What to Ask About Infertility
Confronting a new diagnosis can be frightening — and because research changes so often, confusing. Here are some questions you may not think to ask your doctor, along with notes on why they’re important.
What is your success rate in achieving pregnancies in women of my age and with my diagnosis?
Fertility diminishes with age, and so do I.V.F. success rates. Make sure the statistics cited by your prospective fertility doctor apply in your circumstances, not those of a woman 10 years younger.
Do you have a treatment specialty?
Working with a medical team experienced in your type of infertility can enhance your chances of getting pregnant.
How long do you believe your patients should try less advanced methods before moving to assisted reproductive technologies?
Depending on your age and diagnosis, oral medications such as clomiphene (Clomid) and artificial insemination can increase your chances of conception without the cost or emotional commitment of I.V.F. But patients over 35 years old should not spend too much time on such low-tech methods if they’re not successful within a few ovulatory cycles, many experts say.
How do you treat repeated miscarriage? What are your views on the use of intravenous immune globulins (IVIg)?
Recurrent miscarriage often is treated with hormonal supplements along with pre-implantation screening of defective embryos. Some centers may also offer IVIg, a highly controversial procedure that involves an intravenous cocktail of antibodies from many blood donors. Most well regarded fertility practices don’t administer IVIg because of its risks and as yet unproven benefits.
Do you perform preimplantation testing of embryos? If so, do you do it for anything other than genetic disorders?
Preimplantation genetic diagnosis, or P.G.D., is a procedure in which cells removed from an embryo are tested for genetic abnormalities before it is transferred into the uterus. P.G.D. can help doctors identify devastating genetic diseases, like Tay-Sachs or cystic fibrosis. Yet recent studies suggest P.G.D. is not as reliable as originally believed.
What’s your position on pregnancy reduction?
The more embryos transferred into a woman’s uterus, the greater her chances of carrying one to full term — and of having multiple births, with such complications as premature birth and underweight babies. Many doctors have begun transferring fewer embryos in order to lower these risks.
At what age, or after how many failed cycles, do you recommend the use of donor eggs?
Fertility centers and specialists vary in their approach; the answer also will depend on your age, diagnosis and history of live births. It can be useful to know your prospective doctor’s views and whether a prospective fertility practice would be able to locate an egg donor should you need one.
Can acupuncture aid fertility?
Some evidence suggests acupuncture may have beneficial effects on stress and reproduction, though studies have been mixed. Whatever treatment approach you choose, stress management is an important component of infertility treatment.
What happens to my unused embryos?
A reputable fertility center will have you sign an informed consent form expressing your wishes. The usual choices include donating unused embryos to another infertile couple, offering them to a research institution or having them destroyed.
Do you freeze eggs? Do you use the slow-freezing method or vitrification? What is your success rate with frozen eggs, compared to frozen embryos?
Egg-freezing is an area of growing research and promise, but the American Society for Reproductive Medicine, the main professional body for fertility specialists, regards it as an experimental procedure that should only be provided to younger cancer patients facing sterilizing treatments. I.V.F. with slow-frozen eggs leads to pregnancy less often than procedures relying on fresh eggs or slow-frozen embryos. . Vitrification, a new process by which eggs are flash-frozen, may rival that of fresh eggs, though the procedure is new.
What about ovarian tissue freezing?
The safety and effectiveness of this experimental technique, which involves making a small incision under the navel and removing thin strips of ovarian tissue for later transplant, remains unproven. The American Society for Reproductive Medicine currently states the procedure should be considered only for women who must undergo medical treatments that may leave them sterile, not as a lifestyle option for women who want to advance their careers or find a partner.
The American Fertility Association, a nonprofit advocacy and education group based in Baltimore, also has a list of recommended questions on its Web site, www.theafa.org.