There are lots of hard things about fertility treatment. It can take its toll emotionally, physically, and of course, financially. But perhaps the hardest of all is that there simply cannot be any guarantees. It’s the ultimate gamble: no matter how hard you try, you just can’t know what the outcome will be.
For many, the outcome is worth the gamble a million times over. But for hopeful parents going back for yet another round, trying yet another approach, how do you know when it’s time to seek a second opinion? Genea Fertility Specialist Dr Anthony Marren sheds some light for us…
Roughly how long should a fertility patient expect the process to take? Obviously, there are extremes either end of the spectrum, but is there an average?
Typically, there will be two visits to the Fertility Specialist before you start treatment. The first visit is about capturing the history and undertaking investigations. The second visit is about interpreting the investigations and determining a plan of management. This initial process may take up to six weeks. That’s because some of the investigations need to be timed with the menstrual cycle. If IVF is the management strategy decided upon by you and your Fertility Specialist, the next step is a nursing interview. The Nurse will explain the practical aspects of the cycle like timings, and how to take the fertility medication. The cycle itself is based around the menstrual cycle so it takes approximately 1 month. At Genea, review of our data consistently demonstrates that of those patients who achieve a successful live birth, the majority will do so within the first three stimulated cycles.
How long should a patient undergoing IVF wait before seeking a second opinion? Is there a minimum amount of time you’d suggest to give to the process?
Firstly, it’s important to note that fertility treatment is not just IVF. A competent Fertility Specialist will take a thorough history and perform a comprehensive but relevant set of investigations. They should be able to convey what the underlying issue is and present you with a range of treatment options that include advantages and disadvantages of each. If IVF is undertaken, your Fertility Specialist should communicate directly with you at the end of the cycle and explain what went well and what did not. They should also be able to discuss what, if any, changes are needed in future cycles. Your Fertility Specialist should be aware of the emotional aspects of fertility treatment and offer the clinic’s counselling services if required. They should also be able to present a long-term management strategy as opposed to just the next cycle. It’s a sad fact that some people will never fall pregnant. So seeking a second opinion after an arbitrary time is probably not useful. As a patient, you want your Fertility Specialist to consider a broad range of treatment options, be considerate of the emotional aspects, and have a long-term plan. If you feel like that’s not the case, it’s time to seek a second opinion.
Do you suggest ‘shopping around’ for the right doctor or clinic before starting your first treatment?
As a starting point, it’s important to make sure that your doctor is appropriately qualified. In Australia and New Zealand, Specialists can do specific training in reproductive endocrinology and infertility. The Certificate in Reproductive Endocrinology & Infertility is an additional three years of training and a set of exams. Specialists will have ‘CREI’ after their name. Those with their CREI also spend most of their clinical time managing fertility patients. If you choose a Doctor with a CREI, you can be assured that they are adequately trained and spend most of their time practicing fertility, as opposed to someone else where fertility may make up a small fraction of their practice.
In addition to the doctor’s qualifications, it’s important to choose a doctor who suits your personality. Fertility investigations and management can result in significant stress. A doctor may be perfect for one person but not for another. This is okay. We do not get along well with every person we meet. Likewise, there will be some doctors that you connect well with and others you do not. It is important that you feel comfortable with the doctor that you are seeing.
Finally, when it comes to IVF, it is important that you are comfortable with the clinic.
- Does the clinic offer a range of fertility treatment options, or just IVF?
- Is the clinic open 7-days per week for procedures, or will your procedure occur on a day to suit the clinic?
- Is the clinic transparent about their results?
- Does the clinic actively participate in research? Are they cutting edge and leading the way? Or, are they using old technology?
And how can you tell if your doctor is the right fit for you? What are some questions to ask?
As I mentioned above, finding a doctor who is the right fit for you is very important when it comes to fertility treatment because we’re dealing with what can be an emotionally challenging and physically tiring time of life. You really want to select a doctor who has empathy and a bedside manner that suits you as well as someone you feel will be going the extra mile for you, so to speak. Their medical qualifications and experience are a vital part of the equation as well as I’ve outlined above. Some questions it’s worth asking include:
- What forms of treatment they consider when deciding on the best approach for a patient.
- How many fertility patients they see each year.
- What their success rates are – always ask for live birth rates.
- If their patients can access counselling support as part of their cycle costs.
- If they will be the only doctor you see or if your care will be shared by other doctors.
It can be scary putting all your trust into an expert when you don’t fully understand the science – but it’s necessary. If you’re not getting results, how do you know if you should seek a second opinion?
I’m sure you don’t need reminding but having a baby is your top priority, so if you’re not getting the result you want you need to be your own advocate and look for a new assessment of your situation. Repeated failure with one Fertility Specialist or at one Fertility Clinic doesn’t necessarily mean that you have no chance of having a baby. There is most certainly a difference in the skill of Fertility Specialists across Australia and there is a difference between the fertility technologies and the approaches to treatment used in IVF labs in Australia so therefore there’s a difference in your chance of success. I’d also like to point out that seeking a second opinion about your fertility treatment doesn’t mean you are being difficult or that you’re in denial about your diagnosis. What it actually shows is that you are engaged and empowered and you’re taking an active role in your health care.
Other signs that it’s time to seek a second opinion include:
- Multiple cycles of IVF using the same treatment plan with no improvement in outcome such as number of eggs collected, or number of viable embryos created.
- Your gut feeling tells you that it’s time or thinking about getting a second opinion is keeping you awake at night.
Are there any red flags that might suggest you should seek alternative treatment?
If a doctor isn’t willing to listen as well as speak during your consultation, I would be concerned. I’d also be worried if the doctor presented you with a treatment plan straight away on your first consultation without taking the time to understand your history and conduct investigations into why you are struggling to conceive. Another red flag would be a doctor who doesn’t review each treatment cycle and simply recommends the same approach every time.
What’s the hallmark of a great fertility doctor?
The Fertility Specialist you deserve will be passionate about what they do regardless of how many years they’ve been seeing patients. Their approach will be a combination of a caring and personalised bedside manner with top notch medical experience and expertise. They will be a lifelong learner, never believing they know everything there is to know and they will be on your team, doing everything they can to help you succeed in achieving your dream, to create a family.