A NEW HARBINGER SELF-HELP WORKBOOK

the infertility workbook

A Mind-Body Program to Enhance Fertility, Reduce Stress, and Maintain Emotional Balance
A proven-effective program to help you:
Manage your fears Communicate with your partner Use powerful strategies to improve fertility

Barbara Blitzer, LCSW-C, MEd

seeking medical help and coping with diagnosis and treatment

If youre having difficulty conceiving, at some point you probably will want to gather facts about fertility and about your body. In gathering facts, you will be better able to decide whether or not your concerns are justified and, most importantly, what you can do to remove obstacles to pregnancy. The medical world defines infertility as one year of unsuccessful effort or, for women thirty-five and over, six months of unsuccessful effort. This is important to you in a couple of ways. First, if youre very worried and have been trying for a much shorter time than one year (or six months if youre over thirty-five), you most certainly have no need to be concerned yet. The official definition of infertility also may be important to you if youre counting on insurance reimbursement for your care, since many insurance companies will not reimburse some infertility-related procedures unless your attempts to become pregnant have been

The Infertility Workbook

unsuccessful for a year (or six months if youre over thirty-five). This may or may not affect some of your early choices, but its best to be aware of it and talk to your insurance company before you seek treatment. This chapter outlines what to consider when choosing a fertility specialist. It will help you know what to expect if you go to a specialist and give you tools to organize and track your experience. The Taking Charge section focuses on journaling, a practice that can ease emotions and decrease the stress that can be associated with medical treatment.

Getting Started with a Fertility Specialist

If youve been trying on your own long enough to fit the official definition of infertility, if youve experienced more than one miscarriage, or if you have menstrual irregularities, you may be ready for a fertility workup. Your regular obstetrician-gynecologist (ob-gyn) may have experience with infertility and be able to perform an initial fertility evaluation, or she may refer you to a specialist. A fertility specialist, or reproductive endocrinologist (RE), is an ob-gyn who has completed at least two additional years of specialized training in infertility. Ultimately, the choice to see a specialist will be up to you. Some couples, depending on their personal and medical circumstances, decide to seek specialized help sooner than others. When choosing a specialist, you will want to consider a range of factors, including success rate, procedures offered, doctors experience, affordability (including whether your insurance is accepted), nonmedical services provided (such as counseling and mind-body work), geographical proximity, practice size, medical policies, and the general tone of the practice. Your regular doctor may be able to help you get started, but the better informed you are, the more comfortable youll be in making a choice. What follows is a brief discussion of the various factors to consider.

Success Rate of the Practice

When youre looking for a fertility doctor, one of the first things you will want to know is the success rate of that doctor or medical practice. The Centers for Disease Control keeps statistics on the success rates of fertility practices on its website (see resources). Of course, you will want to find a practice with betterthan-average outcomes. Note that if a practice treats women of all ages and conditions, its success rate might be lower than a practice that treats only couples with the highest chance of success. Therefore, if you are considering a particular practice, finding out what population it serves will give you more information about its real rate of success.

Procedures Offered
The websites for different medical practices usually include what procedures the practices offer. If you need additional information about a particular doctor or medical practice, someone in the office should be able to answer your questions.

Seeking Medical Help and Coping with Diagnosis and Treatment

Doctors Experience
As you choose a doctor, consider the doctors background, including educational and training background. How long has this doctor been in practice? Does the doctor have any special areas of expertise that might be important to you?

Affordability
Expenses will vary between medical practices, as will financial policies. Some practices may not be covered under your insurance (note that you should check to see if your health insurance covers infertility treatments). Some practices offer special packages or money back to some populations if treatments are unsuccessful. There may be a financial counselor on staff who can help you understand your options.

Nonmedical Services
Some medical practices offer onsite counseling, mind-body programs, and, as noted above, fertilityrelated financial counseling. These services may or may not be important to you. Many of these services can also be found outside of fertility practices. You may value having all these resources in one place or prefer to seek nonmedical support elsewhere.

Geographical Proximity
Fertility treatments can involve many visits to an office or clinic, and its important to consider how accessible a specialist will be to you. Spending more travel time than necessary can add to your stress. If two clinics are similar in other ways, think about choosing the one thats easier for you to get to.

Size of Practice
Some medical practices consist of just a doctor or two, while others are very large. You may prefer a larger practice, where several doctors can back up one another, or a smaller, more intimate setting. If you choose a large practice, you will want to know if youll be seeing the same doctor each time or not.

Medical Policies of Practice

Medical policies differ between practices. For example, if youre doing IVFs, you may want to know the policies regarding embryo transfer. Will you be able to choose how many embryos are transferred to you, or

The Infertility Workbook

will the doctor decide? Some doctors have a policy of transferring a greater number of embryos than others. This may be an important consideration for you, since a higher number of embryos transferred can increase your chance of multiple births.

Personality of the Practice

You may get a feeling of the general tone of a medical practice during a visit or even through an initial phone call. Some settings are more friendly, supportive, and accessible than others. If a warm and supportive environment is important to you, you may be able to reduce your anxiety simply by choosing a practice with those qualities. On the other hand, the personality of the setting may be less important to you than other considerations. Once again, its important to know yourself and honor your needs.

exercise: Identifying Your Priorities

Think about your own situation, including your medical needs, your personality, and your financial issues. Review the different factors covered in the previous section and then list your top priorities in choosing a fertility specialist.

Being aware of your priorities will help focus your search for the best specialist for you.

After you understand your priorities, you can begin doing your research. You may want to record your findings as you look into different medical practices or clinics specializing in infertility treatment.

Seeking Medical Help and Coping with Diagnosis and Treatment

exercise: Recording Your Research

Make several copies of the following blank worksheet so you can record information about each practice youre considering. At the top of the worksheet, write the name of the practice youre researching, and then in the following categories record any information about it that you want to remember. Alternatively, you can rate the practice with a plus or a minus in each category. Be sure to compare your findings with your priorities. Name of fertility clinic or practice: Success rate: Procedures offered:

Doctors experience: Affordability: Nonmedical services: Location: Size: Medical policies: Other considerations or impressions:

Based on your research and your priorities, you should be able to choose the fertility practice or clinic that best meets your needs.