lunes, 27 de enero de 2014

Finding a Doctor Who Supports Genetic Screening During I.V.F. -

Finding a Doctor Who Supports Genetic Screening During I.V.F. -

Finding a Doctor Who Supports Genetic Screening During I.V.F.

“Now remember, we’re not judging doctors based on personality,” Solomon reminded me for the gazillionth time. I nodded. “We’re looking for the best treatment plan.”
We were in Israel, a country not exactly famous for its bedside manner. “The meaner they are, the better doctor they probably are,” said my friend’s sister, a 25-year-old who had done I.V.F. for over a year in Israel.
We knew what treatment we wanted: full-force I.V.F. using Preimplantation Genetic Diagnosis or Screening (P.G.D./P.G.S.), which genetically screens embryos before implantation. The method can be used to search for specific diseases such as Tay Sachs or Gaucher, but it can also weed out aneuploidy(abnormal number of chromosomes in a cell), the reason for many first-trimester miscarriages.
Some worry about the use of P.G.D. for gender selection (“Will this become a form of eugenics?”). But I wonder if genetic screening will be the future of reproductive medicine, especially since new technologies keep emerging. Then again, reproductive medicine is still in its nascent stages, so who knows what the future will bring? Maybe all women will freeze their eggs at age 25. Maybe no one will ever have fertility trouble again.
Genetic screening may not increase my chances of having a baby, but it would greatly reduce my chances of miscarrying or bearing a baby with genetic defects. After three miscarriages, it seemed like the best option: I couldn’t put myself through another such trauma. Besides, if all our embryos were bad, we would definitively know it was time to move on.
Embryo screening costs at least $5,000 for one to eight embryos in the United States, but in Israel it would be covered by national health care. Except, we were discovering, most doctors in Israel only do genetic screening for a specific disease, not for repeated miscarriage or implantation failure or Advanced Maternal Age.
“We are at war,” the first doc said lackadaisically. An expert in the field, he was leaning way back with his hands crossed behind his head, as if he were about to take a nap. My medical history didn’t seem to faze him. Nothing did. I suppose. In a country that offers free I.V.F. to thousands of women a year for their first two children, he’d seen it all.
“And in a war, you bring out the biggest guns you’ve got,” he said. “You don’t save ammo — you throw everything you have at it. And if you miscarry? You try again. And again. And again.” I felt my stomach clench. Easy for him to say; he never had to lose a pregnancy.
The next doctor we met was not indifferent. But he also didn’t do genetic screening for repeat miscarriage, describing it using an English curse word that is considered more mild in Israel. He was leaning forward in his posh Tel Aviv office. “Americans love trends,” he said. “Like minimal-stimulation I.V.F. – a trend! No proof for that.”
I interrupted. Even though mini-I.V.F. didn’t work for me, it didn’t mean that it doesn’t work at all. “Actually, there are plenty of studies which show – ”
“Studies? Anyone can do studies,” he said. “Doctors do P.G.D. in America because it makes them more money. They only care about money in America.”
I didn’t know how to deal with this kind of Israeli certainty. I looked to my husband. Solomon interjected, equivocating, American-style: “The nice thing is that we’ve heard a number of different opinions about different protocols.”
“I don’t say opinions; I say fact!” the doctor roared. He talked about his recommendations for me (a “long protocol”), but I hardly listened. We might not have been running a Mr. Congeniality contest, but how could I fly halfway across the globe for either of these guys?
I felt like Goldilocks and the Three Doctors. The first, too indifferent, the second too arrogant. Thankfully, the third was just right. She had a calm and warm air about her. She took down my medical history herself (unlike the other two Tel Aviv doctors, who had their assistants do it) and frowned in sympathy at all our failures.
“I don’t think your numbers are too bad for your age,” she said, referring to my hormone levels. “If we increase your stimulation, I think we can do better,” she said, adding that they could do genetic screening.
I turned to the doctor with our million-dollar question: “Do you think it’s time for us to give up on I.V.F.?”
She paused for a moment before answering: “Well, that’s a personal decision, of course – if you don’t want to go through any more I.V.F., and you just want to be pregnant already. But I think most women would prefer to have their own genetic babies, no?”
I nodded. That’s why we’d come this far.
“I think we should try it,” she said.
I squeezed Solomon’s hand. With this woman, with this treatment, I felt a glimmer of hope sparkling once again.

Amy Klein chronicles her fertility journey weekly on Motherlode.

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