Case of the month May '08: Episode #7
Click here for episode #1
When patients come in for their pregnancy test and they look happy and excited, many times, it’s because they already did a home urine pregnancy test. That was our first guess when Cora arrived to get her pregnancy test drawn. However, when we asked, she denied testing. She just felt nauseous and her breasts were tender. My staff member cautioned her that we really need to wait for the results. Still smiling, she acknowledged this and told us to call her cell. This time, she said we could call her directly with the news, either way, positive or negative.
An hour later, we had a sad call to make. The results were negative. Cora took the news well, considering. Anthony and Cora scheduled to come in three days later to have a talk.
I summarized their situation. They have been infertile for close to three years. Their testing came back normal for sperm and normal for ovulation and abnormal for tubes. So while the tubes were open, the scarring and endometriosis were suspected to make proper egg pickup a difficult task. They have failed three IUI cycles with a total of about 14 mature follicles and still nothing has taken so far! When you are worried about triplets and end up with nothing, that’s a clue that it’s time to consider something different. When you have a lot of follicles on IUI’s and there’s no pregnancy, it could mean that the eggs are not getting picked up by the tubes (most likely in this case), it could mean that the sperm is not fertilizing the eggs or it could mean that bad embryos are being made. In any case, IVF would be the way to go. I told them so. I would do another IUI if they insisted, but I wouldn’t recommend it.
Anthony came right out and said "We can’t do IVF".
There are different reasons why patients choose not to do IVF. The most common one is financial. Not everybody has the financial resources to afford it. Another reason patients choose not to do IVF is because they don’t really understand what it is. Some people don’t want to do IVF because they feel they don’t need it. It turned out none of these were the reasons. Anthony and Cora had a clear understanding of the procedure, a clear understanding that they needed it and they were financially successful. They never said they didn’t want to do it. They said they COULDN’T do it. This was the clarification.
They had met with their parish priest, who had made it very clear that the Catholic church does not allow IVF. Anthony and his entire family had been very involved in the Catholic church for many generations. He had been an altar boy and was in training for the honored position of serving communion. In the short time that they had been in California, he had become very well known in their church, almost as much as his family had been back home near Chicago.
This was not the first time I’ve encountered this dilemma. Many Muslim patients and Catholic patients have asked about their faith’s view of doing In-Vitro. I referred them to speak with their priests or imams. Many chose not to speak with their religious leaders, but went forward with the IVF. I can think of at least 10 Catholic couples of mine who had babies through IVF. Protestant Christians don’t usually bring up any objections to IVF as long as fetal reduction is out of the question and as long as all frozen embryos will eventually be given a chance at implantation. I’ve had patients who were themselves pastors and pastor’s wives of Protestant Christian churches and they went forward with IVF without hesitation. I once heard another RE say that she tells her patients that God does not reject the concept of IVF babies even though the Pope does.
In any case, I approached this sensitive issue the way I usually do. I confirmed that they had spoken sufficiently with their religious leaders. There was one time when a Muslim couple spoke with their imam and then went ahead with the IVF, saying they were hesitatingly given the green light. But for Anthony and Cora, the answer was a clear no. There was zero chance that they would consider IVF. I sensed that Cora wanted to go forward with it, but Anthony was adamant. Once this was 100% established, I discussed all other options, including adopting. The other way would be to keep trying on their own, or to do some more IUI cycles. This couple had been seeing me outside of their insurance and it was costing them more to do their IUI cycles with me than if they would do it within their network. So one option to save money would be to do any future IUI cycles elsewhere. They were welcome to do more cycles with me if they chose to, but I expressed that it wouldn’t be the wisest use of their finances at this point.
Cora was tearful. She thanked me profusely for everything. They left my office, saying that they would pray for guidance. Although we gave them our prayers and best wishes, one of my staff members, who had particularly bonded with Cora, took it extra hard. I noticed that she would mention Cora from time to time, and it took her about three years before she stopped bringing up her name.
Click here for episode 8
