Sunday, July 15, 2007

Oh, I forgot

I did manage to get to see Dr Alterna-tweed. Although he wasn't actually wearing a tweed waistcoat at the time, which disappointed me.

The consultation was fairly similar to May's, with some helpful parts and some not so helpful. It was pricey, but the Americans renting our flat were paying, and it was the very first private medical consultation we've done in this whole thing, so that's not too bad. He's going to check my blood levels of various micronutrients, which makes sense, as I do know that the theory behind some people having babies with spina bifida despite adequate folate intake is that they don't absorb it. So it would be good to know if all this folate I'm taking is going to the right place. He couldn't find much wrong with me using his twiddly homeopathy machine, although he kept trying to make me admit I had had lots of ear infections as a child - actually it was lots of throat infections but he wasn't having any of that. And he suggested that, er, perhaps eating lots of sugar wasn't such a good idea when I've had borderline high blood sugar.

No, really, those aren't muffins cooling in the kitchen. Honest. Well, OK, perhaps they are, but I climbed a hill today from which you can see Blackpool Tower and there were hundreds of blueberry bushes at the bottom and I had to pick enough for muffins, OK?

But he did irritate me in his assessment of my fertility chances. Of course it is due to my age - well, I'm not arguing with him there, though I would interpret it as a chance effect which all women have some chance of but older women have a greater chance of. However he somewhat bizarrely seemed to think that we were "very fertile" given my age - I count about 6 months per pregnancy, which is the average for all women, and slightly more frequent than the average for my age, but it is very hard to tell if statistics are applicable to 40 year olds who have only been married for 3 years, and not living together for years before that, and hence perhaps a little more, er, active than some other 40-year-olds.

But what really irritated me is that he suggested that IVF might reduce our chance of a miscarriage. There is absolutely no evidence that this might be the case, not a jot - he seemed convinced that "picking the embryos with the best morphology" would reduce the risk of miscarriage. He also thinks that big studies have "too many variables" so even if they show that IVF doesn't reduce the risk, then it might at some clinics. Problem is, if on average over a large number of
women - especially if they are at a variety of clinics - there is no reduction in miscarriage (I think even possibly a rise) then if for some women the risk reduces, for others it must increase, and I don't know which side I'd be on.

Incidentally I have read the NEJM PGS article, and although I'm not convinced that it actually shows that PGS makes the outcome worse, it really doesn't improve chances in the case of advanced maternal age. Other bloggers, and commenters, have said that the study was flawed because they "only" checked 4-cell embryos. Actually they only checked embryos that were at least 4 cells, and although I don't know much about embryology, it sounds like they were trying to do a study of "PGS as it is practiced in the real world" i.e. checking embryos that can be checked, i.e. that have reached at least a certain size. So, PGS as it is practiced in the real world is not helpful for achieving pregnancy if you are older, and it is not helpful for unexplained recurrent miscarriage. Once again - and I know none of you were thinking otherwise - there is no point in doing IVF for us.

One of the birthday couples had her own (38th) birthday this week so I rang for an update. They've had all their tests done and are just waiting for results in about 6 weeks. Unfortunately it looks like it might be male factor - her husband's brother is infertile, and incidentally (or perhaps not) his marriage broke up after I believe a matter of months or even weeks. She seems fine with the idea of IVF, and sure that her NHS trust will pay for it (I didn't like to say that I thought it somewhat likely they would try and put her on a waiting list till she was 40 - cynical, me?)

And lastly we got our foster care pack through, we think we are going to apply and hope to get a place on their training course quite soon, and when we have done that finally tell the adoption agency what we are doing. After decorating before we were away I've been re-tidying the "green room" (ex-study/sewing room, current single spare room/sewing room, possible future children's room) and it needs a "window treatment" - I found some batik purple/green giraffe fabric in my fabric mountain, it is very cute but not too childish, so that is going to be made into a blind. My niece (with my mad brother and my slightly less mad mother) is coming to stay next month, so I am billing this as her/her sister's room. If we do foster, there will be a lot of things that we need to buy, but I am oddly excited about possibly needing to buy a waterproof undersheet for this visit.

Yes, I know. Very few people could actually say that.


Thalia said...

The perils of being well informed is that you tend to either upset the docs or at least wind them up because you know the back story. Your interpretation of the data sounds spot on to me - until they've got the technology much improved on PGD, and a better understanding of the level of mosaicism in embryos etc., it's unclear it helps anyone much - except perhaps those with clear issues like translocations (although that's not clear cut either).

Glad to hear things are moving forward, it must feel good to start to see a new use for that room.

Vivien said...

Ah - a waterproof undersheet! I am envious - the adoption thing has ground to a temporary halt with me!
Keep the receipts - you can reclaim expenses and they even give you an allowance for fostering, as I understand it!

littletadpole said...

Hmm, doesn't sound too promising. Let's hope the nutrient check throws up something conclusive.

Geohde said...

It's nice to see that you listen critically and evaluate the information presented to you in a consultation for yourself. My sister, bless her heart, takes it all as Gods Gospel because a medico said it, and they "must know". I "mustn't know" despite my (almost) qualification because I'm her sister. Argh. Drives me batshit when I try and gently tell her that healthcare is just like any other profession, look around and you'll find several flavours of opinion for the exact same problem. I know she's just recently been fed horse-apples and lapped it up because she's vulnerable. Urgh.

Anyway, as for the folate thing. The sad conclusion I came to after my experience with a NTD pregnancy, is that whilst *yes* some women have a metabolic problem with folate metabolism which can be tested for, unfortunately *no* there's nothing specific that can be done, should it be detected other than mega doses of folate. So I saw no point in getting the tests and just take the ridiculous amounts of folate. Sigh. The limits of modern medicine. I've just got to hope that the next baby (should there ever be one) is ok.

PS. thank you for dropping by my blog, I love to get comments!

May said...

*Makes face at Dr Alterna-tweed*

What's with the ear-ache/ sore-throat thing? It was your dang throat!

Anyway, I have no idea why he took it upon himself to give advice about IVF. I thought his job was to improve health and fertility generally, not get all technical about something that is NOT his speciality. I'm a little disappointed in him.

But I hope the rest of it was all useful.

I'm going back to see him next week, to ask him why the heck he was so convinced I had endo. I mean, we've looked now, with a camera and everything, and I didn't. Feeling a little... flattened, I suppose.

Good luck with the fostering thing. The giraffe fabric sounds wonderful.