Ignorance is Bliss, But Sometimes It's Not

Heather at "Can I Get Some Sugar With These Lemons" recently weighed in on this article in Elle written by a woman who became pregnant with twins after an IUI and then struggled over whether she should undergo selective reduction. Heather wrote a scathing but altogether reasonable reaction post here, mainly criticizing the author's ignorance of the multiples risk that was inherent in the procedure she chose to pursue, and also speculating as to the negative perception of infertiles this article would produce among the general public.

And I totally agree with Heather.

But, I can't say that I am at all shocked by this author's ignorance.

Because, here's the thing: I think that infertility bloggers tend towards the opposite end of the spectrum. We are the over-informed consumers of ART. We not only know that a doctor "transfers" embryos instead of "implanting" them, we also know what E2 is, we know how much of it you need per follicle for there to be viable eggs, we know how big those follicles generally need to be to hold viable eggs, we know how high our progesterone should be, we know what FSH is, what MTHFR is, what endometriosis is, what RPL stands for, we know about thyroid problems, we know about PCOS, MFI, morphology and motility. We know based on a beta number and the number of days past ovulation whether to cheer for a fellow blogger with reckless abandon, or whether to cheer for her with words of encouragement and hope. We know that cramps mean nothing. We know that boobs mean nothing. We know that google lies. We know that google tells the truth. We know too much. And I dare say, we may be the outliers, and the author of this article may represent the average IF patient.

Do most IF patients trust their doctors? Do most IF patients get all their information from their doctors? Do most IF patients base all their decision making on what their doctors tell them? Is this a reasonable way to go through IF treatments?

At this point I'd like to relate a story from my own journey through infertility. After 6 months of trying on our own, using OPKs and charting, and having nothing to show for it, I took the first step of making an appointment with my OB/GYN to ask about next steps. The appointment lasted, oh, 5 minutes. He said to me "I'm going to give you a prescription for something that helps a lot of women get pregnant. Take this for 3 months and if you're not successful I'll refer you to a fertility doctor." The prescription, of course, was for clomid. I had never heard of clomid, I didn't I know what it was or what it did. When I got home and told my husband that I had a prescription from the doctor that might help us get pregnant, my husband asked me if it would increase our chances of twins. I remember telling him that I didn't know, and I remember thinking to myself "Duh! It probably does!" At that point, I started doing my own research.

It's entirely possible that if my husband hadn't said anything that I would have continued being as ignorant as the author of the Elle article. But as soon as I started doing my own research, I started questioning everything. Clomid was supposed to be for women who didn't ovulate (or so I read), so why was I being prescribed this when I seemed to be ovulating fine? I also read something that said that clomid can cause cysts, and cautioned against taking the medication without being monitored by ultrasound throughout your cycle. I had previously had two cysts discovered during regular check ups (with a different OB/GYN), and so I began to worry about taking this drug for multiple cycles without being monitored. I actually called my doctor and expressed this worry, told him about my history of cysts, and he dismissed it immediately. But I didn't trust him any longer and after just one unmonitored clomid cycle, where I had a lot of pain and discomfort around ovulation, I decided to move on to an RE right away.

And I haven't trusted doctors since, because now I don't believe anything they tell me! (Kidding! I totally believe them, but only when they say things like "I don't know how much that costs, you'll have to talk to our financial department.")

Speaking of financial departments, I also wonder, if this was all being paid for by my insurance, as it was in the case of the author of the Elle article, would I have a more relaxed attitude? Because as it is, a big motivator for me to be my own advocate is the very real financial risk that my husband and I are agreeing to by undergoing an incredibly expensive treatment (IVF) that only has a 44% success rate (at our clinic, for my age group), and of course the multiple not-quite-as-expensive-but-still-more-expensive-than-an -iPad procedures that we underwent that only had 10-20% chances of success (IUI).

So did her insurance coverage have some influence on her relative ignorance?

I guess it's just hard for me to understand how someone could enter into IF treatments so carelessly. But, at the same time, it only took her one IUI to get pregnant, so it's not like she ever got to the point where she felt she needed to step up and take matters into her own hands.

But here's where I end up: whether the patient is informed and aware of the risks or not, IF treatments increase the rate of multiples. And as such, there are many many women who are finding themselves in the same situation as the author of this article, having to make a heartbreaking decision (though more likely they are pregnant with 3 or more, not just with twins). And until the precision of IF treatments is improved, or the underlying causes of IF are treated rather than just "worked around," women will continue to be faced with the decision to reduce, after working so hard to get pregnant in the first place.