When you and your partner make the decision that you are ready to start your family it can be a very exciting time in your life. First of all, you get to use baby-making as an excuse to rekindle some romance that may have slipped away with the daily routines of your lives. Second, the anticipation of a little one running around, while a bit scary, is invigorating. Finally, you're ready to join the mommy club.
You and your partner try month after month with no success. You're not worried yet because it has only been a few months. More than six months pass and you still are not pregnant. You start to become a little flustered. What do you do now? If you are under the age of 35, most doctors will tell you to try another six months before you consider alternative methods. Instead of just "trying" for twelve months, which can seem like forever when you want to conceive, I recommend talking with your doctor about some inexpensive initial fertility testing to rule out common problems, such as ovulation irregularities. However, if you are over age 35, then my advice is to talk with your doctor about fertility treatment options and the possibility of a referral to a Reproductive Endocrinologist (RE).
If you are new to the topic of infertility, you are probably not sure what to ask your doctor or where to look for resources or information. Below are ten important questions to ask your Ob/Gyn:
1. Do they take a reproductive history to determine if you have any infertility risks such as endometriosis, fibroids, recurrent miscarriages, etc.?
2. If your doctor hasn't done preliminary fertility blood testing, ask for a full-range of tests to determine if you have any infertility risks. It is important to be aware that some of these tests must be done at certain times in your menstrual cycle. Ask your doctor to explain why she is doing the tests when she is, so that you can be certain that your doctor is performing the test at the appropriate time.
3. Do they perform a semen analysis on your husband/boyfriend/partner? For example, if your spouse has sperm issues there would be no reason for your Ob/Gyn to prescribe Clomid (a common drug to stimulate ovulation). The goal is to minimize the drugs to which your body is exposed, the expense, and the emotional ups and downs you may experience.
4. What advice does your doctor offer for life style changes? For example, dietary changes can help increase your fertility as can regular exercise. However, sometimes even diet and exercise are not enough to resolve your medical issues.
5. What medications do they recommend or procedures do they offer for your condition(s)?
6. How much experience does he/she have with helping patients overcome their fertility issues? This is an extremely important question, as you do not want to stay with an Ob/Gyn who "dabbles" in fertility treatments because it could cost you time as well as money.
7. Who within their office can help you understand your health insurance benefits so that you can maximize your coverage for the fertility testing and treatments?
8. If they suggest Clomid, how many cycles will they recommend before considering additional testing or more advanced medications or treatments?
9. If they offer artificial insemination, known as intra-uterine insemination (IUI), do they monitor the number of follicles you produce via ultrasound before the insemination procedure takes place? Monitoring the number of follicles will alert them/you of the risk of twins or a high-order (three or more babies) multiple pregnancy.
10. Which REs do they recommend if advanced procedures are required?
There are four main organizations dedicated to helping the infertile community gather information as well as provide support either through articles, chat groups, or peer-lead support groups. RESOLVE: The National Infertility Association was founded in 1974 and advocates for the community in many ways, including mandated insurance coverage initiatives (see RESOLVE's website for information on the Family Building Act of 2007). INCIID, the InterNational Council on Infertility Information Dissemination, Inc., was founded in 1995 to provide infertility information and support. INCIID hosts discussion forums on its website. The American Fertility Association was founded in 1999 and offers easy to read informational and educational content on their website. Finally, Fertility LifeLines is a new educational resource for the community and offers discount coupons for certain medications.
Two of the most effective methods for surviving your fertility journey are to gather information and ask questions. For most of you, your Ob/Gyn will be your first step in the information gathering process. I urge you not to waste the opportunity to both gain as much knowledge as possible from your Ob/Gyn and to know when it is time to move on and seek the assistant of a fertility specialist.
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