It’s been a rather emotional journey trying to decide how we approach the conception of our third child.  Of course, I feel that this pales in comparison to so many other decisions people face when contemplating issues involving fertility and/or reproduction. Nevertheless, this is part of my journey and required a great deal of thought.

After meeting with the reproductive specialist a few weeks ago, I was confronted with internal conflicts aplenty.  If I do go this route, would the benefits outweigh the risk?  If we don’t go this route, will my child resent me for not protecting him or her?  I learned that the only way to eliminate the BRCA gene pre-conception is to do IVF. The process is lengthy, uncomfortable and expensive.

First I would start hormones which would kick my ovaries into overdrive in order to extract as many viable eggs as possible (red flag #1 : ovaries on overdrive).  Then the eggs would be extracted and fertilized in order to create embryos.  From the successful embryos, the outer layer is scraped and then sent to a lab to be tested by a genetic probe specifically built based on my BRCA mutation (likely along with blood samples from my father and sister in order to be as comprehensive as possible).  Building this probe can take anywhere from 2 weeks to 6 months. At this point they can also test for all known chromosomal anomalies (basically like doing an amnio before you’re even pregnant).  Since this is my third child, I would also have the option of gender selection (tempting since we have two fabulous little girls and interestingly, according to the American Medical Association and other medical organizations in the US, the ethical standard is that gender selection not be used on a first born and only on subsequent children… they call this “family balancing”).  Once all of that is done, the embryos that don’t have BRCA can be chosen from (sort of randomly, but apparently based on which one seems most viable, Baby Darwinism).  Since I don’t have any known fertility issues at this time, only one embryo would be implanted and continuing on the hormones for a little while, I would wait for the fetus to mature and baby #3 would be born free of BRCA, chromosomal disorders, and hopefully a healthy and happy boy (yup, I said it, come on… you knew that was coming).

Damn, that’s a lot of work!!  Just having sex is a lot more fun (and takes a lot less time, wink wink).  Alas, we don’t really have the luxury of ignoring the options and just doing this for the thrill of it.  So the debate was discussed, only now with knowledge and facts to support each argument.  My biggest concerns were “unanswerable questions” (the doc’s term).  Would the hormones and the overworking of my ovaries potentially put me at an even bigger risk to develop ovarian cancer?  My risk is already so elevated that I almost feel the urge to get rid of them immediately (sort of like I did my boobs).  They don’t feel as much like the ticking time bombs that sat on my chest, but they still feel like a couple of live grenades in there, but as long as those pins don’t get pulled, we’re ok.  The doctor did mention the very remote possibility of the ovaries under duress, possibly rupturing and whatever complications might arise due to those unpredictable events.  Since I already have my two children at home who need me and who I desperately want to be around for, the risk to my health and longevity is legitimate and not entirely unselfish (so I try to convince myself). The risks of the baby developing birth defects that are only slightly elevated as a result of IVF (vs. natural conception) is another concern and an unknown.  Timing is an issue (and not that I’m able to predict how long it will take regardless), because building a probe could take up to 6 months, then my two and a half year old little one and the new baby would be even further apart in age than we had wanted. My husband was concerned about the emotional aspects for the baby, who may wonder why his sisters were conceived naturally and he was picked as the strongest embryo in the lab.  Not to mention, this could cost $20k, which our insurance does not cover.

On the flip side, eliminating the risk of this child having the BRCA mutation is so tempting.  Obviously, I don’t want any of my children going through what I did (even though, I honestly feel it wasn’t too hard to handle).  Each of my children have a 50/50 chance of having BRCA1, so if I’m a glass half full kind of person (news flash : I’m not), then perhaps my kids won’t have inherited this after all. And what happens when this kid is 20, gets tested and finds out they do have the BRCA gene and there was something I could have done about it.  Well, that would merit a big “Fuck you, Mom! You could have saved me from going through this? But you didn’t want to put yourself at risk?  Well, now I’m at risk.  Thanks a lot!”

Each argument has valid points and every child is a miracle no matter how it is conceived.  Fortunately, my husband and I are almost always on the same page when it comes to life’s monumental decisions and we feel that we make responsible choices that are right for us.  They may not be what others decide, but they work for us.  In this instance, we feel that the unknowns of IVF are riskier for our family than the knowns of conceiving naturally and facing whether or not this child will have the BRCA gene.  I’m sure I will continue to hem and haw long after this baby is born and you never know how things will go when reproduction is concerned.  We don’t count anything out, but for now, we’ll give it a shot the way we know how and have practiced for the past 15 years (wow, that’s a long time!).

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