Considering Medical Treatments to Conceive a Baby? 10 Questions to Ask Reproductive Endocrinologists Before You Hire One

Something is wrong. You've been trying to get pregnant and it's not working. Is it you or is it your partner? You've talked with your Ob/Gyn and he may have recommended medical intervention to help you become pregnant. Perhaps you tried Clomid (an ovulation inducer, which is a common starting point) and it didn't work. Now you need to consider undergoing testing to pinpoint the cause of your inability to conceive.

Depending on your test results and the procedures offered by your Ob/Gyn, such as Intrauterine Insemination (IUI) - sometimes referred to as artificial insemination, you may consider seeking expert advice from a Reproductive Endocrinologist (RE). If you are new to the topic of infertility, you are probably not sure what to ask or where to look for resources or information. Below are ten important questions to ask an RE before you hire him/her to help you get pregnant:

What type of testing is needed? Depending on how seriously your Ob/Gyn considered your situation, you may or may not need to undergo additional testing. However, generally there will be some tests the RE will want to conduct anyway. Common testing would include a blood work-up, a Clomid Challenge (slightly different than just taking Clomid to induce ovulation), a Fluid ultrasonography (FUS) to look for irregularities or surface lesions within the uterine cavity, and a Hysterosalpingogram (HSG) to determine if there are blockages in the fallopian tubes.

How long does the testing take? One of the challenges, both emotionally and physically, during this time in your life is how long each step of the process can take. Ask your RE how long he expects the initial testing to take. Also, ask for the order in which the tests should be performed and how long between the results and the scheduling of the next test. Knowing the steps and time frame for each will provide some peace of mind.

Do you take any insurance? Even if the IUI or IVF procedures are not covered, some of the initial testing to determine the causes for your infertility might be. If you live in one of these states you have some form of infertility coverage (check your provider for more details): Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia.

Once we receive our diagnosis, what is the timeline for our designated procedure? Something every couple wants to know. The testing is time-consuming, so once you finally determine what is "wrong" or which procedures might work best for your situation, you'll want to know how soon you can begin treatment. During this time, ask questions about how the procedures will work from start to finish. This will give you an idea of the time frame as well. For example, pursuant to my IVF schedule I was on birth control pills for one month prior to starting any medications. I've heard that other REs use a different schedule.

Do you have a waiting list? Many REs have a long waiting list. Check with the REs to determine how long you would have to wait before you can start your first treatment cycle. Also, you might want to ask the REs how quickly they could fit you in if a second cycle was necessary.

If the first procedure doesn't work, what do we try next? Unfortunately, not all IUI or IVF attempts are successful the first time. Ask the REs how many times they'll try IUI before they recommend another procedure. Be aware, however, that many REs will not commit to a course of treatment until they see how you respond to their first effort.

Do you have a specialization? Some fertility clinics have a reputation for certain procedures. For example, there is a facility in Colorado that specializes in donor egg/sperm procedures. Other clinics specialize in managing patients that have experienced prior treatment failures. Determine what each RE specializes in so that you can determine if he/she is the right doctor for you and your circumstance.

What are your success rates? Often this information will be provided on each RE’s website. However, you should still ask the question and tailor it to your specific situation. For example, "What is your success rate with couples over 35 dealing with endometriosis?" Or "What is your success rate with couples using donor egg?" Their success rates should be good regarding the area(s) in which they specialize and the specific area(s) in which you need treatment.

Are you conservative or aggressive with treatments? As with any physician, some REs are more aggressive than others. This difference in approach could be in the dosages they recommend, how they treat external issues that may/may not impact your treatment protocol, etc. One RE we met with wasn't going to treat my elevated prolactin levels during our IVF cycle, while another said he didn't want to take any chances that the prolactin could impact my ability to conceive.

What do you consider a successful outcome? The clinic we used to conceive our twins considered a live birth a success. If we had experienced a loss during our pregnancy or at birth, we could have attempted another IVF cycle at no additional cost. On the other side, another clinic we considered using determined a successful outcome to be a 24-week pregnancy.

Hiring an RE may be one of the most important decisions of your life. Spend the time getting to know the RE you are about to hire to help you become pregnant; you might decide he/she is the doctor who will help you build your family. On the other hand, you may find that another doctor would be a better fit for your circumstances.