Time Magazine and the Impending Twin-pocalypse

An April 16 Time magazine article, “The Problem With America’s Twin Epidemic,” by Sarah Elizabeth Richards, had me nervously looking left and right for a raging epidemic of twins spawned by in vitro fertilization (IVF). Like a paired zombie horde, they would shamble across the nation, incurring unnecessary medical costs and slowly taking over.

And who is to blame for this fearsome future? None other than the irresponsible, selfish and short-sighted couples using in vitro fertilization to create their own insta-families. If any of this sounds familiar, that’s because it’s old news. The topic was covered using most of the same data back in 2010 in BJOG, in 2011 on NPR, WebMd (now in archive) and Fox News among others.

But hey, it’s never too late to drag out 6 year old data and cobble it onto selectively chosen newer info to get everyone’s panties in a bunch. Never mind that the problem being showcased is in the process of resolving.

The article marginalizes, and dismisses parents who gave birth to multiples using IVF, while selectively using data to make the point that these parents selfishly choose an expensive and dangerous route for themselves because apparently it’s easier.

Let’s look at the article point by point. The negativity starts in the sub headline:

Americans undergoing fertility treatments have gotten used to the prospect of the ‘instant family’—but it may carry unnecessary risks.

Wow, those irresponsible IVF parents have been living life large, haven’t they?, Getting an “instant family” while the rest of the planet has to grow theirs one at a time. Those entitled bastards!

First, implying that multiple children = family (or at least that IVF parents think so) is pretty dismissive of all those one or zero child families out there.

Second, IVF is not the parenting equivalent of mail ordering sea monkeys. IVF is expensive, time consuming, stressful, and frequently heartbreaking. People don’t do it because they’re seeking the easy way to have all their kids in one go. It’s a last resort for people who have been trying to conceive other ways (many for years), and often the most viable option for many same sex couples looking to conceive.

But, hey, it is much easier to write an article if you gloss over the very real difficulties infertile  and same sex couples face, and just skip right to portraying all IVF parents of multiples as selfish baddies.

Remember the days when getting pregnant with twins was a surprise?

Remember the days doing surgery didn’t necessarily mean washing your hands? Remember the days when getting pregnant meant a high likelihood of death?” What exactly is the point of the author’s little trip down memory lane?

Now if you’re undergoing fertility treatment, you actually have to decide in advance whether you’re up for double trouble by authorizing how many embryos to have implanted in your uterus.

Oh, that’s the point: a lead up to a simplistic insinuation regarding parents’ choices that gloss over the reality of IVF: that implanting multiple embryos does not mean getting multiple babies.

Just for fun, how about we look a little closer at the gist of the author’s argument: that all parents choosing to implant multiple embryos are doing so to have multiple babies. Turns out there’s this thing called “repeat implantation failure,” that occurs when embryos just don’t take. There are many reasons it happens, and the chances of success start dropping  after that first failed cycle of IVF.

But a new study commissioned by the March of Dimes urges doctors to reduce the health problems caused by multiple births by encouraging patients to get pregnant one embryo at a time.

I love the March of Dimes. Their emotional and informational support was a godsend for my babies’ NICU stay, but at the end of the day, their goal is to “prevent birth defects,” and to “fight premature birth,” which they do on a wide scale. But that doesn’t mean that their advice to implant a single embryo is appropriate for many people seeking IVF.

Besides, the numbers of preterm births have been dropping (albeit slowly) for 6 years, so things are getting better despite the “epidemic.” Yet, this gets completely left out of the Time article. Funny, seems like that news would be important.

You don’t have to get mowed down by a double-wide stroller on a city sidewalk to know we’re in the middle of a twin epidemic.

Because of course, no other parents would EVER feel the need to own a double stroller—it’s not like they’re a convenient way to transport two differently aged wee ones. Oh, and way to compare my kids to a rapidly spreading disease.

Twins account for more than 20 to 30 percent of babies conceived via in-vitro fertilization (IVF), which reached an all-time high with more than 165,000 cycles performed in the U.S. in 2012, according to the latest statistics by the Society for Assisted Reproductive Technology.

There was no link to a source for this data, so I found the SART press release, that accompanied it, which also said that “There were fewer embryos per cycle transferred and an increase in elective single embryo transfer. This led to a reduction in the number of twin and triplet births.”

Wait a minute, at the same time SART published the data Time’s author used it also reported that the situation is improving? You’d think the fact there has been a decreased number of twin and triplet births would have made its way into the Time article. I mean, the quote was right there.

But it doesn’t.

National data show twin births nearly doubled over the last three decades to 1 in 30 babies born in the United States in 2009, from 1 in every 53 babies in 1980.

“Twin births nearly doubled” from 1980-2009, huh? That is quite a spike. . .especially if I graph the NVSS data the way it’s presented in the article (by ignoring the years in between):

Extend that line and it’s clear: we’ll be a society made up entirely of multiples by 2104. . .it’ll be like the Borg, but with double vision.

But what if I add the multiple birth rates from the years 2011 and 2012 to that graph, and include all the years in between? I mean why wouldn’t I. . .the data is easily accessible at the CDC website. The article was written this month, and has already referenced 2012 data, so why not make all of the rest of the data as up-to-date as possible?  NPR managed to unearth it, why can’t Time magazine? Meh, the writer was probably busy. No biggie, here you go:

Will you look at that! It almost looks like twin rates are plateauing. I guess we won’t see hordes of twins after all. Amazing what a difference using all the data makes.

Despite the increasing acceptance of the technique known a selective single embryo transfer, the rates are still low compared to some European countries, where IVF is often covered by national health insurance and doctors prefer to implant just one embryo in the vast majority of cases.

Finally! The article appears to be getting to the complex financial, medical and emotional issues surrounding pregnancy and IVF. Maybe this will turn away from its blame the parent trend. . . or not:

The concept has been a hard sell on American patients, since many can’t afford multiple IVF cycles and are thrilled at the idea of getting “two for the price of one.” Or they’re older patients who worry they’ll have a harder time getting pregnant the second time around a few years later.

Instead the author puts the financial difficulty of paying tens of thousands of dollars for treatments on the same level as thinking it’d be just peachy to have two babies at once. Then manages to add my pet peeve, the “two for the price of one” myth (who is she quoting, btw? Did she talk to a parent who said that, because I promise you that parents of multiples know first-hand that it is definitely two for the price of two. Twins share a uterus. After that, it’s one of each of pretty much everything).

But hey, way to toss in a little shout out to the old mama’s out there doing their part to cause us to be over-run by identical babies. Don’t worry if you missed it; the article circles back to the “older” moms in the last paragraph, saying:

. . .the piecemeal approach may not be for everyone, especially older women who want a ready-made family as soon as possible. Also, the insurance companies who do cover IVF, may not cover genetic testing or embryo freezing, which can cost thousands extra.

Way to make assumptions about the motives of “older women.” I say assumptions because there are no quotes anywhere in this article from IVF patients of advanced maternal age. Were they hard to find? I mean it’s not like they have their own public support boards, Facebook groups (lots of them), books, Meetup Groups, or blogs out there. Oh wait. . .

Had the author taken the time to talk to women of advanced maternal age, she might have found they have a lot to say about the matter, including two who replied to her article, saying “In no way did my three years of fertility treatments and countless failed cycles constitute an ‘instant family,'” and “you have to pay upwards of twenty thousand dollars each time to let doctors in a lab attempt to create your children. After everything you’ve been through the idea of only transferring one is terrifying.”

Huh, maybe it wasn’t a “ready-made” family these mothers were looking for, just a healthy child and an end to an expensive, miserable process. But acknowledging their experiences would make it so much harder for the author to make her point.

And here lies the heart of the problem with this article. There are quotes from doctors, and a selective assortment of stats, but at no point does the author bother to include the voices of families who went through IVF.

IVF parent blogs, articles, and comment streams are all over the internet. And like the older mothers mentioned above, these people have a lot to say when they are in a safe space to do so.

Regarding costs and insurance: IVF “cost us over $14,000. Insurance doesn’t even touch anything involving infertility. They look at pregnancy as a luxury,” and “$10,700 plus meds, ICSI (where they inject the individual egg with a sperm for conception) is additional $5K, assisted hatching is also an additional cost but they do that if you are over 35 or had a failed IVF cycle in the past.”

Regarding emotional and physical toll: “I thought my marriage would also be a casualty of our 7 year IVF battle to have a family. . . 4 years later after no success. . .My husband kept telling me to leave him as then I would have a chance of having children, it was heartbreaking. . .my poor husband had to endure several testicular aspirations under local, which are as painful as they sound! At the same time I was having an egg pick up. . .Now, 5 years later. . .we don’t often think about the bad times, the costs or the roller coster ride anymore.”

Seven years is long enough for a mom to become that “older patient” the author dismisses as wanting a “ready-made family.” To me, their voices say the opposite of what the article implies. They’re not hasty or looking for an easy way out. I can’t imagine a much harder time than 7 years spent trying and failing to bring life into the world. Perhaps a little less judgment and a little more appreciation for their perseverance through a tough journey is in order.

At the very least Time could have given them the opportunity to be heard before dismissing that journey with a few callous comments about “two for the price of one.”

Back to the article, where there’s a study proving that IVF parents are really in it for the twins.

This twin mindset has become so entrenched among patients that even in a recent study in which they were offered financial incentives to go for a singleton pregnancy, 40 percent still declined.

(The article links to a study that the majority of readers cannot access, so here’s the study’s press release.)

The study offered 48 couples free services as long as they would agree to only implanting one embryo. Thirty agreed, eighteen did not. And those 18 are the parents to which this article repeatedly refers. The study explains, “Those [patients] who did not have eSET. . .actively desired to conceive twins.”

Why not mention that this was a tiny study, though? How do 18 people (that scary 40% in the quote) get the same weight as the several thousand in all the other statistics used in the article?

Interestingly, the study’s conclusion included that the number of patients choosing elective selective embryo transfer had increased 52.5%. That’s huge and doesn’t exactly fit in with the article’s tone of fear mongering and blame. I wonder if that’s why the author missed the part where the study concluded “Overall, however, the incentives were effective:  the clinic’s eSET utilization rate increased from under 10% to 62.5%.”

Also worth pointing out, of the 30 women in the study who agreed to eSET, 24 completed their cycles, and 14 had kept their pregnancy at the time the report concluded. Personally, with a success rate of under 50% of those who agreed, I can see why some couples preferred to shoot for twins. It’s that whole “shoot for the moon, land among the stars” thing.

You don’t have to have the whole family at the same time,” explains Sharara, pointing out that even though the first cycle might cost around $20,000, including genetic testing, subsequent transfers of frozen embryos will cost a couple thousand each.

He’s right, but those “couple thousand” add up fast (the medications alone are $3,000-$5,000 per new cycle) and the emotional toll can be significant. In the words of one IVF patient, “IVF cycles are stressful and can really test your marriage.  I was very emotional when on the meds. . .[and] it was always a blow when it was negative. . .I would cry rant and rave then. . .start all over again.”

At the very least this article provides only one side of the issue, but at it’s worst it is something much more insidious. It is an example of how we silence entire groups of people from discussions about their medical care. The article refuses to acknowledge that parents have profound and complex reasons for their decisions, and ignores their voices, relying on the opinions of IVF professionals and of an unsympathetic author to speak for them.

So, how about including a little more even-handed treatment of the data, and maybe, just maybe sneak in a word here or there from the people who know the most about why anyone chooses to implant multiple embryos: the patients themselves. Or would that be too much bother?