Get pregnant now or later?
April 17, 2008 3:53 PM   Subscribe

Marriage, illness, medication, bad timing and having children - what should we do?

This is the situation - we've been married three months (I am the female half). I'm 29, he's 39 and really wants to be a dad. I want to have kids as well but time is not pressing so much for me. Or it wasn't, until recently:

Just before we got married, my now-husband was diagnosed with a fairly rare blood condition (a myeloproliferative disorder - polycythaemia), which is essentially benign and can be kept under control. However, his condition has developed such that he is now producing too many platelets so the doctors want to put him on a chemotherapy drug (hydroxyurea) which will keep his bone marrow activity in check. This means he won't be able to try for children while on the drug, and he could well be on the drug for ever. He hasn't started on the drug yet.

In the meantime, I've had a recurrence of gallbladder problems - I have multiple small stones, which don't cause me any problems as long as I don't eat fat - if I do, they cause me very severe pain. No jaundice or fever has accompanied my attacks (yet). I've had a scan which has confirmed the stones, and will be seeing the surgeons soon.

My husband is storing some sperm at the hospital before going on this treatment. Our options seem to be:

1) wait until my gallbladder is taken out then try to get pregnant with stored sperm (which is of good quality, the sperm-storing doctors say)

2) as he's not on the drug yet, try to get pregnant now and take the chance that my gallbladder problem will worsen during pregnancy (my GP couldn't give me much advice about this except to tell me they wouldn't normally operate on a pregnant woman)

3) ask about 'holidays' from husband's drug

4) investigate the possibility of him taking another drug which will make him feel like crap but which doesn't cause sperm damage (interferon-alpha)

I'm having a lot of low-level stress about this (so is husband). Things I'm worried about:

a) a finite amount of sperm is stored, so if we use it all and I don't get pregnant, that's it - what are the chances of conceiving with stored sperm?
b) what really are the risks of getting pregnant when I know I have gallbladder disease? could I do myself permanent damage/risk my life?
c) what are the risks if my husband doesn't take the drug? I have read research that says that young patients have a low risk of thrombosis - does he really need it?

We're both seeing the relevant doctors (separately and together) and are trying to come up with a plan, but am setting out my story here in case anyone else has had a similar dilemma or can shed some light in any way. Also the process of writing this has calmed me a lot (though I know this isn't what the site is for!)

We're in the UK so health insurance is not an issue (except that we've got some coverage through his job which may mean I don't have to wait long for a gallbladder operation).
posted by anonymous to Health & Fitness (16 answers total)
I think there's a good reason you put option #1 first. It really does make the most sense. So, honestly, you already know the answer.
posted by trinity8-director at 4:07 PM on April 17, 2008

The success rates for human artificial insemination can be as high as 20% depending on the technique, but your hubby can presumably produce sufficient quantities before he goes on the medication to give you quite a few tries. I imagine that it would be appropriate for you to assist in the, er, procedure and probably make the eventual medical bits a little less clinical.

It's very common to inseminate cows and horses with stored (ie frozen in liquid nitrogen) sperm from a bull/stallion. Bulls and stallions are large and grumpy and troublesome to transport, sperm straws are tiny and simple.

You're not livestock, of course, but you can consider it a well-tried process. I would definitely go with #1.
posted by 5MeoCMP at 4:20 PM on April 17, 2008

I would be tempted to get knocked up and let the chips fall where they may, but I'm clucky.

For me, having children would increase my desire for my partner to take all possible steps to avoid a thrombosis--to go to great means to have a child, and then lose that child's parent suddenly and unexpectedly would be nigh horrific.
posted by sondrialiac at 4:32 PM on April 17, 2008 [1 favorite]

Our downstairs neighbours just had a daughter. When I'm up at night, I hear her cry and wake up her parents. Having kids is tough, and your kids don't deserve parents who are sick. They'll need you. Look after yourselves first, and go with #1 when you're better.
posted by stereo at 4:59 PM on April 17, 2008

you should probably get yourselves healthy before you add another person to the mix. my reason for saying that is if you get pregnant and have a baby, that's pretty stressful, and the stress will certainly have an influence on both of your current conditions. in which case you guys wouldn't be the best parents possible and would have to worry about baby in addition to yourselves.
posted by misanthropicsarah at 5:00 PM on April 17, 2008

If you need your gallbladder removed, (called a cholecystectomy) there may be a good chance it can be done laparoscopically. If so, minimal down time (think outpatient or overnight stay if all goes well). This is your doc's call, of course. IANAD, your mileage may vary. . . If this is the problem, get it taken care of. Then go from there.
posted by 6:1 at 5:19 PM on April 17, 2008

You seem to have a pretty comprehensive list of options. I'd say that the best idea is for you to have your gallstones taken care of, and your husband should have his problem taken care of, and only then should any possibility of having children come into the picture. If the stored sperm is of good quality, that's the best you can ask for. So, option 1. Also, that doesn't preclude you asking about the possibility of your husband going off the drug for a while if the frozen sperm doesn't work.
posted by number9dream at 5:29 PM on April 17, 2008

Option 1. Think about it this way: you have no guarantee that you'll get pregnant easily even if you try right now, but you do have a guarantee that it will put both of you under more stress and may adversely affect your health. So get your health problems sorted first, and then you'll be able to approach having a baby from a position of joy rather than OMG must do this now!! Take care of what needs to be taken care of to make sure that your future child will have happy and healthy parents.
posted by MsMolly at 5:45 PM on April 17, 2008

Look, your future kids deserve healthy parents. Take care of yourselves first.
posted by bettafish at 6:34 PM on April 17, 2008

Freeze for later use. Get healthy. Determine whether you need to have the gall bladder removed, since being focund (pregnant) is one of the 4 Fs of gall bladder disease. You may also want to look into the risks for pregnancy and fertility after 35. If you want to have two kids, you only have 2-3 years before you need to get pregnant if you want to avoid the risks of being 35 and over. (But many women have happy, healthy pregnancies after 35.)
posted by acoutu at 8:02 PM on April 17, 2008

Get pregnant now! Don't wait. Don't make it contingent on statistics, and regimens/surgeries that could complicate conception and pregnancy -- both of which are iffy/fraught ventures in the most perfect of circumstances anyway. (Contrary to Hollywood stereotypes, most folks don't get pregnant on the first try -- or the twenty-first.) Not to mention that hubby's 39, and not getting any younger. (Do you want him to play with the kid[s], or just watch?) Note that by the time you're 34, your chances of getting pregnant -- at all -- start to slide dramatically. (Ask your Ob-Gyn.)

IANAD, but I am a dad who faced similar age issues. The minute you consider having children is when you should have them -- like anything else, you could wait forever for the "perfect time," and only realize too late that there's no such thing. Do it now. You will not regret it, I promise.
posted by turducken at 8:29 PM on April 17, 2008

I've never had a gall stone attack, but I know how much pain they cause. Junior throwing off a kick or a punch to just the right spot... I think they'd have to peel you off the ceiling.
posted by Leon at 4:07 AM on April 18, 2008 [1 favorite]

Get the gallbladder removed ASAP. Then get pg the old-fashioned way, with the stored sperm as a backup solution. My hub waited four years to get his gallbladder removed. He wishes now that he had gotten it done sooner, because he suffered in pain uselessly.
posted by cass at 8:41 AM on April 18, 2008

If by relevant doctors you mean haematologists, general surgeons, and gynaecologists, then I think you've got access to all the expert advice you need already. If you haven't seen a gynaecologist specialising in fertility and/or a urologist specialising in male fertility, then I think you should get a referral to your your local hospital's assisted conception unit. To a large extent they should be able to allay your fears. It will probably be at least 6 weeks before you can be seen on the NHS, so this would be a reasonable use of your husband's health insurance. Even if you don't go for fertility investigations / discussions now, you ought to check if the insurance covers you for IVF etc, because NHS provision of IVF is somewhat restricted.

(In the interests of full disclosure, I may be a little bit biased because I am a UK based gynaecologist)
posted by roofus at 9:56 AM on April 18, 2008

b) what really are the risks of getting pregnant when I know I have gallbladder disease? could I do myself permanent damage/risk my life?

For what it's worth, I have had gallstones for years and just went through a pregnancy with no problems at all. But unlike you, I haven't had past attacks. I talked about the possibility of needing gallbladder surgery with my doctors and they said that if I started getting attacks while pregnant, gallbaldder removal can even be done laprascopically or even by going down your esophagus (!) to take it out that way, if needed.
posted by Asparagirl at 12:41 PM on April 18, 2008

A lot of people, regardless of the science, are not comfortable having surgery, taking medications and anaesthetics, and recovering while pregnant.
posted by acoutu at 7:28 PM on April 18, 2008

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