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The State of Your Uterus Based on the Headlines

Stories about infertility are feeling a little bit like popcorn this month.  There was a story here and there, and then in one week, my Google Reader was filled with stories about birth rates and donor gametes and clinic advertising.

Are Infertility Doctors Turning into Predatory Bankers?

Well that is certainly a neck-swiveling question, Forbes (I’ll admit that I don’t actually read Forbes.  This article was linked to from someplace much more insipid.)  I’m going to assume that the answer — you believe — is “yes” because if the answer was a resounding “no,” it wouldn’t make for a news article.  It’s an article about fertility doctors providing fertility loans, and I wrote my feelings on this practice this past summer.  I actually thought it was going to be something on the topic that has been floating around all week on the study about slippery advertising on the part of fertility clinics.  I am going to guess that the media believes that fertility clinics are taking advantage of their patients based on the way both these stories are being reported.  I don’t know what I believe beyond the fact that articles like these drive home the fact that reproductive medicine is a business as much as it is a medical solution.  How do you feel about the loans and the advertising?

Fertility Decline Surprises Women Over 40, Study Finds

I thought this headline from the Huffington Post was rather rich.  Why do you think people might be surprised?  Could it be because the mainstream media often speaks about IVF as if it is (1) the only option to treat infertility and (2) a slam-dunk solution?  Because we speak about 48-year-old actresses having twins without ever mentioning either treatments or donor gametes?  Do you blame women for believing that we’ve somehow evolved to stay fertile longer in the same way that we’ve extended our life span?

Why should we, the reader, be surprised or find it newsworthy that people believe what they read and absorb the messages provided by the media?

America, You Are Getting Really Shitty At Having Babies

This Jezebel article is only remarkable because infertility does not appear anywhere in the post.  The author is musing on why US women are having fewer children and fewer abortions; meaning, they’re not getting pregnant.  Birth control is floated as a reason, and I’m sure it is.  But if infertility rates are growing, doesn’t that have the possibility to affect the overall birth rate?  Unless fertile women begin having more children than normal, the overall birth rate numbers are going to shrink.

Couple Seeking Egg Donor Offers Their Kid’s Nanny $30K … & She Quits

This is a very interesting story.  Let’s take out the nanny’s actions because I find them deplorable.  Someone asks you something in confidence, and you go air their private life to the mainstream media.  In my world, that’s a dick move.  No one violated her rights or did anything illegal.  Her employer asked a question, she gave an answer, and then months later, she went to the New York Post to talk about her employer and her fertility issues.  There was nothing in the article about her employer treating her unfairly afterward or making her life miserable because she wouldn’t be a gamete donor.  In fact, it states:

The employee still left on good terms a few months later. To the best of her knowledge, the mother has not had more children. Elizabeth lists her as a professional reference and, until now, has only mentioned the proposition to close family.

Until now are the key words.

But the employer… did she do anything wrong?  On one hand, she is in a position of power and her question could be seen as coercion.  Is the employee really free to say no to such a personal request if she depends on that employment?  And at the same time, I wonder how our thoughts on that first question come into play when we consider all known-donor situations.  I would personally ask someone to be a gamete donor, and while I don’t have gametes others would want, I would have never been offended if someone had asked me to be their donor.  Are we responsible for someone else’s comfort when reaching out for help?  Is it wrong to make a non-pressured, non-coerced request of another person?  Would you be okay with another person asking for a major donation — gametes, organ, or bone marrow — from you?

Personally, it’s okay to ask me anything.  I may not always say “yes,” but I wouldn’t be offended.

I think I was just really bothered by what was implied in this situation.  Perhaps it hit too close to home since I would consider a known donor, yet how does one ask if they worry about destroying a relationship in the process of asking?


1 Chickenpig { 12.19.12 at 8:45 am }

This is a tough one. I think asking your employee is a shady gray area. If you are a partner in a law firm and you ask one of the lawyers, it is also very different than being wealthy enough to be able to afford a nanny and asking that nanny for gametes. Many nannies are live in, so they rely upon their employer not just for employment, but for room and board as well. The couple that asked must have been very desperate indeed. Who would want the biological mother of their child watching that child and living with them? And I’m sure she gives the young woman amazing references, if she didn’t she would really look like a wacka a doodle, don’t you think?

I myself think there is no harm in asking a friend or relative, heck, even a total stranger, for something. Asking someone from a position of power like this woman…it makes my Socialist hackles stand up.

2 Lollipop Goldstein { 12.19.12 at 8:50 am }

Okay, but here’s the flipside. A lot of nannies and other caregivers become like family. You see their character traits unlike an anonymous donor. And the traits you most often see from a caregiver are all positive ones: care, love, respect, intelligence, creativity. How can we say that a nanny is like family and should be treated like family but also not like family — you see the problem here? We’ve created this odd work relationship as a society.

3 Aerotropolitan Comitissa { 12.19.12 at 9:04 am }

Out of order:

1. I have concerns with fertility clinics offering loans, moreso as a side business or other mutual arrangement. (A discrete set of leaflets in the waiting room from various companies doesn’t seem too objectionable.)

If people take out a loan to pay for treatment, they are getting a fee they would otherwise get. And of course patients are, on average, adequately motivated to pursue treatment as it is. If anything, clinics need less incentive to encourage couples to go ahead with treatment, not more.

Yes, the clinic needs to make money, and that is the reality and we can all live with that, but everyone also needs to feel comfortable that the compensation is merely “fair” and that treatment really is in the patient’s best interests. Setting up a side-business as a loan giver… at the very least, it looks unprofessional.

That said, there is an argument that if part of the fee comes from a loans business, then it all doesn’t have to come from providing fertility services (and possibly also drugs). Would this help to make treatments more affordable, on average? I remain unconvinced but willing to be persuaded by evidence. I tend to think that doctors should try to put money out of their minds as much as possible when talking to fertility patients, and being in the loan business doesn’t seem conducive to that.

4. Did the employer do anything wrong? Yes, probably. So did the employee. There was no need to splash that around, but with all the good intentions in the world I don’t think an employer-employee relationship is a great place to solicit donor eggs. There is a clear and obvious power differential. Of course, the trouble (much cited in debates over egg donation) is that there is often a power differential. Many places have tried to minimise this by only allowing egg donations through anonymous donors organised through clinics with the oversight of ethics boards. Of course, this is a more reasonable proposition WHEN EVERYONE HAS ADEQUATE INFERTILITY TREATMENT INSURANCE and can therefore afford to receive timely treatment and an adequate amount of it, helping to reduce the demand for donor eggs. In other words, blah blah mandate infertility cover and then come talk to me about your leftover ethical issues.

2. Some people get surprised by the most obvious things. On the one hand, celebrity births at 48. On the other hand, every article you just cited. I blame everybody. Bah humbug 🙂 But I encourage everyone on this board take heed and do what you can to leave no woman unsurprised.

3. This is an example of something that I, personally, am not surprised about. America has, until now, had an unusually high birth rate for a country in its socioeconomic bracket. This seems like a sort of falling in with normality. The drop in birth rate doesn’t need explaining so much as how it got to be so high for so long in the first place.

So. That’s it.

4 Aerotropolitan Comitissa { 12.19.12 at 9:08 am }

“How can we say that a nanny is like family and should be treated like family but also not like family?”

Soliciting family as egg donors comes first under the firing line in the arguments above, and for the same reasons.

But you’re right, in that it’s not that you couldn’t make a reasonable arrangement with your Nanny. There is not necessarily an abuse of power – it is only potential, and a potential not exclusive to an employer-employee relationship.

5 a { 12.19.12 at 10:06 am }

Loans – sketchy at best. Advertising – necessary evil.

I wish people would read more critically and with skepticism. Then they would know the difference between long-awaited miracle and unmentioned aided pregnancy.

The birth rate thing – I think I read an article that said that the birth rate was low, not related to infertility. It was factored in somehow…but that was a few weeks ago, so my memory may be faulty.

I can see why the nanny would feel uncomfortable with the request, sort of. She’s 25 and has no idea. I don’t see why she would want to talk to the press about it. I wouldn’t have been offended, because by 25, I had learned how to say no to things I didn’t want to do (even if I felt like I should say yes. Case in point: my friend asked me to stand up in her 2nd wedding. I said that I felt like I would be a jinx since I stood up in her 1st wedding. She took me seriously, and opted to have her new stepchildren be her attendants.) I don’t see a problem with the employer asking, because as you said, a nanny, especially a live-in one, becomes like family. It would be uncomfortable to ask anyone for something so personal. I don’t think, in that case, there was a power factor, based on the information available.

6 deathstar { 12.19.12 at 3:51 pm }

Remind me to have my nanny sign a non disclosure agreement. Of course, I don’t actually have one, but if I did, I would.

7 Denver Laura { 12.19.12 at 4:06 pm }

1. If treatments were covered by insurance, we wouldn’t have predatory practices by doctors and bankers (not saying all of them are bad of course).
2. It’s been a few decades since my sex ed classes, but I do remember them saying something about how fertility declines after 40. (They also said you have a chance of getting pregnant at any point of your cycle too). I find the study a bit flawed as they only interviewed women undergoing IVF. Half of them were surprised they needed IF treatment. I would also assume that some of those women were quite fertile after 40 but had issues with the other half of conception (i.e. lack of partners, quality, etc.) and hence was surprised that they needed IVF.
3. I’m with Aerotropolitan Comitissa. America’s birth rate is falling into normal ranges for first world countries.
4. The nanny had a non-disclosure. Methinks there’ll be a lawsuit soon. Also, although I’m not exactly up on the guidelines for being a gamete donor, but wouldn’t having at least one child be part of that criteria? Also, she was a nanny to a 14 year old. The employer-employee relationship was probably over by that point anyway, so why not ask?

8 persnickety { 12.19.12 at 6:09 pm }

I work in financial services- and I just finished an extensive rewrite of two of our clients Conflicts of Interest policies (regulatory change required it). One of the most interesting comments came from one of the Boards when I presented it- that it was important to document all of the relevant items because it wasn’t so much the documentation of actual conflicts that mattered but the appearance of transparency. So something that is not in any way a conflict (the organisation she works for is sponsored by a rival of this board) still needed to be decalred, because to an outside observer there would be a conflict.
I have reworded it badly- but it really hit the nail on the head- if i didn’t know anything about the situation, i would think potential conflict. Once this is declared- the relevant groups can make a considered decision. I can still choose to take out that loan if I want.

That said- less of an issue at this end- I haven’t quite worked out how much each cycle costs (yeah, I know), but I get a chunk back from Medicare, and the overall cost is lower than it seems to be in the USA.

(c) 2006 Melissa S. Ford
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