Re: Ob: IVF candidate
From: Dr Eberhard W Lisse (el@lisse.na)
Tue Sep 30 01:35:29 2008
Why send her to Namibia?
We are not as bonkers here as you guys are.
el
On 30 Sep 2008, at 06:19 , Meenan, Anna wrote:
> I'm with Joanne and Gary. I vote for no further pregnancies. The
> American health care system can't handle too many of this kind of
> pt. Send her to Namibia. It was good enough for Angalina Jolie,
> after all.
>
> Anna Meenan, MD
>
>> 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
>
--
Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell)
PO Box 8421 \ / Please send DNS/NA-NiC related e-mail
Bachbrecht, Namibia ;____/ to dns-admin@na-nic.com.na
