The New York Times and Stephanie Saul: Infertility! Twins! Danger!

Getting beyond the fact that I usually start twitching when someone sends me something from the New York Times, all the more violently when the byline comes from Stephanie Saul who insists that it's a good idea to use the wrong terminology when discussing fertility treatments, I couldn't help but read the series of articles about multiple births and fertility treatments. Unlike others, I did not bother to click on the accompanying comments because I am familiar enough with the New York Times to know that nothing good can come of reading the opinions of people who see nothing wrong with the fact that their newspaper is wrongly using the term implant in regards to embryos.

You can't argue with the meat of the articles, the first of which can be boiled down to the thesis that multiples increase the risk of prematurity, and therefore, protocols should be in place to discourage practices that would lead to a higher chance of multiples. A pretty sound idea. The second article covers the topic of selective reduction and how IUIs lead to higher order multiples because there is less control than IVF. Again, no one can dispute that fact. A third roundtable discussion covers again the problem with multiple births.

Of course these articles were of interest to me as a mother of twins who were conceived with the help of fertility treatments. They were delivered seven weeks prematurely when they stopped growing in-utero and there was deeply discordant growth. They spent three weeks in the NICU and have been generally healthy with some lingering problems of prematurity. Obviously, I'm one of the target audiences for these articles and you would think that I would have nodded my head a bit more since they do bring up tangentially ideas that I firmly believe.

But the problem begins with the fact that Saul never convinces me that she wants to hold a frank discussion, working together via journalism to solve the problem of multiple births and prematurity in regards to fertility treatments. Instead, the language used, the stories told, and the facts addressed all point to the fact that Saul never closely examines the solutions, instead choosing to only address the problems--and missing the point entirely in the process.

Instead of focusing on reasons why people would risk the transfer of multiple embryos, practicing sound journalism where she would interview numerous subjects and utilize their words to present the story, Saul jumps to conclusions: "patients are eager for children" and they want "to be successful on the first try." But rather than state the real reason why women wouldn't want to undergo more fertility treatments than necessary--money and physical pain--time is given as a factor.

Anyone who has paid out of pocket for a chance to conceive knows that there are two main reasons why people take risks with treatments and they are very closely aligned to the reason why people take risks with any medical treatment--especially one that is tied to quality of life. First and foremost, the exorbitant cost of treatments--mostly uncovered by insurance--goes towards a chance rather than a child. Few have the ability to do treatments until they work. Most need to take risks in order to feasibly pay the high price of family building (and for the love, before you suggest adoption, please first understand the cost of adoption and why it isn't a solution to infertility but instead a wonderful, separate family building option).

Secondly, anyone who has been on the receiving end of a needle knows that you try to complete as few cycles as possible to conceive both due to the physical discomfort associated with treatments as well as the overall health risks that can come from doing treatments. There are times when the risks of prematurity and multiples balances out the risks of doing multiple treatments for both the woman's mental and physical health.

Saul reveals her bias early on (as if she hasn't already done so in the past with her other articles concerning infertility), calling it the "fertility industry," a term used by others to greater impact because it is backed by ideas rather than used unsupported as a slur. We don't call it the cancer industry, implying that people are being churned through like cans of creamed corn or automobile parts. We don't imply that people are being moved through the medical factories mindlessly like just another object if they treat a health issue such as breast cancer. We don't call it the obstetric industry even though we all know the statistics on unnecessary c-sections. The term is as paternalistic as the practices the terms evokes, as if women and men do not have the mental capacity to think for themselves and be careful health consumers.

One of the real financial problems of infertility and prematurity was barely addressed at all in the articles and it serves as the white elephant in the room: if insurance companies covered the cost of treatments, they would save on the back-end in the cost of NICU stays. You would get more people to accept eSET (elective single embryo transfer) or to cancel IUI cycles when too many follicles are made if they knew that they had another chance financial-wise to cycle again.

This has long been the point made by Resolve, the national infertility organization aimed at providing infertility education, lobbying lawmakers, and extending support to those experiencing infertility. It's an organization that has been working hard for actual change as America reexamines health care, lobbying lawmakers for support of two bills that would require insurance companies to cover fertility treatments. In other words, it is asking America to put their money where their mouth is--either we value the health of women and children and want them to make sound decisions about family building or we don't. Either we believe that family building is an important endeavour or we don't.

It is a bit disturbing that an organization that has been at the forefront of infertility education wasn't quoted in the article. She refers to the fertility industry, yet never ventures outside of a small circle of "factory owners" to broach those who would receive no financial gain or loss by having changes to treatment protocols.

And for the love, it is a fertility doctor--Robert Stillman--who brings actual sense to this discussion with his participation in the treatment roundtable, giving concrete steps one could take to solve the problem rather than stand in the wings like Stephanie Saul, starting the horror movie music in the background as she writes such fear-inducing lines such as "an exploration of the fertility industry reveals that the success comes with a price."

She takes extreme examples--a woman with two follicles that split into sextuplets (seriously, Saul, I thought I was going to go into convulsions from your misuse of implant and transfer, but when you stated that the doctor saw "two developing eggs" on the ultrasound screen, I think I literally started foaming at the mouth)--a situation that the doctor had never seen in 30 years of practice--and hold it up as your IUI example. It would be like examining IVF solely through the lens of Nadya Suleman--which...er...I forgot...you already did that a few months ago.

Saul's sole mention of the solution is buried towards the bottom of the first article: create programs that make it financially feasible to perform single embryo transfers. And instead of exploring that option in the second article, Saul chooses to wax on about the dangers of IUI, instead pointing out how much more controlled IVF is (and it is, but that never was made clear in Saul's first article) in terms of limiting multiples. She gives solutions short-shrift. Which makes me question the point of these articles. Is it to raise questions that require answers? Push society to examine where we place family building on our emotional continuum? Seek solutions to what she deems a pressing enough problem to warrant multiple articles?

At the end of the day, it comes down to money and overall health--physically and emotionally. Make treatments financially feasible and people would make different decisions. Create programs where embryo freezing is free for those who elect to transfer one embryo and you'd have more people take advantage of the program. Make future transfers free as well and you'd have incentive to lean towards eSET over multiple embryos, especially when drug intake in future cycles can be curbed.

When I taught eighth grade and my students would negate their own thesis within the paper, I would circle the sloppy writing and point out the mistake and send back the assignment to be rewritten. And it sort of sucks that I'm not Stephanie Saul's teacher because I would have given her a second chance to make a strong case. And as is, the New York Times again is the proprietor of what essentially amounts to verbal Wonder Bread--no substance, no mental nutrition, and mostly air taking up valuable space that could have been filled with useful argument.

Others twitching over Saul's articles:

A Little Pregnant unfortunately read the comments, but still was able to get off the floor and respond to Saul's articles as well as the roundtable discussion.

Tubeless in Seattle, normally a supporter of health articles in the Times stated that she and her husband were "indignant at the tone of the article and incredulous over the claims it makes."

Our Stork Isn't Great with Directions points out what is missing in these articles.

Melissa is the author of the infertility and pregnancy loss blog, Stirrup Queens and Sperm Palace Jesters. She keeps a categorized blogroll of over 2000 infertility blogs and writes the daily Lost and Found and Connections Abound, a news source for the infertility blogosphere. Her infertility book, Navigating the Land of If, is currently on bookshelves (May, 2009). She also runs Blogger Bingo--an online cross-community game.