Friday, April 3, 2009

The Imperfect Science of Medicine

Currently I'm reading Complications by Atul Gawande. If you haven't read it, I highly recommend it. Gawande is a surgeon and uses case studies to discuss the imperfect science of medicine. He discusses the fallibility of doctors, the mysteries and unknowns of medicine, and uncertainty itself. As I'm reading the book I can't help but think about my experience with infertility and the doctors who have treated me. I understand and accept that my RE is human, yet I often expect him to have all of the answers. It's a strange inner struggle that comes from my need to be in control, but as I've learned over the last four years I am far from in control.

Last night and this morning I've been reflecting on our appointment. I have to admit that I'm not really all that satisfied with the notion that we just need to keep trying and hope that one of the good ones is transferred, but at this point the only other viable option is to move on to CCRM or SIRM and neither of us is emotionally ready for that at the moment (not to mention the expense and logistical issues involved). I guess I'd be more comfortable with our plan if the future transfers were going to be to me. I know that I can handle a potential miscarriage because I've handled 4 of them, but to ask someone else to risk going through that is tough. As Dr. S reminded me miscarriage is a risk of pregnancy and anyone who attempts to achieve a pregnancy must assume that risk. I get that and I know every surrogate also gets that, but until you go through it you don't know how you will feel or how it will affect you and your family.

The fact that I've had 4 miscarriages myself and 1 with a carrier weighs heavily on my mind. I realize that some of m/c with my uterus were likely due to my uterine problems, but the fact remains that we still don't know anything about those embryos that we lost. As a scientist I feel like I don't have enough data to analyze to arrive at a sound conclusion. At this point we are hypothesizing at best and we are hoping that future cycles will support our hypotheses. I have to remember that medicine is an imperfect science. Gawande reminds me that often medicine doesn't have all of the data because there are so many uncertainties and unknowns, yet they sometimes have to take a "stab in the dark". I know that there is science in reproductive endocrinology and as Gawande says there's also "intuition and plain old guessing". So, for now the best we can do is go with our intuition, hope that Dr. S's hypothesis that there are a few more good eggs will be supported, and ultimately just take a "stab in the dark".

7 comments:

Bluebird said...

I know. Its so frustrating, but yet a very important thing to be reminded of from time to time. I was sooooo mad at our MFM because it wouldn't give us stats - numbers - for our rate of recurrence. At the end of the day, though - does it really matter? No, not really.

Particularly when it comes to getting pregnant and staying pregnant, they really don't know much at all!! Not only is medicine itself an imperfect science, but its not like they can run "tests" on pregnant women.

Anyway, I'm sorry that you feel left with more questions than answers, but I'm proud of you for writing this post and for reminding yourself that sometimes there just are no answers.

R said...

Your posts are so touching. I check my computer everyday for a new one. I pray for you guys everynight, and yes there is alot to know/learn on the science side of things but sometimes I just have to tell myself (and believe) that everything is really in Gods hand. I believe that God wants you to have another baby (Miles deserves a brother or sister) Sometimes the road to success is filled with heart ache. I think that with out the heart ache we wouldn't enjoy the moments of perfection. (And you did have moments of perfection with miles and you will get more with baby# 2)

Irish Girl said...

I read that book! I thought is was good, too.

As for the imperfect nature of modern medicine: it is so true. The body is so complicated that it is impossible to know exactly what to expect with any treatment, IF related or not. It's a best guess kind of business.

Wishing you all the best, as always :-)

Duck said...

I also find it hard to believe that it's a genetic issue (would your embryos look so good and get to blast if it was all done to chromosomes and not a faulty uterus?). I don't know, but, I also don't not know and I just feel that more trying is the best thing to do, try again a fresh cycle with your emryos and a surrogate (this is my plan obviously) and if then there continues to be issues, you will know more, otherwise, you just won't know. (or again this is how I'm approaching everything).

Kris said...

This is so hard and frustrating. I hope that the lab work comes back from Ks D & C and gives a clue as to what is going on. Thinking of you!
Kris

Lost in Space said...

It really is just so hard to not know why things happen. All we can do is make the best decision we can with the information we have in front of us. I'm sorry this isn't easier......

Kelly said...

Science leaves a lot to be desired. We will never have all the answers and sometimes it is a stab in the dark. One in which we have to take in order to achieve our goal.

Thinking of you....