Working With Your IVF Center

Infertility treatment that includes the assisted reproductive technologies such as in vitro fertilization involves many different procedures. Throughout the course of treatment, most patients work closely with several different medical professionals and others. For the majority of patients, the process runs smoothly. Patients get the information they need and proceed through each phase of treatment feeling well-informed, at ease and confident about the services provided.

Many of the procedures and explanations associated with infertility treatment can be complicated. In addition, because patients must interact with doctors, nurses, therapists and others during the various phases of treatment - including everything from signing consent forms to surgery, blood work and billing - there is sometimes a risk of misunderstanding or interpersonal tension. Some patients may feel that they are not getting the levels of information or support they expected. A request for information may fall through the cracks; a response to a request may be late. In extreme cases, patients may feel that there were problems with their treatment that require review.

It is always the hope that patients receive the most appropriate and effective treatments, along with the levels of information and attention they need and deserve. The best way to make sure that your treatment is as good as it can be in every way is to become an educated consumer and address problems early, quickly and through the most effective channels available.

Guidelines for addressing patient issues

In most cases, efforts to gather information and resolve conflicts are handled most effectively when we consider them as problems in need of solutions. Here are some general guidelines to consider:

• If possible, begin the process by recognizing something positive about your experience
• Define the problem as clearly as you can.
• Be appropriately assertive, but also try to be empathetic. For instance, if a call was not returned promptly, recognize that it may have been a busy day for the doctor while also noting that you were seeking information about important issues related to your treatment.
• Focus on one issue at a time.
• Listen carefully to the response, and try to understand the other person’s perspective.
• Try not to be defensive.
• Do not make uninformed assumptions about the thoughts or motives of other people.
• Avoid disrespectful, sarcastic, or contemptuous comments.
• Be flexible in considering different options in resolving an issue successfully.
• Use the appropriate tone and body language for the situation, and always strive to communicate with respect and civility, demanding the same in return.
• Recognize that a hostile, adversarial interaction is less likely to result in a positive and quick resolution to a problem.

Be an Educated Consumer

One very effective way to avoid a misunderstanding in infertility treatment is to be an educated consumer. At each stage in your treatment, you should and are expected to have questions. Many of your questions will be answered in the informational materials provided by your IVF center. Reading all of the materials related to your treatment carefully is perhaps the single most important step you can take to avoid misunderstandings that could result in problems later on. If you read patient information materials at home, write down any questions you have so that you remember to ask them during your next visit. It is also important to keep a diary of your treatment, noting what happened on each day.

Your doctor or another member of the medical team will go over each phase of your treatment, but they cannot anticipate all of the issues or concerns that will be important to you. So be prepared to ask questions or tell your doctor when instructions or other information is unclear. Many patients also fail to recognize that they get better information by asking the right questions, so try to be as specific as possible.

You can also use other sources for the information you need. There are dozens of reference books available on issues associated with infertility treatment. The American Fertility Association has fact sheets on different topics, newsletters, a web site, patient meetings and other services available. You can talk to other patients and medical experts via message boards and Internet chat rooms. Be warned, however, that many sources of information about infertility treatment are unfiltered and may include personal and non-medical opinions, as well as inaccuracies. Always consider the source when accepting information on health topics.

From Questions to Conflicts

Like many medical problems, infertility can be a very personal and difficult challenge. Feelings of anxiety, sadness and frustration are common. The process is also time consuming and involves interactions with many different people. Though serious issues or conflicts are extremely rare, each of these factors can contribute to minor or major problems for patients at different points in the treatment process.

According to an informal poll of IVF centers, patient concerns or conflicts in IVF most commonly relate to costs and billing procedures, feelings that treatment was inadequate, interpersonal issues (rudeness, lack of adequate information, calls not returned promptly), inaccurate or conflicting information or, on rare occasions, instances of medical malpractice or misconduct.

Before working to address a conflict situation, patients should clearly define the problem and outline their goals for the effort. Do you want to keep your treatment on track and continue without delay? Is your goal to defer treatment until the situation is addressed? Do you want money returned to you? Do you seek justice because your legal rights have been violated?

Patients who have concerns about their treatment usually have several different options to consider in working to resolve the issue. Some approaches are more effective and more appropriate than others. In determining the best response to help you address any situation that might arise, here are some options to consider:

• Speak with your doctor. In most cases, the best first step is to speak with your doctor. Outline the situation as early as possible, before it becomes severe, and try to work out a resolution together. It may be worthwhile to write down your concerns in advance to make sure you describe the situation adequately. You might also approach this first meeting as an opportunity to understand the situation better rather than resolve it immediately. Even in this first meeting, it is important to remain focused on the issue at hand, and build toward a satisfactory resolution.
• Speak with someone else at the practice. You will also develop relationships with other members of the staff of your IVF center. If it seems more appropriate, you can discuss an issue with your nurse or the office administrator or billing department. Keep in mind, however, that many issues at an IVF center are ultimately settled by the clinical staff even though they were initially brought to the attention of someone else on the staff.
• Write a letter. If you speak with a doctor or someone else at an IVF center, and feel that you did not receive an adequate response, consider taking further action soon. It is important not to wait until a small problem becomes a bigger issue that could affect your treatment or your emotional well-being. (At this stage, it is also important to note that conflict resolution related to your treatment should not be about “winning” an argument. It should focus exclusively on making sure that you get the best treatment possible, and that the appropriate steps are taken in the rare instances when treatment is inadequate.) Your next option might be to send a letter stating your concern to the IVF center. If you are thinking of outlining your concerns in a letter, there are several considerations to keep in mind. Many IVF centers have an internal review process for handling complaints. If you send a letter, it will probably be reviewed by a committee, with a response sent back in writing. This process can take from several days to several weeks or more. If you send the letter to a hospital or university with which the program is affiliated, the review process is usually more formal and can take a bit longer. If your letter contains accusations, you should try to present only factual information and substantiate your claims with notes from your diary, forms or other relevant details. Note, however, that if a letter contains a serious accusation or a threat of legal action, it must generally be passed along to a program’s legal counsel. Once a conflict becomes a legal issue, other efforts to address the situation are generally put on hold. Patients should reserve such action for only the most serious of conflicts.
• Get a second opinion. If you feel that your treatment has been inadequate, you may also want to get a second opinion. (This is often a good idea even if you feel your treatment has been adequate, to confirm your opinion and help you feel more secure.) Through message boards, online chats with doctors, patient meetings and contact with another IVF center, you can outline your concerns and have another medical professional offer an assessment of the situation.
• Take it to a higher level. For some more serious issues, patients might consider contacting third parties to review the situation. Some professionals or organizations who can help might include:
  • Your attorney
  • The Better Business Bureau (for billing or financial matters)
  • Your insurance company (for insurance issues)
  • The American Society for Reproductive Medicine (This is the trade association for medical professionals working in reproductive medicine. This may be an option for issues involving treatment or medical malpractice.)
  • The American Medical Association (This is a larger trade association for medical professionals. They may also have guidelines for treatment or medical malpractice.)
  • State office of medical licensing or professional discipline. This will vary from state to state. Call your local Department of Health for further information.
  • The police or state attorney general’s office (for criminal activity)

Patients should recognize that these actions involving third parties should also be reserved for the most severe of conflicts or activities, and that such steps are likely to end your treatment at a specific center.

Conclusion

The unfortunate truth is that some courses of medical treatment do result in misunderstandings or conflicts. Whether a situation is caused by interpersonal issues, inadequate information, improper treatment, negligence or any other factors, patients should recognize that they can and should take steps to address the situation. Only you can determine the best course of action for you. In most cases, patients find that they can resolve a situation successfully simply by talking with their doctor. If that fails to produce the desired result, you should carefully weigh the pros and cons of the other actions you might consider. But all patients should move forward with their efforts to address any conflict with their IVF center until a fair and just resolution has been reached.

This AFA Fact Sheet was funded by a friend of The AFA who wishes to remain annonymous.