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How to choose a doctor for infertility testing and treatment
by: Richard Sherbahn, MD

 


If you are being treated, or considering seeking treatment for infertility:

It is appropriate to start with either a good general gynecologist or with an infertility subspecialist (reproductive endocrinologist). Some general gynecologists are very good at the initial infertility evaluation.

You should know about your doctor's training and experience. Just because it says "Infertility" on the door, (or in the yellow pages) doesn't mean the doctor is a trained infertility specialist. Ask whether he/she did a fellowship in Reproductive Endocrinology and Infertility. If not, the physician is a general gynecologist who probably has a special interest in infertility.

If your doctor is a general gynecologist, you should ask at what point he/she will refer you to an infertility subspecialist (reproductive endocrinologist). In general, you should be referred to a reproductive endocrinologist after about 6-12 months of treatment with your gynecologist. This will also vary depending on the cause of the infertility - some cases should be referred to a specialist immediately.


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Criteria for possible immediate referral to a reproductive endocrinology and infertility specialist:


Female age over 39 to 40

Blocked fallopian tubes at any age

Very severe endometriosis at any age

Significant male factor (sperm concentration < 10 million per ml)

Anovulation treated with 6 months of clomiphene without conception at any age

It does not have to be expensive to see an infertility specialist. The cost depends on what kind of treatment you need.


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If you are already seeing a reproductive endocrinologist and are considering in vitro fertilization (IVF), ask him or her for:


The IVF pregnancy rate of the entire program. You can also ask for their most recent SART statistics - the most recent year currently available is 1994. You can compare their program's SART results with the results of other programs and with the >SART national averages.


His or her individual pregnancy rate over the past year for all embryo transfers performed.


His or her pregnancy rate for all cases done on couples with problems similar to yours.

Ask for pregnancy rates per retrieval and per transfer and know whether they are giving you initial pregnancy rates, ongoing pregnancy rates or live birth rates.



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Make sure you know how much the treatment will cost, and how much your insurance will cover. If they say that "IVF costs $9000", make sure that you know exactly what this means:

Does it include all physician fees?

Does it include all ultrasound and blood monitoring?

Does it include all facility fees?

Does it include all anesthesia-related fees?

Are there any other costs (other than medication) that are not included in the price for an IVF cycle?

Ask for a copy of their fee schedule for IVF services.

If you do not get satisfactory answers to all of these questions, consider going somewhere else.

 

2007 OPTS - The Organization of Parents Through Surrogacy