Recently, the always-thoughtful M-B asked me if I planned to have CVS. It seems like a simple question, but somehow the question has unleashed a torrent of conflicting thoughts and emotions.
The short (and easy) answer to the question of whether I'll have CVS is that I don't know yet if it's even an option. Being in a new country means that I am not certain of the standard offerings available for a woman of "advanced maternal age" (oh how that phrase makes me long for the days when being "advanced" was a good thing!) If CVS is rarely offered here, then I don't think I'll sign up to be one of the rare training cases offered at the local medical school. However, if it's standard operating procedure, and the doctors doing the procedure have a lot or experience and low rates of complication, then I'll seriously consider it.
Practical issues aside, however, I am really struggling with the deeper dilemmas involved in the decision to proceed with a "needle test". This comes as an enormous surprise to me. I had always thought that of course I'd sign up for any available test. I'm addicted to knowledge. I love to know what's going on. I remember being 30 and being annoyed at the thought that amnio was only standard for women over 35. I thought it was unfair that if I got pregnant I wouldn't be offered the level of knowledge and control that technology made available for older women. However, that was before I realized how little control I would have over every aspect of my reproductive journey.
Here's the essential dilemma for me: is it worth accepting the (relatively low) risk of actually causing a pregnancy loss to find out if the growing, apparently healthy fetus has detectable medical problems? The correct decision for any couple will depend on a number of things, including: whether knowing that there is a problem will cause them to take any actions that they wouldn't otherwise take, whether they fear loss or a sick child more, and their ability to handle uncertainty.
I have had several friends who refused all testing because they said that they'd carry the pregnancy to term regardless of what the testing revealed. I don't feel that way at all. While I respect the fact that some people's personal/religious beliefs are such that they could not deliberately terminate a pregnancy, I think that I would decide to terminate under certain conditions, especially if the child was diagnosed with a condition that would cause it chronic pain and certain early death with no hope of treatment. For me, being a parent means being able to put the child's interests ahead of my own, and I think that bringing a child into this world knowing that it would find nothing but suffering here is not a decision that I could make in good conscience. However, I also realize that if I were actually in the situation, my thoughts might be different. If there's one thing that infertility has taught me, it's that you never really know how you would feel about something, or what you would do in a situation, until you actually are IN that situation.
Personally, I believe that knowledge=power, so I very much WOULD like to know if there was something wrong with this pregnancy as quickly as possible. What I would do with this knowledge would depend on the actual diagnosis. However, after working so hard to become pregnant, and knowing that at 38, I will probably have limited opportunity for additional pregnancies, the thought of doing anything that would increase my risk of loss, even slightly, fills me with abject terror. As awful as it would be to be blindsided with a seriously ill child on what I hope will be the happiest day of my life, I think that it might be even worse to have to live with losing a child as a result of my own decision to proceed with CVS or amnio. A friend's sister had an amnio-induced miscarriage (of a fetus that the amnio found to be healthy) a few years ago, and this undoubtedly has affected my feelings about these tests. I know that they're usually safe, but I keep thinking "what if I do the test, have a miscarriage, and then never get pregnant again?"
Then there's the issue of uncertainty. Can I really go through the next seven months not knowing for sure? Won't I be a nervous wreck? I don't know. I am spectacularly impatient, but infertility has been good training for living with uncertainty, and I'm certainly better at it now than I was a few years ago. While uncertainty used to feel like a crisis, now it's more of an annoyance.
So, my plan at the moment is to talk to my doctor (I won't be released to an OB/GYN until 11 weeks), have nuchal fold translucency screening, and then make a decision armed with a bit more information.