She really wanted the baby. Her kids did, too. Her on-again, off-again boyfriend of three years did not.
"I talked to God a lot, asking what does this mean. What am I supposed to do?" she recalls. She was working long hours as an office manager at a chiropractic firm and just making ends meet. She would need to take on a new expense: child care.
"We live simply," says Renee, 36, looking around the living room of her three-bedroom town home. "There wasn't much more we could simplify in our lives." As much as she wanted the baby, she says, "I didn't want to hurt my children."
So after giving birth Dec. 30, she nursed Josephine Olivia Renee for six days. She then did something she would not have imagined nine months earlier: She gave her child to another family.
Renee says placing Joie (pronounced "Joey") for adoption was the most difficult thing she's ever done, but she has no regrets.
"I've never been more at peace in my life," she says. "Joie deserved better." ...
click here to read the full story
In a recent column, I argued that the most plausible reason that couples with daughters divorce more often than couples with sons is that parents, on average, prefer boys. Since then my e-mail box has overflowed with objections, alternative theories, and requests for clarification. In the meantime, I've changed my own mind. I think I have a much better way to explain the facts. So, I want to revisit these issues.First, to the e-mail. The easiest ones to dispose of are those that question the facts, particularly the claim that a one-child American family with a daughter is 5 percent more likely to get divorced than a one-child family with a son. The facts are accurate. The divorce numbers come from a study by Gordon Dahl and Enrico Moretti based on more than 3 million observations from the U.S. Census. With that kind of sample size, there's no way the 5 percent difference is "just a coincidence," as some readers suggested.
Other readers accepted the reality of the 5 percent difference but questioned the conclusion that daughters cause divorce. After all, marriages differ in all sorts of ways that might be relevant—financial stresses, infidelity, emotional distance. The phrase "correlation does not imply causation" popped up a lot.
But in this case, correlation does imply causation, and here's why: If you take 3 million people, have them all flip coins, and divide them into two groups according to whether their coins came up heads or tails, then the two groups are going to look statistically identical in every way—same average income, same average intelligence, same average height. That's called the law of large numbers, and it works for two reasons—first, the sample size is huge, and second, coin flips are random. Now do the same thing, dividing your 3 million people according to the gender of their last-born child. The same thing happens—parents of boys are going to be statistically identical in every way to parents of girls, because you've still got a huge sample size and because the sex of a child is as random as a coin flip. Since everything else is equal, the only thing that can be causing the difference in divorce rates is the gender of the children.
"Why not just ask people why they got divorced?" inquire several e-mails. Answer: You can't feasibly ask 3 million people why they got divorced. You could feasibly ask 3,000, but then your results would be statistically suspect because of a small sample size.
In fact, there are published surveys indicating that mothers of boys are happier on average than mothers of girls. These surveys are directly relevant to the point at issue, but I chose not even to mention them in the original column because Gordon Dahl convinced me that their statistical significance was suspect.
A number of readers offered the comment that, evidence be damned, they would simply never believe that the children's gender could be relevant to a divorce decision. My favorite of these came from a therapist in Iowa—it would probably be inappropriate to mention her name, so let's just call her "Bozo the Therapist"—who took me to task for the "archaic notion" that children ever have anything to do with divorce. Unless she's been practicing not in the state of Iowa but on the planet Iowa in some distant solar system, Bozo must win the prize for "least observant therapist in human history." The fact is that children do affect divorce decisions; if we didn't know this from statistical evidence, we'd still know it from common sense. And to a smallish but non-negligible extent, girls cause more divorces than boys do. Ignoring those facts won't make them go away.
The facts are clear and worth reporting, but there's legitimate controversy about what they mean. There are three key facts: 1) Parents of daughters are more likely to divorce than parents of sons; 2) in multichild families, parents of daughters are more likely to try for another child than parents of sons; 3) divorced mothers of daughters are less likely to remarry than divorced mothers of sons.
I originally said that all three facts point to a parental preference for boys. Several readers pointed out that the third fact—that divorced mothers of daughters are less likely to remarry—admits a better explanation: Mothers don't want to expose their daughters to a potentially predatory stepfather. Excellent point. So, I now think the evidence on remarriages is ambiguous regarding whether second husbands prefer boy stepchildren.
Other readers offered what they thought was counterevidence: Adoption agencies report a higher demand for girls. But this is exactly what you'd expect in a world where parents prefer boys. In such a world, boys will tend to be put up for adoption when there's something seriously wrong with them, but many girls will be put up for adoption simply for being girls. So, if I'm looking to adopt a bright healthy child, of course I'll choose a girl: I expect that among children put up for adoption, girls are on average brighter and healthier than boys. I could well make this choice even if I prefer boys to girls, as long as my preference for bright and healthy is stronger.
Still, several readers came up with other ways to explain the facts. A lot of their stories were rooted in evolutionary biology, e.g., "a boy is a better genetic investment because boys can have more progeny than girls." Unfortunately, that doesn't work. For every boy with more than the average number of offspring, there's another with less than the average number. Boys are likelier than girls to generate 20 children, but they're also likelier to generate zero.
The most creative evolutionary biology explanation comes from reader Todd Peters: Boys with low self-esteem become withdrawn and unattractive; girls with low self-esteem become promiscuous. So, if you want lots of grandchildren, you've got to raise the self-esteem of your sons (by staying married) and lower the self-esteem of your daughters (by getting divorced).
Ooookay. But let's end on a serious note, with a whole new way of looking at this—the way I wish I'd thought of to begin with. Suppose parents believe that inherited wealth is more important to a boy than to a girl—either because wealth gives boys a bigger advantage in the mating competition or because boys are more likely to do something entrepreneurial. Then parents of boys will try harder than parents of girls to preserve their wealth. In particular: 1) Parents of boys will avoid divorce, because divorce is costly; and 2) parents of boys will have fewer children, because extra children dilute the inheritance.
That could explain the divorce statistics and explain why parents of boys are less likely to try for more children. So, here's a nice theory that fits all the facts and doesn't rely on a preference for boys.
Finally, a lot of readers asked me about my own preferences. I cannot imagine why they're interested. If I were reporting on national employment trends, would you want to know my personal employment history? But for the record, I'm pleased to say that I always wanted a girl, I got the girl I wanted, and so far she's perfect. Ask me again next month after she starts driving.
Illustration by Robert NeubeckerSteven E. Landsburg deduced from an array of data that parents, on average, prefer sons over daughters. His evidence lay in a few recent studies that show that daughters have a slight but marked tendency to break up (or else forestall) marriages while sons tend to keep them together. But it turns out there's a fascinating fork in the statistical trail of bread crumbs.For years, it's been common currency in adoption circles that girls are far more popular than boys among adoptive parents. Now there's data to confirm it, which has prompted another round of speculation about gender preference among parents—an issue that is bound to rouse more interest, and concern, as the era of assisted reproduction progresses.
This past August, the Census Bureau released an unprecedented report comparing adopted, biological, and stepchildren based on results from the 2000 Census—amazingly, the first census to differentiate between these groups. First of all, the report found that there are about 105 boys for every 100 girls in the general population of biological children under the age of 18. Adopted children, it turns out, present a very different picture, with a "sex ratio"—the sociologists' term—of 89 boys for every 100 girls. What's more, adopted children under the age of 6 constitute a group where there only are 85 boys for every 100 girls. (The Census Bureau reports that stepchildren—a sizable population whose sex ratio is closer to the norm—are usually adopted at later ages than orphans are. Hence the under-6 drop-off.
Last but not least, the sex ratio of adopted children goes still further off-kilter if you look only at international adoptions. The Immigration and Naturalization Service (now part of the Department of Homeland Security) has kept up excellent data on international adoptions over decades of processing visa paperwork. Its word: Girls make up about 64 percent of all children adopted by Americans outside the United States. That's a mere 56* boys for every hundred girls.What explains the disproportion? If we didn't know better, the most obvious conjecture would be that these numbers simply reflect an imbalance in supply. After all, America's leading source of adoptees is China, where the legacy of female infanticide is the grimmest hallmark of that country's overwhelming preference for males. The organization Families With Children From China reports that about 95 percent of children available for adoption in China are girls. Other Asian adoption hubs (like Korea, the erstwhile lead supplier) have orphan sex ratios that tend in the same direction. So Americans adopt more girls because other countries don't want them, right?
Wrong. Unlike biological parents, who must simply make do with what the procreative coin toss affords them—as in a market determined solely by supply—adoptive parents get to be upfront about their gender preferences. And a look at those preferences suggests that, in fact, the adoption market in China represents a happy coincidence of supply and demand.
Numbers vary, but it's pretty safe to say that somewhere between 70 percent and 90 percent of parents looking to adopt register some preference for a girl with an agency. It doesn't matter if they're adopting from China, where girls far outnumber boys; from Russia, where the numbers are about even; or from Cambodia, where there is typically a glut of orphan boys and a paucity of girls. Everywhere, demand tends to favor the feminine.
And, as the case of Cambodia suggests, demand can in fact exert an influence on supply—and not a happy one. In the late '90s, Cambodia became a popular source for American adoptions, thanks to a relatively quick, cheap, and tidy process. But for whatever reason (some cite a Cambodian tradition that girls are expected to take care of their parents when they get older), Cambodia didn't offer the standard Asian profile of adoptable children. Boys outnumbered girls by a healthy margin. So what happened was what you would expect to happen in an underpoliced free market: Market pressure built up, until certain enterprising Cambodian adoption suppliers, or "facilitators," stepped in and found a way to meet demand.
Evidence of child-trafficking came to light in late 2001 and early 2002, when several poor Cambodian women stepped forward saying they had been approached by someone from an "NGO" who offered them a sum of money—significantly more for a daughter than for a son, though never more than $200—in exchange for their children. When that "NGO" turned out to be an orphanage, the U.S. Embassy and the then-INS slammed the gates on all U.S. adoptions out of Cambodia. They haven't reopened the gates yet.
Scholars inside the adoption community are quick to admit that the historical aura of secrecy surrounding adoption has hobbled research efforts to account for the decided preference among parents for girls. Still, there are a few decent indicators. First, there are certain norms and stereotypes peculiar to the world of adoption that have been wafting around since adoption became a modern institution. Take, for example, the following quote, an excerpt from the 1916 annual report of the Spence Alumni Society, one of the very first American adoption agencies: "Why do so many people prefer girls! The majority seem to feel that a girl is easier to understand and to rear, and they are afraid of a boy."
Quaint, yes, but the same view still crops up regularly enough in adoption-talk that it invites some probing. Parents might be "afraid of a boy" because the adoption market stalks frightful circumstances like poverty, instability, and violence around the map: When taking the somewhat risky step of bringing a foreign element into their family, parents might perceive little boys to be inheritors of their homes' uneasy fortunes, whereas little girls can more readily seem to be hapless victims of circumstance. Or it might be that, as Landsburg suggested in a follow-up piece, adoptive parents choose girls out of an inference that his theory is true—that most biological parents like sons better—and therefore they gather that "boys will tend to be put up for adoption when there's something seriously wrong with them, but many girls will be put up for adoption simply for being girls."
According to Adam Pertman, the real answer lies elsewhere. Pertman, the executive director of the Evan B. Donaldson Adoption Institute, a New York-based think tank, and author of the book Adoption Nation, suggests that the most important step in figuring out why so many people want to adopt girls is to look at who wears the pants in most adoption processes. Hint: It isn't the men.
"The extent to which women are the driving force in most adoptions is probably a factor," he says. "It's usually true that the women are filling out the paperwork, going to the conferences, the support groups." He adds, "If I speak at a conference—whether it's on adoption or family issues—at least 80 to 90 percent of any of these audiences are women."
If men are indeed largely silent partners in most adoptions, it could indicate that men's preferences with regard to their children's gender are simply not as strong when patrimony is not an issue. A man might hanker pretty strongly after a biological son to pass down both his name and his genes; but if that grand prize, so to speak, is not on the table, he may not care as much either way. Furthermore, if women are the ones running the show in most adoptions, and daughters are the ones getting adopted, it might nudge us toward the overall conclusion that parents merely tend to want children who are like themselves. Absent a strong paternal vote, mothers adopt daughters—and, as Landsburg noted, "fathers stick around for sons when they won't stick around for daughters." If adoption has any light to shed on the larger questions of gender preference among parents, this is probably it: More often than not, the view from adoption has it, mom wants a little girl, and dad wants a little boy.
But perhaps it's worth considering whether deeper motivations might also be at work. Let's assume that the parenting instinct combines two different components: a procreative and a nurturing urge. Some might say women disproportionately answer to the call of nurture, and men are more susceptible to the leaner procreative impulse. In most instances, adoption provides people who cannot satisfy the latter part of that instinct (procreate!) with a means at least to satisfy the former (nurture!). By that reasoning, parents (mostly women) who initiate adoptions do so because they want children to nurture and love, and they adopt girls out of a common perception—however accurate or inaccurate it may be—that girls respond better to nurturing than boys do. Perhaps adoption simply isolates one of the variables involved in why people become parents, and that variable happens to be one that favors girls.
Any institution that grafts altruistic motives, and ends, onto stubborn instinctual predispositions—which is what adoption does—is a cause for rejoicing. (Full disclosure: I have two adopted siblings.) But the adoptive parents' freedom to choose their child's gender can, as recent events in Cambodia suggest, cast a potentially darker light on this cuddly scenario. When little girls or little boys become preferred commodities—instead of just glints in the eye—there can be unforeseen, and unfortunate, consequences.
In this, adoption may be a bellwether of things to come, as rising technologies of assisted reproduction begin to afford biological parents a similar freedom to stipulate the gender of their children-to-be. If nothing else, the case of adoption shows that gender preferences can indeed skew pretty far to one side if parents are free to jot them down before the fact of parenthood (after which point one's theoretical desire for either a son or a daughter usually breaks up against an actual, beloved child of either gender). Perhaps, all speculation aside, we should regard this particular freedom with a wary eye—and applaud the growing number of adoption agencies that don't allow prospective parents to stipulate any gender preference in the first place.Correction, Jan. 14, 2003: This piece originally miscalculated the gender ratio for adopted children. It is 56 boys for every hundred girls, not 72. Return to the corrected sentence.
Infertility and IVF: A Womb with a View
Dr. John Janousek, M.D.
Posted: Today
Prior to medical school I worked in reproductive medical labs performing in-vitro fertilization, or IVF. I was an embryologist, the one who joined the egg and sperm together in petri dishes to form human embryos. I saw firsthand the anguish of couples who suffered from infertility and the joy when “miracle babies” were born from assisted reproductive technologies.
The usual course of life for most couples is dating, marriage, then children, and when they cannot become pregnant everything changes. There is terrific emotional stress, feelings of guilt and worthlessness, depression, and frequently marital discord.
Infertility treatments have become very advanced and more successful. IVF has come a long way since the first American baby, Elizabeth Carr, was born 27 years ago after her mother was treated by Drs. Howard and Georgiana Jones here in Hampton Roads at EVMS in Norfolk.
What is infertility?
Infertility is defined as the inability to get pregnant after trying for at least one year. Women who have repeated miscarriages are also infertile.What are the steps in becoming pregnant?
An egg must be released from a follicle on an ovary (ovulation), and must enter one of the fallopian tubes leading to the uterus. Sperm must be present to fertilize the egg along this journey. Finally, the fertilized egg (embryo) must attach to the walls of the uterus. Conditions that interfere with any of these steps can cause infertility.How common is infertility?
Very common. About 12% of women have trouble becoming pregnant. In couples, about 1/3 of the time it is a female factor, 1/3 are male factors, and 1/3 are a combination or unknown.What are the causes of infertility in women?
The most common cause is a problem with ovulation (commonly hormonal). Other causes include blocked fallopian tubes (from pelvic inflammatory disease, endometriosis, or surgery), uterine problems such as a bicornuate uterus (2 compartments) and fibroids. Advanced maternal age decreases fertility as well.What are causes of infertility in men?
Some men produce too few sperm or even none at all. Others have sperm which have an abnormal shape or impaired ability to move (motility problems). Other sperm appear normal on microscopic exam, but for biochemical reasons cannot penetrate the egg.Trying, but no baby; what next?
Ok, a couple has been trying for a year to become pregnant without success. What are the next steps? The couple should get an appointment with a gynecologist who has experience in infertility treatment. A woman can contact her gynecologist to ask about an infertility work up or a referral.What are some of the steps in infertility testing?
To test ovulation, a woman can check her basal body temperature every morning, check her cervical mucus texture, or use a home ovulation test kit. Blood work and ultrasounds can also be performed.A hysterosalpingogram (HSG) is used to check for blockages in the fallopian tubes. Dye is injected through the vagina into the uterus, and fluoroscopy (continuous x ray) enables the physician to watch its passage. Laparoscopy (surgery) involves insertion of a fiberoptic scope through the skin into the pelvic area to directly visualize the reproductive organs. This is also the definitive method to diagnose endometriosis (abnormal location of cells from the lining of the uterus).
Men typically have a semen analysis done, and they can be referred to an urologist for further evaluation. Some conditions such as a hydrocele (swollen blood vein) may require a minor surgery.
What are some infertility treatments?
Infertility medications are given to women to help them ovulate and to mature and release more eggs from multiple follicles which increases the chance of conception. Artificial insemination involves washing and concentrating a sperm sample with injection into the uterus. Treatments are targeted at overcoming the specific problems identified (see steps in becoming pregnant above). Assisted Reproductive Technology (ART) refers to more advanced treatments.What are some types of ART?
IVF refers to joining of the egg and sperm with fertilization outside of the body, in a special type of petri dish containing specific culture media. The woman is given hormone injections causing the ovaries to produce many eggs. When the eggs are mature, they are removed usually by needle aspiration and joined with the sperm in the lab. Embryos are replaced through a catheter inserted through the cervix into the uterus about 3-5 days later.The Jones Institute’s clinical pregnancy rate per embryo transfer procedure is about 43%. Nationwide in the best clinics, there is about 22-32% “take home baby rate” per transfer; this takes into account miscarriages and ectopic (tubal) pregnancies. The CDC has a good site about ART with data from all reporting programs.
Intracytoplasmic sperm injection (ICSI) is used to overcome sperm problems, and involves using a microscope and special tiny needles to inject a single sperm directly into an egg without harming it.
Working as an embryologist was a very interesting and rewarding job for me, although I always worried about dropping the small petri dishes containing human embryos (never happened). The patients were incredibly thankful when the process worked (but of course the doctor got all the credit).
I remember a party I attended at that time, where a woman found out what I did for work. She began telling me loudly and in detail all about her husband’s low sperm count and the problems they had conceiving. The poor fellow was standing there trying to shrink into the wood work!
Remember, infertility is a common problem that can be treated, although even now many couples are not successful. About 85% are treated medically or surgically with only about 5-10% progressing to the point of needing IVF or other ART.
Infertile couples need plenty of emotional support as the inability to produce children is a huge stressor. Sexual union, instead of being an act of love turns into a mechanical process of trying to achieve the elusive goal of pregnancy, with each menstruation bringing on feelings of failure.
The good news: There are a lot of treatment options and we have one of the world’s best infertility centers close by in Norfolk at the Jones Institute. Also, let’s keep in mind another option: adoption; some of the area’s greatest people were adopted, namely ME!
Disclaimer: This does not take the place of regular medical care, and is not a complete review of any medical conditions. Consult with a physician before any treatment or taking any medications. Seek medical attention immediately for any serious symptoms, or call 911. No current or local patients have been referenced, so any resemblance is purely coincidental.
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