5 Things You Need to Know Before Starting Fertility Treatment

Published: 12/10/2015

Infertility is defined as the inability to conceive after one year of unprotected, well-timed intercourse. This does not apply if the woman is over 35 and has been trying unsuccessfully for 6 months, or if either partner has a known history of fertility-related problems. This definition is meant to be used as a guideline — rigid adherence to it is a disservice to any couple who wants to have a baby.

Please do not feel alone. Infertility affects more than 10 million women and men, or, 1 out of every 6 U.S.couples have difficulty conceiving. The problem can be traced to female factors in almost 40% of cases, to male factors in almost 10% of cases, to male and female factors 35% of the time, and a couple’s infertility reasons remain “unexplained” more than 20% of the time.

Any couple planning to have a family should be evaluated if the woman has fertility-related issues like a previous history of a ruptured appendix, gonorrhea or chlamydia infection, pelvic inflammatory disease (PID), irregular periods, abnormal uterine bleeding, endometriosis, fibroids, ovarian cysts, and pelvic surgery (e.g., any laparoscopy, laparotomy, or D&C).

This also applies if the man has a history of a varicocele, a history of undescended testicles, regular marijuana use or alcohol consumption, a history of infections that affect the testicles (mumps), any trauma and/or surgery to the testicles, and low libido, erectile dysfunction, or problems with ejaculation. Valuable time can be lost if evaluation and treatment are delayed -- seeking help is normal and is nothing to be ashamed about.

In almost all circumstances, conceiving challenges are related to an underlying medical condition, and like most other medical conditions, can be diagnosed and successfully treated.

There are 5 things you need to know before starting treatment:

1. Make sure that your doctor is an expert and has had specialized training in reproductive endocrinology and infertility. Although gynecologists are excellent physicians, their expertise lies in a different area. Many times, a woman will spend too much time at her GYN's office because she’s had a long relationship and "is comfortable" with her longtime provider (whose feelings she doesn’t want to hurt). She’s often told to, "start doing basal body temperature charts," and/or "try for another 6 months," or "not to worry," or "you are too young, or too old" to be thinking about having children. Because most OB/GYNs are busy, they do not have the time that you need and desire, and the treatment options they offer are limited. This can lead to increased stress, frustration, anger, and time lost delaying important evaluation and treatment.

2. Once you decide to seek treatment, don't necessarily go to the clinic that is biggest or closest to home or work. Find the one that not only has a reputation for excellent results, but one with a staff that really listens to you without bias or judgment, and one that embraces all patients, regardless of age, marital status, or gender preference.

   Be wary of any advertising that entails the promise of a "100% money-back guarantee," or a claim of being the "biggest." Like with many things, "bigger is not necessarily better."

   The clinic that’s “best” for you is the one where you feel comfortable and have a sense that you are in the right place. The right clinic will have your best interests in mind and will be more interested in you than in their statistics. Be wary of clinics that promote vague terms like "trusted doctors" and make unrealistic claims about their success rates.

   Speak with friends or acquaintances about their fertility experience to discover which clinic is “best” for you. Patient referrals are invaluable, as they provide perspective from people who’ve already had experience with one or more clinics.

   At Arizona Center for Fertility Studies, we give all our patients individual, personalized attention, which often is not possible at larger clinics.

3. Make sure that you are given the option to do the entire work-up, including controversial testing. Up to 35% of couples have more than one reason for being unable to conceive. Once one problem is identified, a common mistake is to stop looking for other issues. This can lead to overlooking an equally-important problem and prevent a successful treatment outcome.

   Our ACFS team believes it’s better to be proactive than reactive, and that all patients should be presented with the option of a complete workup to best inform their treatment decisions. If a couple chooses not to do the complete work-up, they should fully understand the potential risks of overlooking something that may prevent successful treatment.

4. Once the work-up is completed, make sure that the clinic unbiasedly presents you with ALL of your treatment options -- from most conservative to most aggressive. Once you are clear on the pros and cons of your choices, you’ll be able to choose the option that’s best for you, not the clinic.

   Often, a woman who’s having difficulty conceiving is automatically put on Clomid, a medication commonly used to induce ovulation for women with irregular cycles (even though her cycles are regular). Clomid has not been shown to improve pregnancy chances in women with ovulatory cycles unless it is combined with intrauterine insemination. So, rather than improving your fertility, you have wasted more time.

   Even if you’re young, you should be allowed to choose between conservative and aggressive treatments. You need to feel that you’re being taken seriously, at any age. A woman in her 20's can have the same feelings and desires as a woman in her 40's (only with more time to pursue them), and a woman in her late 30's to early 40's should be able to choose the most aggressive treatment option available.

5. From the beginning, your fertility specialist should be listening to what you want. You should never get the sense that you are being talked into or out of something.

   For example, even though you would like to attempt pregnancy using your eggs, some providers will try to talk you into using donor eggs, stating very low statistics based on your age, or the fact that you have an elevated FSH level. Make sure that their motivation is about you and not their statistics. Although women who are older or who have elevated FSH levels statistically have a decreased chance of conception, our team has found success for many of these patients.

   Arizona Center for Fertility Studies specialists will rarely tell a couple what to do, but instead, will inform patients about all of their treatment options and advocate for their right to choose.