Still in the running...

The older I get, the more weary I become of the medical industry. Don't get me wrong, I continue to marvel at the technological advances that continue to be forged. I'm referring more to the general competence of the middle echelons; the general practioners and consultants that interface between the medical industry and the patient.

Today, Flo and I went to visit the gynaecologist at the hospital. We went knowing that his purpose was to inform us that they wanted to discontinue our fertility treatment. Quite frankly, we were not prepared to stop. Of course, we're not prepared to give up on our dream to give birth to our own child, but this is not what is driving this decision.

Those that know me are probably aware that I'm driven predominantly by logic. I do have emotions, but I'm shit at dealing with them... almost to the point of incompetence. In certain circumstances, my emotional incompetence can be very disabling. However, my logical mind can be very useful at times and dealing with obstinate doctors is such an occasion.

The doctor's decision to discontinue our treatment was based on a number of facts and made using their professional interpretation of these facts, with a big slice of subjectivity thrown in. Unfortunately, a number of the facts on which they had made this decision were simply wrong. Most significantly (and shockingly), the doctors were of the opinion that Flo had endometriosis. This is simply not true, since the operation that Flo had recently proved that she did not have endometriosis, but instead a corpus luteum cyst. I think the gynaecologist that we saw was as shocked to discover this (despite it being in our notes) as we were to discover that he thought this.

We had quite a heated discussion with the gynecologist. We tried to determine his driver to discontinue the treatment. His response was that they didn't think it was worth continuing. We asked him why he didn't think it was worth continuing, but his only response seemed to be that this was his professional opinion. We pressed harder... asking if the decision was driven by money, medical risk or statistics. He gave a lengthy argument about it not being driven by money. Fair enough. He said that there's no evidence to suggest that the treatment has medical risks, although pointed out that there's only 22 years of data (IVF started back in the late eighties) and so there's still uncertainty here. Agreed. Then came the statistics... what I meant with that was whether the chances of success were so low that they tended to zero. However, he interpreted it as meaning the hospital's success rates and the national IVF hospital rankings, which I thought was quite telling. He said that if statistics drove the decision that they'd turn away lots of couples. The answer was suitably vague and, despite being pressed several more times, he did not give a satisfactory explanation as to what drove the decision process. I'm left thinking that the hospital would rather treat people with a higher chance of success than us and that if there was a waiting list for ICSI treatment, we'd continually be bumped to the bottom of it.

Our driver is very simple. The chance of us conceiving normally is in the region of 0.01%. This means that it's improbable that we will naturally have our own child. With ICSI treatment, the chance of us having our own child is increased in the order of a thousand times. Therefore, the chance of conceiving increases from 0.01% to something in the region of 10%.

Ask a dying man if he wants to try a very affordable procedure that has limited side effects and a 10% chance of success of leading a normal healthy lifestyle and that if it didn't work the first time, then he could keep on trying until either it worked or he ran out of time. I bet I know what he'd say (assuming that he didn't want to die).

By the end of the consultation, I think the gynaecologist agreed that there was insufficient medical evidence to discontinue the treatment yet. He therefore scheduled to see us again in two months time in order carry out some more tests to see how Flo's body is performing. He agreed that the bodies performance peaks and troughs and that Flo's body may be operating in a trough at the moment (particularly in view of the surgery that Flo recently undertook and the temporary effects that this might be having on her fertility).

The consultation ended with him taking a quick look at Flo's reproductive organs with the ultrasound scanner. I think he was quite surprised with what he saw.

The reason Flo asked to be checked out is because she's been feeling some discomfort recently. It turns out that she has a large cyst on one of her ovaries. Her good ovary in fact (not the one that was operated on, but the one that has been producing the follicles during the recent ICSI treatments). However, what surprised him was that the other ovary, the one that has been dormant recently, was now showing three or four healthy looking follicles. He also commented that Flo's endometrium was looking perfect... nice and thick. If it wasn't for the cyst, then things looked good for another ICSI attempt in fact.

The implication from this is that, if the cyst goes away, Flo could well have another three or four follicles on the ovary that currently has the cyst. Therefore, on a good cycle, it would appear that Flo is capable of producing seven or eight good follicles, which means that the chances of successful fertilisation would be back to average (around 30%).

This would therefore lend weight to one of Flo's earlier comments... maybe they're not very good at stimulating rather than Flo not reacting well to stimulation.

We left the consultation feeling very frustrated; we shouldn't have to argue with the doctors to convince them to continue with fertilisation treatment. We're fast loosing confidence with the hospital, but we're kind of happy that, despite the gynaecologist having a negative outlook when he entered the consultation, he left seemingly optimistic (although I get the distinct impression that he doen't like us... how dare we question his professional medical opinion!). We're happy that we convinced him that there's still reason to remain optimistic about continuing the treatment... there's still hope!