Wednesday, 26 December 2012
A man, a plan, a canal, Panama!
I always ask my newly pregnant patients if they were planning a pregnancy at the time of conception, which is quite funny for infertile women, as all we are ever doing is planning. It's ultimately the process of planning a pregnancy, but it's about scheduling your next appointment, the next diagnostic test, the next treatment intervention, thinking about what the next step will be if that doesn't work out... Planning makes you feel proactive. Planning is hopefully bringing you one step closer. To some extent, planning allows you to feel that you have some control. We had a follow up visit with my RE to review where we were and to discuss our next steps. He admitted that he wasn't surprised we conceived spontaneously (although six weeks earlier he thought we would most likely need IVF/ICSI to conceive) but he also admitted that it may have been a fluke and wouldn't recommend trying on our own much longer. We would need to have at least one normal menstrual cycle before starting IUI, although it has a low success rate and he mentioned that some studies don't consider IUI to be an appropriate treatment for male factor infertility. He advised only doing 2-3 IUI cycles, but I think I would prefer at least 4. While he could appreciate our desire to avoid IVF if possible, he suggested that we shouldn't put it off beyond 2014, as success rates start to decline with each year. Husband also noted that the price increases once the woman reaches the age of 38, which will happen in 2014. The clinic offers the option of doing a split ICSI cycle, where some eggs undergo conventional fertilization, and others undergo ICSI. He brought up the issue of having frozen embryos available to have a second baby in the future, but we countered that as we are both only children, our plan is to only have one. To my delight, he informed us that "at your age, a single embryo transfer would be reasonable". I don't think I had yet heard any advantage associated with my age! He also agreed with my suggestion to do a sonohystogram to evaluate my uterine cavity prior to starting treatment. Meanwhile, Husband's mind went to work on a whole other aspect of these plans -the financing. There was one more obstacle in our planning. The Hawaii trip with my parents and in-laws. When my parents started discussing the trip with us, Husband and I vowed that we would not defer our conception attempts to work around the holiday. I thought of something clever, my mother's sister also has a time share that she can use in Hawaii, and I suggested that they use it at the same time. That way if we have a newborn or if I'm heavily pregnant, my parents can still have a holiday with my aunt and uncle. (Honestly, I don't think my in-laws are that keen to schlep to Hawaii after the long haul from England to California). I don't want to do IVF before we go, as I'll be so depressed if it fails, but if it works, I would still be really early and I wouldn't want to be away from my doctors, in the event that I miscarry again. I'd rather have something to look forward to for when we get back. It also allows us more time to save, there will be a lot less dining out and a lot more meals with beans and rice this year. Who knows? Maybe it will happen in Hawaii -at least that's what everyone seems to be telling me. No one is infertile in Hawaii -right?