You may have always assumed pregnancy would come as easily to you as it did to your mom and are surprised at how many months have gone by without a positive pregnancy test. Or, you may have received a diagnosis of endometriosis, polycystic ovarian syndrome or other disorder which included infertility as a symptom, when you were little more than a teen. Possibly, you have concerns about your age and its potential effect on your ability to conceive. There are many scenarios which might prompt you to contact an infertility specialist for an initial consultation, though many women hesitate to make that call.
Infertility specialists are known as reproductive endocrinologists, or RE’s. RE’s are gynecologists who have received additional training and become board certified in reproductive medicine. Their practices are typically devoted to the diagnosis and treatment of infertility and hormonal issues, and they are able to perform in vitro fertilization when necessary. They also work with patients on a variety of infertility treatments, such as less-invasive intrauterine inseminations. Some also specialize in reproductive surgery. Women often resist contacting RE’s, despite growing anxiety and the passing of time, out of concern that they will be immediately pushed into expensive, high-tech treatments, such as in vitro fertilization.
In vitro, or IVF, is rarely covered by health insurance. It is not only costly, but also time consuming and physically demanding. For these reasons, it is also not the first line of treatment typically suggested to patients. Infertility specialists, after analyzing a battery of tests including blood draws and sonograms, will determine what treatments make the most sense for each individual patient. This decision will be based upon a variety of factors including age, hormone levels and the presence or absence of tubal blockages, such as scar tissue or fibroids.
In order to streamline treatment, it helps both the patient and physician to have a game plan including a time frame and clear understanding of what might work, what won’t work and how many attempts the patient is willing to undergo before moving on to the next step, as well as how much everything will cost. Arming yourself with as much information as possible. as well as attending your first consultation with a list of questions to ask, can help crystalize a treatment plan that leaves you feeling empowered, rather than confused. Questions to ask at your first appointment should include:
· What tests will I (and my partner) require prior to undergoing treatment?
· Will you explain the test results to me in depth?
· What percentage of your patients are in my age group?
· What is your take-home baby success rate for patients in my age group?
· What is your rate of multiple gestations and births?
· Can you help me to avoid conceiving multiples of twins or greater?
· What is your policy on fetal reduction?
· What is your policy on single embryo transfer?
· How many embryos do you typically transfer per cycle?
· How many attempts do you recommend for each treatment, such as intrauterine inseminations, in vitro fertilization and donor egg cycles?
· What about my lifestyle – can I exercise, have coffee, drink wine or smoke? What is my list of shoulds and shouldn’ts?
· How can you help me avoid hyperstimulation syndrome?
· Do you have a therapist on staff I can consult with?
· Do you participate in clinical trials and if so, am I eligible to participate?
· How does your office handle weekend inseminations and tests?
· What is the best way for me to communicate with you both during the week and on weekends?
· What is the role of your nursing staff?
· Do you perform all egg retrievals and embryo transfers yourself?
· How will my treatments and progress be monitored?
· How is your practice affiliated with the embryology lab?
· Are lab procedures done on or off site?
· Do you have an insurance specialist on site?
How do you handle insurance pre-approvals?
· If my insurance doesn’t cover my treatment, do you create payment plans?
· If I don’t get pregnant, how do you determine the end of treatment?
· If I don’t get pregnant and wish to pursue adoption, can you help me?
· If I do get pregnant, how long will I remain a patient here and what will my next step be?
If you are in a relationship, it is important for both partners to attend this appointment. Bring any medical records or prior tests that you have with you and keep in mind that honesty is the best policy. This is not the time to shy away from difficult questions you may have about past sexual history, abortion history and current lifestyle choices such as the drug or alcohol use of either partner. You also should let your physician know about prescription and over-the-counter medications you are currently taking as well as herbal supplements and toxins you may be exposed to in your work place or community. What you don’t discuss today may keep you from getting pregnant tomorrow.
The goal of this first meeting is to determine if pregnancy is possible and to create a partnership with a physician you trust. You are in the driver’s seat and it is up to you to ask questions, be a squeaky wheel if necessary and get the information and treatment that makes the most sense and will hopefully, yield success.