One of the most compelling scenes in 'The Cider House Rules' is when Dr Larch, Homer and Buster are burying a young girl who died from an illegal abortion. Well actually, Homer and Buster are the ones digging, while Dr Larch watches over them. "What did she die of?" Buster inquires. "She died of secrecy." Dr Larch lectures sternly. "She died of ignorance!" he finishes sharply.
I hate ignorance. I hate misinformation. I hate how ignorance breeds misinformation. I have often declared that I want to hunt down the person who started the rumour that women need to start birth control pills when their period ends. However, one of the greatest challenges in medicine is keeping up with new information and new developments that often require professionals to retract or sometimes contradict previously disseminated messages. I can remember at some point in my training (prior to specalising in women's health) learning that women should use alternative contraception and wait three months before trying to conceive after stopping birth control pills. Some of the rationalisation for waiting three months is to allow for a woman to start prenatal vitamins for an optional amount of time before a potential conception, and it allows a woman to observe her own natural cycles and determine her fertile time. Unfortunately, the suggestion of waiting three months seems to have been translated into a presumption that one can't get pregnant until three months after stopping birth control pills.
I know I obviously have advanced knowledge of pharmacology, but it is too logical to follow that if you need to take the birth control pill at the same time every day in order to prevent pregnancy that it can't take three months to flush out of your system? I thought back to when Myrtle told me that the friend who told her it would take six months to conceive after stopping the pill, also conceived within a month or two of her final pill. At that moment, I chose to ignore the comment, especially as I was annoyed at her for flaunting the fertility of others in front of me. Referencing my title for this post, I wish I had comeback with "Well, she obviously knows what she is talking about." said in an acrid and heavily sarcastic tone. Ah, coulda, woulda, shoulda...moving on...
"What do you have for me?" I asked my medical assistant
"She's here for her annual, but also wants to talk about fertility..." I sensed from her pause that there was more to the story
"She stopped her birth control pills and hasn't had a period, and she mentioned that her boobs hurt, and I know my boobs hurt when I was pregnant..."
"Cut to the chase scene, please."
"Her pregnancy test was positive."
Well, this development makes the fertility talk easy, I thought; but I would soon discover that her case was anything but simple.
She was 31 years old and her history was quite complex. When she was 17 she was rushed to the hospital with what the school nurse thought was an acute appendicitis, but it turned out to be ovarian torsion and she lost her right ovary. When she was in her second year at University, she was diagnosed with Hodgkin's lymphoma and battled her cancer with several rounds of chemotherapy. Quite predictably she was concerned about the effects of her chemo on her surviving ovary. I asked her about her fertility plans. She wanted to conceive in about three years, she and her current boyfriend had only been dating for seven months, but she felt that he was the one. I asked why she stopped her pills now. "I've heard that it can take a long time to get pregnant after stoping the pill." I followed by asking where she heard that notion "It took my sister a year to get pregnant, so I figured it would take me even longer."
The news of her positive pregnancy test was a complete shock to her. While she was happy to learn that she had overcome her potential biological limitations, she was not prepared to be pregnant at this time. She had just completed her master's degree in library science and received a coveted offer to work for the National Institute of Health in Washington DC. As a way of celebrating her graduation, she had booked a trip to Central America for two months before her cross country move. Her boyfriend wasn't planning to move to DC with her until he found a job.
I think the most infuriating aspect about ignorance is that most people are oblivious to their ignorance and may be blissfully unaware of the potential consequences. It makes me think of one of my grandfather's favourite sayings, "I wish you were a little smarter, just so that you would know how dumb you are." What I found so frustrating was the fact that she thought that stopping the pills without using any other contraceptive method in order to conceive in three years was a sound strategy. Yet at the same time, I had quite a bit of compassion, as given her history of having her one ovary prematurely aged by the effects of chemotherapy, I felt that I could very easily be following her infertility blog.
In a way, we are all ignorant about our own fertility. No one really knows how their reproductive organs will perform until they are taken for a test drive; but sheesh, don't walk into a dealership unless you're ready to buy a car! I've been asking myself if I knew then, what I know now, would we have done anything differently? As we're technically defined as being sub-fertile, if we had started TTC years earlier, we'd be more likely to conceive spontaneously, allowing more time for the stars to magically align. Yet it would have stretched out the process of watchful waiting much longer. I can honestly say that although Husband was prepared, I wouldn't have been ready for a pregnancy too much earlier before we started trying. I represent the rate determining step, and he's the rate limiting step. I definitely wouldn't have worried about being pregnant at Myrtle's wedding, nor used Plan B to avoid missing our Olympics trip. We could have started to pursue procreation six months earlier, and if it had happened -everyone would have found a way to deal.