Thoughtful Thursday: Prevention

July 30, 2009

Note: There’s still a winning answer (and therefore a pottery prize) available for my Blogoversary Contest. Go submit your guess right now! We’ll wait…

Answer submitted? Good. Okay, time for Thoughtful Thursday.

Thoughtful ThursdayAs you may recall, last week I quipped about the reactions I might get if I went to the drugstore to buy condoms.

As much as I’m sure you would all have enjoyed whatever happened, my fuse is too short right now to deal with wisecracking clerks. I told DH that he’d need to go to the store if he wanted to take advantage of the temporary respite from pelvic rest — but that I could not guarantee that I’d be able to overcome my concerns enough to actually use the condoms.

Always thrifty but more now than ever with the babies on the way, he refused to spend money on condoms unless they would definitely be used.

I told him that if we didn’t use them now, we’d use them eventually — if not later in the pregnancy, then certainly after the babies are born. He was dubious, but I guaranteed that we’d need them later. This led to a discussion of post-baby pregnancy prevention. Let’s continue that discussion here.

(In case you’re curious, at this point, no condoms have been purchased.)

It’s a funny idea, preventing pregnancy after years of infertility and a mind-boggling array of drugs, assessments, treatments, alternative treatments, healings, nutritional supplements, fertility charms…

Once upon a time, when I thought we were fertile, I assumed that we would practice sensible family planning after the birth of our first child to ensure ideal spacing between children. After we’d built our family to our desired number, we’d probably choose a surgical option to close the door on future conception.

(Pardon me while I point and laugh at my old self.)

Then, a subsequent once upon a time, when I knew that we were not fertile, I assumed that we would practice family planning immediately following the birth of our first child. Despite the low likelihood of conception, back-to-back pregnancies would be bad for my body and for the second baby’s health — and at that point, I had plenty of time (“You’re still young” was still true!). After a reasonable wait, I thought that we’d let nature take its course for a while, then eventually pursue more treatments if necessary.

Later, when I knew that we were really really not fertile, with basically zero hope of ever conceiving without a team of doctors, I guessed that after our first child was finally born (because I never stopped believing that treatments would eventually succeed if we tried long enough), we’d try for #2 without intervention just long enough to satisfy the doctor’s and the insurance company’s requirements, then jump back into treatments.

More recently, when I knew that I was pregnant with twins but did not yet know the sexes, I decided that I would never go back to treatments, but that if the babies were the same sex, we’d let nature take its course after they were born. It’s not impossible that given a decade of trying, a woman in her early-mid-30s could conceive a baby boy unassisted after having twin girls, or baby girl after twin boys. Not impossible, not likely, but somewhere inbetween. For the record, DH prefers to stop at two children, but would have gone along with this, knowing that I’ve wanted the experience of parenting a son and a daughter, if at all possible.

Then, most recently, since finding out that we are having a boy and a girl, I just don’t know anymore. DH is 100% satisfied to end our family building efforts with these two. I am probably satisfied, but I am currently unwilling to make a final decision. Maybe raising twins will scare me away from having any more children, or maybe I will yearn for more. We have firmly agreed that, assuming these babies successfully enter this world, we will never go back to treatments (hallelujah!). We will also prevent conception for the first year or so after the babies’ birth, for the health reasons described above (hence the guarantee that the condoms will eventually get used). But prevent conception forever? Or let nature attempt to take its (likely futile) course? Not a decision I can make today. But maybe some of you have your minds made up…

If your family-building efforts are complete, have you taken steps to prevent future conception, even if conception is extremely unlikely? I’m sure that infertiles will have very different answers than those who have dealt with recurrent pregnancy loss, that long-time infertility veterans will have different answers from those who struggled for a shorter time, and that those who needed third-party reproduction will have different answers from those who conceived with their own gametes and body parts.

If you are still family-building, what plans have you made in your mind for future pregnancy prevention, however distant and unnecessary it may seem? (Building off Mel‘s metaphor of having an empty seat at the table…) Once you have filled all of the seats at your table, will you take steps to ensure that you don’t need to pull up any more chairs?

24 Responses to “Thoughtful Thursday: Prevention”

  1. Wishing4One Says:

    LOL… i have never thought about preventing, ever. You are so much more responsible and sensible than I, I just hoped to get pregnant and never thought beyond that, about spacing pregnancies that is. I guess if we are ever successful, and have a child or two or three at once we would definitely wait at least one year to do IVF again. Condoms, don’t need em ever again, no tubes here…

  2. My husband and I have been talking about this lately. After a decade of trying to conceive (with no luck) and finally moving onto donor embryos (with luck) I feel as though neither of us has to worry about prevention after our babies are born. However, he wants to have a vasectomy. I see no point in this and don’t want him to do it, but he is adamant. I could understand his reasoning if we had conceived using our own eggs and sperm, but we didn’t, so it makes no sense to me.

  3. Nishkanu Says:

    After 5 years of intensive treatments (including 5 IVF cycles plus 3 DE/IVF cycles), I am pregnant with DE baby #1. So at this point a) we would really like to have more kids b) DE or adoption seems to be the only route c) I have never gotten pregnant without IVF (male factor + egg quality issues) d) I am 40 so the remaining chances of an oopsie reduce dramatically every year. So our plan if the doc asks us after delivery what our plans for birth control are is to laugh hysterically. And what if something bizarre happens and I get pregnant soon after the birth? Gift from God, I would say. Save us $30k, the hubby would say. I don’t see any BCP at any point in our future, except for BCP pills needed to synchronize a DE cycle. And if we decide to do DE for #2 I imagine we would start early since we have learned the hard way that an attempt at DE is very different from success at DE – just wait long enough to have had some substantial breast-feeding before weaning for the DE drugs. Ditto for adoption since that is not exactly instantaneous either.

  4. Ana Says:

    No plan for prevention. Though not ideal, an oops pregnancy soon after (hopeful) birth of #1 would be a miracle that I will gladly accept. (though not anticipating any time/energy for actual “baby-making” anytime soon after!)

  5. BB Says:

    Haha… as much as I would like to come up with a “plan”, I don’t even think I can “think” about it right. With no news of baby # 1 yet… I will leave that worry for later! However, I have been on BCP for PCOS, as much as I hate to take them (since they technically mess with my natural system)… I might just have to continue them for the sake of my (PCOS) sanity!

  6. Kymberli Says:

    Not bragging here or anything, but merely stating a fact: my particular flavor of infertility isn’t so severe that an oops pregnancy couldn’t one day happen. We tried with great dedication to get pregnant naturally for 2.5 years before seeking treatment, but then Clomid netted us twins and two singletons. We chose to use BCPs after each of the pregnancies and switched to condoms when the pills gave me the crazies, because I *do* randomly ovulate every once in a blue moon. Still, we were a bit sloppy with pill/condom use, to the extent that if were backseat tango teenagers, I’m sure that a pregnancy would have resulted somewhere in there.

    Our family is complete. Done, done, done. Done to the point that to be honest, the thought of having another child of our own scares the heck out of us. Still, I hyperventilate at the thought of either one of us doing something surgical to permanently halt our childbearing abilities. It just seems so contradictory to everything I’ve worked so hard for the past decade (for both myself and others). I hate BCPs and don’t want to be stuck with condoms for the rest of our lives, but for now condoms are a necessity due to cycling for surrogacy somewhere in the relatively near future. Once I’m finished with surrogacy, I’m fairly sure that I’ll get some sort of IUD.

    Good question. This was/is the subject of blog post that I’ve been saving up for a moment that I know is coming in 1-1.5 years.

  7. Shinejil Says:

    Very interesting question, one I’ve been curious about personally and in general. Especially after hearing last night that the one woman I know IRL who did IVF after years of trying and crying, just got a surprise positive and is almost in her 2nd tri. And she’s several years older than me. And we did IUI and got pregnant both times.

    But then you read the stats (which alas have only been studied it seems for IVF pregnancies) that say that someone my age would have a 30% chance at best of conceiving another child.

    So what to do? We’ve decided to do nothing. Since we wound up (happily, very happily) with a singleton and since I’m an only child who knows that a kid can be very happy solo, we’ll likely just toss the dice and see what happens. Maybe we’d consider foster/adoption or straight-up adoption at some point. If we were to have another kid, we’d stop there, most likely with me getting an IUD or my husband a vasectomy (though he’s lukewarm about that).

    Though he’s always wanted a big family for reasons he can’t explain, I don’t. I just know I wouldn’t be able to do everything I need to do while properly raising three or four children. And we’d never be able to afford college for all of them, a huge deal for me.

  8. ^WiseGuy^ Says:

    Whoa! It actually feels like I am in a gameshow, and that every subsequent question is getting tougher than the previous one! This one TT subject is not a common topic of chatter around my house.

    I will let you on a little secret…I want three kids (ideally), and I certainly don’t want to have just one kid (the trend in my cousins)…so for me the magic figure stands at 2.

    Once upon a time, I decided to have my first at 27-28 years, and the second by the time I was 31-32. That would have given a two-three year respite between the two kids.

    The reality: I am 31, and still struggling to bring in my first. That leaves me little time to bring in the second. Even if I conceive within the next few cycles, my baby would arrive when I am past 32 years of age.

    Some things are now fixed in my mind. I would begin TTC#2 six months after the birth of the first. In those six months condoms would possibly be our best friends as well.

    After the birth of the second, I may decide to go for an IUD. I am still NOT decided on surgical prevention of pregnancy after my second.

    I am not really very sure of having a third kid, and mostly, the reason is financial. So possibly, we would end up being a 2 + 2 kind of a family. We would take steps to make sure we do not need the extra chair, but the steps would be non-surgical (as far as what I can make out about my thinking on it, right now).

  9. ^WiseGuy^ Says:

    P.S. If I change my screen name, do I get to make a guess again?

  10. Kristin Says:

    I would still like to have 1 more child. In the past, my problem wasn’t conception but carrying to term (lots of miscarriages). So, if we are lucky enough to get pregnant again, I will have to have another c-section and plan on having them take out the uterus along with the baby. Given my obstetrical history plus my family’s history of large fibroids (my mom had to have a hysterectomy at 53 due to a fibroid the size of six month fetus), I think it’s a valid plan.

  11. Jules Says:

    We’re both sure we’re done. We thought prior to TTC that two would be a good number but never occurred to us that would be at one time. Even if we wanted a third, I doubt we’d conceive naturally and I do not want to do the medicated IUI route again. My guess is I’m still anovulatory but we’re not ready to take that chance and have backup.For now I’m on BCP which I’m not thrilled about at all. (Haven’t ruled out BCP being part of the anovulatory problem)

    I’d like to have hubby get “fixed” and while he has said yes to the idea, that’s as far as he’s moved on it. Although someone did bring up the question of, horrible as it is, if something were to happen to me or the girls, then would he regret the decision.

    I like Wiseguy’s idea on getting a free guess with a new screen-name :p

  12. Ellen Says:

    My daughter and son-in-law had both (mild) female and (severe) male factor infertility. After 3 useless IUIs, their second IVF produced healthy full-term B/G twins. When the twins were 9 months old, less than 2 months after stopping breastfeeding, she and her husband were shocked to discover she was pregnant. I am an obstetric nurse and would have said this could NEVER happen to them. But it did. The children are gorgeous and healthy and wonderful, but coping with 3 babies less than 18 months apart in age was not easy. Unplanned pregnancies can have wonderful, joyous outcomes (as this one did), but if the thought makes your blood run cold, use good birth control, all the time!

  13. jill Says:

    I have two sisters, one 5 years younger than me and one 4 years younger. I always liked this spacing and figured I would try to replicate it with 2 children about 3 to 5 years apart. (Silly me for thinking of things like MULTIPLE children when I probably won’t ever even have ONE…) I’ve day-dreamed so much that I imagined myself, as a fertile person might, taking the mini-pill after the birth of my first child.

    Even though I have TTC for so long, if I got pregnant today, I would still think about preventing for about a year or 2 after the birth. It really depends on how things go. I’d love to have more than one child, if motherhood comes easy for me and my family is doing well then I may not prevent at all. If it turns out to be a struggle, I would want to focus on my child and husband and not complicate things right away (or at all) with another baby, however unlikely it might be.

    Really though, reality has slapped me in the face multiple times, so I no longer (well, I try not to) think about what would be if I ever get pregnant.

  14. strongblonde Says:

    Funny thing. I’ve been thinking a lot about this lately, too. I think that I could be totally fine with the twins and being done. Originally I thought that we would only have one to two children. BUT what’s complicating matters now is what to do with our 4 frozen embryos. I don’t know if I’m at a place where I can make that decision. Would I try again with only those and see who survived the thaw and if it was successful? Would I donate them to science? Donate them to another infertile couple? I don’t know. B doesn’t know. I feel like I can’t even think about it right now.

  15. After I had Nae and went in for my 6week appointment, I told my doctor I wanted to be put on the “mini pill” since I was still breast feeding, but I know my body couldn’t handle another pregnancy. Once we decided to try for a second, we threw EVERYTHING out the window and “had fun”. 5 years later, we sat down and had “the talk” about being thankful and grateful for Nae and maybe we were just suppose to have one child. We didn’t use any type of birth control, but it was too painful to keep hoping.

    When we finally got pregnant with Zilla and made it through the first trimester with him still alive, we talked about what our future held as far as family building goes. We hadn’t come to a conclusion until I got PPD and was put on bed rest. We went to the doctor and decided to get my “tubes tied”. It was not safe for my body to go through pregnancy and it wasn’t fair to Nae to have to take care of herself, or rely on others to do it. It was a tough decision, but we knew it was the right one for our family.

    We are done family building and I am OK with that. We’ve been on the emotional roller coaster enough during 4 pregnancies with two live births to last us a life time. I feel as if I’ve played the “healthy baby” lottery and won two times. I feel so lucky and grateful because the outcome could be SO different.

  16. rosesdaughter Says:

    I have no idea what to do. I am 33. So, even though most people say…”you’re young!” I know it took me a year to conceive the first time, I miscarried and then conceived right after the miscarriage. But who knows how long it would take to conceive again. Another year? Or would I be super fertile after birth and get pregnant right away? I don’t want to get pregnant right away for sure. Hell, I’m not even sure I want a second one yet. So, for the first year or so, I’ll have to prevent. I haven’t thought about birth control in so long, it’s mind boggling. The only question now is….how?

  17. Carrie Says:

    I have 3 children all conceived with clomid and a m/c under my belt. To be honest, I don’t want to be one of those stories my doctor told me when I still hadn’t decided on any b/c, so I opted for an IUD. Nothing is permanent this way.

    I am done having children (unless I win the lottery), but I can’t do anything surgical or permanent. It just doesn’t feel right.

  18. Wow, I’ve been wanting to blog about this since I came back from maternity leave, but you know… time. Anyway, there are a few factors going on for me.

    1. Upcoming book tour: I can’t be pregnant on a book tour. I’m not a good pregnant person, and I’d want to kill myself if I had to travel pregnant, so I’m not getting pregnant again until 2011.

    2. Embryos. Right now we have 8 embryos sitting on ice. When we first started this process, we were like, “Oh, we’ll just donate any we don’t use to stem cell research.” Then I actually got pregnant and it felt like each of those embryos was a little baby. I’m pro-choice for other people, but I do feel a responsibility to my embroyos, and I don’t think I can give them away to science. However, I don’t know about giving them away as donor embryos either, b/c it would still feel like we have children out there who are technically ours and if anything ever happened to them with their adopted parents I would feel responsible and guilty. At the same time we’re not going to have 9 children. That wouldn’t be fair to them or us. In any case, given that I already have this huge ethical dilemma, I can’t get pregnant spontaneously. Strangely enough, I feel like it would be irresponsible of me to do so w/ all of those embryos in the freezer.

    3. I’ve been thinking about the IUD, b/c I wasn’t great w/ the BC situation b/f we found out that we couldn’t have babies w/o IVF, and I really would feel terrible if our situation magically reversed itself (which I don’t think it will but you never know) and I got pregnant spontaneously. However, I’m not sure if an IUD is a good way to go since I want to get pregnant again in a year.

    4. My husband and I have discussed a vasectomy, but a long time ago, so I’m not sure if he’s still up for it. Fun conversation for the future.

    5. We’re planning for 2, but if I sell another book then we can have 3 and still give them all the lifestyle we want them to have. After 3 though, I’m done. a) I don’t like being pregnant, and b) I’m 32 now, I’ll be 34 w/ my second and 36 w/ my third. I don’t want to continue having children into my late 30s.

    Thanks so much for the great question. I feel much better about doing my own blog post now, b/c I was able to organize my thoughts here.

  19. Sue Says:

    I can’t believe I’m thinking of contraception now, yet here I am thinking exactly those thoughts! At age 38 I am finally pg with #1 after 9 years and 4 IVFs. I don’t think I want to go through the stress of worrying about genetic/chromosomal problems if I were to fall pg in my 40’s.

  20. Jennifer Says:

    I want more babies DH says we are done, which we probably are, but I would be willing to do treatment again, but the cost scares me. It was too expensive for us and we took a big hit from it. I am not preventing, but DH is. He wants a piece he has to go out and buy condoms, which he has not done yet. The chances of us getting another BFP is like 3% but you never know people have gotten pregnant on birth control and that is like 1%

  21. Carrie Says:

    Funny you should bring this up. The nurse at my MFM clinic asked me last week if during my C-section with the triplets, I’d like my tubes tied. She looked perplexed when I laughed and said, “I DON’T HAVE ANY!” So, assuming all goes well and the triplets arrive healthy, I will remain sterile with our only method to conceive being IVF.

    When we were still in the conceiving-is-easy stage of life (how naive!) my DH always said he’d get a vasectomy after seeing what a raving lunatic I am on the pill. So if I wasn’t already “tubeless” after this pregnancy, he’d do that.

  22. loribeth Says:

    I actually blogged about this, once upon a time:

    I have a friend whose sister had one baby via IVF, followed by two more “surprises.” So it does happen…!

  23. Chelle Says:

    I totally could have written this post (well, not exactly because you are a much better writer than I).

    Our family building is done with the birth of our girls and I think we have come to the conclusion that I will go back on the BCP for an undecided amount of time after the babies are born. Because I have PCOS, I need something to regulate my cycle anyway. And honestly, I am stll pretty bitter about being infertile (like many) so the thought of getting pregnant without assistance after all we’ve been through really pisses me off… even though I would obviously be ecstatic if it did actually happen, but right now, I am going to prevent that from happening. Does that make sense?

    Another thought: we have one little frozen embabie that we don’t know what we will do with. Will the birth of our girls make us want another one? Will we do an FET down the road? I’m not really sure yet.

  24. Jamie Says:

    I know, without any doubt, that I will be done having children after the birth of my twins. I have three embryos in the freezer and I am very concerned about what we are going to do with them because I know that I do not have the desire to have any more children.

    I guess one of the mixed blessings of my infertility — is that while I had to undergo 6 IVF’s to complete my family I no longer have fallopian tubes. Natural pregnancy isn’t even an option so preventing conception in any way isn’t a worry.

    Instead, I worry about embryos.

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