Saturday, 19 January 2008

Fourth appointment - at which more questions are asked than answered

We got up early this morning, and reluctantly drove the 25 miles to the Great Big Fertility Clinic for our appointment with Dr Abrupt.

Afterwards, we conducted a lengthy postmortem over lunch. Was I being unnecessarily pushy and demanding, I asked Mr H. 'No,' he replied, 'but Dr Abrupt did a pretty good job of making you feel that you were.'

Mr H has up to this point been a major apologist for Dr Abrupt. Dr Abrupt has, Mr H has consistently pointed out, an excellent reputation. He runs one of the largest and most successful IVF units in the UK outside London. For those who set store by such things, he was last year listed as one of the seven best fertility experts in the country by Tatler magazine. More importantly, Mr H recognises in Dr Abrupt a fellow man of science. Like Dr Abrupt, Mr H does not deal in what ifs or maybes; he prefers cold, hard statistics.

But today, Mr H came away from our appointment feeling as non plussed as I did.

The dildo cam revealed that three of the follicles on my right ovary had grown to 19mm, 14mm and 13mm respectively. The remaining two follicles hadn't grown beyond the 10mm stage. 'We have seen this sort of thing before,' Dr Abrupt blithely commented. 'Some couples like to go ahead with egg retrieval, but others prefer to cancel and start treatment again in a few months. What would you like to do?' 'What would you recommend we do?' I asked. He did look pretty shocked to have been asked such a direct question, but eventually conceded that it would probably be best to cancel, given that I only had one fully mature follicle. At this point, I raised the possibility of an IUI. He went along with the suggestion, but does feel that the chances of success are pretty slim given Mr H's swim up analysis. Dr Abrupt would, we decided over lunch, have made an excellent politician, given his seeming inability to respond to any question directly, but instead to quote statistics or to else draw graphs on the back of patients' charts.

'Can you give me some reason as to why this might have happened?' I persisted. 'Is a poor response always indicative of a diminished ovarian reserve?' He replied that a first cycle of IVF was as much a test as a treatment, that they had gained some important information about our fertility levels as a couple, that they had put me on a standard protocol based on my Day 3 FSH levels, that they could safely increase the dose of the stimulant drugs next time, and that they had many different protocols they could use. At this point, I saw my chance and asked him whether those different protocols included a shorter, 'flare' one.

By this stage, it was becoming apparent that I was beginning to get on his nerves. Dr Abrupt, I think, looks at his patients and sees only a set of reproductive organs which will or will not do what they are supposed to. He does not realise that those organs are housed in an individual, an individual who has endured years of heartache before she winds up in his clinic and who will, in all likelihood, have spent some of that time finding out as much as she possibly can about her own condition. He retorted that he had a waiting room full of other couples and so was not willing at this stage to get into discussions about my next cycle, that we would have to wait a couple of months at least before resuming treatment, and that he would explain the short protocol to me nearer the time.

My many questions will evidently have to wait until Dr Abrupt is ready to answer them. But I am not going to be intimidated: I will store them up, and keep asking until I get a satisfactory response. You've all been so helpful with your comments and suggestions, and I'm reassured to learn that several of you have bounced back from a similar situation. Based on some of your comnments, I'm quite reluctant simply to go with an increased dose of Menopur next time round, and will be pushing for a different stimulant.

In the meantime, however, we are going ahead with an IUI - I will do the trigger shot at 10pm this evening, and then we will return to the clinic on Monday morning.


Hekateris said...

Wow, sounds like every doctor I saw at the Aberdeen Infertility Clinic. Only had 4 visits, saw a different doc every time...doesn't exactly inspire confidence, does it?

You've had a day 21 test too, right? I only ask because the testing standards in the UK have not been, in my experience, exactly...thorough.

Good luck with the IUI.

luna said...

first, best of luck with the iui. i think it's worth a shot, so to speak. hey, it can't hurt.

more importantly, I don't like dr. abrupt. I can see how he earned his name. maybe you can make the next appt. with dr. approachable? I know it's hard to question the authority of drs., they think they know best of course. but we know our bodies even better than them...


Lisa Rullsenberg said...

It sounds like I have a sucky attitude to science (which I hope I don't) but in my experience scientists are all too often about the quantifiable action/reaction and individuals/feelings are too damn qualitative for their liking.

Stick with it, and with your determination to ask the necessary questions. It also seems that the rather beligerantly quantitative Dr Abrupt has over-stepped the boundaries of being 'one of the best in the field' to such an extent that Mr H no longer feels compelled to defend Dr Abrupt's science. If science is to work well for human beings, it surely has to acknowledge the emotions and responses that physical intrusion and processes inevitably stir. Dr Approachable can manage this: the least you can expect from anyone else is an ability to justify and explain/ respond to questions. Peer-reviewed research demands an ability to deal with such questions surely...?

Good luck with what happens next.

Meghan said...

Glad you're being such a good advocate for yourself.

Does Dr Abrupt email? I found it much easier to communicate with my RE that way. He always answered my questions within a day. And I could take what he gave me, search like crazy, and then throw some more questions back at him. It's not quite as good as face to face time, but it is better than getting rude treatment like that when you're sitting there half naked!

Good luck with the IUI!

Alexandra said...

I am a newcomer who found my way here from Thalia's blog. I am no help on the UK system or its doctors (beyond generally empathy at the frustrations involved in being an infertility patient), but I am a fellow poor responder who did eventually get pregnant (and become a mom) through a flare protocol.

I haven't read your earlier comments, but I can certainly walk you through the logic of the flare if you'd like.

(The question of which brand of stims you use is, in my untrained but well-read judgment, a much less important question than the protocol. I can elaborate on that too if you want).

Of course I hope this will all be unneeded because the IUI worked. Good luck to you.

Malloryn said...

Dealing with Dr. Abrupt must be extremely difficult. I've met doctors like that -- they might be brilliant but their bedside manner is terrible. Be brave and ask him all of those questions. He has to accept that he's dealing with individuals, and that while some people might blindly go along with whatever he says, others will want more information. There's nothing wrong with wanting to know more.

Best of luck with the IUI!