Making Decisions about Treatment
from the book How to Have a Baby:
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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Discovering that you have a fertility problem can be a difficult process. In
addition to the emotional stress you now find yourselves faced with making
endless decisions about treatment. The word "decide" comes from a
Latin root meaning "to cut away from." Thus decision making, by its
very nature, involves loss, giving up one or more options while grasping
another. Not deciding maintains the illusion that you can have it both ways -
that there is no loss, no risk. Unfortunately, most infertile couples have not
learnt to make their own decisions - and not making decisions is one sense the
worst possible decision of all! You cannot allow your doctor to make treatment
decisions for you either - this can be disastrous as well.
Identifying Your Goals
Most likely, your original goal was to have your own biological child.
However, because of your fertility problem, you may be forced to examine your
deepest feelings about family, children, and parenting. You could find that you
have to re-evaluate your initial plans in order to get the family that you want.
As you work to identify your goals and examine your options, you'll discover
that essentially, there are four choices as regards treatment. Depending on the
cause and treatability of your infertility, you may need to choose one of the
- To pursue having a biological child with infertility evaluation and
- To try to have a child biologically related to only one parent, either
through donor insemination or egg donation
- To adopt a biologically unrelated child
- To decide to remain childless
You may want to rate each of the four options as "desirable,"
"acceptable," or "unacceptable" at the beginning of your
evaluation and periodically re-evaluate these choices.
For some infertile couples, trying to have a biological child and
childlessness ( child-free living ) are the only options. For , the switch from
having a biologically related child to adopting or having a child biologically
related to only one parent may be easier than having no children at all.
Many couples lose track of the fact that their main goal is to be 1parents,
even if they can't be biological parents. Therefore, they may pursue infertility
treatment for several years and find themselves above the age limit to adopt an
infant through an agency. Furthermore, since a woman's fertility decreases after
the age of 35, this also decreases the chances of successful treatment. You and
your physician should try to take these possible consequences into account when
evaluating and choosing your options.
If you are relatively young, there may be a good chance that you will achieve
pregnancy without expensive procedures. Therefore you may not wish to explore
these as yet. If you are older and have less chances of conceiving , a more
aggressive approach might be called for, since time is at a premium.
The decision making process is different for each couple and depends on
individual situations and personalities. For example, some couples may opt for
expensive high-tech treatments, while others in the same situation will wait to
see if they can become pregnant without treatment.
What Kinds of Treatment are Available?
Once you've discussed your infertility with your physician, you'll find that
there are a number of treatments available. These include:
- Medication that may be prescribed for either partner to improve fertility
- Surgery to correct an impediment
- In vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) for
patients who require assisted reproductive technologies
- Donor insemination , if male infertility is the problem
- Egg donation , if the female cannot produce eggs
- Surrogate parenting , if the woman has no uterus
Questions You Should Ask Your Doctor
Your doctor may be able to make recommendations about treatment - but there
are a number of questions that you should always ask your physician so that you
can make the best decision. Unlike other medical questions, infertility
recommendations are not always clear. You need to evaluate whether and how well
each treatment option will help you reach your goals. Then you'll have to
determine which options you will pursue. The following questions may help you
build a foundation of medical information to assist you in your decision making
- How much will this treatment improve our chances of pregnancy?
- How much risk is involved and what kind of risk is it?
- How long will we have to undergo this treatment in order to give it a
reasonable chance to work?
- Will undertaking this treatment eliminate other options?
- How much will the treatment cost?
- Are there other options if this treatment fails?
Your physician can help you determine how much time, physical discomfort,
risk, and money will be required for a particular treatment option. You will
have to decide how much money you are willing to spend, and how much emotional
stress you can take.
You need to design your own fertility treatment plan. Not only will this help
you maintain control over your life as you proceed with treatment, it will also
help to ensure you get good quality medical care.
Issues Affecting Your Choice
Issues which affect your choice include:
- Medical Factors:
- Diagnosis ( or lack of one)
- Quality and availability of medical care
- Success rate of treatment
- Level of technology required
- Personal Factors:
- Time commitment needed for treatment
- Personal feelings - physical and emotional
- Partner's feelings
- Job and career
- Financial resources
- Ethical and religious concerns
- Family and friends
- Other obligations and commitments
- Willingness to change life-styleAggressive or low-key approach to
Each of us has a different personal decision-making style. It is for you to
choose which one of the following best fits your own personal style for making
- I prefer to make the final selection of my treatment after seriously
considering my doctor's opinion.
- I prefer that my doctor make the final decision with regard to which
treatment should be resorted to, after seriously considering my opinion.
- I prefer to make the final selection about which treatment I will receive
on my own.
- I prefer to leave all decisions regarding my treatment to my doctor.
It is important to understand that there are no right or wrong styles, and
that your style may change as you proceed through diagnosis and treatment. It is
imperative that you find a doctor who respects and understands your personal
Just as there are no right or wrong styles, remember that there are no right
or wrong decisions about your treatment, and as your options change with time,
you may also change your priorities. Counselling may be helpful in setting your
priorities - especially if you and your partner disagree on the course of
action. As your options change with time, you may also change your priorities .
Try to be as realistic and open-minded as possible. While the final outcome will
always remain unknown at the time of making decisions, if you take the time and
the trouble to make your own decisions, at least you will have the satisfaction
of knowing that you tried your best!
In order to make infertility treatments less stressful, you'll need to place
time limits on them. Doing this may help you define your goals more clearly.
Many couples are willing to accept only two to three years of therapy, because
continuing treatment for long periods of time may cause excessive stress.
It is important that you do not lose sight of your relationship with your
spouse . Make sure that each of you understands how the other feels about each
stage of treatment. Throughout treatment, both of you may encounter times of
ambivalence about having children. This is a normal reaction, and you should
remember to have realistic expectations of one another.
If reasonable goals are maintained and difficulties and limitations are kept
in mind, stress can be minimized. If this is not the case, then a break from
treatment, change in plans, or counseling for stress and marital issues may be
Sometimes, recording information on a worksheet can be helpful. Here is a
sample worksheet for making medical decisions about treatment:
Decision (in the rank of choice)
You may want to take each of the options your doctor has suggested, gather
the information you need, and go over the options in terms of :
- Physical and emotional risks
- Chances of success, with and without treatment
Also keep in mind how much money and time is needed, what is available and
how much you are willing to invest. As you go through this decision-making
process, you will probably find that your answers change with time.
If you do not conceive after pursuing your initial plan of treatment for a
set period of time, you may need to re-evaluate your goals and options. You may
find that you want to discontinue medical intervention, or you may want to seek
a different kind of treatment. Keep in mind that it is not at all unusual for
partners to have differing views and feelings about infertility and its
treatment . Open communication can help both of you to make the best decision.
An early step in the entire process is to try and prepare yourself . Ask
yourself if it is worth the risk of pursuing treatment without a guarantee of
success. Anticipating difficult situations and emotions may help you deal with
them more easily.
Your doctor can provide you with information and can refer you to further
sources. You can take steps to prepare yourself for what could be a long and
frustrating process. But you may also find that as you and your partner work
through the stages of infertility treatment, your relationship grows stronger.
Your physician, support groups, other couples who have made similar
decisions, and counselors can also provide support and guidance. Above all,
remember that with patience, a positive attitude, and the appropriate treatment,
most infertile couples can eventually become parents.
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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