On the Radio and in the Magazines–The Grayest Generation

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.

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8 responses to “On the Radio and in the Magazines–The Grayest Generation

  1. Oh they want you to give them your gametes to freeze. Its a bank not a storage facility. When I put my money in a bank what do they do with it? They invest my money to make more money for themselves. I don’t know what they do with it specifically so long as I can get back what I put in. All money looks the same to me. Is it the same $5 bill I gave them? No, its another $5 bill but it will work just the same. I can still buy something with it. Its not the one I gave them but I still get the desired outcome which is functional money.

    Gee I wonder what they will do with all that eggs and sperm that is more valuable than gold and impossible to keep track of unless we dna test every child born at birth against the people claiming to be parents. hmmm. hmmm.

    • It’s more like the $5 bill your grandmother gave you when you were six with a loving message written on it. Just like every other note, but utterly personal and meaningful just to you.

      And yeah, how on earth would you put controls in place to ensure that the gametes belonged to the right people.

      • bingo last sentence. They don’t care and they know that nobody will be able to tell the difference at least until its far to late to do anything about it. A child has to be born before a person would begin to wonder that the child was someone else’s offspring. And then what could anyone really do? They are using healthy gametes frozen now for sure, selling them taking them and then they’ll give people healthy frozen gametes back for sure they just won’t be their healthy frozen gametes.

        • it’s me marilynn ballpark is just a thing from when I was a tough girl on the construction team of a new baseball stadium I typed it by mistake.

        • There are actually very sophisticated controls–all sorts of matching/tracking stuff. It’s not just sitting on shelves in unlabelled jars. People sign their own samples and then they match signatures and so on. I’d be unsuprised if in the future you see them offer DNA testing to confirm as it’s becoming cheaper and cheaper.

          I think we can all agree that tracking systems are necessary. But let’s assume for a moment you have them–is this trend a good idea? What do we make of it?

    • I’m not quite as cynical as you are but it’s not like I think this is altruistic behavior. It seems clear to me that offering people the opportunity to freeze their own gametes for their own use opens a whole new market to clinics/banks. People who would never be providers for others might be willing to pay to have their own stuff frozen. The ability to offer this service and exploit the market demand depends on your ability to track the materials and I think many clinics do have very sophisticated tracking systems. I don’t know if you’ve really looked at what the best practices are, but I don’t think you’d find the abuses you’re worried about.

      I don’t mean that there aren’t less reliable clinics/banks. Of course there are. And if I were going to do this I’d want to choose carefully. But you are, I think, painting with far too broad a brush. The interest of clinics here is not only to have more gametes to sell–they want to bring a whole new clientele in the door.

  2. Despite what it says in the article, it’s only recently that they discovered techniques for freezing eggs that are reasonably reliable. So you might freeze eggs, then discover they are unusable upon defrosting, in the same way that a proportion of frozen embryos are unusable.

    In the UK paternal age is going up too (finally – as a counterbalance to all the news articles exhorting ‘women’ to have children younger – as if we manage this stuff all on our own and are just being awkward). Seems to me that men are also choosing to delay, and this is a decision that couples make together.

    The 20s is not ‘dead time’ – I’m not sure where she gets that idea from – surely finishing your education, paying off debts in a bad job, working your way up, is pretty traditional for that part of your life where you’re building the groundwork for your career.

    http://www.bbc.co.uk/news/health-21197679

    • I keep meaning to come back here with another post. If egg freezing proves to me reliable (and I suspect it will become more and more reliable as they work out the kinks) then I bet more and more young women will freeze their eggs–particularly young women on career tracks. As most careers are structured, you cannot take the time in your 20s to raise kids.

      I worry a little that the idea that women can now choose to delay parenthood while they build their careers is deceptive. For many young women there isn’t a choice–you have to delay parenthood or it shows you’re not serious about your career. That’s an idea I’m planning to write about more in a future post.

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