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01/10/2006

Medical moment

On the advice of my OB/GYN after I failed my more-than-a-year-postpartum glucose tolerance test, I recently visited my primary care doctor for the first time in five years. Three things of note happened at this appointment:

  1. She glanced at my glucose numbers and barked, "That's not high. Why are you here?"

  2. When I told her I'd recently lost weight, she asked whether I intended to lose more. I told her I'd like to drop ten more pounds. "And you think you can do that?" she asked, sounding more skeptical than I strictly cared for. "Sure," I answered heartily. "I've lost twenty pounds already. Why not?" She parried with a question: "When was the last time you were at that weight?" During my twenties, I told her. "That was fifteen years ago," she told me sternly, glancing at my birthdate, and changed the subject.

  3. As we discussed Factor V Leiden, I told her my OB/GYN had directed me to stop taking the pill. "What are you doing for birth control now?" she asked. "Nothing," I told her. She looked incredulous, then said slowly, as if I were a very small, very slow child, "You know you could get pregnant."
So she doesn't think I can lose weight, but she does think I can conceive without assistance. I know: I'll show her. I'll lose ten more pounds and I'll fail to get pregnant, entirely out of spite.
...

I attended a long-awaited consultation with a hematologist about Factor V Leiden. Here is what I learned:
  • On average, the risk of developing a blood clot (or a DVT, deep-vein thrombosis) before age 40 is about 1 in 10,000. Because I'm heterozygous for Factor V Leiden, my current risk is somewhere between 4 and 8 in 10,000.
  • If I use oral contraceptives, my risk is 35 times higher.
  • If I use drugs that stimulate estrogen production, such as in controlled ovarian hyperstimulation, my risk is 100 times higher.
  • If I get pregnant, my risk is 7 times higher.
  • These risks are based on my status as having Factor V Leiden alone, without taking into account my family history of DVTs.
  • These risks are automatically compounded by increasing age.
Her conclusion: If I'm going to cycle again — a big if — I should do it now.
...

While lying on my chaise longue languidly eating bonbons and dangling a marabou-trimmed mule from one impeccably pedicured toe, I noticed that the most recent CDC stats are out. These numbers are for 2003, when I did three cycles at my local clinic, so I was eager to see how everyone else I saw dejectedly slumped in the waiting room did that year.

According to the clinic's reporting, which I have no reason to doubt, 52 fresh non-donor cycles were started for women in my age group. How many of those cycles ended with live births? 48%.

To contextualize that number, I'll point out that for the same year in the same age bracket, Cornell, widely regarded as one of the country's best clinics, came in with a 46.5% live birth rate. The nationwide live birth rate is a dismal 37%.

In summary, that year my local clinic kicked embryonic ass. But I know personally and intimately of three cycles that did not result in live births. So let's crunch the numbers. Say I'd gotten and stayed pregnant on my first cycle:

If, out of 50 cycles (52 actual - 2 of mine that failed), there had been 26 live births (25 actual + 1 of mine that hypothetically might have occurred), my local clinic's live birth rate for 2003 would have been 52%.

Say I'd gotten and stayed pregnant on my second cycle: the live birth rate would have been almost 51%.

Say I'd gotten and stayed pregnant on my third. 50%.

Or, heck, say I hadn't cycled at all. 49 cycles, 26 births. 51%.

So...hmm, carry the three, divide by pi...yes. By doing three unsuccessful cycles, I personally was responsible for knocking three whole percentage points off my local clinic's live birth rate.

Jesus, no wonder they suggested I consider donor eggs.

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