I know how devastating IVF ruling is
Almost exactly one year ago, I was driving down Interstate 57 with my sibling and my mother in the car, naming embryos. “Lucretia!” shouted my sibling. “Golbi!” I announced. “Ooh, that’s a good gender-neutral one!” said my sibling, who is non-binary. “I like Julian,” added my mother, from the backseat. “We have 53 to go!” I laughed, as we drove from the University of Chicago, where I was in my final year of residency in Obstetrics and Gynecology, to the University of Illinois, where my sibling was getting their diploma in Social Work.
I knew there were “53” because that morning, I had sat in the ultrasound suite where a technologist used a vaginal probe to count my ovary’s follicles. The egg extraction would be in the next couple of days, with immediate fertilization using my husband’s sperm. I was young (32) and healthy — but I carry the BRCA2 gene, a genetic marker that increases my lifetime risk of breast cancer to about 70% (in non-carriers, it is about 13%). I am also at increased risk for ovarian, pancreatic and skin cancer. The purpose of freezing embryos was not confronting infertility, but rather so that we could identify which ones did not have the gene.
Last month, the Alabama Supreme Court ruled that frozen embryos are “extrauterine children.” This case will be used to further limit access to abortion, which is already in a state of emergency, and will deter patients with infertility from seeking and receiving medical care. The University of Alabama has since paused IVF treatments. The field of infertility is already racially and socially imbalanced; it will only get worse.
I know this as an OB-GYN and an IVF patient myself. And now that I am undergoing treatment for breast cancer, the implications of this ruling have hit me harder.
Last year, when I had my eggs frozen, IVF solved a medical problem that loomed but hadn’t yet hit. My final embryo report was
striking: just six of 27 total embryos were without the BRCA gene, but we got the report for all of them. One stood out because it had 50 chromosomes. When we looked up which organisms have 50 chromosomes, the list included the pineapple, which became my family’s stand-in name for this entire stressful process.
Last year, when I had my eggs frozen, IVF solved a medical problem that loomed but hadn’t yet hit. My final embryo report was striking: just six of 27 total embryos were without the BRCA gene.
Our inside jokes and the discomfort continued in the background hum of life as my husband and I moved back to my hometown of New York City and got married. I started my first job as an attending physician. Thoughts of family-building and its ramifications could wait while we enjoyed autumn on the Upper West Side.
Then, on Christmas Eve last year, I felt the lump. Here is the blessing and the
curse of my medical training: I knew. I knew as soon as I felt the thing, in the shower. The way you recognize your mother’s footfalls in another part of the house though you cannot see them, cannot even really hear them, but rather feel them, and know that they belong to her.
One month later I was on the operating room table. I am 33 years old.
I cannot tell you what percentage of the conversations surrounding my breast cancer have been about my future children, but I can tell you it has been high. My first, immediate realization was that I would never breastfeed. Later I heard a collective, enormous sigh of relief from each and every one of my doctors when they discovered that I had already frozen embryos.
Then, the discussions of when and how. Chemotherapy is not kind to ovaries. I would be getting an ovarian suppressant during chemotherapy to put me into chemical menopause. This serves two purposes:
to protect my young, active ovaries from the toxic medications, and also to starve any remaining cancer cells of estrogen. We would double down on that starvation after chemotherapy, adding a second agent to zap any remaining estrogen from the fat and liver cells in my body.
Then, after two years of menopause, I could take a breather and try to get pregnant with my überkinder. See if the pipes still work.
Some women delay their cancer treatment in order to harvest their eggs. That I was not faced with that choice is a blessing for which I do not have words. Now in Alabama, and potentially elsewhere, depending how other states respond, some parents won’t be able to freeze their eggs at all.
I wanted to spare future children a lifetime of scans, anxiety and possibly cancer. If this sounds callous, I agree with you. I have always felt an unease with this aspect of current medical technology. I hid
this unease with humor, referring to the embryos as überkinder, to winkingly highlight my understanding of how close we are to hand-picking and choosing our children’s fates. I asked relatives and friends how they would choose the sex of their future babies — all to spread my discomfort with the decision I made about a family I do not yet have in a field of medicine that I myself practice. But I know I don’t want any court to condemn my future children to the same experience as I’m going through right now.
My parents come over to our apartment and cook me oatmeal because it’s all I can tolerate in the mornings. My mom makes a design using chocolate sauce, just like she used to when I was 9. When she hands me the bowl and smiles, there is terror in her eyes instead of maternal cheer. Would the Alabama Supreme Court condemn me to the same terror? Must I watch my children suffer, when I have the means, unlike my mother, to protect
them from at least this form of suffering? The implications of this are sickening regardless of my current medical state, but as I shake through my chemotherapy session, I cannot help but feel an even deeper rage.
Cancer should not have to be the silver bullet by which these arguments are won. I am first and foremost an abortion activist. But I am also a young cancer patient. To force me to implant an embryo that might develop the same cancer that is currently ravaging my body would be an act so cruel, it leaves me with only one conclusion about the decision of the Alabama Supreme Court: It is not about life, religion, children or murder. It is about hatred for the female body and the need to exert control over it.