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from the book How to Have a
Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
Previous page: Alternative
Medicine: Exploring Your Treatment Options
Next page: How to Find the Best Doctor
Table of Contents
How can you be sure you are making the right decisions about your treatment ?
What are the issues which will affect your final decision ?
What tools can you use to make better decisions about your options ?
How can you prepare yourself ?
How can you be sure you are making the right decisions about your treatment ? Discovering that you have a fertility problem
can be a difficult process. In addition to the emotional stress
you now find yourselves faced with making endless decisions about
treatment. The word "decide" comes from a Latin root meaning
"to cut away from." Thus decision making, by its very
nature, involves loss, giving up one or more options while grasping
another. Not deciding maintains the illusion that you can have it
both ways - that there is no loss, no risk. Unfortunately, most
infertile couples have not learnt to make their own decisions -
and not making decisions is one sense the worst possible decision
of all! You cannot allow your doctor to make treatment decisions
for you either - this can be disastrous as well.
Most likely, your original goal was to have your own biological
child. However, because of your fertility problem, you may be forced
to examine your deepest feelings about family, children, and parenting.
You could find that you have to re-evaluate your initial plans in
order to get the family that you want.
As you work to identify your goals and examine
your options, you'll discover that essentially, there are four choices
as regards treatment. Depending on the cause and treatability of
your infertility, you may need to choose one of the following options:
- To pursue having a biological child with infertility
evaluation and treatment
- To try to have a child biologically related
to only one parent, either through donor insemination or egg donation
- To adopt a biologically unrelated child
- To decide to remain childless
You may want to rate each of the four options
as "desirable," "acceptable," or "unacceptable"
at the beginning of your evaluation and periodically re-evaluate
these choices.
For some infertile couples, trying to have a biological
child and childlessness ( child-free living ) are the only options.
For , the switch from having a biologically related child to adopting
or having a child biologically related to only one parent may be
easier than having no children at all.
Many couples lose track of the fact that their
main goal is to be parents, even if they can't be biological parents.
Therefore, they may pursue infertility treatment for several years
and find themselves above the age limit to adopt an infant through
an agency. Furthermore, since a woman's fertility decreases after
the age of 35, this also decreases the chances of successful treatment.
You and your physician should try to take these possible consequences
into account when evaluating and choosing your options.
If you are relatively young, there may be a good
chance that you will achieve pregnancy without expensive procedures.
Therefore you may not wish to explore these as yet. If you are older
and have less chances of conceiving , a more aggressive approach
might be called for, since time is at a premium.
The decision making process is different for each
couple and depends on individual situations and personalities. For
example, some couples may opt for expensive high-tech treatments,
while others in the same situation will wait to see if they can
become pregnant without treatment.
Once you've discussed your infertility with your physician, you'll
find that there are a number of treatments available. These include:
- Medication that may be prescribed for either
partner to improve fertility
- Surgery to correct an impediment
- In vitro fertilization ( Fertilisation Video ) (IVF) or gamete intrafallopian
transfer (GIFT) for patients who require assisted reproductive
technologies
- Donor insemination , if male infertility is
the problem
- Egg donation , if the woman cannot produce
eggs
- Embryo adoption
- Surrogate parenting , if the woman has no uterus
- Adoption
Your doctor may be able to make recommendations about treatment
- but there are a number of questions that you should always ask
your physician so that you can make the best decision. Unlike other
medical questions, infertility recommendations are not always clear.
You need to evaluate whether and how well each treatment option
will help you reach your goals. Then you'll have to determine which
options you will pursue. The following questions may help you build
a foundation of medical information to assist you in your decision
making process.
- How much will this treatment improve our chances
of pregnancy?
- How much risk is involved and what kind of
risk is it?
- How long will we have to undergo this treatment
in order to give it a reasonable chance to work?
- Will undertaking this treatment eliminate other
options?
- How much will the treatment cost?
- Are there other options if this treatment fails?
Your physician can help you determine how much
time, physical discomfort, risk, and money will be required for
a particular treatment option. You will have to decide how much
money you are willing to spend, and how much emotional stress you
can take.
You need to design your own fertility treatment
plan. Not only will this help you maintain control over your life
as you proceed with treatment, it will also help to ensure you get
good quality medical care.
What are the issues which will affect your final decision ?
Issues which affect your choice include:
Medical Factors:
- Diagnosis ( or lack of one)
- Quality and availability of medical care
- Success rate of treatment
- Level of technology required
Personal Factors:
- Age
- Time commitment needed for treatment
- Personal feelings - physical and emotional
- Partner's feelings
- Job and career
- Financial resources
- Ethical and religious concerns
- Family and friends
- Other obligations and commitments
- Willingness to change life-styleAggressive or low-key approach
to resolution
Each of us has a different personal decision-making
style. It is for you to choose which one of the following best fits
your own personal style for making medical decisions:
- I prefer to make the final selection of my
treatment after seriously considering my doctor's opinion.
- I prefer that my doctor make the final decision
with regard to which treatment should be resorted to, after seriously
considering my opinion.
- I prefer to make the final selection about
which treatment I will receive on my own.
- I prefer to leave all decisions regarding my
treatment to my doctor.
It is important to understand that there are no
right or wrong styles, and that your style may change as you proceed
through diagnosis and treatment. It is imperative that you find
a doctor who respects and understands your personal decision-making
style.
Just as there are no right or wrong styles, remember
that there are no right or wrong decisions about your treatment,
and as your options change with time, you may also change your priorities.
Counselling may be helpful in setting your priorities - especially
if you and your partner disagree on the course of action. As your
options change with time, you may also change your priorities .
Try to be as realistic and open-minded as possible. While the final
outcome will always remain unknown at the time of making decisions,
if you take the time and the trouble to make your own decisions,
at least you will have the satisfaction of knowing that you tried
your best!
In order to make infertility treatments less stressful,
you'll need to place time limits on them. Doing this may help you
define your goals more clearly. Many couples are willing to accept
only two to three years of therapy, because continuing treatment
for long periods of time may cause excessive stress.
It is important that you do not lose sight of
your relationship with your spouse . Make sure that each of you
understands how the other feels about each stage of treatment. Throughout
treatment, both of you may encounter times of ambivalence about
having children. This is a normal reaction, and you should remember
to have realistic expectations of one another.
If reasonable goals are maintained and difficulties
and limitations are kept in mind, stress can be minimized. If this
is not the case, then a break from treatment, change in plans, or
counseling for stress and marital issues may be good idea.
What tools can you use to make better decisions about your options ?
Sometimes, recording information on a worksheet
can be helpful. Here is a sample worksheet for making medical decisions
about treatment:
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Option 1
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Option 2
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Option 3
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Option 4
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Benefits
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Success
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Risks
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Costs
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Time
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Decision (in the rank of choice)
You may want to take each of the options your
doctor has suggested, gather the information you need, and go over
the options in terms of :
- Time
- Physical and emotional risks
- Cost
- Chances of success, with and without treatment
Also keep in mind how much money and time is needed,
what is available and how much you are willing to invest. As you
go through this decision-making process, you will probably find
that your answers change with time.
If you do not conceive after pursuing your initial
plan of treatment for a set period of time, you may need to re-evaluate
your goals and options. You may find that you want to discontinue
medical intervention, or you may want to seek a different kind of
treatment. Keep in mind that it is not at all unusual for partners
to have differing views and feelings about infertility and its treatment
. Open communication can help both of you to make the best decision.
How can you prepare yourself ?
An early step in the entire process is to try and prepare yourself
. Ask yourself if it is worth the risk of pursuing treatment without
a guarantee of success. Anticipating difficult situations and emotions
may help you deal with them more easily.
Your doctor can provide you with information and
can refer you to further sources. You can take steps to prepare
yourself for what could be a long and frustrating process. But you
may also find that as you and your partner work through the stages
of infertility treatment, your relationship grows stronger.
Your physician, support groups, other couples
who have made similar decisions, and counselors can also provide
support and guidance. Above all, remember that with patience, a
positive attitude, and the appropriate treatment, most infertile
couples can eventually become parents.
Next page: How to
Find the Best Doctor
Previous page:
Alternative Medicine: Exploring Your Treatment Options
Table of Contents
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