Scene: midday Monday at the offices of The Fertility Institute at Posh Hospital; a slightly nervous couple waits to speak about IVF with a doctor they have never met
Doctor: Hi, nice to see you. (shakes hands) So, why hasn't this worked yet?
Andrea: That's what we'd like to know.
Doctor: Well, we can't tell. You're young. All your numbers look great. You've had a number of mature follicles every cycle. Your sperms counts are fine. But IUIs only give a 17-18% chance of pregnancy. IVF, for patients your age, has a 70% success rate. So I really want to push things. I want to increase your dosage and get as many eggs as we can.
Doctor: Then I'm going to say we do IVF with ICSI. (spelling it out and speaking slowly while writing on a chart) That's intra... cytoplasmic... sperm... injection...
Andrea: Yes, we know. We've actually done two IVF cycles with ICSI at a previous clinic. (thinking to herself, "It's all in that fat stack of patient records you're holding; have you glanced at those?")
Doctor: Oh. (glancing at papers) I see that.
Andrea: When we did IVF before, we only...
Doctor: (back to the chart he's writing out) So we're going to run a bunch of tests first, to make sure we don't miss anything and we have the best chance of making this work. We'll do a Clomid Challenge Test, to determine the best dose of medications for you. We'll do some bloodwork to check for antibodies that would fight against pregnancy, and for blood-clotting disorders. We'll do one test - and this one isn't covered by insurance - to check for enzymes in your endometrial lining that would support a pregnancy.
Andrea: Okay, all those tests sound fine. But you should know, we don't want to freeze or discard any embryos. We want to fertilize a small number of eggs and transfer all the viable embryos.
Doctor: Boy, kids. That really, I mean really lowers your success rates to almost nothing. I mean, I understand, I respect where you're coming from. But if you don't give me any out, I can only let you fertilize three eggs. What if they all fertilize? Three embryos is the most I'd be comfortable to transfer, and I can't take the risk of you having more than that.
Andrea: Well, when we talked about all this with Dr. Owlish, he told us that only one out of every five eggs has the genetic material to turn into a viable pregnancy. So he suggested we fertilize 6-8 eggs.
Doctor: Hmm, Dr. Owlish is usually more conservative than me. I can't let you do more than three. What if we end up with four embryos, and you have quadruplets? They'd probably have all sorts of disabilities. They wouldn't be able to take care of themselves, you wouldn't be able to train them. I would haunt you for the rest of your lives. Your lives would be a living hell.
Aaron & Andrea: ... Um, we know the concerns, but our history...
Doctor: I know my numbers. I can't do more than three.
Andrea: Look, we don't want high order multiples, either. But we fertilized four eggs at our previous clinic, and we only ended up with two embryos for a day 3 transfer for our first cycle, and one embryos that barely made it to blasocyst for a day 6 transfer for our second cycle. So doesn't that show...
Doctor: I know my numbers. We're better than your previous clinic. We have much higher pregnancy rates.
Aaron: But doesn't our track record have an influence?
Doctor: Every cycle is different. I know my numbers.
Andrea: So why, if we know fertilizing four of our eggs in the past did not result in four embryos to transfer, would it be different here?
Doctor: Better eggs. Better lab.
Andrea: Well, have you worked with patients who only fertilized three eggs before? What were the results?
Doctor: It runs the gamut. Some end up pregnant. Some don't make it to transfer. We don't have many patients who restrict us this way. I respect your position, but you have to respect that I know my numbers. I can't do more than three. You might be able to find another doctor in this area that would work with you, that would let you fertilize more eggs, but they don't have the success rates that I do. I'm sorry, kids; I know this isn't what you want to hear.
Andrea: (this is going nowhere; let's change the subject) So, we run all these tests during one cycle?
Doctor: Yes. (standing up to leave) So call on day one and we'll get you started.
Aaron & Andrea: Wait! Dr. Owlish also suggested donor embryos?
Doctor: Hmm, that's really rare. Nobody wants to do that.
Aaron & Andrea: more questions...
Doctor: more non-answers... Good luck! (exit)
So, how do you interpret the conversation? We were less than pleased. Whether he's right or wrong about the number of eggs we should fertilize (and I'm inclined to think he's wrong, because we know what happened with four eggs fertilized), he is not the kind of doctor I feel comfortable working with. Though this was the first time we met, he didn't do any introductions and he never addressed us by name. He didn't really listen to anything we said, and he seems far more concerned with his precious numbers than with the individual patients sitting in front of him. I'm trying, with mixed success, not to be angry at this doctor. I'm glad that my confidence is not in doctors but in God, who does hear me. Our plan, at this point, is to go ahead with all the tests (doesn't hurt to gather more information) while researching other doctors in the area and considering our next steps.
Oh, and I think the blog nickname for this particular medical professional will be Dr. Ego.