Posted by: thatjen | March 25, 2005

Good Friday? The Jury’s Out – Part 2

Noteworthy item #2: We met with Dr. Reserved (our RE) today, and the outcome of the appointment didn’t please anyone. The conventional thinking on partial molar pregnancies these days is that you need to wait 6 months after your beta is negative to try again, as a precaution against the small but real possibility of recurrence. However, from all the Googling I’ve done, there’s no evidence that the risk of repeat moles changes at 3, 6 or 12 months. It’s not until you get to some absurd timeframe like 3 years that the risk drops appreciably — and we’re talking about a risk of less than 1% to begin with. I’m willing to wait a few months to allow my body to recover and for the methotrexate to clear completely, but any longer than that seems cruel and unjustifiable.

Armed with this knowledge, Cait and I went into the appointment with the intention of trying to get him to agree to 3 months instead of 6, but apparently he came into the meeting with the idea that we were going to debate 6 vs. 12. Guess who won? He was willing to listen up to a point but did not want to budge on 6 months. He finally said to me, “I’m going to cut this off or we’re going to keep going in circular arguments.” I kept asking him to justify the need for the extended wait, and he couldn’t/wouldn’t provide one, but said that it was the standard of care and he had a responsibility as a physician to be prudent. I showed him a Japanese article that suggests shorter waiting times don’t lead to worse outcomes, but he was dismissive, saying different countries have different approaches.

He did agree to double-check with a colleague and see if he would support a shorter wait – but since this is the guy who’s been advising him all along and we haven’t liked his input much so far, we are not hopeful. However, the receptionist saw how upset I was when we went back to the waiting room and got Nurse Cheery to meet with us (behind closed doors) and she said she’d try to get another doc in the practice to weigh in and possibly help our cause. So there’s some hope, but it looks like there’s a strong possibility we won’t get to insem again until September or October — one year after the D&C.

I would just like someone to provide a rational explanation of how the extra wait can benefit me. I only see the harm.

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Responses

  1. I’m so sorry that you have to go through this. My mother had a molar pregnancy 2 years before I was born (at the time my brother was 2). This was in the 70s in a rural area, so she didn’t know what was wrong until she went into labor at 6 months. I am hoping and praying that your doctor will be conscientious enough to follow the protocol advocated by more current studies rather than simply following the protocol that has been in place for several years.

  2. Ugh, your poor mother. I can only imagine how much worse it would have been if it went on longer. We’re really grateful that medical technology has come as far as it has, because the only reason we found out anything was wrong was an ultrasound. I had tons of symptoms right up to the day of the D&C, even though they think the baby had been dead for over a month. Who knows when my body would have figured it out — and how much more invested in the pregnancy we would have been?

    Thanks for your thoughts.

  3. Oh Jen, believe me I know EXACTLY what you are going through. My doctor, who is a molar pregnancy specialist (as in, that’s the only thing he does) wanted me to wait 12 months post D&C and simply would not reconsider. He even said he would be more confortable with 12 months post 1st negative beta but he was willing to go with the post D&C criteria.
    We started trying 8 months post D&C (which was about 6 mths post negative beta) even without his go ahead because we just couldn’t wait any longer.
    I know just how stressful those appointments were and I used to cry and cry when we came out of his office because he would never say what I wanted to hear. I guess it’s their job to minimize the risks but it is our body and if we are well informed it is our decision. He won’t make you have an abortion or anything if you go and get pregnant without his go ahead.
    Sorry this got so long. Many hugs

  4. Thanks, Ana. I know you do know how it feels.

    Post D&C? That’s interesting. I haven’t seen any US recommendations that start counting at the D&C. I kind of like that, since 6 months post D&C is NEXT MONTH! But I know he won’t go with that. He’s counting from the first negative beta (and thinks THAT is generous because some doctors count from the 3rd weekly zero beta).

  5. Apparently he considers that the mole was effectively evacuated at the D&C and it just takes some time for the HCG to leave your sistem. Had the mole regrown though, and had I needed chemo, he would start counting from the first negative beta then.


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