Saturday, February 19, 2011

The Conception Chronicles: Being Prepared

This is the seventh installment in a short series about baby making.

The wonderful world of fertility medicine has a "dirty little secret," selective reduction.  We've all heard about Jon & Kate Plus 8 and Octomom, and many have seen TLCs annual sextuplet follow up specials with the family in Iowa. The thing is, and its not talked about much on these shows, is high order multiple pregnancies are really, really risky to both mom and babies.  The survival rates aren't terrific, disabilities like cerebral palsy are fairly common, and prematurity is almost a given (even for "low" HOMs, your basic triplets).

A well managed triplet pregnancy has a 9% chance of miscarriage by 20 weeks and about a 2/3 chance of delivery by 32 weeks (a 32 week delivery will buy the babies, if healthy and all goes well, at least one month in the NICU). Moms are often on bedrest by 24 weeks to help keep the cervix healthy.

Why do I know these stats? Our RE like to repeat tell them to us (and remind us that triplet+ parents have high rates of depression, somewhat attributed to sleep deprivation). Our fertility doctor is pretty conservative in treatment protocols and strives for one baby, considering even twins, while generally pleasing to the parents, a (partial) failure on his part. While some people have these conversations early in treatment, we never saw enough development on the basic drugs to warrant it.

On the injectibles, Chris had a so-so response. She responded, but even with low and varied med levels and slow medicating (I won't bore you with the exact protocol, but it wasn't that bad - nothing like the IVF folks), she never had a super amazing lead follicle. So to get anything big enough, there is risk. Hence, "the conversation".

I'll preface this by saying we are kind of under the gun on the fertility thing due to impending insurance changes, so canceling a cycle is a big risk to us (not to mention the expense, though limited for us, and massive hassle of injectible meds).

Princess Charming and I discussed what we would do with HOM at length, and decided we are ok with selective reduction (to be clear, it is a pregnancy termination of one (or more) fetus done towards the end of the first trimester, generally for health reasons). We would reduce quads or more without question. The risks are just too high. Triplets are on the edge, and a harder decision. Twins are not on the table, as the risks of a twin pregnancy are not nearly that high.

There are about 18319294 issues that play into such a grave decision, a decision made that much harder for people who have had trouble getting pregnant in the first place. There's issues of finances. There's issues of ethics. There's issues of health for mom and fetuses and eventually babies. A fairly limited number of Maternal Fetal Medicine doctors are skilled in the procedure, and all (to my knowledge anyway) do extensive testing and counseling regarding the procedure for patients considering it.

I realize not everyone would consider reducing a HOM pregnancy, be it for ethical or religious or even insurance reasons, and have no interest in debating it (well, no more than I would be interested in debating abortion rights in general). If we ever have to cross this bridge, it will be a medically based decision for us, and most likely not one we will share with many, if any people. Just another rock in the infertility bucket of things polite company doesn't discuss, but a very important thing to work out with your partner before getting too far into treatment.

No comments:

Post a Comment