Faith and Fertility Treatments (part 2)

So you're back for more, huh? Gray, deep, and murky waters haven't deterred you yet? Good for you. If you missed part 1, catch up here. I'd like to again preface this post by saying this: I am in no way an authority on this topic. Today's post will be almost entirely the decisions that we have made, that allow us to feel comfortable moving forward with IVF. The same may or may not be true for your family, and that's okay, because the deep end may be dark and murky, but there's a lot of grace out here too. I don't have to agree with you to love you. This is a chance to discuss these hard topics in a safe and open space. It is also an opportunity to explain how I've dealt with the unavoidable moments when pursuing treatments and my faith want to bump heads. Thanks for diving in with me.

Infertile friends, let me pause for one second and explain a little to the rest of the world. I was reminded recently that a huge portion of my readers are not "in the know," and terms like IVF still throw them for a loop. Bare with me. In vitro fertilization (IVF) is essentially the extraction of eggs (hopefully several) from a woman's body in the hopes that fertilization will take place outside of the woman's body. If fertilization takes place, embryos develop and they can, at some point, be returned to the woman's body. That's as bare bones, boiled down as I can make it. Now of course there are lots of variations. Sometimes the embryos go in after being frozen and thawed (frozen embryo transfer), sometimes the eggs are harvested from one woman, but returned to a different (donor egg and surrogacy), but essentially it all comes down to the attempt to fertilize an egg outside of a woman's body and then successfully return it to a woman's body.

For a lot of people, IVF seems too far. Like you're playing God. I get that, but hold on, let us explore the deep end a little more. Because the truth is that there are moral and ethical issues with other treatment methods as well. The initial hurdle most couples go through is oral medication. It seems innocent enough. The goal is to increase the chances of ovulation by providing an increase in hormone response. This also increases the chances for multiples though. I've heard many stories in which women become pregnant with three or four babies after one or two rounds of Clomid. Difficult decisions for sure.

If oral medication doesn't work, women are often encouraged to try intrauterine insemination (IUI). We've all heard of John and Kate Plus Eight. It's unlikely to happen, that's for sure, but there were supposedly only three or four follicles visible by ultrasound before their IUI, but low and behold, they became pregnant with seven babies, and eventually gave birth to six children. My point in all of this is simply that even the "lesser" procedures deserve a lot of thought. But even more important is an understanding that this is all gray. I don't think you can give a hard and fast rule on when to proceed and when to stop. Where one woman may be asked to cancel a cycle, another will be encouraged to continue. Take me for example: I was initially told my IUI cycles would be cancelled if I had more than three mature follicles because the chance of triplets was just too high. However, after three failed IUIs, we were encouraged to continue even when there were potentially five follicles. See what I mean? It's murky water.

However, it's not all that often that oral medications or IUIs cause serious ethical or moral dilemmas. The arguments and tough conversations really deal with IVF. Some would argue (like this author) that this is an incorrect way to think... IVF is safer and more ethical because the woman only becomes pregnant with one, maybe two children, 95% of the time. However, I agree that IVF is a big deal and it certainly deserves caution, wisdom, and a good deal of thought. The gun powder of the IVF dilemma is a part of a much broader debate: when does life begin?

Can we just pause for a moment and agree on one thing: the mystery of life it just that, a mystery. I don't think my reproductive endocrinologists all agree on this topic and they have witnessed embryos growing, multiplying, dwindling, failing. If they can't say beyond a shadow of a doubt, I'm not sure that any of us can say with 100% certainty. Even the  Christian Medical & Dental Association acknowledges a lot of confusion around the idea of conception. And for that reason, this is where we (my family) begin to use restraint. Since we don't know with 100% certainty, we have drawn the line as far back as possible. So we have decided that conception will be defined as the moment Sam's sperm enters into my eggs. From this moment on, I will consider these embryos my children.

We've never done IVF before. The assumption is that I will respond well and that we will be successful at creating embryos because I am young(ish) and I have good numbers. How successful? No one knows. If we fertilize ten eggs, we could get ten embryos or none. My immediate reaction to that news is both "fertilize them all, just in case" and "I don't want ten children" at the same time. So then the question becomes how many embryos should we attempt to make? Which brings us to my family's first non-negotiable: we will not discard living embryos. You see? I told you this was deep, dark, swirling water out here. Many people, fertile and infertile, disagree with that decision. But remember, I say all of this with grace. Here's why we've decided not to discard living embryos: I can't say which embryos will live or die, so I will give them all a chance. Therefore my options in terms of fertilizing eggs become: a- only fertilize as many eggs as I desire children (i.e. I want a max of 5 kids, fertilize 5 eggs), b- be willing to use every embryo, no matter how many children we have, or c- be willing to donate any left over embryos after our family is complete. Like I said, this is tough stuff. No matter the answer, the question deserves a lot of thought.

An added issue that will most likely arise due to our first non-negotiable is this: which embryos should we freeze? And should we freeze at all? I'd like to pause here and say that this is the territory in which I feel the least resolved. The next few months will be filled with a lot of research and a lot of prayer. That being said, questions arise like "at what point should we discard an embryo, if ever?" and "if freezing potentially damages the embryos, with a less than 100% thaw rate, should we freeze at all?" Tough questions. Lets tackle them one at a time.

At what point is an embryo essentially dead? I can't tell you how many hours I've spent thinking about this. Many of my doctors would encourage me to view it simply by numbers. If an embryo doesn't have the right number of cells on a certain day, it will surely stop growing they explain. My counter to that is this: as a believer, I recognize the existence of miracles. I believe Jesus called Lazarus from the dead after he had spent days in a reeking tomb, so I'm 100% confident he can give life where it seems that death reigns. So with that in mind, just because the embryo looks bad, I don't believe that the embryo is in fact a lost cause. Do I believe He will call my embryo back from its progression toward the grave? No, probably not, but that doesn't change the fact that He can. I won't put my mom in the ground until I'm 100% sure that she is gone (you're welcome, mom); in the same way, I don't want to throw my children in the trash until I'm 100% sure that they are gone. What does that mean? Like I said, I'm not sure yet, lots of prayer and research to come.

What about question number two: if freezing embryos potentially damages them, or lowers their chance at life, should I freeze? Have I mentioned before that these are sensitive topics? Yea, even my husband and I don't fully align on this one. He's a science guy. He has cut up people (dead people) and seen the inner workings of their bodies. I'm not a science girl, not at all. I've learned more science in the last two years dealing with infertility than I did in high school and college combined. The science world seems to take the stance that a good, vital, healthy embryo will survive the vitrification (freezing process) and the thaw. Embryos that don't survive wouldn't have gone on to be viable babies, or at least that's what I keep hearing. But I don't feel 100% confident in that right now. There's a lot of research left to do and a lot of soul left to search. My options are essentially, 1- freeze at day three or day five, hoping that the science world is right, 2- freeze at the pronuclear stage, because embryos at day one freeze and thaw better, or 3- freeze unfertilized eggs. Lots and lots left to decide.

Lastly, the question of how many to transfer will have to be answered. This is kind of a funny issue. I feel like everyone I talk to has an opinion on this. "You should transfer two," I hear that all the time. Some people feel very strongly about one, some people want us to insure success and encourage three. Let me go ahead and assure you, three is most certainly not on the table. Sam would die or heart failure if we saw three heart beats. My husband's fear of multiples makes this decision fairly easy for us, but it also leads me to my family's second non-negotiable: we will not use selective reduction. In case you aren't aware, selective reduction is the elimination of one or more babies while in utero. The goal, when done for non-medical reasons, is typically to give the remaining baby or babies a higher chance of success by lowering the risk for complications. We will not utilize this procedure. With that said, I can't imagine the fear associated with a pregnancy that could actually kill me... it would be an incredibly hard decision. Therefore, I want to limit the chance that I would ever have to make that decision. For our first embryo transfer, we will be putting back, at max, two embryos. If one or more of those decide to implant, and potentially split, heaven help us... literally.

I bring all of these tough topics up, not to stir up controversy or to make anyone feel defensive; that's not my intent at all. My soul purpose here is to say that these are lofty, weighty decisions. They deserve thought. All too often, doctors ask patients to make decisions in a split second. I, personally, want to have thought through as many possible scenarios so that I am prepared when unexpected circumstances arise. It is easy to allow fear of the unknown to sway our decisions. Add in the pressures from the financial costs and it is easy to get swept along in the current of the doctor's recommendations. Despite the fact that IVF is a huge financial undertaking for my family, I never want our finances to cause us to make decisions we will later regret. The temptation for us will be to get the most for our money, but there are ethical questions to be answered before we create twenty embryos. That's why my family is trying to answer the tough questions now. My faith guides many of these decisions, but regardless of faith, regardless of your beliefs, these are mighty large questions for all of us.

But the truth is this: the fact that there are ethical concerns surrounding fertility treatments doesn't automatically mean that we shouldn't pursue treatment. It simply means that we should do our research, move forward with our eyes wide open, and take the time to answer the hard questions. Whether you're aware of it or not, adoption has important ethical concerns too. Just because there is a potential to do more harm than good, doesn't mean we should stop adopting. The same is true for IVF and other fertility treatments.

Thanks for diving in with me. The water may be murky, but the shore is reachable: I pray those of us that feel lost at sea all find the shore with our faith and family intact... and a miracle to boot. My original intent for this series was to encourage other women of faith. I know that I have often wondered if my faith precludes me from treatment, and I'd like to offer my opinion that no, it doesn't. There is a path in which you can seek treatment for your miracle, bring-home baby and maintain your beliefs. Is it necessarily my path? Do you have to agree with me on each issue? No, not at all. Navigating the dark waters of faith and fertility treatments just takes time, thought, prayer, and a lot of soul searching. But if nothing else, I hope this series encourages thought and discussion amongst everyone. I encourage comments and dialogue, but let us all remember to offer grace and love before accusation and condemnation.