Really really tired.
I was helping to set up a fundraiser all day yesterday (like 7:00 am til whenever) and stayed out all evening AT the fundraiser, had too much to drink, and spent too much at the silent auction.
I'm exhausted, and slightly hungover.
And then I woke up at 3:00 am and couldn't get really back to sleep for hours. I finally gave up at 5 am, got up and read the paper and started puttering around. I'm catching up on all your news right now, apologies if I'm a bit late commenting!
Thank you to the people who sent me copies of that study, and others! Really really helpful.
And to answer a question that I guess I wasn't very clear on; I believe that if fertility treatment was fully funded, drugs and all, and patients were educated on the real odds of multiples, and the real odds of prematurity & survival that almost none of them would opt for doing more than a double embryo transfer, and many would opt for single blasts. I think Doctors should be required to follow a really good program to educate patients about this issue prior to ANY treatment, and if people want to do IUI with larger numbers of follicles, or IVF and implant more than 1 embryo, they should only be treated if they are pro-choise enough to agree to consider selective reduction.
(You'll note I didn't say they had to agree to selective reduction ahead of time....just not rule it out.)
For people who believe ahead of time that they could never do a selective reduction, they should only be allowed to do one embryo at a time, and understand that if they do lower tech treatments, and hyper-ovulate that the only ethical religious stance is too refrain from sex or not do the IUI that month. (A truly religious person who's a "pro-laffer" can see the logic of that, IMO.)
I don't mind funding as many cycles and as much drugs as needed for any couple to complete their families, if it means less dead & disabled children in the end, but I hate making hard and fast absolutes, because there are always exceptions, like couples who are dealing with balanced translocations or genetic issues and no PGD test exists for them yet. Or for couples whose embryos don't freeze well, etc.
Right now, there is such poor diagnosis out there, so much money involved, and such unrealistic portrayals in the media that I think we don't need to decree single embryo transfer, just tell patients the real honest to God truth, instead of pretending it's all about living babies and perfect pregnancies, and that Drs. can save them all easy.
Any opinions?
Whoo-whee, 1st one!
ReplyDelete"I believe that if fertility treatment was fully funded, drugs and all, and patients were educated on the real odds of multiples, and the real odds of prematurity & survival that almost none of them would opt for doing more than a double embryo transfer, and many would opt for single blasts."
Exactly as I noted in last post concerning my BF -- she didn't WANT twins, she only wanted a (single) healthy baby! Now not only is she risking her own health (w/hypertension threatening to put her on bedrest), hopefully her babies will have no serious health complications other than prematurity (which guarantees her a scheduled C-section & several wks in the hospital at bare minimum for her babies)... In the meantime we're ALL on pins & needles!
Once again it all comes down to education. Making an informed decision is so critical and I don't think that they emphasize that enough to physicians, except for malpractice suits. It's a shame that malpractice seems to be the only motivating factor for informing patients.
ReplyDeleteIf we have 2 embryos next time around, we will transfer 2. Why? Because of the costs involved.
ReplyDeleteIf our IVF was covered, I wouldn't have a problem with a single transfer.
Even if it's completely covered by insurance, I think going through failed IVF after failed IVF must take a huge toll, both physically and emotionally. I'm not speaking from my own personal experience here, but from what I've read of other people's stories. So I think, realistically, there will be limits on how much fertility treatment people will want. Though, of course, that limit will vary from person to person.
ReplyDeleteProbably most people would very strongly prefer either a singleton or, at most, twins. It's just that they feel that their only chance of getting one or two babies is to transfer a whole bunch of embryos. I think your idea of limiting such multi- embryo transfers to people who would at least consider selective reduction is a very good one.
I know other people have said this, but you've thought through all these issues so thoroughly and have so many fascinating thoughts and opinions that you really should consider writing a book. I know, it would be an enormous undertaking. But you would be able to help so many women.
I can't fault your reasoning.
ReplyDeleteBea