Tuesday, December 18, 2007

Bullets 2 & 3

Today I'll address bullets 2 and 3 from our discussion with Dr. M., contrasting his opinion with that of Dr. S. - it's sort of like a boxing match between two heavyweight fighters ... if they had a physical fight, my money's on S. (he's younger, and appears to be more agile ... and Dr. M's weak handshake may be correlated to a lack of overall physical strength)

Post Coital Test

Next bullet on the list of concerns from our discussion with Dr. M. is Post Coital testing. According to my shallow understanding, this procedure assesses my wife's cervical mucus to determine if it offers a hospitable medium for the migration of my sperm to her egg. Sometimes the cervical mucus kills the sperm, making it impossible for them to reach the egg alive, thereby mitigating the chances of pregnancy. This is a test we bypassed during our first round of IVF with Dr. S. If our first round had worked, we would have been none the wiser for bypassing this test. Given that IVF didn't work, however, we now have to retrace our footsteps picking up the missing piece of information we skipped the first time.

The test requires us to have intercourse (yes!), my wife to lay down for one hour (which will be hard because she will probably have to pee), and for her to go into the office the following morning. They will pull a sample of mucus from her cervix and observe it under a microscope to see if there are living, swimming sperm in it. If there are, this is a good sign and indicates there are no issues with her cervical mucus. If there are dead sperm, then we have a problem - I'm not sure what steps are required to get around it, but I would guess they are pretty straight forward.

No Pill In Following Month

This one really burns us up. In a previous post, I cited some comments from the OBGYN Doctor my mother-in-law works for on the topic of achieving pregnancy in the month following IVF. Dr. M. echoed these sentiments exactly in yesterday's meeting when he said that he has data showing an increased likelihood of pregnancy for infertile couples in the 3 months following IVF! Given that Dr. S. placed my wife on birth control immediately after our failed cycle, we completely missed the chance to cash in on this statistical opportunity! We could get into some discussion of incentives of infertility doctors and how they are somewhat misaligned with the goals of their patients, but I'll assume that these doctors operate ethically. Dr. M. recommended that my wife cease consumption of the birth control pill and that we get busy "trying" as our window of opportunity is not completely exhausted (although 2 of 3 months are gone) Again, Dr. S. and Dr. M. offer completely opposing assessments on this aspect of infertility!

So, there you have bullets 2 & 3 - the 4th and final bullet will be revealed tomorrow (it's nothing big, so don't expect a major revelation ...)

6 comments:

Tracy said...

Interesting...

I don't quite understand why you need to do the post coital if you're doing another round of IVF, though? We bypassed that test (by choice) because we'd moved on to IUIs and IVF...didn't feel it was pertinent.

Joe said...

You know, I'm not sure what we're doing anymore! We went into this meeting with Magyar fully expecting to discuss our second round of IVF. Now it feels as if we're rewinding to the beginning, approaching the whole thing from scratch ... I'm willing to bet we'll end up doing IVF again at the end of this, but hopefully the data collected between here and there will give the Doctors more guidance in how to conduct the procedure, meds, etc.

I'm totally confused, but am okay with it! I'm more comfortable taking a slow, deliberate pace through this process ... the incremental expense we will incur as a result of the extra testing will provide incremental comfort to my wife and I. When we get to the point of having to put down REAL money on ICSI or IUI, we intend to seek a third opinion utilizing all of the data collected at that point. Maybe it's overkill, but I'm taking matters into my own hands as much as I can ...

Hekateris said...

I don't get the post coital, either. If you were going to do IUI, sure, but with IVF, what's the point?

Tracy said...

As long as it provides you with a level of comfort, then it's worth it. Have you received any diagnosis at this point? Do they think they know what is causing your IF?

Joe said...

We should have done post coital testing before doing our first round of IVF, because if I understand this whole thing correctly, post coital testing is one of the tests that help a doctor to assess whether or not IVF is even required. Based on his recommendation to conduct post coital testing, I can only deduce that Dr. Magyar may have reason to suspect Dr. Shamma's diagnosis (keep in mind he is using the same information that was available to Dr. Shamma ... clearly the two Doctors don't see eye to eye on the conclusions that can be drawn from this data) So, Dr. Magyar seems to be dismissing Dr. Shamma's conclusions, and is exploring our condition via his own approach. Where Dr. Shamma said "You need to do IVF ICSI to achieve a pregnancy." Dr. Magyar is saying "Based on the data I have at this point, there is no reason to suspect you can't achieve a pregnancy through normal means. I would like to pursue further testing to determine what is causing your difficulties." - those are two completely different conclusions drawn from the exact same set of data. In such an instance, I will side with the more conservative approach ...

As I said in my last comment, I suspect we will end up at the same place (IVF), but this time, we will have a higher degree of certainty about the diagnosis, and about the chances of success if we do proceed with IVF. I don't think couples should approach a Doctor to say "We want to do IVF" - rather, the couples should approach the Doctor saying "Please help us get pregnant" - Having only met with him once, I have a good feeling about Dr. Magyar's intentions to help us achieve a pregnancy without passing go, and proceeding directly to IVF.

kellg said...

Joe:

There's a lot of skepticism of the post-coital test, in fact, it seems to be done less and less (it's very subjective and open to lots of human error by the person in the lab). So, I wouldn't be too shocked that it was not ordered the first time around (I asked about it before we proceeded to IVF and was told it was unnecessary -- that more information was available from the HSG results). In our experience, if morphology is the issue (as it was with my dh), then IVF with ICSI is really the only option. IUI's cannot overcome that male factor problem. Sorry. But maybe this new doctor can help you find out why #1 didn't work. Good luck!

Oh, and thanks so much for writing from the male perspective. This whole issue is so difficult for most men to deal with, let alone discuss with someone besides their spouse. I wish I could get my dh to read your blog!