Dear Dr. Marc,
My husband and I have been trying to get pregnant for a year now. We have taken Clomid 3 times with my OB/GYN but have not become pregnant. I am getting ready to go see a specialist but I don’t know what questions to ask. Do you have any suggestions on what we should ask when meeting with an infertility specialist for the first time.
The first interaction with an infertility specialist can be quite overwhelming. Sharing the most intimate details of your life as well as your hopes, aspirations and fears with a perfect stranger is daunting. Additionally, any strain which infertility has placed on a marriage is often magnified in the setting of a doctor’s office.
With this in mind, it is a good idea to prepare some questions for your doctor before going into the consultation. The questions will serve you well not only through their answers, but if the doctor anticipates them and provides answers before you ask, that is a good sign!
Obviously, each patient and situation will have its own unique set of questions. The following list includes general questions and should apply to most people speaking to a fertility doctor for the first time.
1. What is my diagnosis?
-While this sounds like an obvious question, it is hardly ever asked and even less frequently answered. I like to think that a diagnosis provides patients with a “target.” Once they can identify what the problem is, it is easier to overcome. While your doctor may, or may not be able to provide this to you on your first consultation, you should at least receive some possibilities. Even if your doctor says you have “unexplained” infertility, at least you will be able to label the cause and move on from there.
2. What is my chance for success?
This is useful for planning, and setting appropriate expectations. In some situations the doctor can be very specific. For example, most IVF clinics publish yearly success rates broken down by age. Your doctor should be able to provide these to you. If you are not doing IVF, the doctor should still be able to give you some general guidelines as to the chance of conceiving as well as the chance of delivering a healthy baby.
3. What is my chance if I keep trying naturally?
This may not apply to single patients, same sex couples or those with blocked tubes or no sperm; however for patients with “sub-fertility” they still have a chance for natural conception each month. It is important to consider this chance in comparison to the success rates your doctor provides you.
4. Are there other treatment options available to me?
Some doctors will tell you what to do without offering alternatives. This is not necessary a bad thing, it is good to have a doctor who is decisive and confident. However, fertility treatment is highly personal and most patients are well informed. I feel it is better to provide several appropriate treatment options, recommend the best one and then allow for a joint decision between all parties.
5. What are the risks to me?
As with any medical treatment, there are risks to fertility therapy. In general, the likelihood of complications is low and most complications are minor, but I feel that one of the best ways to avoid complications is by acknowledging their existence. Further, patients who are aware of potential complications are less likely to encounter them.
6. What are the risks to my offspring?
There has been significant research looking for an effect of fertility treatment on offspring. The truth is that there may be up to a twofold increased risk for fetal abnormalities (from 2% in the general population to 4% to those conceived with fertility treatment) in babies conceived through fertility treatment. What is unknown is if that increased risk is due to the fertility treatment itself or simply a reflection of a greater risk of fetal abnormality in people who require fertility treatment. Regardless of the cause the overall risk is low, but important for patients to discuss with their doctor.
7. What would you do if you were in my situation?
This question is tricky and may not be appropriate for all doctors, but I think patients can get a good feel for their doctor’s personality through this question. If your doctor is not comfortable sharing their personal views, that is fine, but what better way to get to their strongest recommendation than to find out what they would do for themselves.
So Lisa, this is really only a partial list, but having a game plan and some prepared questions before your consultation will help ensure that you get the most out of your time with the doctor.