Saturday, March 12, 2011

An Indiscretion During An IVF Cycle

Dear Readers,

From time to time I receive letters from women who have no where else to turn for advice. Some months ago I received this letter. In this case, an indiscretion is causing this woman a great deal of anxiety and her positive IVF cycle result hinges on my being able to reassure her as best I can. A physician can never allow moral judgement to get in the way of medical reasoning. Yet, a physician also has to consider the mental health of their patients, hence the final advice that I give in the following Q&A. Even though the letter writer gave her permission to publish, I have changed dates/times/text to give it further anonymity.



I'm not sure where else to go. My husband and I have been trying for X years to have a baby. He has some viscosity problems and motility is low also with some abnormalities. We have been put on Letrozole, we have done IUI's, we have done X# IVF/ICSI cycles and X# frozen cycles...all have failed.

Our private life has become a trial and I have been unhappy with it. Our doctor put me on Letrozole on *** 30th for 10 days, we were to try on our own and then do another Single embryo FET. Stupidly and sadly I had an affair on *** 11th. I felt sick about it. I had my HCG shot on *** 13th. My husband and I tried the following day and the next day. I then had the transfer on *** 18th. By ***1st I had blood work. The next day they called to tell me I was pregnant with HCG level at 70. Four days later on the 5th another blood test which was reported at HCG level of 600. My doc thinks it's either twins, although he could only see 1 sac.

My concern is that it is not my husband's, as he has never been able to get me pregnant. I am thinking of taking steps, though I'm not sure how at this point to terminate. What are the chances it could be another man's, and what do you recommend? It was a horrible mistake and I just don't know who to contact or where to go from here. Please Help. Writing from ***.



First let me say that I avoid moral judgements so my opinion is based on reason alone.

There is no way to know 100% if by some odd chance your pregnancy is a result of your indiscretion. However, FET cycles are very strictly scheduled and timed because there is only a small window where the embryo can be transferred and implant. Even 1 day too early or too late could cause the cycle to fail. In addition, there is only a 12 hour window for fertilization to take place after ovulation.

The HCG was given to induce ovulation and since the ovaries are monitored with an IVF cycle, it is unlikely that you ovulated prior to the HCG. So, that means that your indiscretion was not timed appropriately for you to become pregnant. Despite the fact that you don't feel like you can become pregnant with your husband, your doctor has done what it takes to help you achieve a pregnancy with him and my professional opinion is that there is certainly a good chance that you could become pregnant with your husband's sperm. Therefore I think that for you to even consider terminating this pregnancy would be a big mistake. I would celebrate it with your husband, not think about the indiscretion any more and move forward with your life. If you went forward with the termination, I feel that not only would you have the guilt of the indiscretion, but you will also have the guilt of the termination. That is a LOT of guilt to have to bear.

Although the ultimate decision lies with you, I do believe that you'll be better off to put it behind you and celebrate your success.

Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

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