Friday, October 23, 2009

A Shot in the Dark

I wanted to spend some time discussing what Shannon and I heard, learned and decided about vaccinations. I know this means wading into a potentially controversial subject but, I figure, we're already full steam ahead with the highly divisive subject of overseas surrogacy so what harm can a little immunization discussion do? Anyway, the point here is not to persuade, just to explain. In that vein, let me get this out of the way - Shannon and I are in the 'vaccinations are typically safe and effective' camp. Everything that follows is colored by that context.

Please also keep in mind that I am not a doctor and never even played the game when I was younger. The rest of this post is a mixture of fact, opinion and conjecture - all of which is to say, if you've got international travel in your future, please don't use the following as a primary source of information.

Ok... Like most countries, the US Government recommends a long list of vaccinations prior to international departure. And, like most countries, India recommends a long list of vaccinations prior to arrival. However, with one exception - yellow fever (if traveling to/from specific countries) - no vaccination is required. It's your call. So what to do?

The choice was a lot easier for me. There are few if any contraindications for vaccines in men. My little guys ('sperm' for readers not getting the hint) are seemingly incorruptible. Sure, coming down with a nasty fever could undermine their quality. However, the fact is the illnesses for which I'm being immunized are more likely to cause a major medical catastophe than the innoculations. I'm getting the shots.

The trick is Shannon. As readers know, she will not be pregnant throughout this process. However, she will be producing the eggs and, seemingly, eggs are the more vulnerable partner in the embryo dance. To what extent do we vaccinate her?

Well, Dr. Yash told Shannon, no vaccinations. Period. She didn't leave us with the impression that Shannon should never in her life. It was more about the timing. So sure, Shannon's not immune to Hepatitis A, has a lapsed polio innoculation, was never vaccinated for pertussis, never prepared for H1N1 - all of which can be encountered during our trip. But the recommendation was don't do it. Make the embryo first. Basically, take the gamble with her health.

Now remember, we're a couple who believes in the value and safety of vaccinations. And because we had decided not to travel to India until January or February for retrieval (we could have gone in early December), we thought we had a good cushion of time. On the other hand, we're also pretty busy believing in the powers of IVF and really don't want to muck it up. In such a confusing medical circumstance the recommendation is to get a second opinion. For us, this came in the shape of a referred Travel Clinic.

Turns out that in the US, the identification and application of travel vaccinations (say that three times fast) are the responsibility of Travel Clinics - your local doctor won't do it. Their doctors are typically infectious disease specialists and this is all they do for a living. Our fertility doctor recommended one in particular at a local hospital and, following the handshake, Shannon and I disclosed every detail about our trip. If all goes well, we will be in India twice, the first time about two or three months from now, for one week, with Shannon hopped up on IVF meds and the second time, a much longer trip, approximately nine months later.

We had a very long back and forth about Shannon's options during which the doctor - bombarded by questions - asked, first, if either of us was a doctor and then, second, if either of us was a lawyer. Ultimately, we reached a concensus and acted immediately as we felt the more time that passes between vaccination and departure, the better.
  • We would avoid attenuated vaccines - that is, vaccines containing live but modified forms of viruses and bacteria. The modification reduces the microorganism potency but there is still a slight risk of getting sick. For Shannon, this meant not being innoculated for typhoid.
  • We would be ok with other types of vaccines - that is, vaccines that contain either killed forms of microorganisms, pieces of them, etc. This meant that Shannon would get vaccinations for things like Hepatitis A and polio.
  • We would get flu shots using killed virus. For H1N1, that means the injection and not the nasal spray. (In general, the medical community believes one's immunity benefits more from attenuated vaccines than alternatives but for Shannon, this was the no-go.)
  • For malaria we are going to use Malarone (proguanil & atavaquone) for prevention. It's meant to be taken daily so it's a bit of a hassle but supposedly quite reliable and with minimal side effects. For the moment, however, we're considering not starting Shannon on this pill until after retrieval. It's a to-be-determined. [I should add that our Clinic also suggested Lariam, instead of Malarone. Lariam is taken just once a week but its potential side effects are positively awful. In fact, this drug's losing it's popularity.)
I'm not comfortable being overly carefree with Shannon's health as our baby/babies would prefer to grow up with both parents, if you know what I mean. This will likely disappoint the SI doctors but ultimately, as there is no definitive guidance, the decision comes down to the two of us. We're comfortable with our decision and think it's optimal.

Plus we got to walk away with cool band-aids. Shannon's are all sparkly, mine are the Batman logo. That's right, the Batman logo. Jealous?


  1. Hi again

    Just want to comment on the Malaria prevention. Here in Norway the vaccination office told us that there were no need for Malaria medicine because there is no high danger of getting this in the cities and not on that time of the year. If you are going out of the city to the jungle og villages then you should take the medicine she said. Just wanted to tell you that :)

  2. Thanks for that, Linda. Our doctor advised us the same about city centers but stated there is a mosquito risk at the airport. That said, we're still back and forth about if and when. My guess is, statistically, we'd be fine to go without precaution. And really, what could possibly go wrong? ;-)

  3. Great post! I am so happy that you have done your homework and the malaria pills were harmless to us. Our travel doctor did tell us to get a Malaria pill. One of the surrogates came down with it just before we arrived. So we decided that we better get it just to be on the safe side. We didn't get sick once on anything. You two are going to make awesome parents. Everyone is sure to give their opinions on this. Ultimately it is your decision. I am so glad you two stuck to your guns and went with what you believe in. We will be going to India in March or April. So you will have to fill us in on this stuff when you get back. Ok I think my comment was longer than your post. :(

    Talk to you soon!!

  4. Hi

    Been to India three times now. Never had a vaccination for anything.

    Do what makes you feel safe. I never saw one mosquito in either Mumbai or Delhi. We drank the water, brushed out teeth with water from running taps ... even waded into the Arabian Sea.

    Please, keep yourselves safe as much as you can, but don't get too paranoid about this stuff. There are far worse things you will face in India. Malaria, and Delhi Belly are the last of what you might face.

  5. The batman band aid is hilarious!!!

    Both Darren and I were already vaccinated against Hepatitis A & B and typhoid. We did not take malaria preventions. We once took tablets when travelling to Thailand but decided on our trip to Mumbai not to worry and...we were fine. It was the middle of the monsoon and all but not one mosquito.

    In the end you have to do what feels right for you. Good luck guys and keep the updates coming.

    Johnny & Darren

  6. Vaccinations are a personal choice and you have done your homework, weighing out the pros and cons. You can feel confident in your choices as you didn't do it blindly. We did not vacinate for our trip to India and won't again for our next, and for us this is ok. Now onto the fun stuff..needles and hormones and .....
    All the best!

  7. When we were to India this past January, we had some vaccinations done (rabies, Hepatitis A and B, etc.). We could not find a place to get a yellow fever shot but probably did not search hard enough. We both took Malarone for malaria, and while I was fine, my wife had a bit of a reaction to it. She has a sensitive stomach so this could be the cause.

    Speaking of malaria and mosquitoes... To our total surprise we did not see a single bug in Mumbai, be it flying, crawling, or otherwise. It only dawned on us after our return to NY that there were no insects what so ever.

    Despite all the precautions, I became violently ill a day after our return home - we're talking explosive diarrhea, a 104 fever and seizure like shakes. Fortunately my wife was fine. I was rushed to the ER where they managed to put me back together in just one day. Turns out it was most likely caused by something I ate on the plane.

    Moral of the story: While you can never be too cautious, despite every precaution taken, things still go wrong sometime. When you travel to India, definitely bring anti-diarrhea medication, watch what and where you eat, and I strongly advise you NOT to drink water from the faucet.

  8. I just came across your blog, and congratulations on your journey! You've done all your homework on the vaccinations,. For what it is worth, we made sure we were current on hep A, hep B, typhoid, polio and diphtheria/tetanus. I only needed the typhoid again as I had the rest from past travels, but my partner got the works. I'd also get the H1N1 and seasonal flu shots... no point in taking a risk with those.

    We didn't bother with the antimalarial meds; our travel doctor advised against them unless we were venturing outside of Mumbai (and I didn't see a single mosquito while there, unlike the hellish number we've had at home this fall!)