It is always difficult for women to hear that their chances of conceiving are not great. How do you decide what to do with that information? Go ahead and pursue your preferred protocol with faith and hope that you will beat the odds? Or listen to the doctor’s advice and consider a different approach to motherhood?
Whether it is egg donation or embryo donation you are wrestling with… moving from IUI to IVF… using medications to potentially enhance fertility… or considering adoption instead of conception, there are a lot of ways today to become a mother that are not the “standard” we grew up with.
I asked long-time Choice Mom community supporter Dr. Rani Abbasi, of Columbia Fertility in D.C., for her insights on how she counsels patients about this issue.
How do you counsel women?
I try to assess the patient’s age, time already spent trying to conceive, the urgency of the situation based upon her desire to conceive and the hormone levels. If the patient has already conceived before without a problem and is now experiencing infertility that may change the dynamics of the counseling. Each situation is different and there is not usually a one-size-fits-all formula.
How do you know as a doctor what to say?
It comes with training and experience. After awhile one gets comfortable with the clinical scenarios and can counsel patients appropriately. It is also important to attend conferences and continuing study to keep on the cutting edge of science and research.
How do you talk to a woman whose numbers are against her and is hopeful?
This is the most difficult. There is the science of medicine — and then there is the ART. (No pun intended). I usually am very honest with them, without being abrasive. I usually tell them the statistics and show them the literature and studies supporting my rationale. After that, if the patient still wants to try, I may allow them to try a few times, but at some point they have to accept that this is a losing proposition.
I explain that it is more than getting an egg. The miscarriage rate, and the rate of chromosomal abnormalities has to be factored in.
If a woman wants expediency with IVF, is that always the best course?
Usually, but not always. Sometimes, in spite of good hormonal numbers, there is diminished ovarian reserve and the pregnancy rate is low even with IVF. There are many factors that go into this decision. But generally speaking, the more aggressive the treatment (IVF), the quicker the time to pregnancy and the higher the pregnancy rate.
When are fertility drugs recommended? And when not?
Fertility drugs are generally recommended in conjunction with any treatment protocol when there are hormonal issues, or assisted technology like IUI or IVF is contemplated. Also for donor egg or donor embryo cycles.
Treatment protocols utilizing natural cycles are generally for patients who are very young and have no infertility factors (other than maybe male factor) or for patients with diminished ovarian reserve where the ovarian response is minimal even using fertility medications. If a patient is doing IVF with fertility drugs and has only one follicle developing, they may use a natural cycle in future attempts.
Why are there so many variables that make this not an exact science?
There are many variables because the biology is different. Even if there are protocols, individual responses may make patients fall out of the bell curve. It is not mathematical. Hormone levels, egg quality, sperm quality are a few of the factors that can make the responses different.