Infertility Patient's first visit to the MD

Article Conference CoverageFrom 55th Annual Meeting of ASRM held conjointly with CFAS- Toronto, Ontario, Canada - September, 1999

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Barbara Nesbitt: "I'm Barbara Nesbitt and I'm in Toronto today with Dr. Jane Frederick. I think I forgot to tell you, we're at the American Society of Reproductive Medicine. I'm going to take a moment here with Dr. Frederick, and I'm going to play the role of the woman who is infertile, and she's going to Dr. Frederick for the first time. I have no idea in the world what's going to go on. Dr. Frederick, here I am."

Dr. Frederick: "First of all, it's very important that you seek out somebody who is a specialist, and you see the reproductive endocrinologist as someone that would be very knowledgeable in how to treat infertility. I always tell my patients that they should try for one year to achieve a pregnancy, and if they're not pregnant after one year to seek out someone who is knowledgeable. If the patient, however, is over forty - they should really seek out a specialist within six months period of time. So it's important that they consider the age before they decide how long to take in trying to get pregnant. Now there are some simple tests that we can run, and the first test is a semen analysis. A semen analysis will show that there is no male factor involved in the infertile couple. About 40% of my couples have a male factor, so it's very important to rule that out."

Barbara Nesbitt: "I didn't realize that, I think most of us think it's all our fault."

Dr. Frederick: "No, it's a couple and usually I encourage both men and women to come in - husband and wife - to allow us to examine both. So a semen analysis would be very critical. The second testing would be a x-ray called a "hysterosalpingogram." That x-ray tells the physician that the patient has normal tubes and ovaries and that the tubes are functioning and able to help that patient get pregnant. Tubal factor infertility occurs in about 40% of my couples as well. Secondly, we may look at some hormone testing for the patient, ruling out thyroid disease. It's very important if the patient is older that she have a FSH level, which is a hormone that tells us that she still has eggs in her ovaries. We would try to then predict when the patient is ovulating and ovulation kits are very helpful. A progesterone level, which is a blood test on day 21 would also be very helpful to document that the patient is ovulating. Then thirdly, a post-coital test is performed, that is a test that checks the mucus of the cervix, and it tells us that the mucus is not hostile to the husband's sperm. So it's very important that the cervical factor be ruled out as well. And lastly, it would be a laparoscopy. A laparoscopy is an outpatient surgery, and that's where the physician would be able to diagnosis things like endometriosis, adhesions, or scar tissue. So laparoscopy is the fifth tool that we use to diagnose an infertile couple."

Barbara Nesbitt: "Is my insurance going to cover any of this? How do I find out if they're going to cover it? And is there a level where I can say - I'll try this much, I can afford this much money, I have to pay for it myself, and I have to give up after that. I think one should be realistic, don't you?"

Dr. Frederick: "Yes, insurance plays a big part in treating patients, and at some point the patient should be aware of what her insurance will cover, and she should ask those questions to the insurance company directly. In my office, I also have a lot of knowledgeable personnel that will assist the patient in trying to figure out what their insurance will cover. At the initial consultation with the physician, a treatment plan should be made so the patient will know what she's in for in terms of testing and how many treatment cycles she'll need. So it's very important that the initial appointment review all of that."

Barbara Nesbitt: "I guess every woman that goes is going to ask you the same question - what's the success rate? In my mind, could I say that there's hope that I could probably have a baby or be pregnant in six months? Is that realistic or unrealistic?"

Dr. Frederick: "The success rate of trying to get pregnant really depends on how old you are and what factors are involved. It's very important that the older patient know that her chances are diminishing as she gets older - so I encourage my older patients to come in as soon as possible and to be aggressive with their therapy. But there's a lot of tools, a lot of techniques that are available for infertile couples. Our field is expanding constantly, and there are a lot of treatment cycles that don't require a lot of cost to the patient but allow the patient to get pregnant with low-tech. Not everybody needs the hi-tech, and that's an important thing to remember. There's a lot of progress made in this field, and I encourage patients to seek out the help."

Barbara Nesbitt: "Thank you very much."

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