Reply of the author

Abstract

In response to the query from Dr. Hecht, I agree that a formal informed consent is beneficial when a physician initiates treatment with gonadotropins. In reflecting on Dr. Strong’s statement, one must consider the emotional turmoil of the infertile patient about to receive gonadotropin injections. This emotional state is compounded by a host of anxiety-producing factors, including childlessness, the fear of failure, fear of the injections and their side effects, including cancer, financial worries, husband’s frustrations of having to perform on demand, marital discourse and all to often—frank depression. For patients in this high anxiety state, who have endured years of infertility—envisioning themselves pregnant with one, let alone multiple gestation of high order—is often an impossible stretch of the imagination. They have no idea how they would relate to a fetus/fetuses growing within them. They are not in the right state of mind to make the difficult decision of undergoing selective reduction should they conceive with a certain number of fetuses. Furthermore, even if they indicate their hypothetical resolve to the physician, they are likely to reconsider and even reverse their approach once faced with the real dilemma. No, Dr. Strong, the doctor-patient relationship in our field is all but “silent,” as one of your references suggests. It is out of respect, commitment and above all—compassion to our patients, that after presenting them with detailed information on the drugs we are about to use, we stop short of compelling them to make such difficult, yet totally theoretical decisions, while supporting them through one of the most vulnerable periods in their life.