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Thursday, February 26, 2009

Implanting Ideas

Updated at bottom:

The coverage of Nadya Suleman's octuplets has been like fingernails on a chalkboard--especially the misuse of the term implant concerning embryos. The verb choice may not seem like a big deal in the grand scheme of things (I mean, am I missing the point that the woman just had 8 children--8!--who cares what verb they use?), but I actually think the words used are just as damaging to the general public's understanding of infertility as the actual act itself.

Out of the 50 or so stories I've read over the last few weeks concerning the octuplets, the only source that has gotten the correct terminology is People magazine. Seriously. It felt a little Alice in Wonderland when People magazine was using the correct terminology and the New York Times had it all wrong. In fact, they didn't just have it all wrong--they had it all wrong on purpose as per a quote by New York Times reporter, Stephanie Saul:
We had an internal discussion about whether to use the term "implant" or "transfer." We decided to use the word "implant" because, to the average reader who is not well-schooled in the terminology surrounding in-vitro fertilization, it is an accurate description of what happens. The average person does not really understand what "transfer" means in this context.
Apparently, People magazine believes that they have a more intelligent readership than the New York Times. That, or the New York Times is greatly underestimating their own.

It's a switch of a single verb, but it has major implications in the way the general public views IVF as well as other fertility treatments. Embryos during IVF are transferred to the uterus, placed inside the organ with the hope that it will adhere to the uterine wall and grow for nine months. Embryos cannot be implanted, a verb that bypasses the reality of chance and success and hides the limitations of the procedure.

Why is the correct term important to the 7.3 million Americans who are currently diagnosed with infertility; even those who will use other fertility treatments to build their families and will never utilize IVF?

Peruse the comment section on any recent newspaper article concerning infertility and you will see vehement opposition to assisted reproductive technology. These opinions, more often than not, are formed based on media coverage of infertility topics rather than experience. The main argument that repeats is variations on the theme of control.

The idea of control is easy to see when you consider the picture the wrong verb paints in the mind of the average reader. If doctors can implant embryos, it follows that people believe that doctors currently have control as to which children are born. This couldn't be farther from the truth.

Fertility treatments are meant to circumvent fertility issues by mimicking what occurs in a well-functioning body. In other words, it is the equivalent to having a tutor in school--it is meant to enhance reality and not create an unnatural state. Unless intracytoplasmic sperm injection (ICSI) is used, millions of sperm have a chance to fertilize the egg albeit in a dish rather than inside the uterus. Not all eggs fertilize, creating the first stage of attrition. Not all embryos make it to transfer, arresting in the petri dish, creating the second stage of attrition. Finally, the embryo is transferred to the uterus where, just like all women who conceive without assistance, it is up to the uterus to create the optimal environment (drugs can encourage an optimal environment--they can't create said environment) and the embryo to adhere itself to the uterine wall. Implantation cannot be manipulated at this point in time because too many factors exist--from the uterine lining to the pinopodes used to attach the embryo to the lining--for doctors to wrest control from the body and nature itself.

Doctors can simply place the embryos in the body and hope just like everyone else that a pregnancy continues with the birth of a child nine months later. See--IVF isn't that different from unassisted reproduction if you take out that whole fertilized-outside-the-body part.

And yet, because the word circumvents the limitations of fertility treatments, those choosing not to pursue treatments or leave the path of treatments are met with incredulity that someone wouldn't utilize this "sure thing." How many times have those choosing to resolve their infertility by living child-free heard the term "give up" as in "why are you giving up on treatments?" Giving up implies that there will be success if one plugs away long enough in the situation. Those choosing adoption as a first or later path to parenthood are questioned about why they're not giving fertility treatments a chance (care to explain uterine anomalies and loss rates with Aunt Jane?). While treatments can help many, there are no procedures in place at this time that can circumvent all fertility issues.

I think it is detrimental to the health and well-being of those undergoing fertility treatments when they enter the clinic with the same expectations held by the general public. It is too easy to approach fertility treatments with blinders on, trying the next thing and the next thing and the next thing without considering the larger implications of these choices--namely mental, physical, and financial health. And yet, when you believe that most will have success with fertility treatments, it is difficult to walk away regardless of what else you are losing in the moment.

It is understandable if journalists are simplifying a process or removing medical jargon from a news story in order to make it more accessible for someone outside the experience with limited knowledge about assisted reproductive technologies. But trading the word "transfer" for "implant" doesn't remove an uncommon term in favour for one more well-known. It is sloppy writing, saying something the author doesn't mean at all. And, in turn, the reader does not get a factual presentation of the procedure.

Due to my background, I can spot these mistakes within an article on fertility. At the same time, it makes me wonder how many other medically-based articles I've walked away from without truly understanding the nature of the disease or procedure. What else have I been overpromised by the media in regards to my health?

Others have also weighed in with commentary on the misuse of the term "implant"--both for and against its usage.

I Want to be a Mommy is frustrated over the misuse of the word, stating,
I know that the general public often don't know the in's and out's of fertility treatment but all the misleading information or quotes flying around are maddening. If the media would at least use the right terms which they can research easily enough, maybe there wouldn't be so many people who thought IVF was a sure thing and that everyone doing it was bound to end up with at least one if not two take home babies.
Our Own Creation points out how simple it would be to use the correct term. "If they could be implanted, it would be a whole lot easier. Why can’t interviewers on major network news shows just check with an RE to see if their questions are valid/correct before actually interviewing someone about their fertility procedure?"

A Little Pregnant makes an argument for allowing the media to use the term implant, explaining, "Within our own echo chamber, we can all agree that we're right. And we are right. Transfer is a better word. It's just such an esoteric point that no one else on the planet cares, not even a little."

As journalists continue to write about Nadya Suleman and the eight babies, it would be helpful for the general public's understanding to choose a word more closely aligned with transfer. Journalists can write about how doctors placed six embryos in her uterus if they believe the reader cannot understand the concept of transfer. And once we get the terminology correct, readers will have the tools to correctly form their opinion on the ethics of IVF.

I wrote this for BlogHer, but I really wanted it cross-posted here. Because, damn, I really want people to get the terminology correct. And I absolutely love Julie for the part about us sounding like Trekkies at a convention--we do!--but I also do believe that the change in verb affects how the noninfertile community views fertility treatments (as well as the choice/non-choice to not use or stop fertility treatments). I think when you have the word implant associated with it, people don't understand how often it fails and while they know that not every pregnancy results in a live birth, I don't think they have a true understanding about IVF's limitations nor its success rates. IVF cannot circumvent all issues and fertility treatments are not a done deal.


While this doctor claims he has created a procedure to implant embryos, the reality is that unless he is manipulating the embryo to tap into a blood supply and burrow into the wall, he is not implanting the embryo at all. That said, this is not the first story that has misused the word implant. It is every media story I have seen or heard in the last few years. Except People magazine. They get it right. Go People!


Tash said...

You make a valid point. Like I said In ALittleBit's comments though, I think the real disservice here isn't to the people who know the lingo and what it represents (although I agree it's hurtful) but to those who do not. Because the people who do not understand reproduction -- and believe me, I bet we could line up a seriously scary interview type poll where we ask people about eggs and embryos and eggs they eat for breakfast and we're gonna run into all sorts of freakish nonsense -- are sadly the people who sit in state legislatures. They're the ones getting frustrated by what they presume to be out of control micromanaging of reproductive activity, and they're going to be the ones passing laws starting to limit these things. And the people in states who don't know transfer from implant (or egg from embryo) will be asked to vote in referenda. And so on.

It is about control of the procedure, but I think the NYT et al would have done a much greater service to use the correct terminology AND EXPLAIN WHAT EXACTLY IT MEANT. Assuming your average person knows about how babies are made -- sadly -- is not a great assumption to make.

~Hollie said...

Very Well Written, and I whole heartedly agree with you! Can I put a link back to this on my blog?

loribeth said...

Well said, Mel. It's galling that People's reporting can be considered more accurate than the New York Times's!!

As I said on Julie's blog, I think what's most upsetting about the misuse of the term -- other than the fact that it's just plain wrong & gives the wrong image of IVF, as you said -- is that it's just so typical, so symbolic of the lack of understanding, respect & empathy we who live in this community tend to get from the fertile world. Maybe we'd be willing to overlook it, if things were better for us in other respects (but they're not).

Elana Kahn said...

I totally agree with you. Every time I hear someone refer to "implanting" embryos" I just want to smack them.

SS said...

I am actually not that bothered by this. I believe the use of the word inplant outside of the infertility world is not that big of a deal. I think most people reading the NY Times do not know that 'implantation' is when the embryo burrows down into the uterus to create the first steps of a viable pregnancy. I think to them implant can just mean place inside or to insert. I don't think it implies to them that the doctor impregnates a women during this step. I also think there has been a fair amount of discussion regarding the odds for success so people following the story should be aware that the doctors "implanting" or "transferring" does not automatically result in pregnancy. Just my thoughts-

SS said...

Want to carlify that I do think the news coverage of this in general has been horrific and it will taint people's view of ART and could have very negative consequences in the legilatures. But I find much more fault with Nadya, her parents, and the doctor/embryologist that did this than I do with the new sources reporting on it.

Cassandra said...

I have been mad because I am a stickler for precision in language, but I hadn't made the connection about implying a sure thing until you pointed it out.

The mainstream media necessarily simplifies complicated things. The very best journalists simplify while maintaining full accuracy. Most don't quite understand it themselves, and report the gist as they see it. Some, apparently, choose to report inaccurately.

Most of us who have knowledge about a specialized area are appalled at almost all mainstream coverage. In most cases I'd say that it's better to get the message out period, though I would prefer more accuracy. But in the case of Octomom, I wish the media would shut up.

Anonymous said...

I find myself watching every sensationalized media piece on this woman like I'm passing a gruesome car wreck. I just can't help myself.

A blog by Infertility Warrior earlier this week mentioned that maybe all this publicity in the long run will be good for IF. I'm inclined to think not. Just as Britney Spears didn't bring any REAL attention to Bipolar disorder and mental illness, the story of Nadya has much less to do with IF and much more to do with the fact that people are fascinated by others who are in the crap-whole of life. It makes us all feel a little better about ourselves.

As far as the terminology, I get your point, but like other's have the long run, the world really doesn't care about IF: they think we should all just adopt and shut our traps.

I know that's bitter, but it's true.


luna said...

I'm appalled at the NYT justification for using the wrong term. and I agree it is (sloppy, lazy and) misleading for both the general public and prospective patients, giving the mistaken impression of success. i

luna said...

oh and let's not forget about "implanting eggs." as if!

Kristin said...

Brilliant post my friend!

LJ said...

I can't say this any better than you can. I had no idea about the NYT, and really find that reprehensible. In the general populace, no it isn't a big deal, but that's my problem with it. This should be a big deal. Infertility is a very mis/sub-understood issue, and when the opportunity arises to shed light on it, why not use it properly?

PamalaLauren said...

I thought though this doctor used a different technique which isn't a transfer but rather an implantation which is why some believe he put 6 in, in the first place because he needed to pad his numbers to show that he's successful?

Kim said...

Bravo! I agree!

Lisa said...

I was so annoyed by this one day that I mentioned in a post that Wikipedia was the only place I'd seen use "transfer." WIKIPEDIA. Kudos to People, and shame on the NYT for having that ridiculous official opinion.

I'm most bothered by the media making assumptions about what any audience can "handle." First of all, "transfer" is an easier term than "implant," and it's easily understood used in context. If journalists are THAT worried that their readers are idiots, they can easily say someone had 6 embryos put back or put in. Secondly, what's wrong with taking the simple step of explaining what the heck you're reporting on and, thus, respecting proper terminology/process, respecting your audience that either knows the lingo or can be educated SO easily? That's what I learned in journalism school, and it's also what I do as a children's and education-market writer. Besides, isn't learning something new *the* reason anyone reads an article or watches the news?

Studies show that students learn more, and better, when they need to reach a little. Giving clear explanations in terms a student or reader can relate to is NOT the same thing as dumbing things down. That's just lazy. And offensive.

debbie said...

I totally agree with you Mel. I was having a discussion with my coworkers about Octomom, and this guy chimes in, "Well I heard that they IMPLANTED SIX EGGS IN HER and my friend's friend, who did this thing, says you usually only put in two." I couldn't help myself. I had to respond. So, I politely told him that it was embryos, not eggs, and they transferred, not implanted, 7. I said I wasn't trying to be rude, but if we're going to talk about it, it's always good to use the right terminology. He said, so sweetly, "Who the hell cares?" I said, not so sweetly, "As someone who's gone through this whole process--ME."

Can you say akward work moment??

I couldn't help it though. I figure if anything good at all comes from this octomom situation, it's that there is dialogue happening and people have just a little chance at developing further understanding of the IF whole process.

On reflection, I realize that I'm not so concerned with terminonlogy as I am with a general understanding, and I really wish more people would read this:

PaleMother said...

The myriad of human variables in ART scencrios are more (no pun intended) art than science. That doesn't make ART bad, it makes it ~complex~. The poor word choice undermines the public perception of precisely HOW complex ART is. So to my mind, it's a bone worth picking. Good judgements cannot come from misinformation.

The reason the use of the imprecise term bothers me so much is that the shade of meaning that is lost/destroyed by the use of the wrong term creates serious collateral damage -- it misguides public impressions and public opinion, that sometimes frighteningly mindless force to be reckoned with. That ship won't turn on a dime. Whoops. Too late. Iceberg ahead.

The bottom line issue of the implantation/transfer word choice debate for me is this: The way the technical information has been presented, it leads sane (if clueless) people to conclude that heavy regulation of ART might be a good thing, a 'solution' ... necessary even. But as you point out, if you could IMPLANT embryos ... everyone who did IVF would be automatically ~pregnant~ and each embryo would always = a baby (or two if it splits). Of course that is far from true and it is ~exactly~ the reason that there is No. Such. Thing. as a one size fits all prescription for ART. It is the reason that the prospect of regulation horrifies both doctors and patients (the people who are most affected by infertility and it's treatment -- maybe the only people who truly understand the whole picture).

The rest of the infertile population should not have to suffer the consequences of/pay the price for sloppy writing and sloppy if passionate public misperceptions, just because Nadya and her doctor created a disaterous worse case scenario by abusing this miraclulous technology. People have been abusing their reproductive priviledges since time began ... this is just the first time an infertile woman did it and then caught the public eye because of the grotesque scale of her consequences. The public loves a freak show. But as Dr. Oz said this week ... it takes one fool to throw a coin down a well and 99 wise men to pull back up.

I had a situation in my treatment that illustrates the pitfalls that one can encounter while trying to apply the guidelines for limiting risk of multiples in ART and how easy it can be for lay people to misunderstand individual risk. The guidelines must be applied on a case by case basis because the risks are ~vastly~ different depending on one's history/circumstances.
I will try to blog a bit about that if I get some time.

I clicked on a link yesterday about the fertility doc involved in this case ... hoping to learn more about how he is being investigated for the obvious ethical violations. Instead I found a photo gallery that included a picture of the sign on his clinic door -- The name of his clinic was something like "The Center For Embryo Implantation" ... I couldn't believe my eyes! I tried to copy the photo so I could send it to you. But the right-click didn't give me a 'copy' option. Funny that you wrote about this today.



Amy said...

Well is unnerving to read "implanted" vs. "transferred" when I know better.

ms. c said...

Amen, sister.

I agree with you about wondering if I am mislead on ohter medical issues. I often think about that when watching medical dramas on television. As the writers/researchers get info on fertility treatments "mostly right", I find I take most medical info with a grain of salt.

(PS, should you ever find something that you feel that you need to address concerning Private Practice, let me know, the medical consultant is the brother of an aquaintance...)

MamaSoon said...

Yes, these are EMBRYOS! Not HAIR PLUGS or SILICONE BREAST POUCHES! Embryos IMPLANT themselves.

And I thought you were supposed to learn from reading. I find it frustrating too. I wish someone could implant embryos into me. It would really help speed this adventure along.

Why not use the word 'placed' if people are too dumb for transferred.

Even more irritating to me is the use of Egg instead of Embryo. 'They implanted 6 EGGS in her!' Way to get everything wrong and ignore the most basic parts of reproduction.

Megs said...

I am so glad you touched on this! I just read an article yesterday through MSN that used the term "implant" and it is about to drive me up the wall. I mean, I really wish it were that easy, because dang, then it would be almost a guarantee of pregnancy! We would go on with it in a heartbeat! :)

So...very good post. If they really feel their readers are that dense then maybe, just maybe we need to actually have some education in the article? But that would be tedious.

serenity said...

Well said, Mel. I can't get past the raw emotion to even remotely write a post this well. :)

Angie said...

Kudos ~ well said/written!! The whole "implant" verb is driving me crazy, too! Every time I hear that word, it makes me cringe! Implant means it *stays*....if only that were the case, all of us IVF'ers would be mommies a gizillion times over.

Emmy said...

Thank you for this post. I think you explain it very well, and much more eloquently then I ever could!

Dora said...

Spot on! The egg/embryo thing annoys me too. I read something where a vegan referred to people eating "chicken embryos." Uh, no.

What really annoys me most with the implant/transfer thing is how many drs I see on tv getting it wrong.

Rebecca said...


Although can I just say I'm so sick of hearing about "Octomom"? I thought I was going to knock someone out last night at work because that was all they were talking about. Her 15 minutes is over. At least in my mind!

But, as always, awesome post!!! There is still so much education that needs to be done about IF and ART.

SMK said...

I AGREE 1000000000% When Oprah and Dr Oz interviewed the grandfather I wanted to throw something at the screen every time they said implant... then I was sent a video see my blog for the link... He did something very different to TRANSFER the embryos. It may be the future of IVF... but still I consider it TRANSFER if only we could have them implanted!!!!!!! Thank you for taking a stand!

Christy said...

I was bugged a bit by this too when I first started hearing about it. Then, one "news" story I saw talked about a newish procedure that the doctor in quesion used, which really does (apparently) implant the embryos in the uterine wall. They showed video of the nearly microscopic images (obviously from a different patient) which showed a tiny cut being made in the tissue and the embryos being forced in. Now, I really don't know how reliable that segment was, but it sure looked different than what I saw on the screen during my own transfer. Until we hear directly from the doctor what exactly he did, I guess we won't really know if the correct terminology is being used or not.

All terminology aside, the whole situation seems ridiculously irresponsible.

Mrs. Olson said...

Thank you Thank you Thank you for addressing this! You said it so well! I had to have this talk with my family a couple of weekends ago, as well as some people at work.

It's very upsetting to see and hear the way people are reacting to this story, and you are very right, most of it could have been solved by a simple switch of words.

If the NYT was so worried about people not understanding, why couldn't they have put a simple definition in the story as well?? Very frustrating from the IF point of view.

~Jess said...


Hear! Hear!

That little difference in verbage makes the whole difference in all of this, especially to people who aren't familiar with IF and IVF specifically.

battynurse said...

Great post. I was so annoyed by the comment from Stephanie Saul of the NYT. Thanks also for the mention.

lostintaipei said...

Uh boy. This one esp. hits home to me right now as I await my TRANSFER on Sunday. Simply put: another example of lazy, irresponsible journalism that only fans the flames of IFer ostracism. Good job NYT, you're staying true to your fictitious reporting history.

Their reason (excuse) for this decision is inexcusable. The English language is wonderful because there are so many words to specifically communicate ideas--it's their JOB to use words authentically and well.

I have many punches I'd like to swing on this. Is that the hormones? Not sure. This is ALL so rage-worthy.

Yesterday I wrapped up my "prepping my womb" post--an exercise in hope as I establish a fluffy home for the embies. It was an emotional process. But more importantly, in that post, I address ABORTION. I'm vehemently PRO-CHOICE. Legalized abortion is inextricably intertwined with our rights to utilize ART procedures. It's a slippery slope. Admittedly, it's a touchy subject I have yet to read posted by a fellow IFer.

On my 2nd post on the same day, I bemoan the fact that they do not yet have the technology to actually do the implantation.

That doctor has already established he is unethical. So why in the world would he be believed that he has figured out how to do an actual implantation vs. transfer?

Seriously want to line these people up for my punch fest.

lostintaipei said...

Okay. Call it the hormones...

It's beyond my control, I cannot resist adding this additional thought. As time passes and we look at these events in hindsight, as HISTORY, these are the events that could have a seriously negative snowball effect not just for women TTC their own bio baby, but evvvveryone--whether they give IF a second thought or not:

3 words: embryonic stem cells.

Thank you, Mel, for the post. Thanks for being so visible out there as our honorary IF spokesperson. Thanks for your continued total absence of apathy.

kate said...

I'm sorry. I have to be with Julie on this one.

I just feel like we have bigger battles to fight, and while the Sapir-Whorf theory of linguistic power has some merit (and seems to be at the root of this debate), when we focus instead on flailing our fists at the dummies who use words incorrectly, we come off as people who'd rather fight semantics than actual issues. In this case (though Mr. Sapir is a really cool fellow), I have to disagree that this word's incorrect usage intrinsically causes misunderstanding.

While the general public has no flippin' idea how IVF works (or even what the difference between IVF and other ARTs might be), I think that the general population doesn't even begin to have the sophistication to understand the nuances of the "transfer" vs "implant" concepts. I want them to understand that it's medicine, and that it's an acceptable procedure to be used to attempt to resolve infertility. It would be nice if the terms were used correctly, but I'd rather that the broader concept of "medical treatment" be understood.

What this argument brings to the forefront is the frustration we feel over the general misunderstanding (and thus lack of acceptance) of infertility. And for me, the best way to clear up misunderstandings is not to get caught up in a battle of terminology, but rather to get caught up in a battle of knowledge.

I want to spend my time sharing the idea that we infertile types aren't a bunch of freaks but are rather just plain ol' people who happen to be dealing with broken babymakers. And the constant focus on terminology lends to us an air of the freakish.

It's like when I start geeking out on report design, and ripping on people who don't use the word "query" correctly (and oh, dear, don't start us on whether "SQL" is pronounced "ESS-CUE-ELL" or "Sequel"- that debate will never end), I come across as an arrogant know-it-all rather than someone who genuinely wants an outsider to understand the process.

I mean, think of how you feel when you are having a conversation and someone smacks you down because you use the wrong word. If you have the understanding of the concept (at least as far as is necessary for the purposes of whatever conversation), when someone corrects your usage, it comes across as petty, and it makes you feel like that person has no desire to have a conversation with you, but instead to "instruct" you on all the nuanced ways that you are wrong. Which, I mean, if I'm in a classroom setting, might be appropriate, but in casual conversation is never appropriate, unless you are just trying to make the other person feel dumb.

I think arrogance is the death of understanding and so to continually point out what (to outsiders might be considered small and irrelevant) differences in word usage results in people shutting off the understanding part of their brain and instead turning on the defensive part.

So. I will continue to piss off the infertile world by refusing to take people to task when they use "implant". I know I'm supposed to toe the party line, and I know I just lost my IF club card by saying so, but there it is. I couldn't care less about the general uneducated population's usage of "implant".

Parenthood For Me said...

Great article. Very well written. It makes so many wonderful points about how misunderstood ART is due to the media. The problem is so large, where do we begin to try and educate the "public"- non-infertiles?
Unfortunately I haven't had time to read the articles on nadia (I won't use her media given nickname). Thank you for helping me to stay informed. We (the educated public)all knew this would be a nightmare...

Seriously? - Erin said...

Here from ICLW. I am frustrated by this story as I see people having more negative reactions to any sort of fertility treatment.

I personally was helped by oral medications and I have a friend starting IVF. I want to smack every one asking her if she is going to have 8 kids like that lady.

Thanks Lady for the 5 steps back...

bleu said...

Years ago they did implanting of embryo's in Japan I believe. I say this as in they placed the embryos into the endometrium lining instead of simply transferring them. My RE told me about this, and the results hit on exactly what you closed with, they had no better results than with transfers because they can not tap into blood supply even if they do burrow it into the wall. As a result they would never bother with the added expertise and expense of continuing to do it and likely it should be called a "burrowed transfer" rather than a true implantation.

Anyhow just a factoid.