Finding the right physician under any circumstances can be a daunting task. A patient who needs help with fertility may be faced with complicated medical decisions. Friends, family, and even the press and the Internet can provide contradictory information, making it extremely important that each patient find the most appropriate physician to advise her, support her and guide her through treatment. The reproductive endocrinologist will be responsible for directing medical testing and directing the appropriate treatment. Clearly, finding the right doctor to guide a patient through the process can be difficult.
Many patients will rely on the recommendations of their primary Ob/Gyn, with whom they already have a long relationship and on whom they have come to rely for good medicine and good advice, and others will depend on insurance companies to direct them. Whether one uses the yellow pages, an Internet search engine, or word of mouth, however, it appears that especially in the field of fertility, not all physicians and practices produce identical results. In fact, the degree of emotional support and likelihood of a successful outcome may be vastly different depending on where one is treated.
Physicians are required to meet standards set by the state in which they practice, but being a physician goes beyond these criteria. A compassionate and caring attitude and an ability to educate the patient in a sensitive manner are essential. Even in a high volume fertility clinic, it is important for each patient to be treated as an individual, have their questions answered, and know that they are being taken care of.
How does one choose a reproductive endocrinologist? What should a patient expect from an infertility clinic?
A patient should always expect to be treated with courtesy and with respect by office staff. A patient should have access to her doctor and nurses, with all of her questions and concerns addressed in a timely and direct manner, especially after the initial consult, when new questions are likely to arise. The office should be open seven days per week if intrauterine insemination or in vitro fertilization services are offered, so that the timing of these procedures can be done when the chances for success are optimal; physiology and biology do not adhere to a standard five-day workweek. Emotional support, and, when needed, professional mental health professionals should be available. Medical treatments should be based on science and evidence and the patients’ best interests must always be followed.
Most importantly, the patient must have confidence in her treatment. The Society of Assisted Reproductive Technology (SART, www.sart.org), the primary professional organization dedicated to the practice of assisted reproduction, collects data from IVF clinics in the United States in order to provide essential data on fertility therapy. SART plays an active role in creating guidelines for clinical practice and for setting practice standards. SART works in close association with the Centers for Disease Control and Prevention, which, by law, annually publishes data on IVF clinics operating in the United States (www.cdc.gov/art). SART data, however, cannot be used to compare one clinic directly to another, since patient characteristics at one clinic can differ markedly than at another, so the expected outcomes may be different. For example, if one clinic got only “hard” cases and one only “easy” cases, then simply looking at the outcome data doesn’t really give a good sense of how good the clinic is, since skewed results would be expected. However, the report provides a standardized reference: for example, the number of treatment cycles for each clinic is reported, as are additional parameters such age of patients and various other outcome measures. Fertility clinics can vary in the way they disseminate data, but this source provides verified outcomes.
Patients must understand clearly the definitions of the categories of data that clinics may choose to report in advertisements, which may be different than data in the national report. For example, pregnancy rates and live birth rates are not the same; patients must be aware of this since they provide different information: the first may be a positive pregnancy test, but the second can be nothing other than a live born baby. Unfortunately, because miscarriages occur, not all patients with positive pregnancy tests will have a successful outcome. Some patients may need multiple attempts at IVF before becoming pregnant, so only reporting outcomes on a per patient basis rather than on a per cycle basis may obscure the duration of treatment and number of treatment cycles. It’s critically important to understand which number is being reported.
Because it takes time to collect the data, verify it and publish it, and because it takes nearly a year for the outcome of a live birth to occur from start of a successful IVF cycle, the SART report lags by approximately two years. Although there is a lot of statistical data available, every patient must keep in mind that she is a person, not a statistical result. The differences that make us unique influence the probability of treatment success.
Treatment of infertility can be a frustrating and emotionally challenging experience. By choosing a reliable clinic with a proven track record and good reputation, a patient can be assured that she is receiving the best possible care. Good communication is essential: with clear explanations of the cause of infertility and its treatment and the opportunity to follow up with additional questions when they arise, some of the stress of fertility treatment can be relieved. With confidence in her physician and the clinic, a patient can focus on achieving success.
Eric Flisser, M.D.©
RMA of New York
635 Madison Ave, 10th Floor
New York, NY 10022
Telephone: (212) 756-5777
© Copyright Eric Flisser, M.D.