Wednesday, April 3, 2013

Margaret Wente: Infertility fact and fiction


This blog has looked closely at plagiarism in relation to Margaret Wente.  Today, a look at other problems in the most recent of her articles on infertility and older parenting.  And a personal perspective.
The Globe and Mail’s house contrarian offers up a regular parade of caricatures - silly young men, entitled young women, various incarnations of “elites” (a class she pretends not to belong to).  Recently, she had another go at “grey parents”, with some alarming claims about autism. Mostly, she goes after older mothers, who she regularly characterizes as waiting around for a late appointment at the IVF spa.  But for some women, and I’m one of them, not doing IVF can be risky, even life threatening.
 
To begin with, in the opening of Why old-age parenting is a bad idea, Wente seems to leave readers with the impression that the availability of IVF and other fertility procedures to older women can lead to autism.   After opening with the American Society for Reproductive Medicine’s latest recommendations for (some) women, and her standard observation that infertile women are just “too busy” to notice the biological clock, Ms. Wente laments the “hundreds of thousands of useless and costly medical procedures, thwarted expectations, marital stress, heartbreak and an epidemic of children with autism, learning disorders and perhaps even schizophrenia.”
That last bit (my emphasis) was surprising, and anyone who stopped reading a few paragraphs in would think this “epidemic” had something to do with older mothers. That’s because it’s not until much further down a page focused almost exclusively on women that Wente offers some sentences about mutations in the sperm of older men.

They echo a BBC report which says: "Men over 45 may have offspring which have a higher likelihood of neuro-cognitive disorders, such as autism and schizophrenia.” Or the CBC:A child is more likely to be born with autism if their father is over the age of 35 compared with a younger dad,” (though Scientific American cautions that, “The study does not prove that older fathers are more likely than younger ones to pass on disease-associated or other deleterious genes”).

Despite this, Wente links these genetic problems to older women, implying that it’s because of older moms that men are fathering these kids.

But older fathers do not equal older mothers.  The same BBC report notes the dramatic rise in older fathers having children with younger mates:  “it's to do with the rise in second marriages for men, sometimes with younger women, which can mean becoming a father again at a more advanced age”. 

We know this even without the stats.  There’s been a bump in men starting second families with partners often a generation their junior.

So you’d think if one were genuinely concerned about an “epidemic” of autism, learning disorders and schizophrenia, the number of aging dads would be important.   Numbers like these: “a dramatic rise in the number of men having children in their 50s and 60s…official statistics show the number of over-50s fathering children has risen by 40 per cent in 12 years.”

But Wente seems fixated on straw women, and provides figures only for “grey” (over 35) mothers, concluding with advice to the daughter she didn’t have:  “I’d tell her to get on with it”.  That’s remarkable too.  Since, given the evidence, it would be better to advise older men not to get it on with her daughter.
Wente also uses statistics from a survey that appeared in a November 2012 Globe article by Tralee Pearce.  From there, numbers diverge. Pearce says: “In Canada, the pregnancy rate is 18 to 20 per cent for women 40 to 41 years old who complete a cycle of IVF using their own eggs…”.  Wente, on the other hand, writes: “the odds of having your own biological child after 40 are no better than they were 20 years ago. With each cycle of in vitro fertilization, the success rate is 11 per cent”.    
But the odds are changing, as the lede in Pearce’s article indicates:  American researchers have just announced they have a method that gives a 40-year-old woman the same chance of conceiving via in vitro fertilization with her own eggs as a 32-year-old.”

It’s pretty clear what Ms. Wente wants readers to believe.  But why?  Oddly enough, in 2006 she took a position completely opposite to the one she adopts now, even writing a glib, upbeat defense of a 63 year old mom: “Women are no longer enslaved by their reproductive organs — and a good thing too. If technology can give women wider reproductive options — as men have always had — that's fine with me. And because we're living so much longer and healthier, 63 is no longer old”.   

Wente also describes how she herself was too busy for children and later realized that, “my poor old eggs were past their sell-by date”.  For her, that was fine:  “the childless life has its compensations”.  Perhaps - if you have a well paying job with lots of travel.  For others, rewards may be few, especially when couples with less income spend everything they have trying to have kids.  I’m not sure those compensations should include passing judgment on families who struggle with infertility or pregnancy loss for medical reasons very different than one’s own. 

As Dr. Carl Laskin says to Pearce, “IVF is a tool”. It can be an important one.  I know.  I have two IVF kids – one born at 39, the second at 42.  Had I done IVF years earlier, I would have been spared five pregnancy losses (three of which nearly cost my own life).   For some women who want to have children, not doing IVF can be risky.  That’s why simplistic negative commentary like that regularly dispensed by Ms. Wente is problematical.  Not only is it inaccurate, it has the potential to scare women away from appropriate treatment by suggesting the success rate is low, the procedure overly risky, or now, that their kids might be autistic. 

Like thousands of women, my medical problems weren’t caused by being too career centered.  Like thousands of women, I had a condition that made pregnancy difficult (and dangerous) at any age. 
Here’s a glimpse of what that was like:  We lived in small village at the time.  Pregnant for the fifth time, my husband and I had driven an hour to a larger hospital in a nearby city for morning blood tests to determine if the baby we had tried so hard to have would make it to delivery. Afterwards, we went to the hospital cafeteria for breakfast.  That’s when my fallopian tube burst, and I was rushed back to the doctor’s office.  I was lucky to be in the hospital when it happened.
This was my fourth ectopic, so I already knew exactly what the pain ripping through my abdomen meant. The ultrasound confirmed that the pregnancy was outside the uterus, again.  Even though it had ruptured, we could see the beating heart. 

But I was already bleeding internally. As they tried to insert the intravenous for another emergency surgery, my panicked husband said, “You can’t operate now - she just ate”.   Standard protocol didn’t apply.  If they waited, I’d die. 

That’s just one of the many, many, different, individual realities of infertility.  Ectopic pregnancies remain a leading cause of maternal death.  I had 4 of them, along with one miscarriage, attempts at surgical reconstruction, and various excruciating investigations along the way.  As is the case for thousands of women, this was not related to age.  The little malformation was there when I was younger. But problems may take so long to investigate, treat, and resolve, that some women may be older by the time they present to a clinic or a child arrives, if at all. It’s not fun.  And it’s unfair to depict these women as latt√©-sipping careerists, penciling in an appointment at the IVF spa for 40.

While IVF may be used with less success for older women with other conditions, the ‘primary indication’ for the procedure is tubal disease.  It’s the reason IVF was first developed, and it’s a successful, cost effective therapy for women with damaged fallopian tubes who can make up “nearly 35%” of infertility cases, according to some studies.  That kind of disease alone takes a big bite out of Ms. Wente’s cartoon.  It’s also why women with blocked fallopian tubes have been eligible for OHIP covered IVF for decades - another important fact Ms. Wente omits in this and previous articles. Many fertility problems have nothing to do with ones’ eggs being “past their best before date”, as Wente likes to say.  There might be a problem with the delivery system, or some other piece of equipment. 

There’s also no correlation between various reproductive diseases and the ‘highly educated’ but ‘deluded’ women Wente claims are the “chief customers for fertility treatment”. Tubal abnormalities, polycystic ovaries, endometriosis, immunity issues, along with varieties of male factor infertility, can hit early and are evenly distributed across classes.  Unsurprisingly, they fail to concentrate in Wente’s cartoonish ‘elite’.  The infertile constitute a range of diverse medical profiles, not a simplistic social or economic one. 

The profile Ms. Wente routinely presents looks, in fact, strangely like her own.  I’m also tired of IVF kids reading that their parents didn’t want them enough to give up their careers, or that the biological fathers they grew up with are actually anonymous sperm donors.  But mostly, I’m worried women will be swayed by the inaccuracies in articles like this and forego effective and even necessary treatment.

My pelvis is scarred. But let’s talk about Margaret Wente’s pelvis for a moment – X-rays of which adorned a recent feature article about the “nightmare” of her artificial hips.   Rather than wait in line for standard hip replacement, she’d apparently managed to get a leg up on a newer procedure similar to ones that have since failed in other patients.

Now, Ms. Wente, like other Canadians, is certainly entitled to as many hip replacements as she needs to allow her to continue horseback riding into her 60s.  This, despite the fact that, like infertility, deteriorating joints would have been considered “normal” several decades ago, and treatment for what is essentially another form of age-related decline (like fertility) would have been more limited.

In that regard, Ms. Wente’s remarkable 2006 article on how she gained access to quicker treatment is instructive in terms of fair and equal access.  It was the subject of another article called Too many jumping health-care queues:

"Margaret Wente, a columnist in The Globe and Mail, described how she was helped to obtain a quicker hip replacement partly by 'pulling strings.'", Eric Dowd wrote.
When informed the waiting list for hip replacement was "a year long", "the columnist decided to obtain another opinion and called 'a well-placed acquaintance,' who contacted another surgeon, who squeezed her in for an appointment within two days". 



"I found shortcuts. I asked for favours. At first, I felt guilty", Wente wrote then. "There are the public, formal lists, and the private, informal ones. How quickly you are referred and treated depends on a myriad of random factors… Knowing someone who can make a phone call or write a nice e-mail message on your behalf is priceless. Being on a hospital board also helps. But being educated, middle-class, diligent and assertive is what helps the most of all. My Portuguese cleaning lady, who barely speaks English, has arthritis too. There's no chance she will ever get the access and the state-of-the-art treatment that I did".



Of course Ms. Wente deserved her hip replacement.  But shouldn’t treatment be just as important for her cleaning lady, and for patients with other medical problems?  

I’m not saying that all fertility treatments are necessary or advisable, or that they should all be covered by taxpayers, especially when budgets are tight.  Nor am I arguing in favour of extreme “grey parenting”.  But let science provide the data. And let us debate the various drawbacks, priorities and benefits (these might even include the fact that IVF kids will pay for some of those hips).  And let fairness and consistency be guiding principles for that discussion.  For that to happen though, journalists need to provide opinions based on full and accurate information - not caricatures that reflect their own interests.  And some of them should perhaps try, every now and then, to look a bit more closely, and with more genuine curiosity, at the world and the people around them. 

7 comments:

  1. Such a shame that Ms Wente's cleaning lady doesn't know someone who can make a phone call or write a nice e-mail message on her behalf.

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  2. There's a good response to Wente's article in the "What Readers Think" section (April 4th):


    Margaret Wente warns that we are risking a genetic catastrophe because of a supposed surge in late childbearing (Old-Age Parenting Is A Bad Idea – Focus, March 30). There is, however, little new about the present rates of older women giving birth. The average age of British mothers is about the same now as it was before and after the Second World War. The percentage of American women 45-plus giving birth was slightly higher in 1945 than 2009. Fertility rates among Canadian women between 40 and 45 peaked, not in the 21st century, but in the 1920s.

    The real historic shift came in the 1970s, when the number of older parents declined sharply due, most notably, to the widespread availability of reliable birth control.

    Now, as career paths are changing, older parenting is making a comeback. There are, of course, differences. More women are having their first child later, and a very small percentage of women are benefiting from reproductive technology. Some studies suggest greater risks when women give birth later; others demonstrate better long-term outcomes for the children of older parents.

    Older women always got pregnant – the difference now is that they have more choice in the matter.

    --Tori Smith, Mark S. Bonham Centre for Sexual Diversity Studies, University of Toronto

    -------


    Keep up the good work! Cheers!

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  3. Thanks for keeping an eye on this lazy, incompetent person.

    I don't think I could bear to read through one of her articles unassisted by cogent criticism such as yours.

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  4. correct me if i'm wrong, but i swear i remember reading, years and years ago, a column by wente on her own struggles - physical and emotional - to conceive via assisted reproductive technology. it was passionate and emotional and truly human. and then 6 months or so after that, a column highly dismissive of the whole thing, basically writing off her previous attempts as a momentary whim, in direct contrast to the prior article. this would have been maybe in 2000? or 2001? i don't remember the dates but i do remember being shocked at her about-face. i had kind of liked her columns previously, but this seemed to be a turning point and her writing went downhill from there - more and more outlandish, with lots of angry digs at all manner of parents, and no further disclosure of the personal events which might colour her opinion. i don't have the time (or will) to go look it all up, though.

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  5. I’ve been involved in journalism for 40 years, and I’ve never experienced a time like this when mass media corporations are feeding us such distorted, one-sided news. The Focus Canada survey outlines how Harper – supported by corporate media – is way out of line with what the majority of Canadians want.

    http://nickfillmore.blogspot.ca/2013/02/freedom-to-read-week-right-time-to.html

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