Wednesday, November 08, 2006

Helping infertile couples to make decisions

I recently received an email from a patient who had had 2 miscarriages at 8 weeks of pregnancy after 2 IVF attempts.

" I feel so DONE with IVF that we are already considering adoption. I think my doctor thinks that I should try donor egg, but finding a Chinese donor is very difficult (so we've considered using a Caucasian donor and Chinese donor sperm), but I am very skeptical about spending $30000 (yes, I am attending one of the most expensive programs in the country, and I've only seen the doctor five times total) without a known cause for the miscarriages. Had the karyotypes came back abnormal, I think donor egg would be an option. But because once came back, at least in the mind of the lab, conclusively normal and the other came back "possibly" normal, we are left wondering. For the same reason, the thought of doing another round of IVF is staggering. With the medication and the facility fees, I am paying about $15000 per cycle.

Based on your website information, I am very impressed by the information you provide and also the costs relative to the costs in the US. Also, because of a great interest in spirtual pursuits, I would love to visit India.

I am conflicted between just moving on to adoption versus trying more IVF versus donor egg/donor sperm, although I am certain I do not want to pay my current clinic $15000 to $30000 more on top of the $30000 I've already paid. Please let me know if you believe that your clinic might be a good option for more IVF, or if you believe that I probably have an egg, sperm or egg/sperm quality problem. Also, please let me know if you believe that your clinic might be a good option for donor egg/donor sperm, or if you believe that the two miscarriages may be an issue even with donor egg/donor sperm. We are ok with adoption, and plan to pursue foreign adoption only, both because it is easier and we believe has many spiritual benefits. A not insignificant part of me feels that I am being spiritually selfish and arrogant for relentlessly pursuing a biological child, while another part of me would really like to have that biological connection with my husband and the child (as I mentioned earlier, we are both adopted, so have no known biological relatives)."

This was my answer.

" I think you have to accept that today's medical technology does not have the answers to your questions.

In any case, I feel the question should NOT be "Why did I miscarry ? " This is a good question, but we cannot answer it ! Rather, I feel the question should be be - What can I do in order to have a baby ?"

After all, no one cares about problems - we only care about results - about having a baby !

Let's first list all your options:

1. child-free living
2. adoption
3. repeat another IVF cycle with your own eggs and sperm
4. donor egg
5. donor sperm
6. donor embryo
7. surrogacy

( This is the McKinsey MECE technique - make a list which is mutually exclusive and completely exhaustive).

The absence of alternatives makes decision making easier - you are going to have to choose between one of the above ! What to choose will also depend upon what will give you emotional closure and peace of mind that you tried your best. This is a very personal decision - and you need to make it yourself.

I feel donor embryo IVF is a logical option, but only your own heart can tell you what's right for you."

Making decisions is always hard - especially for infertile couples, when there are so many options. I offer non-directive counselling - and tell patients to choose " the path of least regret", so that when they are 70 years old and are looking back at their life, they have peace of mind they gave it their best shot !

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