March 30, 2017

Checking up to see if patients are telling the truth

I had to be a little bit sneaky today.

In the past week, three couples returned for a second baby. These three had similar stories in that all of them conceived with IVF within the past few years and were now back for another baby using their frozen embryos.  Two of these couples came back for their re-consultation as a family (husband + wife + baby/babies). One of the big perks of this job is the opportunity to actually see, hear and touch (sometimes even smell, ugh) the babies we helped conceive and to learn that they are happy and healthy and that the parents are glad they did the treatment. I have yet to encounter a couple who tell me “You know? It’s really a lot of hard work to raise a baby. I don’t know what we were thinking and now we wish we hadn’t done it.” Perhaps there ARE couples out there who feel that way, but they just are so mad at me for getting them pregnant that they don’t wish to ever speak to me again. Who knows?

Anyway, two of these couples came back all together with a whole family, but the third one came back as wife and baby alone. She said that her husband was too busy at work to make it. This created a problem for me – not a medical problem but more of a legal one. Hypothetically, how was I to know 100% for sure that this couple was still married since the time of the original IVF? How was I to know for sure that this was not a case of an ex-wife wanting to get pregnant again WITHOUT the blessings of the ex-husband? How was I to know that a disgruntled estranged husband, who is now on the hook for child support payments for a child that he did not wish to have conceived, won’t get mad at me for helping this to happen? Sure the scenario sounds far-fetched, but there have been lawsuits reported in just such a case.

I have to confess I may not have been as diligent about this ten years ago, but over the years, especially with this recent octuplets case, it has come to our attention that we, as RE’s can stand to be a little more aware of the overall picture of future social implications, rather than just be embryo-placement technicians. Even though there are consent forms required for the FET, which require signatures from both partners, it’s fairly easy to fake a signature. We don’t require notarization on our consent forms.

So I picked up the phone and played detective. I called her husband on the pretext of just saying hi. Then I subtly said, “Hi ‘John’, this is Dr. Lee. How are you? I just met with ‘Jane’ and we discussed the upcoming embryo transfer. I was wondering if you had any questions for me.”
He acknowledged that he had no questions. I then asked him if he was in agreement with our future strategy on how many embryos to transfer. He replied that he would not mind twins this time, but was really hoping for just one. We then exchanged a few friendly words regarding basketball and then ended our conversation. It took all of three minutes, but I was then able to document in the chart that I spoke with the husband and I am assured that he is on board with our upcoming baby-making project. Notice I didn’t overtly call him and say, “Hey John. I see your signature on the consent form here in front of me, but I need to hear from you explicitly that you are aware and in favor of Jane doing a frozen embryo cycle. You ARE, aren’t you?”

That would just sound too untrusting of me.

  • http://www.mloknitting.com MLO

    Not that it was relevant for DH and I, but all of our clinics required us to determine who owned the embryos created prior to starting a cycle. I was under the impression that this was done in most cases.

    I realize that REs are feeling jumpy, but I think your behavior was a bit, well, paranoid. Most men don’t necessarily want to be at every consult. But, I can understand the feeling in the current environment.

  • IVF-MD

    Haha. Well, I AM obligated to confirm that both partners are on board for the upcoming cycle. Since the wife is the one carrying the babies, she is definitely on board. Many other programs require a notarized signature. I chose the option that was easier for the patient. I either have to call the husband to convince myself that he is aware OR get his consent form notarized. I figure it’s less inconvenient (and a little more reassuring) for me to call him and chat for 3 min than to force them to go find a notary which would take them at least 20 minutes of their time. To take the paranoia further, somebody wrote me just now and (jokingly) asked me how I knew that I really spoke with the husband and not somebody with a male voice masquerading as such. That’s why I talked to him about basketball and something specific about the Lakers that we had discussed during their previous cycle. Due diligence only goes so far. You could argue that for the couples in which the husband came to see me in person, how do I know that the man who came in with them was not somebody disguised as their husband? Arrgh. 🙂

  • Robin

    THANK YOU THANK YOU Dr. Lee.

    This isn’t about you being suspicious and making sure because of the adults involved, this is about (at least from my prospective)protecting the child that is brought in to the world with any RE’s help. You wrote above of some lawsuits that have occurred over this. OK fine, adults can sue, they can bicker, she took me for a ride with my sperm, now there’s this kid I didn’t have any say in bringing to earth but what about the child? Should any child be brought into the world through deceit and grow up knowing that? Someone has to stop concentrating on the rights of all child-bearing aged adults having the right to conceive willy-nilly. No I’m not saying sterilization or anything of the such nothing at ALL like that. But when one gets involved in the actual process and facilitates a child being brought forth I think it is absolutely incumbent on them to make sure this child is wanted by both parents, it’s simply a moral issue, legality or not. As states are reacting with trying to bring forth legislation on this (Georgia and California just recently) I am beyond relieved in my heart to know that you and other RE’s care enough about the outcome of their work, the life of a CHILD, to act in a LOVING and responsible manner towards preventing a possible tragedy.

    Nice basketball touch 🙂 Just think, as soon as the child is old enough, he or she can throw hoops with a father who wanted him.

  • IVF-MD

    Thanks, Robin. We are on the same wavelength. I would love nothing more that to be reassured that every child grows up in a fantastic home with loving “normal” parents, but on the other hand, I have to avoid being too judgmental either. Doctors are in a position where they can be overly paternalistic in some cases. I will also agree that the burden of responsibility for protecting children is greater when we RE’s are involved and actively increasing the chances of pregnancy. But as an aside, I wouldn’t mind policies for people who get pregnant NATURALLY to have accountability before being allowed to get free money. I have volunteered in orphanages in Mexico and I have to say, growing up in the loving environment there is way better than growing up with a meth-addicted welfare mom. Perhaps we can devise a compromise where moms who bear kids they can’t care for be given a chance for regular visits, while the children grow up in a stable loving environment or a safely-run orphanage. Meanwhile, the moms could demonstrate motivation to get educated and work. The main problem is who would we get to design, run and supervise these orphanages. In Mexico, those were efficient Christian organizations, where the couple running it did it truly out of love and not for the sake of getting a fat government check per child.