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The Ethics Of Fertility Treatment

14/08/2014 16:49 | Updated 22 May 2015

The ethics of fertility treatment

I got into a very interesting discussion about IVF recently. It was all sparked off by an article in The Guardian about selectively reducing twin pregnancies that resulted from fertility treatment.

It's another example of how modern fertility treatments like IVF lead to interesting moral questions that we don't know how to react to. It begins when you sit in the consultant's office to hear the words, "The only way you'll be able to have children is to undergo IVF treatment".

Should you have the treatment? Should you go against fate like that? How will your body cope with the unnatural things you're going to have to do with it? If you are fortunate to have a treatment cycle which results in more than one viable embryo there is then the big question – how many do you implant? And this is where you start playing the statistics. Implanting more embryos increases your chances of a successful pregnancy, but also obviously increases your chance of a multiple birth. So what do you do?

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Speaking from personal experience, I was prepared to do pretty much anything for the chance of a child of my own.

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I took herbal supplements, nearly drove myself mad charting my Basal body temperature, had acupuncture treatments, gave up caffeine, alchohol, all sorts.

When we were told our only chance was not only IVF, but ICSI (where a single sperm is injected into a single egg to fertilise it), I knew we were going to go ahead with the treatment. Thankfully, so did the geekdaddy.

We used our savings to pay to have the treatment done privately, and therefore quicker, as neither of us was getting any younger. I got over the mental barrier of stabbing myself with a needle, and administered the daily doses of hormones.

I became a hormonal wreck, the main result of which was that I seemed to spend an awful lot of time crying all over my boss at work. Luckily she was the understanding sort, and just got into the habit of grabbing the box of tissues off her desk whenever we had a one to one meeting!

Finally, egg collection day arrived. As I came round from my sedation I was told the good news – 11 eggs harvested. They were stuck into a small fridge, and then the geekdaddy headed off in the car with my precious eggs whilst I recovered. The collection was undertaken at our local hospital, but the embryology work was done at Liverpool Women's Hospital, so the geekdaddy had to head up there to deliver my eggs and his "contribution".

The next day, a phonecall. "9 fertilised". Great! Nine was a good number. There should be a few attempts in there. I frustrated our consultant throughout this first treatment cycle by referring to it as a rehearsal. The fantastic thing you can learn through IVF is whether your eggs and your partner's sperm can come together to produce a viable embryo. No other fertility treatment can tell you that – it's all guesswork.

Me, I like facts, and all I wanted to know out of this first cycle was that we could in principle make babies together! I was already mentally preparing myself for this to take more than one try, and I knew that having "spare" embryos in the freezer would make future cycles easier.

With that many embryos available to us, the hospital froze four immediately, leaving the other 5 to develop. On the third day, implantation day, we had 4 that looked good, and one that wasn't developing as fast as the others.

So, four embryos. We were told they would implant a maximum of two. That was hospital policy. What did we want to do? Take the risk of having twins and implant two in order to have a better chance of one sticking? Again, it seemed like a no brainer. In fact, I think we even joked that as we wanted to have two kids in total, twins wouldn't be so bad and would result in a complete family for one treatment cycle. Despite knowing people with twins who had told us how hard work it was. We were prepared to take the risk. Oh how young and foolish we were!

I had an early scan at 7 weeks. Another "perk" of being treated by the fertility department. One heartbeat. One. What happened to the other embryo? No sign of it. The consultant said it had probably been absorbed back into my womb. There was never any bleeding, never any sign of loss. But it still felt like a small loss, and actually my overwhelming memory of that first scan was not "oh wow, I'm pregnant", but a kind of disappointed "only one then".

Ironically I lost count of the number of times the geekdaddy and I looked at each other during the first 6 months of the geekdaughter's life, when we were struggling to adjust, and said "thank goodness it wasn't twins!" I must say though, if that first scan had shown two heartbeats, I wouldn't have considered any reduction.

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I strongly believe if you don't want multiple kids, don't implant multiple embryos.

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When we decided the time was right to try for a second child, we embarked on the process to undergo a frozen embryo transfer cycle. Thankfully this involved fewer hormones, but it did give us further tricky moral questions.

You see, second time round we were adamant we didn't want twins. Which meant only implanting one embryo. But hospital policy was to defrost in pairs. And although we were told they could be re-frozen if not used, could I really look at two healthy embryos and only implant one? I wasn't sure that I could.

To this day, I don't know the answer to that. Of all the calls I was expecting on thaw day, the one to say neither of the first two had survived the defrost was not it. I gave the instruction to thaw the next two in a bit of a daze – this couldn't be right, surely?

We'd been told on several occasions how good our embryos were, how well we'd done to get a live birth out of our first ever IVF cycle. How well the embryos had developed. "Sometimes they just don't make it" was all the embryologist could say. So we gave the instruction to thaw the next two.

One survived. Four embryos defrosted, only one made it. In the space of one day we'd gone from having 6 embryos in the freezer to having two. Six embryos to me meant at least two cycles. It was my safety net. Two embryos didn't feel like very much. We agreed to allow the single defrosted embryo time to grow overnight, and make the decision the next morning as to whether to defrost any more, or just go with that one.

Morning came. The call came through to say the embryo had grown nicely overnight. To me, that made the decision. Let's give this one a chance. It fits right in with our "we definitely don't want twins" philosophy! We had been planning to allow the embryo(s) to develop in the lab for another day before implantation (there is some evidence that an embryo matured to fives days old is more likely to implant than one matured to the more usual three), but when the decision was made that we wouldn't defrost any further embryos, I had a sudden strong feeling that this one little embryo, my survivor, would be better off back in me than it would in the lab. So we made arrangements to get to Liverpool and do the transfer.

Again we were hugely lucky. A positive pregnancy test after the statutory 14 day wait. A lovely (single) heartbeat at the 7 week scan. An event-free pregnancy, and a healthy baby, the geekson, at the end of it.

I can completely sympathise with couples who do have multiple embryos implanted to increase their chance of success because I've been there. We did it. I've been that person prepared to do anything to increase my chances of success. But at the same time, a word of caution. Don't just play the statistics. Think about the implications of your choices. If you don't want twins, don't have more than one embryo implanted.

Of course this then starts another ethical question – given that each IVF cycle costs money (or if you're being treated by the NHS you only have a small number of cycles funded for you), couples feel the pressure to have a successful cycle even more. And again that means multiple embryos implanted. It's not easy. I am so thankful for my children, who are worth everything we went through to bring them into this world.

Ruth Arnold is a geeky, tech-loving wife and mother of two (aged 5 and 3), trying to juggle working part time with running the home and organising the family. When she gets any spare time she likes to share tech tips and family milestones.

Blogs at: Geek Mummy

Twitter: @geekmummy

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