Abortion restrictions continue 20 years after ruling

[tracy]

What really freaks me out is the danger associated with messing around so much, so aggressively with a woman's hormones. It makes me SO nervous that the medical industry is so willing to dabble. And it strikes me as an area where, yet again, the stigma drives it. Because society, even to this day, expects a fertile woman. To this day, women feel less like a woman if they don't have babies, if they have to adopt. Yet, the adoptions I've seen where the moms get together before the baby is even born... wow... the connection is so instant. The baby is so very theirs, from day one, that it made my cousin angry that she'd wasted so much time going the other route and beating her head against the wall.

I do completely understand that there are women who can't handle the thought of doing it any other way. But I think society still needs to close some gaps to make adoption a more viable, less stigmatized choice, for the women (both giving up, and adopting), who want a different option.

Careful, you almost sound like a women's rights lobbyist I agree completely for what it's worth that women shouldn't be made to feel that procreating is necessary for them to be "real" women. But, I also support a woman who chooses to try infertility treatment if that's what she feels is right for her and her family. It wouldn't be right for me because of my life experiences. Abortion wouldn't be something I'd be interested in either barring health issues, but I still think it's best to let individuals choose for themselves.

 

[tracy]

The troubles stem primarily for it being profit motivated, through surrogates and donors. As well, since it is so expensive you get people and professionals returning more embryos than there should be since everyone is trying to get the biggest bang for the buck without going broke. The UK had IVF through national healthcare. They're considering reducing the number of embryos per cycle to one and providing everyone three chances to make it work. Taking finances out of the equation helps reduce the negative health and social impact.

I also think the trouble stems from no one wanting to admit the down sides. The infertility industry wouldn't make nearly as much money if it honestly told people about the down sides and if they only treated people who had a reasonable chance of success. I see this industry as taking advantage of people's desperation sometimes. I know a 43 year old still doing IVF. Nevermind the fact she's had countless failed cycles and miscarriages. Nevermind the fact that the longest she made it with a pregnancy was 23 weeks and that baby lived a whole 6 months before dying. It sickens me to think of a doctor still telling her to keep trying. If the number of pregnancies is in the double digits without a single living child to show for it, then maybe medical science just can't give you a child and they should stop taking your money.

Most NICU nurses I've worked with have also noticed we see A LOT more IVF babies than we should. There is either something that happens during that procedure that makes for a less healthy pregnancy or the people doing it are more prone to that or something. Very few children are conceived that way, they are overrepresented in the NICU. It's definitely a reason that IVF wouldn't be something I could do.

 

[karrie]

From what I understand, IVF on its own isn't overly bad. If it's a motility issue, or a mere absence of eggs or something, it has good success rates from what I've been told. It's when there's a hormonal, or structural problem and it's used that it ends up with low rates of success and high rates of NICU presence isn't it?

 

[Kreskin]

Tracy, the last time I saw stats there was something like 1.5% higher risk of abnormalities through ICSI. In Canada they are pushing for mandatory counselling prior to IVF. 7 years ago we saw genetic counsellors who gave us a very minute chance of success. The clinic didn't push, they left the decision to us based on what the counsellors said. We tried anyway and it worked. This was through UBC. A private clinic is more likely to decline the help since it would skew their success rates. I thought the profession did a marvelous job with us. The highest standard of ethics in my opinion. When you peel away the onion though it is the march to profits where people and the industry get into trouble. Women doing IUI's on 6 eggs, 4 embryo transfers, paying big bucks to donors who some are scammers. The financial issues are what cause most of the grief.

Karrie, IVF is putting sperm and eggs together to let them fertilize. The gametes work naturally to fertilize. ICSI is the procedure where sperm are injected into eggs. It's primary used for male factor infertility. This is a lot more unnatural but the stats don't indicate much difference in the presence of abnormalities in children. The long term effects aren't known. The first ICSI baby was conceived in 1993 so there they oldest ICSI kid is 14 or 15.

 

[talloola]

There is a very good reason for the difference in cost. It's the same reason a heart transplant costs more than treating a urinary tract infection. IVF is very complicated and time consuming. It requires more drugs, more professionals, more procedures. Even after all that investment, you aren't guaranteed a thing. It's something I would never be able to choose for myself. I see too much of the bad side of IVF. I think the infertility industry has a lot of problems. I don't see how people can complain that abortion is financially driven, but not see the same thing in infertility treatments. Try paying less than 10K for an egg donor down here. Need a surrogate? Save about 25K minimum. On the bright side, you get to pick genetics that are much better than your own when you do those things, but it's still pretty expensive for an egg that may or may not give you a baby in the end.

I do understand that one procedure is much more 'complex' than the other, but I
am listening to Kreskin who has been through the experience, and seeing it from
his vantage point would be frustrating. I would hope with more research the
procedure will be 'simplified' much more, and cost brought down.

 

[Pangloss]

It is a medical procedure: it should be as accessible as any other procedure. Any decent therapist will talk to the woman first (there are, after all, emotional consequences to the abortion) - limiting access to abortion is more about ideology than health care.

This was clumsily written. . .

Pangloss

 

[tracy]

Tracy, the last time I saw stats there was something like 1.5% higher risk of abnormalities through ICSI. In Canada they are pushing for mandatory counselling prior to IVF. 7 years ago we saw genetic counsellors who gave us a very minute chance of success. The clinic didn't push, they left the decision to us based on what the counsellors said. We tried anyway and it worked. This was through UBC. A private clinic is more likely to decline the help since it would skew their success rates. I thought the profession did a marvelous job with us. The highest standard of ethics in my opinion. When you peel away the onion though it is the march to profits where people and the industry get into trouble. Women doing IUI's on 6 eggs, 4 embryo transfers, paying big bucks to donors who some are scammers. The financial issues are what cause most of the grief.

Karrie, IVF is putting sperm and eggs together to let them fertilize. The gametes work naturally to fertilize. ICSI is the procedure where sperm are injected into eggs. It's primary used for male factor infertility. This is a lot more unnatural but the stats don't indicate much difference in the presence of abnormalities in children. The long term effects aren't known. The first ICSI baby was conceived in 1993 so there they oldest ICSI kid is 14 or 15.

Abnormalities is generally a genetic term. Most of my kiddies in the NICU aren't abnormal genetically, they are simply premature. IVF kids are way overrepresented in this population (probably partly because of the increase in multiples as well). They are genetically normal as far as we know, but prematurity carries a lot of health problems.

I am glad your experience was a good one. I agree with you that profit motives in this industry is what leads to the problems. I'm also upset when I hear about sextuplets. IMO, that's a problem with the doctor and the clinic and it's probably partly because people only hear about the happy stories and forget the bad ones. I've seen too many dead kids because someone implanted too many eggs and they took. A woman's body isn't meant to produce 6 children at once.

 

[tracy]

From what I understand, IVF on its own isn't overly bad. If it's a motility issue, or a mere absence of eggs or something, it has good success rates from what I've been told. It's when there's a hormonal, or structural problem and it's used that it ends up with low rates of success and high rates of NICU presence isn't it?

It can be used for a structural problem, but it's often just used for infertility without any known cause. I suspect that whatever is impacting a woman's ability to conceive could also impact her ability to carry to term. Obviously if it's the man's health issue, this wouldn't apply. It's become routine for me to get report on an IVF baby where the mom has had a dozen miscarriages, only to finally barely make it to viability with a baby. Then it's months in the NICU (if they survive) and many possible health problems in the future. They are often just so desperate for it to work and it's easy for a clinic or doctor to take advantage of that. If they choose IVF that's their business, but it wouldn't be for me. I don't need my own genetic offspring badly enough.

 

[Kreskin]

Abnormalities is generally a genetic term. Most of my kiddies in the NICU aren't abnormal genetically, they are simply premature. IVF kids are way overrepresented in this population (probably partly because of the increase in multiples as well). They are genetically normal as far as we know, but prematurity carries a lot of health problems.

I am glad your experience was a good one. I agree with you that profit motives in this industry is what leads to the problems. I'm also upset when I hear about sextuplets. IMO, that's a problem with the doctor and the clinic and it's probably partly because people only hear about the happy stories and forget the bad ones. I've seen too many dead kids because someone implanted too many eggs and they took. A woman's body isn't meant to produce 6 children at once.

Multiples are a problem. Although there are no strict guidelines here in Canada yet, some clinics are placing a voluntary cap on 2 embryos for those under 38, unless there are very high chances of unbalanced chromsomes. We did 4 but we also had UBC Genetics Department do a thorough analysis on us before coming up with a number. Unfortunately money plays a big part in the decision to transfer back for a lot of people (when not restricted by the clinic). At a personal cost of 10-20k a pop some people will do anything to make it work the first time.

 

[gerryh]

Kreskin....by chance was your specialist Dr. Victor Gommell(sp)?

 

[Kreskin]

At the genetics it was David Koehn. At the IVF clinic it was RE Christina Williams and embryologist Dr Sai Ma.

 

[tracy]

Multiples are a problem. Although there are no strict guidelines here in Canada yet, some clinics are placing a voluntary cap on 2 embryos for those under 38, unless there are very high chances of unbalanced chromsomes. We did 4 but we also had UBC Genetics Department do a thorough analysis on us before coming up with a number. Unfortunately money plays a big part in the decision to transfer back for a lot of people (when not restricted by the clinic). At a personal cost of 10-20k a pop some people will do anything to make it work the first time.

The thing is, it isn't the implanting that's the complicated or expensive part (for the clinic I mean). They could easily save more embryos and implant them in another round with little cost. The fertility clinic associated with our hospital in Toronto limited embryo transfers to 2 or 3 at a time max because they didn't want to make parents have to think about selective reduction. There's one of the grey areas of abortion. If the unthinkable happens and your wife got pregnant with 5 embryos regardless of how many were implanted, then you have to ask yourself if you want to risk trying to carry 5 babies to term or if you want to abort a few so the remaining ones have a better chance at surviving. Unfortunately, you can implant 2 embryos and wind up with 4 babies. There is nothing that stops identical twins from forming with IVF. I knew a couple here who implanted two, but the one egg produced twins so they wound up with 3 babies. And IVF is fairly controlled. Drugs that stimulate ovary production are a lot cheaper and for many women the first thing tried in fertility treatment. There, you have absolutely no control over how many eggs are produced or how many will be fertilized. It's scary.

 

[Kreskin]

Mega-multiple are probably more likely to occur through IUI than IVF because it is less controlled, as you said. Someone carrying sextuplets is probably a fertility drug patient and not an IVF patient.

The financial factor centers around success rates. There is a better chance of a negative result during each attempt than there is a positive. Clinics want to bump the success rates up so they can promote it to get more clients. Clients just want success and not pay for susequent FET's or fresh cycles. So the temptation to push the limit factors in from both sides. I personally think clinics should do more testing before treatment. There are a lot of people going through it diagnosed with unexplained infertility.

 

[Zzarchov]

Well, personally, I think you probably guessed that it's not the sort of thing I think a doctor should be compelled to do, and I think many doctors refuse for a host of reasons... safety concerns, religious/moral reasons, or just misinformation even.

Thus, yes, size matters because without the infrastructure or money to attract doctors, you lower the odds that you will get doctors who are willing to perform the procedure.

Im going to have to disagree on the point in blue.

If a doctor has moral reasons against doing his job, he should not do his job. I don't want to die in a hospital room of blood loss and have my doctor come out and say to my family "Im sorry, there was nothing I could do, Im religiously and morally opposed to blood transfustions".

Or a doctor saying "Im sorry, I couldn't prescribe medication..the bible says that one should only annoint with oils"

Or saying "Im sorry, I would have liked to have saved your wife, but the Koran states I shouldn't touch her"


Likewise I wouldn't expect a social worker to not report spousal abuse because "punishing the husband for rightfully disciplining his wife is against his morals" or a teacher to refuse to teach little girls because "girls learning alongside boys is against his morals".


You only have protections for your job based on morals and religion (or gender etc) if it is not a bona fide requirement for the work you are to do. In this case it would be a requirement.

 

[karrie]

You only have protections for your job based on morals and religion (or gender etc) if it is not a bona fide requirement for the work you are to do. In this case it would be a requirement.

Many would argue (as I would as well), that it is not a necessary part of a doctor's job to remove healthy tissue from a healthy person. Abortion is often not a medical decision... it's the only one that people can demand of a doctor regardless of risk or necessity. It's a moral decision, even in how it is guaranteed to a woman. Thus yes, a doctor's own personal morals have as much right to come into play as the woman's do.

A doctor is compelled only to heal when the body has gone into dysfunction.

 

[Zzarchov]

If the law says thats your job, it is. If you don't like it, find a new job. Hence, reduce the legal limbo by just passing a law.

 

[karrie]

There's no law stating doctors have to provide abortions as far as I know.

Just like there's no law stating they have to provide nose jobs.

 

[tracy]

Many would argue (as I would as well), that it is not a necessary part of a doctor's job to remove healthy tissue from a healthy person. Abortion is often not a medical decision... it's the only one that people can demand of a doctor regardless of risk or necessity. It's a moral decision, even in how it is guaranteed to a woman. Thus yes, a doctor's own personal morals have as much right to come into play as the woman's do.

A doctor is compelled only to heal when the body has gone into dysfunction.

I agree only so far as to say when health is endangered, a practitionner's moral objections should no longer excuse him or her from a procedure. A doctor isn't required to perform abortions, order blood transfusions, help with end of life care, prescribe birth control, etc. if it goes against his or her moral or religious beliefs. BUT, they do have to refer their patients to a practitioner who will and if their refusal ever caused harm, you can bet they would be risking their liscence and a nice lawsuit.

All OB/GYNs should be trained in different techniques used for abortions because they are used to heal women from ectopic pregnancies and miscarriages where the products of conception remain in the uterus. Those aren't uncommon occurances and a doctor needs to know how to deal with it. If an OB/GYN refuses to even learn how to do it, then they are in the wrong field. There are things I don't necessarily agree with in my job, but I do my job because it's the one I chose. If I felt strongly enough, I would change to another specialty.

 

[DontQuoteMe]

If there is no law about Abortion at all, Doctors shouldn't have to perform it.

If there is put in a law about Abortions and women having a requirement to them, Doctors should have to do it or quit.

Whether or not their SHOULD be a law about Abortions is another matter.

But IF there IS a law saying women can have them, Doctors shouldn't let their choices over-ride yours and have you pay them for that privelage.

Likewise if there is a law against abortions I would expect doctors not to provide them (Even if the law itself is a bad idea)

 

[Kreskin]

Do other medical treatments have laws? I understand the Canada Health Act doesn't go into many specifics other than the provinces are required to provide medical services based on the objectives of the Canada Health Act in exchange for federal funding. The provinces have medical boards that determine what services will be provided.