When my dad had cancer, I naturally was the de facto choice to accompany him on his medical visits. I had those fancy letters at the end of my name, right? But, in reality, he and I collectively absorbed about 50% of what was said. It made me realize that even as purportedly the best qualified representative, I still had no clue what would be best to ask. (Of course, my mom the RN was the one who truly understood plans of care and how best to navigate and inquire about his case — big ups to our nurses!). I see this every day with patients. Commonly, the process of even sitting in the chair can feel overwhelming and so people forget their mental catalog of queries. So, I’ve compiled a list of important questions to ask when you are at the fertility doctor. I’ll also demystify what to expect when you are there (so you’re not surprised when you see the condoms).
HOW TO FIND THE RIGHT FERTILITY DOCTOR FOR ME:
This is the essential first question. Liking your fertility doctor is important. You’re going to be seeing him or her (hopefully not too) many times in the span of months. There are marathon hour-long visits or multiple ones within a week. Of course, you want the doctor and the center that will help optimize your chance for a baby. But no guarantees exist. Therefore, it’s important to find someone who you know did their best for you even when you don’t have the hoped-for outcome.
- Check out your doctor’s credentials. A caveat — it’s easy to be dazzled by fancy schools, but all training programs have rigorous standards to meet. And sometimes the best programs for a specific niche aren’t the stereotypical ones we think of for undergrad. Check to ensure they’ve done Reproductive Endocrinology & Infertility training. This is a competitive fellowship that takes 3 years after the 4 years of general OBGYN residency. Other important credentials are board certification, showing that physician is in good standing with their national society and has committed to ongoing learning.
- Look up reviews. And cross-reference to get the complete picture. Google, FertilityIQ even yelp (yes, yelp!) require people to provide some form of verification before posting, so those may be more legitimate.
- Speak to the office staff on the phone. This gives you an instant idea of the culture. Yes, sometimes people can be very busy or have an off day. But listen to your gut if you’re consistently having off-putting interactions.
THE INITIAL CONSULT:
If possible, bring your partner (to every visit!). You’ll be hearing about many new concepts and it’s helpful to have someone else there to corroborate or add to your understanding. In this time of COVID, you may want to check the specifics with the office beforehand.
What to Expect:
- This visit is foundational. It’s information gathering to determine the road map for you and a time to discuss your goals.
- You’ll get an understanding of the basic fertility workup, hormones, imaging, and next steps.
- It will be a long consult, anywhere from 30 minutes up to 1.5 hours.
- Be prepared to discuss your menstrual cycle in great detail, plus bleeding history, ObGyn history, family history of genetic or fertility issues or cancers, and partner’s history.
- Please bring in any fertility awareness biomarker charting or apps to review. Prior labs are helpful, too.
- If in person, you may have a physical and pelvic ultrasound (though there’s no need for a full bladder). And yes, we use condoms to cover the transvaginal ultrasound probe. If you have a latex allergy, please tell the staff beforehand.
- Many times, especially if there hasn’t been prior testing, we won’t yet have an idea of exact diagnoses or treatments. So, most likely you won’t be discussing the details of fertility cycles at this time.
- You will leave with a better understanding of possible causes but typically won’t have a tailored diagnosis for your situation.
What to Ask the Fertility Doctor:
- If there is something specific you’ve been afraid of, make sure to ask. You may not have the definitive answer, but based on your history, what you fear may be very unlikely and will provide some reassurance.
- Ask for specific next steps and take notes. You’ll be getting the macro view of a fertility evaluation, but it’s important that you understand the directions. For example, what do cycle day 3 blood tests actually mean (ie, where to go, how the orders will be transmitted, if fasting or a specific time of day is needed).
- What day do they count as cycle day 1? It seems basic but there is sometimes variance and it’s good to know before 11 pm on a Friday when you are only having spotting and aren’t sure when to go to the lab.
- Insurance questions are key. Fertility coverage is complex (and this is a huge understatement). See if you can speak with someone to understand an overview of costs and what your plan covers. This extends to lab work, imaging, and medications, too!
- Overall timeline and next visits. Again, this will be tailored and possibly not clear, but it may help with peace of mind to know a rough estimate of next steps.
THE FOLLOW UP VISIT:
This may be more than one consultation depending on what evaluation you’re doing and your time in cycle.
What to Expect:
- Lab results. Your doctor will review these in detail with you.
- Radiology results. I always show patients the actual images and think it’s enlightening. Inquire to see if this is a possibility if you are interested.
- Getting a diagnosis. It’s so important to ask if you are unclear about what the cause of your specific fertility issue is. And if you still don’t get it, please don’t hesitate to ask again for clarification! You are your own best advocate and it is important for you to speak up.
- Being given an overview of options and next steps. This is key to make sure you grasp. I am a firm believer of the patient having choices, and that their pros and cons are delineated. Prognosis is important and should be specified.
- Treatment details. This includes logistics, timing, side effects, and risks.
What to Ask the Fertility Doctor:
- Specifics of how you can start treatment.
- If you opt to use fertility medications, these are typically given around the time your period starts.
- You may need ultrasounds at this juncture and it is important to understand who to contact to schedule this.
- Also, clarify any medications that may begin before your fertility treatment.
- Timing of intercourse and any recommendations they have can be helpful, too.
- What lifestyle choices / changes do they recommend?
- Food is medicine.
- Stress has physiologic effects on our body (though this is typically not the reason for fertility issues) and by focusing on this we may optimize our bodies and our chances.
- What supplements may be helpful?
- Are there other healthcare modalities to consider? Acupuncture and naturopathy are two examples.
- Who will you be seeing for treatment?
- Is there a group of doctors? Ultrasound techs? Nurses? Coordinators? Find out who you will be interacting with and who will be delivering news to you.
- What pharmacy do they work with and do you need to prepare how medications will be delivered?
- Most fertility specialty pharmacies have same-day delivery options, but this is always good to check, especially if you live somewhere remote.
- If you are considering in vitro fertilization, get details about their program.
- Pregnancy outcome data can be obtained both through the CDC and SART. However, there is a lag time and these reflect outcomes from years ago. So, asking about more recent stats is helpful.
- Embryology lab specifics. The best way to compare center to center may be by assessing donor egg outcomes. Since it is thought that egg quantity and quality are high in this situation, it may better reflect the impact of the lab on pregnancy chances.
- Times that the lab may be closed. There is typically maintenance that is performed on a regular basis.
- Stop gaps and policies to ensure the equipment doesn’t fail.
Though this list may seem overwhelming, it will hopefully provide a starting point. Determining what answers you need to feel at peace with whatever option you choose places you in some control. And having the right fertility doctor supporting you is part of the tribe of people who is rooting for your best!
I am a USC-trained Reproductive Endocrinology & Infertility physician with a boutique practice in Orange County, CA. I am also a Fellow in Integrative Medicine at the Andrew Weil Center at the University of Arizona, a FEMM Fellow at the Reproductive Health Research Institute, and serve as Associate Clinical Faculty at UC Irvine. My goal is to radically reimagine my field by focusing on whole body methods to identify the root cause and heal reproductive issues, like fertility, miscarriage, and abnormal cycles. I do this through integrative medicine practices coupled with traditional REI techniques, all while avoiding aggressive procedures. I’m grateful to have been selected for multiple years running as a Southern California Super Doctor and Rising Star, Orange County Physician of Excellence, and Top Doc in Pasadena. I am a Healthcare Task Force member for Life Perspectives, a leader in education, research, expertise and support after reproductive loss; serve on the Advisory Board for Pre-Health Shadowing, a non-profit that makes discovery of different medical specialties accessible to students; and have been an invited guest at multiple conferences and podcasts as well as an author of book chapters and multiple articles. I am excited to use an integrative medicine lens to educate about women’s issues!