Monday, September 18, 2006

Amazingly enough

... I accomplished both my big goals today. I got my blood test records from my HMO (to be faxed off to CPMC tomorrow), and also talked to the doctor who will be performing the reduction on the 25th. And his timing was perfect -- he called after I stepped out of the shower, but before I left to do battle with the HMO. Sometimes ya gets lucky.

Also luckily, the doc seems like a very nice guy, as well as very knowledgeable. A little chit-chat before we got down to business established that he is a fellow Texan (yeehaw!), so we'll just call him Dr. Tex. (Though I have a feeling that he hasn't actually spent that much time in Texas, since his accent was undetectable. But then, people tell me that I don't sound like I'm from there either, so who knows.)

Dr. Tex told me that there is about a 4 to 5 percent chance of miscarriage of the entire pregnancy when you do more than one reduction (odds similar to those of amniocentesis). Basically, whenever you start sticking needles in your belly, you're looking for trouble -- and in this case, hoping you don't find it. And yes, that is how the reduction will be accomplished -- a needle through my belly, and into the fetus, which is then injected with a chemical to stop the heart. (I don't like this. I'm just reporting it. If I don't have the guts to look all this in the face, then I have no business having started any of this. A man should be able to shoot his own dog, and a woman should be able that she is having an abortion at least partly as the result of her own lack of judgment.)

He said that they numb the skin where the needle goes in, but there will still be some discomfort, since the needle goes through muscles and that doesn't get numbed. It's not like I'm not used to needles, having gone through IVF twice, but I must admit that a needle in my belly will be a new experience. (However, there's a masochistic side of me that's telling me I deserve it. If not worse.)

Dr. Tex will perform a nuchal fold ultrasound before the procedure, looking for "soft signs" of chromosomal or other problems -- a thickened nuchal fold (a fold of fat at the back of the neck), the lack of a nasal bone (a sign of Down syndrome), lack of growth of the fetus, etc. I asked him if CVS was an option, and he said no. He told me that even with twins, they sometimes have problems with contamination of the samples, and with four, there are just too many placentas in there to be really sure of which one you're sampling. I mentioned to him that there had actually been six sacs to begin with -- the four fetuses plus the two empty sacs -- and he said then that absolutely, CVS was out of the question. Even though it is a much more reliable test in terms of getting specific genetic information, it is a lot harder to get hold of a reliable sample to do the test in the first place. (And since Dr. Tex also does countless CVS procedures every year, and has been doing all this for 15 years, I have decided to take his word for it. I have no reason to think that he would steer me away from CVS unless there was a good reason, since he does so many of those as well.)

I asked Dr. Tex if he did many quad reductions, and he said that he used to do a lot more (as well as quint reductions) but that with advances in IVF, you didn't find that situation so much anymore. He said that these days, it was mostly a reduction from triplets to twins. I also told him that we wanted to choose the fetuses to be left solely on the grounds of health, not as a means of sex selection. He said that was good, since gender is still a little hard to see at 12 weeks, and that way he wouldn't have to spend time trying to figure out which was what.

And then I asked Dr. Tex about my biggest fear with this procedure -- that we'll go through with it, and then later we'll discover that the two we left in have Down syndrome after all. He said that it wasn't absolutely impossible that that would happen, but he told me that in his 15 years of doing these procedures, it never has happened. So actually, I'm pretty content with that. I mean really, am I so special that our pregnancy will be the first he misidentifies? Well, I hope not, and logically I find it pretty unlikely. At least that's one fear that has been (mostly) crammed back into the closet.

I'll be on pretty strict bed rest for three days after the procedure on Monday, so don't expect an update on these pages until the following Friday. (He said that getting up for meals and to go to the potty are okay, but not to go anywhere, do meal prep, or anything else. I have to infer that sitting upright in front of the computer for the half hour or so I need to write these is probably out.) Although if I'm feeling well, I'll try to sit here for five minutes and just give a quick thumbs up or down. (Hopefully -- as is appropriate for The Hopeful Baby Blog -- it will be thumbs up.)

I'm so glad Dr. Tex got hold of me today. He seems very knowledgeable (and therefore, one would hope, also quite competent), he seems like a nice guy, he comes highly recommended, as does his clinic, and the scuttlebutt I found about him on the Internet was all positive. I feel better now about doing this procedure than I have throughout this whole planning stage. My general modus with doctors is to find a doc that I feel like I can really, really trust, and then just ... trust him. (Or her, of course.) I did that with Dr. Enterprise (I could bore you for hours with the research I did on her and her clinic -- I've even read the papers she published on the Internet, which I'll bet you a doughnut none of her other patients have), and that worked out well for us. (Not perfectly, obviously. But I am pregnant, at the doddering age of 44, with my own eggs and my husband's rather haphazard sperm.) So I am hopeful, baby, that this will work out equally well.


Blogger casey said...

No wonder you're so're a Texan! (And I mean that in the most positve way.) After all, you're absolutely right about being able to look yourself in the eye and go through with any of this. I am grateful to better understand what (technically) you'll be going through...and only wish you had a court stenographer in your room with you for the three days to take copious notes and transfer them to this blog. But, I'll be thinking of you no matter what and hoping for the BIG thumbs up.

12:09 PM  

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