extorting treats from the adults who stayed behind to dole out the candy. In particular I enjoy carving pumpkins and each year my kids seem to pick the hardest designs to test my ability. It takes a steady hand and a great deal of patience to carve those overgrown squashes into a jack-o-lantern.Here are examples of this year's crop of designs with a Disney theme. I thought that Snow White came out pretty well....if I do say so myself.
So what does this discourse have to do with infertility? Honestly, absolutely nothing...but since I spent an entire afternoon scooping out pumpkin guts and carving little wedges out of my pumpkins, I thought somebody should see them besides the neighbors who were fixated on the Sour Patch Kids anyway.
But since we are on the topic of Halloween I wanted to address some fears that patients can have that do not involve Jason or Freddy or Dracula....I think that Dr. Gabe San Ramon covered some of these very nicely at the ASRM meeting.
Fear #1: Patients can be afraid that they need IVF.
Some patients look at IVF as an indication that their case is so hopeless that IVF must be used as a first line treatment. I understand that concern and certainly sympathize with their view. However, IVF is not the only option from which to choose and many patients find Natural Cycle IVF an option that is a bit less intimidating than traditional IVF. Some patients just want to try IUI or IUI and clomid or even just do diagnostic testing only. Walking into the office does not lead to getting hopped up on fertility drugs in a few days!
Fear #2: Patients can fear that they will never have children.
Clearly there are all different paths to parenthood. Some couples are more accepting of alternative pathways (such as adoption, donor egg, donor embryo or gestational carrier IVF) than others, but many will circle back to these options if success eludes them. In addition, unless a couple is truly sterile, spontaneous pregnancies can and do happen...you just can't predict it.
Fear #3: Patients are afraid of twins and triplets.
No argument from me on this front. Although I understand the attraction of twins for some ("buy one baby, get one free"), in truth twins are high-risk and can result in a huge cost to the couple, the babies and to society. If I never end up with another set of twins I would be ecstatic but the reality is that sometimes you just can't predict the outcome. If there are 2 follicles for a clomiphene/IUI then there can be twins....although rarely!
Fear #4: Patients are afraid of fertility drugs.
Although Oprah may believe that fertility drugs cause cancer, medical professionals do not believe that the data supports her view. The reality is that birth control pills, tubal ligations and previous full term pregnancies reduce the incidence of ovarian cancer. Since most fertility patients do not have many of these risk reducing factors, their risk of ovarian cancer is increased compared with the fertile population. However, the real question is whether fertility drugs increase the risk of ovarian cancer over baseline in fertility patients. The answer is no.
Fear #5: Patients are afraid that no one cares about them.
I come to work everyday to a clinic with some outstanding nurses and other clinical staff that care a great deal about each and every patient. I imagine that most other fertility physicians feel the same way about their staff. Patients ultimately vote with their feet. Here in Washington DC there are many options so patients can choose a doctor/clinic/staff that meets their needs. We all work hard to earn the trust of our patients and give the best advice that we can because we know how tough this journey can be on everyone.
Back to familiar topics next post!
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