I have an announcement. It’s a big one. In fact, it’s HUGE. So prepare yourselves, sit securely in your seat, this is going to Blow. You. Away.
I have started charting.
Um, so maybe it’s not that big an announcement. And my chart doesn’t look like much yet. But I’ve never done it before, and to be honest I didn’t think I ever would. It’s just not that big a deal in the Land Down Under and in my experience it’s not common for TTCers to take temperatures, chart cervical mucus and analyse graphs. In the end I made the decision to chart because the inactivity of my last 2WW almost drove me crazy, and I hope that the small daily act of charting might give me a sanity-saving – although totally false – sense of control.
This difference between Australia and the US made me think. One of the things that I have noticed from all my blog reading is the difference in fertility treatments between Australia and the US. The drugs are much the same, and some of the protocols are similar, but the process itself is totally different.
To start with, unless they have specific gynaecological issues, most childless young women here do not have an Obs/Gynae. They see their GP for pap smears and the like. So right from the start of the IF process we are referred to a Fertility Specialist.
And that’s another thing. In the Land Down Under our IF docs are trained O&Gs who have sub-specialised in fertility. In theory it is possible to be a fertility specialist by training as a physician, specialising in Endocrinology, and then sub-specialising in reproductive endocrinology, but I don’t personally know any doctors who have done that.
Then there is the amount of monitoring throughout a cycle. I’m doing 4 cycles of Clomid, with no monitoring except for one blood test on CD23 (LH, β-hCG, Progesterone). This suits me, although sometimes I do wish there was more monitoring just to give me a sense of purpose! I’m sure I would get more monitoring if I was doing injectables, but even so… you gals in the US sure do have to undergo a lot of blood tests and ultrasounds!
In terms of IVF, the level of monitoring seems more similar. But the big difference is that in Australia and New Zealand it is uncommon for a FS to transfer more than one embryo. They will only do it if, after lots of discussion, the couple absolutely insists. While it is common for REs in the US to routinely transfer two or even three or four embryos, any FS who routinely transferred two embryos would be considered a renegade, and to be honest would probably find it difficult to get a job in any major clinic. They are absolutely prohibited from transferring more than two embryos. Fertility clinics consider multiple births a blight on their reputation, and the aim is always one healthy baby and one healthy mother. Which system is best is a matter of opinion. Based on some (admittedly haphazard) research our rates of pregnancy per IVF cycle are lower (around 30% per egg retrieval), but so are the rates of complications. There are two main IVF clinics in Melbourne, and they differ slightly. The pregnancy rates and hyperstimulation stats are roughly equivalent, but the clinic my FS is linked to base their model of care on day 2 transfers and do less monitoring than the other clinic.
To be honest, despite the fact that I like to feel proactive, the relatively non-invasive treatment plan suits me. I work at a job that is almost totally inflexible and getting time off for appointments can be tricky. Doctor’s appointments play havoc with my psyche because although I usually feel reassured after one, I feel uniformly anxious beforehand. If we need to move on to injectables or IVF I’ll do what it takes to make it work, but in the meantime I’m enjoying the sense of normality that the system here provides. That’s one of the reasons that I chose to see a FS linked to my particular clinic – the less disruption to my life the better!