Sunday, October 11, 2009

Small Rant (About an NYT Article on Twins)

I read the New York Times online for my news most days. I think their Health articles are especially good and send them to friends often (a habit I am sure they do not enjoy always). Last night an article called "21st Century Babies: The Gift of Life, and its Price" by Stephanie Saul caught my eye. I called my husband over to my laptop and we read it voraciously, both of us indignant at the tone of the article and incredulous over the claims it makes.

The article focuses on twins. More specifically, how IVF can result in twins and how multiple pregnancies are infinitely more risky, and often result in preterm birth. While briefly acknowledging that most twins are completely healthy, there are still risks associated with prematurity. It begins with this:

"Scary. Like aliens. That is how Kerry Mastera remembers her twins, Max and Wes, in the traumatic days after they were born nine weeks early. Machines forced air into the infants’ lungs, pushing their tiny chests up and down in artificial heaves. Tubes delivered nourishment. They were so small her husband’s wedding band fit around an entire baby foot."

After I read that, all I could be was angry. I am quite sure that this woman who had gone through a fertility treatments and a difficult pregnancy did not just think her newborns looked like aliens. I would be she thought they were also the most perfect, desired and loved beings she'd ever seen. And I bet she was extremely grateful for fertility treatments allowing her to become pregnant.

It discusses the irresponsibility of Reproductive Endocrinology and how the "Fertility Doctors" transfer too many embryos to inflate their birth rates and "lure" more customers. It discusses the promising research on Single Embryo Transfers (SET) which are more successful as they are better able to grow embryos to blastocyst stage.

Another major focus is the cost to "society" of preterm infants and how insurers should not have to pay for babies' care conceived via fertility drugs or IVF. It alluded to a national health crisis caused by the cost of caring for babies in the NICU. The article allows for comments, and I read over 100t this morning. Most people wrote something along the lines of "Outrageous! Irresponsible and dangerous industry" or "Just adopt!" as though one could just run out and adopt a child, and not spend many years and many thousands of dollars trying to do just that. Many people wrote horror stories of higher- order multiples, selective reduction and severely disabled twins. A few were more level-headed, and acknowledged the risk of twins but also pointed out that people who underwent fertility treatments were also extremely cautious and well-cared for prenatal patients.

In response to some of these idiotic or ignorant comments, a woman wrote this, and I cheered:

" ... if you, personally, deem care of babies produced via fertility processes just too expensive to pay for, then heck, I guess I'll just deem the exceptoinal costs associated with treating cigarette addicts, overweight diabetics, and any manner of self-inflicted sicknesses out of bounds.

Really, how selfish to continue with your unhealthy and costly habits when you could just adopt an apple."

Go give this article a read, and leave the editors a comment letting them know what you think. Apparently, this article is first in a series and I really hope the Times has something better in store for the remainder.


  1. I find it hard to read news articles and watch news reports on TV because of things like this. The fact that you really only hear one side of the story is really disheartening. News reporting is all about the "drama" - the more emotional (positive or negative), the better - and this just serves to give people a warped view of something they may not know much about. It's Sad.

  2. wow. I cant read things like that without getting mad and I am not even in the throws of infertility. I cant imagine the response these articles get from those who have had to undergo fertility treatments and were blessed with children because of it. You cant place a price on a child. Plain and simple. Thanks for the article link.

  3. Yes, my DH and I read this article in the morning! Just like you said, I am normally all praises for NYT articles, they are "normally" well balanced and informative. I was furious about the bias! It's sad how the media portrays this industry and science!

  4. Thanks for sharing!! Those kinds of articles-- the comments especially-- infuriate me. ... I just tried to type a long response to articulate my reaction to the article, but I couldn't get it right. All I can say-- and I know I'm sounding like a 5 year old-- is that people JUST DON'T GET IT until they are in the same situation. It's easy to cast judgement until you find yourself in the shoes of someone going through it.

    PS Glad your beautiful boys are doing wonderfully. I'm saying silent prayers for you every day and hope that the next 2 weeks go fast and uneventfully!!!

  5. First, I'm so very glad for you and your family to have made the 32 week mark. Nice work! I know is hasn't been easy. I look forward to you hitting your magic c-section date in a few weeks.

    Hmm. This article is a tough one. Honestly?
    I don't think the article was terrible. (but the reader comments, as usual, were mostly made by the seemingly ignorant and uninformed.) Maybe this sort-of negative article was needed to counteract the unrealistic ideas our society has about twins/triplets/multiples. It's a very scary business and many people don't fully understand the risks both short and long term.

    I, however, am as biased as you are! I am currently (and very thankfully) 19 weeks pregnant with a normal healthy pregnancy after IVF. It has been a terribly long road. My husband and I discussed for weeks if we would transfer 1 or 2 embryos. On transfer day we met with the RE proir to the procedure and she suggested the transfer of 3. We were surprised, but assumed that folowing the protocol was the right things to do. The result? Triplet pregnancy. After much research and tears like I've never cried before, my husband and I decided that the risks associated (some as noted in the article-some not even mentioned) with higher-order multiples were not something we were willing to live with. We chose selective reduction (some would call abortion-to each his own) at 12 weeks. It was absolutely terrible and one of the worst days of my life. I'm certain that I made the right decision for my family and me, as you, Carrie, have made for yours.

    I suppose I'm saying that it was refreshing to see an article that gave human faces to the very grim statistics that I read so much about. And, maybe it will help others make better choices than I on transfer day.

    I'm so happy that you and your boys seem to be well past the dangerous part of your journey. Continued best wishes to you all. p on the east coast

  6. Hi. I've been following your blog for a few months now and I think I've probably commnented in the past but I'm really not sure of that. Congrats on your pregnancy and getting so far! You are doing awesome. I anxiously await your updates to see how you and those 3 boys are doing.

    I do have to chime in on this article. I agree with Anonymous above. I think the more articles like this that get out there the better (I will say that I didn't read any comments on the article). I have twins myself. Born at 30 weeks. They spent 8 weeks and 1 day in the hospital. That was the absolute worst 8 weeks of my life...well until Baby B was diagnosed with Cerebral Palsy one week after his 1st birthday.

    Most people just don't get the risks and complications that twins or higher order multiples bring. So many people say "I wish I had twins". Or something even worse like "I'm going to pretend I have fertility problems so I can get fertility drugs to increase my chances of having twins". These make me want to scream.

    I wish I could have had my Ben and my Daniel at a time. I could have enjoyed each of them on their own and hopefully would have had 2 full-term pregnancies.

    I usually think your posts are great and enjoy reading them. But in this case, I have to disagree with you.

    Good luck with the rest of your pregnancy...keep those babies cookin'! Looking forward to your next update.

    Mom of 2 year old twin boys, born 30 weeks 2 days

  7. Wow, not sure I want to read that will no doubt infuriate me! What a miracle that you have carried triplets for this long. Truly wonderful.

  8. I have not read the article yet but want you to know that nothing you have done is wrong. I have a son who was a SINGLE pregnancy who was born at 29 wks 1 day. His 1st birthday is Oct 26th (hopefully your boys' birthday). Should I have had an abortion so that he wouldnt be a burden to society. NO! IVF helps those good people like you who cant get pregnant its just a formality.

    Take care of yourself and those boys! Dont worry about those in society who have too much time on there hands to ponder such ridiculous things.

  9. First, wanted to say I made pumpkin cookies from your recipe today and they are mmm, mmm good.

    Also, I find that the best way to raise my blood pressure is to read the comments that people leave on any newspaper article I care about. People are idiots, on any topic. And anything around infertility brings out the knee-jerk patrol who are waiting to say "if you can't have a baby the 'natural' way then God doesn't want you to reproduce" etc.

    BTW I transferred two and one stuck. Although we made the decision of how many to transfer after a lot of hard thought, I don't think I would transfer two again. I had no clue how hard pregnancy with ONE would be (for me). Not that I think you should wish you got my outcome, don't get me wrong...

  10. Generally, the articles on ART by people who haven't experienced infertility are not balanced. They are not fair portrayals of people struggling to grow their family. Duh. But I have also noticed on several infertility blogs the...I'll call it naivete, by certain people who have experienced infertility and the pain associated with it "wishing for twins." And frankly, that sort of irks me, for lack of a better term.

    I have to agree with Caryanne and anon. I've written about this before in someone else's comments section and have even go so far as to mentally bookmark blogs that I've noticed put an emphasis on wanting twins, so I can avoid them in the future. I get the feeling from the tone of certain blogs and certain writers that's it's not about having a genetic connection to your embyos (I read a blogger who talked incessantly during a 2ww about her desire for twins. I thought 'okay, she is connected with her two embryos.' woman discovers she is pregnant with identical twins and is thrilled. No mention of the lost embryo, just the fact that she was having twins was what she wanted), it's not about a "one and done" pregnancy because many of these women want more than 2 children (and have every right to have as many as they want), but something about the "allure" of twins and triplets gets inside many minds. My theory is that years of trying, years of having friends and family have babies, get to make announcements and even getting lapped 2 and 3 times, that some (emphasis on SOME) women who suffer from infertility see not only having that one child but having twins or triplets as a sort of ultimate 'prize' or blessing! Two babies! How exciting! Everybody they know may have a baby, and they may be the last ones, but they are having twins and twins are just "so cool."

    The ideal use of ART is to help people struggling with fertility issues to add to their families ONE baby at a time. And I realize that many times, based on different circumstances that 2, 3 and more babies can result from this great technology. But I won't pretend it doesn't sadden me to see when bloggers write in various posts "please let it be twins!!!!!!" and some expressing profound disappointment when it's not, without a hint of acknowledgment regarding the possible complications. I also realize that finances may be a big factor in the desire for twins as ART is expensive and healthcare and insurance is undoubtedly broken in this country. People who would normally be thrilled with one baby at a time may have a heightened desire for multiples when the number of chances they have to get pregnant with ART is limited. If one only has 1 or 2 chances at IUI or IVF, I can understand the inclination to want, what some people call, a two for one deal. But I still ache when I see the "I want twins" blogs. Especially as studies have shown that multiples born as the result of ART are more likely to be born via c-section, have lower birth weights and lower gestational ages than spontaneously conceived multiples.

    Sorry this was so long and turned into a mini rant. I am all about the joy ART can bring to people, but I am passionate about healthy babies and well informed decisions instead of blind lust for twins (which I don't mean to sounds harsh and haven't ever gotten that sense from you).

    I am thrilled that you've made it this far and have really enjoyed reading your writing. I wish you the best of luck and happy, healthy babies and a happy, healthy mama!

  11. Really interesting article, Carrie, and really interesting comments. I too think there are way too many women out there who idealize having twins. There are REAL risks to the mom and the babies. However, as someone pregnant with twins from infertility treatments myself, I understand how multiples happens even when you are being responsible. I had one son from my first battle with IF, and we even reduced the strength of the meds this time, and still ended up with twins! Not everyone is careless like Octomom or Jon & Kate, but unfortunately, that's how we get painted.

    One thing that is ALWAYS true: mass numbers of idiots flock to online news stories to spout the most ridiculous, ill-informed comments EVER.

  12. When I did my brief undergrad stint in neonatal paeds, I heard an interesting turn around on the cost of preemies argument.

    Spending the majority of health dollars ont eh beginning of a life generates a healthy adult who works and pays TAXES.

    Currently, we spend the great majority of health expenditure on the other end of life. Purely economically speaking, it's less logical. Emotionally, more complex of course, especially since most of us raised in the first world never really expect to die of anything.

    Regardless of that argument, mutiple pregnancies are higher risk and SET is a reasonable thing to do. But when it costs so much to get to that point it's understandable why many of us do not. I've written articles on the risks of multiple gestation and how IVF works, and I transferred more than one embryo when it came down to brass tacks. I have twins.


  13. I'm apalled at how judgmental people are, especially some of the commenters on your blog who have experienced infertility firsthand.

    Although I agree that one baby at a time is the ideal, and I certainly don't minimize the risks associated with high order multiples or the costs associated with preterm birth, it's nobody's business to judge.

    And yes, Anonymous, my triplets are the ultimate blessing!

  14. I swear... I'm a twin and I now have fertility problems probably leading towards IVF. Now, IDEALLY I don't want twins myself. I was premature and had lots of problems. HOWEVER, its a reality that can happen and in my darn luck due to pure genetics along with IVF. They could put back one embryo and have it split. This to me is ALL THE MORE REASON for insurance coverage. I'm all for single embryo transfer, but financially its not realistic. I just love the people who say "maybe you were not meant to have children." OK.. so the women who have FIVE childre by FIVE different fathers and all the children are drug babies who are paid for by the GOVERNMENT should have children and NOT me!!! I don't think so. I'm so glad that those people are all knowing and all mighty enough to think that THEY are able to procreate so easily so that others must suffer. Those that scream "adopt" should do so themselves and go through the hoops and expense.

  15. I think things like this stem from Octo mom! Everyone would probably agree that HER doctor was a bit "Off" to say the least when she already had 6 other kids at home, was a single mother, and very obviously has mental issues. However, she is just ONE case that has caught the media's attention and has gotten WAY over exposed. I know of SEVERAL sets of twins and even 2 sets of triplets who are perfectly healthy and don't cost any more than the rest of our singleton babies! And, if someone wants to complain about paying too much for health care, who is complaining about the Duggars and their 18 (and one on the way) children!? I am not complaining about them but it just seems that people who are going to have 19 children are probably costing the healthcare system MORE than a few sets of twins! The person who wrote this article VERY obviously did NOT suffer from infertility NOR do they know the pain that comes with it!

  16. I am a "lurker" that has been reading your blog for awhile that has come out of the woodwork to comment :) And also say a huge congrats on getting to this amazing milestone with triplets!

    We have severe male factor and our 8 month old son was conceived through IVF/ICSI. We are now pregnant again with baby #2 (it is still very early though.)

    I was surprised when my husband showed me this article yesterday and I said,"I read that couple's blog!" I headed over there and saw the link to the article and video, etc.

    From what Kerry posted today, she is a bit disappointed the direction the article took. She thought it was going to be about their twins and another set that were born premature, as well as their IVF journey and link to their blog. But she saw how the article somewhat "dissed" infertiles seeking treatment (her words) and read the comments which I think were really hurtful to those of us dealing with IF (one said her twins never should have been born.)

    Too bad I didn't realize the comments were closed when I submitted my 1500 word rant lol...

    Anyway, I think SET should be covered and more people would have oppertunities to use them. BUT as usual, the decision falls on us because we are paying thousands out of pocket for a chance at a dream.

    Again, Carrie, singelton, twins, triplets, doesn't matter. You were faced with a tough situation and chose to make the best decision for you. I am so very happy for you and admire your strength it takes to bring these boys into the world.


  17. I think I better not read the rest of that article...I have enough worries! Thanks for your comment on my blog, you give me so much hope, and if I can make it to 32 weeks I will breath a huge sigh of relief. Actually Thanksgiving day I will be 30 weeks exactly, you can imagine how thankful I will be. Question...when did you start steroid injections? I have an appointment tomorrow so that is on my "list." As you can tell, I'm a worrier too! Also, did you use progesterone? I have heard of some using the suppositories to help the cervix, but my doctor has not mentioned it.

  18. This stuff gets me SUPER heated! I think, in the long run...we must not judge what we would do in a situation until we are faced with it. I also had a singleton pregnancy that resulted in premature labor at 24 weeks(though I carried him to 36 weeks). In TTC #2, when faced with my premature ovarian failure, we opted to go straight to IVF and skip IUI with injectibles, due to the less 'controllable' number of eggs fertilized with IUI. Before starting IVF, I was thoroughly examined to make sure there were no 'physical defects' that would've contributed to my PTL, and my RE even made sure my uterus was 'big enough for two' if necessary. We paid out of pocket for our entire IVF...and could only afford one cycle. Under the recommendation of my RE, we transferred two embryos due to my age and presumed poor egg quality (only had 5 fertilize out of 11). To our ENORMOUS surprise, I became pregnant with twins. It is very scary, knowing I'm high risk for PTL. But knowing what I knew then, I don't think I would've done anything different.

    I REALLY do hope that insurance would cover SET cycles. I think that would've made the difference for me. But now I'm just doing the best I can to get these twins healthy to term!

  19. Thanks for writing about this. I read this article yesterday and couldn't quite articulate why it made me so mad - I'm glad someone did!

  20. I made the huge, huge mistake of reading the online comments yesterday morning on that article. Painful. I agree that the article itself was uneven at best - but the truth is, I just don't have the heart to fight that stuff anymore. I'm glad others are ready to, though.

    Interesting how many anonymous comments popped up on this post!

  21. I'm anon 7:00p.m. I didn't want anyone thinking I was hiding behind "Anonymous" but I don't have a google (yep, still using 'fantastic' AOL after more than a decade) or wordpress, etc. I just forgot to leave my name and I'm surprisingly non-bloggy for a late 20-something. I could leave my facebook account, but I think that might be weird.


  22. I am still dumbfounded at how many people come out to post in comments on news articles. I mean, the comments that are vicious and mean. I just don't get it.

    Anyways, we are working through the foster system. Women on their 9th child, drug addicted and taken away at birth. In the system forever, costing tax payers tons of money. But it is within their right to continue on giving birth (whole other bag of worms). My point is, those of us who go through ART, most of us, we recognize the risk and the expense and we move forward in an educated manner. And as one person posted above, these children tend to become tax payers in their own time.

    That being said, I too click away or mentally note blogs where women are romantisizing about multiples without ever thinking about the risks. I enjoy your blog for the simple reason that you never have done that. I follow your journey because you are what happens sometimes in ART and your struggle to bring these boys home as safe and healthy as possible helps keep things in perspective.

  23. Hi. Caryanne here again. I just wanted to pop back in to clarify a few things.

    Carrie - I never meant my words to be an attack on you (or anyone else for that matter). I don't think you took them that way but I just wanted to make sure. You seem to be an amazing mom and I anxiously await the arrival of your boys (although hopefully not for a few more weeks).

    I have never struggled with infertility. I am pretty certain that if I had and had to deal with the cost of IVF that I would have transferred at least 2 embryos. I am a strong believer in insurance coverage for SETs. I think this is the best course for all involved. However, I will say this again. If i was faced with the decision on how many to transfer and it was my buck that was paying for it, I am pretty certain that I'd be transferring more than one.

    The problem that I have is the "romance of having twins". There is nothing that gets me more heated up than that. So when I see articles like this one, I cheer. I really do. I feel the masses need to be educated about the risks and potential complications of multiple births. I was once a part of that uneducated mass...but I got educated real quick...when my boys arrived a whole 10 weeks too soon. Ben ended up on a ventilator due to 2 collapsed lungs. They both had brain bleeds, multiple blood transfusion and infections. They were in the hospital for 57 days. Then just when I thought things were going OK, we started to realize that Ben was really delayed developmentally...and this eventually led to a Cerebral Palsy diagnosis.

    It's interested what "heats" people up. For those dealing with infertility, articles like this can set them off. For someone like me, who is experiencing the risks firsthand, it's comments like "I always wanted twins".

    Thanks again for posting this. I'm enjoying reading the comments and everyone's reactions to it.

  24. I guess I should STOP paying taxes that pay for women who bear children with drug addictted babies. Such biases in this article I could JUST scream. They JUST DON'T GET IT!!!! In all fairness, they never will and they don't realize what an amazing luxury that is. They are doing ANOTHER story today on IUIs. The responses are JUST as cruel. I remember the days before I was diagnosed that I would think "I would NEVER do IVF." Just the process overwhelmed me. The whole thoughf of it was too much. Now, faced with it I KNOW I can. I use to think "Well, if they beleived in God they wouldn't NEED fertility treatments." That frame of mind is out there and very rampant. It only took a few months for me to quickly and very humbly change my opinion.

  25. I read that article and commented on it ... 3 times, I got so irritated (mostly, but not exclusively, by many of the comments). The first comment I left is the first one listed as "selected by the editors." Actually, one of my complaints was the focus on IVF to the exclusion of IUI (as a source of multiple pregnancies), and I was, I'll admit it, pleased to see that the paper has posted another article addressing IUI.

    I too agree that there were problems with that article (and there were also problems with the IUI article that followed). And, yes, 60% of the comments were horribly offensive (the last comment I left on that NYT article pointed out that the two most frequent remarks seem to be in the vein of "infertiles aren't meant to be parents" and "you should just adopt" ... um, logical consistency? Anyone?

    But honestly? I agree with the basic premise and am glad it is being written about (especially now that the IUI article is part of the, and I use the word optimistically, dialogue). I mean no offense whatsoever to you, or to your triplets, whom I hope will continue to grow healthily inside you for a number of weeks. And I certainly don't imagine that ART is the source of all premies, or of all high-risk pregnancies or babies with health problems. Moreover, I absolutely and fully support providing the best quality of medical care to pregnant women and developing infants, as well as post-partum women and neonates, whatever their origins or circumstances. Octomom included.

    But ... there is a standard REs should be held to, and it is this ... singleton pregnancies. Any treatment that leads to anything else should be judged as less successful. I put it in my (first) comment on the NYT, writing about the decisions I made when cycling and I'll say it here ... in my judgment, there are worse outcomes than never becoming pregnant. You'll note the qualifier; I don't presume to judge for you. Still, maternal and infant mortality are horrible, and real, risks, whenever they occur, and they occur more frequently with twins and higher-order pregnancies.

    I deeply hope that you won't experience anything more alarming or unpleasant than you already have, and honestly as far along as your pregnancy has come I know your prospects -- ALL of your prospects, you and your babies -- are really quite good. But it's clear from reading your early posts when you had just learned you were expecting triplets that you were well aware of the risks and concerned, as I imagine anyone with that awareness would be (and as you yourself noted, you are better positioned than many would be to welcome triplets into your lives). I hope and trust that your triplets will thrive and bring you vast amounts of joy, but I do think we infertiles ... those most affected by the practice of ART ... do no one any favors by ignoring or downplaying the risks of the pregnancies-with-multiples that disproportionate numbers of us assume.

  26. While I agree that some REs are irresponsible (Octomom, anyone???), I think the majority of them understand the risks associated with fertility treatments and do their best to minimize them. Our RE will not trigger an IUI with more than 3 follicles and prefers to do only 2. (She will do 3 if one looks less developed, but you are well informed of the chance that the third could release a mature egg and know, going in, that triplets are possible). Same thing with transfers. She transfers 2 and, on occasion 3, embryos. She doesnt want you to have multiple babies because of the risks and doesnt want to be famous because her patient got pregnant with higher order multiples.

    What pisses me off is that, yes, multiples increase preterm labor, but so do countless other things. My IC has NOTHING to do with carrying more than one baby. Does that mean that my singleton who will have to go to the NICU (because, honestly, even with a single pregnancy, I'd probably have PTL)is less of a drain on society? No, of course not.

    While we dont have a national health plan, I pay premiums so that my babies can have the best medical care, both in the womb and outside of it, no matter how early they are born. (And I've seen several full term infants in the NICU over the last month. Should we not care for them because of how expensive it is? Because their parents maybe werent as diligent in prenatal care or because the baby was born with an issue of some sort?) In a national system, the idea is to care for ALL people, regardless of issue, so that would mean any problem someone developed as an adult or the prematurity issues of a baby born early.

    I agree with the comment you posted. Here here for that woman and her "adopt an apple" comment.

    Aliens. What a jerk of a comment. Babies are perfect and beautiful, no matter when they are born.

  27. I'm glad that people are aknowledging that twins are riskier than a singleton pregnancy. While I was pregnant with my twins (fertility treatments & IUI), people kept expecting me to be like all those supermoms, working out, running around, working til' the end. I didn't. I took vitamins, tried to eat healthy and did very little else besides gestate. My twins were born at 36 1/2 weeks, at 5 and 6 pounds, with no time spent in the NICU. I too am getting sick of these Anti-Fertility articles - we are not all Octomom. She's shocking because she is so outside the norm. Also, Just Adopt is one of the cruelest thing to say to someone who is trying to have a family. It isn't easy on one who is trying to concieve or one who is trying to adopt, because it implies a simplicity and ease that just isn't accurate.

  28. I hear you sister! I ranted about it as well. Great blog. Keep writing. Michele