Preparing for Your First Appointment:
Questions to Ask
The goal of your first visit with a reproductive endocrinologist is to gather as much information as you can to help you make an informed decision about how to address your fertility concerns. A good first step in preparing for your first visit is to develop a list of questions to ask in order to get the information you need. Sit down and brainstorm with your partner about what you need to know.
To help you get started, here is a sampling of questions often asked by fertility patients, along with the kind of response you can anticipate. You'll want to take time to develop your own list of questions, or concerns, to review with the doctor on your first visit.
- What are the first steps you will take to determine and/or treat our specific fertility problem?
- Should I be charting my basal body temperature (BBT) each month?
- What are the different treatment options for fertility medications?
- Can you explain the difference between artificial (intrauterine) insemination (IUI) and In-vitro Fertilization (IVF)?
- What are the costs of treatments and how much does my insurance cover?
- What are the side effects and risks of fertility drugs, including the chance of multiple births?
- When I am in treatment how often do I need to come to the office for appointments and can you be flexible to accommodate my work schedule?
- What are your pregnancy success rates?
- Can I do all the necessary testing and procedures in your office or will I have to go out to separate laboratories or hospitals?
- Is there someone I can call for questions at any time?
- How should I prepare for my first visit?
Q: What are the first steps you will take to determine and/or treat our specific fertility problem?
A: We first will take an extensive medical history of you both. Then, we will perform a physical examination plus a pelvic ultrasound of the woman's reproductive organs. We will also recommend any necessary diagnostic testing, discuss management options, review coping strategies and stress reduction and answer additional insurance and financial concerns.
Q: Should I be charting my basal body temperature (BBT) each month?
A: BBT charting is one of the many ways to check for ovulation however it is not the most accurate. We recommend using an ovulation predictor kit which you can purchase at any pharmacy. Please bring your BBT charts and any other information about your ovulation history to help us evaluate you.
Q: What are the different treatment options for fertility medications?
A: There are a variety of options for fertility treatment. It's important to keep in mind that no two patients will have the same problem or an identical approach for treatment. Therefore, we individualize patient care but usually proceed with some form of ovulation induction with Intrauterine Insemination (IUI). Treatment may involve oral medication alone, a combination of oral and injections, or only injections depending on the diagnosis. (These injections use insulin-like needles and are easily placed directly under the skin.) There are also those patients that are best assisted by In-vitro Fertilization (IVF). We will work with you to determine which treatment option provides you the best chance for a successful pregnancy. Most importantly, we continue to analyze your cycles to make changes for improvement, if subsequent cycles are necessary.
Q: Can you explain the difference between artificial (intrauterine) insemination (IUI) and In-vitro Fertilization (IVF)?
A: Intrauterine insemination involves the simple process of washing sperm in the laboratory to enhance fertilization. Then, using a small catheter, the sperm is gently placed into the upper uterine cavity. Since IUI passes through the vagina and bypasses the cervix, a high concentration of total moving sperm is placed closer to the fallopian tubes where fertilization normally occurs. This procedure is performed in the office without the need for sedation since a woman rarely experiences more than a mild menstrual-like cramp.
In-vitro Fertilization (IVF) is the Assisted Reproduction Technology (ART) advancement that revolutionized the fertility treatment of women when the first baby born was using this process in 1978. IVF literally means "outside the body fertilization." After stimulating a woman's ovaries (with medication) to produce multiple follicular cysts-- each containing an egg-- ultrasound is used to guide a needle through the woman's vagina into the ovary to puncture the cysts, aspirate the fluid and collect the eggs. The eggs then are immediately analyzed in the laboratory and eventually inseminated later that day for fertilization. This procedure is usually performed in an office procedure room while the woman is under sedation and takes less than 30 minutes. Originally developed to assist women with damaged fallopian tubes, IVF has now emerged as the fertility treatment offering the highest monthly chance for a successful pregnancy above all other treatment options, regardless of diagnosis.
Q: What are the costs of treatments and how much does my insurance cover?
A: The cost of diagnostic testing and management will vary among patients due to the individualized treatment approach at Fertility C.A.R.E. Our financial coordinator works closely with patients to utilize their maximum insurance benefits for services.
Fertility C.A.R.E. is a member of Advanced Reproductive Care, Inc. (ARC), the nation's largest network of Reproductive Endocrinologists (physicians medically certified in reproductive medicine and infertility treatment) who are committed to making the cost of fertility treatments predictable and affordable to assist couples with their challenges of building a family. Patient options include: affordable and predictable package pricing, financing options and 100% refund guarantee.
And we also offer "The Family Fee Plan" by Capital One where you can work out monthly payments for your treatments.
Q: What are the side effects and risks of fertility drugs, including the chance of multiple births?
A: Fertility medication to induce ovulation will cause an increase in a woman's estrogen production by her ovaries. This results in increased symptoms that mimic 'pre-ovulatory' feelings such as abdominal bloating, breast tenderness and nausea. The most common risk of any medicine that induces follicle development for egg production is a multiple pregnancy. Using clomiphene citrate tablets, the risk of a multifetal pregnancy is estimated at 5-10% of pregnancies. This risk increases significantly when a patient uses gonadotropin injectable medication, approximately 15-20% of pregnancies with a 5% risk of triplets.
Although most patients believe IVF increases the multiple pregnancy rate, this is not necessarily accurate. The percentage of multiple births from infertility treatments in this country is essentially the same when IUI is compared to IVF. Actually, the risk can be lower with IVF when responsible decision making and education is applied. At Fertility C.A.R.E. we counsel couples extensively about ways to reduce the risk of multiple births including offering a single embryo transfer for good prognosis patients and this can provide above average pregnancy rates.
Other risks of fertility medications are even more rare. These include the risk of:
- Ectopic pregnancy - Apotentially life-threatening pregnancy occurring outside the uterus,usually in the fallopian tube. This situation can be treated medically in the early stages, but may require surgery if severe.
- Ovarian torsion - An ovary containing cysts that gets twisted on its blood supply, possibly requiring surgery. In very rare cases, an ovary must be removed.
- Ovarian hyperstimulation syndrome - This is a rare but potentially fatal condition resulting from excessive cyst production by the ovaries in response to fertility medication, causing fluid accumulation in the abdomen but, at the same time, severe dehydration. In serious conditions, patients require hospitalization. Fortunately most cases resolve within one to two weeks.
- Ovarian cancer - A major study in the journal of Obstetrics and Gynecology, April 2004, demonstrated NO association and a possible reduction of risk after women were exposed to fertility medication compared to infertile patients never receiving these medications.
Side effects will certainly vary among patients and most tolerate the medicine very well.
Q: When I am in treatment how often do I need to come to the office for appointments and can you be flexible to accommodate my work schedule?
A: Once you are in a treatment cycle, the number of trips to the office will vary according to your medications. Visits are usually 15 to 20 minutes (unless you have questions for the nurse and/or physician). In general, patients using clomiphene citrate require approximately two to three ultrasound visits plus an IUI. Gonadotropin injectable cycles require three to four visits, not including IUI. After you and your physician decide on the type of treatment, the nurse will go over the number of office visits expected for that particular cycle.
Q: What are your pregnancy success rates?
A: Since programs are now required to report their statistics through the Society of Assisted Reproductive Technology to the Center for Disease Control and Prevention, only our IVF statistics are maintained and reported by Fertility C.A.R.E. Dr. Trolice's programs have consistently been above the national average for IVF pregnancy rates. Although reported pregnancy rates are often used by patients to compare the quality among clinics, this approach may not be accurate since patient prognosis and criteria for acceptance into an IVF program may vary.
Alternatively, the national average for IUI pregnancy rates is approximately 10-15% per cycle.
Q: Can I do all the necessary testing and procedures in your office or will I have to go out to separate laboratories or hospitals?
A: For your convenience, and to ensure consistency and accuracy, we offer all the reproductive medicine diagnosis and testing you will usually need for your evaluation and management. This includes blood drawing and hormonal testing, pelvic ultrasound, hysteroscopy, hysterosalpingogram (HSG), comprehensive sperm testing and preparation for IUI, and In-vitro Fertilization (IVF).
Q: Is there someone I can call for questions at any time?
A: Yes, please feel free to contact us or call us at anytime for any questions you may have whether it is nursing, insurance or general questions regarding your Reproductive Health care. Additionally, our physician is on call 24 hours a day.
Q: How should I prepare for my first visit?
A: We recommend you complete our history questionnaire and have all your pertinent medical records forwarded to our office prior to your appointment. You may also find it helpful to bring a list of questions to your visit and please allow approximately 90 minutes during this time.
