Questions When Choosing a Reproductive Endocrinologist (RE)

Questions When Choosing a Reproductive Endocrinologist (RE)
by Cara

The best type of patient is a prepared patient! I was both excited and anxious for my first appointment with my RE. I find I function best when I know what to expect and I stay calm if I am organized. In order to help you through this potentially nerve-wracking first experience, I have prepared a list of tips, questions and expectations for your first appointment with your RE. If you are not satisfied with the answers from the first RE and clinic that you visit, I urge you to keep looking for one that is a better fit.

Tips for your first appointment:

• Bring your list of questions with you
• If possible, have someone accompany you to the appointment–2 sets of ears are better than one
• Take notes during the consultation
• Bring relevant medical records: surgeries, recent pap test, list of medications
• Bring copies of any fertility work up you or your partner have had completed with the OB
• Bring list of concerns/observations about your cycle. If you have a month or two before your first appointment, try charting your basal body temperature
• Do not leave your appointment until all your questions are answered to your satisfaction!

Questions, Questions and more Questions!

About the Clinic

• How long has this clinic been in business?
• What are your office hours?
• What procedures are performed on the weekend?
• Are the Clinic and Lab open 365 days a year?
• How much work should I expect to miss?
• Do you provide pre-natal care? If not when will I be released to an OB?

About Communication

• Who is the case manager?
• Who is available if I call with questions?
• Can I leave a message for my RE? Can I email my RE directly?
• How long will I wait to receive a return call/email?
• Is there a number for off-hours problems?

About the Reproductive Endocrinologist (RE)

• Where did you earn you degree?
• What is your training in infertility? Are you board certified as a reproductive endocrinologist?
• What hospital are you affiliated with?
• Will I always get to see you?
• If not, how many REs are part of the group?
• Will I always see the same nurse?
• Will all my treatment and procedures be performed by you?
• How often will I get to meet with you face to face?
• How open are you to discussing information that I have learned about from other sources?
• Do you recommend counseling?
• Do you have a counselor on staff? If not, can you refer me to one?
• What books do you recommend reading?
• What is your view on alternative treatments (acupuncture, TCM, vitamins)?

About Initial Evaluation

• What tests do you perform to evaluate me/us?
• How long will it take to diagnose my/our problem?
• What specific tests would you recommend to diagnose my infertility?
• How long will you wait from the time of diagnosis to starting treatment?
• What do you see as our first step in treatment?
• If that fails to produce a positive, where do you see us moving next?

About Treatment and Procedures

• Will my treatment be individualized or will you follow set protocols?
• What procedures do you perform at your clinic?
• Which do you perform on-site? Which in a hospital?
• How will you proceed if we have unexplained infertility?
• Do you monitor while on Clomid?
• What kind of monitoring should I expect for other types of medicated cycles?
• During a treatment cycle, how often will I have to come into the clinic?
• What are your office hours for different procedures (ie: Blood tests, ultrasounds)
• If we go to IUI or IVF, can I bring in sperm sample or does it have to be produced in the clinic?
• How long do you stick with a particular treatment before moving forward?

About the Lab

• Do you have a Donor Egg and Donor Sperm programme?
• Do you do Blastocyst transfers?
• Do you do Assisted Hatching?
• Do you do Intracytoplasmic Sperm Injections (ICSI)?
• Do you do Pre-implantation Genetic Diagnosis (PGD)?
• How long do blood tests and other results take to receive? What is the procedure for getting the results?

About Expenses

• Do you have a price list? Can you run through it with me?
• Do your fees include the medications? Injection Instruction?
• Is it possible to set up payment plans?
• Will my insurance pay for the testing and/or treatments?
• Will your clinic help me determine what my insurance will cover?

About Success

• May I contact any of your patients who have had similar treatments?
• What are your statistics for couples with our diagnosis?
• What are your live birth statistics for different procedures?
• How do your statistics stack up against national averages?
• What would account for these differences?

What you might expect from your first RE appointment:
You can expect your first appointment to last from an hour to two hours. You will meet with the RE and your primary care nurse. The RE will ask you about your medical history as well as your sexual history. Check your embarrassment at the door! The more honest you are with your doctor, the quicker he may be able to arrive at a diagnosis and treatment plan. Whenever I feel myself getting embarrassed about something, I think: no matter how weird/abnormal this seems to me, the doctor has certainly seen worse!

At your first appointment your RE will probably order blood tests to check for the following diseases: Rubella (female only), Chlamydia (female only), HIV antibody, Hepatitis B surface antigen, Hepatitis C antibody, RPR (syphilis).

Depending on where a woman is in her cycle, your RE may also take blood to check the following: Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Estradiol, Progesterone, Prolactin, Free T3, Free Thyroxine (T4), Total Testosterone, DHEAS, Androstenedione.

For women, the RE may also wish to perform a vaginal ultrasound to look for any abnormalities, measure ovarian volume and look at antral follicles. The RE will probably order a Hysterosalpingogram (HSG) to be done between days 7 and 10 of the next cycle.

Men may also do a semen analysis, even if they have done one or two before. Be prepared: abstain from sex 3-5 days before your appointment! If the man has had previous semen analyses with abnormal results, the RE may refer him to a urologist. The urologist will order blood work to look at hormone levels, and he may recommend a testicular ultrasound.