Department of Pediatric Critical Care, Children's Hospital of New York, Presbyterian-Columbia University, Member-at-Large, AMA-RFS; Julie Talbott, Director, AMA Department of Resident and Fellow Services
Kristin Ognibene, MD,
The following case affects so many people, and yet so few of us take the time to understand the difficulties many couples face while trying to have children and how this can affect not only our patients' mental health but their physical health as well. You may say, "I'm not an OB/GYN physician so it doesn't matter to my patients," but you would be terribly wrong. We hope that the following account will make us all better able to serve some of our patients.
"It started simply enough. After a few years of marriage, it seemed just the right time to start our family. The first year was uneventful and no matter how hard we tried, the pregnancy tests were negative month after month. We decided to see a fertility specialist, thinking that a simple pill would do the trick.
We underwent a series of intrusive, painful, and embarrassing tests only to find out that there was no apparent reason to explain our difficulties. So we started clomiphene with intrauterine insemination (IUI). This was the first blow to what should be the simplicity of making a child. We were now dependent on medication, doctors, and catheters—not the way we always dreamed of having a baby. As if that wasn't bad enough, after 6 months I was still not pregnant and I was getting very antsy, to put it lightly. After some discussion with our doctor and lots of time spent on the Internet doing research, we decided to proceed with in vitro fertilization (IVF).
So we threw ourselves into what would prove to be a very long, painful, and expensive process. After taking shots of leuprolide for 3 weeks to down-regulate, we started the ‘real'injections. The regimen consisted of 2 to 3 painful shots per day and almost daily trips to the doctor's office to monitor follicle development. I did not respond well to the medicines and we retrieved only 4 eggs. Three days later, we arrived at the doctor's office for the embryo transfer—hopeful and excited. We waited for 45 minutes before anyone had the decency to come out and tell us the horrible news—that our embryos had failed to develop and that there would be no transfer. We were devastated, and I think I cried for a week straight. The outer limits of technology didn't seem to be able to help us.
It was at this time that we decided to change doctors. Not that our doctors weren't great people, but the practice was too big, with too many patients. We always felt like cattle being herded rather than individual patients with individual needs. And so we moved on.
Our new doctors agreed that IVF was the way to go and we planned to start in April, when my schedule would allow. Very few people realize the toll this process takes on one's life. We have not been able to plan vacations or holidays and have had to make many excuses as to why I was late to work. I've had more ‘flat tires' than I think is possible for one person to have in a lifetime, let alone in a year.
We were excited for our next cycle and went in on day 3 for blood work, only to discover that my progesterone level was high and we would not be allowed to start. This meant that we would have to wait 3 more months before my schedule would allow us to try again. So began 3 more months of anxiety and pain, and yet another ruined holiday. There would be no celebrating Easter for us this year.
And so we started again in June, and that cycle failed. Then we started another cycle in August and another one in October. And then we endured another change of doctors and another cycle in December, and a home equity loan to pay the mounting bills. And I was still not pregnant. This has been the worst 2 years imaginable. They are years during which I have lost myself completely and barely function as a person. I struggle just to get out of bed everyday, let alone lead a productive life.
We have become big advocates for infertility coverage. Insurance companies and doctors must realize how devastating this condition is, and that infertility is a disease that will make you just as ‘sick'as many other conditions. We are now $80,000 in debt, but we're lucky that we can ultimately afford it. Many can't afford it, and as a result will never have the family they so desperately want and need."
What are you interested in advocating for? You can make a difference by getting involved and joining us in Washington, DC, on Monday, March 14, 2005, for our annual Lobby Day. It is a great chance to change the future of our profession. We urge all of you to come. Together we are stronger.
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