The Trials of a Fertility Doctor

• Author: Elizabeth Kennard Md.
• Pages: 105-108

Page 105

Having a baby used to be a simple idea. Two people, a husband and a wife, voila-a baby. Today, as you are already aware, we can now have as many as five individuals involved in creating and parenting a child. An egg donor, a sperm donor, a surrogate mother and adoptive parents. There may be only one parent. There may be 2 parents of the same gender. This "fission" of a process which use to be obvious and simple has created unique ethical and legal issues.

I have enjoyed listening to the presentations this morning and appreciate being asked to contribute to this seminar. My role is that of practitioner. My day to day work involves reconciling the moral/ethical issues that technology has created for us. Today I hope to give you an idea of some of the challenges we face in the field.

One of the practical problems is that success rates are not what we would like. As Professor Momeyer stated, 75% of embryos which form naturally do not implant. That means, that no matter what I do as the physician, I will probably not ever be able to get an implantation rate of even 50%. This is not what the public expects and may not be what many in this audience may have experienced which they started attempting to have children. An unintended and perhaps unavoidable side effect of extensive public education regarding the need to prevent unplanned pregnancies has occurred. People think they are in control of when they will get pregnant. Most people are not. Most people believe that if they count back 9 months from when they would like to have the baby and throw away the contraception, then it will result in a delivery 40 weeks later. People are shocked when it usually results in menses 4 weeks later.

Furthermore, success rates at achieving pregnancy heavily depend on the age of the oocytes. Females form their oocytes in utero, unlike men who form new sperm constantly. Women are born with all our oocytes, indeed, we've lost many prior to birth. The fact that reproduction becomes more difficult with age is something many people are shocked to discover. I'm not sure we want to risk changing our public health message regarding contraception since unplanned pregnancy is such a huge problem in this country. However, I am sure that young women are not clearly aware that their fecundity, their ability to conceive, drops rapidly after 35, and that pregnancy after 40 is possible, but unlikely. I suggest that there must be some way to effectively educate the...