Some Thoughts on Selective Reduction

"What are you thoughts on selective reduction?" our nurse asked during the final ultrasound on Friday. My initial thought was: thanks a lot, Ms. Debbie Downer, for putting a huge negative slant on one of our first potentially positive monitoring appointments. 

The good and bad news is that, in the two days since my last ultrasound, I have 5 follicles that measure at least 14mm. By the time I take the Ovidrel and actually ovulate, this could possibly result in as many mature eggs. Given that I am still relatively young in the land of fertility, and we have no other known factors, the likelihood of multiple embryos implanting is quite possible.

This is a touchy subject. It can raise a lot of potential moral, ethical, and religious issues. Please know that these are my beliefs and opinions and are not meant to offend anyone and are not meant to start a debate.

I was very glad that C was with me for this appointment and he was able to express his opinions and ask questions I didn't think of. I was also very glad that we had previously discussed this possibility, as the message of having too many follicles was beat down our throats since we began monitoring with the past RE. I am glad that we were generally on the same page.

These are my thoughts: I do not want multiples. I do not want to jeopardize the health and safety of myself and my future child(ren) by risking carrying too many at one time. I do not want the risk and I do not want to subject my body to that. I am also pretty terrified of the idea of raising multiples, as if one isn't going to rock our world enough. This last argument is pretty weak and I'm sure it would be good in its own way, but it's still a terrifying prospect.

From a moral standpoint, I believe that the dichotomous view of life vs death/non-living is limiting. I believe that there is more than just being alive versus not-alive and that having a beating heart doesn't mean full life, either in the womb or on life support at the end of life. I believe that there are actually multiple levels of living and that, at some point, the the rights and health of the mother takes priority over an embryo. As never having had to suffer through a miscarriage, I know that this is my current bias.

The nurse did explain some aspects that were unfortunate surprises. First, from a practical standpoint,  she said that not many centers will readily perform selective reduction procedures and that she knows of only two main facilities in all of US that they trust, the closest being about 2.5 hours away and in the next state.

Secondly, and more importantly, C asked about the timing and when the procedure would occur. She said that they would only recommend this after determining that the embryos were viable, meaning at least 6-8 weeks, after heartbeats were heard. I have to admit that when C and I had discussed this before, we did it thinking about removing a few cells, not actually stopping a beating heart. This fact definitely caused us pause, but ultimately did not change our opinions. I told C later that, if it came to this, I will insist that I do not hear the heartbeats until we are sure that they will all be given a fair shot of developing. Maybe this is unfairly distancing myself to make our decision easier, but it will help me to emotionally cope with this challenging situation.

The nurse was not able to tell us at what point this would be recommended or two what extent (e.g. 3 to 1, 4 to 2, 3 to 2, etc.) and said the the Dr. would discuss this with us in more detail if/when necessary.

They did give us the go ahead. We are moving forward. This is probably the most excited I've been since we began this process. This is literally our first opportunity to experience the "two week wait," to pee on a stick with actual hope. Yet I can't help but feeling a gray cloud leering overhead, far above our happiness, ready to rain on our parade.