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Houston Fertility Journal

3 Important Considerations before choosing a Fertility Specialist

[fa icon="calendar"] Feb 26, 2018 4:46:15 PM / by Center of Reproductive Medicine   

Center of Reproductive Medicine

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So you have decided that it is time to see a specialist for infertility. This is not an easy conclusion to come to, and there are still many difficult decisions you will have to make from here on out. What is undeniable, though, is that you want a family. You are so sure of this you are prepared to travel into unknown territory, and that is admirable.

Still, because you have never done this before and there are a good deal of possible outcomes, it is very important that you prepare yourself adequately. You will find a lot of advice on the internet and from friends about where to look for a fertility specialist, but while you are doing so, make sure that you are considering these 3 important things.

This is a Time Commitment

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Be sure the clinic and specialist can accommodate your schedule. Depending on how busy your schedule is, it could be difficult for you to make appointments in the specific timeframes that are required for fertility treatments. You will need to be ready to move things around or even cancel certain plans so you can arrange the necessary visits to your clinic.

At the same time, the clinic and specialist should be understanding that you have a life and this can make scheduling difficult. The more hours they stay open the better. Furthermore, there should always be a way for you to get in touch with someone at the clinic if you have a question or concern, no matter the time or day. The best professionals working in this field make their patients top priority and you should always feel that way.

Be prepared for the impact it will have on your daily life. In Vitro Fertilization (IVF) and most other fertility treatments will demand a lot of your time and energy, physically and emotionally. Just 1 cycle of treatment will take anywhere from 4-7 weeks.

The treatment will require you to ingest pills and receive injections as well as be constantly monitored for signs that your body is responding well. This is a lot of driving back and forth and you may experience stress from the hormones. Below you will see just how specific and crucial your schedule will be from day 1.

  • The first 2-4 weeks. With IVF, the first 2-4 weeks are when you will begin oral contraceptives to allow the ovarian suppression process to get going. Lupron will be overlapped with these pills, which is the daily injection meant to complete the pre-stimulation ovarian suppression. After 2 weeks you will go to the clinic to get an ultrasound and blood test to ensure that everything is working as expected.
  • The first 8-12 days. Once your specialist is sure that down-regulation has been achieved they will start ovarian stimulation with fertility medications through injection. They will continue giving you Lupron in lower doses and the rest of your fertility medications to take daily will also begin.
  • At day 5. Once you have reached day 5, most specialists will require that you will begin making regular visits to the office. This means every 1 to 2 days. When you are there they will check that everything is working well and then require you to check in with them later in the day to receive your blood tests results and any further instructions you may require.
  • Somewhere in between day 8 and 12. The goal at this point is to trigger ovulation with an injection of human chorionic gonadotropin (HCG) once your specialist observes that the follicles are mature. It is very important that this is timed correctly, as the follicle aspiration must be performed 36 hours after the HCG is injected.
  • 36 hours following the HCG injection. This is the day that your egg retrieval will be performed. You will be asked to show up to your appointment 1 hour before this procedure is scheduled to take place. The whole thing will take no longer than 2 hours. The procedure usually takes less than 30 minutes. The sperm are also retrieved from the male on this day, and in some cases more is obtained 2 days before, when the HCG injection took place. A 3rd specimen may sometimes be taken the morning after the eggs have been retrieved if it is believed that the extra sperm will be of use. You and the male partner will be asked to not have sex for 2-7 days before he gives his sperm, as ejaculation can affect the quality of the sperm. The sperm and egg will be joined for fertilization on the same day of the retrieval.  Most of the time the fertilization occurs naturally, but your doctor may need to help it along if necessary.
  • 3-5 days after egg/sperm retrieval and fertilization. The embryo transfer will be performed 3-5 days later and you will be asked to arrive 30 minutes prior to the procedure. Patients are usually given something to relax their muscles, such as Valium, another person will need to be with you to drive you home. You will also need to remain in bed for 30 minutes after the procedure. A progesterone suppository is placed in the vagina when the embryo transfer takes place, and you will be asked to use the suppositories 2 times a day until the end of the first trimester of a successful pregnancy or after a 2nd negative pregnancy test.
  • Day 14 and 21. There are usually 2 pregnancy tests done on day 14 and day 21. They check to see if you are pregnant by testing your blood, and the physician usually contacts you later that day with results.

As you see, each step is dependent on your ability to commit your time accordingly. With the right fertility specialist, you will be able to come up with a schedule that works between the 2 of you.

Success Rates do not Tell you Everything

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When looking for fertility specialists, the first thing people tend to look for are the success rates of the clinic. Luckily, it is required in the United States that each clinic reports their rates to the Centers for Disease Control and Prevention. This data can be informative, especially for those responsible for focusing on the areas on the procedures that could use improvement. Yet, these numbers have a tendency of being very deceiving for those desiring treatment.

Multiple births shows higher numbers but greater risks. A large number of clinics have higher success rates because of the number of embryos they transfer in 1 procedure. Doing so increases the chances of success, but it also has often resulted in multiple births. Multiple births are commonly linked to a higher mortality rate, a collection of health complications, and increased financial burden. In the end, these outcomes are devastating for patients, and the higher success rates should not be considered a positive thing.

The separation between fresh and thawed embyros. Success rates for IVF are separately notated depending on whether the embryos were fresh, or frozen and then thawed. The number of fresh embryos in the US have become increasingly less common and many centers have begun to freeze all of the eggs which have been retrieved. It is important to check the method that is being used by each clinic, and why it is that they are achieving a higher percentage.

Not every clinic reports their success rates. Though the success rates may be deceiving, it is better to be able to see them rather than not at all. Some clinics fail to report their rates to the CDC. If you are considering treatment at a facility and you cannot find their rates, that should be an instant red flag. A clinic should be comfortable providing complete transparency of it’s practices and success. The law was put into place because clinics were faking their numbers to draw more patients, so be sure that the clinic you are interested in is on the CDC website.

IVF success rates can still be manipulated, even when posted with the CDC. One small adjustment to the average age in a clinic’s patient base can change the way the success rates appear. “In 2011, women younger than 35 who underwent assisted reproduction cycle gave birth to a live, single baby 27 percent of the time. In women older than 44, the success rate was just 1.1 percent.” In other words, if a clinic is only treating women under 35, they are bound to have a higher success rate.

You may need help understanding the success rates posted by each clinic, and you can ask a trusted doctor to assist you with this, especially if you have scheduled an appointment with one that you are interested in.

This is About You

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Through the process of deciding how to approach your fertility treatment, you will have a lot of people telling you what is best for you. This is why you will want to go in with a sure understanding of exactly where you stand and how much you are willing to do.

If your initial treatment does not work, are you willing to try again? There is a 46% chance for a woman under 30 that her 1st IVF treatment will be successful. Women between 40 and 46 have a less than 12% chance of success. No matter who you are, the possibility exists that you may be faced with the decision to try again.

It can be very helpful for people to determine just how many cycles they are willing to try, and if they would be ok with taking a different approach. You should never feel pressured by your doctor or anyone else to do something that you do not want to do. The case always remains that this is your journey and your body, making the decision completely yours.

It is important to realize that your specialist may not know exactly what is causing your infertility until attempting IVF. They may come to the conclusion that another treatment is better for you once they can observe the way your body responds.

There are other options, such as:

  • donor sperm
  • intracytoplasmic sperm injection
  • donor eggs
  • surrogacy
  • donor embryos
  • and reproductive surgery

Your physician may come to the conclusion that the compatibility between you and your partner is not strong enough and that another approach may be better. It is up to you and your partner to decide whether or not this is something that you are comfortable with.

Stay in Tune with Yourself

It is not uncommon for the stress of treatment to become overwhelming. As you begin this journey, be aware that you have many resources available to you to help you through the stress of it all. A good clinic will put you in touch with resources and/or tactics that will be useful to you.

Remember that the specialist you choose should want nothing more than to provide you with the utmost care. If you do not feel comfortable with the treatment that you are receiving, trust your gut. The most important thing is that you are listening to yourself and doing what makes you feel good.

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Topics: Fertility Journey, Fertility Specialist

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