Month: March 2022

P:  Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from? 

 

Nicole: Yeah, I’m Nicole graves Lipson, and I live right outside of Boston in Brookline, Massachusetts. 

 

P: Nice. Lovely. So sometimes in thinking about the families we create, it’s useful to think about the families we’ve come from. So Nicole, do you have any siblings? 

 

N: I do I have one brother. Yeah. 

 

P: And growing up to do you think I’m definitely having a family or I want to recreate this or

 

N: I always knew that I wanted to have a family and have children. I don’t think it was in a intense active way. But when I envisioned my future, family and children were always in it. 

 

P: Okay. Let’s get to the family then. Do you have two kids? 

 

N: I have Three, 

 

P: three kids. Okay. Yes. So was it easy to get pregnant? 

 

N: It was not at all easy to get pregnant. My husband and I were married for six years before we had our first child. I had assumed as I think a lot of women assume but it would once we decided to have a child that would be in a year, year and a half. or so before we would get pregnant at the most. And that did not pan out. And so we pretty quickly realized that we needed to turn to fertility treatments and assisted reproduction to help us out with our first 

 

P: so let me ask you about that before we get into that even more. We needed help as well. And I found that kind of shocking and awkward. And you know, once you invite more people into the process of creating a baby, it’s just it’s just not what we were kind of fed growing up. Right. That’s not your image of baby making. Were you equally kind of taken aback by that or did you just you thought this is Thank God this is here. 

 

N: I was taken aback by it. I think I think what was hard for me about it wasn’t so much that there was a stigma around it or anything like this. It was the feeling that for so many things in my life as a kind of driven, ambitious person. I’ve been able to control outcomes. If I worked hard enough, if I focused I could make a lot of the things that I wanted to happen happen. And it was hard for me to come to terms with the fact that there was nothing that my brain could do to help my husband and I create a baby. 

 

P: Oh, totally. And we briefly talked before we started taping about uncertainty. I have the exact same mindset and I thought well, I will just work super hard to make it happen. Yeah, that’s how it works. Right? Although I have come to reflect on that idea as naive. And maybe my sense of my control over all those things was less complete than I thought it was in the moment. 

 

N: Yeah, I think it’s really hard. To let go of that tendency. 

 

P: Yeah, 

 

N: I would still think about it all the time while I was going through the process, not only because there are elements of it that just make it very consuming, whether it’s yourself medications, or things like this, but I think I still had that feeling of if I put brainpower to this you know, if I think about it enough, you know, if I read enough online forums, you know if I know enough about this, if I do the process well enough meaning, you know if I give myself that injection, not at the no one at night or similar 659 But exactly at seven o’clock so I think it is really hard to give give up that control. Another that you’re doing in assisted reproduction. You are you are handing over control of this process to to medicine 

 

P: to someone else, right. You’re giving me a flashback of our I remember myself in a room practicing the injections on an orange did you have to do that? 

 

N: Oh, sounds actually familiar. And now that you know, you say it, I might have done that as well. A universal thing? 

 

P: Yeah, yeah. Okay, so So you realize you need help and what does that look like and how does that go? 

 

N: Doing some research and finding out you know, different well regarded fertility clinics here in my area that are many in the Boston area? 

 

P: Yeah. 

 

N: And so we were lucky in that regard, and then having a consultation with a couple people and going with the doctor who we felt comfortable with and and who we felt we would have a good shot with. 

 

P: you Did IVF right?

 

N:  Wasn’t that your before our first child? We did IUI. We did three rounds of uterine insemination and the third was successful. That’s it. 

 

P: That’s what I did you and that’s pretty gentle in terms of art, right? I imagined that I’d walk in there and they’d have like a turkey baster. Which is how they’re filling you with with the materials of life. 

 

N: Yeah. I think the hardest part of that experience for me was that on one of the inseminations there was like a good teaching hospital that I did. There were like, six residents in the room. Like one of them actually did the procedure and I was like, I’m not so sure about this. There you go again, with right like handing over control. 

 

P: Yes and uncertainty. For sure. I’ve definitely been in the teaching hospital setting where I’ve thought I mean, I should just sell tickets. I feel like I’m getting used here. So the first one is a success and how is that pregnancy 

 

N: that pregnancy we might end up working? We might end up going off on a tangent here at that pregnancy, with the exception of nausea. I was nauseous at the beginning of all of my pregnancies was wonderful until week. 28. I want to say when I went in for a routine ultrasound, and it was determined that my cervix was shortening which you might know means often that you’re near labor, put on immediate bedrest, so as I’m bedrest for you know, modified bed rest at home for many weeks until I got to be in my you know, 30 Something pregnant and 36 weeks pregnant or something like this and nothing had changed in my cervix and my my OB was like, this just must be your body’s physiology. And so I ended up being induced at 40 weeks after all of that. Oh, I think you’ve got you’ve talked about the rest of the show. I mean, that’s a whole other. 

 

P: It’s useful to know it’s so widespread.

 

N: It’s so widespread. I mean, I wrote about this in one of my other pieces, actually, I think that the turning to that as an option. is not something that would happen if men gave birth. I was the head of the English department at my school and I, one day I was the head of the department the next day, I was on my couch and you know, like 

 

P; crazy. 

 

N: Yeah, there’s a lot there. Like the assumption is is that somebody else is managing the finances somebody else is able to provide if there’s other children, you know, it’s yeah, there’s a lot a lot. 

 

P: that’s crazy. So you bed rest for a while and then how’s the delivery? 

 

N: That was all great. I agreed. 

 

P: Okay, good. So then how long between the first and the second? So I started to try to get pregnant again. I’m born with a second child like two years apart. That was our ideal. So I started to try to get pregnant in probably when my my first child was like 18 months or so. And, you know, I think we tried naturally for a while and but we didn’t want that to go on too long. And then we sort of marched through the different levels of intervention, right? So first, we did Clomid, and then we did IUI and eventually our fertility doctors suggested it was probably time to move on to IVF for this one. So that is what we did. Yeah.

 

P: and IVF is an entire project as I understand it. 

 

N: Yeah, at the beginning, it’s quite like IUI what you went through where you are injecting yourself with a follicle stimulating hormone over a series of weeks and then so you have to go into the clinic for regular ultrasounds to measure the size of the follicles, the egg follicles and how they’re growing and get regular blood tests to measure your estradiol levels. And so it is involved in the sense that you are making regular visits to your clinic or hospital for these interventions. 

 

And then it’s just obviously a lot of mental, a lot of mental energy. A lot is hinging during those weeks on, you know, the the call you get from the nurse at the clinic in the afternoon telling you how the follicles are growing or how many there are. I think the thing about the IVF process or or or really any intervention, fertility intervention I think is how it takes up so much space in your brain when you are going through it. I think that’s, to me that was harder than the actual injection of the shots or, or all of this it was how the sort of fixation on how things were going, how things were going to turn out sort of eclipsed the other things going on in my life at that time. That was hard.

 

P: Well, you are given a window into how intricate and complicated this process actually is. Because if you don’t get pregnant just by having sex one night then then that process is broken down into 45 separate steps where now you have all these other things to focus on and will the cells divide and what will they look like and you are being forced to examine and focus on all these details that you otherwise took for granted? What does not agree it seems understandable if that’s how it would go I remember waiting for the call. And when I was waiting for the call, I guess it was on like the edge of cell phones. So not everyone had a cell phone so you had to be home. 

 

N: Right? 

 

P: impossible to imagine. Now I can totally relate to how hard each and every step is, especially as we talked about with your interest in controlling things that you’ve previously controlled in. Your life and now it’s in someone else’s hands and I’m not sure about you, but I felt really responsible for all my numbers. Like all these numbers are being produced by my body even though I can’t do anything to change the FSH control 

 

N: that really resonates with me what you just said and I think there’s so much about fertility and childbirth and motherhood, especially early motherhood. For me there were so many things about it that made me feel for the first time that my body’s involuntary functionings were reflection of one moral character in some way like you know whether or not you can produce a baby easily whether or not you can breastfeed, right? No woman has any choice over whether or not breastfeeding comes easily for her or not. And yet in our culture, there seems to be such like a value just to health value placed on breastfeeding your infant but almost a moral value right and so it becomes this like morally laden thing. Can my breast produce breast milk for my child can I can I create a wonderful latch you know, between my child and me, these involuntary functionings that we don’t think about otherwise suddenly carry this moral ethical weight. 

 

P; yeah, those feelings are totally familiar, but it sounds like in this case the IVF works. 

 

N: the IVF works. Yes. And the first the first round of IVF work so we were very lucky in that regard. Yeah. 

 

P: And then the leash gets longer after the first trimester because now you’re freed from the fertility people. 

 

N: Yeah, absolutely freed from the fertility people. And just regular pregnant woman at this point. Yeah. 

 

P: how does that pregnancy go. 

 

N: Hey, I really loved being pregnant. I loved being pregnant. All three times that I eventually ended up pregnant. 

 

P: I’m glad that went smoothly. I read a piece that you wrote. It’s called 

 

N: very nice blastocyst, 

 

P: a very nice, very nice blastocyst. Is that with reference to the third pregnancy? Or where’s that in the lineup? 

 

N: That’s reference to the second pregnancy. 

 

P: Okay. So let’s talk about that because that was a beautiful piece that you wrote, In case and in it, you’re sort of contemplating what to do with the other embryos, right? 

 

N: Right. So what happened in that IVF cycle? 

 

P: To give a little background on a typical IVF cycle, I got in touch with a reproductive endocrinologist today, we are lucky enough to have Dr. Tanya Glenn a reproductive endocrinologist from Yale on you have a clinical practice and you’re an instructor at Yale as well. Is that right?

 

Dr. Glenn: clinical instructor The third year fellow, so I’m still in training, and we’ll be graduating in about four months.

 

P: Oh, exciting. Congratulations. Thank you. Thanks so much for coming on the show. Can you give us a quick walk through what the process is? Just so people who have you know exactly what’s happening

 

Dr. Glenn: so to IVF is when patients will take their medication determines what that means is there are natural hormones where your brain tells your ovaries each month and a patient that’s having regular monthly cycles to grow an egg, and usually our bodies when they can, okay. And in this case, we take over that brain to ovary signal by giving them hormones that they take through an injection. And this instead of just saying grow one egg, I’m telling the body girl lots of eggs. And then when they get enough large eggs, we call them follicles at that point because eggs are microscopic so I can’t see eggs themselves by say I see the home that they live in. And as the egg gets more mature, the home gets bigger. And so once that follicle gets to a certain size, we give them what we call a trigger shot. This kind of mimics our body’s natural hormone rush that causes the body to ovulate or release the egg then approximately 36 hours later, we do a procedure called an egg retrieval that includes a transvaginal ultrasound with a little needle in the end, or we actually go into the ovary and suck out the follicles or the eggs under ultrasound guidance. We would then give those eggs to the embryology lab. And let’s say someone is has a male partner or using donor sperm. And in that case, we would expose the eggs to the sperm. And then you know, watch them fertilize in the lab and then usually grow them to day five, sometimes day three if they’re lesser quality. At that point at day five, they’re called a blastocyst and a blastocyst can either be transferred back to a patient she desires to get pregnant in that cycle, or we freeze everything? And especially with patients who have let’s say a couple like they don’t just have one embryo they have five or six that say they want one place back but now with these other five, they’re going to freeze them. It’s called process called vitrification, which is Latin for making glass and they can transfer them in another cycle. And the purpose of that too, is that we know even for patients with you know less than 35 so peak fertility is actually in the mid 20s. But we can really see it go down at 35. And so even patients younger than 35, we only see about a 55% chance for live birth each time that you place an embryo back, so it’s not 100%. So it’s nice to have those I say something reserved in the bank. And so we know that the live birth rate after about three embryo transfers one each time is about 90%

 

N: I think I had 14 eggs that were extracted at the end of that cycle, maybe five or six fertilized normally and the doctors picked the very best two and this is interesting. I learned that embryos are graded like diamonds, it’s a similar grading system that diamonds have like clarity color. There’s a very similar grading system for embryos and so I from us process we had two beautiful sparkling high quality diamond embryos and so two of those were been implanted in my uterus and and that’s determined based on your your age and an algorithm you know, how old are you? How likely are you to have multiple babies? I would have welcomed twins if that had happened but it did not only one of the embryos implanted and that embryo turned into my son, who is now eight. 

 

P: That’s sort of amazing and you’re talking about feeling judged based on what your body does and but you’re literally your eggs are being judged. They’re like, 

 

N: Oh, I’m proud of my diamond embryos. Like it’s like my husband and I produce these diamonds. Absolutely. Like you’re sitting there I remember sitting on the on the hospital table with like the paper sheet over me being shown this photograph of the two embryos and Doctor explaining to me what made them so perfect. And you know, I was just I had, like my first glimmer of maternal pride in these little creatures that might become a child of mine. So, yes, and and then what they do is they they continue to let the remaining embryos that are in that petri dish, their cells continue to multiply and they watch them and the ones that continue to live on which means that they are in the strongest condition have the best hope of you know ever developing further they freeze and so after our IVF cycle, we had three frozen embryos left over should we ever want to use. 

 

P: So that becomes a little bit of a tricky question, right? What do you do with the embryos which I feels like it’s weighty? 

 

N: Yeah, so that’s the question that I explore in my essay, very nice blastocyst. Anyone who has had a child knows how all consuming it is to have an infant. And so you know, for for the first few months to a year of my son’s life. I’m breastfeeding I you know, I have his older sister at that point is a toddler age three. And so I’m a busy lady, with a lot going on, and not something I ever really thought about, you know, the embryos at that point. They were, you know, the IVF wasn’t that far behind us. You know, there wasn’t any question because my baby was so young that I was going to have another child anytime soon. Nor did my husband and I know if we wanted to have another child that was not something that we had planned for or discussed. We very much knew that. We wanted two children and not one we were very hopeful that we could have a second child after our first but beyond that, and never more children had never been a big factor in our thinking our planning we’d never gotten further mentally than into 

 

P: Yeah, and I can see because I also did not get pregnant easily. I know the drive and the focus, to make the babies and have it work. And that kind of overrides everything. So you don’t necessarily think about what’s going to happen to those embryos. You know, you’re so excited that you get pregnant when you’re when you get the call and you are pregnant and it’s going to work and you’re so focused on that. And so seemed like in your essay, you were saying that issue of these frozen embryos occupied a space in the back of your mind pretty continuously and sort of what to do with them. 

 

N: Right. So again, the saying earlier, the fixation on successful that getting a baby is so strong and so overwhelming. That I think it it pushes your brain away or pushed my brain away. I can say from thinking about other things, anything tangential and a future fallout from this experience. I wasn’t thinking about oh you know, is this going to be harmful to my ovaries in the long run to be stimulating them this way? Because I didn’t care. I just wanted this baby. You know, I didn’t care if you know there was heightened risk for ovarian cancer. I wanted this baby. 

 

P: people who use assisted system in production are pretty focused on getting pregnant. History really do we know if there are any long term consequences?

 

Dr Glenn: That’s a great question. I think that overall there has been some information looking at specific or mentally responsive cancers like breast cancer and IVF and one paper I know that I reviewed recently looked at maybe if there is a slight increase it was a Danish conference study that there might be a slight increased risk of breast cancer within the short amount of follow up time. However, when you looked at the risk, it was point 9% of the population versus 1.1% of the population. If there wasn’t a difference. It was incremental. I always have a caveat as well as that this is looking at a very homogenous population. It was a Danish cohort, how much does it apply to our own patients? And so there has been a certain studies looking at that if you look at something like egg donors, you know, we limit it to six cycles and so and it was actually not for the potential for increased risk for cancer, because looking at the increase of cumulative risk of doing something like stimulating your ovaries and going for an egg retrieval. So overall, it’s a risk for any kind of complications from an egg retrieval day. infection, bleeding damage to certain structures like your bowel and bladder is like less than point 1%. However, when you look at someone doing repetitive cycles over time that increases and so we just want to make sure we protect everyone. But overall it is it is a safe procedure. They take the each individual and say what are their risks and benefits knowing their history?

 

N: The same way did I know that there was a likelihood that my IVF cycle would result in frozen embryos? Yes, my husband and I were given among all the many piles of paperwork you have to sign when you when you do IVF there’s a form we had to sign even before embarking on IVF about storing frozen embryos because the clinic would store those in their own facility for up to three years. But beyond that, if you didn’t want them to be destroyed at that point, they would need to transfer them to an outside cryogenic facility. So all of this required paper work in advance and the clue to the fact that I just wasn’t giving them this topic. The brainspace that I probably should have before I embarked on IVF is that those papers I found those papers unsigned and unreturned after the IVF cycles, so there was something about those papers. You know, I remember reading them and thinking this is crazy. How can I be signing papers about genetic material that doesn’t exist that might not ever exist? Decisions for possible future genetic material and where I’m going to store it and it just seemed, it’s it was daunting paperwork and there was something almost like speculative about it. It just it was I didn’t want to look at it. I didn’t want to face it. I didn’t want to think about it. And I didn’t. 

 

P: Yeah, I mean, it almost seems overconfident to be like, where are you going to stash this haul? Like I don’t have anything yet. Right? 

 

N: Exactly. Like are you kidding me? I just want to have a baby. I don’t want to think about this doesn’t this doesn’t relate to me. And so obviously wasn’t a deliberate omission not to sign the papers, but I did find them unsigned later in my folder of IVF records. 

 

P: So one thing I wondered when I read your essay, because I don’t think you mentioned it to have this issue weigh on you. Do you have to think that those embryos are a life is that what is holding you up because I I’m not sure if I think of them as a life or not in the context of the abortion debate. Which is so polarizing and kind of flattens the arguments that can be made. I would say this is not a life… solely my opinion, and because I had so much trouble getting pregnant and with the pregnancies, the intricacy of all the things that have to happen. To turn that tiny ball of cells into a person gives me distance from them. 

 

N: Yeah, but I wonder what your feelings are about all that. I mean, maybe I’ll talk about the essay to get it that what was so interesting to me about going through this process, I’ll backtrack and I’ll just explain the predicament. I found myself. So after our son, you know was when he’s around two or so, you know, my husband and I did start to discuss are we done having babies, you know, do we want to have another baby and we weren’t sure. But the fact that we had these embryos felt like a strong nudge towards having another child I felt if we were on the fence for various reasons that it was that factor that tipped me over into wanting a third child. So we actually disagree with it. 

 

P: Let me stop you there. For a second is it that you went through this difficult procedure to get the embryos and so and so you should use them or it’s that these embryos represent a life and we should realize its potential? 

 

N: So little bit something in the in the middle, I think, 

 

P: Okay,

 

N: I think if we were just deciding whether to have a third child without factors, the embryos being involved, it would be a decision that had no if we decided not to have a third child. That decision would have no impact on anyone whatsoever. Only us right. But the fact that there were these embryos suddenly meant that that decision carried a lot more weight than it otherwise would have. We would actively have to do something not to have a third child. We would actively have to make the decision to destroy these embryos to not use them. Right and I do not think that embryos are life. Do think of them and this is where as a mother the issue became complicated for me. Our potential 

 

P: Yeah, agreed

 

N: they are read intial life. And so there is something very hard about letting go of potential. And I think especially if you’re a parent trained, you know to to love potential to look for potential to want to nurture potential. And so that was the meaning that these embryos started to take on for me and since we were on the fence about having a third child, I said I’ve got that nudged us towards yes having one. But then something happened to make things complicated, which is that once they got the process, going reconnected with our clinic, made an appointment for a baseline ultrasound, which is when they look at a do an ultrasound of your uterus to just see where it stands and what would need to be on what hormones would need to I would need to take to prepare the lining of my uterus for the implantation of one of those embryos.  once we’ve made all of those moves I got pregnant naturally.

 

P: of course you did…that’s how it works

 

N: which itself was a very wild experience after having worked very, very, very, very hard for my other two pregnancies to simply have a late period, have that moment of wondering, going buy the CVS and now on my way home from work, pee on the stick and be pregnant was like, writing my essay that it was as if all of a sudden somebody told me that my fingers could spin gold like that my body could do this was totally shocking and disorienting and wonderful.

 

P: especially when you see behind the curtain right now you understand the thing. Everything is amazing.

 

N: Absolutely. So that was wonderful and and that pregnancy went well and resulted in our in our daughter, but it did leave us then with this again, but the question of these embryos,

 

P: but I’m imagining it’s a slightly different question. Now that you have three kids right. Then you have to take into consideration the other three, right it’s

 

N: it was a pretty much out of the question. We were not going to have a fourth child for for many reasons. It’s just not feasible for our family. It was not something that we thought would be best for our family and so that left us with these embryos. And what my essay explores is sort of my shifting orientation to these embryos over the years because the truth is, I could not bring myself to make the call to our clinic to have them destroyed. And so their existence is something that I ignored that I I sort of willfully ignored for a long time. And you know, there would be moments when you know, I would think to myself, I can’t believe that I call myself a full grown adult when I am not taking responsibility for these embryos and making the choice to to have them destroy because I’m a writer, but it’s not hard to imagine like some of the like Apocalypse apocalyptic visions of like embryos out there in the world. And basically, I’d ceded all responsibility for our genetic material or potential, our potential but this potential that we’re responsible for to total strangers in a lab somewhere a couple miles from our house, but it’s a because it is so hidden and because these embryos are frozen in the they are unseen, right is what it is. They’re not a reality that you need to confront every day, right? You need to confront the reality of your children every day. You know, you need to prepare the meals you need to deal with whatever struggles and hardships come their way you need to attend to them but the embryos it’s very easy not to and truthfully way that I’ve since learned because I don’t know a whole lot about this at all, but the way that fertility clinics, deal with them. Also makes them sort of quite easy to ignore, because clinics are not particularly this. I shouldn’t speak for all clinics. I can speak for ours but my understanding is that this is pretty universal. They are not aggressive about getting their patients to make decisions about what to do with the embryos. I knew that that they were still at our original clinic I had never signed any papers authorizing them to be transferred anywhere. I you know, did wonder on occasion if they had been destroyed without my knowledge since they had been there longer than the three years. I did, you know, one day email our clinic because you know, and I write this and they they essay it wasn’t because I had some sort of resolve or I had come up with some sort of decision about them but I just I wanted to know if they were still actually around. Or if they had been destroyed. You know, there was a very lovely receptionist on the phone in the lab who basically was like, oh, no, they’re here if you want to transfer them. You just have to sign this paperwork. 

 

And there was nothing urgent about it, you know, whatsoever. And so it’s one of those like decisions that indecision that ends up happening because there’s no particular moment where anyone is putting a paper in front of you saying like this has to get done or else my relationship with these embryos began to take on almost strange, magical tenor and what I mean by that is no at first I sort of thought of them as a as Life rafts. I’m going to knock wood as I say this, but like God forbid should anything ever happen to our children there. There would be despair, there would be anguish, but there would be these embryos right so we could rebuild a biological family if tragedy befell ours. And then that over the years began to dissipate a little because you know my husband and I are getting older and as we got further and further from the baby stage, my my my youngest is now six returning to the baby stage seems it almost is harder and harder. Right? Like we are

 

P: totally understand what you’re saying by this kind of insurance policy. At the same time, my guess is I don’t know whether you’d be able to bridge that loss.

 

N: Yeah. t’s magical thinking and then it became more magical because it sort of more from like, well, these are sort of like an insurance policy to almost like superstition. If I destroy these embryos, something terrible is going to happen to my family. So there’s all of this kind of magical thinking bound up in them. You know, it’s just such an interesting juxtaposition when you think about like the rigid science that actually that actually created these embryos and then the the meanings that they that they take on and you know, during the IVF process, you know, as I said, I was fixated on the process resulting in a baby but the sort of thinking that I can do about these embryos now without that kind of urgent desire mixed in is I think about generations that came before my husband and me and our families. I think about all of the history in in that DNA, right? I think about I’ve read about in the essay, you know, my ancestors who my ancestors on my father’s side who escaped pogroms in Eastern Europe and you know, went through all sorts of turmoil to make it to the United States, right, and then lived in tenements Lower East Side and, you know, thinking about my grandmother and all of the fate and escapes that needed to take place for those embryos that are frozen to exist. And so all of these sort of meanings started to accrue and attach themselves to these embryos over the years. In a way that I never ever could have seen.

 

P: Once you start thinking about it as a family line, then there’s no way to extricate yourself from those from those embryos, right? You really only have like four choices, have them yourself, which you’re not going to do destroy them. Give them the science for experimentation, or give them to someone else to have that baby giving the embryos to someone else as a form of adoption. I interviewed a woman I think in episode five or six, who did just that she and her husband went through IVF had twins and decided they didn’t want to have more children. And they found families who wanted kids but for whom IVF was prohibitively expensive, and they donated them.

 

N: I mean, I think that that is incredible. I admire this woman. 

 

P: Yeah, totally.

 

N:  I understand. I see the beauty in that. Gesture. I myself personally could not do that. It would feel and this is where that word line the web in life and non life comes in. it would feel to me like giving away my living children in a way to be raised by total strangers. Obviously not quite so extreme. I have a relationship with my living children, but not so far from the same. 

 

P: Yeah, 

 

N: I don’t know what kind of parents these people would be. I don’t know what kind of circumstances you know, they would would put my child and so that didn’t feel comfortable to me. The science research part didn’t feel comfortable because you know, I think I read in my case like science for whose purpose you know, you don’t have any say in what we’re what purpose is, are. Are these embryos being used. And so that vagueness was a discomfort to me. And so I can’t say that I was or am proud of my feelings about these things.

 

P: Well, they, they just are right, they just

 

N: they just are. I often wish you know that I could think of these embryos. As you know, like biopsy tissue or something right, like disposable, you know, useful for scientific purposes. And I think there are people who who can who do think of them way

 

P: this is obviously a really fraught issue and that I brought to Dr. Glenn so Nicole and her partner can’t be alone in this quandary about what to do with frozen embryos. Does your clinic offer counseling or what do we tell people? 

 

Dr. Glenn: You know, I don’t think specific kills like that for our clinics for this topic, but it’s something that I talk to patients about during their IVF and then before they sign it is like, you know, these are the different parts you need me to discuss or you know, you alone, you determine that. And so they have questions, of course, as part of the conversation about like, next step. So when you do it, to be honest, we have less patients that kind of go forward on this part. And I think, kind of like you said, the initial part is I just want to know what to do next, and I just need to keep going. I think that most patients don’t think about that until later on

 

 And unfortunately, I think that this is a personal struggle that they sometimes don’t reach out for, they don’t look at as your decision is such a personal decision. So they talk to their friends, family. Or they talk to other people who have gone through IVF 

 

I went through IVF twice and so that’s also something that you know, you look at it you’re like cheese Wow, this is intense, because not only putting something that you feel is yours and special in this kind of box of three check box do and destroy. Do you want to donate to another person? Or do you want to donate research? And it’s weird to like go from something is very personal just to these three checkbox. And it’s also very finite on your life. It’s like what if something happens to you? What if something happens to your partner, if you have a partner, it’s a struggle for some of our patients to that they decide not to freeze embryos, they actually freeze eggs and sperm separately and then only inseminate one or two at a time. And so in other countries, it’s also illegal to freeze embryos. So in Italy can’t do embryo freezing you can only do egg and sperm.

 

 

N: Potential, you know, that always trips me up the potential that is bound up in them. So I you know, I’ve been thinking a lot and I tried to explore this in the essay about what it means to mother, right? What does it mean to when you think of mothering a child, as I mentioned before, it’s so much of what we love, right? Or what you think about is like nurturing potential growing potential. But what I started to think about as well is how much of mothering how much of parenthood is also about letting go and about seeing your children’s limits? At times and coming to accept you know, what isn’t going to be right like a child is born and it seems like they’re this blank slate and the sky’s the limit and they can be anything and do anything and they think anyone who you know has children in any you know, element for a preschool or elementary school age seems like, you know, there are things that that you need to let go of as a parent and things that your child will not ever be and maybe that’s not disappointing to you, but it’s disappointing to them or maybe in some way it is disappointing to you, but letting go and accepting what isn’t going to be or what shouldn’t be, I think is also a big part of parenting of mothering. So that is ultimately you know, what is what has helped me move forward in my embryo journey.

 

P: So would you say you’re at the end of the embryo journey are we’re still they’re still in limbo.

 

N: It’s still in limbo. I’m still in limbo. But I know the answer. I do know that. The answer is that I have to destroy these embryos, but I haven’t done it.

 

P: I mean, I don’t know if it gives you any comfort to imagine that no matter what you do, there’ll be regret. Because there’s no perfect answer here. Right. But while you’re talking, I’m thinking, why would I would probably donate them to science and then I can literally feel the regret of making that choice. And I don’t have any eggs and I haven’t made that choice. But there’s nothing here except having all the children which is not going to happen right for for almost everyone who goes through IVF that is not what the goal is to have all these have all these children and it’s a little bit of a mismatch between what interventional fertility can do and what our lives look like. 

 

And so maybe there’s some point in the future where they can better estimate which eggs will survive and which eggs will produce and they’ll take fewer and they’ll make fewer embryos and then we won’t have this dilemma because you won’t, I mean, you’re not going to be sad about an egg because you’re shedding eggs every month, right? So that’s a thing. Right? But right now we’re in this mismatch where we can’t I mean, it’s a little bit like everyone who goes through IVF The doctor has to choose how many embryos to put in there within your uterus, which is a wild decision that nature doesn’t force you to make in that way, right? You don’t have access to five embryos.

 

N: Right. Yeah. It is. I think it is a really interesting question because, you know, that I thought about while writing this pieces, would it have made a difference if my fertility doctor had said to me right now is the point in the journey when we’re going to talk about planning for frozen embryos? And yeah, you know, and thinking about that and I want you to be fully aware, you know, that this is a quandary that many parents face afterwards. And I don’t know maybe that would have led me to ask more questions about how many follicles that we’re trying to harvest. I’m not sure, but I don’t know, things might have changed, and maybe those conversations are part of the process now, but they weren’t when I was going through IVF. So it was sort of an unspoken aspect of the of the process.

 

P: I mean, I think IVF sheds some light on how little we know about many of the intricacies of this process. Even if you do IVF as you know, you don’t get pregnant every time.

 

N: Right. Oh, and totally and also you’re not so at the mercy of the knowledge of these doctors, right? Like, are you say that I expect if I have, you know, 13 follicles great like, let’s do it, like, produce 13 follicles. 

 

P: I asked Dr. Glenn. She can imagine a future in which we can grade egg and sperm so well that we know exactly what we need to use to get an embryo that will successfully lead to pregnancy.

 

Dr. Glenn: The problem is the attrition rate. I talked to this when patients are freezing eggs for future use. Is like well, how many eggs do I need and someone that triggered over 80% live birth rate of less than 35 year old would need to freeze 16 eggs? Not every egg survives a freeze thaw process not every egg gets fertilized. Not every fertilized egg makes it to day five. So freezing embryos is a better guarantee that you get embryos out of it.

 

P: Do you think there’s a time in the future where we will be able to identify markers on the egg to know which ones will freeze and which ones won’t? Or which ones will fertilize 

 

Dr. Glenn: future? Who knows right? I’m always impressed about what when I’m an embryology Lab. I’m always impressed but they can do. They also can look at a little bit if they’re doing a procedure called ICSI which is intracytoplasmic sperm injection. If there’s a problem with male factor or problem with the sperm, then they actually can take us in each individual sperm and injected into the egg. When they do that. They have to kind of clean up the egg a little bit. When they clean up the egg. They do get an idea of how good the egg looks and so they kind of grade them that way in our lab, but I’m sure in the future they’ll be able to look at the egg and kind of determine better about potential for how many fertilized and quality and those are our struggles right now is that we have a very limited view of quality you know, we can kind of determine quantity of how many is called ovarian reserve or how many eggs a woman has left that we have very limited achievement of is quality. likely they are to get pregnant with a successful healthy baby. And so there’s so much unknown out there. But it’s also hard because this is an ethical quandary about working with someone’s eggs, sperm or embryo 

 

P: and there’s no way before you make that decision to know whether it would have been viable like thought and let it grow a couple more days and see

 

Dr. Glenn: so a couple more days wouldn’t help or even Nestle work because the lab can only grow embryos to certain points of time and you don’t know until you put an embryo back whether or not it’s going to be good or not personal experience when I did my IVF cycle a few years ago after embryos get to day five, the embryologist looks under the microscope and grades them on how good they look very specific criteria about what’s called Hope Spanner they are embryos actually have a little protein shell kind of like an egg and they hatch out. So they look at that how thin it is how it doesn’t look like it’s going to hatch out and attach to a uterus. Then they look at two things that trophectoderm in the inner cell mass the trophectoderm comes the placenta and the inner cell mass becomes the embryo. They grade them and how good they look. And again there’s very strict criteria.

 

I had almost perfect looking at embryo with fabulous. I had a negative pregnancy test 

 

P: wow so that just means it didn’t attach or do you know what that means? There’s like they

 

Dr. Glenn: just did not attach or if it it tells you it was not good of quality. And there’s other things besides the embryo there’s a signals between the embryo and the uterus. Is a uterus being receptive at that time. Did it not you know get to that point. The and the uterus called Pina bogs and attached appropriately with the cytokines and the protein than amino acids just a little bit imbalanced that day. There’s so much we don’t know about implantation, but the embryo is not the only thing that’s important. 

 

N: You know, I don’t know if I would have had the perspective to ask the questions that might have prevented this quandary that I’m now in.

 

P: I dont know this for sure but I can well imagine that there’s some evolutionary pressure they’re forcing you to focus on reproduction as you know, up to the absence of anything else right because that’s kind of what you’re

 

N: I like that idea. take some pressure off. Yeah, I really like what you said earlier, though, about I don’t remember exactly how you put it but how, no matter what decision, you know, make or I make in this like there’s going to be regret. And I think that that’s also something it’s just a process of coming to terms with right that oh, there’s going to be some answer that makes everything okay. 

 

P: Who is hashing out these ethical issues is there there are medical ethicists who are working on it or? Well, there’s

 

Dr. Glenn: a lot of people that are not only just PhDs, but also there’s like an ethical committee on the American Society of Reproductive Medicine. We have ethical committee guidelines that discuss all these things. And usually you don’t want to just doctors on this panel. You want a lot of other great minds in there too. So there is definitely a lot of research people that you know, do their PhD in ethics. And so I would actually kind of go back to those ASRM community opinions and guidelines for ethics just as we continue to struggle with different topics as we learn more as we’re able to do more you know, when you look at the beginning part of IVF and the you know, late 80s, the chances of success disciple was like 2% and they couldn’t freeze extra extra embryos. They had no capability of doing it yet. And so as we get better at doing things, more ethics come up

 

N: there’s going to be something that happens in the future. That just makes it really, really clear that now is the time when I need to say goodbye to the embryos and I’m still sort of magically waiting for that. I know that I wanted to let go of these embryos but why today on Wednesday at 156 day now, and you know, and perhaps there will be some moments when crystal clear to me in some way that this is the moment when it just poetically makes sense, you know? So that’s I think, just part of trying to tamp down the regret.

 

P: Yes, yeah. Who wouldn’t search for clarity. That’s totally makes sense. I so appreciate you coming and talking about this because there’s not that many conversations about this and everyone who goes through IVF must have some version of this quandary…especially if you go through IVF and it is successful, then the potential of those embryos feels exceedingly real.

 

N: That’s exactly right. Yeah. Yeah. I think watching my son grow also was part of this difficulty in letting go of the embryos. These embryos were formed, you know, at the same time that he was formed, is so tangible to me. He is a particular person is a boy who loves breakdancing and Brawl, parsley, basketball, and his dog, you know, and he has his very particular room and his likes and dislikes and so not so hard to extrapolate from there right these other these other embryos but I I do want to be very clear also just because the abortion debate right now is so front center in our country that I think that our choices my husband’s and my choice, but he’s very much prefer to me my feelings are much bigger than his around this. And so it’s our choice, but it really it really is my choice just because of how his feelings lie. But my choice about what to do with these embryos feels very important to me the fact that I have the freedom to decide what to do with these embryos and that I know, given our family circumstances, given my husband’s and my age, whats right for them, and that to me feels like a part of mothering that feels like nobody terminates life. Nobody destroys frozen embryos because it’s easy, but because that is what they know to be to be right for them and for their life and, and for the life of the embryo or unborn fetus. So that’s just I don’t know if we want to go into all that but I do think since we’re talking about like this sort of like middle place where embryo scan between life and non life, you know, that’s sort of my my thinking on that and all there is right to deal with this like, as you say like coming to terms with the unsettlement of things such a big decision, but I’d still think that it’s a decision women should be able to make

 

P: I totally regret that the abortion debate is so political and so polarized, because it’s kind of a nuanced question, and it is, I think, if really want to talk about the science or what’s at stake. No, that gets into the conversation. It’s treated as is very black and white thing, which clearly it’s not, you’re in this middle space where it’s not in your body, and so even a little bit more leverage over it. But

 

N: I like to offer myself up as an example of someone who does not see an embryo as being as disposable as biopsy tissue, and does see the sort of weight of an embryos potential and yet I absolutely believe with my whole heart that a woman should have the choice of what to do with that embryo.

 

P: I totally agree. I just think like the abortion debate, debate forces women to say not life period at the end, while it is not a life it is something it is potential it is it is something that is important and valued, it is tricky. So maybe there will be more discussion around this topic if the abortion debate wasn’t hanging over it.

 

N: Totally. Well, I do think so many of our like public conversations force us into black and white thinking sort of like that polarized one side or or the other, but embryos really do occupy this very mental state, which is which makes them really interesting to think about. Yeah,

 

P: I totally agree. Well, Nicole, thanks so much for coming on and sharing your story. And I will definitely attach her essay to the show notes because it is beautifully as a writer totally blown away. And probably you do this too. When you read other people’s writings. There’s certain phrases where I think oh, so beautiful and Nicola has thought of it and now I can’t use it.

 

N: That is such a compliment. Thank you so much for your kind words and for reading the essay and for having me on your show.

P: thanks again to Nicole for sharing her story and her struggle about what to do with her frozen embryos…as Dr. Glenn suggested, ethics is working hard to keep pace with science, and until they are fully aligned it seems we each have to figure out how to manage this situation. To be clear I completely support a woman’s right to manage her own fertility, whether that involves a pregnancy or an embryo–but having that right doesn’t make the actual decision easier. I wish NIcole and her family luck and comfort in the decisions that she will make on her own horizon…and thanks to Dr. Glenn for sharing a little bit of her experience and her expertise about the complicated and fascinating process of IVF.

 

I will put a link to Nicole’s writing in the show notes, which can be found on war stories from the womb. Com…

 

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