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Welcome!

This blog addresses various emotional aspects of experiencing infertility. It is written by a clinical psychologist who specializes in infertility counseling. Thank you for reading, and best of luck with your journey!

Thursday, February 10, 2011

To "POAS" or not to "POAS": psychological implications of home pregnancy tests in infertility treatment

As every person whose ever done an infertility treatment cycle knows, the two weeks spent waiting to see if it worked or not are often excruciating. For the woman involved, the constant self-monitoring of her physical sensations can be overwhelming. Was that a cramp? If so, was it a "good cramp" or a "bad one"? Are my breasts hurting? Do they hurt more than yesterday? And what about that toe-itching? Does that mean anything? Add into the mix the fact that infertility medications usually taken during the two week wait, like progesterone, have their own slew of pregnancy-mimicking side effects, and that early pregnancy symptoms are themselves notoriously fickle, coming and going with no rhyme or reason--and you've got all the makings of a very stressful time.

Enter the home pregnancy test--loved by some, hated by others, and feared by most. Some women swear by them, saying that they give them the soonest possible information--good or bad. To these women, tolerating the anxiety of not knowing is so difficult that testing seems like the best option. Others regard them as "evil"--whom among us has not seen them referred to as the "evil pee stick" online? These women argue that "POASing' (peeing on a stick) can drive you crazy--test too early, and you've convinced yourself that you aren't pregnant when perhaps you are. If you test at the right time and get a negative result, it might be inaccurate. Regardless, even with a negative, you will still be hoping it is wrong, and then will be just as crushed when the clinic calls to say that your pregnancy test was negative. And regardless of what you feel about the idea of taking HPT's during a treatment cycle, we all share the experience that the few minutes it takes for the test results to appear are some of the longest-seeming minutes of our lives!

From a psychological perspective, is taking home pregnancy tests a good idea or a bad one during infertility treatment? To me, there isn't one right answer to that question. Rather, I think it depends on what I like to call your "defensive style"--the usual methods you use to cope with stress and anxiety.

When POASING may be helpful

If you tend to deal with stress by thinking about the stressful situation frequently, you are probably a person who, for better or worse, tends to experience your anxiety consciously. You may repeatedly go over the situation in your mind, trying to come up with a solution--even when there really isn't one sometimes. You may tend towards impatience, and dislike surprises or the feeling of being taken off guard. In this case, I think that you may find using home pregnancy tests (with a few caveats, listed below) will be helpful in managing your emotions during the two-week wait.

When POASING might not be for you

If you tend to deal with stress by focusing on things other than the stressful situation, and if you find thinking about or talking about them to be difficult, you may want to avoid home pregnancy tests. For you, they might just stir things up too much,causing you to feel unnecessarily traumatized. You may be better off dealing with the results, whatever they are, just once, when you hear them from the doctor's office.

If you are going to POAS--POAS "smart!"

If you find that you are the type of person who may want/need to use home pregnancy tests, I offer the following advice to minimize the chances of getting inaccurate information and the level of emotional turmoil involved. My first suggestion is that before you go to the drugstore or start running to the bathroom, you need to decide, in advance, what your POAS strategy will be for this cycle. What is more comfortable for you--testing as early as is feasible to get information as soon as possible, or waiting to make sure you don't get a false positive or negative? Figure this out, make a plan, and stick to it. Decide what day you might start testing, and how you will proceed depending on the type of results you get. Some women feel most comfortable waiting until the morning of their beta to test--others may prefer to start as soon as possible.

You also must promise yourself that no matter what the results are, you will not stop your medications, or stop following your doctor's orders, until your official test results come back--no matter how hopeless you feel the situation may be. Even if there is only a slim possibility that a home pregnancy test may be wrong, it still exists--and you don't want to have to live with lingering regrets about such a decision later in life.

If you are in the "start as soon as possible" camp, then keep in mind that if you took an HCG trigger shot, it can give you a false positive as the HCG remains in your system for several days until it washes out. So you probably need to wait at least 10-12 days from when you took your trigger shot to start testing. (Although, as a client of mine pointed out, you could POAS every day after the trigger shot, and wait for it to turn negative, and then if it starts turning positive again, you know you might be pregnant. While scientifically interesting, this method is definitely not for the feint of heart!)


Regardless of when or how often you decide to test, you should use a consistent method of urine collection and test administration in order to assure the most accuracy in the results. Take the test at the same time every day--most people find their first morning urine to have the highest concentration of HCG. If your urine isn't very concentrated, you may have to "hold it" for a while and test several hours later in order to get accurate results. Some women find peeing in a cup, and then holding the test stick in the cup for the number of seconds designated in the test instructions, to be more accurate.

Also, please be aware that different brands of pregnancy tests have different levels of sensitivity. If you are wanting an early result, you will probably need to buy one of the more sensitive tests. A list of tests and their HCG sensitivity levels can be found at several sites on the internet, including here.

Regardless of whatever strategy you choose, please keep in mind that a pregnancy test is just one piece of data from one point in time, and it may or may not tell the whole story. Like anything else in life, there are emotional risks involved in using them--but if you keep to your strategy, stay on your medications no matter what, you will hopefully find that there will be no lasting damage to your psyche.

19 comments:

  1. I am not one for POASing. I have peed on pregnancy strips only twice in my 1.5 yrs of TTC. Needless to say they were negative, and the feeling of doom that set in after was too hard for me to handle.
    I'd much rather wait for my period to show up. That way, I get to hold on to the hope and dreams for just one more day.
    One other problem I have with POAS is that if it turns out to be a chemical pregnancy, then you feel worse, having known that at least briefly, you were pregnant. For some, this may give a sense of hope that maybe things are working ok, for others it could produce a feeling of guilt that they were somehow responsible for the pregnancy not sticking.

    Thanks for sharing ur thoughts on POAS!

    ReplyDelete
    Replies
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  2. Always enjoy your posts. Looking forward to the one on disclosure. See you in a couple weeks.
    CB

    ReplyDelete
  3. In the UK we don't have a beta test. I don't even know what one is. I find out if my IVF had worked by POAS and then call the clinic to tell them.

    ReplyDelete
  4. I, for one, am terrified of POAS. I've seen 3 positive only to lose all 3 pregnancies. I think I am actually terrified of getting pregnant again for fear of another loss. Fear sucks...

    ReplyDelete
  5. I am definitely a POAS addict and appreciate someone who understands that this can be beneficial or detrimental dependign on your defensive style- not a one size fits all thing!

    ReplyDelete
  6. Thank you Dr Rouff for this incredibly helpful, informative, yet funny post! Haven't decided my POASing strategy yet, but just reading your thoughts on the subject is making my FET1 5dp5dt anxiety fade away. Thanks for making my day :)

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