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Re: Ob: IVF candidate From: Joanne Bulley, MD (islesannie@gmail.com) Mon Sep 29 22:34:57 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Gordon Goldman: "Re: Ob: IVF candidate" Previous message: Efrain Ramirez: "Re: 12 hour PROM and GBS" In reply to: Garry E. Siegel, M.D.: "Ob: IVF candidate" Next in thread: Gordon Goldman: "Re: Ob: IVF candidate" Reply: Gordon Goldman: "Re: Ob: IVF candidate" Wait a minute ... She has had 3 premature deliveries ... now has a prior classical CS with dense adhesions ... and another twin pregnancy with increased for yet earlier delivery. She already has 4 living children. At what point does the MD, ObGyn specialist have a responsibility to say "you have 4 healthy children - a twin pregnancy is going to increase the risk of yet an earlier delivery (not to mention uterine rupture and loss of both the babies and the uterus and difficult emergency surgery) .... maybe you should not have more babies."? OK - I have not "done" Ob for 10 years - but this one seems like she needs to be happy with the family she has - not have 6 children to raise. I am probably biased here toward the globe having enough humans ... and that is part of why I quit doing tubal reversals and would never make it in an IVF clinic. I would continually be saying "and just WHY do you and this globe need more babies after you have had 2?" I am interested in seeing what those doing OB say - and that may include telling me I am off base here! Joanne At Mon, 29 Sep 2008, Garry E. Siegel, M.D. wrote: > >Here's a case for discussion: > >41 YO P1414 with no medical problems or issues. I have cared for her >only in her last pregnancy, and the history is from the reliable >patients, as opposed to records. > >Ob #1 32 week Monoamniotic twins, IUFD, C/Section > >Myomectomy > >Ob #2 36 week C/Section (PTL) >Ob #3 Term C/Section >Ob #4 35 week C/Section (PTL) >Ob #5 First trimester missed Ab, D and C >Ob #6 36 week C/Section, PTL, Classical due to densely adherent bladder > >Subsequently, she had an apparent ventral hernia of some type, and >underwent an abdominoplasty and the general surgeon did not find a >hernia. While in the OR I did a Pomeroy TL via the laparotomy. > >She now has sought IVF and is planning to do so. She ideally would want >a twin pregnancy, as she wants two more children. > >Obviously, she is at risk for surgical complications at laparotomy, AND >increased risk of uterine rupture, premature labor, hysterectomy, and >abnormal placentation. > >She asked (paraphrased): > >If we could predict this, and I had enough embryos, should I "shoot for" >a twin pregnancy, versus two separate singletons to have two more >children? > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- Joanne Bulley, MD solo gyn Keene, NH Next message: Gordon Goldman: "Re: Ob: IVF candidate" Previous message: Efrain Ramirez: "Re: 12 hour PROM and GBS" In reply to: Garry E. Siegel, M.D.: "Ob: IVF candidate" Next in thread: Gordon Goldman: "Re: Ob: IVF candidate" Reply: Gordon Goldman: "Re: Ob: IVF candidate"

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