Wednesday, December 26, 2007

Book Review: Having A Baby...When the Old Fashioned Way Isn't Working

I was asked to review Cindy Margolis' new book, Having a Baby...When the Old Fashioned Way Isn't Working: Hope and Help for Everyone Facing Infertility, and I agreed. For those of you who don't know, Cindy Margolis is the celebrity spokesperson for RESOLVE: The National Infertility Association. While I realize now how crazy it was to agree to read, let alone review, a book with newborn triplets in the house, I did get the book read and I will now attempt to write a coherent review between feedings!

I really wanted to love this book. I think Cindy Margolis has done a lot of good for the world of the infertile myrtle, having been brave enough to talk about something no one talks about in a very public forum (Cindy first came out of the infertility closet on an Entertainment Tonight interview!). Alas, I can't say that I would recommend this book without some serious reservations. I enjoyed reading Cindy and Guy's personal tale of their infertility journey, and I wish that had been the true focal point of the book. Had Cindy presented her story, and the other personal stories of other people that she included in the book, and left it at that, I probably would have recommended this book heartily. But she took it a step further and tried to provide insight into the medical procedures one might endure in an infertility workup and treatment as well as insight into the surrogacy and adoption process.

I actually really appreciated Cindy's insight into the surrogacy process, including advice on how to identify a surrogate agency, identify the important considerations you might have in picking your surrogate, etc. But when it came to the medical information about infertility, the book fell short, in large part because the information was seriously out-dated. It's clear that Cindy has been writing this book for a long time, and while the information may have been true when she started writing the book, some of it is just plain untrue today (bear in mind that this book is being published in January 2008, so there's no excuse for outdated information). I'll give you one glaring example:

There is nothing normal about in vitro fertilization. Amazing, yes, but normal, no. Frankly, you have to ask yourself what normal even means, when more and more people have to turn to IVF to get and stay pregnant. Add to this the very real possibility of multiples with each attempt, and we're talking the outer edges of norm, people. And here's why. To maximize the chances you will get, and more important, stay pregnant, doctors have to play the odds. They're not going to waste their time and your money implanting only one embryo, as good quality as that embryo may be. Unless you absolutely beg them (and even then I'm not sure you would find a doctor to agree), you will typically want to try up to six embryos each time.

Now that doesn't mean you'll end up with sextuplets, although there's always that chance when you play with Mother Nature. Usually, however, despite the implantation of multiple embryos, only the strongest will survive past the first few days leaving you with a much more likely chance of having the one child you are planning for.

So I've got a few problems with the medical information in those paragraphs. First of all, Cindy repeatedly mistakes embryo transfer for embryo implantation. I know this may seem minor, but I think it's a major misconception which does the infertility community a major disservice. If the medical community could actually implant embryos, we'd never need to do more than a single embryo transfer. But that's not what happens. Doctors transfer embryos to your uterus and hope that at least one implants in the uterine wall. The fact that people believe doctors actually implant embryos, is one of the reasons that the fertile-myrtle community believes that women who end up pregnant with higher order multiples (this is more common with IUI than IVF, by the way) made irresponsible decisions in their fertility treatment, and that's just not so. That's problem number 1.

Problem number 2 is that while it may have been true 5 years ago that doctors would want to transfer as many as six embryos, this is no longer the recommended practice for fertility specialists. In fact, studies have shown that transferring multiple embryos does not increase the chance of pregnancy in a given cycle, it merely increases the chance of a multiple pregnancy! While under some circumstances, a doctor may recommend a 4, 5 or 6 embryo transfer, this is no longer the standard of care. Many doctors are considering single embryo transfer protocol for a large number of patients. Again, this may seem minor, but it isn't. The point is that there was a medical advisor for this book, so my guess is that this portion of the book was written several years ago and was reviewed then, but hasn't been re-reviewed since.

If this passage were my only problem with the book, I'd be fine. I didn't particularly care for the writing style, and I found it to be disorganized. I DID appreciate Cindy's assertion that it is important to take the stigma off of infertility and important to be talking about it publicly. I agree with her wholeheartedly, and for that reason, I think this is an important book. I just think it could have been executed better. That being said, Cindy's story is compelling and I appreciate having a first-person account of infertility available in mainstream literature. Anywhozit, I think it's an okay book for someone starting out on their infertility journey, so long as they ignore the medical information in the book. As for someone deeply entrenched in the infertility process... I'm not sure how much they would get out of it, but I've been wrong before.


My Reality said...

You have time to read and write a review on anything with triplets in the house?

I think this is one book I will skip reading.

Erin said...

I know you've called yourself SuperMom, but the fact that you took this on TRULY emphasizes that you can do anything and everything! With that said, I'm with My Reality--I'm skipping this one. The "implanting embryos" thing drives me up a wall, and someone in her position should have the ability to use appropriate phrasing.

Rachel Inbar said...

You are indeed amazing :-)

The other review of this book that I read earlier today mentioned the same thing - 6 to 7 embryos. Being ancient myself (hey, my oldest IVF daughter is over 14) - the standard way back when was up to 4, particularly when some were poor quality - so I don't even know where 6 to 7 comes from.

I wrote just this week about single embryo transfer. I predict this subject will become more and more talked about (and acted upon) in coming years.

chicklet said...

I haven't read the book but yea, just a little inaccurate (being sarcastic). All the stats now go to the 1 or 2 transfer unless you have had failures or have shitty embryos. And the whole implant vs transfer, yeesh.

What surprises me most is they didn't have a fertility doctor review/edit - someone with knowledge would've caught this.

whattoexpect said...

Pardon me while I get up on my journalistic high horse...

How do these things make it to print? If I transliterate Muhammed incorrectly, my editor practically craps a horse. And I work at a newspaper! We have to translate every story from Hebrew on deadline and still get it into print!

Why, oh why, can there not be a book published that is accurate without being overly medical? And moreover, why would RESOLVE allow this? Inaccuracies like this one are a disservice to infertile women the world over.

Thanks for bringing it to our attention. If I can stay awake for more than 20 minutes and drum up more focus than a goldfish, I might send a strongly worded letter.

Diana said...

Very interesting, I found myself getting hot under the collar just reading that section! Thank you for speaking on behalf of those of us that were not asked to review the book :)

Kudos to you for having time to read! You are super woman!!!

OHN said...

If it is not being published till 2008, is there still time to have it corrected and updated? I don't know the inner workings of the publishing world but was just wondering.

Anonymous said...

Wow, that book sounds VERY annoying and filled with bad information! It will only encourage those comments like "Well you did fertility treatments, of course you got pregnant with triplets..." UGH!