|
Infertility treatment is full of potholes,
roadblocks, diversions and traffic-jams. You need to learn to navigate
your way through this inhospitable route, and one of the most difficult
tasks you will need to master is how to make decisions . Many patients
want to use their doctor as a navigator , so that the commonest question
is – Doctor, what should I do next ? Being infertile can be stressful –
and so can being an infertility specialist ! The truth is that there are
many questions , and very few answers.
Why did the cycle fail ?
What do I do next ?
How many embryos should I transfer ?
Should I do another cycle or should I adopt ?
Unfortunately, we can only explain about one-third
of things which happen ; one-third is educated guessing; and about one
third we have no idea and can't explain why it happened. It's not much
fun not having the answers, but this can be a humbling experience ! This
is why I prefer treating well-informed patients, who have realistic
expectations of what we can do - and what we can't !
As a doctor, I am the “expert” , and it’s very
tempting to tell patients what to do – to provide all the answers. In
fact, many patients expect this, and are quite upset when I refuse to
tell them what to do next. I ask them to decide for themselves, since I
believe in non-directive counseling . I feel I need to empower my
patients , so they can make their own decisions for themselves ! I
promise them I will never let them make a wrong decision, but when there
are choices, they need to decide for themselves.
Making decisions is always difficult, because when
you select one choice, you are rejecting another at the same time. And
there is always this niggling doubt in the back of your mind – am I
doing the right thing ? Is this my best option ? As Robert Frost put it
so eloquently in his poem, The Road Not Taken…” I shall be telling this
with a sigh Somewhere ages and ages hence: Two roads diverged in a wood,
and I— I took the one less traveled by, And that has made all the
difference.”
You need to devise a strategy which maximizes your
perceived benefits and minimises your risks. Because everyone has a
different perception of what acceptable risks and benefits are, this is
a very personal decision. For example, some patients would be delighted
to have twins; while for others, this would be a disaster. The trick is
to work backwards – list all your options, and then decide which ones
are acceptable and which are not.
Let’s look at the common dilemma of how to select
the right number of embryos to transfer. I tell all my patients, if the
technology was perfect, there would be no problem – we would transfer
one embryo for everyone, and everyone would have one baby !
Unfortunately, because the technology is not perfect, we need to
transfer more embryos in order to increase the odds of at least one
implanting. But, as with everything else in life, there is a price you
may for this – more is not always better. If we transfer more embryos,
there is a greater risk of a multiple pregnancy, and the obstetric risks
associated with this. This means there are 3 possible outcomes – 1 good;
and 2 bad. The good outcome is getting pregnant with one ( or two).
There are two possible bad outcomes – not getting pregnant at all; or
getting pregnant with a high order multiple. Now, you need to decide
which of the two bad outcomes is “less bad”, so you can make the
decision which is correct for you. For some patients, triplets would be
a major disaster, and they refuse to consider the option of fetal
reduction. For other, not getting pregnant would be the biggest
catastrophe, and they would rather have “three in the hand, rather than
nothing in the bush”. This is a constant dilemma, and it never becomes
easy to resolve it . The only guideline I can offer is - follow your
heart, not just your head.
There are no “right “ answers. If there were, then
your doctor would make these decisions for you ! You need to choose
whatever gives you peace of mind. It’s best to take what I call the
“path of least regret” . Remember that you rarely regret the things you
did but you often regret the things that you did not do.
Often, not may feel that your decision is not
“rational” . This is fine – just follow your gut feel and do what’s
right for you. If you are not happy, you can never keep anyone else
happy. A good doctor will allow you to make your own decisions – even
the “wrong” ones which he may not agree with.
You may find that your thinking is “crazy “ or you
may even suspect that you are going crazy yourself. This maybe because
you were not even aware that your desire to have a baby could be so
strong and overwhelming , and this can be scary, especially when you
have always prided yourself on being cool , calm and collected. Be kind
to yourself ! You are not abnormal – it’s the situation you are finding
yourself in which is abnormal. Under these abnormal circumstances,
behaving “abnormally” is actually normal !
Remember that it’s your life , and you need to be
mature enough to accept the consequences of your decisions. This means
that you cannot leave your head out of the decision making process.
There are many real-world factors you will need to factor in, such as
the expense of the treatment, and you will need to realistically assess
your chances of success as well. Wishful thinking will not help, but
making these touch decisions will actually help you become a better
human being !
Remember that infertility treatment is not just
about success or getting pregnant – it’s a whole lot more. IVF should
also help you achieve closure and resolution, no matter what the outcome
of the treatment. It’s equally important that it give you peace of mind
that you tried your best , so that you can move on with your life.
|
