egg(s) back into a woman—either the donor or a surrogate—for gestation.

The procedure has been a boon for couples who wish to conceive together but can’t. Its
techniques have also led to scientific advances such as cloning and the creation of human embryonic stem cells.

As human achievements go, IVF is pretty impressive, up there with the discovery of fire, landing on the moon, and right turns on a red light. It represents the extraordinary creativity, imagination, and tenacity that make our species unique. But on a more local, human level, IVF is decidedly a mixed blessing.

IVF typically starts with a drug like Clomiphene (clomid), which stimulates the ovaries to produce eggs. This can lead to multiple ovulation, dramatically increasing the chance of twins and triplets. I beg my patients going through IVF to discuss what they might want to do if they find themselves with 2, 3, or even more potentially viable embryos; physicians can easily do the simple embryo reduction that assures patients will have only one pregnancy at a time.

I typically think this reduction makes sense given the emotional, logistical, and financial turmoil the IVF patient or couple is typically in, but in my experience they rarely want to even discuss it. It’s easy to understand the typical attitude: “We didn’t journey all this way through (in)fertility hell to abort anything, even if it means damaging the future of our relationship or other children with an unwanted multiple birth.” Short-sighted, although understandable.

Like all drugs, clomid has side effects such as nausea and flushing. But one well-known side effect is unpredictable mood swings—and I’ve never known an IVF patient who was adequately prepared for this. In such an emotionally volatile situation, this can push an already fragile relationship or family down a slippery slope from which they may not recover, regardless of the fertility outcome.

IVF costs roughly the annual salary of a 2nd-grade teacher. The price, together with the desperation and irrationality of the customers, creates a consumer purchase that generally requires mortgaging a family’s future—sometimes the very house they live in. When baby Leroy comes into the world, he MAY be entering a home filled with joy, but it may also be filled with anxiety, resentment, and alienation. Welcome to adult life a wee bit early, kid.

The ethics involved in humans seizing control of the creation of life make for interesting debate, apparently reducing half the population to modern-day Amish—drawing the line at “some” technologies simply because they could be dangerous, could undermine precious human values, etc.. It’s good, of course, to be wary of the unintended consequences of any technology, but suspicion and defensiveness about THIS technology strikes me as curious and revealing. There’s rarely a similar level of hesitation or rancor about technologies that prolong life, bring back people from the clinically dead (no Larry King jokes here, please), or transplant crucial parts of animals inside humans. One could easily argue that vaccination, the airplane, eyeglasses, and reading itself fundamentally change our relationship to ourselves and the planet as much as IVF does. None of the above is in any way “natural.”

With dad wanking on schedule to crank out a fresh supply of sperm on demand, and with mom being poked, analyzed, and seen primarily as an egg-laying machine, how sexy does either of them eventually feel? It’s a truism that fertility problems can ruin sex, but if there’s a fertility physician who demands that couples consider this before committing to the process, I haven’t met him or her. Instead, I get couples in the latter stages of fertility treatments when they’ve already damaged their sex lives beyond recognition. Indeed, IVF is one of the few things that can even ruin masturbation.

Finally, we should acknowledge the incredible pressure IVF places on the kid who may be created thereby. True, my parents called me their million-dollar baby—but it was either because I was sooo cute, or because I was so much trouble that they felt entitled to a big bonus when I reached 18.

The IVF-generated kid, however, is expensive in a variety of ways. Various would-be parents will not only have spent their live savings or half their retirement funds. They will have sacrificed vacations, a more comfortable home, a newer and safer car. Beyond money, they will have invested their dreams, will have shown each other their dark sides, will have questioned their own (and their partners’) sanity, and will have experienced a level of desperation, hope, and foxhole bargaining they never thought possible.

And after a year or two or three of treatments, and several months of actual pregnancy, they may be shocked and ashamed of the ambivalence they feel now that they’re on the brink of achieving their heart’s desire.

I’ve never had a patient (male or female) willing to have sex during an IVF-induced pregnancy—it’s always considered too dangerous for the precious cargo. By the time the kid pops out and everyone’s slept two nights in a row, sex is often a distant memory.

At that point, with all due respect to the pain of infertility, generating a satisfying sex life may turn out to be a far more difficult problem to solve than infertility.

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