Case #1: Tracy and Dylan

Tracy and Dylan

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Case #1: Tracy and Dylan by Mind Map: Case #1: Tracy and Dylan

1. 2 cycles of IVF, GIFT, ZIFT or low tubal ovum transfer, with not more than 2 embryo implantation per cycle.

2. How can we apply informed consent to this patient?

2.1. Four aspects of informed consent

2.1.1. 1) Decisional capacity

2.1.2. 2) Voluntary

2.1.3. 3) Well Informed

2.1.4. 4) Specific Enough

2.2. Decision-Making capacity is not black and white but some-one with competency should be able to understand the options and consequences as well as have the ability to evaluate the personal cost and benefit of the consequences

2.3. Tracy is not being forced into the decision so it is voluntary and there is no specific steps needed for consent for pregnancy (specific enough)

2.4. In addition, she has information of the risks of her condition (Well Informed)

2.5. Finally, she is an adult and not vulnerable/compromised judgement due to a condition (Decisional Capacity)

2.6. In the case of Tracy, the four bases are covered for informed consent. However, Tracy might be biased and have clouded judgement.

2.6.1. The medical student was worried about her decision and probably believes that she isn't ruminating her options clearly

3. How does cost/coverage of insurance for infertility apply here?

3.1. Infertility is defined as the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period

3.1.1. In this case, Tracy is deemed infertile

3.2. Connecticut Health Care Coverage

3.2.1. 4 cycles of ovulation induction

3.2.2. 3 cycles of IUI (donor sperm)

3.2.3. Each fertilization or transfer is credited as one cycle towards the maximum

4. What are her options for treatment?

4.1. Because Tracy's lupus is mild and she has functioning ovaries, she can have a normal pregnancy

4.2. The preferred procedure would be to use donor sperm to conceive

4.2.1. That would involve a simple procedure that uses a syringe to place semen into the woman's vagina to assist her pregnancy. This can be intracervical or intrauterine insemination

4.2.2. However, Tracy has been trying for a year with this method without success and she has complications as well as an age over the recommended 35 years or under

4.3. She could also opt for the more complex IVF, which has mature eggs retires and fertilized in a lab and transferred to the uterus.

4.3.1. This would make fertilization easier, but her pregnancy issues due to SLE are still there

4.4. Other assistive reproductive technology

4.4.1. ZIFT (Zygote Intrafallopian transfer) where eggs are taken and fertilized outside in a lab and placed in the fallopian tube (ampulla)

4.4.2. GIFT (gamete intrafallopian transfer) where eggs are removed from a woman's ovaries and placed in fallopian tubes, along with man's sperm

5. What are the risks medically?

5.1. Systemic lupus erythematosus

5.1.1. Chronic inflammatory disease where T and B cells become self-reactive and produces autoantibodies

5.1.2. Complications during pregnancy

5.1.2.1. Women with SLE are at a higher risk for complications during pregnancy (i.e. pre-eclampsia and premature delivery)

5.1.2.2. In addition, antiphospholipid antibodies can appear in the blood and increases the risk of miscarriage

5.1.2.3. Other complications are excessive bleeding after delivery, clots, and emergency c section

5.1.3. Minimizing Risk of Complications

5.1.3.1. Take a nutritional supplement of folic acid (reduces neural tube defect risk)

5.1.3.2. Stop consuming alcohol or smoking marijuana before pregnancy

5.1.3.3. Check which prescription medications are safe to take before pregnancy

5.1.3.4. Reduce Caffeine intake

5.2. Spinal Muscular Atrophy

5.2.1. Tracy is a carrier for Spinal Muscular Atrophy

5.2.1.1. The most common form of SMA (types 1-4) are caused by a mutation in SMN1 gene (chromosome 5)

5.2.1.2. Due to the location on a non-sex linked chromosome, the inheritance pattern is autosomal recessive

5.2.1.3. This is a disease that is cause by abnormally functioning motor neurons that control voluntary movement

5.2.1.4. Therefore, as long as the donor is not also a carrier the child can only

6. How to social issues (ex. mental health) apply to this case

6.1. Tracy stated "how happy she’s been since meeting Dylan."

6.2. They moved in together shortly after her arrival in Connecticut and were married a year later

6.3. This implies that she was previously unhappy in a relationship and possibly had issues with depression or an abusive relationship

6.4. Physician should ask about previous history and see if she's had any mental state concerns (i.e. depression, etc.)

7. References: https://www.emedicinehealth.com/informed_consent/article_em.htm#decision-making_capacity https://resolve.org/what-are-my-options/insurance-coverage/infertility-coverage-state/ https://americanpregnancy.org/infertility/zygote-intrafallopian-transfer/ https://americanpregnancy.org/infertility/donor-insemination/ https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716 https://www.mda.org/disease/spinal-muscular-atrophy/causes-inheritance