It's a scenario that's played out a few times before in my life: I'm staring across a shiny mahogany table at my latest fertility specialist in a crisp white lab coat, wondering if my inches-thick stack of medical records measures up to the framed degrees on the wall. Intimidating? Yes, but after all this time trying to conceive, I know my body pretty well. And when it comes to assisted reproductive technology (ART), that knowledge and experience must count for something, right?
Sure it does, says Andrew A. Toledo, M.D., the CEO of Reproductive Biology Associates in Georgia. "When a couple comes in, there's already frustration, anxiety, a feeling of 'Something's wrong with me, I must be defective, I must be getting punished for something,'" he says. "As a doctor, you have to do a good assessment of what's already been done to help the patient. If a couple has been through so much, you don't start over or reinvent the wheel."
Which is why it pays to speak up about your past experiences and medical history, and ask whatever burning questions you have. Whether it's your first time meeting with a reproductive endocrinologist (RE) or your fourth, here are five ways to advocate for yourself while still keeping the wheels rolling forward toward your parenthood dreams.
Do Your Research
Choosing the right practice and a receptive RE can make all the difference when it comes to negotiating your care. "A vast majority of infertility couples will be good with a general, well-established center," says Dr. Toledo. "But those who have more complicated cases will require a center with a more advanced approach."
Ask around for recommendations—word of mouth can help you sift through the overwhelming list of unfamiliar specialists and clinics. Then check the Society for Assisted Reproductive Technology's website for each shortlisted practice's reported stats. Pregnancy rates per embryo transfer and instances of frozen embryo transfers are two major ones to note, says Jane Nani, M.D., director of the Center for Collaborative Reproduction at Fertility Centers of Illinois. "It's a good thing to have high pregnancy rates per transfer, and high frozen transfer rates tells you they do a good job with freezing embryos," she explains. "This means they are good at culturing embryos to transferring at the blastocyst stage." An egg's ability to survive to a Day 5 blastocyst is a strong indication of its quality.
Know Your History
I've switched RE practices a few times because of an out-of-state move or unsuccessful rounds of IVF. And every time I've walked into a new RE meeting, you'd better believe I used my "insider knowledge" to my advantage, especially if the doctor recommends tests or procedures I've had in the past.
"Always have a good sense of personal history," advises Dr. Nani. Information such as the regularity of your cycles, the success or failures of previous pregnancies, confirming ovulation with luteinizing hormone (LH) surge kits at home, and remembering whether a previous doctor ran a sperm test on your partner is all important "so that we don't go back to basic treatment," she says.
In fact, Dr. Toledo says it's smart to be wary of a specialist's one-size-fits-all approach to care, even more so if you've experienced repeated losses or are of advanced age. "Every situation, every person, every couple is unique," he says.
Know Your Family's History
Though infertility can be attributed to many different causes, some cases are stubborn mysteries. Knowing your family history can go a long way toward helping your physician figure out what's derailing your dreams of motherhood. "Have a good sense of family history when it comes to both reproductive and general medical problems, particularly genetic diseases," says Dr. Nani. "What we see often is that some couples don't know if they have carrier status for some of these genetic disorders, like cystic fibrosis or sickle cell [disease]."
Discuss Your Limits
A friend once shared that she and her husband agreed they would not try an assisted reproductive technology procedure more aggressive than insemination. Despite being in her 40s, she just couldn't see herself going through IVF and decided that if insemination did not work, they would not pursue anything further. After her first intrauterine insemination, she got pregnant with a healthy little girl, who is now a smart, thriving 4-year-old.
Dr. Nani supports the idea of patients voicing their personal limits. "Couples should come into their meetings with physicians with their limits on what they would not consider," she says. For example, "not everyone wants to use an embryo or egg donor. Couples should state that to their physician."
Ask the Right Questions
When you're in that shiny-mahogany-desk meeting with your RE, and feeling powerless over your infertility, know that you can salvage some sense of agency and hope—even if your case is tough to crack. The key is to ask the right questions. "Find out how the RE handles the 20 percent of cases that are considered more complicated," Dr. Toledo advises. "Ask them, 'What do you think you could do that's different from the standard?'"
And for the majority of couples whose histories are not so complicated, the same question-raising approach applies. Asking your RE about alternatives to IVF can clue you in to whether your RE prematurely jumps to the most aggressive options. "Not every couple who can't get pregnant on their own have to do IVF," cautions Dr. Nani. "Some people get pregnant with insemination. And if IVF is the best option, remember that someone who is young and healthy doesn't have to do a big stimulation. There's a way to cater the protocol so that young people don't need stimulation so aggressively. Even if women are older, we now have the ability to select one genetically normal embryo to transfer."
Worried that asking such direct questions will make a bad first impression on your specialist? Don't be—the focus of your visits should be on you, not your RE's ego. "One of the things that's so hard on patients when they come in for meetings is they feel there's something wrong with them," says Dr. Nani. "So it's important to come prepared with questions, because it gives the couple back some of their power."
In other words, your list of questions may not earn you a framed degree hanging on the wall, but the reassurance and confidence it provides are priceless.