Starting Fertility Treatments? 10 Questions to Ask Your Reproductive Endocrinologist Before Your First Cycle

You've been trying to make a baby on your own, the old-fashioned way. It isn't working. You've decided to look into fertility treatments as an option to become pregnant. If you haven't yet interviewed a few Reproductive Endocrinologists (REs), read my article Considering Medical Treatments To Create A Baby? 10 Questions to Ask Your Reproductive Endocrinologist Before You Hire One before you choose your physician.

Once you've hired your RE, there is still some information-gathering to be done. If you're not familiar with medical terminology, then an in vitro fertilization (IVF) cycle can be intimidating. Even one of my friends who is a nurse was intimidated by the medication schedules and procedures associated with IVF. You'll be less nervous and more confident if you have knowledge about your procedures and how the RE's office operates.

Below are ten questions to ask your RE before you start your first cycle:

1. Do they offer clinical trials? Fertility treatments are fairly expensive and not covered by insurance in most states. Ask what the requirements are for eligibility in a clinical trial. If you are eligible, ask how you can participate. Keep in mind, it make take longer to start your clinical trial than if you proceed as a general client. Sometimes trials are cancelled; ask your doctor about the possibility of this occurring.

2. What are the side effects of the medications? It is important to understand what all of the medications are used for and the possible side effects. For example, you should not exercise when taking Lupron, a hormone agonist used to decrease the production of hormones from the pituitary gland, as it weakens your bones and exercising could result in bone breakage. The clinic should be able to provide you with a detailed description of the purpose of each medicine you take, along with the side effects of each medicine.

3. What are the steps in the procedure? Fertility treatment procedures are stressful. Learn as much about your treatment schedule as possible. If they don't provide a schedule, ask for a calendar of your medication schedule, dates of appointments, and activities to be performed at each appointment (blood draw, retrieval, injections, etc.). It would be especially helpful if this is in written form for you to take home and read.

4. Who will be your point of contact? Learn who will be answering your questions. During our IVF procedure, we would ask the nurse questions about our medication schedule and we would ask the doctor other types of questions. If you know the right person to contact, you'll be more likely to get a quick response. Have them describe how office communications work during your procedures.

5. Who performs the procedures? During your testing and actual fertility treatment you'll be poked and prodded. Determine who will be performing which procedures so you know when you'll be interacting with your RE and when you’ll be interacting with the RE’s colleagues or the nurses. For example, during our IVF cycle all of the invasive procedures, such as the Fluid Ultrasound, egg retrieval, and embryo transfer were conducted by our RE.

6. How many embryos do they transfer during an IVF cycle? Or, if you are proceeding with an IUI, you'll want to know what the maximum follicle count would be before they would cancel the cycle. If you are using injectables with timed intercourse, the follicle count is important as well. Each doctor has a different protocol and the number of follicles or embryos transferred for each patient might also differ. Our RE was initially only going to transfer two embryos, but when the day arrived he transferred three. The main reason for the change in his approach was based on the quality of our embryos.

7. What are the risks of twins or high-order multiples? This includes both the chances of having a twin or high-order multiples (triplets or more) pregnancy as well as the health risks to the mother and babies involved with such a pregnancy. The risk of having twins or high-order multiples is fairly high with IVF or IUI procedures. What will your doctor do to minimize those risks? In addition, you might want to ask them what percentage of their procedures result in twins or higher. This information might be available on their website. Know your risks and be prepared for them. For example, twin pregnancies are considered high-risk because one in three results in premature birth.

8. What would cause the treatment to be canceled? You'll want to know the possibilities that a cycle could be canceled. A few women I know have had their IVF canceled because they responded poorly to the medications or because they developed cysts from the medications. Our RE never mentioned that it was possible a cycle could be canceled. It's best to be prepared and know possible reasons this might occur.

9. Do they encourage or recommend complementary or alternative medicine? Studies are proving that acupuncture, massage therapy, homeopathy, Reiki, and other forms of alternative medicine can increase the success rate of fertility treatments. Does your doctor have a referral list for these types of practitioners? If they do not encourage complementary medicine, will they nonetheless try to coordinate with your alternative efforts? This is important to know as some REs discourage use of alternative medicine.

10. What outside resources do they recommend? There are at least four national organizations that focus on infertility information or awareness. In addition, there are magazines, books, support groups, and therapists to help you manage the emotional and physical aspects of your treatment. Your RE may be aware of some of these resources that you would not find on your own.

The desire to become pregnant is often stressful and can become all-consuming to women and their partners. Knowledge is power. The more you know the less nervous you'll be. Remember, there is no such thing as a stupid question. Knowing the steps in the process and knowing the risks, whether that be of multiple gestation or a canceled cycle, can help you manage the strong emotions you might experience during your treatment.