A letter to my Infertile Friends

September 11, 20158 Comments

Dear Infertile Friend,

I am sorry I started this letter with “Dear ‘Infertile’ Friend”. I am sorry I labelled you ‘Infertile’, because if there is any one single wish I had in the world, it wouldn’t be ‘I wish I was pregnant with my child’, it would be ‘I wish there was no such thing as infertility’. I do not wish infertility upon even my worst enemy. Infertility is not a label, and it doesn’t define you, so I am so so sorry I started this letter in this way. But….I am differentiating you from my non-infertile friends because you have given me something my non-fertile friends are unable to. This letter is to say thank you. Thank you for helping me get to where I am today, yes I am still empty arms, but I am stronger now than I was when I started this winding, mountainous path called infertility.

It doesn’t matter where you are in your infertility journey, you have given me something that has made me stronger. Whether you have just discovered you are less than fertile, going through medicated treatment, IUIs, IVF, surrogacy, donor eggs/sperm/embryos, adoption, child-free living, pregnant after treatment or living with your rainbow baby – you have amazed me.

To those who have shared with me their intimate stories of struggles, pain and, most importantly – light, you have inspired me to stay strong on my path. Whether you shared just a brief snapshot into your life or have shared every minute of every step of the way – it has all added up to how I feel today. Stronger with you in my life.

My friend, you have layed open your heart on the table, exposed it, allowed it to be vulnerable just so you could help me understand what lay ahead of me – so I could prepare for the good, the bad and the damn right ugly.

Please do not underestimate the power of your voice and how it has touched me. I can’t measure it – but just know that it has.

Thank you,

Your Infertile Friend X

Just when you thought it was safe

September 11, 201531 Comments

If you have read my earlier post from today, you will know I was waiting for my hCG results, my doctor was expecting to see a drop or at least a similar level because I have bled so much since Monday.

I got the call at 2.15pm, my doctor said ‘Your levels have increased again to 3200 (from 2600 yesterday), I want you to take the methotrexate. There has to be something growing somewhere other than your uterus. When can you come in?’.

Fortunately Chris was with me because he was working from home, so we were out of the house and on the road to the fertility clinic. We had to stop by the pharmacy to pick up the methotrexate. The pharmacy was in a children’s hospital. I joke with you not. The pharmacy was having problems processing my insurance details, so we waited about 45 minutes. Babies and children EVERYWHERE. It was a very cruel joke. Then to top it all off, it turns out my insurance wasn’t going to cover it. Well – using methotrexate to effectively abort a pregnancy is an off label use of the drug. Duh. Of course my insurance wasn’t going to cover it. Fortunately, the pharmacist used a coupon and it only cost us $23.

Finally we arrive at our clinic, drug in hand. When 5 doctors are telling you to take the methotrexate, it’s time to listen. If my hCG levels got any higher I would not have been eligible to take the drug and surgery would have been my only alternative option. We are not completely out of the clear…the drug is effective only 90% of the time. In 7 days time we find out if it actually worked – and of course I’m still on ‘ectopic rupture watch’ until then.

One of the doctors injected the drug into my buttock muscle…honestly, all I was thinking was – can’t a nurse do it? Only because he asked where I would like it to be injected arm muscle or butt muscle (nice to have the choice!), we decided on butt muscle – he then turned to my doc to ask where would be a good place on the butt! This was the point I was nervous!! But I think it had to be the doctor injecting it – I don’t really know. It was painless compared to progesterone butt injections, the needle was a lot smaller though.

Methotrexate comes with a long list of side effects…I am already experiencing two of them (though these should only last about 24 hours and are relatively normal) – tiredness and nausea – they hit me about 3 hours after I was given the injection. I won’t list the things I have to watch out for as a side effect, they can easily be found by googling ‘methoretexate ectopic pregnancy’.

We are truly gutted this had to be our course of action, but it seems to be the safest considering the large unknown growing inside me 😦

Tomorrow is M-Day (Methotrexate Day) Ummmm NOT!

September 8, 20158 Comments

Yesterday I started to properly bleed, but it was on and off and only about a regular pad’s worth of blood. Today I woke up with spotting. Damn it I thought. But then at lunch time it came – the bleeding got heavier and has continued today. I think my body is going to deal with this naturally. I am starting to feel more positive about me saying no on Sunday to the methotrexate injection.

Today I rang up my clinic and explained what happened over the weekend. After multiple calls from various nurses and doctors, this evening we eventually decided upon a plan of attack. Tomorrow morning I go for a beta blood test, then in the afternoon I will return for an ultrasound. By that time my doctor will be free out of surgery so she can see me personally, and she will have my blood test results. So fingers crossed my hCG levels are in fact going down – surely they must be if I am bleeding this much? Otherwise if they are still increasing she wants me to take the methotrexate.

My liver function blood test results all came back normal, but my Blood Cell differential results didn’t come back exactly all normal. But they are not too far from the normal limits i.e. pointing towards anemia. It will be interesting to see what the doc says. I know what is normal for me because my work makes me take an annual medical which includes a full blood cell count – I’ve always had quite low numbers and is why I take multi-vits to top me up – perhaps it is just the IVF treatment, or perhaps it is normal for a pregnant lady. But we shall find out tomorrow!!!

Where’s Waldo??

September 3, 201514 Comments

“Where’s Waldo? – Do you know who Waldo is?”

My doctor asked me as she used the vaginal ultrasound to search my uterus and fallopian tubes for a potential sac. Today at my ultrasound appointment my doctor carefully searched as she discussed it with the more ‘junior’ doctor. The ‘junior’ doctor also had a go with ultrasound wand. But nothing was there – not even that black teeny dot from Tuesday was there anymore.

My hCG went up to 1066 from 686 (55% increase in 44 hrs). This is not the direction my beta levels should be heading in right now.

My doctor helpfully told us today that her cut off is 7 weeks for a decision on whether to use methotrexate; in the mean time if my hCG continues to rise she will closely monitor me every 48 hours with ultrasound and beta blood tests until 7 weeks. Today I am 6 weeks 2 days pregnant, so only 5 days left for me to miscarry naturally. She is now more confident that when I return on Saturday they will see the growing empty sac now that my beta hCG is above 1000. The question remains – where will this empty sac be? We are still hoping it will be in the uterus and not the fallopian tube.

So I’m still on ectopic watch for now. I have no bleeding or spotting, the odd pain twinge here and there, today I woke up a bit more nauseous and I’m starting to pee a lot again, so my ‘pregnancy’ symptoms are now returning as my hCG levels continue to rise. But overall I feel physically well, a little bit mentally drained.

Today I took a sick day which was a good idea because I am not sure my brain could have coped with work today, instead I spent some time doing adult colouring in. Very therapeutic, but sometimes I can’t stop because I don’t like leaving things unfinished, and then it stops being therapeutic as I create a chore for myself!!!

Anyway, until Saturday…..we continue to wait.

Sad, but starting to feel mad

September 2, 201521 Comments

This afternoon I had my mobile (cell) phone with me on loud so I could hear the doctor ring with my results. I get a lot of notifications and pings every 5 minutes so I am sure my colleagues were getting annoyed with me. But anyway, I received three pings all at once, which I thought was odd, so I checked my email to find a notification from my clinic for a new appointment, with my doctor tomorrow morning (The three pings were from my email and app that tracks my appointments). Well isn’t that just nice? My eyes started to well up because I knew this had to be bad news – what a crappy way to find out? After 20 minutes of consoling myself, I finally received the call from my doctor. My hCG levels have continued to rise again to 686 (Tues) from 345 (Fri). Not good news. So my doctor starts talking more about this potentially being a tubal (ectopic) pregnancy…she didn’t really tell me anything new from yesterday, she stressed again that there is zero chance that I have a viable pregnancy (OK so I got that from yesterday when there was nothing on the ultrasound).

Tomorrow morning I will have another ultrasound to double check my uterus for a (non-viable) pregnancy and some blood tests to see if I am suitable candidate for the drug methotrexate. I have done a bit more research into this drug, and I really want the doctor to explain all tomorrow – I will be using my 3 point guide to help me feel better informed! The best guide I found is from the NHS:

“The use of methotrexate to treat pregnancy of unknown location and ectopic pregnancy” available here.

I have been having some random (but not sharp) short pains today, including pain on the left side. I have also not passed any blood today. The problem is with Irritable Bowel Syndrome for me is that stress causes pain, so I am having a hard time distinguishing between the two – I don’t feel stressed per se, but this rollercoaster surely can’t be good for my gut.

In the meantime I’m looking forward to tomorrow’s appointment as I move from feeling sad to feeling mad – mad that this feels really unfair and crappy. I’m taking bets on how many med students/doctors/fellows/nurses they can squeeze this time in the room for my ultrasound tomorrow…..I have a feeling there will be some interest 😐

Nothing….

September 1, 2015September 1, 201520 Comments

There was nothing there on the ultrasound screen, just my beautiful uterus – empty. There was the teeniest tiniest black spot that may have been the beginning of a sac, but it was so small my Doctor was not certain. She didn’t need to say anything for me to quickly realise that I was not one of the lucky 1%. My doctor checked my ovaries: my right one is still hyperstimulated from the IVF and I had some VERY big follicles/cysts (but this is normal for after IVF and of no concern, but may explain any pain I may have here), my left ovary too was swollen, but not as bad as my right one.

What does this mean? It was difficult for my doctor to say without knowing what my beta test results are. If my hCG levels are continuing to rise, it is likely that I have a tubal pregnancy (ectopic pregnancy – a pregnancy that grows outside of the uterus). If my hCG levels are falling, then it will be safe to assume that I have a chemical pregnancy* and the little black spot on the screen was indeed huckleberry.

My symptoms have been spotting dark brown blood since Friday, general abdominal pains all day Monday, my spotting surprisingly stopped today (Tuesday). I have had some pains specifically on my left side, although not overly sharp pains, and I pointed out to the doctor (doctors – there were 2 others in the room with her) where this was….yeh, about where my ovary/fallopian tubes are.

If this is a chemical pregnancy then the doctor will prescribe me some medication (a vaginal pessary, I cannot remember the name of it) to help my body along with expelling the uterine pregnancy. If this medication doesn’t work, or my hCG levels come back higher with a likelihood of a tubal pregnancy, then I will be prescribed Methotrexate (an intramuscular injection – YEY another injection, of course!!!). I want to avoid taking this drug because it will mean we are not allowed to conceive for at least another 3 months because the chemical can stay in the body and harm a developing embryo. But at the same time, we don’t want to wait and see for too long because there is a chance my tube could rupture and I would lose a fallopian tube. I have read that even after being given the shot their tube still ruptured because it was left too late.

So I was asking you to hope with me that I didn’t bleed, but now I want to bleed….please, please body, just bleed!!! I think this will be one of those times when I cry tears of happiness when I start to bleed full flow! I know it will also be sad at the same time….choo choo, all aboard the emotional train wreck!!!

I mentioned that there were two other doctors in the room, one was ‘shadowing’, the other was a fellow (no not a chappie you silly Brits!!!). The fellow interjected and answered some of our questions, he was clearly very knowledgeable, but there was a lot of bouncing around between them. Chris was getting frustrated with the information we were receiving, they were talking to us as if we were medical professionals. It took 5 minutes of Chris’s continued questioning to get the doctors to say that despite the miscarriage being bad (and sad), what we were seeing was ‘normal’ or ‘common’. What they really needed to start out with was – don’t worry, there is nothing seriously wrong with you, chemical pregnancies happen frequently with IVF (because they are transferring 2 embryos). I think I had a bit more knowledge than Chris and didn’t feel quite as frustrated because I had googled a lot on miscarriage, chemical pregnancy, blighted ovum and have read forums/blogs etc. So my lesson here is to share more of my ‘google expert medical opinion’ knowledge with Chris before these types of appointments.

We also discussed my hCG levels (49, 110 and 345) and my doctor did admit that my first hCG result of 49 was borderline low- to non viable. So why, oh why, did the other doctor (who did my IUIs) seem so happy and chirpy on the phone, proceed to tell me my progesterone and estrogen levels were excellent but fail to tell me my hCG level. All it required was this: “Congratulations Ms Dani, you are pregnant, but your levels were a little lower than average, we would like to see you again in 5 days just to make sure you levels are doubling nicely. Your estrogen & progesterone levels are excellent, so this is a good thing.” Expectation management is not a bad thing.

So – we have one big question answered, I feel a relief, albeit a sad relief – there is no viable pregnancy. The next big question we wait for an answer is – is this a chemical pregnancy or a tubal pregnancy?

*A chemical pregnancy is a clinical term for a very early miscarriage. It happens before an ultrasound could even detect a heartbeat (before the 5th week of gestation). This occurs when an egg is fertilized but it does not implant on the uterine wall. Chemical pregnancies are actually quite common, occurring in 50 – 60% of first pregnancies. There are many possible causes of chemical pregnancy – inadequate uterine lining, low hormone levels, luteal phase defect, infection, or other unknown reasons. The most common assumption is that they are due to chromosomal problems in the developing foetus. This can result from poor sperm or egg quality, genetic abnormalities from either mother or father, or abnormal cell division of the foetus.

You just can’t make this stuff up – facebook again

August 31, 20157 Comments

They say a picture paints a thousand words…so here it is.

For those who cannot see this picture, it is a screen shot of my personal facebook post from this evening. I wrote:

“It has been a difficult week for the both of us, I am pregnant, but the doctors have now given us less than a 1% chance of my pregnancy continuing successfully. We wait to see how things go, but have readied ourselves for the worst. We are being open and honest because so many other struggle with this in silence. The IVF process has been a roller coaster of emotions for us and would like to say thank you for everyone supporting us through it all.”

Above my post is a facebook sponsored advert for stitch fix maternity clothes. Can you believe how mad I was to see this – only 5 minutes after posting it??? Especially after I have already changed my facebook settings to prevent all ads relating to parenting, family, pregnancy, babies etc. Clearly the facebook algorithm reads my post status with “I am pregnant” and over-rides my chosen settings. The fact that I am already a stitch fix customer adds insult to injury!!

I will write to facebook to tell them how upset this made – in spite of the fact that I had changed my settings to prevent this from happening. They really must do better at this.

On the positive side, we have had lots of love and kind messages in response. We thought it was time we gave an update because today when we went to our softball social league where someone congratulated us – then we had to tell them the bad news, and I think they just felt awkward over it. Facebook – the good, the bad and the ugly.

Trying not to cry at work is HARD

August 28, 2015August 28, 201526 Comments

On Tuesday, after my second beta test, I went home from work early so that I could receive the good or bad news in private. But my results had not ‘come back in time’, so not knowing when I would receive my results, I went into work on Wednesday. I was busy running around the office preparing for a one day workshop I was leading the next day when I received the phone call. You may know already that the news was ‘not good’. Receiving news like this whilst at work is difficult. My eyes were welling up when I dashed to the toilet quickly, passing one of my senior bosses and trying not to look him in the eye. I called Chris and had a good old cry – lucky there are not many women at my work to gate crash my pity parade. Chris said he would come to my work for a hug and he would be there in about 30 minutes. So I collected myself, and headed back to my desk. A colleague of mine who had promised to provide me some input to my project report for about 3 weeks decided to tell me he was not able to do it and he was going on leave the next day. Let’s just say, this was the wrong time to be telling me this. My attitude initially to him going on leave was….”and…..?????”. I had waited some time for his input and my report was already late. I said “No worries…..” in a very sarcastic and mean tone. Then my friend walked past us happy and bubbly….realised she had just interrupted something and asked if she should go, to which I nodded. Anyway, I was clearly in a grump.

After 40 minutes of being really pissy one minute, and on the verge of tears the next, Chris arrived at my work. We had a big hug and cry together in my work car park (parking lot). Chris stayed for a coffee, and we decided we would work from home for the rest of the day. I went back to my desk to finish off my preparations for the next day when my colleague (who I had been grumpy to) asked if everything was OK? So I told him about my phone call. I held back the tears as I said it, but said it was OK, I was going home for the afternoon, which he agreed I should do. I felt a little bit bad for my pissyness, but I know he understood that it wasn’t personal against him.

Thursday….I kept myself super busy at my workshop all day, I hardly stopped to think about anything else other than work. It was great!

Today, Friday, I had my third beta blood test. It didn’t start out great as my appointment was already eating into some ‘compulsory training’ time at work…and of course, the clinic had a waiting room FULL of patients. I was greeted by a nice enough nurse who I had never met before. I thought I had met them all!!!! In fact, it was very bizarre, I noticed that the receptionist was someone I had never met before, and all the other nurses I saw wondering around were all new. I wondered briefly if they had done ‘swap staff with another clinic’ day. V. weird. Anyway, the nurse who took my blood was pretty distracted by another nurse who was ‘in training’ (who at my last beta test, I blamed for my late result 🙂 ). They were gossiping, I did not appreciate a lack of attention when I was already upset with having to be there. Grrrr.

After I made into work this morning 40 minutes late, I sat in on about 1.5hrs of pointless training (I am actually already trained, and didn’t know they were going to be covering this same material). You can tell it was going to be a good day for me….not. The office was very quiet today, everyone was out on travel or on leave, which was probably a good thing, but I felt lonely. So I took myself off to a quiet empty meeting room and typed up notes from Thursday’s workshop to keep me busy…but it was slow going, my mind kept wondering to my results.

At 2pm my phone rang, I was surprised because the results weren’t due back til 3pm. It was the doctor who had done my egg retrieval and transfer calling with the bad news. He said my hCG levels were 395 (actually it turns out he was wrong, they were actually 345). My first response was wow it went up again, OK – I wasn’t expecting that! But he brought me back down to earth and said he did not believe this would be a normal pregnancy, he would expect an absolute minimum level of 800 by now, and I should stop taking my medications to prevent prolonging the pain (Emotional pain he meant), he did say that I could choose to stay on the meds if I wanted to be 110% sure, but he recommended to stop them. He also told me to arrange a follow up appointment with my doctor as soon as possible. And that was it. I actually did not cry, I was just confused. Sad, but confused. I stayed in my meeting room and focused on my task at hand, surprisingly I got a lot done in the next two hours.

It is so hard to not cry in front of work colleagues, but at the same time, being there has been a good thing when I needed to divert my mind’s wondering to sad things.

As I left work I received a phone call from my doctor, she started talking to me as if I did not know my results. However, she was far more informative about my results and what she wanted to do next. She told me that she agreed with the other doctor I should stop taking the medication, there is a very very small chance (about 1%) that this might be a viable pregnancy, but coming off the meds will not harm the developing foetus if in fact it is developing. By stopping the medication my body will be allowed to do what it probably would ordinarily have done and let me bleed. She wants to see me on Tuesday afternoon for an ultrasound and another beta test to be sure I do not have an ectopic pregnancy, although very unlikely, she wants to check. It is normal if I don’t start bleeding for another 4-5 days, but in the mean time if I get any sharp sudden pains or difficulty breathing to call her immediately. She also started talking about what we have in the freezer – we have just one blastocyst that was frozen on Day 5 stored away. They won’t do a transfer with just one frozen, so we would have to do another round of IVF. Can’t even think about that right now.

As soon as I got home I took off the estrogen patches from my stomach. It feels good to not have anything stuck there, and we don’t need to think about doing an injection either. I’m trying to think of the positives here!

I always say it’s never over ’til the fat lady sings….predicting a successful pregnancy outcome

August 26, 201518 Comments

I always say it’s never over ’til the fat lady sings. But that doesn’t mean I can’t see that fat lady getting ready to get on stage…I can also hear her warming up, running through a few scales too.

So, my suspicions were pretty much confirmed about why I didn’t get my results yesterday. My results were not good. And let me point out here that these are not my words, but the words of my nurse.

My hCG levels last Weds were 49 – just a bit lower about where they should be, but were not overly worrisome…

My results from Tues this week, however, were 126. They went up!!!! But those of you who are familiar with hCG levels and where they should be by now will know this is not a great number. hCG levels should double every 2 to 3 days. What does this mean? Well my doctor wants me to keep taking my progesterone and estrogen, just in case – there is always a small chance this pregnancy is still viable!! But I have to go in for another beta test on Friday to double check that this pregnancy is, in fact, over.

I can safely say I am no longer feeling cautiously optimistic….I am feeling pessimistic as hell and sad. If you would like to hold onto hope for us, I gratefully take your strength and thank you for helping to hold us up, but quite frankly when the nurse tells you it is not good, it’s not good. I understand she is preparing us for the worst.

BUT!!!!! I decided to do a bit of research on what all this really means, what are MY chances? You know I had to do it, as one of my colleagues told me today – GTS! (Google That S#*% !!!). OK, I’m going to get a bit technical here….hang in there if you have in interest in hCG levels (the beautiful pregnancy hormone!!)….

I found a very useful study* that looked at the predictive values of hCG levels for a viable pregnancy 13 days after a 3 day Embryo Transfer (I took my first beta test 14 days after my 3 day Embryo transfer). My result of 49, according to their model, gives me the following chances of outcome: 45% successful singleton pregnancy, 31% miscarriage, 13% bio-chemical pregnancy, 9% ectopic pregnancy, 3% successful multiples pregnancy. Well I am glad they didn’t tell me what my hCG levels were last week!

According to these researchers’ analysis, they decided that the cut-off level for predicting a viable pregnancy was an hCG level is 76 IU/I (80% sensitivity)….although this is considerably higher than some other researchers have reported (for example other studies have found the cut off at a similar sensitivity to be: 42 mIU/ml (Qasim et al., 1996); 55 IU/l (Bjercke et al., 1999); and 50 IU/l (Sugantha et al., 2000)).

Wow guys, 76 seems to be a whole lot higher than the others….so do they have credibility in their research? Well from what I can ‘statistically understand’ and in understanding their research design, it looks solid; their sample size is excellent, some of the best I have seen in articles about artificial reproductive technologies….but I am not a medical professional, so I am totally relying on my knowledge of stats and may be there is something ‘medically awry’ that I cannot see.

If I use any of these models, and consider my hCG level of 49 from last week, these researchers would have told me my chances of a viable pregnancy were always going to be low.

However, there was one interesting point that came out from this study that caught my eye:

In subjects with unexplained infertility, ICSI may result in lower than expected HCG levels (Gold et al., 2000)….The explanation for this was not clear. Although the early embryo cleavage is delayed in ICSI-derived embryos and the fragmentation of embryos is increased the implantation potential is comparable with IVF-derived embryos.

Even though my numbers have not multiplied nicely….in the back of my mind I am holding onto this slither of hope….holding on that we are the ones in that 5% extreme quantile who defy the norm, and it is because we are unexplained and our embryo was ‘ICSI-ed‘ that my hCG numbers are much lower.

Until Friday…………. :-s

*Pokkeus, P., Hiilesmaa, V. & Tiitinen, A. (2002) Serum HCG 12 days after embryo transfer in predicting pregnancy outcome. Human Reproduction 17(7):1901-1905. Available at: http://humrep.oxfordjournals.org/content/17/7/1901.full

How to get the most out of your doctor

August 23, 2015August 23, 201512 Comments

It took me about 24hrs after it was confirmed that I am pregnant to realise I do not know how to be pregnant. This might seem very weird considering we have been talking about this moment for more than two years now. Once we started trying to conceive I just of buried my head in the sand. I didn’t want to jinx our chances by buying a book about it, and I started to avoid all pregnancy related websites and apps after 6 months of failing to succeed in our quest to make a baby. I know the basics, like smoking is a big no-no, drugs are dangerous, avoid raw meat and reduce caffeine, but really, that is the limits of my knowledge. So yesterday we went to the book store and bought two books on pregnancy. One was the standard text book “Great expectations: Your all in one resource for pregnancy”, and the second was “Expecting Better”, beautifully demonstrated in this picture by Sushi:

Sushi, my book keeper

This second book interested me because I have always wondered whether Japanese women stop eating sushi, or French women stop eating brie when they are pregnant. Really? I don’t think so. I hope that this book will enlighten me to what the conventional wisdom really means. But when I started reading the first chapter I didn’t need to go much further with it to be completely satisfied with my purchase. Why? Well the author, Emily Oster, is not so different from me, she was not happy with what her doctor was telling her. I realised that my experience with my fertility clinic’s doctors and the feeling I had that there was a poor lack of communication. All of this was because I was not asking the right questions. I didn’t know I needed to ask them. And this is silly because all along I had the key questions in the back of my mind…I use them everyday at work!!!

In my job I help leaders make decisions every day…I do this by presenting the evidence, the facts – for and against a decision – I do some analysis on the data that supports the decision, I try to be unbiased and objective in my analysis, and then I present a recommendation to the leader on the best course of action. The leader doesn’t always go with my recommendation, but I have presented them with the facts and figures to make their own mind up. Sometimes I feel a bit hurt, but then I remember, I am not the one taking the risk. So when it comes to our healthcare and doctors, WE are the decision makers. We need to be presented with the arguments for and against, and be told what the supporting evidence is. WE are unique in many different ways and the decisions we make will be unique, blanket guidelines are not always appropriate for everyone.

I think a good example of this is when we were told we should do ‘ICSI’ because of our unexplained infertility. We didn’t ask the questions: What are the pros of ICSI? What are the cons of ICSI? What are the improved success rates with people like us? (i.e. what’s the supporting evidence/data?) We were not armed to make a decision, we just went with what the doctor said, and in the back of my mind I felt like I had not been given a chance to make a decision. I did actually do a lot of this research myself, but it would have been better if my doctor would have told me – after all I am not the medical professional, I just have the fortunate ability to interpret statistics from studies and experiments. So although I was finally happy with the decision to do ICSI after my research, something inside me was niggling about our doctor’s communication.

Another example is when it came to our embryo transfer. We were told that it is the standard practice at the clinic to transfer 2 embryos on day 3, unless there were over 6 fertilised embryos then maybe we would be a candidate for waiting to Day 5 to transfer 2 blastocysts. We did not ask the questions: what are the pros of us waiting to Day 5? What are the cons of us waiting to Day 5? What are our personal chance of success with 4 fertilised embryos compared to if we had had 6? (i.e. what’s the supporting evidence/data?). Again, I did a lot of this research myself.

I could go on with other opportunities throughout our infertility treatment where I could have asked these three simple questions that would have revealed the knowledge I needed to feel like I was in control of making a decision. We rely on doctors to make the decisions for us…and most of the time I am happy with that fact, but there were times that I felt like we should hold that responsibility for a decision. When it comes to my pregnancy I want to be able to ask these questions to my doctors and nurses so I can take the responsibility for making some of the big decisions such as prenatal testing or birthing plans.

Emily Oster suggests reading the book “Our medical mind: How to decide what is right for you” by Jerome Groopman and Pamela Hartzband. I think I might try it, and I’ll let you know how it goes. Has anyone read this one?

In the meantime my friends, next time you are in a consult with your doctor, remember these three simple questions to help you make the best decision, for you, and get the most out of your doctor….