Wednesday, March 31, 2010

Professor Bunny ina HOOOOOUSE!

Like many of you, I am addicted to reading material in the domain of infertility. And like many of you with online access to journals via a university, I head right for the primary source material. I loves me some Fertility & Sterility, the Official Journal of the American Society for Reproductive Medicine! I get the alerts when a new issue is coming out and everything, so I can make sure to read papers such as Estrogen and progesterone receptors in smooth muscle component of deep infiltrating endometriosis. (Um, yeah, not so much on that one.) But despite my desire to avoid unreliable information, and even with all my training as a social scientist, I find that I am still susceptible to a basic flaw in human cognition: we tend to look for evidence that will confirm whatever it is we want to believe. Psychologists have labeled this the confirmation bias, and suggest it's part of a family of principles in human thinking. These principles are adaptive in the sense that they allow us to reason quickly, and don't lead us to be eaten by tigers all that often. I mean, if you encounter a tiger, it's better to believe that all tigers will eat you than to believe that every tiger you've encountered thus far will eat you, but perhaps this next one won't, and you should really test your hypothesis in a way that might allow you to falsify it. So while these principles may not lead to accurate reasoning, um, humans don't reason accurately. And yet we do pretty well for ourselves.

So lately the confirmation bias has manifested itself in a somewhat...selective...approach to reading on my upcoming surgery. Basically, I'm looking for things that will convince me my fertility will be radically improved. That I'll instantly have a hundred fat, happy babies. There are plenty of papers with small numbers of patients that present encouraging figures (e.g., in the year following the surgery, 40-70% of women conceive, with age being the major factor that improves your prognosis). Buuuut...there almost no studies where the entire participant population consists of infertile women or women with recurrent loss. So there's no causal link between the surgery and improved fertility. (Because women who conceive after the surgery might have conceived anyway--they weren't infertile.) In addition, there are several review papers on the surgery that present a more discouraging picture. These are papers that summarize and evaluate lots of other papers, rather than presenting new research. And they are much more cautious, pointing out that many of the encouraging studies are, to use the scientific term, crap. Anways, guess which ones I like to read? I repeatedly find myself looking at abstracts that end with an encouraging conclusion--those papers I download and read. But the abstracts that end with a discouraging conclusion--those I pass by. 'Cause I don't want to learn. I don't want to know the truth. I want data that will confirm what I want to believe.

Fortunately, in my case it doesn't matter whether the surgery helps or not: I can't have IVF without it.

And at least today I found a paper with COLOR PHOTOS of the procedure! Really cool! It shows the different sutures used for different layers of the uterus and everything! Perfect lunchtime reading.


  1. Ah, those photos sound awful! Gross!

    I don't see what the problem is with reading articles to give you hope. You're not a fertility specialist trying to design an experiment or study to create new and more effective treatments. You're a lady who's getting necessary surgery and hoping for the best outcome possible. So hope away! What harm will it do?

  2. It's a way better pastime than looking up "reviews" from other IFers on it. I hear that baby dust is the key to get you pregnat, and I think I can confirm that with a few minutes of research here.

    I do exactly the same thing looking for the one thing that's wrong with me to be THE thing. Unfortunately, the variant I have of MTHFR is not believed to be the serious one. That said, I've armed myself with at least 3 people who say that it might be a problem. See? I've confirmed my bias.

  3. Umm, I do the same thing b/c I hijack my husband's access to academic journals. I almost mailed an endometrium/vitamin E study to Dr. C after our last consult. :) I read this crap on the bus, at work, at home at night....forget US Weekly, get me Fertility & Sterility!

    And, um, yeah. I only download the studies with abstracts conclusions that support what I'm hoping will happen. We are so predictable, aren't we?

  4. Like the rest of you, I sit here busily reading scientific papers on IF, ttc, etc., appearing to all the world like I am soooooo interested in researching the last 50 million years worth of plant evolution...

    Except if one were to look a little closer at the axis labels on that graph that I am studying as though it contains *the cure*...

    Yesterday I got caught staring at my FF chart by someone who came in to my office to talk to me (I really need the change the angle of my desk). Hopefully that person didn't know what it was.

    Anyways, my basic conclusion is that there is a serious lack of actually infertile women in the group of people who publish on infertility. Why can't they figure this shit out? I'm not saying to CURE it or anything, I'm just saying, can't they at least get the data that we want to see? Like, right, why don't they do a study comparing the before-myomectomy to the after-myomectomey rates of pregnancy??? Hello-- 40-70% is not only the world's most meaningless range of percentages (why don't we just call it 1-99%??), but it is also basically the rate of pregnancy anyways.

    The one that annoys me the most is the one we all know about (Wilcox et al. and other studies like it) telling us that our chances of conceiving are ~33% on o and o-1 days. However, if you look at the standard error, it is 0.06 (with a sample size of 625-- these are also pseudoreplicated by the way, but let's move on...), which means that the standard deviation is 1.5. Two standard deviations would be 3, meaning that basically according to their results you have, reasonably, anywhere between a -266% chance to a 333% chance of getting pregnant each cycle. THANKS!!!! Wow, what great information.

    Can't we see something on the individual-level variation???

    I'd LOVE to get my hands on all that FF data, and I even have repeatedly written them suggesting analyses (yeah, totally psycho, I know), but they don't seem to understand what I want. I also want to standardize the way women chart their signs-- I'd be a total nazi, all for science of course, if I were running FF.

  5. I'm pretty sure I would have thrown myself off a bridge if I had read endo studies before my surgeries... It was hard enough to just read the endo message boards!
    I find myself disliking the positive endings just as much as the negative ones now, just because there's no way to tell on which side of the statistics I'll end up at this point.
    Pictures sound cool, though :).

  6. Hey, a good study is a good study. And maybe they're called "crap" because they didn't isolate single factors well enough; but, y'know, we're all bundles of variables. Reductionism is overrated.

    I wish there were a summary table of the whole IF pipeline. Say you start with 1000 newly diagnosed couples. How many conceive and carry unassisted? How many experience RPL? How many conceive and carry with 1, 2, 3 IUIs? How many conceive with IFV (non-donor gametes) or IVF (donor gametes)? How many expand families via adoption? How many live child-free?

    I want one chart for everyone and then versions of the chart broken down by IF diagnosis. And maybe by age. Then it could all be programmed so that I could plug in all my info and get a percent probability of a live birth within the next 3 years.

    This could be a weird amateur science project.

  7. The capcha for my last comment was "femili." That's gotta be a sign! :-)

  8. Yep, you nailed it. We can pretty much find anything we want to read/hear if we just look. It's frustrating and sometimes I feel like I just need to tune out and trust my doctor, but I'm not very good at it. My google searching abilities for all things fertility-related are pretty awesome, I must admit.

  9. Ahhh, the confirmation bias is my good friend. As is my academic journals subscription. Nice to know I'm in good company.

  10. I often find that a little dollop of delusion keeps me sane. So I only read what I want to about risks and rates and whatnot. It's not like I have any immediate control over outcomes, anyway. I might as well be pacified. :)

  11. What relaxing viewing for good digestion:) Like you, I read those articles quite frequently. Like you, I'm always looking for the ones that will back up my more optimistic assumptions. Then, if I happen across one that I don't like (and there are plenty of those) I investigate the detractors and naysayers. OCCASIONALLY, I'll come across detractors of the articles I DO like, the ones that help me sleep. But I've come to the conclusion that those people (in that specific category) don't know what the hell they're talking about.

  12. Firstly, I am completely envious that you have access to all the Fertility & Sterility articles!!!!!!!! I get the email updates that tell me whats in the next issue, but I don't have access to anything other that the abstracts so I only have about 30 words to hang on, rather than an entire article!
    I am a culprit for biased researching so its nice to know i'm not alone.
    I think its ok to be a bit selective on what you read. The reality is that reading the articles is not going to alter the outcome for you. So you may as well indulge yourself and not punished by the studies that show negative results - they will only put you into a frenzy and make the stress levels reach breaking point. Who needs that? Keep up the good work I say.

  13. Delurking to say that I LOVE this post. :) I am a current PhD student and I know all to well the temptation to guide one's reading towards the things they want to read. Don't get me started on the time spent reading about miscarriages and the tendency towards the "light at the end of the tunnel" articles.

    (Blog Warning - My blog features my child. Do not proceed if in a vulnerable/sad/pissed-off place. I totally get it.)