Coming to terms with one's own infertility issues is sort of like coming out of denial about the life circumstances you're faced with. What may seem obvious to those on the outside are not so revelatory within. I think I've finally crossed that line and come to terms with the mere thought that our situation is one of those sad stories in which people politely smile sadly and give you encouragement but secretly think "better them than me". I've always known we didn't have the greatest of luck, but just like an addict that keeps thinking that they will get sober whenever they feel like it, I have been thinking for so long that we'd get this infertility stuff "figured out" and we weren't going to be one of those hopeless couples that we all take pity on.
As mentioned in my prior post, I met with the OBGYN yesterday to discuss next steps for Intrauterine Insemination. Remember that this is similar to the "turkey baster" type method of directly inserting the sperm to get it closer to the egg. Both Jon's urologist and my own Reproductive Endocrinologist (RE) suggested this as a possible next step if Jon's next swim test (which he will be doing in early February) indicates that the surgery was not successful. Both likened the success rate to 20% bearing in mind that this is the likelihood of a successful pregnancy for a normal fertile couple so those odds are hopeful for a sub-fertile or infertile couple. The cost to do IUI is several thousand dollars at the RE office and the cost at the OBGYN (keeping in mind that seeking out infertility services at an OBGYN is kind of like buying a laptop at Wal-Mart--it works, but eh?) is only several hundred dollars. I thought I would at least meet with the OBGYN that came recommended to me who practices evidence-based medicine and see what he had to say about our options.
I naively went into this appointment yesterday expecting that we would discuss costs, probabilities of success, and step by step instructions as to what I would need to do if we decide to pursue this option. Instead, I was greeted by a frazzled MD who barely had a moment to glance at both mine and my husband's medical records before proceeding to say in the most indifferent of terms that we were not good candidates for IUI because Jon had a triple whammy of low count, low motility (how efficiently the sperm move) and poor morphology (the shape). I sat there dumbfounded as he rambled on about how our likelihood of success given Jon's latest swim test was near that of just 1%. This was far from the 20% probability that both the Urologist and RE office had indicated with us in our past visits. He then moved on to tell me that we likely wouldn't see any success following Jon's surgery because Varicocele repair surgery was controversial and he had seen very little improvement with this surgery.
As I sat there listening to him ramble on how we had gotten pregnant on our own and could continue on with trying without intervention or consider IVF my mind was racing with thoughts and utter confusion. How is it that my RE had told me on several occasions knowing the full magnitude of Jon's male factor infertility that our chances of IUI success was approximately 20%? And didn't the Urologist say exactly the same thing? Surely this is merely an estimate because no one can fully understand the magnitude of our infertility so these estimates are accurate only in retrospect. Secondly, I am fully aware that physicians do adhere to some bias because they are trying to sell you their services. Yet, both physicians had been forthright with us explaining the probabilities, advantages, risks, and costs with us. Our RE even went so far as to tell me to get my labs done at my own home clinic because they were more expensive at the RE office.
Leaving the physician office I felt not so much defeated as just confused because it was so not what I was expecting and it was a game changer. I called my sister to debrief her in which she subsequently started reading the medical literature on both the efficacy of IUI and Varicocele repair. To my astonishment, I found that the research replicated the conclusions that the OBGYN outlined for me at the visit. Why am I only hearing about this now?
Jon and I are now left scratching our heads as to what we do now. All of these contradicting opinions serves as a prime example as to how elusive the study of infertility really is, and I hate that I'm caught in the middle of physicians that all have suggestions as to how they can help us. What's the right answer? There is no right answer. No one knows except in hindsight.
For now we will wait for Jon to do his repeat semen analysis and see if the surgery worked. Our urologist said we had a 75% chance of seeing improvement, and after the surgery he debriefed me on the surgery with some encouraging remarks that seemed to indicate that Jon's Varicocele was rather large and that he was "fairly optimistic" that we would see improvement. He didn't have to tell me this so I'm baffled as to why he would "embellish" something like this unless it were actually true. So how do we go from these encouraging thoughts to an OBGYN telling us that these surgeries are rarely successful? I had done my own research before Jon went in for that surgery and found that the success rate for this surgery was largely inconclusive and was dependent on severity and bilateral v. unilateral, but I did trust our Urologist (and still do). Surely he wants our business, but I did not sense from him that he was trying to manipulate us. If Jon's surgery isn't successful then I will be meeting with the RE to discuss IUI once more in hopes of clarifying these contradictory conclusions.
After that debacle I went to bed last night thinking about IVF and adoption. And then it hit me--wow, am I really thinking that these are our probable next steps? Aren't these outcomes only for those couples you only hear or read about? Didn't I used to pass judgment on people who pursued IVF because I thought that they weren't being patient enough? Are we we now that couple? For so long I held on to this idea that we'd figure this out and I never thought IVF was relevant to our lives. Yet after roughly 20 months and one miscarriage later we've found ourselves confronted with these daunting decisions in which we may have entered a whole new realm of possibilities that we never thought would be our inevitable misfortune.
No comments:
Post a Comment