First Day Jitters
Meet and Greet Your Fertility Doctor
Oh man, are you nervous. This is it. That doctor you’re about to talk to is going to give you answers. Finally, someone is going to tell you what you have to do to get pregnant. Do you feel hopeful or scared out of your wits?
Chances are you’ll be excited and terrified at the same time when you make the decision to seek help. You already know something is not right since you’re not pregnant after a year of unprotected sex or six months if you’re over 35. The clock is ticking, you can almost hear it. All of your friends are having babies and you feel that this is the right time. So you’ve gotten a referral from your OB/GYN to see a reproductive endocrinologist (RE) and the emotional roller coaster ride has begun.
First of all it’s important to know that these feelings are completely normal. “Patients experience the anxiety of not knowing and the hope that the doctor will be able to fix it,” says Ellen Speyer, a marriage and fertility therapist in Newport Beach, CA. “The most common scenario is to go to the doctor very hopeful.” Speyer finds this is true even when patients have already been through some treatment. “There’s a cautious optimism.that a new doctor will have a new treatment… if they don’t have any hope, they’re unlikely to schedule the visit.”
There’s also nothing wrong with your decision to get help from a pro (not your garage attendant, your mother or your colleague at work). In fact, it’s a good sign. It means both you and your partner are thinking seriously and deliberately about your future as parents. You’re more than ready. So what to you do first?
“First of all, we want both partners in at the first meeting,” says Joanne Libraro, RN and IVF Team Leader at the Cornell Center for Reproductive Medicine and Endocrinology in New York City. “Infertility affects both partners in a relationship… so it is equally important for the male to understand his potential significant or subtle role in this situation.”
“Most reputable centers,” agrees Karen Hammond, a nurse practitioner specializing in reproductive medicine and Chairman of The AFA Board of Directors, “will not proceed with evaluation if one partner is unwilling to go through with the initial evaluation.”
The anxiety one feels in anticipation of the first visit can be compounded when patients aren’t in a traditional relationship, notes Speyer. So if you’re interested in becoming a single parent, or are in a same-sex relationship, make sure the RE and the fertility center you’re considering will work with you.
Listen for What’s Hard to Hear
Patients’ hopes and dreams filter what the doctor’s going to tell them,” says Elaine Gordon, Ph.D., a counselor in Southern California. “It impacts whatever information they do get, how it’s processed, what they take in and what they don’t hear.”
That’s why Andrea Braverman, Ph.D. and director of psychological services of Pennsylvania Reproductive Associates in Philadelphia, advises that both partners “set some time aside later that night to go out to dinner together and process what you’ve heard…. Make sure you’ve heard the same things.”
The first visit requires that both partners will be forced to become introspective. Not for presumed failure to achieve an elusive pregnancy, infertility is no one’s “fault,” but for each partner’s unique background and how they mesh. You’ll be looking at not only your current physical health but also your past, the past of your parents and siblings, and all those day-to-day aspects of your life that just might be affecting your fertility.
“A lot of programs send information telling patients what to expect prior to the first visit,” says Hammond. “I include new patient forms in there, which is a common practice. It helps because it urges them to think about some of the things they don’t already know, like family histories.”
You may actually have to call Mom to find out whether she ever had a miscarriage or if you had all your vaccinations. Your partner may not recall if he had the mumps when he was a boy.
To Talk or to Test?
Some first visits are just for consultation; others will include a basic physical for the woman. “It depends on their comfort level,” says Hammond, and on whether the timing is right, since some hormone-level blood tests have to be taken on specific days of the woman’s cycle. It also varies depending on how much is known, and what if any indicators that information gives.
“Nine times out of ten,” says Hammond, “patients will give you the diagnosis. If they have irregular periods, ovulation problems may be the issue. If there have been pelvic surgeries or PID, there may be tubal problems…. Sometimes it can quickly point you in the right direction.”
It’s always a good idea when making the appointment, to ask how much can or will be done on the first visit. “Generally the first visit is just a talk visit,” says Luanne Johnson, patient advocate at the Center for Applied Reproductive Science in Johnson City, Tennessee. But they may “come at the appropriate time in their menstrual cycle and if the doctor can save her a visit, he will.”
You may have to travel a considerable distance to the office. This may entail multiple visits that can wreak havoc with your schedule. “Depending on the protocol,” she adds, “you may be coming to the office frequently and might need to make arrangements with work or school.”
But most important of all is that you feel comfortable with the RE. “Some doctors are extraordinarily clinical,” says Speyer. “They make no conversation and focus only on clinical information. Some doctors are very warm and want to make conversation. The patient’s experience will depend on their perception of the doctor. Some people prefer a very clinical physician and feel they’re serious, while others prefer someone warmer.” Be sure you’re getting what you need.
Some people wonder what judgements the doctor is making about them. Here you are, 25, or 33, or 39, and as young/old as you are you can’t get pregnant. Or you waited so long, why did it take you until now to settle down?
It is important to remember that you’re not there to impress your doctor. “Patients try very hard to behave themselves,” says Gordon. “It’s the good patient syndrome. All patients want the doctor to like them…. and they think if they’re ‘good boys and girls’ it’ll work. There’s engage in lots of magical thinking. They’re in psychological distress but they hide it because the doctor might think they won’t be good patients or good parents.”
Wanting to keep things “nice” is not nice, for you, your partner, the child you want, and even your doctor. Your uncertainties and insecurities, in other words how you’re feeling, tells you if you’re in the right place and also guides your doctor. They let the RE know if he/she’s going too fast or too slow and clues them in to what next steps to suggest.
Trying to be nice may also cause you to hold back questions, questions the doctor should be fully prepared to answer. You have every right to expect substantive and comprehensive answers to all your questions. The doctor has a limited amount of time to spend with you, so Braverman advises that you, “Go in with everything written down in order of what you want to get answered…. it reduces anxiety that (you’re) not going to get all your questions answered.” (Visit http://www.focusonfertility.org to view Focus on Fertility fact sheet, “Important Questions For Your Doctor” to provide you with some questions for your initial appointment and questions if you decide for a follow-up meeting.)
“You and your partner should establish your goals as to what you want out of the (first) meeting,” she says. “Do you just want to meet the doctor? Are you comfortable with them? What’s the game plan for the next six months? You’re not going to get a diagnosis out of the first visit, so what is an achievable goal?” Keep your expectations realistic, she advises because “The doctor isn’t going to know whether or not you’re going to conceive.”
In addition, make sure to find out, usually from the support staff, what their procedures are. When can you contact the doctor or nurse with questions? Who do you talk to for test results? If it’s a big practice, will you see the same doctor or do they rotate?
And then there are the questions you and your partner have to answer. Your information and complete answers to the doctor’s questions may give the RE that bit of information that will ring a diagnostic bell.
When you walk into the RE’s office they should have your complete medical history in front of them. You should have all medical records from any previous consults or treatments sent over before you show up. You’ve filled out the new patient form or questionnaire you got by mail or in the waiting room. And they’ll be prepared to review them with you. So should you. (For more sample questions, visit http://www.focusonfertility.org and refer to Focus on Fertility fact sheet “Worked Up Over the Infertility Workup? Calming the Nerves with Knowledge”) Here’s a taste:
For the female
- Reproductive/Gynecological history: Any previous pregnancies? What were the results? What kind of contraception, if any, do you use? Is your period regular? Do you have PMS? What is your sexual history? When was your last Pap smear? Have you had any vaginal infections or fibroids?
- Family history: Do you have any sisters? What’s their reproductive history? How old was Mom at menopause?
For the male
- Reproduction: Contributed to any past pregnancies? Have you had any surgeries, infections, hernias?
- Family history: Any past infertility?
- Lifestyle/work: Exercise, occupational habits, stress, caffeine, alcohol cigarettes: what kind and how much.
- Medical: All conditions minor or major-back to childhood. Are there any birth defects or genetic problems?
- Nutrition: The pyramid: fruits/vegetables, starch/grain, protein, fats.
- Home environment: Heavy-duty chores, chemical-based cleaners, general stress.
- Medications: All of them: prescribed, unprescribed, and over the counter
- Ethnic background: Some ethnic groups have a higher incidence of specific genetically inheritable diseases that require special testing. You’ll be asked for your background so the appropriate tests can be done.
After reviewing your histories, the RE will discuss with you a possible treatment plan, including whether to start that day with a basic exam. An alternative may be to do the baseline physical on the third day of your cycle, when you can also have a complete blood workup.
If you start that day, the RE will draw blood (for hormone tests that aren’t time-sensitive) and check for physical signs of hormone imbalances, for abnormal masses that may signal tumors, and for organs that are either enlarged or tender or not as mobile as they should be. “The physical exam (is) head to toe,” says Dr. Kaylen Silverberg, of the Texas Infertility Center. “The endocrinological exam (for hormone function) is physical at this point.” The male will also be instructed to have a semen analysis done if one hasn’t been done yet, since there’s an equal chance that male factor is the cause of infertility. (For more detailed discussions of the physical, baseline testing and semen analysis visit http://www.focusonfertility.org and refer to Focus On Fertility fact sheets: “Worked Up Over the Infertility Workup? Calming the Nerves with Knowledge”, “Get Thee To A Urologist” and “Swimming Toward Conception: The Semen Analysis”)The “Right” Thing to Do?
How do you find the best doctor? What if he or she says you will not be able to have your own biological child?
These are tough questions to answer when all you want to think about is the baby of your dreams. The fact that they have occurred to you at all means they need to be answered and unresolved anxiety won’t help your efforts to get pregnant. Asking the questions isn’t a judgment; it doesn’t presume you’re incapable or unfit. It means you’re reasonably and honestly considering that you may need a little, or even a lot of help, and deciding to visit an RE is the best place to start. Educating yourself, understanding what’s ahead and identifying what emotional support you require are the essential first steps.
It’s also important to remember you’re not in this alone. You can have support, a place to discuss your concerns and gather information to prepare you for that first visit to the RE. So contact the American Fertility Association, toll-free at 1-888-917-3777 or log on to http://www.theafa.org or visit http://www.focusonfertility.org. We’ve been through it. We know exactly how you feel. We can help.