Pregnant with multiples and she chose to reduce to one baby. This is why.

Shelby Van Voris Monday 5 November 2012 12:57pm

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Shelby chose selective fetal reduction.

Desperate to be a mother, Shelby Van Vonis became pregnant with multiples as a result of IUI. She was then faced with a heartbreaking choice of whether or not to reduce her pregnancy to a single fetus, in order to protect her own life and ensure safe delivery of the remaining baby.

The difficult of her decision was only compounded by the fact Shelby’s partner was a soldier serving in a war on the other side of the world. And like all partners of front-line soldiers – Shelby could never be completely sure he would return.

Shelby chose to reduce to one baby. This is why.

By SHELBY VAN VONIS

I found in a truly difficult position: facing fertility issues and the possibility I could lose my husband to a war on the other side of the world. These are confusing and frightening prospects for a woman wanting to have a baby with the man she desperately loves.

With that, we decided to put my husband “on ice” and we would try IUI (inter uterine insemination) one time while he was deployed. The remainder of the sperm would be our “insurance policy” should something happen to him, as a means of IVF.

I admit, I went into this process blind. I did some research on the matter but I figured that’s what we were paying the doctor for. He was well aware that we were unwilling to consider a high-order multiples pregnancy, to which he told us “could not happen in your case”.

In March 2008, I began an injectible fertility medication to increase egg production; every 2 days, I had an ultrasound to check the number of follicles I was producing. During one appointment, my doctor condescendingly said to me “are you even taking the medication? You have nothing, this will never work. You are wasting my time.” With that, he increased the dosage of the medication for another 3 days prior to insemination. I think this was the point I was starting to worry I truly was wasting my time and money, his time I could not have cared less about.

The morning of insemination, my fertility doctor said this, which dashed every hope I had of becoming pregnant: “you aren’t going to get pregnant, one, possibly two follicles. You didn’t take the medication did you?” I had the puncture holes on my belly to prove I was taking the medication. Despite his reservations on my use of the medication, he performed IUI two days in a row and told me not to expect much.

Following IUI, I assumed I wouldn’t have that coveted double-lined stick take photos of and share with family. Plan B was we’d wait until my husband returned so I could discuss options with him in person, rather than during static-y calls for 5 minutes a pop. I did not get the opportunity to speak with him daily, it was as time & safety permitted. Some conversations were crystal clear, others sounded like he was in a wind tunnel.

Our main form of communication was email. I emailed him my lab results, bills, anything that he would normally see during the process, so he was as involved as he could be from 8000 miles away. Within 7 days of IUI, I began getting sick, I have equated the sickness I experienced to what someone suffering from Bird Flu might experience. Wretched does not begin to describe how I felt. I used the last pregnancy test, I should have bought stock in Clearblue easy, assuming I was coming down from all the hormones I was pumped full of…it was positive! I was elated! I raced to my neighbor’s house with the test and showed her, she squealed and said “that’s REALLY positive, I’ve never seen one that positive at 4 weeks???” This comment was foreshadowing what was to come.

Shelby chose selective fetal reduction.

Seven days later, I went to my fertility doctor who was excited I was pregnant, but unhappy to report I was pregnant with HOM (high order multiples). He was concerned, my blood pressure was extremely high. Immediately, I was told to go to the perinatology clinic in town for an exam. After the exam, I was admitted to the hospital for high blood pressure & dehydration. I refused medication, as I did not want to take any risks.

Once I received fluids and slept some, I was released. For the remainder of first trimester, I saw three perinatologists getting opinion after opinion. I carried around index cards with descriptions of each, and summaries of their diagnosis. I emailed all of those notes to my husband, who would then respond with his questions to either myself or the doctor. It was quite the merry-go-round trying to get the all of the information to my husband.

Thankfully, the year prior to getting pregnant, my husband and I discussed the “what-ifs” of fertility. Being in public health, it’s my job to assume the worst. We agreed if we became pregnant with more than 2 fetuses, the risks were just too high and we would selectively reduce the pregnancy. But, this discussion was worlds away from what we assumed reality was: in our minds, we’d get pregnant with one, have a second a few years later and possibly adopt years after that.

When I was told I was pregnant with high-order multiples, I remembered that conversation with my husband and relied on that to carry me through the process. I am thankful we had a discussion, because on a clear day, anon-hormonal, non-emotional Shelby read about the risks of triplets and quads and knew I did not want to take those types of risks. The “if” somehow happened…and never in a million years would I have told you 4 1/2 years ago I’d be in the shoes I am today.

Given all of the information about my health, I knew I had to act fast. I agreed to return to the hospital for fluids and monitoring of my blood pressure biweekly, at it’s highest was 200/154 (I have been told several times, I should be dead). In the meantime, I spoke to several of the worlds best perinatologists and maternal-fetal doctors and found Dr. Mark I. Evans in NYC through several scholarly papers on selective reduction. I contacted his office, explained to the staff my situation. I made an appointment and Dr. Evans called me to get the particulars on my situation.

I explained as much as I could, but didn’t want to know much more about what was going on in my womb, by doing so I was disconnected from my pregnancy. I just wanted to survive the process and become a mother. But, I firmly believe that was the point I really did become a mom–I had to make a very difficult decision with my husband, who was away at war. It was an excruciating process: what if we decided to wait and see if my blood pressure got better, what if we reduced to twins…what if my husband was shot tomorrow…what if I loose the whole pregnancy? So many questions and I had such a short amount of time to decide.

My gut told me to reduce to one, my perinatologists (all three of them, not in the same office) agreed that one would give me the safest possible outcome. Finally, when I flew to NYC with my mom and asked Dr. Evans, he said one was the safest choice. So, we decided to reduce to a singleton and stuck with that. My child was born JUST shy of 36 weeks, so I feel so lucky that I made the choice to reduce to a singleton.

Dr. Evans had told me several times that after the procedure, women can experience a variety of emotions and not to hesitate to discuss those with him if needed. I am not ashamed to say that with the sad, came relief. I experienced a lot of “oh my god, what just happened” to “I am going to connect with this pregnancy, I AM PREGNANT!”. The emotions were intense and extreme, the excitement of a pregnancy countered with the confusion of what could have been. All of these emotions Dr. Evans told me could occur and to talk to him or his staff about them anytime. I took advantage of that and chatted with them a number of times. I do feel deeply connected to Dr. Evans, he rescued my pregnancy and saved us from demise.

First trimester, I was utterly disconnected to my pregnancy. I didn’t feel pregnant and I didn’t let my head go there. Sickness, exhaustion, hospital visits, the war and the sadness took it’s toll on me. I almost felt trapped by something that was consuming me. However, once the procedure is over, Dr. Evans flipped on the television screen so I could finally see the fetus growing inside of me.

I cried…and I cried a lot in the following days. I had never wanted to be in a position of making the hardest decision of my life; but I also did not want to be responsible for causing the demise of another person or myself. The risks of high-order multiples were just too great for us to consider.

A lot of people question whether the financial, social, emotional aspects of choice are relevant and/or valid. I believe so. Setting my own medical complications aside, I felt like I was always staring down the barrel of a gun: the wars in Iraq and Afghanistan. As my husband had been to war previously for a year, this time for 15 months, I knew he would return to war once again. Every military wife stares at government vehicles driving by wondering “are they looking for my house? has something happened to my husband?”

How could I even consider managing 3 children, possibly one or more with health problems, when my husband was either at war or disabled himself. My parents work, his parents are not capable of helping us…so, I think the mental toll of this pregnancy did cross my mind. I know that a child changes a parents’ world, in a wonderful and awe-inspiring way. But, what if both parents weren’t there or capable of even parenting? What if I lost my husband? How would I cope?

I went through the worst battle of my life during first-trimester. I was depressed, I was angry with my fertility doctor, and I was worried that I would loose everything: my pregnancy, my husband and my own life. I wouldn’t wish this situation on my worst enemy. So, now that I’ve explained all of this, can you possibly understand how I feel pride in my choice and pride that I survived? I will never be shamed into thinking otherwise, nor should anyone else.

Shelby is a mother, a public health consultant, a military wife and runs the website mother-to-one.com.  She was interviewed for 60 Minutes piece, “The Impossible Choice” on selective reduction aired May 20, 2012.