Wednesday, December 15th 2010

Around the web: female behavior

The “Around the Web” series highlights informative websites, and also targeted blog posts and news articles, relevant to the courses I teach. This semester I teach Anth 143: Biology of Human Behavior, an introductory-level course that covers the basics of evolution, behavioral biology, and the interaction of biology and culture. My hope is that these posts are useful not only for my current students, but other people hoping to gain background or insight into these topics.

The second to last Around the Web of the semester covers female behavior. Because testosterone and aggression are sexy, there is a lot more popular coverage of it. Further, when I do find popular science coverage of topics that relate to female behavior, a lot of it relates to the menstrual cycle and mate preference. That stuff is interesting, but there is a lot more to female behavior than when we feel like having sex, and who we choose when we are ovulating or not. The other issue I often find interesting about the study of female behavioral endocrinology versus male behavioral endocrinology is that, for all the jokes made about men being driven by their hormones, most people work pretty hard to provide a nuanced perspective on the relationship between testosterone and aggression. Perhaps people have arrived more recently at the study of women, but I don’t always notice the same nuance when looking at menstrual cycle research.

So, I have a handful of links for you today that try to cover some of the other material. I think I’ve picked some of the best posts for you, ones that do their best to have a reasoned, thoughtful perspective.

Emily Anthes of Wonderland has an interesting post on impulse shopping and rewards; she discusses an article that found women in the luteal phase had a higher rate of impulse buys compared to those in the follicular phase. She also refers to an article she wrote in Scientific American MIND covering these issues more broadly. Both are worth a read.

Next, a few posts about women’s behavior and hormonal contraceptives – specifically because a student in class asked me to cover it. This is an increasingly important field of study as 1) we still don’t seem to understand the pharmacokinetics of women as well as men and 2) more women, and younger and younger women, are getting on the pill every day. To give you a sense of the pervasiveness of hormonal contraceptives, I’ll start you out with this OB quote: “Really? Without any regulators?” This demonstrates that hormonal contraceptives are no longer just for, you know, contraception, but for “regulating” the cycle. Why the cycle needs to be regulated is a topic for another day.

Then, Scicurious does an excellent job providing her perspective on a research finding that recently received a bit of attention. Scientific American wrote about an article that found that women’s brains who were on hormonal contraceptives were different than those who were not. Since women with spontaneous (that’s without contraceptives) cycles and hormonal contraceptives cycles have very different hormone profiles, this shouldn’t be surprising. We don’t even know if it should be cause for concern. Either way, it’s interesting, and I think Scicurious’s take on it brings the frenzy down a notch, and assesses the validity of the study’s claims.

As always, where would I be without Ed Yong and Not Exactly Rocket Science? He cogently reviews all the articles I wish I had the time to read (where do you find the time again, Ed?). In fact, I used information from two of his blog posts in the lecture I provided on this topic: his post on the oxytocin receptor gene and cultural responses to social stress, and the one on the “dark side” of oxytocin that discusses how oxytocin enhances favorable and unfavorable perceptions of mothers’ parenting styles.

Random links

Just a couple of random links for you today. First, Ed Yong (I know, again! I can’t help it!) helps us curb our holiday eating with his post on mental exercises that can curb food cravings.

Next, a new article by Gettler and McKenna that covers the biology of breastfeeding and co-sleeping practices in humans. A great article for those new to this topic. (hat tip AAPA Bandit)

Then, an interesting perspective on “patient refusal” being a contraindication in the use of epidurals during labor over at Unnecesarean.

Finally, a post about beauty in the birth room over at Science & Sensibility (quickly becoming a favorite blog of mine), which constructively criticizes a Boston Globe article about women who want to look beautiful while in labor.

The last Around the Web of 2010 will cover cognitive sex differences, and it will be a doozy. Thanks to Cordelia Fine’s book, it’s a good year for discussions on this topic!

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Wednesday, October 6th 2010

My IVF story: after conception, being preggers

This is the second post of four on my experience with IVF and pregnancy, and my thinking on its broader meaning to the public and to anthropology. Find the first post here.

ResearchBlogging.orgPreggers

A few weeks after the positive blood test, I had my ultrasound where we saw a tiny little bean and a beating heart. During this time I was having what felt like bad menstrual cramps. The nurse told me this was quite normal, but I still spent a lot of mental energy fretting over it. The rest of the first trimester was pretty uncomfortable. In addition to being exhausted, I was nauseous. I didn’t want to eat vegetables. In fact, all I really wanted was toast (gluten free, of course). I concocted a pretty awesome smoothie that I would drink once or twice a day, made of chocolate almond milk, peanut butter and ice cubes. It settled my stomach, and it’s probably because of those smoothies that I only lost four pounds.

At this point we also transitioned from medical doctor care to a midwife. At first we were just given to the next available midwife in our practice. But when it became clear that in order to stay in that practice we’d have to have a hospital birth, we transferred to the Cambridge Birth Center in Cambridge, MA and the midwives there.

Where to give birth and why

The Cambridge Birth Center is a stand-alone birth center associated with (and across the street from) the Cambridge Hospital. There are no doctors, but you can get into the OR in four minutes for an emergency C-section if you need to (yes, they practice and time these things). So I was completely confident that, if I had a straightforward, low-risk pregnancy and labor, I would be best suited to the birth center, and if anything went wrong I was minutes from a doctor.

We were a bit nervous about this decision, because of the stigma attached to IVF children. Do IVF pregnancies lead to more difficult pregnancies or labors? Are we going to have a child with greater or fewer limbs than the average? The reality is that, while the egg was fertilized in a rather special manner, a fertilized egg, then blastocyst, trophoblast, and so on that makes it to become a fetus, and then makes it trouble-free through the first trimester? That fetus is very, very likely to be healthy and normal.

The other reason we were firm in our decision is that a number of interventions that are automatic upon entering a hospital are not physiologically necessary, and even increase the risk of later interventions. Pubic hair shaving is still a common practice in some hospitals, which is just plain dehumanizing. More common are continuous fetal monitoring and putting in an IV immediately. Continuous fetal monitoring is more likely to find false positives, which means it’s more likely to find pathology in a fetal heartbeat that goes up or down but resolves on its own naturally. IVs restrict movement and lower the barrier for a doctor to suggest, and a woman to agree to, pharmaceutical interventions. This is in addition to the many other criticisms I could launch but won’t because I find it all so exhausting.

The biggest issue, for me, is that if you walk into a hospital you have at least a 33% chance of having a Cesarean section, and the reasons behind that are largely related to the ratcheting up of interventions as one intervention necessitates the next one. A C-section is major abdominal surgery. It takes a long time to recover. It is hard to breastfeed, it is hard to pick up your child, and you spend more days in the hospital. These are days when your sleep is more disrupted than when you’re home, and you increase your and your child’s chances of infection by being in a hospital, and extra days when you as a family could be figuring out a routine at home to make sure the mother isn’t the only one bonding to the new baby.

Then there are indications that C-sections create health concerns for the baby as she gets older. Babies of C-sections have higher rates of allergy (i.e., Roduit et al 2009), asthma (i.e., Davidson et al 2010) and Celiac (gluten intolerance) (Decker et al 2010). I am a C-section baby myself and I have severe allergies, allergy-induced asthma, and gluten intolerance (a trifecta of awesomeness!). Given that I’ll be passing on some of the genetic proclivities for these things, I wasn’t too keen on giving my child the environmental components that would also increase her risk if I could avoid it.

So we started seeing a midwife, and I got to know a different part of Cambridge better than I’d known before. I really fell in love with Inman Square.

Going meta

Throughout my pregnancy, I devoured popular books on pregnancy (good: anything by Sheila Kitzinger, bad: What to Expect When You’re Expecting) but also searched for a lot of information on PubMed and kept an Endnote library devoted to my results. I read about the craptastic relationship between symphysis-fundal height measurements (this is when they use measuring tape to measure the size of your belly) and birth weight (i.e., Johnstone et al 1996) – even in those studies that found a statistical correlation, SFH often explained very little of the variance in birth weight. I read about exercise during pregnancy (de Groot et al 1994) – and I played soccer through my first trimester, jogged through my second, and worked out five days a week through the whole pregnancy, up to the day before my due date. I read about meconium, I read about fetal monitoring, I read about maternal stress. When I wasn’t working I was reading, and when I wasn’t reading I was exercising. All the other time I was in prenatal appointments or sleeping.

Of course, as excruciatingly long as the pregnancy felt, as boring and normal and yet delightful as it was, it did eventually come to a close. Family flew in from out of town to be around for my due date, and there was a lot of pressure – joking, but pressure nonetheless – to produce offspring before everyone left. When my due date brought with it the occasional half-hearted contraction, nothing I hadn’t felt before, I went to bed disappointed.

The next morning I woke up, got out of bed, and my water broke all over the bedroom floor.
* * *
Next time, I’ll talk about the joys of drug-free labor.

References

Davidson, R., Roberts, S., Wotton, C., & Goldacre, M. (2010). Influence of maternal and perinatal factors on subsequent hospitalisation for asthma in children: evidence from the Oxford record linkage study BMC Pulmonary Medicine, 10 (1) DOI: 10.1186/1471-2466-10-14

Decker, E., Engelmann, G., Findeisen, A., Gerner, P., Laass, M., Ney, D., Posovszky, C., Hoy, L., & Hornef, M. (2010). Cesarean Delivery Is Associated With Celiac Disease but Not Inflammatory Bowel Disease in Children PEDIATRICS, 125 (6) DOI: 10.1542/peds.2009-2260

de Groot LC, Boekholt HA, Spaaij CK, van Raaij JM, Drijvers JJ, van der Heijden LJ, van der Heide D, & Hautvast JG (1994). Energy balances of healthy Dutch women before and during pregnancy: limited scope for metabolic adaptations in pregnancy. The American journal of clinical nutrition, 59 (4), 827-32 PMID: 8147326

Johnstone, F., Prescott, R., Steel, J., Mao, J., Chambers, S., & Muir, N. (1996). Clinical and ultrasound prediction of macrosomia in diabetic pregnancy BJOG: An International Journal of Obstetrics and Gynaecology, 103 (8), 747-754 DOI: 10.1111/j.1471-0528.1996.tb09868.x

Roduit, C., Scholtens, S., de Jongste, J., Wijga, A., Gerritsen, J., Postma, D., Brunekreef, B., Hoekstra, M., Aalberse, R., & Smit, H. (2009). Asthma at 8 years of age in children born by caesarean section Thorax, 64 (2), 107-113 DOI: 10.1136/thx.2008.100875

Tuesday, October 5th 2010

My IVF story: pregnancy

A few things have made me decide to tell my conception, pregnancy and birth stories, and provide some broader context, on my blog. Of course one thing is the CNN.com story that came out on Monday. Then I was struck by how the criticisms being launched by opponents of IVF – to me personally on the CNN.com story’s comments, and broadly in the media coming off of Edwards’ Nobel Prize win – are so overtly sexist and are so related to the way I frame my research. And, earlier this semester I also had a student leave me a note in my Question Box. (The Question Box is a box I leave out for students to submit anonymous questions. Sometimes serious, sometimes ranting, often clever, it’s an interesting part of Anth 143.) This student asked whether my understanding of reproduction, as someone who studies it, affected how I viewed pregnancy and childbirth when I went through it myself.

So this post chronicles how I got to be pregnant. Later posts will discuss my pregnancy, my childbirth, and how sexism and the pathologization of women’s bodies are damaging and incorrect.

The beginning of my family

Brendan and I met in college, at Nerd School. I knew Brendan had had leukemia just a few years before, and I remember thinking that it made him calmer, more mature. I valued his thinking above the other young men I knew. Thankfully, he felt the same way about me. It took us six or seven months to start dating, and a few months after that for me to discover he was infertile. I just asked him one night, he told me he was, and that was that.

I remember feeling as though the chance to have children was slipping away, because of who I had fallen in love with. I remember seeing how Brendan turned inward a bit, in that moment, I think expecting rejection from me. He talked about how much he wanted to be a dad one day, and I thought, I fucking hate cancer. And then I figured, science will take care of this by the time we actually want kids. Either that or we’ll adopt. So I tried not to think about it. And of course, over several years, we fell more in love, and we got engaged, and we got married.

Over this period, we were both going to graduate school. I was doing dissertation fieldwork in Poland until two weeks before we got married. After a year of lab work (undiluted spit and piss stink more than you might expect) and I was in the writing stage, I moved back up to Cambridge and, for the first time since we started dating, we lived together.

Brendan, being a year ahead, finished his doctorate before me and went on to an amazing post-doc position at Children’s Hospital. I was a lecturer at Yale, and then preceptor faculty in the Harvard Expository Writing Program while finishing my dissertation. But while writing in coffee shops and libraries, I found myself intensely, painfully jealous of pregnant women. I wanted to hold little babies and smell their hair. So I started talking to Brendan about it, and it was something he wanted too. He looked into his healthcare, and it was amazing. In vitro fertilization would be totally covered. Totally covered. As in, cough up the occasional co-pay and you can try to have a baby. It made me feel almost like a normal person.

Going for it

We made an appointment with a fertility specialist. We figured it made sense to try while I was young and not a limiting factor, seeing as we already had one in Brendan. Poor Brendan had to submit to a number of tests, because it was decided that there was a very, very small chance that maybe there were some sperm in there somewhere. There weren’t, but let’s say he found out the hard way. Then there was a chance that Brendan had a single vial stored somewhere that was taken between chemo treatments. Chances were nothing was alive inside it, but our doctor was excited by this news and recommended we try IVF to see if we could use this sample.

Then it was time to figure out a backup plan. Neither of us wanted to use a stranger’s sperm. So then it was a matter of deciding who to ask.

Of course, privately, years ago, we had already discussed Brendan’s youngest brother. You see, his middle brother was his bone marrow donor when he had leukemia. We always felt it would be fitting to have his other brother be our sperm donor. But how the heck do you ask someone to be your sperm donor, especially a twenty two year old someone who, understandably, doesn’t exactly have babymaking on his mind?

We needn’t have worried. We called, we chatted, we nervously explained, and Brendan’s brother was beside himself with delight. I suspect he had always been disappointed to be the brother who wasn’t a bone marrow match. As a fifth grader with his oldest brother battling cancer and his middle brother getting holes punctured in his hip to donate bone marrow, he got his class to sit down and make paper cranes. They didn’t quite get to one thousand, but they got close.

With Plans A and B all set in terms of the sperm, it was time to figure out the eggs (I’ll spare you what turned out to be insane details scheduling and timing Brendan’s brother’s trip to coincide with my treatment). I had to undergo a battery of tests including a hysterosalpingogram and vials and vials of blood to make sure I was fertile and wasn’t harboring any nasty diseases or genetic proclivities to nasty diseases. Brendan and I also had to go to a therapy session. I felt like all my spare time went to phone calls and doctors’ waiting rooms. I understood why I had to go through it all, but resented what I had to go through when other people could just have sex and get pregnant. Once we were cleared, we couldn’t even get started with the stimulation protocol, because we had to be fit into the embryologist’s schedule: they don’t want too many embryos to watch at one time. As rational as all this was, it was hard to feel rational when I wanted to move forward.

IVF in accord with our lifestyle and environment

Our doctor was exceptional. She was hopeful in a measured way, she listened well, she was not condescending, and she appreciated the fact that I was a scholar in women’s reproduction and had a few opinions of my own. We discussed going for a very mild protocol to avoid hyperstimulation, because a higher dose would be unnecessary for someone like me: healthy, young, athletic, fecund. I said I would rather have this all not work then feel like I was so desperate to have a baby that I would risk my or my child’s health.

So we went for a lower dose. Birth control pills, then little needles in my leg, more appointments to count follicles and measure my endometrial thickness, a perfectly timed hCG shot to mature my eggs.

Fourteen eggs were aspirated in an outpatient procedure. Brendan’s sample was thawed. The sample was essentially empty. Brendan’s brother’s sample was used. My heart broke just a tiny bit when I was told that part. But then I remember thinking to myself, rather fiercely, of the incredibly strong baby that will come out of all this, and call Brendan Daddy, and how the bonds of our family would knit even closer in the wonderful blend of genes and environment that would be our child.

We risked a five day protocol before blastocyst transfer. In IVF, the most typical protocols are to transfer a three day embryo, or a five day blastocyst, back into the mother. The three day was more common in the past, but you risk the mother’s endometrium not really being receptive yet. The five day transfer would mean a few more risky days of being cultured in vitro, but a greater chance of there being an alignment with the receptivity of the endometrium. The other decision we had to make was whether to transfer more than one blastocyst. Continuing with our decision to not take risks with my or potentially a baby’s health, we wanted to reduce the chance for having multiples, so we opted for a single embryo transfer.

These were a panicked few days, waiting for the embryos to culture, hoping some would actually be left by the time we got to the fifth day. I had trouble maintaining a rational perspective, that the way we were doing this was best. But we got there. We went in for our outpatient procedure to have the embryo transferred to my body. I had to take a Valium and drink an enormous glass of water: the Valium was actually more to keep my muscles, including the muscle of my uterus, from contracting, and the water was to get my bladder as full as possible to make it easier to image my uterus using abdominal ultrasound while they implanted the embryo.

Our “textbook” blastocyst.

The ultrasound and embryo transfer were excruciating, not because it was painful, but because I needed to pee so badly that I wanted to scream. You try drinking an enormous glass of water and then have someone pressing an abdominal transducer down on your bladder while someone else is making you stay still while they put an embryo in you. Then, continue to lie still there for a while before you can get up and pee.

The second the doctors left the room, I turned to Brendan and burst into tears. At least for that moment, I was pregnant. There was a blastocyst inside me, and I was so absolutely happy and terrified that I could barely contain myself. We grinned at each other like fools, clutching our picture of our “textbook perfect blastocyst” and when I finally got to go to the bathroom I hoped that I wasn’t flushing anything else down the toilet.

A new beginning

A week later while on a family vacation in Maine, I was exhausted all the time, wanting to go to sleep early, and writing it off as wishful thinking or aftereffects of the stimulation protocol. We still had another week before our official pregnancy test. So of course on the drive home from vacation Brendan and I went to the store and bought three.

The first one came up immediately and unequivocally positive.

We had our official test soon after, and it told us what we already knew. I fell to the floor of our apartment as the nurse on the phone, accustomed to such a reaction, waited for me to stop crying.

I was pregnant.

* * *
Tomorrow, I go all meta on my pregnancy.