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Nobody does it better

In the comments on my last post, Erin asked, "Will an IVF clinic do another cycle for someone who has a history of HELLP?"

If I were feeling cynical, I'd answer, "Oh ho ho ho, my friend, you have much to learn about the fertility business."  Then I'd adjust my monocle, chuckle wearily, temple my fingers, and caress an exotic pet.  Next I would give a detailed explanation of my secret evil plan.  Then, apparently having concluded that while a well aimed shot from a large caliber firearm is practically foolproof, it lacks subtlety and panache, I would nonchalantly swagger out of the room while my burly henchmen strapped Erin to some whizbang high-tech spy-killin' machine.  Under no circumstances would I actually stick around to make sure she was good and dead.  And by and by, my sinister plan would be foiled, my empire of darkness would crumble, and naked lady silhouettes would gambol across the screen behind the closing credits.

But my house is clean, I'm down another pound, and Charlie's off at day care, so I'm feeling positively sunny.  This one, I'll play straight.  Erin, you may live.

If I know this, reproductive endocrinologists certainly do: infertile women who conceive after treatment have a higher rate of complications than the general population.  There are any number of contributing factors at play.  We're older, for one thing.  We have a much higher rate of multiple pregnancies, and therefore of complications stemming from same.  Many of us have suffered various insults to the cervix and uterus through treatment or recurrent losses.  Certain conditions such as ectopic pregnancy and bleeding are more common after IVF.  And, oh, yeah, let's not forget we're infertile, a condition that carries with it all sorts of plausible reasons to expect a bumpy ride. 

So any reproductive endocrinologist knows that the pregnancies he or she helps bring into being could be risky, more so when a patient's previous pregnancies have been complicated.  And yet they do it anyway.  Why?

I don't know.  My working theory is that they know that even given the worst case statistics, the chance of a good outcome is still greater than the chance of a poor one.  And that they trust their patients to educate themselves and evaluate their own best interests with sufficient care. 

This theory aside, I'm not worried, because I think I'm just too goddamned attractive — in an entirely clinical, impersonal, aboveboard sense, good people of the ethics committee — to be turned away.  By reproductive endocrinological standards, I'm a very good patient.  I comply with any and all instructions.  I maintain impeccable personal hygiene.  I entertain myself during long waits.  I make jokes to dispel the tension; when I do cry, I'm quiet, not sloppy.  When I fail, I'm at least interesting.  And I do get pregnant, which is, from an RE's perspective, the point.  My checks don't bounce and my feet don't smell.  I ask you, who could resist?

I've heard of women being turned away by REs for only a few reasons: age, high FSH, and previous failed cycles, all of which doctors might see as predictors of a poor outcome.  I've never heard of anyone being declined treatment because of previous pregnancy complications.  Have you?

If so, I need to know, and soon.  It will take some doing to divert some of my secret evil budget out of the "diamond collar for venomous lizard" cost center toward "amoral cadre of expert forgers."  Those medical records aren't gonna falsify themselves, you know.