The summer between my sophomore and junior year of college, I went to Oslo for three weeks to accompany a friend on a camping trip and ended up backing out at last minute. There I was, stuck in Norway, with several skeins of yarn and an apartment at my disposal, but no food. I went to the supermarket to pick up some ingredients so I could make dinner and after hitting the fruits and vegetables, quickly became lost when I entered the land of cartons and cans.

There was appelsin saften written in black block letters against a white carton. Without an image helping me along, I could have been holding juice, chicken broth, or a vacuum sealed carton of cheap wine. I threw it in the basket assuming that since appelsin looked like the English "apple" and Nynorsk was a Germanic language, I was probably going to end up with something apple-like. It was orange juice.

(This, does not in any way trump my brother's stories from Amsterdam where he ended up drinking a full bottle of salad dressing before realizing it wasn't fruit juice despite the picture of fruit on the label nor does it top the time he thought he was getting milk and ended up with a carton of pudding. But since both those tales took place in Amsterdam verses sober, scared, sophomore-year Olso, we must take them with a grain of salt when considering brands and labels).

I complained about the lack of branding and clear labeling to a Norwegian friend and she commented on her own experience with America. There were too many brands, too many choices. She entered a supermarket to purchased peanut butter and was met with pictures of flying elves and dancing peanuts. Not only did she need to choose between several brands, but she needed to choose amongst their many options: crunchy or smooth, natural or sugar-laden, low-fat or high-fat. Supermarkets were ridiculously large simply to house all of the numerous brands for the exact same product.

And, she pointed out, once you chose a brand, how did you know that there wasn't a better peanut butter out there that you hadn't tried yet? New peanut butter products were coming out weekly, how could one know if they should stick with the peanut butter they loved or constantly try each new product.

If choosing a peanut butter brand wasn't complicated enough in this day and age, those undergoing fertility treatments need to make difficult decisions in the face of a multitude of choices. These choices are not even some of the more obvious ones listed in the related reading section to give you a sense of the constant struggle infertile men and women have to make concerning the numerous paths out of infertility. There is assisted hatching and ICSI and PGD. There are one embryo or multi-embryo transfers. There is a day-3 or day-5 transfer. PIO vs. suppositories, Follistim vs. Gonal-F. There are simply too many choices.

And at the same time, intense feelings surrounding the creation of embryos and the desire to maximize the chance of a healthy birth. It becomes like a giant round of double dutch with the jumper second-guessing the best time to enter. Compounding the issue are all of the new techniques and medications and products that come out on the heels of every new study. Is DHEA the wonder supplement that will kick-start ovarian function? Is this new product--due out in 2009 according to Time magazine--the Holy Grail of embryo creation:

But in 2003 a Swiss gynecologist, Pascal Mock, envisioned a new approach: instead of fertilizing and developing the embryo in a laboratory, do it in the most natural environment possible — a woman's womb...The innovation is a tubelike silicone vessel with hundreds of tiny holes. Less than a millimeter in diameter and only 10 mm long, the supple, permeable device is injected with sperm and eggs (or fertilized eggs) and then placed in the uterus, allowing fertilization and development to take place inside the womb rather than in a test tube.

Children have already been born from this invention and it holds much promise. But how does one weigh the knowledge of technology on the attainable horizon against the technology in their backyard? Do they travel to where the technology exists pre-FDA approval? Wait until it's available at your friendly, neighbourhood fertility clinic, or wave it away as simply another choice down the line with barely a difference from the technology already utilized--sort of like yet another brand of peanut butter coming out on the market?

Related reading from excellent bloggers who are in the middle of making choices:

Henry Street: the author considers the choices she has already made as well as ones she might make in the future.
Southern Infertility: the author has been debating for a bit about which path to take and especially whether a new set of eyes and a new protocol may be in order before doing IVF again.
Reproductive Jeans: the author is wrestling with anger after a failed cycle and trying to gain mental clarity before deciding the next step amongst a plethora of choices.

Melissa is the author of the infertility and pregnancy loss blog, Stirrup Queens and Sperm Palace Jesters. She keeps a categorized blogroll of over 1100 infertility blogs and writes the daily Lost and Found and Connections Abound, a news source for the infertility blogosphere. Her infertility book is forthcoming from Seal Press in Spring 2009.