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02/19/2009

In defense of "implant," or, Ow. That hurt, in a miniature kind of way.

I'm gonna shatter what remaining infertility cred I have with a single crotchety declaration:

I don't quite get what's wrong with implant.

Wait, now, hear me out.  I'm as big a stickler for precision in language as anywhatsis.  If you knew how long I spend sometimes poring over the compact OED looking for juuust the right word, you'd beat me with the scaled-down magnifying glass cunningly stored in the slipcase.  (It's a little thing, this glass, and probably wouldn't withstand any sustained whaling.  You'd have to be gentle.  It would take some doing to cause any lasting damage.  Lots and lots of teeny tiny taps.  But my feelings would be hurt, and that'd be devastating enough.)

The cause of confusion with implant seems to be the unfortunate fact that the same seven letters are being used to spell two utterly different words.  One of those words is transitive, taking an object: Next thing you know, we'll learn that that crap-ass doctor implanted two dozen embryos into the rhinestone-crusted minaudiere of a tranq'd-out drag queen.  Subject: doctor.  Verb: implanted.  Object: embryos.  See?  Transitive.  Someone or something does something to someone or something.  (When it comes to creating catchy mnemonics, I simply have no equal.)  The definition of implant when used in this transitive sense is to insert or fix (tissue or an artificial object) into the body.  And that is what is being done upon embryo transfer, no?

The other i-word is intransitive, taking no object: Of those two dozen embryos, seventeen implanted, stretching the tiny handbag well past its breaking point and scattering diamantés, like, everywhere, but improving the doctor's clinical pregnancy rate appreciably.  The embryos do their thing, but they do it to no one and nothing.  The OED doesn't seem to carry any relevant definition of this sense.  Maybe if I give it a punishing series of wee little whacks with the glass it will cough some up.  For now, let's just define this sense of implant as burrow its intrepid way into the endometrium like the bravest of naked mole rats.  (Naked mole rat embryos, I suppose, as long as we're being precise.  Godspeed, you ugly bastards.)

See what I mean?  Totally different words.  It is merely a sad accident that they happen to consist of the same letters in exactly the same order.  I know: What are the odds? 

I just wonder if maybe we don't get a little too hung up on this.  It's kind of like a bunch of Star Wars freaks — excuse me, enthusiasts — getting all indignant and pissed off because...see, I don't know enough about Star Wars to construct an analogy that's even remotely plausible, but just imagine.  (Perhaps something in a Wookiee with an anachronistic wristwatch...?  Because everyone knows that titanium alloys weren't available on the lushly-forested planet of Kashyyyk during the era in which The Star Wars Christmas Special was set.  Do they take us for morons?)  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.

Most of the objections I've seen to using implant instead of transfer center on the contention that doing so fosters a false impression of the mechanics of IVF: that putting embryos into a uterus invariably results in pregnancy, implantation being in every way equivalent to implantation, the simple act of placement implying the beginning of a pregnancy.  But I cannot believe that the people who think this do so because of unclear terminology.  Since when, after all, did your dumbass co-worker know that the establishment of a pregnancy is called implantation?  Her?  She wouldn't know a cytotrophoblast from a syncytiotrophoblast if they got all up in her personal uterine business and said, "Hey, could you keep it down?  We're trying to differentiate here."  Believe me, you're not going to confuse her.

So although, as I said, I appreciate careful word choice, that's not an argument that gets me frothy.  It doesn't bother me when a layman uses implant for transfer; I figure he has no reason to know that one is preferred while the other will make infertiles all over the Internet crazier than a shithouse naked mole rat, and his meaning is always clear.

And it doesn't bother me when a doctor uses it, someone who "should know better," as I keep reading.  Because, I mean, of course he knows better, that transferring embryos does not necessarily imply a pregnancy.  (That is, unless it's the OB who prescribed the 39-year-old you a year of Clomid without any monitoring whatsoever, who considering his other shortcomings might well not know, in which case I encourage you to buy your own OED.  The 1971 edition's the real peach, the one with two volumes.  The current edition is something of a disappointment, coming as it does with only a chump-ass fish-eye of a magnifier, completely unsuitable for performing a much-needed beatdown.  And when it comes to optics-as-weapons, why, don't you deserve the best?)

Where was I?  Oh, right.  Of course the board-certified card-carrying dues-paying member of the ASRM quoted in a relatively reputable newspaper knows better.  That he still uses implant suggests, I think, an intriguing possibility: that implant-transitive might just be a perfectly workable term.

So go on.  Go buy yourself a dictionary and tap the sloppily worded shit out of me.  Clearly I need a good beating if I'm agreeing with the establishment on this one.

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