Thursday, December 06, 2007

Bioethics & Television - Private Practice

It's too bad there's not a way to easily track the increase in call volume at fertility clinics. I'd give a lot to see what the call activity looked like this morning, after folks saw last night's episode ("In Which Dell Finds His Fight") of ABC's spin-off of Grey's Anatomy, Private Practice.

One of the two medical story lines followed in this episode centered on a couple who wanted to conceive, but the husband was diagnosed with azoospermia. The couple rapidly - as in, immediately after receiving the diagnosis - rule out adoption and decide that, since the wife is currently ovulating, they will try for sperm donation immediately.

Let's pause for a moment to consider the likelihood of a private practice based ob/gyn/fertility specialist and fetal surgeon/genetics specialist (we could really stop that sentence right there, but...) going from delivering a diagnosis of infertility to, within minutes, agreeing to allow the couple to select a sperm donor for insemination that day. I admit, this isn't my area of specialty, but I would think that this might be a process that takes time. Certainly more than the span of a few minutes.

However, that in and of itself, while rapidly paced and smoothed over for dramatic license, wasn't terribly egregious. It's the next part, where they opted not for sperm donation, but advanced sperm removal and IVF, that took the show beyond dramatic license and into the realm of "creating headaches for fertility clinics nationwide."

The two doctors explain to the couple that they can do a procedure called microsurgical retrieval of epididymal sperm, or MESA, and then extract the currently ovulating ovum from the wife, and use intracytoplasmic sperm injection (ICSI) to create a viable fetus, which was then immediately placed back into the uterus. The picture above is from this scene; you'll see that the patients were there and talking to the doctors as they performed this several stage complicated procedure all by themselves.

One of the things being talked about is just how real all this medicine was, and from what I saw and know (please correct what I get wrong), the procedures are all actually sound. It's the speed, the setting, and the overall depiction of the entire process that I find problematic. It's one thing to accelerate, for dramatic license, multiple office visits to discuss sperm donation and the details that would make, frankly, for boring television. No one wants to watch people sitting around talking, and it seems that the general knowledge level is such that no one expects to walk in to a fertility specialist office for a first visit, and walk out a hour later with sperm floating in their uterus.

MESA and ICSI are much more obscure, new, and not known procedures. By depicting them as joint events that can be simultaneously with single egg extraction during ovulation, and as something that takes no longer than an office visit instead of a several day if not weeklong or so process, gives an awful lot of false information that specialists then have to work at undoing. It's no longer a matter of educating a patient on a procedure, it's about undoing the subtle information bias that they might not even realize they hold.

Is it irresponsible for a show to compress and simplify a complicated procedure or concept so that it fits into the time allowed for the story? Maybe not, we expect dramatic license when we watch fictional television. The problem is just the degree of license - when you're going out of your way to establish authenticity with realistic imagery and dialogue, and strive for medical accuracy, it seems that putting a limit on just how far you stretch reality has to come in to play, as well.


SabrinaW said...

This type of storytelling bothers me because it reinforces many societal conceptions - adoption is a poor second choice to undergoing a complicated (and risky) fertility procedure; the decisionmaking process for fertility treatments is driven primarily by how much the patient wants it; the medical and congenital risks of using ICSI pale in comparison to the thrill of "having your own" child.

But I guess choosing to adopt a child doesn't make for good medical drama.

Kelly Hills said...

Actually, and in the show's favour, they did, in a digression, spend a significant amount of time addressing why a biological child was so important to both of them. Backstory on the patient was that she was adopted, and he wanted her to have one person in the world that looked like her.

While I find it hard to understand that mentality, because I don't really have any desire to have children, I know several adopted adults for whom creating a biological family so that they had the blood, and the genetic inheritance and looks (the whole package), was very important. It wasn't necessarily a commentary on their own adoption, as it was they had always grown up wishing they had their grandfather's unruly hair, or someone else was as uncoordinated as they are - small things that indicate relation.

The show did cover that admirably, why the desire... it was just a shoddy rush job on the rest of it!

Bea said...

I think it's highly irresponsible. Infertile couples go through a long and detailed decision-making process before deciding on a course of action - be it IVF, adoption, donors, or choosing against children altogether - and this type of storyline reinforces the idea that (to use Sabrina's words) "IVF is all about the thrill of having your own child". (Aside - adoption is also about the thrill of having your own child.)

The same can be said for the oversimplified portrayal of the practical, medical side of the process. The whole thing is belitting of what infertile couples actually go through.


MLO said...

SabrinaW - adoption is both more expensive and more invasive than even complete donor IVF. There are at least 3 potential adoptive parents for every 1 baby. And, having worked with disturbed children, most new parents do not have the skills to adopt a child with mental issues stemming from abuse.

I have never seen any medical procedure accurately portrayed on television - ever. I suffer from allergies and it the danger is always minimized for comic effect. People die from reactions.

Not for one minute do I believe anything on TV is sound medically. I have too many relatives and friends in the medical field who cannot watch any medical shows (outside of General Hospital - who knows?) without having a hissy fit about the medicine.

No one, unless they have long known about azoospermia or such, would move immediately to IVF. And NO way would any clinic allow someone to move to IVF without a thorough exam. The sperm tests are usually ready way before all of the exams a woman has to undergo.

And, as Bea said, it is terribly irresponsible toward all the infertile couples who are actually trying to have a child. The process is long, boring, and hard. (And only a handful of clinics in the world will do single egg retrieval without having done a stimmed cycle.)

You see, in order for there to be an egg retrieval, there has to be stimming with some sort of drugs unless you have opted to go with a clinic that specializes in Natural Cycle IVF which is frowned upon in the US in general.



Linda MacDonald Glenn said...

ML0, maybe more expensive (although I do question), but more invasive? IVF is physically invasive, but I'm having a hard time seeing how adoption might be...

MLO said...


Like most people who are not involved in either IF or adoption on a day to day basis, you are likely unaware of the reality of the situation.

Adoption is incredibly invasive to one's privacy - and this is a much greater deal to many people than bodily invasion.

I suggest you read around the actual IF and Adoption blogospheres to see the REAL experiences people are having - not the media's sugar-coated and ignorant representations.

The reality is, that there are 3 couples (usually infertile) for every healthy infant born. And, no, infertile couples should not be expected to adopt unhealthy children just because they are infertile - that is extremely unethical in my mind.

This has become a very real hot button issue for me because the majority of "experts" know nothing about the reality. Most are living in the late 1960s not the 2000s in their conception of adoption. They only contribute to the pain the IF and adoptive parents feel with their paths.

Many - not all - adoption agencies are less than ethical in their dealings with potential parents and birthmothers, and they are not very well-regulated either. On the international front, the competition for children has gotten to the point where many things will preclude parents even when they do not reflect on the person's ability to parent.

Your comment really only shows a great deal of ignorance. Hopefully, instead of arguing with what I said, you will actually educate yourself.

I posted a synopsis of the real issues here: