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Archive for February 8th, 2009

Possibly My Only Octuplet-Related Post

Posted in octuplets on February 8, 2009| 5 Comments »

Okay, I’ve stayed pretty quiet on the octuplet-story for a reason. The whole thing ticks me off, but, it’s kind of cliche to say so, isn’t it? I mean, it’s OBVIOUS that it ticks me off, right? I mean, I put myself out there ON TELEVISION for my clinic because it ticks me off so much. Hello? My neighbors could have found out that I’m in the middle of an IVF cycle because of this. I do NOT discuss my IVF status with my neighbors! (Fortunately, it aired on a Friday night. Sneaky, I know! Er… though it turned out one of my friend’s nannies saw me on TV and blabbed about it to everyone. Foiled again!)

Anywho!

This is not the point.

So some crazy chick goes and gets herself pregnant with six children. She’s not married (SO WHAT? PEOPLE! Since when is it a pre requisite to be married to be a mother! GET OVER YOURSELVES!) Two of them are twins. At least one is autistic. She’s a student. And then she goes back to her RE, she has, theoretically, six frozen embryos, according to her story, and she tells him to transfer them all. He obliges, for whatever reason, and bada bing, bada boom, against all odds, the gamble she took turns out (according to her) “perfectly” and thirty weeks later, she has octuplets. Unbelievably, she actually has healthy octuplets.

Now here’s what REALLY pisses me off about the whole damn thing.

For the love of PETE, can no reporter in this God-forsaken country figure out that in an IVF or FET cycle a reproductive endocrinologist TRANSFERS embryos? They do not IMPLANT embryos.

Is it so much to ask that they get this one tiny word correct?? Is it so much to ask that with a story this big and destined to be ongoing that we get the terminology correct at long last????? Honestly, the frickin’ New York Times can’t even get the term correct on a regular basis- what has the world come to?

It seems like such a small issue, but it really isn’t. If doctors could implant embryos, it would mean they could guarantee pregnancy. Maybe not ongoing, successful pregnancies, but at least initial pregnancies. This is an important point because the word “implantation” skews the public perception of IVF, fertility patients, and reproductive endocrinologists. It leads people to believe that every time a patient undergoes IVF, if they transfer 2 embryos, they are guaranteed to be pregnant with two babies afterward. This is, of course, far from a guarantee, as you well know. Even with my one blastocyst, I have only a 40% chance of pregnancy – which means a 60% chance of failure. If my doctor could have implanted that blastocyst into my uterine lining, rather than just transferring it to my uterus and letting it float around until it decides whether it will implant, it would have been a 100% guarantee of pregnancy.

As far as I understand, doctors so far haven’t been able to pinpoint what determines whether a particular embryo will or will not implant (though it does seem that high grade embryos have a tendency to implant at a higher rate than lower grade embryos, but that doesn’t mean that low grade embryos never implant – certainly low grade embryos do implant and grow to become healthy babies and there are plenty of high grade embryos that never implant, but no one knows why).

Beyond the implant vs. transfer issue, it just seems that the media is so focused on her unwed status and the fact that she already has six children that it is infuriating. The first question that one of the reporters asked me (that didn’t make it into the televised report, I’m certain because I didn’t give the soundbite they were looking for), was “What do you think of this unmarried mother of six children who just had eight babies out in California?” My answer? I don’t think anything about her since I don’t know her, though I feel for the situation she’s now in and I know she’s got a number of challenges ahead of her, and I’m concerned about what led her to be in this position in the first place.

Am I concerned that her doctor possibly repeatedly did IVF procedures with her involving 6 embryos each time? Yes. I am concerned about it because it far exceeds the standards set by the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology’s standards for embryo transfers for women under the age of 35 (she is 33), which recommend no more than 1 or 2 (preferably 1, when possible) embryos be transferred in an IVF cycle. I am concerned because this mother’s answer is “Those are my children, and that’s what was available, and I used them. So, I took a risk. It’s a gamble. It always is.”

While, yes, the embryos are her property, what about her doctor’s obligation to protect her risks? What about “First, do no harm” as stated in the Hippocratic Oath? I know that there are various ethical and legal issues here. A doctor can’t – and shouldn’t turn away a patient on the basis of “she has six children already, therefore I’m not going to treat her with IVF in order to have one more.” Nor can a doctor withhold her property – her embryos – from her on that basis. No doctor has the right to tell a woman that just because she has six children she is therefore not allowed to have any more children, except under extreme cases where the doctor is concerned about abuse, perhaps drug use, severe psychosis. A doctor refusing to treat a patient must be prepared to offer names of other doctors who may be willing to treat that patient. But just disagreeing with a lifestyle choice to have a big family is not a reason to turn away a patient for treatment.

Certainly, there are people who feel that I shouldn’t have more children. People who feel that I have no right to want, to expect, to try to have more children. And obviously my doctor thinks that I’m completely off my rocker to try to have more. But he never refused me treatment. (He may have called me meshuga a few times, but that’s another story). Only my husband and I have a right to decide when our family is complete. The size of our family isn’t anyone else’s business.

BUT – there’s a line to be drawn. I shouldn’t have a right to force my doctor to do something that is potentially life-threatening. I shouldn’t be able to force my doctor to do something that he believes could compromise the lives of me or the potential babies that could result from treatment. I have heard some arguments and seen some court cases that have argued that, in fact, a patient ultimately has total control over the decisions to be made about what happens with her embryos. But can that be true? Should that be true? I don’t think it should be. Ultimately, I wouldn’t want that to be true, particularly after I’ve completely pumped myself full of hormones and made myself completely irrational. I want my experienced doctor to guide me in my decisions and to look out for my safety and for the safety of my potential children.

A doctor should be able to have some autonomy to be able to say, “No, I will not put your life in danger. I will not transfer six embryos to your uterus, because that will potentially endanger your life.” And, frankly, that’s what her doctor should have done. If what this woman is saying is true – then she had five successful IVF cycles in the past, so there was no medical reason to believe that she needed to have six transferred this time in order to have a chance at success this time.

Many have criticized the mother for not selectively reducing the pregnancy – but I can’t condemn her for that. I can’t and I won’t. Until you’ve walked down that path of decision making – you simply cannot even imagine how difficult it is to even consider such a thing. And I don’t blame her a bit for refusing it.

I just think we’re all focusing on the wrong issues.

Issue 1: Transfer not Implant, people!
Issue 2: Who cares if she’s married?
Issue 3: It is irrelevan
t that she already has six children.
Issue 4: What IS relevant is that she shouldn’t have had the final say in how many embryos got transferred to her uterus. Her DOCTOR should have had that say, and her doctor should have said “absolutely not.”

But really, the most important issue here is that it is a transfer, not an implantation. I’m so sick of hearing “implant” in this news cycle. I almost threw my computer across the room the other day reading the AP news story after the Today show report.

The one good thing I can say for Ms. Suleman is this: She, at least, used the word transfer when speaking to NBC. Even if the damn reporter couldn’t get it right.

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Thumb Twiddling

Posted in 2ww, IVF#1 on February 8, 2009| 6 Comments »

“So… how’s that bed rest thing going for you, dear?” my husband sarcastically asked me while watching me clean up the living room.

Yeah. Um. So you know, now I totally get why it is that my perinatologist said that if I get pregnant even so much as with twins he’s admitting me to the hospital at 12 weeks. I thought maybe, just maybe, that was a little alarmist, but… no. No, it’s totally on the money, and I get it now. He knows me. He knows me very well. I was an extraordinarily good patient and did everything he told me to do in my last pregnancy, but it would be a physical impossibility this time around, and he knows it. There is just no way. I will absolutely shoot myself if I end up with monozygotic twins.

In other news, progesterone makes me hungry, I think. I am almost never hungry, but twice this weekend, I was suddenly ravenous. But absolutely nothing appealed to me. Sigh.

A bunch of you asked if I had anything good enough to freeze yesterday… I hadn’t said anything about freezing in part because I forgot to, and in part because I actually don’t know. As of yesterday, nothing was there yet, but they just didn’t know yet if anything would make it to freeze. I didn’t get any calls/messages today, so my guess is no. I’ll check with NurseAwesome (whose name, I think, I’m going to change to SuperNurse – I like the parallelism with SuperDoc) on Monday, but … I’m pretty sure the answer is no.

Speaking of your questions – Lori, the answer to your questions are 1. I live two blocks from my synagogue and 2. Yes.

Someone also sent me an email today asking me if I’d mind elaborating about who my clinic actually is – just for the record, if you’re looking for a clinic for treatment, and you’re looking for a referral, etc., I am more than happy to share this information (as was the case with this particular friend). If you’re asking out of plain curiosity, please respect my privacy. I use a pseudonym for the clinics for two reasons – to keep myself as ungoogleable as possible (in real life terms I mean) and also to protect the innocent – I’d hate to be having a bad day, accidentally say something not-nice about my clinic (not that I can imagine doing so, but you never know, right?) and have that be the impression I leave with folks. I have the highest regard for my clinics, the physicians there, the nursing and professional staff, etc. and I am thrilled to be able to refer anyone else to this wonderful clinic as I believe that they provide the highest quality of care available in a caring, compassionate manner with an individualized approach and proven success rates. And no, I’m not on their payroll.

Finally, I am annoyed with a friend. I made my standard remark about how I’d shoot myself if I ended up with monozygotic triplets. But I qualified it by saying that yes, I know the odds are certainly against it. But hello? I had like 5% odds of conceiving HOMs the last time! Heck, that last cycle, SuperDoc didn’t expect me to get pregnant at all. The whole cycle was a disaster that was doomed to fail, and in the eyes of reproductive endocrinologists everywhere, frankly, it did. Which is why when I walked back into SuperDoc’s office, he took one look at me and said, “Okay, so how about that IVF with elective single embryo transfer idea, shall we?” And there was no question that that’s what we’d be doing this go-around. ANYWAY, I made this remark to my friend and she, in her self-righteous way, as usual said, “I don’t know why you didn’t think you’d end up with HOM’s. As soon as you triggered with, what 12 follicles last time, I knew you’d be pregnant with HOM’s.”

Let me tell you something… no one. NO ONE knows what’s going on with my cycles as clearly as my doctors do, including me. Even I don’t have my entire chart with all the associated bloodwork and ultrasounds, etc. laid out in front of me when crucial decisions are being made.

I questioned my doctor’s decision to trigger me that day for nearly two years – you all know this. I went back to his office in January and told him that I couldn’t understand it. That while I love the smiling faces in the nursery that greet me every morning, and I’m grateful for the gifts he gave me, I’m still plagued by that decision he made that day and could he please tell me why, oh why he made that decision. Suffice it to say, I was more than satisfied with his response. It was clear that he had absolutely no reason to believe that I had any significant risk of an HOM pregnancy. In fact, in all of my other cycles, I had been warned whenever I had more than one dominant follicle, that I could have a twin pregnancy as a result. In that cycle, no such warning was presented to me. What I’d been told, quite clearly, was that I had very little chance that any pregnancy would result from that cycle, and we prepared to move on to my IVF cycle immediately.

There is no possibility that I would still be with this doctor at this clinic today if I thought that there had been any recklessness in that decision on that day. Believe me, I never sought to have HOMs. I love them. I can’t imagine my life without them. But it was never my goal, and it most certainly is not my goal to repeat the experience.

It is for this and similar reasons that I choose not to share with the group the logic behind the particular blastocyst that was chosen for transfer. SuperDoc shared with me the grade of the blastocyst that he and the embryologist had chosen, and what the other option had been, and explained why it was the best option. He also explained that he believed with this particular blastocyst, I have, perhaps, a 40% chance of achieving pregnancy (I didn’t ask if by that he meant implantation or ongoing pregnancy – I am not sure I want to know). I don’t wish to share the grade at this time because I find when people do such things that commenters start making their own judgments as to the odds and likelihoods and all that. And I already have a doctor for that and I just don’t want to hear it. I can’t hear it, honestly. I have put my trust in my medical team, and that’s where I need to leave it, for otherwise, I will lose my grip on what little sanity I have.

I leave you with a picture of George: