Re: Ob: IVF candidate
From: Gordon Goldman (obgyndoc@swbell.net)
Mon Sep 29 22:53:50 2008
Garry,
I think I come down on Joanne's side on this.
If that lady walked into my office, I would probably send her down
the hall to that SOB I hate so much.
Alternatively, you might refer her to El.
Gordon
On Sep 29, 2008, at 10:36 PM, Joanne Bulley, MD wrote:
> 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
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