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Partnering with your Reproductive Endocrinologist

Why don't we? Why should we?

Remember when you were in charge of how and when you had a baby?  At least we all thought so:  what time of year to get pregnant?  What age for my spouse and me?  How many children to have? 

Now, in the reality of infertility, it feels like you have the least control and understanding of how, when, and if a baby is conceived.  Perhaps, having wrestled with the various stages of grief, you made a mental “bargain,” something along the lines of “I will be the best infertility patient there ever was and comply with everything asked of me to give us the best chance of having a baby.”  After all, these are the experts, right?

You are also an expert.  Infertility is a medical condition that, like any other, is best addressed as a partnership between you and your Reproductive Endocrinologist.   To participate unquestioningly is to weaken this partnership.  An infertile woman almost always struggles with feeling that her control over her reproductive ability has been lost.  The more you can be informed and join your practitioners in making decisions, understanding results, or seeking second opinions, the more you regain some sense of managing your body and treatment.  Mentally it is empowering for you, and physically it will help your treatment if you use your knowledge to partner in your own care. 

What are the risks? 
Why do many women, who would act differently with any other medical professional, hesitate to take a more active role in their infertility treatment?  The fear and anxiety is great.  By the time you have found your Reproductive Endocrinologist, you have experienced agonizing losses.  You want to completely trust in the skills of this competent physician.  You don’t want to question and possibly offend him or her.  Your mind knows this doctor would not give you anything other than his or her best skill and knowledge.  Your heart, which has already endured much pain, irrationally fears that any breach in the relationship threatens your chances of conceiving a baby.  Also, if you participate in the decision making process, you introduce the possibility that your physician needs your input in this partnership.  That possibility makes him or her human and fallible, and right now you need a perfectly wise, all-knowing physician.  But what are the risks of not questioning, or assessing, or partnering with your highly-trained, very competent, but nevertheless, human physician?  You risk removing from the medical treatment your instincts and experience, your opinion and insight, your resolve and focus.

• An infertile couple sought IVF treatment to address poor sperm count.  The vibrant 27-year old wife appeared healthy.  It was only after their failed IVF that her FSH was tested; it was significantly elevated.  At her young age, she was essentially in menopause.  The news was devastating, but it was also something that should have been available to this couple in making their decision to pursue IVF. 

• A 39-year old woman was told that her eggs look “good” and the embryos were developing “normally” during a third IVF procedure, which ultimately failed.  When she later read the embryologist’s report and then met with him, she found out the quality of her eggs was good for a woman her age, but the color and clarity were not what would be seen in a younger woman. This information helped her make a decision about whether she would consider an egg donor.

• A 40-year old woman has an energetic two-year-old from a donor IVF cycle.  She has frozen embryos from that cycle and would like to try for a sibling.  She is told that her endometrium is “not ideal,” but is encouraged to proceed with the transfer.  She asks a few more questions:  what is the thickness and quality of her endometrium and what does this physician consider ideal?   How did her endometrium look in previous cycles?  With respect and tact, she discussed with her physician the advisability of waiting another month to see if she can get a better endometrium.  Together they made the decision to wait.  She successfully became pregnant two months later, and is due to deliver her second son within a few weeks.

• A 34-year old woman had two failed IVF attempts and was contemplating discontinuing treatment.  She met with her physician and he encouraged her to try one more time.  He explained the specifics of what he had learned during these failed procedures:  how her body responded to the various medications and how he wanted to change her protocol.  What he said made sense, and she and her husband agreed to one more IVF.  Ten months later she held her baby daughter.  After two failed procedures, her questions made sense.  Perhaps if her physician were planning no changes in protocol, she may still have decided to stop.  Maybe this IVF procedure was successful for a reason no one understands.  But, discussing her protocol and understanding the rationale for modifying her medication was an appropriate step in making her decision to proceed.

The keys to joining your physician as a partner are knowing what you need to understand and being sensitive to how you ask questions.

What do you need to know?
In general, probe further whenever you hear descriptive words such as “normal" or "good, or "okay."  Ask for specific numbers, measurements, and results and ask your physician what he or she considers a good or ideal range.  Get an understanding of what factors affect those numbers and if the results can be modified—things you can control, such as BMI (body mass index) or that your physician manages, such as medication and protocol.  Ask to read the Embryologist’s report.  If your fertility is limited by factors not believed to change, such as ovarian reserve or egg quality, you are in a position to make more-informed choices about how you want to proceed. 

The advantage to a partnership is that you do not need to complete ten years of medical training!  You don’t have to learn everything your physician knows.   You do want some degree of understanding about the following issues:

"The clients and members of my Resolve support group say they love this book...."  

-Kathy Fountain, M.S., LMHC
Infertility Specialist