November 10, 2010

Infertility's ethical dilemma.

Tomorrow I have my second opinion appointment. I've filled out all of my pre-appointment paperwork. Larry has filled out all of his pre-appointment paperwork. I have a 1-inch thick file of all of my bloodwork results in the last year and a half, and two handy Excel spreadsheets summarizing my thryoid workups and female hormonal workups. I am ready to go. And well... I'm a little nervous.

Anytime I open myself up to more diagnostics, more testing, I always worry that I'm opening myeslf up for something worse. What if it was never POF all along and instead it was... pancakes? Or dumptrucks? Or... *gasp* Sunday coupons?! (I'm replacing all of the other horrible things a gal could be diagnosed with less severe things as I'm superstitious to ever name actual horrible conditions, like, if I write it here, I'm jinxing myself).

I'm 99% sure I'm going to receive the same diagnosis of POF; my FSH hasn't really dipped below 50 and was at its highest, around 67 I think. I'm not so much looking for a second opinion on the diagnosis as I'm looking for a) a more competent doctor, because as I talked to many folks at the conference this weekend, Dr. G is bad news and b) the slim chance that maybe, just maybe, we could build our family without the use of donor eggs or heading straight to adoption.

Which lead's me to infertility's ethical dilemma... what if I pass on my infertility to my children?

Here's the thing: if I were to do IVF with my own eggs (which, as far as I know based on one opinion, this isn't possible), it would probably save us anywhere from $5-$7K out of pocket (potentially more with agency fees on top of that). I'm lucky because my insurance would cover all my medical costs as well as the donor's medical costs, but I'd still have to pay for all the donor compensation for her time and travel, essentially, the donor fees. Also, insurance (of course) will not pay for legal fees as donor egg use requires the use of a laywer to negotiate the legality of the future child, as in, who's child is this legally. So if I were to use my own eggs, I wouldn't have to worry about paying for anything out of pocket other than office visit and prescription co-pays.

Not only would using my own eggs be cheaper, but I'd get to live that dream of making a baby that's party me, part my husband. But if I do use my own eggs, I could very well pass down my infertility to my potential children.

Would my future child resent me for it later if and when they try to conceive and they ran into issues? I realize that I don't resent my parents for giving me a predisposition for diabetes and heart disease, but if I knew that my parents had a choice in the matter... well, I don't know then. I mean, I'd rather be the person that I am, future potential medical issues or not, rather than not existing at all (as who I am genetically) because my parents used donor gametes. Maybe I'd be able to have a closer relationship with my child, instead of them pushing me away, because Mom and Dad would understand, and we'd be able to share resources with them.

And it's all a gamble anyway... what if we used donor gametes and our future child still had infertility issues later in life? What then?

What if, what if, what if... it's so easy to start formulating endless possibilities and scenarios, like a flowchart of doom branching menacingly into the future. But this is a valid question with which I really struggle: what if I gave this G-d awful, terrible, heartbreaking, tragic disease to my own child?

All just for the sake of being able to say that this child is half-Keiko and half-Larry?

Is it worth it?

. . .

I know there's no answer to that question, and I don't know if any of us could answer that question. But I have to be honest: it doesn't feel rhetorical.

And it doesn't feel ethical. But I suppose, barring genetic testing and selective reduction, there's not a whole lot I can do. And even those options feel icky and just not the best decisions either.

This is infertility's evil Catch-22.

. . .

And this is all on the assumption that I could ever conceive a child with my own eggs. The odds are stacked against me, no matter what doctor I see. So it's all just a waiting game: arming myself with a long list of questions for the doctor tomorrow, and hoping to finally get some encouraging news for once in this journey.

11 comments:

Shorty said...

From what i understand, IF isn't something that is necessarily genetic, or predictably so. It seems many parents had no problems but their kids do.

Shorty said...

PS Good luck with your appointment. I believe in second, third...opinions.

AL said...

Best of luck at your second opinion appointment!

MrsSpock said...

I don't worry about passing on my IF to my children- mine was more easily resolved- but I do have a long and strong family history of severe mental illness (3 family members in my generation, plus my father, two uncles, aunt, and grandmother). At one pint I considered not having children, but then it dawned upon me that I myself have a much higher risk of mental illness than my children will, as I can control who I choose as a husband and the environment they are raised in, and that despite the shadow of these illnesses in family members that I have had to live with, I would never choose not to have been born. It doesn't take away the fear my children will be haunted by the family curse, but I am glad we've made them.

Alex said...

Interesting question. I've often wondered if my future child will have problems like me, assuming of course, there is one...

Good luck at your appointment - I'm interested to hear what the new doc says!

Elana Kahn said...

Good luck with your doctor's appointment! Sure, you could pass on the Hashi's, but you could also pass on your smile and your sense of humor and sweetness. It's the same as if you were to pass on diabetes or heart disease, in my opinion. Not everyone with Hashi's has infertility, too. I'd say if it's a possibility then go for it. Your child should (and will) appreciate his/her being alive, regardless of other medical issues.

Marica said...

good luck!!

and.. don't worry too much for the future!

Brave IVF Girl said...

I do think about this. It's the silver lining to considering donor eggs, actually.

But I also think awareness of potential infertility goes a long way towards being able to manage it, either via freezing eggs, or testing for issues, etc. And science will continue to progress.

Good luck at your second opinion appt!

Virginia said...

Good luck with your second appointment. If you do find that you can try with your own eggs - I would say go for it! So may of our endocrine problems today are not simply a matter of genetics but are also strongly related to all of the chemical and hormone exposure we encounter in our lives. You'll get a baby sooner or later, one way or another - once you have that baby in your arms, you can work on doing everything you can to minimize and mitigate their exposure to things that can trigger endocrine problems. Good luck!

Kristin said...

Mrs. Spock said it beautifully. All I can add is good luck.

Sara said...

I think about something like this on a daily basis. Not only am I infertile (endo, which is at least partially heritable, and at this point, old-fartiness too, which luckily is not), but I also have another genetic disease that is inherited in a dominant manner (so any biological child of mine has a 50% chance of getting the gene), although the penetrance is incomplete (so having the gene doesn't necessarily mean that you exhibit symptoms of the condition). The thing is, though, that I'm glad that I'm alive too, despite the fact that I have a couple of irritating conditions. I'm glad that my dad chose to have me despite being a carrier of the disease, and I'm glad that my grandmother had him, despite HER being a carrier). And, I already have one bio kid, and words cannot express how glad I am that I had her. I it turns out that she got "the bad gene" we'll deal with it. Really, each of us has some crappy genes somewhere or other in our genome, so I think that we really just have to weigh the good and the bad and hope for the best.

It's a definite consolation prize of using DE, though. It will be a huge relief to know that there is no risk that I will pass down conditions that I know about to my child (although of course there is still the possibility that the screening won't pick up on a disease that the donor carries). Knowing that my own genes are suspect makes it easier to be open-minded about using somebody else's.

Good luck with your appointment!