Choosing a Fertility Doctor
Out of desperation, many people turn to the first fertility specialist they find in the phone book, or someone they've heard about from a friend. But it's important to find the right doctor for you, one who can come up with a treatment plan tailored to your needs and be sensitive enough to help you through the rough times.
It's also crucial to educate yourself about infertility and its possible causes and treatments. That way, you can ask your doctor the right questions and make sure you're getting the best treatment possible.
What kinds of doctors treat infertility?
There are good reasons to want to stay with your OB/GYN, but don't be afraid to ask exactly how much training, experience, and success he or she has had in treating infertility. OB/GYNs, or gynecologists, are trained to diagnose and treat women's reproductive problems and to care for women during pregnancy and childbirth. Some gynecologists have acquired considerable experience in fertility issues over the years as well, but only a fraction receive formal training to treat infertility or perform more advanced reproductive technologies (ART), such as in vitro fertilization (IVF).
For this sort of expertise, see a board-certified reproductive endocrinologist, an OB/GYN who has undergone several years of additional training to diagnose and treat infertility in both men and women. Reproductive endocrinologists also must have at least two additional years of clinical experience, and pass oral and written exams.
Men may also want to consult an andrologist, who is a urologist certified to treat male infertility.
How do I find the right fertility specialist?
Most women begin this search with their regular gynecologist, and men consult their primary care doctor. This is fine for a first consultation and, in some cases, for an initial infertility diagnosis or even preliminary treatment. If your insurance covers fertility treatments, you may need a referral from your general doctor or OB/GYN before seeing a specialist anyway. Ask if your doctor has some experience with the specialist he or she would refer you to, and ask him or her why the specialist is recommended. That way, if the specialist had good experience with several patients, you can take advantage of that knowledge.
But more and more experts -- as well as women who've been through the process -- now recommend that couples struggling with infertility issues seek out a qualified specialist early on.
If you're 35 or older, you might want to go directly to a reproductive endocrinologist. A specialist can better determine the appropriate course of treatment if a woman has a history of miscarriages, irregular menstrual cycles, or pelvic infection, or if a man has had a semen analysis that shows a low sperm count.
What should I look for in a doctor?
You should feel as if your doctor is an ally in your effort to conceive. Although the issue of fertility is intimate, private, and sensitive, some patients complain about specialists whose bedside manner is cold or even dismissive. During your initial consultation with the doctor, make a point of observing how much the doctor listens to you, answers your questions, and treats you with respect. If a doctor rushes through the consultation, or declines to explain options such as surgery or drugs without discussing why, then move on. Don't waste critical time. You may be able to check out potential doctors by searching Web sites that have evaluations of fertility specialists.
If you have health insurance, try to select a specialist in your health plan's network of specialists. To do so, check the provider directory, either in booklet form or online. This can save you out of pocket costs and also take advantage of the credentialing the health plan does for all network providers.
What other things should I consider in choosing a fertility doctor?
The American Medical Association and the American College of Obstetricians and Gynecologists have searchable databases of physicians by name, city, or zip code. You can also look in the Directory of Medical Specialists, which lists OB/GYNs and their specialty training. (This guide is available at most public libraries.) Other information, like the doctor's education and board certification, is available on some health plans' Web sites.
Organizations like Resolve, a national infertility organization, also offer referrals to reproductive endocrinologists. They recommend interviewing several physicians before selecting one. Resolve suggests you start by asking the following questions:
- Where did you receive your medical training? When?
- Are you a board-certified reproductive endocrinologist?
- How long have you been treating infertility?
- Do you or your nurse have a call-in time so that I can ask questions?
- Who can I call if I have a problem after office hours?
- Can procedures be done on weekends?
- Are you affiliated with a hospital?
- What insurance plans do you accept?
- Do you offer any financing options or long-term payment plans?
- How much will treatment cost? Does that include lab work, procedures, and medications?
- Do you offer advanced reproductive technologies, such as IVF?
- Does your practice have a sperm or egg donor program?
- Can you explain the success rates for your clinic? For women my age?
- Can you prepare a treatment plan, including which tests and treatments I'll undergo?
Also, discuss your expectations. How aggressive do you want your doctor to be? How much risk are you willing to assume? How complex are you willing to make you and your partner's life in order to succeed? What is the physician's philosophy toward patients and their contributions to the process?
How do I know when it's time to try someone new?
The emotional roller coaster ride that usually accompanies fertility treatment can often make you unsure of your reactions to people and your ability to evaluate your doctor. However, if you don't feel you're getting the proper treatment, it is well within your rights to seek help somewhere else.
Experts at Resolve say the following warning signs indicate it may be time to find a new doctor:
- Your specialist suggests you continue a course of treatment even though you've been through three or four cycles without success.
- You can't ask questions freely, or your doctor dismisses your concerns.
- You have to remind the doctor constantly about your treatment plan or ask to have certain tests.
- Pregnancy drug treatments are not being carefully monitored with blood tests and ultrasound exams.
Be your own advocate
Even if you and your doctor are a good team, you may still need to be your own best advocate. "It's obvious that women in their forties should be priority patients at infertility clinics -- time is of the essence," writes 43-year-old Liza Glass,* an infertility patient in the San Francisco Bay Area. "Yet the overworked MDs at my clinic rarely follow my case. Most of the time, I must steward my own treatment schedule.
"There are, for example, certain routine steps in the course of a medicated fertility treatment a patient must carry out each cycle," Glass reported in her treatment diary. "These include monitoring estradiol levels to make sure the ovaries have not been overstimulated and ultrasound exams to measure follicles and determine the optimal time to attempt conception." Nonetheless, she says, "I had to battle to book appointments for these procedures. At one point, my doctor was away on vacation and the tests he asked me to take had not been authorized."
Denice Dirks of Southern California says two key factors were responsible for her eventual pregnancy by in vitro fertilization: educating herself about her condition and finding the right doctor.
Dirks felt that the first doctor her OB/GYN referred her to was not aggressive enough, so she sought a referral to another specialist. She also made a point of educating herself about infertility and her treatment options, something she recommends to other patients. By doing her own research, she was able to overcome her feelings of frustration.
"I'm not sure we would have been successful if I wasn't as diligent in taking charge of my own care, or if I'd had a doctor who was not open to that," she says. "You really have to take responsibility for your own medical treatment."
*Liza Glass is a pseudonym.
American Medical Association: 515 N. State Street; Chicago, IL 60654; 800/621-8335; http://www.ama-assn.org
American Board of Medical Specialties: 1007 Church Street, Suite 404; Evanston, IL 60201-5913; 847/491-9091; 847/328-3596; http://www.abms.org
Resolve: The National Infertility Association: 1760 Old Meadow Rd, Suite 500, McLean, VA 22102; 703/556-7172; http://www.resolve.org
Interview with Denice Dirks, an infertility patient.
Selecting a Fertility Specialist, by Diana N. Clapp, BSN, RN, medical information director, Resolve, the National Infertility Association, 2005.
What is an infertility specialist? Resolve, the National Infertility Association.
Who should see a specialist? Resolve, the National Infertility Association.
Getting the most out of your care, Resolve, the National Infertility Association.
Questions and Conflicts: Working With Your IVF Center, the American Infertility Association.