There are a couple of tabs that have been open on my computer for a very long time as I’ve tried to find the time to produce a post worthy of them. There’s this–an article by Judith Shulevitz that appeared in the New Republic–and then this–and interview by Terry Gross with Shulevitz. I came across the second first because I’m a huge Terry gross fan and try to listen to Fresh Air regularly. If you do the gym or you’re out for a walk or whatever, you should really try to take the time to listen.
Shulevitz makes a number of points that a worthy of discussion here and that’s really what’s hung me up. It’s the picking and choosing. But time is so hard to find these days that I’m just going to plunge ahead here, accepting that I will probably skip as much of interest as I’ll comment on. And worst of all, by now I’m working from distant memory of the interview which has become mingled with my own thoughts about it. All of which is by way of a caveat or an apology, but here goes. In this post I’ll make two points leaving a third for later.
Towards the beginning Shulevitz notes that most of the solid information about the results of various forms of ART are from studies outside the US. This is because there is no systematic record-keeping for ART in the US while other countries–particularly those with some form of nationalized health-care–do tend to keep those sorts of records. Actually, we don’t have that much centralized medical statistics keeping in the US generally, so this shouldn’t be so surprising. But it is nonetheless striking to me.
Think for a moment about how the ART and medical industry is organized in this country. A person might get sperm from one place and take it to a fertility specialist in another. If pregnancy results she will then go to an OB/GYN or a midwife. The sperm bank may never know that a pregnancy resulted. And while the fertility specialist probably does know there was a pregnancy, she or he may never know what the outcome of the pregnancy is. Similarly, while the OB/GYN or midwife will know that there was a live birth, she or he may not know anything about how the child was faring a year or two or five after the birth. In the end some information is simply lost (the success rate of the sperm bank, say) and some is impossible to connect up (outcomes with various actions).
By contrast in countries with national health and electronic medical records (think Austrailia, UK, etc.) this information is all collected just as a part of providing the medical care. Thus, it is possible for researchers to crunch the data from there in ways that simply cannot be done here. It’s possible to do studies here, but it means starting by figuring out ways to collect the data. (As I recall, Shulevitz goes on to advocate for a bit more systematic collection of data about the whole ART process and this seems to me like a very sound idea.)
The second striking point Shulevitz makes is that there is increasing evidence that the age of the gamete providers matters to the well-being of the child–and not just the age of the female/egg provider. Apparently it is increasingly accepted that sperm and eggs from older people are more likely to carry with them complicated factors for children conceived using that sperm.
Now I don’t think it is actually the age of the people who produced the gametes that really matters. What I really think she means is that it is the age at which the gametes are produced that matters. So if a woman produces eggs at twenty-five and they are then frozen until she is forty, the fact that she is forty isn’t the critical thing. The eggs (assuming there aren’t storage issues) are from a twenty five year-old.
Surely if women wish to wait until their late thirties to have kids (and there’s some really interesting stuff about this–but it will wait till tomorrow), it would be wiser to freeze their eggs early on so that when they are forty they have access to those eggs from their twenty-five-year old selves. And the same would be true for men. (I’d assume, by the way, that typically when women wait until late thirties or so to have kids, men are often in that same age bracket.) Thus, although I don’t think this is what Shulevitz discusses, emerging concerns about the effects of older gametes could well lead to a bonanza for those in the gamete freezing line.
I’ll stop there–because the third thing I wanted to comment on will take a bit of time to formulate and this is long enough. Meantime, the interview is really worth a listen if you have the time.