Trouble Conceiving?

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It was 7 AM. My husband whisked himself out of bed and hopped into the shower. Trying to make up for lost time, he skipped his usual shave. Meanwhile I laid in bed for the next 20 minutes with my hips hiked up to what felt like the ceiling. Maybe, this time would be the month.

We had literally exhausted every suggestion I had heard of from the fertile community. My husband had changed to boxer shorts, I cut caffeine out of my diet, and we went on those vacations! Still, after 3 years of trying all of these stunts, I could not believe that we could be having problems conceiving a child. After all, bad things never seemed to happen to me!

I firmly held on to what everyone else who had had success was telling me - that it must be the stress at my engineering job that was contributing to my inability to become pregnant. Nevertheless, after countless vacations to "relax", taking my temperature religiously, and making love at the precise times every month, we were still left empty-handed.

As most of us know, denial is the first step of any grief process. Looking back now, it's obvious that I was in denial at that time - in the worst way. Perhaps the reason why those of us (who cannot conceive at the drop of a hat) have a hard time believing this truth at first, is because we have grown up in the era of birth control. Because birth control is relatively 100% fool-proof these days, we have somehow misled ourselves into believing that birth control equals fertility control. Even though I had never been on the Pill, because of the very fact of growing up in this era, I also believed the same - that when I was ready to have a child, I just could... and would!

Now after an 8-year battle with infertility, I have learned so much from a patient perspective that I changed my life's full time occupation to that of "fertility consultant." In this series of articles I will try to give some former patient advice on how to recognize, deal, and cope with a fertility challenge.

Life is not fair. Having a fertility challenge quickly teaches you that. But by having the proper tools you need to cope with this challenge, you will inevitably save yourself time, money and some heartache in your quest for a child.

Time to Seek Help

I run across so many people who are in denial of their condition every day. They tell me, "We just aren't timing it "perfectly" every month. Therefore, we really haven't been trying for over a year." That was my thinking as well. However, the facts of the matter are, that if you have had a regular sex life (once every week on average) over the course of a year, and you are not pregnant, it is time to take action! No, it is not in your head. Yes, it is something to be concerned about, and taking a vacation in most cases will not do a thing. A vast majority of fertility impairments is caused by an underlying medical problem. And good medical attention is what you need first and foremost.

It is far easier these days to get the right medical care you need to succeed than it was only 5 years ago. The latest figures estimate that there are close to 300 fertility clinics in the US alone. And with this new competitive market comes higher patient care.

Selecting a Fertility Doctor

But how do you choose which doctor to see, once you've decided to do something about it? Perhaps here is where many women make the number one biggest mistake regarding their fertility and waste not only time and money, but also potentially add undo heartache to their situation.

Non-Board Certified OB/Gyns

Many regular OB/Gyns (whose primary business is to see pregnant women and deliver babies) claim to specialize in "infertility" well. However, if you choose to see your regular OB/Gyn you must be cautious of how long you will waste seeing him/her and what him/her capabilities truly are.

If you choose to use a non-board certified OB/Gyn for your basic work-up, you must know that most of these physicians will only run a minimum amount of tests such as a hysterosalpingogram (HSG), sperm analysis, and post-coital test on you as a couple, leaving a lot of room for "undetermined" causes.

In my experience as well, I have seen an utter abuse of clomiphene citrate (Clomid®, Serophene®) by regular OB/Gyns. Many OB/Gyns will prescribe this mild fertility drug for over 6 months time while not even monitoring their patients. Dr. Perloe, a noted fertility doctor, once stated that "when clomiphene therapy is successful, 50% of pregnancies occur in the first ovulatory cycle; 85% occur by the third, and 97% by the fourth cycle."

You should also know that anyone who is taking any kind of fertility medication should be checked via ultrasound equipment for follicular growth and potential cysts which can arise from the use of these drugs during every cycle on the medication. This helps minimize the chance for multiple births and other health effects from arising.

Fertility Specialists

If you want to really save time and money, one of my biggest bits of advice I give is to seek out and use a fertility specialist right from the start. Granted, the initial fees may be a bit steep at first, but my experience has shown that it's money well spent in the long run.

Since the term "fertility specialist" is a gray time and not recognized by the medical community, as a consumer you need to know who the true experts in the field are.

At the minimum, I always suggest by starting with a board-certified OB/Gyn whose only patients are those with fertility problems.

Better yet, see a reproductive endocrinologist (RE), an OB/Gyn with a board certification in the subspecialty of reproductive endocrinology. These are the "cream of the crop" doctors who are can usually quickly and properly diagnosis a person with a fertility impairment.

Finding the Right Fertility Specialist

How do you find these "specialists"? It's easier than you think! First off, be cautious of word-of-mouth physicians. It may seem logical that you use a physician suggested by someone who has had success. But, remember, your situation is unique. Their doctor could have just been "lucky" with their situation. What you need to look for in a doctor is one with two attributes: credentials and compassion. For credentials, check out the American Society for Reproductive Medicine and the Society for Reproductive Endocrinologists (SRE). Both have patient directories to find doctors locally.

You must note, however, that the ASRM's directory is a physician self-designated directory. You may want to check with the ASRM directly to cross check a physician's true credentials. On the other hand, you must be a board-certified reproductive endocrinologists to be listed in the SRE directory.

Fertility Specialists in the HMO System

Ah, but the healthcare system! What do you do when your HMO requires you to get a referral letter from your primary OB/Gyn to see a specialist?

Never fear! As with all good things that are worth it, this may take some work and determination on your part. To tackle this situation, first ask your regular OB/Gyn right from the start to refer you. If you have a particular specialist in mind, who is listed on your plan, mention this person as the one you'd like to be referred to see. If your OB/Gyn is hesitant, and you do not wish to have him/her perform any tests on you, then there are ways around this as well.

Find the fertility clinic/specialist you want to be referred to. Call their office. Ask them who'd they think would refer you to them, and then, if your plan allows it, switch to this OB/Gyn to get a referral to the specialist of your choice. Granted, it may sound a little crazy, but as the saying goes "desperate times deserve desperate measures."

Time to Interview the Specialists

When you finally have located a specialist you think you'd like to work with, call his/her office for a phone interview. Yes, you heard that right - interview them. My sister-in-law did this and turned down two potential clinics until she decided to see the physician she ended up having success with several years ago. Questions to ask include:

How long do I have to wait to get a first appointment?
How long is your usual waiting room wait?
Do you share office space with other OB/Gyns who see pregnant women?
Will I always be seeing the same doctor?
Who will I be seeing if my doctor is unavailable?
What are your terms of payment?
How do claims get processed?
Does your clinic offer an emotional support group or is there a support group you could recommend?

Granted, the person answering these questions will likely be the office staff, or maybe a nurse, but you will get a feel about the clinic from these first line people. Remember, you will be calling this office a lot during diagnosis and treatment for results, and you want to have compassionate people on the front line to work with you!

Fertility Patient Rights

As a patient, too often we forget that we have underlying rights as well. Being a fertility patient, you have some fundamental rights which must not be denied to you. Take these rights into consideration as well, as you are selecting and working with your fertility care providers:

The right to access the specialist and laboratory facilities seven days/week while you are undergoing diagnosis and treatment, so that (if necessary) tests, inseminations, or monitoring can be conducted on your appropriate days.
The right to ask questions of your doctor at the end of each visit and to have your questions answered in a satisfactory manner.
The right to be seen in a reasonable amount of time. Although doctors (especially clinics) tend to handle high patient-to-physician loads, you should be granted an initial appoint to see a specialist with no more than a 2 month wait. You also should not have to wait more than an hour from your appointed time to see the doctor. Remember - your time is valuable also!
The right to have costs explained to you prior to each new procedure. This should include an explanation of how insurance will be filed, payment terms, etc.
The right to have access to ultrasound equipment which can be used to monitor follicular growth and potentials cysts which may develop from the use of fertility drugs on a monthly basis - this monitoring should be done even with the use of every cycle of clomiphene citrate!
The right to have a courteous staff, including the doctor, who will be attentive to your needs and questions, and who will treat you with respect.
The right to review your records and all test results.
The right to change doctors for a second or third opinion and to have your records forwarded as requested.

As a final note, as you may have found out by now, not all specialists are created equal. Through the last phases of our diagnosis and treatment, my husband and I were not seeing a board-certified RE. However, the doctor we were seeing, a board-certified OB/Gyn whose only patients were those with fertility difficulties, was a pioneer himself in the fertility field. He was in his sixties, and since he practiced his whole profession in this area and kept up with the latest advances, we felt very comfortable in his care. He and his staff measured up to all the qualifiers listed above. In fact, he gave us more definitive answers to the causes of our fertility impairments and treated us with more human dignity, than one of the reproductive endocrinologists we had been previously seeing. So, as with any other purchase you may make, be a wise consumer of the medical care you receive.

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