Friday, March 14, 2008

Who wants to gamble?

Don and I had our very first infertility appointment Wednesday... I think it went really well. I've spent the last couple of weeks reading all of the books I could find about infertility and recurrent miscarriage; partly because I'm just interested in whatever could be messing us up, partly because I like to be well-informed and understand everything the doctors are saying-- I'd hate to hear a new word (like sonohysterography, for example, or chromosomal translocation, or thrombophilia) for the first time in a doctor's office, you know?-- and partly, (mostly), to check up on my doctors. Terribly distrusting, I know, but how else to be certain that they are covering all the bases? What if, for example, they say that there are three main causes of recurrent miscarriage? If a patient hasn't done their own research, she wouldn't know that there are five and that two potential causes might be overlooked by that practice. My doctor covered everything, though, with a thoroughness that has me feeling relieved and hopeful.

I like my obstetrician, and Don does as well, which is more surprising. My general reaction to people is to like them as a default until something changes my mind, while his is rather the opposite; most people are unworthy until proven otherwise, going double for doctors. Unfortunately we won't be working with him now, as he's already referred us to a reproductive endocrinologist (say that three times fast!) to "get us pregnant" (I didn't point out the amazing ease with which Don and I already get pregnant; I figure it's part of his usual spiel and that he meant "keep us pregnant"), at which point we'll be bounced back to his care. At which point I'll probably try to switch back to the midwife I wanted to work with before, if that won't be too rude.

For anyone interested, the potential causes or recurrent miscarriage include:

1. Hormonal problems. An out-of-whack thyroid, too much of this hormone or too little of that one, or just the wrong amounts at the wrong times, can start a chain reaction that disrupts everything.

2. Uterine abnormalities, like it being shaped funny, or split into two parts, or filled with fibroids.

3. Chromosomal defects in either me or Don, or both, that would be creating embryos with fatal problems.

4. Bacterial infection.

5. Fetus-unfriendly antibodies in my bloodstream.

6. Blood-clotting disorders (thrombophilias) that block blood flow to the developing placenta.

(Two of those should be combined into one but I can't remember which.) I'll offer decent odds on any of the above except the last-- I've already had the panel of tests for the thrombophilias and proved normal,-- does anyone want to start a pool? My money will be on options one or two, as I already know that my hormones are a little out of whack, just based on the timing of my cycle, and that my uterus is in a funny position. I'm trying to decide what option sounds best-- isn't that funny, to try to figure out what bodily defect is the most attractive?-- and right now I'm shooting for the hormones, because they're the most detectable and the most fixable. Blood tests to determine, shots or pills to fix. (The doc said something about me getting blood drawn every day for one period cycle to check my progesterone levels, but I am pretending right now that I misheard him. I don't have enough veins to do that.)

Popular wisdom continually stresses the enormous life-changes that are pregnancy and parenting; I am starting to think that infertility is at that level as well. It feels like life will never be the way it was before Don and I found how difficult it is for us to have a family. The difference is that pregnancy (and eventually parenting) start off with a bang; one minute you're happily sipping white wine, the next you're staring at a positive pregnancy test, while infertility creeps up slowly. A few too many months trying to conceive, one miscarriage and then maybe another, and eventually, it's finally clear that something is wrong.


ayla said...

I'm glad you had a good appointment. Honestly, I would stick with the OB until at least 26 weeks, then switch. If you make it into the third trimester safely, it should be okay to switch at that point, and your OB might have fewer objections, especially in working as backup. Make sure you mention to the RE that you so far have had great ease in getting pregnant. Good luck!

Mara said...

Of course, we'll wait until it looks absolutely OK before switching out of OB care-- or not at all if whatever IT is, makes for high-risk pregnancies all the way through. It's more the etiquette angle I am worried about-- I don't want to be rude, especially as I like this doctor and he's supposed to be the best.