LEARN INSURANCE

This is a guest post from a very thoughtful patient of mine. I know many IVF patients will be able to identify with her experience . I just wish more doctors would read this as well, so they can provide more support to IVF patients !

When you do ivf as a medical tourist soon you'll find out you have become a traveller between the worlds. Between continents and between medical worlds: "normal" obstetrics and ivf. Unexpectingly it turns out to be much easier finding an ivf doctor in India than finding an obstetric gynecologist in your home town. And once you are lucky enough to get an appointment, you are faced with different treatment concepts: pregnancy in obstetrics and pregnancy in ivf are a world apart it seems.

Unless you are already established with an ob gyn - not so likely; you would not be an ivf patient if you had made it into the normal gyn world - getting an appointment with a gynecologist becomes a real challenge.

After returning from India I called a gyn I had seen once to schedule appointments for the row of betas after the two week wait. She reluctantly ordered one blood test and told me right away that she was not willing to deal with ivf patients in general, much less with ivfers from abroad and that she was not an obstetrician anyway for that matter.

I then contacted other obgyns in my area but they were so fast in telling me that there were no appointments available any time soon that I did not even had the chance to explain the vital importance of the row of betas in ivf and that this was why I needed an appointment much sooner. Since this was my fourth ivf cycle, as a recurrent ivfer I had by now acquired a daunty respect for those fearful beta numbers and their always heart-wrenching doubling time. During the two weeks of wait for the first beta, the tension grows denser and denser and the only thing that can ease your strain, slightly, is a good doubling time. I had to find a beta-willing gyn at any cost.

A certain familiarity with the medical establishment led me to the conclusion that local doctors in private practice might have arbitrary freedom as to wether accept new patients and therefore insisting on small private practice doctors would lead nowhere. I had to find a public structure with more inclusive patience acceptance. I called the medical faculty associates office at a the local university. Among the options at the answering machine : "if you are pregnant ..."That sounded promising.

I pressed the required key and a friendly voice said, he would now check for available appointment dates. I explained right away that I was doing ifv abroad and that I needed two blood tests and a scan done on specific dates. He was listening for a while and after what seemed to me a long stretch of silence he was trying to find out where in his scheduling scheme I could possibly fit in with my outlandish request for a row of betas. "A row of betas ? I don't think the doctor will do that for you". He appeared to want to be helpful, but just could not comprehend my urgency for blood tests. He suggested to do a home test in the meantime.

I did not want to lecture on the difference between qualitative and quantitative bhcg testing for fear this might ruin his sympathetic attitude towards me. I just began to understand myself that timing in ivf was far away from timing in normal obstetrics. The beta frenzy was a thing exquisitely ivf. He was willing to give me an appointment to see a doctor on a day that luckily turned out to be the day my ivf doctor wanted me to have my first scan, in 10 days to come. I gratefully accepted. I had to find another way to find relief from beta hell. There was no way I could wait 10 days without knowing my beta numbers' fate.

When dismissed from Dr. Malpani's clinic, he will ask you to inform him on your beta results. I emailed him that I was not able to obtain blood tests and therefore could not inform him. Within a few minutes he replied sending me a link to a online lab. What a relief. I would have had to pay for the tests privately though. Relief from awful beta-anxiety has no price.

The beta numbers came in, anxiety stayed. Doubts about adequate doubling time and no doctor to talk to. Again I emailed with Dr. Malpani and was reassured.

While my appointment with the obgyn was approaching, I imagined that I would have to go through at least two assistants before I could talk to the doctor. They would both ask me the same questions again ,checking the same checklist. Why was I so hypercritical ? I should be thankful that someone was paying attention to me no matter how formal.
This doctor turned out to have one assistant only and she was indeed simply friendly and asked me where I had my ivf done. "India ? That's pretty far away".
"Only on the map" I replied thinking of how easy it was to get advise from my ivf doctor by email while I hadn't yet seen the local doctor. I was so tense about seeing the doctor and whether he would have me have a scan done, that I made no attempt to explain this apparent contradiction. Whatever her assumption regarding my state of mind that moment , she was surely right.

And then she asked me about the due date. The due date ? WTH ? Heavens, I am doing ivf ! I am not in the usual pregnancy business. In ivf the due date is an almost non-existing concept. In ivf you go from hurdle to hurdle, from beta to beta, from scan to scan, day by day, week by week. The relief of one doubling beta lasts the blink of an eye and you start worrying about your next beta two days from now. And once you made it to the ultra sound level and you are lucky enough to see what could be a a gestational sac, a black little hole, you start getting very nervous when your next appointment approaches: will there be a heartbeat ? You will never forget that flimsy flickering filament and life appears to be so fragile and delicate, a friable thread of silk.

"The due date", I said, "I never got that far". A look at her told me that she considered my situation to be too complex. She did not inquire and I was glad I did not have to go over my ivf history. I handed her my discharge papers. Without having a look at them she said the doctor would be here soon and left.

The doctor stepped in, I explained I was doing ivf abroad. I told him my beta numbers and he decided they were too low. The feeling of desperation took over. I had the impression that maybe he was not used to see beta numbers at such an early stage of pregnancy and that was why he considered them too low. But I had not enough energy to find that out. I would ask Dr. Malpani.

By now I have become an established patient with both the pregnancy worlds. Pregnancy symptoms might be the common interface. I learned to navigate myself through the "normal" obgyn world being aware that I am confronted with a somewhat different obstetric culture. There is no "clash of civilization" in obstetrics, no self-fulfilling prophecy of conflict. After all, a pregnancy is a pregnancy, no matter where.