Pointer 9: Make Decisions In A Timely Manner.

            Making the right decisions will enable you to up the odds of getting pregnant when you thought you couldn’t.  Since our last edition, we have found that decision-making is central to all of what we profess is this book, so important that we made decision-making a unique pointer.  When couples seek our help, what they want to accomplish in their sessions might be getting in touch with their feelings or changing their thinking, but all for the purpose of enabling them to make decisions about their treatment.  No one would suggest that infertility counseling should not focus on thoughts and feelings—well adjusted, thoughtful couples make the best patients.  But more importantly, you and all the couples who seek our advice and read our book need to take action and make good decisions, decisions that will enable you and them to get what you and they hope for:  a baby in your life.

            Often decisions are easy ones, like what month you will begin treatment, or how many months you will try clomid before you move on to fertinex, or who will give you shots.  But, although most couples would find these decisions quite simple, we have seen countless couples who found even those decision hurdles almost insurmountable.  The McCallisters, both school teachers, talked for many sessions about the ideal time for treatment—summer was hard because of family commitments, September was impossible and Christmas was no good.  The Bermans focused on when they should move on to injectables.  Was three clomid cycles enough and eight too many?  No amount of reading or surfing on the Internet could help them decide.  The Grillos almost cancelled a cycle because Sam couldn’t do the injections, Lilly didn’t know a soul who could give the shots and the nearest hospital was forty miles away.  

            In some ways, making the decisions represented more than they were—perhaps realizing finally that pregnancy wasn’t going to occur without assistance, that some of life is out of one’s control, and that there are no absolutes about treatment.   Unfortunately, the McCallisters have still not found the perfect time. They are unable to make a decision.  In contrast, the Bermans, having become as educated as they could,  have made a plan and, factoring in their age and their insurance coverage, have arrived at the decision to do six clomid IUI cycles before moving on to injectables.  The Grillos decided to bite the bullet and paid a nurse to give Lilly her injections.  That decision was a good one—they are the proud parents of twin boys.  Would they have become pregnant if they had decided on another choice, like Sam forcing himself to do the shots or Lilly introducing herself to her neighbor?  No one will ever know, but in fact, at this point, Lilly and Sam never think about that decision, they are so busy with their boys.

            Some decisions are infinitely more complicated and are time critical in nature.  In this case, timing isn’t everything but certainly a big part of the decision.   The decision to use a particular egg donor, for example, often must be made fairly quickly.  Cara and Mitch have been presented with a number of donors who seemed on the surface to meet their requirements.  Yet, every time, Cara whines, “This is such an important life decision; what we do will determine who my child will be.  We need more time and more information.”  They pass on each donor and then, months later, usually after they have been presented with a new profile, wish they had selected the donor presented previously.  Cara and Mitch are frozen.  Even though they understand that the nature of the procedure at this clinic is that they have to make fairly quick decisions, they are unwilling to go to another clinic that works differently or to recruit a donor on their own or to work with a donor broker who might be able to provide them with more detailed information.  Because they can’t change their thinking or get in touch with their feelings, they also can’t make a decision—to accept a donor, to change clinics, or to move on to adoption.  They can’t put into action the decision-making techniques we’ve been helping them master because they really aren’t ready to use an egg donor.  Once they face the fact that no “perfect” donor will arrive nor will Cara’s eggs rejuvenate themselves, then they will be ready to select a donor.

            In contrast to Cara and Mitch, the Hollands are model decision-makers.  They made choices about treatment options, clinics, insurance plans, and even whether to freeze excess embryos.  The last decision they had to make was one that took them by surprise—whether or not to undergo a selective reduction from four babies to two babies when they found out that they were pregnant with quads.  Probably no amount of projecting themselves into a less than ideal future would have prepared them for this decision--one that had to be made in less than two weeks.  Using all the previous pointers: gathering information, partnering with their doctor, talking to others who have reduced to twins and those who have delivered quads, as well as speaking to  their minister and us, the couple decided to reduce to twins.  They knew that the procedure was risky and they knew that they might feel sad and depressed during the pregnancy and even after,  but the Hollands made a decision quickly and definitively.   The odds were on their side and happily they have given birth to two healthy girls.