Showing posts with label Answers. Show all posts
Showing posts with label Answers. Show all posts
So is it, like, really hard and stuff?
It's been quite difficult, yes. If you have personal reasons for wanting to know more, such as your own fertility concerns, I'd be happy to speak with you further. If you just want to know whether it's really worth me carrying on like I do, the answer is "yes".
Why don't you take a break?
We do take breaks. We take them when we want them and when we need them. If we neither want nor need it, a break is worse than useless - it causes undue stress and allows us to get slightly less fertile as time ticks by. Don't worry - we have it under control, we promise.
Why can't you commit to anything at the moment?
At present, we have a planning horizon of less than four weeks. Accurately, between one day and two weeks. If we want to make plans for anything other than IVF, we either have to put IVF on hold to do so, or make plans which are subject to cancellation if anything IVF-related clashes with them. It's not practical to put IVF on hold for most things (including international visitors).
(Also, let me just say this: "Gosh, having kids really does put a hole in your ability to plan things!" and give that head shake and martyrly sigh again. Excellent. So much better.)
(Also, let me just say this: "Gosh, having kids really does put a hole in your ability to plan things!" and give that head shake and martyrly sigh again. Excellent. So much better.)
What's wrong with "some things just weren't meant to be"?
When someone says this, or something like it, there are two possibilities.
- They might be voicing the opinion that, when things in life get hard, one should throw up one's hands in defeat, in which case I beg to differ.
- They might be trying to make soothing noises, in which case I regret to tell them they are failing spectacularly. If I can redirect their efforts: "Ooh, gosh, that's terrible. I really hope things get better for you soon."
Why can't I get interim reports on how things are going?
Why would you want them? Interim reports mean nothing. It's difficult getting up enough enthusiasm to give them, and even more difficult trying to explain to people how little they should care about them. It's all tealeaves. It's so meaningless it's not worth the time and effort of exchanging the information.
Our best embryo to date resulted in a negative. By contrast, our lamest, probably-won't-survive-the-night embryo resulted in a (very short) pregnancy. Getting a nice thaw is only good news if it results in a live birth. Otherwise a nice thaw just means going through a longer period of suspense, more drugs and greater physical discomfort for the same eventual result. Ditto getting pregnant. Morning sickness is not worthwhile if all you get out of it is a closer inspection of the toilet bowl than you would otherwise have made. There is absolutely no point discussing it and it's kind of irritating to do so.
Really the only thing worth getting excited about is being discharged from the hospital with a healthy baby in tow. But we'll probably give you a cautious heads up if the odds of that happening move sufficiently in our favour, so don't worry (and do try not to get too excited unless the aforementioned hospital discharge happens). Til then - trust me, none of it means anything and it's not worth riding the rollercoaster. So let's not talk about it or I may be forced to sigh as if heavily wearied.
Our best embryo to date resulted in a negative. By contrast, our lamest, probably-won't-survive-the-night embryo resulted in a (very short) pregnancy. Getting a nice thaw is only good news if it results in a live birth. Otherwise a nice thaw just means going through a longer period of suspense, more drugs and greater physical discomfort for the same eventual result. Ditto getting pregnant. Morning sickness is not worthwhile if all you get out of it is a closer inspection of the toilet bowl than you would otherwise have made. There is absolutely no point discussing it and it's kind of irritating to do so.
Really the only thing worth getting excited about is being discharged from the hospital with a healthy baby in tow. But we'll probably give you a cautious heads up if the odds of that happening move sufficiently in our favour, so don't worry (and do try not to get too excited unless the aforementioned hospital discharge happens). Til then - trust me, none of it means anything and it's not worth riding the rollercoaster. So let's not talk about it or I may be forced to sigh as if heavily wearied.
What's wrong with giving advice, making recommendations, or telling heartwarming stories of hope?
Nothing wrong with it per se. The following are examples of ways in which you can very helpfully do so:
Please don't be offended or discouraged if the answer is "no". Your next piece of information might be highly useful and we would hate to miss that! And besides, we do appreciate the thought. However, please understand there is a high chance you are about to tell us:
- which is why I reserve my right to say, "No, but thanks."
If you are about to phrase your suggestion/story in any of the following ways, please stop:
("Why don't you...?" also skates on thin ice, depending on your tone of voice.)
Suggestions and stories phrased like this come across as thinly-veiled ways of saying, "You've got nothing to worry about!" and, "Clearly, you can't look after yourself properly." Which isn't what you meant.
- I read something the other day about such-and-such a thing. Would you like me to send it to you/tell you about it?
- I know this person who did something-or-other. Would you like me to tell you their story?
Please don't be offended or discouraged if the answer is "no". Your next piece of information might be highly useful and we would hate to miss that! And besides, we do appreciate the thought. However, please understand there is a high chance you are about to tell us:
- stuff we already know to death
- something completely irrelevant to our situation
- a story so heartwarmingly hopeful it will cause me to have a minor panic attack just thinking about the number of horrible things that couple went through before gaining eventual success
- which is why I reserve my right to say, "No, but thanks."
If you are about to phrase your suggestion/story in any of the following ways, please stop:
- You should...
- If I was you, I'd...
- So-and-so's doctor told them to...
- It might be a good idea if you...
- Don't worry, I know a couple who...
("Why don't you...?" also skates on thin ice, depending on your tone of voice.)
Suggestions and stories phrased like this come across as thinly-veiled ways of saying, "You've got nothing to worry about!" and, "Clearly, you can't look after yourself properly." Which isn't what you meant.
Why don't you do IVF in Singapore?
There are several reasons.
- Our embryos live in Brisbane. You thought travelling with kids was hard? It reaches this whole other level when your kids are frozen in liquid nitrogen.
- We have insurance and medicare in Australia. Even accounting for flights, it is cost effective to fly home. This is especially true if I end up with complications like I did for our first cycle, when I was admitted to hospital for ten days.
- We don't have the necessary support network in Singapore. We could struggle through a stimulated cycle without practical help, but it wouldn't be pretty.
- I have no desire to start from scratch with a new specialist, when our current guy's just getting a handle on all the little nuances of my reproductive system.
Gosh, well now I feel all awkward. What should I say?
Truth be told, anything you do say about IVF or infertility has a high chance of getting right up my nose. If you're not sure, why not email it? Your chances of being smacked in the face will be greatly reduced questions and comments are welcome, but they will be received more in the spirit with which they were intended if they reach my ears on a good day. I'd also very much like the chance to clear up any misapprehensions or concerns you may have directly, rather than hearing about them vaguely through the grapevine. If email's not your thing, you can write or pass messages via one of our Mums. Or simply ask me if you can start an IVF conversation before launching straight in.
In real life, you would be safe with:
Things to definitely not say:
In real life, you would be safe with:
- How are you?
- How are things going? (May or may not be answered with infertility-related subject material.)
- Best of luck/I'll be hoping things go well.
Things to definitely not say:
- How lucky you two are to have avoided the burden of parenthood!
- Let me give you some advice and/or tell you a story about a friend of a friend of mine... (Why not?)
- When can I visit you in Singapore? (See Why can't you commit to anything at the moment?)
- Some things just weren't meant to be. (Why not?)
- What's happening now? And now? And now? (Why not?)
Will you freak out if I announce my pregnancy and/or child's birth to you?
Maybe. Which is why I'd like you to either:
Please let us know as soon as you make your announcement public.
The sort of situation I'm trying to avoid is one in which you tell me your news via a chirpy email with attached photos on (for example) the same day my OB confirms the imminent end of yet another hard-won but tragically short-lived pregnancy. Generally, we receive bad news related to our fertility a couples of times a month. And sometimes that news reaches me when I'm under the influence of whole cocktails of hormones and/or feeling physically unwell. So - let's just play it safe.
As an aside, I would advise caution when writing an announcement for a hundred-strong cc list. Most people on your list will be overjoyed, but there is a statistically high likelihood that, unbeknownst to you, your email is going to someone for whom fertility is a sensitive subject. Be careful. Keep it low-key for those you don't know well. Consider putting things briefly and including a link to an online photo album/blog/website rather than having everything in the email (this also gives you a chance to provide more photos than you could otherwise attach). Most of you do this already.
- Send an email to A.
- Send an email to ivf.faq at gmail dot com .
- Pass the news along through our Mums.
Please let us know as soon as you make your announcement public.
The sort of situation I'm trying to avoid is one in which you tell me your news via a chirpy email with attached photos on (for example) the same day my OB confirms the imminent end of yet another hard-won but tragically short-lived pregnancy. Generally, we receive bad news related to our fertility a couples of times a month. And sometimes that news reaches me when I'm under the influence of whole cocktails of hormones and/or feeling physically unwell. So - let's just play it safe.
As an aside, I would advise caution when writing an announcement for a hundred-strong cc list. Most people on your list will be overjoyed, but there is a statistically high likelihood that, unbeknownst to you, your email is going to someone for whom fertility is a sensitive subject. Be careful. Keep it low-key for those you don't know well. Consider putting things briefly and including a link to an online photo album/blog/website rather than having everything in the email (this also gives you a chance to provide more photos than you could otherwise attach). Most of you do this already.
Won't you end up having a whole litter of babies all at once?
No. You're thinking of the good old days.
Back in the good old days they hadn't quite worked this whole IVF thing out yet. Success rates were poor, and doctors transferred lots of embryos at once to try and compensate. Every once in a while all the little buggers would stick and it would end up in the papers.
Now they know what they're doing, the most they transfer at once is two. The most they transfer for me, most cycles, is one. This means I have no more chance of having twins than the next woman on the street. Higher order multiples? I think I'd get my own case study.
As an aside, when you hear of couples with sextuplets and so forth in the papers, this is almost always the result of lower-tech fertility treatments. The lower the tech, the less control you have over the outcome. Programs in other countries also have higher rates of multiples, because of the way IVF is funded in those countries (or rather, not funded). I'd like to pause and congratulate the Australian government for allowing Australian families to pursue IVF safely by funding infertility like the legitimate medical condition it is, although I realise their decision is not only informed by a desire to protect the health of the mother and child, but also by some careful accounting. (It's cheaper to fund IVF than to force parents to take risks which lead to expensive complications.)
Back in the good old days they hadn't quite worked this whole IVF thing out yet. Success rates were poor, and doctors transferred lots of embryos at once to try and compensate. Every once in a while all the little buggers would stick and it would end up in the papers.
Now they know what they're doing, the most they transfer at once is two. The most they transfer for me, most cycles, is one. This means I have no more chance of having twins than the next woman on the street. Higher order multiples? I think I'd get my own case study.
As an aside, when you hear of couples with sextuplets and so forth in the papers, this is almost always the result of lower-tech fertility treatments. The lower the tech, the less control you have over the outcome. Programs in other countries also have higher rates of multiples, because of the way IVF is funded in those countries (or rather, not funded). I'd like to pause and congratulate the Australian government for allowing Australian families to pursue IVF safely by funding infertility like the legitimate medical condition it is, although I realise their decision is not only informed by a desire to protect the health of the mother and child, but also by some careful accounting. (It's cheaper to fund IVF than to force parents to take risks which lead to expensive complications.)
So... what's the procedure then?
Way back when, I did a full IVF cycle. You can read about the procedure here. I got ovarian hyperstimulation syndrome, so instead of having an embryo transfer, I got admitted to hospital for ten days. It was fun. On the upside, many women have assured me that childbirth is a doddle compared to that, so at least I don't have to be afraid there.
In any case, all our transfers so far have been frozen embryo transfers. You can read about frozen transfers here. (These information sheets are provided by the clinic, but some of them are slightly out of date, and all of them are quite general.)
The way a frozen embryo transfer cycle will work for us, in particular, is this:
The way a full IVF cycle differs from the above for us, in particular, is this:
Please note, this all makes it difficult to commit to many things.
In any case, all our transfers so far have been frozen embryo transfers. You can read about frozen transfers here. (These information sheets are provided by the clinic, but some of them are slightly out of date, and all of them are quite general.)
The way a frozen embryo transfer cycle will work for us, in particular, is this:
- I fly back to Australia.
- I start daily hormone injections to stimulate ovulation of a single follicle. I have blood tests and ultrasounds whenever I'm told to, usually every 1-3 days.
- The transfer is scheduled. I have three days' notice of this.
- The embryo/s is/are thawed the night before transfer. This is a nerve-wracking time as some may die in the thaw or arrest shortly afterwards.
- On the morning of transfer I'm admitted to the day theatre for a couple of hours. I get to sweat nervously whilst waiting for the embryologist's report, the transfer is (hopefully) performed (providing our embryos have thawed ok) and after a short period of rest I go home again.
- I start different hormones, which I continue for the next two weeks. This makes me increasingly more emotional as time goes by. It's fun! At some point during this time, I fly back to Singapore.
- I have a blood test with my obstetrician in Singapore a couple of weeks after the transfer to see whether our embryo is dead yet or not. If it's not dead yet, I continue taking hormones and have a followup blood test either a week later or when things start to go awry, whichever comes first.
- Once our embryo is well and truly dead, we can do another cycle. If we have embryos left, we will do another frozen cycle. If not, we will do another full IVF cycle. If we are feeling sufficiently demoralised, we will wait before cycling again. I'm not sure why everyone doesn't want to do it this way, really.
The way a full IVF cycle differs from the above for us, in particular, is this:
- B will fly home to Australia, where she will stay for the six to eight weeks it takes to complete an entire cycle, inclusive of everything.
- A will try to fly home at some point towards the last third of that, probably for a couple of weeks.
Please note, this all makes it difficult to commit to many things.
Isn't there a point beyond which doing more IVF is just a bit... sad and desperate?
Well, I wouldn't have worded it like that, but yes, there is. There is a point for every infertile couple beyond which it's just not worth continuing. That point varies widely between individual cases and depends on a variety of factors. The only people aquainted with enough of these factors to make a decision on the matter are the couple themselves - not their friends, or family, or even (in most cases) their medical specialists. It would be best not to offer an opinion unless asked.
Does infertility increase your moral obligations with respect to any of the following problems?
- child poverty
- the depletion of the earth's resources
- the passage of inferior genes from one generation to the next
I know this never even crossed most of your minds, but somehow these questions continue to come up, even in this day and age. So I feel I should pre-emptively supply the answer, which is, of course, "No."
Especially the bit about genes. We both have much more chance of passing along something horrible which isn't related to fertility at all, just, in fact, like any fertile couple. Note the world's first IVF baby recently gave birth after a natural and easy conception.
Our moral obligations to help children out of poverty and conserve the earth's resources have not changed at all because of our diagnosis. They're no different from the obligations of a fertile couple.
It's important to accept that infertility is a legitimate medical condition, as deserving of treatment as any other medical condition.
See also why don't you just adopt?
- the depletion of the earth's resources
- the passage of inferior genes from one generation to the next
I know this never even crossed most of your minds, but somehow these questions continue to come up, even in this day and age. So I feel I should pre-emptively supply the answer, which is, of course, "No."
Especially the bit about genes. We both have much more chance of passing along something horrible which isn't related to fertility at all, just, in fact, like any fertile couple. Note the world's first IVF baby recently gave birth after a natural and easy conception.
Our moral obligations to help children out of poverty and conserve the earth's resources have not changed at all because of our diagnosis. They're no different from the obligations of a fertile couple.
It's important to accept that infertility is a legitimate medical condition, as deserving of treatment as any other medical condition.
See also why don't you just adopt?
Isn't it a bit expensive?
Not compared to other medical conditions. And not in terms of the overall cost of raising a child. Some people spend money on private schools and holiday theme parks. We're having to start our parental spending a little more upfront. On conception.
And can I just say this: "Gosh you really just can't throw money away on luxuries once you have kids to provide for, can you?" and maybe sigh and shake my head in a matyrly fashion. Good. I've been waiting to do that for some time. It was as much fun as it looked. But back to my point.
This also holds true if you want to argue about the public purse or pool of health insurance funds. Our children are not likely to cost taxpayers/our insurance company any more than the average child over the long term. We're actually very cheap citizens overall, and we've more than paid our way.
And can I just say this: "Gosh you really just can't throw money away on luxuries once you have kids to provide for, can you?" and maybe sigh and shake my head in a matyrly fashion. Good. I've been waiting to do that for some time. It was as much fun as it looked. But back to my point.
This also holds true if you want to argue about the public purse or pool of health insurance funds. Our children are not likely to cost taxpayers/our insurance company any more than the average child over the long term. We're actually very cheap citizens overall, and we've more than paid our way.
Can you tell me what makes sense about moving to Singapore in the midst of all this?
Well, this could take some time. Rather than remain unecessarily paralysed, we have chosen to get on with our lives. It's easier that way.
Why don't you just adopt?
Because there's no such thing as "just" adopting.
- IVF is easier, almost certainly cheaper, probably quicker, definitely less painful and invasive, morally and ethically simpler, and less restrictive of our lifestyle than adoption, and for us, as of the time of writing, it offers about the same chance of success over the same time period.
- Adoption won't lower my risk of breast cancer, for which I have a family history. Pregnancy will. (IVF makes no difference to my risk.)
- We can adopt later if we decide we want to. We can't do IVF once the biological clocks have spoken. And because adoption takes so long, we'd be pushing uphill against advanced maternal age by the end, so it's more or less a one-way street.
- Our adopting won't benefit anyone else. Because the supply of children available for adoption (including international adoption from poorer countries) is dramatically outstripped by demand, joining the long and winding queue of adoptive-parent-hopefuls will not get a single child out of poverty any faster than what's already being done. In fact, all we'd be doing is making a lovely couple who are very committed to the idea of adoption (and perhaps have no other choice) wait a little bit longer for their much-anticipated family. If we want to help a child we'd be better off buying a goat or something.
Why hasn't it worked?
Well, it has and it hasn't.
Ultimately, of course, it hasn't, as evidenced by the fact we're not holding our baby now. But we have achieved several interim successes along the way, including conception and pregnancy. Yay for us!
No-one knows why these interim successes haven't lead to ultimate success. We've looked. We've even looked for really whacky things. Modern medicine holds no answer.
Ultimately, of course, it hasn't, as evidenced by the fact we're not holding our baby now. But we have achieved several interim successes along the way, including conception and pregnancy. Yay for us!
No-one knows why these interim successes haven't lead to ultimate success. We've looked. We've even looked for really whacky things. Modern medicine holds no answer.
Why do you have to do IVF?
Because we have no chance of conceiving without IVF.
That's zero chance. That's not "I knew this couple once and they did IVF for years and finally gave up and then on her 44th birthday after they'd adopted two children they were completely surprised to find..." - no. Zero chance. Ever.
You see, infertility has many different causes. Some people are unable to conceive at all (that's not us, thank goodness), some are unable to conceive without assistance (that's us) and some are merely very unlikely to conceive without assistance (that's that couple you knew once).
So - zero chance. Ever. For real. Medically impossible. No matter what happened to so-and-so. Believe it - it's true. I should know.
That's zero chance. That's not "I knew this couple once and they did IVF for years and finally gave up and then on her 44th birthday after they'd adopted two children they were completely surprised to find..." - no. Zero chance. Ever.
You see, infertility has many different causes. Some people are unable to conceive at all (that's not us, thank goodness), some are unable to conceive without assistance (that's us) and some are merely very unlikely to conceive without assistance (that's that couple you knew once).
So - zero chance. Ever. For real. Medically impossible. No matter what happened to so-and-so. Believe it - it's true. I should know.
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