The episode of NBC’s hit show This Is Us that aired October 9th, 2018 featured a risky procedure that left us wondering if Kate was going to make it through.
Kate and Toby are trying to have a baby.
Kate’s doctor didn’t want to take her as a patient initially because she said the risks were too great. I almost said too large. That was the problem though. Kate’s weight increased her risks of having complications while going through IVF.
What this episode of This Is Us and previous episodes didn’t explain was what those risks were and how likely complications were. They also didn’t talk about one of the largest risks of IVF, which is not affected at all by Kate’s starting BMI. I think it is important to be specific.
Having a baby can bring about immeasurable joy. I don’t fault couples for accepting certain risks in pursuit of pregnancy. I think that couples should do and know 3 things before pursuing assisted reproductive technologies, like IVF. By the way, I am not an IVF doctor, so my recommendations are not laced with any motive other than to provide information.
Let’s get into it.
Do You Meet Criteria for the diagnosis of Infertility or Subfertility?
People spend so much time and energy trying to not get pregnant that, when birth prevention is removed, they expect to get pregnant right away. Now, start taking prenatal vitamins 3 months prior to attempting pregnancy because you may get pregnant right away. If you don’t though, things may still be fine. Women under 35 can take up to one year of unprotected intercourse and still be normal. We give women who are 35 years old or older 6 months before pursuing further evaluation.
Well, Doc, we’ve only been “trying” for 3 months, but we haven’t used condoms or any form of birth control for over a year.
Then, ma’am, you have been “trying” for over a year. By a gynecologist’s definition, not preventing is considered trying. You don’t have to be tracking every change in your temperature or urinating on sticks to be trying. Simple sperm in vagina action counts.
It is nice to know even an estimate of when you are ovulating. A free period tracker app should do it. Intercourse at least every other day in your 3-5 day ovulation window should give you the best shot. Do your best to keep it fun and low stress. Get massages. Go on vacation. Relax.
Oh, and don’t go to any Zika territories. It’s still a thing.
Click here to see an up to date list of Zika territories you and your partner should avoid if you are or are planning to be pregnant.
The point of meeting criteria for infertility is 2-fold. One, if you know that it may take a year, hopefully that takes some of the pressure off month to month. Stress and anxiety are counterproductive for fertility. Two, insurance companies often require a certain duration of attempted conception before they will pay for assistance.
Do You Have Insurance for Infertility Coverage?
If you are thinking about trying to conceive and your open enrollment for your health insurance is coming up, just check to see what your infertility coverage is. It is just good to know if you will need additional coverage if conception isn’t easy. Infertility coverage is not a part of all policies.
If it is a part of your policy, you may have a maximum allowable expense. All infertility treatments do not cost the same. In Vitro Fertilization (IVF) is significantly more expensive than Intrauterine insemination, or IUI. Quite honestly, Kate and Toby may have been candidates for IUI with Clomiphene.
Clomiphene, known by the brand name Clomid, is a medication that helps women ovulate, or release an egg. This is especially helpful for women who have very irregular periods because they may not be ovulating regularly, like women with PCOS. The story of Kate and Toby included Toby’s sperm that were underperforming. If they were just slightly low-functioning, IUI is a fertility treatment that can turn a sperm marathon into a 5K.
Ultrasound and hormone testing are also evaluations that can often be done for women even if they don’t have insurance coverage for infertility. Still, though, waiting until you have given trying a good run is appropriate.
Risks of IVF are high, but so are risks of pregnancy.
Some of the risks of IVF are related to the high doses of hormones administered. Blood clot risks are higher, ovarian hyperstimulation is a significant complication, and ectopic pregnancy risk is higher with IVF than with spontaneous pregnancy, to name a few. Blood clot risks are also higher than baseline for spontaneous pregnancy.
IVF can also increase your risk for twins or higher order multiples. This is because two embryos are sometimes placed in the uterus in hopes that at least one will implant. Well, sometimes both implant. A single embryo can also split, causing twins. Twins are cute and all, but twin pregnancies also lead to higher risks, like gestational hypertension, diabetes, preeclampsia, c-section etc.
So are you saying we shouldn’t try IVF, Doc?
Absolutely not. I just think that knowing your risks is better than being afraid of some unknown TV Land risks. Surveillance and monitoring are always high for women undergoing reproductive assistance, with hopes that catching any complications early will help improve the overall outcome.
Women’s ages of first attempted conception are getting higher and higher.
The use of assisted reproductive technologies is becoming more and more common. Rebecca, Randal, hell EVERYONE was worried about Kate. I personally was happy when Toby spoke up and reminded everyone that this was their decision. If they understood what they were getting into, the risks, the benefits and the alternatives, they could make their own informed choices.
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Dr. Wendy Goodall McDonald is a board certified OBGYN. She began practicing medicine in 2007 and now uses her extensive knowledge and growing following to increase health awareness in a fun and viral way. She is the founder of The Gyneco-blogic and an author of numerous books for adult and childhood health education and social growth. For more, check me, I mean her out at dreverywoman.com