Making Your Fertility Treatment Plan: Finding the Right Doctor

The first interview with your doctor provides an excellent opportunity for you to assess how well you will be able to work together.

To prepare for your first visit, write down a list of questions you want to ask. To help formulate your questions, you may want to refer to the workup overview in chapter 4 as well as to the next section, which lists the questions people most frequently ask me. The reasons for asking some of these questions may not make complete sense until you've read the rest of this book. However, I feel I should put them here so you have them as background.

If you are already receiving fertility treatment, it is not too late to ask your doctor these questions. If you spot any of the "Four Poor Treatment Danger Signs" discussed below, you may wish to reconsider your choice of doctors.

About the Doctor's Practice

• Do you have experience in fertility treatment?
• When do you consult with a reproductive endocrinology specialist?
• Will you refer me to an obstetrician when I get pregnant or will you deliver the baby?
• Will you send me to any other physicians or laboratories for treatments or tests?
• Will you treat my spouse? If not, who will?
• Do you arrange for adoptions?
• Do you document surgeries with photographs or videotapes so I can see your findings for myself or provide them to other doctors?
• Which hospital(s) do you use?
• Do you use Pergonal/Metrodin/Humegon/Lupron to induce ovulation? If so, do you monitor egg development with ultrasound and blood estrogen to avoid multiple births?
• Do you perform sterilization reversals? What is your success rate? (Should be about 60 percent.)
• Do you perform microsurgery? What is your success rate for vasectomy reversal? (Should be about 90 percent.) For fallopian tube repair? (Should be 50 to 70 percent.)
• Do you belong to the American Society of Reproductive Medicine?
• Are you on the RESOLVE, Inc., recommended list of physicians?

About Tests, Surgery, and Treatments

• What kind of procedure is it?
• What will the procedure tell you?
• What results do you expect?
• How long will it take?
• What will it cost? Does insurance cover it?
• Will it hurt?
• How will it make me feel afterward?
• Can you do it in your office? As a hospital outpatient?
• Will I be incapacitated? For how long? Will I miss work?
• Will my spouse be involved? How? Will he/she miss work?
• Can I drive home afterward?
• How many times will it be repeated?
• Will it interfere with our sex life? How?
• Will we have to delay our vacation?

• What results do you expect?
• How long/often will I take it?
• What will it cost? Does insurance cover it?
• Will it hurt or have side effects?
• Do I take it at home or at your office?
• Will I have to miss time at work?
• How many times will it be repeated?
• Will we have to delay our vacation?

Once you've selected your physician, you are responsible for monitoring your doctor's performance. That may sound strange to you, but if you hired a carpenter, auto mechanic, or roofer, you wouldn't think twice about making sure you were getting the work you contracted for. It's the same for a doctor. However, you must be an informed consumer in order to evaluate the doctor's performance.

Below are four danger signs that will alert you that you may have chosen the wrong person:

1. No clear cut fertility treatment plan. If your physician does not formulate and discuss a treatment plan, you may be on the "hit-or-miss" regimen. After your first conference, your doctor should be able to outline the initial phases of your workup. After the basic workup, which may take four to six weeks, your doctor should be able to outline a treatment plan. You should be confident that your doctor, as would any good investigator, is using specific step-by-step procedures for getting answers about your fertility problem. If your doctor hasn't shared the plan with you, ask for a detailed explanation. (I'll describe the nature of these plans later.)

   Take notes and make sure that your doctor follows that course. If your doctor deviates from the plan, find out why. Was it because of an unexpected test result? Our did the doctor forget certain details that were planned initially? Remember, a ask questions when they arise. Waiting for the straw that breaks the camel's black or assuming that the doctor is an infallible being who will take care of everything will get you into trouble. If your doctor's response to your request for a plan is not adequate, find a different doctor.

    

2. Poor communication. If you can't talk to your doctor, at least one of you has a problem. Doctors are usually very busy, so as a rule they won't sit down and strike up a conversation hoping that eventually you will feel at ease enough to ask a question. If, after you leave the doctor's office, you always remember a question you meant to ask, I encourage you to write down your questions before your appointments. You should feel free to call back and talk to the nurse practitioner or to the doctor personally. If you feel that your doctor is not taking your questions seriously, is giving you superficial answers, seems impatient about explaining terms and treatment, persistently talks over your head, will not return your calls, or is too frequently not available when you need help, find another.

    

3. Unorthodox treatment or methods. After reading this book, you will be well acquainted with the methods your doctor should be using. If your doctor deviates from these regimens_for example, by failing to perform a semen analysis, prescribing fertil ty drugs before doing a complete fertility evaluation, or administering Pergonal without using an ultrasound to monitor the number of eggs you're developing_you have reason to be concerned.

   Talk to your physician. Don't just assume he or she is incompetent. You may have misunderstood something you heard or read, or your condition might be out of the ordinary. If after getting the doctor's answers you are still troubled, however, you may wish to request a second opinion, especially when surgery is recommended. No good doctor should balk at this perfectly reasonable request. If you don't think your doctor is using the "best" fertility treatment procedures or if you lack faith in your doctor's decisions, then find another doctor.

    

4. Your treatment is taking too long. This is a tough one because the amount of time required to diagnose and treat each fertility problem is different for each patient. However, there are a few benchmarks you can watch for. Your initial workup should be complete within four to six weeks_ two months at the most. At that point your doctor should be able to give you the preliminary findings and should present your options for additional tests or treatment. As your treatment progresses, you may tend to become impatient. You may forget, for example, that even after you are "cured," you are no more fertile than the average population at your age. At the most, you have a 20 percent chance of getting pregnant each month. So if your doctor feels that your fertility problem is resolved after six months of treatment, it may take another six to nine months for you to get pregnant. If you don't conceive in that time, your doctor may recommend conducting further tests.

   Doctors may often use a more aggressive treatment approach with an older couple like Richard and Margaret B., who were in their mid-thirties. A woman in that age group doesn't have that many fertile years left and her odds for "normal" pregnancy are getting slimmer each year. If you feel your fertile years are slipping away, discuss your concerns with your doctor. If your doctor isn't responsive, find another doctor.

   I tailor the rate of treatment to each couple. Some people want to know all of the answers right now. Others want to proceed more slowly_they need time for things to sink in. For example, Shelley T. had a limited budget, so the pacing of her treatment plan was slower than for Margaret, who wanted to get pregnant as soon as possible. Each of these women required a custom-designed treatment plan that would accommodate her lifestyle.

Is your treatment taking too long? That's very hard to judge. But if you're really worried about it, talk with your doctor and your RESOLVE support group counselors. If you don't feel that you're making progress, get a second opinion or find a new doctor.

I encourage you to learn as much as you can about fertility treatment and, above all, never to accept your doctor's recommendations complacently. Ultimately, you are responsible for the quality of care you receive. You are responsible for selecting the doctor who is best qualified to help you get your miracle baby.

For more information on your initial visit to your physician read the
INCIID Routine Fertility Workup or IVF.com Homepage.

Miracle Babies and Other Happy Endings
for Couples with Fertility Problems
Copyright © 1986 Mark Perloe M.D., and Linda Gail Christie.