Beyond Second Opinions: Making Choices About Fertility Treatment

November 3, 2011

by Judith Steinberg Turiel

A trip through the infertility treatment maze is akin to a rollercoaster ride. In Beyond Second Opinions, Judith Steinberg Turiel implores patients to consider all of their fertility options before jumping on the ride. Subtitled Making Choices about Fertility Treatment, Beyond Second Opinions takes readers down a path not revealed in other infertility books.

Turiel takes a critical look at the current treatments available, and reveals to patients how medical professionals make treatment recommendations. Through almost 400 pages, Turiel constantly reminds patients with certain diagnoses that they may have a fair chance at attaining pregnancy with minimal or no infertility treatment. Certainly Turiel advocates the road less traveled for many.

Beyond Second Opinions is fabulously well researched with a comprehensive list of works sited and author's notes. To share compelling points of this book thought provoking excerpts have been selected for each chapter.

Chapter 1: Facing Infertility: Into the Medical Realm

If patients could see what I have seen of the disagreements among doctors, the uncertainties, the non medical pressures that are shaping our medical care, they might think very differently about their infertility diagnosis and reach different decisions about pursuing medical treatment. (p. 4)

Chapter 2: A Couple Decides: What Informed Patients Do and Do Not Learn

For many couples however, particularly if they have been trying for less than two years and the woman is not yet nearing forty, a conservative approach-waiting for a spontaneous pregnancy-is at least as likely to succeed; the woman can avoid the risks of a medical intervention...(p.26)

Chapter 3: Assisted Reproductive Technology: A Modern Fact of Life

Fertility specialists now recommend some form of in vitro fertilization to nearly any woman who does not become pregnant with less invasive treatments. (p. 35)

Chapter 4: Experiments in Fertility: Mixed Results, Mixed Messages

Questions also loom about any manipulation of an individual's immune response. No one knows whether immunization with a different person's lymphocytes, for example, may have long term consequences for the woman or an exposed fetus. (p. 106)

Chapter 5: Fertility Medicine's Older Woman

"Those nearing or past the age of 40 should ask a fertility specialist about current testing procedures that can predict individual chances of conceiving with and without treatment and what the results may suggest about whether, when, and how to intervene." (p.145)

Chapter 6: Of Mice and Men, and Especially, Women: Learning from Research Past, Present, and Future

Patients seeing doctors affiliated with a medical school are most likely to be offered the option of entering a randomized clinical trial. (p. 162)

Chapter 7: How is Consent Informed?

Different schools and programs emphasize different treatment approaches (e.g., surgery or endocrinology), as well as more general philosophies about medical intervention (e.g., more or less aggressive)-all of which shape what a doctor trained there is likely to do. Patients may want to ask doctors directly about the type of training they received and their general approach to diagnosis and treatment. (p.189)

Chapter 8: Protecting Patients: Work Enough for All

Present and future generations of women and men could certainly benefit from shifting the medical gaze upstream-toward determining what compromises their fertility, pushing them into a pool of patients needing medical help to conceive a pregnancy. (p. 241)

Chapter 9: Finding What You Need

Clearly, the positive side of fertility medicine during the past three decades is that more treatments have been developed for women and men who have fertility problems,. The difficulty comes in matching these treatments to individuals who may benefit. (p. 273)

Solidly helpful appendixes cover terminology, references and resources, elements of informed consent, minimizing fertility problems, and diagnoses. A section on finding and using medical literature could have been improved with a list of reproductive-related keywords for Medline searches.

As one who has fortunately/recently/successfully completed a ride on the infertility rollercoaster, I am not sure that those who most need this book will find it on the shelves. There is a time during treatment, when patients do not want to consider various scenarios and alternatives. Rather, each couple turns to their reproductive endocrinologist for a recommendation on what is most likely to work for them NOW. Just stepping on to the infertility rollercoaster causes the biological clock to tick louder and louder. Most patients just want to DO SOMETHING and I fear that they may not be likely to yield to Turiel's cautions. Patients have learned to band together in support groups to negotiate the maze through the pathways of diagnosis and treatment. There's even an unfortunate social hierarchy where patients look to "more experienced" infertility-survivors for guidance. Moreover, there's peer pressure that "It's time to move on to IVF."

I applaud Turiel for her revealing look at the world of infertility and treatment. It is a thought-provoking book about life's most important topic. She steps boldly and bravely forth with her cautions and critical assessments. While patients may not want to take the time away from aggressive treatment to consider their alternatives, it will be strong couples who are able to read this book, learn from it, discuss it, and make wise treatment decisions that they can live with for the rest of their lives.

References:

Beyond Second Opinions: making choices about fertility treatment

Judith Steinberg Turiel

University of California Press

Luanne O'Loughlin is a computer book writer who has also spent years transversing the infertility maze. Following primary and secondary infertility, and multiple miscarriages, she is the grateful mother of two daughters, Carly and Katie.