In which I actually make an infertility-related post

In the course of commenting on this post, I feared I was starting to hijack Julie's comments thread and thought that maybe I should continue in my own space.

According to Reuters "medical groups representing U.S. fertility experts, alarmed by rising numbers of multiple births, on Tuesday advised limiting the number of embryos implanted in women undergoing in-vitro fertilization" (link also via Julie). The proposed guidelines for my age range would actually be less restrictive than what I'm dealing with in Switzerland, if I'm correct in assuming that "earlier-stage" embryos means two-day embryos; that is two- to four-celled embryos. (On a side note, fertility patients, especially US-based fertility patients, are the most specific people I know; these are women who can rattle off their E2, progesterone levels, lining thickness and number and size of follicles per ovarie in their sleep. What, exactly, is an "earlier-stage" and a "later-stage" embryo? Please, give us the number of days in the dish or number of cells.) In Switzerland we can transfer a maximum of two, and we do a day two transfer. The maximum of two is precisely toreduce the likelihood of multiples; and the two-day transfer is because at day two you can't really tell which embryos are going to stop dividing so at day two you have just as good a chance of tranferring a doomed embryo as a graced one and anything resembling embryo selection, even just waiting around to see if the embryo up and dies on its own, is strictly verboten. (But you can terminate later if you discover a genetic disorder, which strikes me as an ethically odd set of rules to co-exist, to say the least. No PGD* because we don't want you to be able to discard your genetcially damaged seven-celled embryo, but sure you can terminate at 18 weeks.)

You can see why I thought I might be hijacking the comment thread, considering I've already hijacked my own post twice. Anyway. So Julie posed the questions: what do you think about the guidelines? what did you do? what kind of information did your RE give you? what do you think about all this? And in the course of commenting, I realized that a) I have a fairly strong opinion about not transferring more than two even though b) I have been spared from really having to consider the question. Needless to say that leaves me feeling a little uncomfortable about myself. I never really had to think about the guidelines, and I never had to answer the tough question of How Many to Transfer, because I live in a country with pre-existing guidelines and we were not interested in travelling to do IVF. Certainly not at first until we tried here. So I had to work with the rules my RE works by.

I did question why we could only transfer two, because initially that surprised me, and my RE said simply, Because we don't want triplets. (Let's avoid the whole question of spontaneous division and multiples, by which a two embryo-transfer could yield quads. It does happen, but if we wanted to reduce our risk of multiples to a certain zero we would have to forego IVF altogether. Even a single embryo transfer can yield twins, right?) Another clinic we interviewed but didn't go with will cancel an IUI if you've got too many follicles. The one set of triplets they ever had (so they said) came from a cancelled cycle when the couple went home and had sex against medical advice (so they said). She really wanted to make it clear to us that those triplets were Not Their Fault. Since there was nothing we could do about this rule, we went ahead with our IVF and transferred two embryos - a two-celled and a four-celled (they don't allow embryo grading, either, so don't ask about quality; they looked pretty is all). That cycle -my first and only - resulted in Small Boy and the Hockey Team - ten frozen embryos.

And now we're inching closer to the FET, and we've decided to transfer a single embryo. I think twins (and yes, could still happen) would be unfair to Small Boy. The chance of twins was worth taking when it was the first child we were trying for, but now...I know me, and I know how hard it was with just the Small Boy, and I'm worried already about having an infant on top of my beloved perpetual motion machine and to think of twins. Well. It would be unfair to Small Boy. He'd be pushed to the side in a thousand different ways just due to the sheer physical logistics of twins and I can't face that. We had coffee today, Small Boy and I, at the Beck around the corner from our apartment, sitting on the couch together while he drew circles - he makes the most excellent precise little circles, it's astounding - and I drank my Schale (basically a latte) and we shared a Mandelgipfeli (almond croissant). He's my guy, and my first loyalty is to him. For as long as any subsequent children remain hypothetical, my first loyalty is to him. I'll divide loyalties later, when I have to. And maybe the choice I'm making now will mean that subsequent children will always be just a hypothetical, but I can't make the choice differently. He's here, he's real, the damp sweaty curls at the back of his neck and his outie bellybutton and his nose kisses. He's the reason I'm transferring a single embryo.

But here's the thing. I got pregnant on my first IVF. The pregnancy was uneventful, I went to term, the birth uneventful. And I make these choices going into my FET believing it will succeed. Foolish perhaps, but there it is. I think it'll work. I haven't had to try very hard at this; I feel guilty about that sometimes, about my smooth road. So it's easy for me to say guidelines are a good thing; they worked for me. Or, rather, I had success even within their confines. But if it had all gone wrong, with failed cycle after failed cycle - would I be wondering if we could just transfer a third, or a fourth, wouldn't that help? Hell, yes, I'd be wondering that. I'd be pissed. I'd fly to New York and cycle there. So it's pretty easy for me to have an opinion about guidelines, isn't it, me with my son sleeping face down on my 20-year old teddy bear in the room next door. It's easy for me to move through the guidelines here because our diagnosis - straightforward male factor - is the easiest problem to solve. And I was typing this comment to Julie's post and I realized how dismissive I sounded - not just sounded, was being. Because, granting that infertility sucks, our infertility has been of the least-sucky variety.

And I'm opining about guidelines.

And it has never in my life taken me so many paragraphs to tell myself to just shut up already.

* Even as we speak, the Executive Counsel is supposed to be drafting regulations defining the circumstances under which PGD is to be allowed but Holy Government by Consensus Batman! they're taking their sweet Swiss time about it.