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Infertility Tests Every Aspect of a Couple's Life

Infertility Tests for Every Aspect of a Couple's Life

Beyond the Cookie Cutter

When Annette Wax of Wheeling, Ill., had trouble conceiving her second baby at 29 and experienced side effects from the first fertility drug she tried, her OB-Gyn sent her to a well-known fertility specialist who also was covered by her health insurance. Yet from the first visit with the doctor, who outlined a regimented course of treatment, she felt like she had been propelled into a cookie-cutter protocol in which her own needs and desires were ignored.

"It was like a factory -- I felt like a nobody among 30 people in the waiting room," recalls Wax. "They told me that if one thing didn't work, they'd try the next and the next. ... I felt like a guinea pig."

Doctors say that feeling comfortable with a program is just as important as its statistics and success rates. "A fertility program needs to give personal attention -- otherwise it'll wreak havoc with you emotionally," cautions Dr. Sherman Silber, medical director of the Fertility Center of St. Louis and author of "How to Get Pregnant With the New Technology." "The doctor probably won't have all that time to provide, but there should be counseling personnel to hold your hand every day."

That's why word of mouth is among the best ways to find a program you'll be comfortable with, advises Dr. Richard Rawlins, director of the IVF/ART Laboratories at Rush Medical Center in Chicago. "Find a support group for infertile couples, like RESOLVE, and talk to those women because they've been through it. Ask them where they were well taken care of and where they had a good doctor-patient interaction." RESOLVE is an infertility support, education and advocacy organization based in Somerville, Mass., with chapters nationwide.

Infertility programs typically start with an exam and tests to explore three factors that could contribute to problems conceiving -- sperm, ovulation, and structural abnormalities in the fallopian tubes or uterus. Depending on the diagnosis and the age of the woman, treatments might involve fertility drugs to correct hormonal imbalances, intrauterine insemination, surgery or experimental assisted-reproduction techniques (ART) such as in vitro fertilization, in which the sperm and egg are fertilized in a lab.

Although diagnostic tests can sometimes be dragged out for as long as 18 months, Daniel Kenigsberg, co-director of Long Island IVF in Port Jefferson, N.Y., advises finding a specialist who will get the testing done in about six weeks and who includes successive options if one course of action fails. He also advises that couples truly understand their chances of conception every month.

"Even if you were to restore a couple's fertility to normal, they'd still only be getting pregnant at a rate of about 20% per month. If people don't understand that basic premise, infertility can become especially stressful because somebody will get a fertility drug or insemination for one month and think it's gotta work."

Couples may be limited to certain programs or treatments by their insurers, and in states with mandated coverage patients are often referred more quickly to in vitro fertilization than they are elsewhere. But experts encourage arguing with insurers if need be. "I think that insurers for the most part want the patients pregnant in less tries, too, but sometimes they're not looking at the success rates as closely as the patients are," says Dr. Michael Zinaman, director of reproductive endocrinology at Loyola University Medical Center in Chicago.

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