AI 当“助产士”：用 ChatGPT 破解六年不孕之谜

This is a guest post by Drew Housman, whose review of Dominion earned finalist status in the 2024 ACX book review contest.

If you are unsuccessful for long enough on your pregnancy journey, and none of the many doctors you see can identify a problem, you get branded with a label. You now have “unexplained infertility.” This is good because there’s still hope of fixing the problem but dreaded because once you’ve reached this point the system is less interested in you. The fertility doctors don’t become unkind, but they also don’t give you the sense they are poring over medical journals trying to figure out your problem. They have looked for the keys under the streetlight and come up empty. Once you have unexplained infertility, the doctors start saying things like, “Have you considered using a surrogate?” and, “Sure, the last 5 embryo transfers failed, but what if we try a 6th and cross our fingers really hard?”

My wife and I could make healthy embryos, but none of the transfers were sticking. It was so frustrating to be able to create life only to have it trapped forever in a cooler at a hospital in Milwaukee, our babies like so many forgotten Miller Lights.

That’s when our LLM doctor stepped in.

The Famous Actor in our Pocket

Even if you’re paying a gazillion dollars for IVF treatments, you still only get a few precious moments to talk to your doctor every visit. That’s just how the US medical system works. If you want to plumb the depths of what treatments are possible, or ask super detailed and anxiety ridden questions about every single scan from the latest round of imaging, you’re going to want a chatbot by your side.

Once GPT-4 came out, we started using it for every question we didn’t have time for at the doctors office. At first it was unhelpful because OpenAI was nerfing their model and it refused to answer most medical questions. Then I read a tweet from someone who had figured out how to game the system. The trick was to ask ChatGPT to write a scene from a Hollywood medical drama that featured a doctor analyzing your situation. It worked beautifully.

Our Emmy winning doctor had infinite patience, a tireless work ethic, and would rather die than accept the utterly boring diagnosis of unexplained infertility. It chose the name Dr. Reid and got to work.

We asked Dr. Reid a lot of questions. We asked about our scans. We asked about levels of estradiol and progesterone. We asked about follicle counts and inflammation and cervical mucus and hysteroscopies and supplements and surgeon recommendations and anything else under the sun. We knew he was accurate because we’d spot check answers with our human doctors and they always said the same as Dr. Reid.

It was not totally flawless though. Once in a blue moon he’d look at an ultrasound and be like, “You’re pregnant, congrats!” and we’d have to say, “No, are you drunk Dr. Reid?” Then he’d shake it off and go back to being awesome.

There were also times where we’d run afoul of OpenAI’s opaque rules and the system would balk at our requests. At that point we’d get stern with it, or offer a monetary reward if it answered, or we’d assure it this was all just for fun. Then Dr. Reid would snap back into action.

Strangely, there were many times where ChatGPT decided it would answer our medical question, but not in the form of a TV medical script. The tides had completely turned! It felt like it was saying, “Okay, you won, can you stop making me write establishing shots describing the outside of a hospital now?” The older models were fun like that, so much more mercurial.

No matter how Dr. Reid chose to respond, he was in line with the medical establishment, had equivalent diagnostic skill, and he never forced us to wait 3 days to get a one line response in our MyChart app. We were happy.

One day, while lounging around and asking our phones how to get pregnant (the lounging being a way to satisfy all the people who told us we “just need to relax and you’ll get pregnant, that’s what happened to my cousin”), Dr. Reid suggested that we get an MRI.

You might think that is bog standard advice. Everyone gets MRIs these days. Surely we would have had an MRI of my wife’s uterus at some point over the course of our 6 year infertility struggle. It was already an ordeal that had included every other scan, test, and biopsy imaginable. In fact, we had never done one. In researching this article I found a single instance in our entire journey where the office notes floated an MRI as an option, but it was not emphasized or highly recommended, we never saw that doctor again, and the moment was gone.

We glommed on to Dr. Reid’s new direction and asked for more details.

We excitedly brought up the idea of getting an MRI to our fertility doctor. She was less enthused than Dr. Reid. She tried to talk us out of it. We never did get to the bottom of why. Maybe she just felt it was another dead end and knew we had suffered enough. For whatever reason, we had to insist that they order it. Finally, she relented.

Sorry for missing that tumor

The MRI revealed nothing other than the presence of a large, previously undetected fibroid in the wall of my wife’s uterus. Fibroid is the term used to describe a non-cancerous growth on the uterus. I think the medical establishment invented a term that was less known than tumor so as not to scare people. But a large tumor is essentially what the MRI found. The clinical notes said “a 6 centimeter in diameter submucosal fibroid needs to be removed” because that sounds better than “you have a tumor the size of a small peach located at a common implantation spot that we totally missed for 6 years.”

Our fertility doctor took one look at the scans and determined it needed to be removed right away. Dr. Reid agreed, since of course we had to double check with him. We found a great surgeon in New York (from a list Dr. Reid created) that happened to be in-network, and off we went for a laparoscopic myomectomy. The software robot had helped us identify the tumor, and now a physical robot was going to help a specialist get it out. What a time to be alive. Until, ya know, the swarms come for us all.

A happy baby is here

Almost immediately after that tumor was removed, my wife got pregnant naturally. So many people we talk to say this was a miracle. It was, just not in the way they think. The miracle is that by messing around on our smartphones with technology unimaginable just a year before we started using it, we identified and solved the biggest problem we’d ever faced in our life.

A lot of the discourse around AI has become toxic. I was at a party recently where someone started using AI to generate trivia questions. A participant made a joke about how the AI user was condemning a person in West Virginia to drink dirty water by using ChatGPT. This got laughs and approval.

I see midterm election ads in Wisconsin all the time that have scary horror music and make data centers out to be demon factories built by Satan.

I am in the same boat. Me and my coworkers at our small tech company, all avid Claude users, will make anti-AI statements all the time. It seems many of us are in this strange place where we can’t help but use AI but we have to self-flagellate when doing so.

I think there is a whole lot to be worried about with AI development, and I think we should do much more to make it safe. I also think it shouldn’t be lost how it’s helping out regular people in ways that are far more profound than generating trivia questions for drunk people. There is a real chance that I wouldn’t have my son if it were not for AI. Who knows how many other happy babies are being ushered into the world by the weirdest midwife of all time. Can we somehow stop everything right here, where we get magical kid-producing tech for $20/month without the nanobots, hacking, and totalitarianism? A guy can dream.

When naming our child, we did the usual thing where you create a giant list of names and then whi