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Question: I think I need a second opinion.  I feel disloyal to my Reproductive Endocrinologist. What do I do?

My husband I are in our early 30's and have been married for 6 years. We are both very active and healthy and it never crossed our minds that I would not be able to get pregnant when we were ready.

All of our close friends have all had one baby and some are pregnant with their second child while we continue to struggle with disappointment after disappointment.

Two years ago we sought treatment from a highly respected infertility group in our community. They discovered both my husband and I have factors that contribute to our infertility. We have had two IVF cycles and one frozen cycle, which have all failed. I am devastated and feel as if we are running out of time and financial resources. My husband would like for us to get a second opinion I know that makes sense but it also worries me. I don't want to anger or hurt the feelings of my doctor and staff, especially if we decide to continue with them. It is difficult to think of starting with a new infertility group when I feel like my doctor knows our case so well.

We know we have the financial resources for only one more IVF and may need to consider using a donor. I have so many unanswered questions as to why we aren't conceiving, it's difficult to even consider making what feels to me to be a drastic choice. I feel desperate to move forward yet paralyzed by the enormity of the choices before me.

-Carol

Answer

First let me say that physicians believe that good patients are also good consumers of health care.  We remind ourselves of that when we seek care for ourselves and we remind our patients.  A good consumer  seeks to understand everything she can about her diagnosis, treatment options, risks and benefits of options considered, and likelihood of the hoped for outcome.  The more informed one is, the better for making the treatment choices that fit one best. An additional medical opinion, attained by consulting a different (and qualified) physician, is an excellent way to expand one's understanding of these issues. The whole field of ART is extremely complicated as is every individual couple. Therefore, it's quite possible for a different physician, taking a fresh look at your workup and treatment failures, to see with a new perspective something important for success. Every physician has provided second opinions on other physicians treatment.  It's a time-honored tradition in medicine, which is not threatening to a confident physician.  

Its normal for you to feel almost a sense of disloyalty at the thought of consulting another physician.  Your current physician has been with you through some of the most-intense emotional times of your life.  You have naturally formed a trusting bond.  In the midst of all that you and your husband have had to endure, you want to rely upon this individual unquestioningly.  Let me reassure you, your Reproductive Endocrinologist wants you to have the best possible care and wants you to emotionally feel like you have made the best, well-informed choices. 

The best way to deal with the push/pull of "desperate to act, yet paralyzed" is to begin taking a few steps.  Start by researching RE's that you would like to consult. Then obtain a copy of your medical records.  Whether you decide to seek a second-opinion or not, it is helpful for you to have a copy of your records.  If you discuss this consult with your current RE, tell this individual that you have the highest regard for his/her expertise which is why you chose this practice in the first place.  Before deciding on a fourth go at IVF you would like to see what a fresh set of professional eyes might see and suggest. Therefore, you would like to have a copy of your workup, treatment record, and embryologist's records to use in a consult with another physician.  Make no apologies, only expressions of gratitude along with your clear request. 

Alternatively, you may simply call your RE's office and ask the secretary or other med ical records person to copy your chart including all of the above referenced records so that you can come by and pick it up. Many states mandate that a patient is entitled to one free copy of their chart records. If the office person asks why you want a copy of your records you can say something like, "Before I make a final decision about a fourth IVF cycle I would like to get a second opinion about my all of my options." If the office offers to send the records directly to the consulting physician, just say, "Thanks for the offer but I'd prefer to come by and get them myself."  First of all, these are records about you and you will want a copy. Secondly, you may want to have them for yet another opinion somewhere along the way.

When you see the consulting physician, take your records and explain that you are seeking his/her input about your diagnosis, past treatment efforts, and their medical opinion about the treatment changes they would suggest should you choose to proceed with a fourth IVF cycle. You may be forthright in asking if he/she sees things differently in your case. When finished tell this RE that you will go home and consider what you've heard and may be calling for further clarifications as you and your husband digest all of the information and options.  Ask if you may return to do the next cycle with them if you decide to switch physicians.  Of course, after the consultation you might decide to return to your original RE and the consulting physician will understand this.

In short, please feel empowered to seek all of the knowledge and input you need so that you can choose the medical care which is best suited to your own unique situation (which includes, among other things, your personalities, diagnoses, resilience, and finances.) Consider each caregiver as one expert consultant you will use in making your own treatment decisions.  It's your baby you are pursuing; it's your body, your marriage, and your wallet.  So, be clear that this is your call.  Make no apologies for seeking what's best for you.

—Robert Stewart, M.D

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