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IVF: Look Before You Leap

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a blog by Traci Shahan, RN, WHNP-BC, Doctor of Nursing, Albrecht Women’s Care: A Center for Reproductive Endocrinology and Infertility, April 27, 2011

Let’s say that you have been through a fertility work-up by a fertility doctor (reproductive endocrinologist), experienced applicable fertility treatments — such as oral fertility drugs and intrauterine inseminations (IUIs) — and have not become pregnant. At this point you may be directed toward in vitro fertilization (IVF) by your fertility doctor.

But before you pick up the phone or hold the mouse in your hand ...


I wish to speak from a former patient’s perspective first.

I was told IVF was the next step after I had undergone surgery, fertility treatments, much imaging, and recurrent pregnancy losses. I live in arguably one of the cities in which IVF and reproductive endocrinology are highly competitive and successful. When my doctor told us to start considering IVF, I took a few months off and did more research, partly due to my inquisitive nature, but also due to reports from friends that I needed to exercise self-restraint, good judgment and directed research to better understand the treatments and technologies available.

Thank heavens I had friends who gave this wise counsel or I might have ended up in a program that was not a good fit for me.

What Do I Mean?

I mean that I was tired, emotionally spent and wary of treatments. Because I was exhausted, I wanted to cave into the path of least resistance. This is not my normal MO, but again, it is impossible to explain how the years, disappointments, setbacks and financial drain can take their toll. They do, even though I thought myself a pretty strong, resilient person.

I mean that it’s easy, to quote someone whose name I have long forgotten, to subconsciously allow commercials in the “United States of Advertising,” to dictate our behavior. Think. Do not react. Do not do allow the media this kind of control. There is a lot to consider to optimize the outcome of in vitro fertilization.

Speaking as a Nurse Practitioner

I have been in the field of reproductive endocrinology and watched it grow since the 1990s. We have much to be proud of as a discipline: incredible technology, ever-on-the-rise statistics, comprehensive treatments, and for some clinicians, awareness that infertility can be the nadir of a patient’s reproductive years, and some of the patients’ needs extend past physical treatment. Fertility treatment is challenging no matter who you are, what station in life you hold and where you live. Take some time to better understand the field and your options.

We also have much in the field to examine and grapple with, such as a hypercompetitive environment that could potentially cloud clinical judgment, applying technologies only when truly needed, not because a third party is pressuring us however covertly to do so. It is true that pharmaceutical companies are big business, and that many clinicians are still courted by these companies in various ways, although there have been some changes in the last few years. There remains room for improvement. (For one perspective, get your hands on the book, “What the Drug Companies Won’t Tell You and Your Doctor Doesn’t Know.”). Changes notwithstanding, the fertility drug market is very competitive and lucrative.

I have noticed a shift in the reproductive endocrinology climate over the years. First and foremost, health care has become more demanding, requiring changes in clinicians, like being more aware of time, cost of supplies and cost of running a profitable office. (I live in a state that does not mandate fertility insurance coverage, which of course affects my perceptions.) IVF can be a profitable endeavor. Too, training programs vary. Some offer more surgical training than others; some emphasize IVF more.

Look Behind the Media Images

The people in the field of reproductive endocrinology are as human as our patients. We get tired. We get sad, frustrated, annoyed. We are jazzed by a positive pregnancy test and bummed by a negative. As I have said elsewhere in blogs, this field is a microcosm of our society in general: gentle people, incredibly smart people, people who are full of themselves, people who are hard workers, people who are loafers, and every other personality you’ve ever met in your life. It is your absolute right to meet and decide if a certain team will be responsive to your needs, that their reputation is consistent with their media campaigns.

Because of the highly personal and individual needs during fertility treatment, I recommend that you make an appointment first for a meet and greet. Go with your gut: If it tells you that this is a great fit, rock on. If the staff seems strained, oddly distant or, heaven forbid, skittish around the physician or each other, check with the community — online or in person — about the clinic.

Dig Deep on IVF Success Rates

Let’s talk numbers for a minute: When I first started working in the field, the practice I worked with felt comfortable saying that we had a solid 35 to 40 percent pregnancy rate in under 35-year-old women. Today we say as a generalization (this will NOT apply to every person; this is based on young, healthy women undergoing IVF) that today’s rates for the same group are certainly over 50 and even approaching 70 percent in some settings.

It is very, very important to remember that many factors determine a clinic’s reported success rates, such as selection bias of patients, whether intentional or not, and willingness of patients to pony up for ancillary procedures like ICSI. To be sure, there are gifted fertility doctors with extraordinary rates. Likewise, there are equally gifted fertility doctors who are not influenced by their rates — many people in this field will treat all patients even if there are factors that might adversely affect reported data.

Although I intended originally to cite SART data for various clinics, it became very clear to me when I searched nationwide that there are some fabulous ART/IVF doctors whose rates are not “the best,” who may not win popularity contests, but are nevertheless devoted to all patients even if they are not ideal IVF candidates.

So, after you have taken a break to consider many factors, my recommendation is that you sit down now with your mouse, paper and pencil and start looking at fertility practices and consider the statistics. See what other patients have to say in online forums. Pick up the phone and make an appointment with at least two different practices. You will know when you meet the practice that best fits your needs.

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