Q from U: Philosophical questions about IVF

June 15, 2014Carole 4 Comments »

The other day I received an email from a patient who wanted to understand what it feels like emotionally to be an embryologist. I thought her questions were interesting and ones that most people in this field probably think about at one time or another – or obsess about always. First, I preface my answers by saying, that I am one of thousands of embryologists and there are probably almost as many answers to these types of questions as there are people who think about them and I don’t pretend to speak for every embryologist. As usual, I can only share my own thoughts, opinions and experiences. The questions are in bolded italics below.

Q. I find this process mind-boggling and amazing. I totally get that a process which is magical, stressful, and suspenseful for patients is routine for embryologists. But I’m curious if you/your team maintains a reverence for the work, or if you strive to remove yourselves from the human aspect.Like, do you note the names on the dishes and ever wonder about the hopeful intended parents, especially when you see the same names repeatedly, making multiple attempts?
A: For me, I tried to stay focused on the technical details when I was working. Considering the emotional context- the implications- of the routine work too much is a dangerous distraction and more likely to make you miss a step, drop something or forget to do something which is going to harm the very people you are emotionally worried about. When I saw the same names again and again, I usually had some back story from the nurses which made the patients even more real than just a name on a plate- and it was more likely that I might actually have met the patient before so yes, of course, it becomes less a puzzle to solve as a obligation to deliver results.
Q.When selecting embryos for transfer, do you ever have feelings of “playing God” and wondering whether the selected potential life will be a “better” human being someday than the one that isn’t selected?
A: For me, it was about, which of these embryos has the best chance to make it, period. You always choose for implantation potential based on any data you have about the embryos (appearance, progression in culture, genetic results, gender preference of parents etc). If the embryo doesn’t implant, the rest of your musings are pointless. Never felt like I was “playing God”- not that naive. 🙂 There are plenty of steps after my role that have to go right to make a healthy live birth. Embryologists just get the process going, facilitate or help nature;  they don’t determine the end result.
Q. When you discard the embryos that don’t make it, does it feel like a different kind of loss than if you were working with cell culture in some other format?
A. Yes, there is always a twinge of “what if”. Some embryologists, feel compelled to leave the human IVF field because they are so troubled about having to follow patients’ directions to discard embryos, or more troubling, clinic policy to discard when the patient abandons the embryo(s) and does not provide a directive for disposition. This emotional distress about discarding embryos that many embryologists feel to some extent may be due to religious reasons or simply the feeling of disappointment that not all embryos that might have the potential to implant are given the chance. Some embryologists deal with this emotional dilemma by enthusiastically supporting  and encouraging embryo donation from one patient to another. For me, I never felt that what I wanted for other people was relevant. I didn’t feel it was my right to tell others how to have or not have children. Every child should be wanted, but that doesn’t mean that every embryo must be given the chance to implant. In my opinion, that is up to the intended parents, not the medical staff that facilitate family building.
Q. When we got transfer results, we were told that our embryos are in Tray #7. Does the team keep all embryos from a single patient together, or is there an effort to distribute them somehow so the risk of tray damage (like from a tray being dropped) is distributed?
A. This is a policy matter that varies between clinics. I have worked in clinics were we had many multiple dishes for a case. In other clinics, we had one or two dishes that held all the patient’s embryos. There are arguments pro and con for each approach. If you distribute the embryos for a case into multiple dishes (or trays) , you have some insurance against total disaster in case one dish (or tray) holding everything gets dropped. However, multiple dishes mean more manipulations for each case, which arguably drives up the chance of a technical mistake. With more dishes in a single case, you will have to open the incubator door more times and may have the dishes out longer to perform the manipulations on the embryos across multiple dishes, which also increases the time outside the ideal environment that is the incubator. Over time, I have come to the conclusion, that less is more and so minimize the dishes needed for each case.
Q. Does your work affect how you feel about parenting? Does knowing how hard it can be to conceive life make you more appreciative of it, and less tolerant of child abuse or neglect?
A. I already had one child and was pregnant with my second when I started working in IVF so I already had very real experiences with parenting so I don’t think caring for embryos made that any more meaningful at that point. I did sometimes feel guilty about being pregnant in front of patients, especially since I’d never experienced infertility in my own life. I knew I was lucky in that respect and never took my fertility for granted. I don’t equate embryos with living breathing children. Not all embryos will implant and result in a child, even if given every opportunity to do so. I think my intolerance for child abuse or neglect rises out of my humanity, not my embryology experience.

© 2014, Carole. All rights reserved.

4 Responses to this entry

  • It Is What It Is Says:

    As always, I appreciate your thoughtful candid responses. This was a very interesting Q&A (not what I expected from just reading the title of the post) and I’m about to share the link on FB.

  • Smith Shah Says:

    Emotional bursts would always be there. Additionally, there is a medical skill and indeed god’s grace that stands apart with a successful result!

  • Tamara Says:

    Hello Carole,

    Thanks for your invaluable insight into issues raised on assisted conception.

    My husband has extremely low sperm count, (1.8ml, at the last count). We are interested in ttc via ivf. Do you think male fertility supplements would improve his sperm count? I have read up on male fertility supplements and there are quite a few available. ProXeed for e.g. I am thinking of buying 3 months supply for DH, ahead of ivf cycle, do you think this will help?

  • Carole Says:

    Hi Tamara,
    I addressed this question in an earlier post: http://fertilitylabinsider.com/2015/01/can-supplements-really-improve-sperm-quality/ I hope it is helpful. I would recommend that your husband see a physician who is board certified in male infertility. Usually these are urologists who decide to specialize in infertility. A good diagnostic work up would ask questions about his exposures at home and work, medications he is taking and other factors (varicocele) that could play a role. There might be adjustments/treatments/surgery that might improve his count, depending on what is found. Here’s an article about medications that can decrease sperm quality http://fertilitylabinsider.com/2011/10/medications-that-can-impair-sperm-quality-and-fertility/
    Good Luck!! Carole

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