Questions To Ask About Infertility (source – NY Times)

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.

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How To Select An IVF Doctor – The 411

When looking for a IVF doctor, a good place to start is to ask your OB/GYN for his/her opinion of doctors in your area. Because fertility treatment usually requires several office visits, you will probably not want to travel too far for testing and treatment. Other sources are friends or relatives you know who have had an experience with a fertility doctor. Because there is a wide range of IVF clinics, it is helpful to know the ins and outs of how to select an IVF clinic.

Though some OB/GYNs do provide limited infertility treatment, they are not trained in the more advanced reproductive technologies like IVF. You will want to find a doctor who has been trained to do IVF.

Reproductive Endocrinologists (RE) represent a subspecialty of obstetrics/gynecology devoted specifically to treating infertility.  RE’s are required to have specialized training that is above and beyond their 4-year OB/GYN residency training and board certification.

Once you have narrowed down your options, you should make an appointment to meet with, and interview, the doctors on your list. Your partner should attend the appointments with you.

Some questions to ask:

  • Where did you receive your medical training? When?
  • Are you a board-certified reproductive endocrinologist?
  • For how long have you been treating infertility?
  • Do you have a treatment specialty?
  • How long have you been in this practice?
  • Are you affiliated with a hospital?
  • How many patients have you treated with IVF, and how many IVF cycles have you performed?
  • What are steps in the procedure?
  • If the reason for my infertility is unclear, what diagnostic tests do you recommend?
  • Do you have a call-in time so that I can ask questions?

As with selecting an IVF clinic, you will want to listen to your gut when choosing your doctor. Your comfort level with the doctor is a very important aspect that should not be ignored.

How to Select a Fertility Clinic- the 411

So, it’s been recommended that you find a fertility clinic. With over 400 IVF clinics in the United States, there is no shortage. But how do you choose among them?

Often women or couples are referred to a particular clinic in their area by word-of-mouth. Recommendations may come from your gynecologist or from friends and relatives. Sometimes clinics are known by ads and news articles or found through Internet searches. Even if you are given a recommendation, it is wise that you do your own research in advance of visiting a clinic. Doctors report that IVF patients these days are typically well-informed and knowledgeable when visiting a clinic for the first time. It is to your benefit to be an educated consumer and to know what to look for.

First, you should check this list and rule out centers you SHOULD NOT use ! :  http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2013/default.htm

Types of clinics

There is a range when it comes to types of fertility clinics and no two clinics are alike. There are pros and cons with each type, with no type being better generally better than another.

  • Sole practitioners
  • Small practices with 2 – 8 member physicians
  • Large, full-service practices
  • Fertility networks
  • University-based clinics
  • Hospital-based clinics

Sole practitioners may offer a more personable experience than a larger practice, and you may have more direct access to the doctor when you have questions.  Larger practices typically have the benefit of an in-house lab, equipment and more resources available, but it is more likely you will be communicating with nurses and staff, rather that directly with the doctor when you have questions. With a larger practice you may not always see the same doctor from visit to visit.

Fertility networks are groups of clinics that have come together under an umbrella organization. They offer different forms of financing.

Clinics at university hospitals are involved in research which could be advantageous in that they could be using the latest techniques, and offer discounts.  Medical students are sometimes present during exams at university-based clinics.

With both university-based and hospital-based clinics, there are usually lots of resources, but typically bureaucracy as well. People often wrongly assume that a clinic’s reputation is the same as that of the university or hospital within which it resides, but that is not the case. it is important to assess a clinic in the same way you would any clinic.

Success rates

It is important to know the the success rates of clinics that you are considering. The Centers for Disease Control (CDC) mandates that all IVF clinics report their statistics annually. Note that it takes two years for the CDC rates to become available and, therefore, it is possible that the published data may not be representative of an IVF center’s current performance. Many factors that contribute to a clinic’s success rate may have changed. For example, physicians and staff may be different, equipment and training may, or may not, have been updated, and so on.

You can see individual clinic’s statistics by referring to the Annual ART Success Rate Reports. It provides an in-depth picture of the type, number, and outcome of ART cycles performed in U.S. fertility clinics. To help you interpret the CDC’s individual fertility clinic statistics, be sure to read How to Read a Fertility Clinic Table and Introduction to Fertility Clinic Tables.

Understanding IVF clinic success rates

While a majority of clinics publish their success rates on their websites, some do not. When investigating a clinic, you should ask a for a report of a clinic’s success rates, and it is always wise to compare their reported statistics to the CDC report. Some clinics may choose to show only a subset of their statistics.

When selecting a clinic, be sure to look for one that has a success rate that’s at least above the national average.

Financial aspects

Cost

Of course you will want to know costs ahead of time. When looking into the cost of IVF you will find that costs depend on your individual circumstance.  Also, you will find that costs vary from clinic to clinic.  It is important to ask exactly what is included when you are given a quote for the cost of an IVF cycle.

While cost is an important consideration, it should not be the determining factor when selecting an IVF clinic.

Health insurance

Find out if your health insurance policy covers fertility procedures such as IVF. Even if it a procedure like IVF isn’t covered, your insurance may cover fertility diagnostic procedures.

In either case, if you want to take advantage of your coverage, you must choose a doctor that is in your insurance plan.

You can read about state infertility insurance laws to see how they pertain to you.

Interview

Once you’ve narrowed down your options, you should contact the fertility clinic(s) to set up an interview.

In conclusion

As you can see, there are a variety of factors to weigh when selecting a fertility clinic that is right for you.  After doing your research, in the end, it is very important to listen to your gut. Remember that fertility treatments can be an emotional and stressful experience, and you will want to feel comfortable and supported with the medical provider you choose.

The Nourishing Traditions Book of Baby and Child Care

The Nourishing Traditions Book of Baby and Child Care

THIS IS A MUST HAVE !! Great info prior to pregnancy and beyond. There is an awesome recipe for homemade baby formula. There is info for a pre-conception diet that will blow your mind. I ordered the book from Amazon.com.

The Nourishing Traditions Book of Baby & Child Care makes the principles of traditional nutrition available to modern parents. The book provides holistic advice for pregnancy and newborn interventions, vaccinations, breastfeeding and child development, as well as a compendium of natural treatments for childhood illnesses, from autism to whooping cough. The work of Rudulf Steiner supports the book’s emphasis on the child’s spiritual requirement for imaginative play.