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Tuesday, April 29, 2008

Barren Advice: Two

This is the second installment of Barren Advice. You can ask questions that are fertility or non-fertility related.

Barren Advice is posted each Tuesday. If you have your own question for Barren Advice, click here to learn how to submit. Please weigh in with your own thoughts in the comment section and indicate which question you're addressing if there are multiple questions in the post.

Dear Mel:

I want to keep TTC, but I need some dental work. The dental work may not be complete before my next cycle, and I definitely need it done. Should I not keep TTC?

--Queenie from Baby, Borneo or Bust

You didn't specify what type of dental work--if it would be a one-shot deal or a multi-part surgery such as a root canal, but regardless, the answer remains the same: focus on one medical crisis at a time and take care of any problems with teeth and gums before trying-to-conceive.

If something (and teeth fall into this category) affects pregnancy or trying and you can address it and remove it from your plate, I would simply take care of it and move on. Once you become pregnant, teeth can also play a possible role in some types of loss. I say this with a slight cringe because so many times with loss, you are seeking an answer and there isn't a clear one. Emotionally, that can be very difficult to accept and leads to many fears in future pregnancies (or can stop someone from trying again). Studies have been done that show a correlation between gum disease and preterm labour (according to the AAP, women with periodontal disease are 7 times more likely to have a preemie). Beyond that, the hormones in pregnancy--higher levels of estrogen and progesterone--can change the way your body processes bacteria and create gingivitis even if you never had dental problems prior to getting pregnant.

You can drive yourself crazy with the what ifs that arise out of each study that states or disputes a correlation between loss and another aspect of your health. I seriously wonder--even as someone who believes everyone should be a key player in the medical decision-making process--if Google Medschooling and reading all of the studies as they come out is emotionally healthy or if it simply leads to more fodder to beat yourself up with when things aren't going as planned. Regardless, the bottom line is take a break from trying and address the dental problem simply to be done with it so you can return your focus (and give over the enormous time commitment inherent in treatments) to trying-to-conceive. And I give this advice even in the face of time and sensitivities with age and conception. When things go right, we don't have to deal with the what ifs. But I always lean with the insurance of addressing the what ifs just in case things do go wrong.

Dear Mel:

In real life, I am very open about my infertility with family and friends. As a result, I have a lot of conversations with people about infertility. A situation has arisen recently that I'm not sure how best to approach. I'd like your input: what can I do when someone tells me something about their infertility that sounds medically incorrect? I'm not talking about something like minor variations in IVF protocols, but something that makes clear that this person isn't understanding or isn't being communicated with appropriately. How might I get involved, ideally without making a total ass of myself? How can I help encourage someone to take control of their infertility in real life?

--submitted anonymously

Here's the one silver lining in being infertile in this particular situation. You can take your own experience with infertility and ask yourself what you would want to hear, keeping in mind the unique needs and desires of the other person. If the other person is extremely private and you are open about your infertility, what you would want to hear may not match what she would want to hear or vice versa. But it can be a useful barometer.

It can be painful to read or hear someone you care about stumbling around on a path when there are clear steps they could take to help themselves. Sometimes, those steps are very personal to how we view the world--we can look at someone struggling with a piece of information and think to ourselves "their life would be so much easier if they just came out with the truth rather than keeping it hidden." Other times, the steps are a different shade of grey--a person may be making choices you would never make such as not visiting an RE after recurrent losses because they don't wish to enter treatments. And still other times, those steps are clearly black-and-white: their RE is telling them that recurrent loss is okay and not running any tests or encouraging them to transfer 15 embryos at a time.

In the first example, I would always caution a person not to place their own opinions or what works for them on another person. We need to keep in mind that even with the people closest to us in life, we only have a small portion of information--whatever they wish to reveal to us. We can never be inside the head of another person or know how their previous life experiences are affecting this current decision. Therefore, do nothing. If you can't stand the decisions they are making, remove yourself from those conversations.

In the middle example, the greyer situations bring about greyer answers. I always take a step back and ask myself if they are doing something physically, financially, or emotionally harmful to themselves. If the answer is no, I move these situations into the first category. If the answer for any of the three is a yes, I sit with it longer before moving it into that third category.

The third category does require attention--if not to help them than to relieve your own guilt over watching someone you love doing something harmful to themselves. How would you feel down the line if the worst case scenario happened and you could have stepped in and helped? That said, much like beauty, help is in the eye of the beholder. Meaning, you may see yourself as helpful and the other person may view your actions or words as meddlesome. There is always the chance that stepping in will create a wedge between you and the other person. That said, sometimes I would take the wedge over standing by and watching someone get hurt.

A case in point, I had a student who was cutting herself and asked me not to tell her parents. Of course, it would be irresponsible of me to know that she was hurting herself and not pass along that information to people who could help her and needed to know. The student never spoke to me again, but I'd rather take the wedge and know that I have her eternal frustration than know that I could have helped and did nothing in case the worst case scenario came about.

Often times, people share information with us because it doesn't quite sit right with them either. Perhaps this person is sharing details with you because they want your opinion. Or they may be sharing details out of a sense of obligation or because they simply need to vent. Regardless, weigh out which category they fall into on the spectrum and act accordingly.

A handy chart to summarize...

No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely.

Leave a comment in the reaction box below--only keep in mind that conflicting advice is embraced and rudeness is not. Make sure you indicate which advice you're addressing by numbering your comment with a 1 or 2. Want to ask your own question? Click here to see what you need to send in order to be included in a future Tuesday's installment of Barren Advice


Jen said...

For the dental work, my dentist swore up and down (his own wife is pregnant) that there is very little that you cannot do during pregnacy. He said the only thing he doesn't like to do is x-rays and even that is probably okay in same doses- it is just one of those just-in-case things.

Now, that being said, I squeezed all my dental work into the two week period when I knew for a fact that I wasn't pregnant and didn't have to worry about it.

shinejil said...

If you're dealing with a long-term process (like an implant), I say get it started and then cycle. My dentist said basically what Jen's did: that very little they do would affect a pregnancy.

That said, my dentist did prescribe a sedative that was Category X, so if your procedure included scripts, make double sure.

SarahSews said...

About the dental, pp dentists thought all was okay during pg, but some disagree. Mine won't fill a minor cavity until after baby is born in 10 weeks. And if you have existing issues with gum disease, it is best to get that taken care of as best as possible before pg.

As for advice, I've been in those shoes. I've had friends and support group pals share news they found upsetting from the RE and when I heard it, it went against a lot I'd learned in our experience and own research. I used several things to help me decide if I should give other points of view, acknowledging I'm not a doctor. If the news they received impacted whether and how they would continue to TTC or not and the news didn't sound accurate -- I'd always always always recommend they get a second opinion before making any final choices. Even if it sounded like their choice was final. I'd rather throw a wrench in their immediate future than feel like they made a choice without all the best info possible since in many cases you can't take back the time wasted if you moved on thinking you didn't have any other options. And if I knew a doc who specialized in the issue they were dealing with, I'd happily point them in that direction.

I guess I'm more in the camp of sharing rather than not in hopes that it helps someone else find the answers they need.

I don't interfere if it is a matter of personal choice -- ie someone not seeking treatment for personal or financial reasons, or chosing another path because of some issue with another option.

Kate said...

i'm a bit nervous b/c I am TTC and (currently in the midst of what is now a three week wait) and had dental work done. Before I did it, my OBGYN and my dentist told me it was safe to do. (It was a root canal and crown prep and build up)

Natalie said...

Interesting that you post about dental work, since I'm getting that done right now... trying to get everything squared away while I'm not-pregnant.

As for the advice/what to say to people... I think Mel hit the nail on the head. sometimes I don't agree with the path someone has chosen, but it's not my life and everyone has to make their own choices. But if I think someone is getting incorrect information or doesn't have all the information in order to make a decision, then I'll speak up. It's up to them what they do with the information, but I want to at least make sure they know it's there.

Dianne/Flutter said...

Anonymous...The only other option that I would leave with you is that your loved one may simply be not ready to hear your comments/suggestions. Wishing you luck.

Pamela Jeanne said...

"Sometimes I would take the wedge over standing by and watching someone get hurt."

I'm with you here, Mel. This is not bad advice regarding heels over flats with calf length dresses, I'd try to (gently) set the record straight on the wrong info.

wanttobeamom said...

About the dental work: I think it depends on the dental work. I would spend some time researching the effects of that particular dental work on a pregnancy before making a decision. If it is not good to be pregnant while having the work then I would get it done quickly so I could get back to ttc. Mel had a good point about taking care of the problem so you don't have to worry about it any more.

About giving advice. I also agree that if the person has incorrect information it may be appropriate to offer unsolicited advice (while still acknowledging that you are not a medical person...). One option I thought of was offering to give your friend some websites and blogs about the same issue that your friend has (e.g. if she has PCOS give her the site for SoulCysters and some blogs of people who have dealt with PCOS for a while). That way, your friend can do some research on her own and come to her own conclusion. You might offer the websites as a way for your friend to find support and solidarity with others in the same situation... Of course, depending on the personality and circumstance of your friend this could all be assvice...

Bea said...

I know I'm way late to the party here, but for what it's worth:

The only thing I'd add about giving advice is that you can't assume you know the full story.

Perhaps it's a matter of the friend not understanding properly (as you say), which I find concerning personally, because I think patients do better when they are fully informed, but ultimately it might not make a difference to the treatment and is more of a value judgement than anything else. In any case, I don't think you need to force someone to understand something to the level *you* think is appropriate. If they are happy with their level of understanding, back off! If you think their level of understanding is dangerously bad, you could encourage them to question and increase their level of understanding by asking them questions. What are the pros and cons of that course of action? Etc etc. They may not care about the answer at the time, but they may go away and decide to ask at the next appointment.

However, the friend could also be withholding info for personal reasons. I know we agreed not to reveal our diagnosis to friends and family, and that left one friend in particular questioning why we were doing the things we were doing. It didn't make sense to her, but of course that was only because she was missing major pieces of info about our medical situation. I know others who have said their infertility is "unexplained" or who have made up some answer in order to cover for the infertile partner - so even those giving an answer may not be telling the truth.

The friend who tried to give me advice really pissed me off. She meant well, and I could see her "choosing the wedge" because she thought it was right, but actually she just had no clue. I told her directly, several times, that the situation was under control and that I was not in need of her suggestions, yet she persisted - because what we were doing didn't make sense to *her*. So yes, give your advice, but be sure to explicitly acknowledge when you give it that you may be missing an important part of the picture, and then, having given it, don't keep beating that horse. Your friend will follow your advice, or not. If not, be prepared to let it go, and don't demand to know why.

The best "nutshell" advice I would give is to try and rephrase as a question. eg. Instead of, "I think you should..." say, "You don't have to tell me the reason, but is there a reason you're not...?" You could also get bold and say, "I'm worried that you're not getting the best treatment because... Is there something you can tell me to put my mind at ease?"