Obligation to the Public Good

Bravo was at it again: adding to the fertility conversation with good intentions and questionable results. They recently posted an article that appeared in my feed, using Meghan King Edmonds (with the caption, “Meghan was very open about the IVF process.”) to launch a conversation about forty-something fertility and its relationship with IVF. The first problem here is that MKE is in her early thirties and, by all rights, perfectly fertile. She used IVF to conceive with her husband’s frozen sperm post-vasectomy, closing out her highly publicized first round of IVF with a baby girl and two PGS-tested frozen blastocysts. The article itself, however, opens by reminding the reader that “Janet Jackson is pregnant at 50 with her first child.” It subsequently goes on to quote Dr. Jackie of Married to Medicine, who details the increased risks for chromosomal abnormalities, gestational diabetes, and hypertension for women who conceive after 40. Late in the article, she addresses Janet Jackson explicitly, and the vague language annoyed me because it still managed to dance around the likely egg-donor reality:

My guess would be with someone like Janet Jackson going on 50, is that she’s got an egg or sperm and did IVF, or in vitro fertilization,’ she says. ‘That would be my guess for her. That is definitely an option when you talk about somebody in their late 40’s. Early 40’s, there’s a chance that her own eggs could be used and that the baby would be fine chromosomally.

The semantics of “got an egg” irritate me, and I can’t decide if this is deliberately imprecise to obfuscate the truth or if the article is poorly written. Where are they insinuating she “got” this egg?  From a donor? From her own 50-year-old ovary? From a previously stockpiled cryo-stash? (Albeit, we know this would not have been a viable option for Jackson when she was 35 because the advent of vitrification to make egg-freezing possible came years later.) Did the stork bring her this egg? Did she pray to Saint Gerard? I hate this sentence because I believe information is power, and this plays into a myth perpetuated by Hollywood startlets that lulls women into a false sense of security around the timeline of their own natural fertility. For example, my husband and I spent the weekend at the Jersey Shore with our couple-friends, “Maureen” and “Jack,” when I was newly pregnant and so sick that I had no choice but to disclose. Maureen and I were swimming in the ocean when she unloaded on me stories of the relentless pressure Jack’s mother  had been putting on her to have a baby “before it’s too late.” She told me that she was “still not sure” and that “there is a 20% part of [her] that does want to be a mom” but that it just wasn’t feasible at that time in her life because of her highly demanding and financially precarious career in media with its volatile schedule and constant traveling. She is turning 42 this November but nevertheless seemed to believe that she could table the question for now and pick it up again when circumstances became more conducive to family life. I broached the subject of fertility and aging as gently as I could, asking her if the genetic connection was important to her, and she seemed genuinely astonished to learn that 42 is the end of the road for most women using their own eggs. “What about Halle Berry,” she asked. So the kind avoidance I see in this Bravo article, which further publicizes fertility miracles like Jackson’s without taking a hard, honest line on the details of how causes a lot of suffering, and it seems especially cruel since the middle-class women reading Bravo articles likely do not possess the inexhaustible financial arsenal potentially necessary to bring about a child after the decline of natural fertility.

On the other hand, I am not without compassion for these women in the limelight.  The imperative to delay child-bearing often stems directly from the demands of their careers: not unlike my friend, the constant traveling and grueling hours in addition to the chauvinist pressure to look twenty-something and ageless indefinitely in order to keep doing what they love. When they finally do arrive at motherhood, their primary obligation is to the welfare of their own children, as it would be for any of us. Are the means of that child’s conception or the nature of his/her genetic origins fodder for public consumption, where they will be sensationalized and bandied about by media vultures to incite public commentary from every close-minded bigot on social media platforms across the world? I think not. Ultimately, the decision to shroud the details of treatment in secrecy is made by a mom in the interest of her baby. Those motives are sort of universally human, so I cannot condemn them.

As a microcosm of this, a drunk uncle blathered to me at Christmas the remnants of an ongoing conversation surrounding my own pregnancy. One of my nosy aunts, who apparently thinks I am 40 instead of 37, had been jabbering about the “miracle” of conceiving twins at this age. There had been some chatter about risks and conjecture as to whether the babies would turn out to be “healthy” (read: not have Downs Syndrome) despite my advanced maternal age. I was more than a little stunned in the moment, and I don’t know that I fielded these notions as gracefully as I might have given time to c0nstruct a more thoughtful response to the gossip. All I said was, “I am not forty! I am the same age as ::other cousin:: and three years younger than your daughter.” This pivoted the conversation toward my cousin, the hostess, celebrating her 40th birthday, and as the subject moved further and further away while I ruminated some on the issue, it seemed awkward to say anything more about it. What do I wish I said? I’m not sure. Do I tell them that these are IVF twins? I’m certainly not ashamed of that. In fact, I thought it was a well-known fact in my family that I was going through treatments all these years. Do I tell them that I conceived these embryos when I was 35 and they spent two years in a freezer? Do I break out the white board and offer a short mini-lesson on PGS testing so they understand how I have ameliorated the risks of chromosomal abnormalities or how I sought out the care of a great MFM who has done extensive non-invasive screenings to rule out problems in their anatomical development? This seems like a bizarre subject to hash out over vegetable dip and cocktail weenies. And yet, I don’t want my aunt going back to Florida and clucking to all her yenta friends the “miracle” of my “healthy” twins “at 40” because it is a kind of betrayal. The truth is that I started trying to conceive at 30, not because I felt ready (I didn’t) but because I was wary of the biological reality. In that way, the title of this post is a question. I certainly have not helped to spread awareness, but I’m not sure how much of my private life I’m morally obligated to divulge in the interest of the public good.

21 thoughts on “Obligation to the Public Good

  1. What an interesting post. At the heart seems to be the age old battle between physical reality and human perception.

    For instance, at the physical level, biology is just a series of chemical reactions, and so it doesn’t give a damn what we think or how we feel. But people care very much about their feelings. And so you found yourself in the position of kindly and gently presenting some facts to a friend who may one day be very shocked if things don’t dovetail the way she expects them to.

    The question that springs to mind is ‘who is responsible for biological education?’ The government, parents, the medical profession? Or should people find out for themselves? Maybe everyone should play a part? Good sex/reproductive education seems important for teenagers and (to many people’s minds) schools should probably play a part in that. But as a person gets older, should they take more responsibility for their own general knowledge?

    Which comes back to the harsh reality of biology not caring either way! It just does what it does, and doesn’t care whether or not you knew what you were doing!

    Personally, I don’t think there was any harm in giving your friend a helpful hint. It seemed like a good idea at the time. You clearly had her best interests at heart and didn’t want her to suffer through ignorance. But just because you tactfully educated a friend, doesn’t mean that you were morally obliged to reveal very personal medical information with your whole family over eats and treats.

    Spreading awareness (of any issue) is always about timing. Some moments are good and some just aren’t. It is perfectly clear that when the time is a right, you’re prepared to share and educate. That’s the best that anyone can do. 🙂

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    • My friend took it really well, actually. She sort of said that she wasn’t attached to her genes, and we ended up having a conversation about donor embryo. I was just surprised that she was so unaware. She is smart and educated, but she is also part of the New York City crowd, where older moms really seem to outnumber the ones having kids in their twenties. It’s easy to believe in the false timeline when that is your environment.

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  2. I feel like I’m done sharing my private life and people can go be their selfish clueless selves, because they will anyways.

    I got reamed out a couple weeks ago about “trying to make people feel guilty about having healthy kids” when I disagreed with her about nurses being required to get flu shots. My brother and SIL just exposed my kids plus my sick mom to hand foot and mouth because staying home on a holiday is just tragic. And they’re about to have a pre-term baby because .. I don’t fucking know why, but hey it’s close enough to term so it’s all fine they say in front of my 36w3d twins who spent 2 weeks in the hospital.

    If people want to think they can have babies until they’re 60, let them. They won’t change their minds anyways unless they find out the hard way for themselves.

    (Sorry, I’m bitter and fed up with people.)

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    • I do think it’s sort of strange that so many people are so naive on this issue. I remember being keenly aware of 35 as the magic number long before I ever struggled. As adults, I guess it really is their own responsibility to know, but where is this rampant misinformation coming from?

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  3. These are such challenging and complex questions – and you’ve nailed many of the issues squarely – and such a surreal tightrope walk for each of us to navigate. I have a diversity of thoughts and a hot mess of feelings about this subject – these subjects really because you’ve raised several – myself. And no clear answers of what’s right, only some fiercely protective emotions and a boat load of compassion for the Halle Bs and the Janet Js of the world. Why is it our right to rob them of the privacy they and more importantly their children deserve no less than does mine? I have told two people I trust to keep quiet that I used a donor egg to create baby A. Two. Am I ashamed of that? Nope. Do I plan to tell my children? Yes. Do I think after doing that it’s my responsibility to tell anyone else? No. I tell people we used IVF whenever the issue of my recurrent losses comes up and I feel like it. Do I think I have an obligation to do that? No. Do I think my occasional (and sometimes persistent) silence helps perpetuate false beliefs among post-40 women? Maybe. Do I care about that more than my child’s privacy. Not one fucking bit. And as long as any other mother feels as I do there may yet be articles like the one you reference. And in my view, that’s better than outing people who have no less a right to let their donor-conceived children decide when and if and who gets to know. The misogyny that runs deep in our society and fuels your friend’s ignorance is beyond regrettable. It’s a horrid offence against humanity. If we could make some headway there (gah – I had a flash to that teenage shit in your class calling you fat when pregnant with twins just now; things are so clearly not getting better) maybe in time this conversation would be moot. For your daughters’ and my sons’ sake I would love to see that happen. But as I see it the fertility and donor products industries have a vested interest in keeping the lies alive. I think it’s part of why so many REs are misogynist slugs.

    Sorry. Rant over. Next time I’ll try telling you what I really think. (Clearly these are triggering subjects for me, huh?).

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    • If I had a child via DE, this would almost not even be a question. When we pursued that failed cycle in Czech, DH and I agreed that any resulting child would be the first person to know his origins and would subsequently control who else was privy to that information. That is such a delicate thing that I totally understand your position.

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  4. Another wonderful post. I struggle with this—one part of me yearning to write, speak, destigmatize, educate, the other part trying to learn how to cultivate privacy, which can be a source of personal healing. I think of the phrase “speak out” often these days (re: a number of issues, not just this) and how I admire and appreciate those who do. But I remind myself that I don’t have to speak out–I get this itchy urgent feeling that tells me to write essays and articles now, send them out for publication…but it’s only once I’ve started a piece that I realize how raw I still am. I wrote one thing that got some interest at a women’s mag—a how-to kinda thing, how to talk to friends/fam who have gone through infertility and loss, informed by my personal experience and my psychology background—but the editor pushed for a personal memoiry essay instead. And I realized that I didn’t know how to write that for a general audience yet and, more importantly, didn’t want to. But at first I was torn. I knew how helpful such pieces were for me, not too long ago. But I didn’t want 2 million readers to know my pain, no matter how helpful, or educational, it could be. Anyway…the part you wrote about giving mini-lessons over treats–wow, yes! That brought back a flood of frustrating, awkward moments. I sometimes wished I could just hand people a pamphlet with succinct explanations inside–“hey, could you take five to read this and then we’ll resume our conversation?” But more often we are simply left feeling unfulfilled, quizzical, wondering how to be, when to be what, say what. Once S turns 3, I goes we will start to introduce the DE aspect of his conception, and then we can be more open about it generally—Im not looking forward to that, actually. For me it’s just that I find parenting in general to be so challenging—I’ve lucked out and my son is this gentle, good-natured wonder, but the hard part is ME. I’m not really those things. I often feel quite messy. So just figuring out how to be a good mama—not just loving and kind (that’s the easy part) but in control of my emotions with others while around him, learning how to take care of myself, etc—is already so much to process that I’m intimidated by adding this other layer to our relationship and to my role as a mother (which is already plenty layered!). But it’ll unfold as it should–I’ll learn how to guide it. And when it comes time to have the conversations with other adults in our lives about DE, I’ll develop some way of educating gently, I hope.

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    • I can see that: the privacy being healing, the wanting to blend and claim some normalcy for once after everything has been so unusually complicated. This was likely part of my hesitation. It was so nice to bask in all the regular-person’s excitement about new babies when seeing extended family for the first time in awhile. And I really connect with this part of your comment: “But more often we are simply left feeling unfulfilled, quizzical, wondering how to be, when to be what, say what.” There’s this whole other side of me that acquired a vast education in treatment, who writes a blog to advocate on behalf of this cause and give voice to the inherent problems in presents, but when is it appropriate to show that face? It felt awkward and strange in that particular moment, so I guess it’s just a process of trusting one’s instincts.

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  5. Phew. Yes, this is a tough one.
    While I’m always annoyed when friends only reveal their problems conceiving after the miracle pregnancy, I wasn’t really any better… I think biological limitations should be as much part of sex ed as the possibility to get pregnant.
    Side note: in Europe, Bravo is a magazine for teens tackling questions like “can I get pregnant from oral sex?” (and not shy about the answers).

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    • Ha, that is funny. Our Bravo is an obnoxious TV network of sensationalized reality shows that feign honesty but portray a loud and contrived rich people’s alternate reality.

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  6. As far as obligation, I think your blog does plenty for the public. There are families who live for the opportunity to take whatever a person divulges and play with it, juggle it, reshape it, mash it, bend it, and cook it until it resembles nothing they were given, but gives the one who offered it heartache. Avoidance is the only available strategy, but, as you know, there is no free lunch, since they will talk about your avoidance. The baby is coming no matter what the craziness is in the family, so that is good. When the next New Year after this one comes, new life!

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  7. I love this post. It’s that constant struggle of infertility — weighing out your privacy and that of your future child with educating on the reality of fertility. I don’t think it’s any one person’s responsibility to be that voice of education and bubble-popping, and you can pick and choose when you say something and how specific you are to your own situation. I loved this sentence, “This seems like a bizarre subject to hash out over vegetable dip and cocktail weenies.” I think there are some circumstances where you could educate incredibly intelligently and the people just won’t care or hang on to the bits that count. I felt for your friend, betrayed by Halle Berry and the endless swarms of mid-forties celebrities having babies, but I also get what you said — being so much in the public eye, maybe their silence is less about perpetuating a myth and more about protecting their family from the snares of the internet trolls and the public evil eye. Interesting food for thought. I started trying at 33, and so was not “advanced maternal age” at the start either, and was shocked when I got slapped with that label at 35 when 40+ women (real ones, that I knew) were having babies, and still have some level of disbelief that it just never happened for us. Such a thought-provoking post, thank you for the brain food and discussion!

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    • I like your insight about knowing the audience and the fact that some people, even given intelligent explanation, don’t come away any more educated. I honestly would have had to start at the very beginning with them and explain what IVF is. To try to expand on that to include cryopreservation and PGS and why it’s relevant to her gossip…sheesh, not on Christmas. Lol

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  8. I love this post, and agree with so much of what you’re saying, and understand your dilemma too. I always feel we should share only when we feel strong enough to do so, and when we feel it will be received well. It’s not a matter of being ashamed, but a matter of self-protection, I always think. I am much more likely to impart generic information – along the lines of statistics etc – if I don’t want to share my own private history.

    I’m equally frustrated with poor quality reporting and writing about reproductive technology. …”got an egg” is horrible writing too! It hasn’t improved much, if at all, in the last twenty or thirty years either, and I find that very frustrating.

    I think you were wise to gently inform your 42 year old friend about genetic and ageing issues, and I know you did it tactfully. In my volunteer days, I also had cause to point out biological changes to a woman who was trying to conceive naturally at 44 or 45, and kept referring to the fact that she only looked 30! But I also point things out to 20 or 30-somethings, as they are the ones who can do something with the information we give them. Whereas your drunk uncle and nosy aunt won’t.

    I had to laugh too, thinking about your nosy aunt figuring it all out when you turn 40 in a few years! If I were you, and saw her in the meantime, I think I’d allude to the conversation too. But on your terms.

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    • I guess the best thing to shut down my aunt’s gossip is to give birth, so that conundrum has a natural expiration date. I tend to agree, though, that a comprehensive discussion of fertility rather than just puberty and contraception are important topics for the unit in high school health class.

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  9. Ah so interesting. Sorry that you were put in the position of responding to awkward assumptions and statements. As for “responsibility to educate,” or to be educated about fertility, I think it comes down to whether there are is a critical mass of people facing fertility issues. I read many bloggers who say they feel like outliers (I.e. surrounded by fertile people who don’t really get it). That’s one reality. Mine is different: few friends/family have children, and those who said they did often married late. When you have enough people who are affected by something the questions are going to be asked, the issue is going to be raised. There’s a limit to how much can be concealed. I don’t know for sure if that shift is happening, but I think it quite likely. And hopefully it will mean more people talking about fertility. The sad part is that it will be because more people are struggling.

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    • Yeah, I mean the fact that Bravo has repeatedly picked up this issue sort of serves as evidence that (sadly) more people are facing this and demanding more conversation about it. I’m still just stunned at how many regular people think there is “plenty of time!” People said that to me again and again when I grudgingly got started right after the wedding and my reaction was like, “um, no, it’s safest to have all your children before 35, so if I want two…” Famous last words.

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      • Yes. The other common mistake is that fertility is somehow hereditary: I.e. if your mother had kids when older or aunt or sister or whatever than things are probably ok, whereas as far as I know very few fertility issues are inherited.

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