Eye of the Tiger

I am raring to go . . . ovridel is in . . . insemination tomorrow.  I'm like Rocky - running up the stairs with the sweatshirt over my head - eye of the tiger playing in the background - I'm ready for the big fight.

But I also feel like I already got beat up because I had to strong arm my REI into putting off the IUI by a day.  (husband couldn't do it today and they wanted to push it up instead of back.)  She was afraid I would ovulate first and miss the window - I really wanted a second follicle out of it.  (They're both on the closed tube side anyway.)

We have a saying in medicine about patients when "they know enough to be dangerous".  We generally refer to this when we are talking about patients that dictate their own care in a way that we would not recommend.  Generally this is a person who is intelligent, educated in a non-medical field and has their own ideas about exactly what should happen.  I'm not talking about people making educated decisions after talking with their physicians  - its more like husbands who want to deliver their own babies at home because they read a book on childbirth and saw how to do it on you tube.

Some people trust Dr. Google more than their physician.  There is nothing wrong with searching the internet and trying to gain education.  Goodness knows I've learned a lot about infertility from blogs and websites written by the people that have experienced it first hand.  But if someone is coming into my office I am tayloring my education and counseling to that persons specific problem.  Google gives the same information to everyone - and most of it is not quite accurate  - and some of it is just plain wrong.

Maybe its just me but I love it when patients come in with a list of questions that are burning in their head after their online searches - it gives us lots to talk about.   But I think we as physicians universally hate it when we feel that a patient is dictating their care in a way that we feel is unsafe.  (no sir  .. . I would not recommend delivering your baby at home . . .yes I understand you took an infant CPR class already but I am concerned for your wife and child's health because if something goes wrong it could be bad)

So I am wondering if I am being one of those people?  The poor infertility doctor literally has less time in practice than I do.  I was also quite a precocious medical student and resident when it came to infertility because thats what I thought I wanted to sub-specialize in.  (turns out I'm more of a surgeon and I was too tired after residency to keep going).  So in short, I know a thing or two about infertility - but of course I don't know nearly as much as she does.

I have had 5 cycles to figure out follistim.  She has had hundreds of cycles across many patients.  Who am I to tell her that I think the timing of the IUI is off or that I think we would do better if we waited longer.  I am to an extent dictating my own cycles.  Fortunately she is willing to listen to me and I her.  If she tells me strongly to do something I will do it.  I just hope I am not a pain in her rear and I also hope that I am not screwing myself.

I saw someone different yesterday because my RE is out for a week.  Someone who I went to residency with and who I like and respect.  I think she was seriously internally rolling her eyes at me for coming up with my cockamamy plan after dissecting the stats about ovulation timing and sperm survival from my infertility textbook from yesteryear and how that overlays and interacts with my husbands call schedule.

Does this make me crazy?  Partially.  Does infertility in general promote some degree of an anxiety disorder  - probably (but thats another post).  In the end though, I have to be happy with the decisions I made and how I prepared for the fight.  When I step into that ring tomorrow - win or loose I will at least know that I am ready.  There is something slightly empowering about it during an experience that has taken away all control.  Most of all though - I hope I am right.