8 Things to Discuss with your Reproductive Endocrinologist

The keys to joining your physician as a partner are knowing what you need to understand and being sensitive to how you ask questions. It's important to be respectful to your physician, and also to stay informed so that you can make intelligent choices.

 

What do you need to know?
In general, probe further whenever you hear descriptive words such as “normal" or "good, or "okay."  Ask for specific numbers, measurements, and results and ask your physician what he or she considers a good or ideal range.  Get an understanding of what factors affect those numbers and if the results can be modified—things you can control, such as BMI (body mass index) or that your physician manages, such as medication and protocol.  Ask to read the Embryologist’s report.  If your fertility is limited by factors not believed to change, such as ovarian reserve or egg quality, you are in a position to make more-informed choices about how you want to proceed. 

The advantage to a partnership is that you do not need to complete ten years of medical training!  You don’t have to learn everything your physician knows.   You do want some degree of understanding about the following issues:

• Ovarian Reserve:  The number of eggs you have available is an important factor affecting your fertility.  Your physician may use various tests.  Two common measurements are FSH and Antral Follicle count.  FSH, Follicle Stimulating Hormone, is an indicator of your ovaries’ ability to produce eggs.  There are other hormone levels that are measured throughout the treatment and you may want to also learn more about them.  The Antral Follicle count is obtained through ultrasound.  It is a count of the number of immature eggs in your ovaries.

• Egg Quality:  Even with a normal number of eggs available, the quality of the eggs varies, usually becoming of poorer quality with increased age.  Read the embryologist’s report or ask to meet with him or her.  Eggs are graded on factors such as color, clarity, symmetry, and hardness.  Sometimes grading scales (A,B,C,D) are used.

• Embryo Development:  The Embryologist will also observe and note the interaction between the egg and sperm, and the development of the resulting embryo.  The quality of the embryos will be a factor in deciding how many to transfer or how to proceed.

• Endometrium thickness and quality.  The creation of an ideal uterus for implantation of the embryo and growth of the fetus is assessed by this measurement.  The thickness of the endometrium, usually measured in millimeters, and the layering, referred to as trilaminar, are evaluated during a vaginal ultrasound.

• Protocol:  What medications (how much and when) are finely tuned based upon your physician’s experience with your body’s response.  Understand what changes, if any, to your protocol are planned.  Write it down or ask to have it in writing.  A useful way to pursue a second opinion, is to visit another physician or facility:  bring all of your records as well as your proposed protocol and ask this physician what he or she would do differently (or not) in your treatment.

• Prognosis:  Maybe we’re afraid.  Often we don’t actually ask the physician:  “What do you think are my chances?  How likely are we to be successful?”  If embryos are not progressing, you need to know so you can manage your expectations.  If you have many healthy and growing embryos, you will need to start thinking about how many to transfer and eventually what you will do with extra fresh or frozen embryos.

• Medical History:  You are the expert on your medical history.  You may need to remind your physician of aspects of your history while at the same time asking for more information.  Could my previous D&C be affecting the endometrium growth?  Does my diabetes affect this medication?  Don’t assume your physician remembers every aspect of your history or that it is all correctly listed in your chart.

• Communication   What is your normal procedure for communicating with us?  Does the embryologist call every day?  How does that happen?  I know changes happen every day; what can we expect?  I will do much better if I am kept informed.  Good news will allay my anxiety.  If something isn’t going as well as hoped, it will help me if I have realistic expectations.