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Saturday, April 16, 2011

Signing the IVF Paperwork, Overwhelming Much?

Cue the ominous music. Yes, my husband and I did this last year and yes, we filled out the exact same paperwork. However, I think last year we were all caught up in the hurricane of it all to really read the words to some of what we were signing. The same day we signed the paper work we were there to give our blood for testing and that clouded our thoughts. We both hate giving blood and needles. The thought now makes me queasy (or that could be the left over stomach flu). Whatever it was that day that didn't make us realize just what we were signing couldn't have been that serious for us to just blow through the paperwork like it was just a formality and didn't mean much. We just wanted kids. Where do we sign and how fast can we do it?

This time they mailed it to our house for us to bring in when we have our blood work done next Friday. So we got the chance to sit down together in the privacy of our own home, just the two of us to "sign away". Of course the doctor went over everything in detail last year, but you know how that goes. Blah, blah, blah, sign here and here. Initial here. In the meantime, our heads were just spinning with blood work and babies. So I don't blame the doctor at all, I just find it odd we blew right through it all. Because when you actually stop to read it, it's quite morbid at times. Let me explain.

There are a total of three packets of information to read through and sign. The first one is solely for me because it goes into detail about all the risks I am putting myself through. The treatment of using follicle stimulating hormones to increase the number of mature eggs for ovulation is called "Superovulation Therapy". So the packet we first had to read through was the Consent for Superovulation Therapy. It lists all the side effects of the shots and we just had to laugh as we read them. Nausea, vomiting, fatigue, flu-like symptoms such as fever, chills, muscle aches, joint pains, headaches, abdominal bloating associated with pelvic discomfort, and last but certainly not least MOOD SWINGS. They go on to say that additional side effects can be hot flashes and RARELY short term memory loss. Now all of those go away after you're done with the shots usually, but that's a bad two weeks if you know what I mean. My husband and I continued to laugh because I think I had just about all of those and then the following risks as well.  Ovarian Hyperstimulation Syndrome or OHSS can include the formation of cysts (which can rupture if you're not careful) and fluid shifts in your body. Yep, had those too. Now we're hoping for the next risk: MULTIPLE PREGNANCY. Now don't get me wrong. We don't want six or eight, but two. Two would be nice. We just saw a story this morning on the news interviewing a couple who were in the under 1% of pregnancies that turn into identical twins. Only they had two sets of them at the same time! This lady had two identical boys and two identical girls all in one belly. This came from only two implanted embryos via IVF. So, yes, multiple pregnancy is a risk, whether it's from multiple embryos being implanted or those multiple embryos then dividing after implantation.  It goes on to list ovarian cancer as the last risk, but explains the data doesn't confirm this. There are shortcomings in the studies that suggest this so really I wasn't worried about that one at all. Personally, again, where do I sign to try to have a child? That packet was easy enough. I've already been there and done that. I know what's coming.

The next packet was the consent for IVF retrieval and embryo transfer. Obviously both of us read through and signed on the dotted line. Yep, this is what we want. Another shot at our family. It goes into detail describing IVF and the risks of overstimulating the ovaries. Again, yes we know, bloating, blood clots in an artery, flu-like symptoms, allergic reactions, and ovarian cancer. Some of you may have read blood clots and gotten spooked. From the time you start your shots, you are put on a low-dose aspirin to prevent that so again, that didn't bother us at all.  It goes on to explain egg retrieval and its risks. This is the outpatient procedure done under sedation where they puncture each of your follicles to aspirate the eggs from them. Yes, when you wake up, it feels like you were stabbed a bunch of times on the inside with a needle. The procedure takes about 15-30 minutes. I laugh when it says there may be some discomfort because that's not what I experienced. However, that's different for everyone. Some women who have been through the HSG test know more pain I understand. So if you've already been through that, you probably have nothing to worry about! After they tell you how the procedure works they also mention that there could be a failure of that attempt. Some women don't have eggs in their follicles or the eggs weren't mature enough to go through the process of fertilization. That would suck! I was fortunate last time and they were able to retrieve 15 eggs! I hope for the same or more! Let me explain why. With that 15, only 9 fertilized and out of that 9 only 3 were viable enough to transfer. We didn't even have any left over to freeze and save for a later attempt. Usually that's the goal. So, yes, I would like more of them to either be good enough or for them to get more eggs next time!

The rest of the packet goes on to explain the risks involved with progesterone shots you then have to do after the retrieval to create an optimal environment for transfer. More bloating and mood changes, great! The embryo transfer is essentially the same as IUI in that it's done the same way, I think you just feel that much more pressure not to move watching the whole production. The doctors want you to have a full bladder, as if you weren't already uncomfortable enough, so they have a straight shot for those embryos to get to your uterus. More risks of the IVF: it might not work and again, multiple births. You also sign up for which ways of assisting you are going to do with the IVF. We check the boxes for both ICSI and Assisted Hatching because apparently, we need all the help we can get! With IVF, if you achieve pregnancy, there are risks of miscarriage, genetic defects, birth defects or stillbirths. There is some evidence that IVF increases these risks but most studies don't support this. At the end they touch on the psychological risks (ha!), release of liability and financial responsibility. Yeah, yeah, where do we sign again?  All of that may seem overwhelming, and it is at first, but you really have to focus on the positive at that point. It is not likely that you will get all of the side effects, I just happen to be that lucky! No, really, the doctors keep a close eye on you and monitor your every step of the way to prevent a lot of that from happening. Just remember this: you are giving yourselves another shot at having a baby! YAY!

The last packet is what really made us think. You have the option to discard your unused embryos or cryopreserve them. Of course we want to freeze any in the hopes of a future attempt. Well now you have to stop and think about your death, or your husband's death, or both.  And of course you have to think about dollar signs. It costs money to freeze those embryos and keep them frozen year to year, with an initial fee no doubt. Well, we're in it for IVF, we might as well keep going with the spending if it will all lead to a success someday. So they ask you to initial after each question. What happens if one of you dies? What happens if both of you die? What happens if you get divorced? Are you leaving your embryos to someone in a will? (Never thought about that one and still haven't!) What happens if one or both of you no longer wish to store the embryos? What if you cannot be contacted by the program? What happens if the program is terminated and no longer continues? Never knew we had to think about all that, we just want a baby. Crazy!

That all makes you stop and think a little. But in the end, you realize it's all toward the same goal, hope and dream of being a family and having a child together. So the ominous music can fade away and reveal something happier...lullabies, perhaps?

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