Luanne O'Loughlin

A trip through the infertility treatment maze is akin to a rollercoaster ride. In Beyond Second Opinions, Judith Steinberg Turiel implores patients to consider all of their fertility options before jumping on the ride. Subtitled Making Choices about Fertility Treatment, Beyond Second Opinions takes readers down a path not revealed in other infertility books.

Turiel takes a critical look at the current treatments available, and reveals to patients how medical professionals make treatment recommendations. Through almost 400 pages, Turiel constantly reminds patients with certain diagnoses that they may have a fair chance at attaining pregnancy with minimal or no infertility treatment. Certainly Turiel advocates the road less traveled for many.

Beyond Second Opinions is fabulously well researched with a comprehensive list of works sited and author's notes. To share compelling points of this book thought provoking excerpts have been selected for each chapter.
 
 Chapter 1: Facing Infertility: Into the Medical Realm

If patients could see what I have seen of the disagreements among doctors, the uncertainties, the non medical pressures that are shaping our medical care

, they might think very differently about their infertility diagnosis and reach different decisions about pursuing medical treatment. (p. 4)
 
 Chapter 2: A Couple Decides: What Informed Patients Do and Do Not Learn

For many couples however, particularly if they have been trying for less than two years and the woman is not yet nearing forty, a conservative approach-waiting for a spontaneous pregnancy-is at least as likely to succeed; the woman can avoid the risks of a medical intervention...(p.26)
 
 Chapter 3: Assisted Reproductive Technology: A Modern Fact of Life

Fertility specialists now recommend some form of in vitro fertilization to nearly any woman who does not become pregnant with less invasive treatments. (p. 35)
 
 Chapter 4: Experiments in Fertility: Mixed Results, Mixed Messages

Questions also loom about any manipulation of an individual's immune response. No one knows whether immunization with a different person's lymphocytes, for example, may have long term consequences for the woman or an exposed fetus. (p. 106)
 
 Chapter 5: Fertility Medicine's Older Woman

"Those nearing or past the age of 40 should ask a fertility specialist about current testing procedures that can predict individual chances of conceiving with and without treatment and what the results may suggest about whether, when, and how to intervene." (p.145)
 
 Chapter 6: Of Mice and Men, and Especially, Women: Learning from Research Past, Present, and Future
 
 Patients seeing doctors affiliated with a medical school are most likely to be offered the option of entering a randomized clinical trial. (p. 162)
 
 Chapter 7: How is Consent Informed?
 
 Different schools and programs emphasize different treatment approaches (e.g., surgery or endocrinology), as well as more general philosophies about medical intervention (e.g., more or less aggressive)-all of which shape what a doctor trained there is likely to do. Patients may want to ask doctors directly about the type of training they received and their general approach to diagnosis and treatment. (p.189)
 
 Chapter 8: Protecting Patients: Work Enough for All
 
 Present and future generations of women and men could certainly benefit from shifting the medical gaze upstream-toward determining what compromises their fertility, pushing them into a pool of patients needing medical help to conceive a pregnancy. (p. 241)
 
 Chapter 9: Finding What You Need
 
 Clearly, the positive side of fertility medicine during the past three decades is that more treatments have been developed for women and men who have fertility problems,. The difficulty comes in matching these treatments to individuals who may benefit. (p. 273)
 
 Solidly helpful appendixes cover terminology, references and resources, elements of informed consent, minimizing fertility problems, and diagnoses. A section on finding and using medical literature could have been improved with a list of reproductive-related keywords for Medline searches.
 
 As one who has fortunately/recently/successfully completed a ride on the infertility rollercoaster, I am not sure that those who most need this book will find it on the shelves. There is a time during treatment, when patients do not want to consider various scenarios and alternatives. Rather, each couple turns to their reproductive endocrinologist for a recommendation on what is most likely to work for them NOW. Just stepping on to the infertility rollercoaster causes the biological clock to tick louder and louder. Most patients just want to DO SOMETHING and I fear that they may not be likely to yield to Turiel's cautions. Patients have learned to band together in support groups to negotiate the maze through the pathways of diagnosis and treatment. There's even an unfortunate social hierarchy where patients look to "more experienced" infertility-survivors for guidance. Moreover, there's peer pressure that "It's time to move on to IVF."
 
 I applaud Turiel for her revealing look at the world of infertility and treatment. It is a thought-provoking book about life's most important topic. She steps boldly and bravely forth with her cautions and critical assessments. While patients may not want to take the time away from aggressive treatment to consider their alternatives, it will be strong couples who are able to read this book, learn from it, discuss it, and make wise treatment decisions that they can live with for the rest of their lives.

Beyond Second Opinions: making choices about fertility treatment

Luanne O'Loughlin is a computer book writer who has also spent years transversing the infertility maze. Following primary and secondary infertility, and multiple miscarriages, she is the grateful mother of two daughters, Carly and Katie.

Articles

Beyond Second Opinions: Making Choices About Fertility Treatment

I'm pregnant. Big deal? It is for me. I've had one live birth and four losses. We've also done the full arsenal of infertility treatments. This is pregnancy number six and "she" is the result of IVF/ICSI. As happy as we are, all good news is received cautiously.

Based on my prior history and my extra thick medical chart, there was no doubt that this pregnancy would be designated as high risk. I also knew that eventually I'd be facing  bed rest due to my trick cervix. I am a DES daughter and I spent 12 weeks on modified bed  rest in the pregnancy that resulted in the birth of our daughter, Carly, in 1992.

Back then, we lived in a small condo, I had no other child to chase, my husband traveled a lot (courtesy of the Navy), and house arrest was as good as  bed rest. I felt that bed rest worked.

Since then, we've moved cross-country three times. We're in a much larger house, Carly is six years old, and we have a new network of friends. An indeterminable amount of time known as Bed rest loomed ahead and I spent hours trying to figure out when it would hit. That's a skill akin to predicting the path of a tornado.

At 18+ weeks, the perinatologist decided that it was time to begin modified bed rest. Carly is a kindergarten student in a half-day program. I sent a note home to all the girls' moms to explain our pregnancy difficulties and requested any play dates that could be scheduled in their homes. The moms really came through for me, and three took standing days each week. As much as I hated to ask, it was rewarding to know that I had such good friends.

The weekly high risk appointments continued and I also saw the perinatologists for frequent cervical ultrasounds.

Fast forward to 21+ weeks. I should have known that it was going to be a bad day, when, upon arrival at the clinic, I looked down and saw that I had a black shoe on one foot and a blue shoe on the other foot. (Pregnancy brain!) First I saw the resident, who was very upbeat. She said that my case been discussed in the morning meeting--I was doing well and they'd be seeing me less often. I had my doubts, but thought it would be wiser not to comment until after the exam. She didn't check my cervix so there was nothing to worry about. Then I went to the reception area for the perinatologists' office and one of the docs came out, sat near me, and said, as if it were a tape recording: they'd discussed me in the morning meeting, I was doing well, and they'd be seeing me less often. I concurred with the doc, and kept my doubts to myself. Eventually, I was escorted back and another perinatologist began the transvaginal ultrasound. From the first measurement (of the length of my cervix), I knew there was trouble in River City. At the first ultrasound of my cervix at 12 weeks, it had the shorter than normal length of 3.5cm and now it was down to 1.6. Before I knew it, I had two perinatologists taking measurements and presenting options.

Plan 1 was to be sent home on strict bed rest. Plan 2 was an emergency cerclage, which carried its own risks. Plan 3 was to be put in an inpatient bed, and monitored carefully for a few days, with the possibility of an emergency cerclage if needed. We live in the DC metro area and depending on traffic, it can take 45-90 minutes to get to the hospital and clinic. Plan 3 won.

The next two weeks were in the hospital bed on the antepartum-postpartum floor. I was monitored frequently, and had ultrasounds every 48-72 hours. I learned a lot from the nurses about how the hospital works. Sadly, a couple of premature babies died during my stay. Their deaths reinforced my need to be vigilant in doing all that I could to follow medical advice to maintain this pregnancy.

During the hospitalization, time I quickly pulled together a support team. The backbone of that support team are the same mom-friends who had been helping with Carly. My mother died a few years ago, and so, we had no one able to come help. My husband notified his co-workers and supervisor. The fact that I was an inpatient certainly stirred folks to action faster than if I'd been sent straight home on strict  bed rest. I called the Moms who had previously received my note, and pulled together after school plans for Carly. Tom talked to neighbors about driving Carly to school. When you are used to doing everything for yourself, it is hard to ask for help. It is rewarding to have friends who really want to help.

My nurses and friends began to tease me about all of the arrangements I was making from bed --coordinating child care, shopping, changing my phone service, and arranging help. I'm a bit of a Type A, patience is not one of my virtues, and I don't know how to slow down.  Bed rest is a huge obstacle to accomplishing tasks. For the past few years, I've been a freelance writer. I've written and contributed to books about the Internet and online services. And, my laptop came to my hospital room.

My friends began to comment that I needed to write a book about bedrest. After all, there I was: a writer on bed rest. I needed something to do. I'd never designed a web page, and I was embarrassed by this. How could I as a computer book author not have designed a web page? There was the kernel that became my web page. I searched other web sites and found interesting tips for  bed rest. What was needed was a practical, how-to site. I created a web page: Surviving Pregnancy Bed rest.

I've mentioned it to my friend on an IVF mailing list, and I've also posted it to the newsgroup, misc. kids, pregnancy. I've been thrilled with the responses I've gotten from women who want to forward it to friends. The best messages have said, "I've never been on  bed rest but now I know how to help someone who is." That's the best part, I'm thrilled to share all the wonderful ways that friends have helped and the ideas that have helped me to be more productive and organized in bed.

Surviving Pregnancy Bed rest is a work in progress. I look forward to the day when I can add the birth announcement and until then I will fiddle with the page to add links, enhancements, and tips that have worked for others.

Luanne O'Loughlin

Articles

Beyond Second Opinions: Making Choices About Fertility Treatment

Surviving Pregnancy Bed Rest