Reproductive Immunology

Rainy day. Poopie mood.

In writing about my three past OBs and reading about reproductive immunology and speaking with Lisa (who is Lisa? Wait? Has she mentioned Lisa before?), I’ve sort of answered my own question by now. With the only problem being that the answer is “get the testing done” which leads to two questions–by whom and with what money?

Oh…wait…the question.

After the twins were born, the OB who delivered them (who was the doctor on-duty that night at the hospital) sat down in my room and said she wanted to talk to me. It’s never a good sign, by the way, when a doctor sits down. The babies were IUGR (intrauterine growth restriction) which means that they stopped growing in utero. They discovered this at 34 weeks and they were delivered that day. What could have been a huge problem leading to stillbirth was averted due to careful monitoring. Let’s at least thank OB #3 for following the guidelines for monitoring twin births. I’ve heard stories of OBs who don’t.

IUGR is sometimes caused by a clotting disorder (thrombophilia). Thrombophilia can also impede fertility and cause miscarriages. I had told this doctor about my fertility history while in labour, and putting all clues together (problems with implantation, IUGR babies), she told me that thrombophilia was a possibility. She said I should be tested for this because it’s important information to know not only if I want to get pregnant again. Thrombophilia can lead to other health problems later in life. So there you have it–go have fun with your new kids and try not to think about it!

When I went to the new OB, he laughed at me when I said that I wanted to be tested for a clotting disorder. He told me that reproductive immunology wasn’t real science and that I didn’t have a problem. Really? You can diagnose that with just your eyes? Amazing. But I’d still rather have a blood test.

Paz, who I’ve mentioned before (the chickie who kicked off Common Thread) was the first person I knew who benefitted from reproductive immunology and I started poking around to see if some of these things could apply to me. Then Lisa (oh…here’s where she’s mentioning Lisa) sent me this email:

My RE tested me after our second failed cycle and found elevated levels of IGM which may or may not mean a potential problem. He put me on Lovenox and baby aspirin for the remaining three cycles (which obviously did not help) but then my RE at Cornell told me he didn’t believe in the whole immunology thing and wouldn’t prescribe Lovenox. When I went to my OB once I was pregnant, he saw the previous test results and asked why I wasn’t on Lovenox. He sent me to a hematologist who put me back on it, but by then I was 12 weeks pregnant. I learned first hand how controversial the whole issue can be in the medical community. One thing I learned through this whole process: medicine is an art, not a science.

Lisa has pretty much the most rockin’ Secret Hope Story ever. She was over this week and we were talking about the controversy surrounding reproductive immunology. I had no idea that this division existed in the medical world, and the varying reactions made sense. The doctor who took it very seriously and urged me to get tested. The doctor who laughed it all off. And the ones in between who shrugged their shoulders and said, “maybe.”

And the patient in the middle who is circling the drain of what ifs. Who is admittedly a bit of a freak about worrying about the future. Early on in the relationship, I took Josh on an 18-mile canoe ride. Trapped in a boat on still water, he paddled hard to get back to the car and away from my incessant what ifs that I was using to see if he was husband material. Could he handle what ifs day in and day out? How well did he thrive when peppered with what ifs that involved nazis taking over America and forcing him to choose between me and every other loved one in his life?

That established, what if there is something to reproductive immunology and a simple blood test holds the key to whether I try for a few months or a few years to conceive again? What if taking heparin and some aspirin can keep another child from being IUGR (and two pounds at birth)? What if this knowledge can keep me from other medical problems such as a blood clot later in life? The answer is simple: take the blood test.

BUT.

Do I go to the OB who has already laughed me off and ask him to order it? Would he be aggressive and order the right lab work when he seems to have little respect for reproductive immunology? Do I make an appointment with my RE and jump back to his office even though I’m not completely ready to be back at the RE and I have no idea where he stands with this? Do I skip all known doctors and go straight to a hematologist? Two options not on the table–going to the doctor who suggested this in the first place since she no longer works at the hospital OR switching OBs.

I know most of you are screaming, “run don’t walk” when I tell you my OB laughed at me. Didn’t I learn anything from my three previous OBs? I promise you that I did. I stay with my OB for two reasons: (1) the RE recommended him because he refers out quickly to the clinic. He takes fertility issues seriously and when I met with him, he recommended only trying for three times on my own before returning to the clinic. (2) When you start throwing out OBs over every snicker, you’re going to be left with your vagina hanging in the wind because OBs altogether are a very smug group of know-it-alls. It could be the “playing G-d” status they have of bringing life into the world. But he took my other concerns seriously and spent over an hour speaking with me at my first appointment and pap smear. Can I blame him if he is siding with the anticontroversy on a controversial topic? And to be frank, I’m just tired. My standards have become too high for an OB. I want them to gallop up to my doorstep on a white horse and examine my hoo-haa while I remain in bed, watching the Food Network. And…well…the short of it is that I am sticking with this OB for the time being.

The next BUT.

If insurance is not going to pay for this, do I push for the tests? I know the knee-jerk answer is “yes.” But at the end of the day, I’m not a doctor with a plethora of additional information about hormones and blood disorders at my fingertips. I earned my honourary medical degree from the stirrups, which is obviously different from taking actual medical tests. Tests shmests. That said, if a doctor says it’s not necessary, do I push forward and say, “it is!” without proof of negligence over my health care?

Because at the end of the day, we’re passing the financial corner of the Bermuda Triangle of Infertility and the triangle is threatening to swallow us alive if we test these waters. We just don’t have the money. So I am also looking for advice from people who have had this type of blood work completed and had insurance cover it.

Which sucks. Bigtime. To make medical decisions based on money. I know all people who aren’t independently wealthy consider the financial aspects when making medical decisions. But…well…I just want it to be different.

As I said, writing about it this much has made me figure out my next step somewhat. At least for the time being unless you have advice–by all means, pass it my way. And by figure out the next step, it is the idea my husband came up with last night. Go to my GP. Someone neutral who probably knows little about reproductive immunology. Who will refer me to a hematologist. So it
looks better for insurance reasons. So the person doing the diagnosing is actually a doctor rather than one who plays one on the computer. Appointment is next Thursday. Come with me as we delve deep into the immunology controversy. Which makes this sound a bit less like a soap opera and a bit more like one of those sensational news shows. But whatever. I mean, it’s not like it’s a big deal. It’s JUST MY HEALTH!

Grrrr…