Before you take the next step in your journey to become pregnant, it's worth seeking out a good fertility clinic.
Let's say you've been getting advice from your gynecologist, who's run a blood test for hormones or had you record your basal body temperature for a couple of months. At the same time, your husband has had his plumbing checked out by a urologist. When it comes time to diagnose where the problem may be and suggest solutions, you may wish there were a single doctor you both could see. That's where the infertility specialist comes in, providing big-picture advice. Women over age 35 or who have a history of three or more miscarriages; men with a poor semen analysis; and couples who have tried for at least two years to get pregnant, should plan on seeing a specialist, recommends Resolve, an infertility support group.
Irregular or abnormal ovulation accounts for 30% to 40% of all cases of infertility. Having irregular periods, no periods, or abnormal bleeding often indicates that you aren't ovulating, a condition known clinically as anovulation.
Although anovulation can usually be treated with fertility drugs, it is important to be evaluated for other conditions that could interfere with ovulation, such as thyroid conditions or abnormalities of the adrenal or pituitary glands.
However, you need to do some homework first. Before you step foot into the fertility clinic, find out what kind of invasive tests or procedures might lie in wait for you. And give some thought ahead of time to how far you're willing to go with this process. Advanced reproductive technology can cost many thousands of dollars, can involve strong drugs or hormones, and can be an emotional roller coaster. Knowing your limits will keep you from being talked into some nifty new procedure that you really don't want and can't afford.
When it comes to choosing a clinic, do thorough research ahead of time. One useful resource is a federal database kept by the national Centers for Disease Control and Prevention that contains the success rates of fertility centers around the country. The statistics are updated every few years, so check the date. Keep in mind that some fertility centers that looked great several years ago may have had high staff turnover and declined in quality. But the numbers give you a place to start. Also, ask a lot of questions of every fertility clinic you're considering.
"You shouldn't look at the report and say 'Center A has the highest success rate, I'm going there,'" says Arthur Wisot, MD, an infertility specialist in Los Angeles, Calif., and author of ''Conceptions & Misconceptions,'' a book about choosing infertility care. "Just be sure they have a success rate that's at least above the national average."
We've all heard the scary stories about embryos ending up in the wrong womb or ugly legal disputes over someone's frozen eggs. To be sure you don't become the next reproductive-technology headline, check that the clinic has good quality control and strong ethics.
Questions to Ask of a Fertility Clinic
Wisot recommends asking:
How long has the fertility clinic's medical director been there?
How long have the doctors and technicians been there? High staff turnover can be a sign of bad management and can contribute to mistakes.
Which procedures do you do, and how often? Be sure the clinic has a wide range of infertility remedies available and is familiar with the latest technology, such as something called blastocyst transfer.
Do you have age limits for treatment? If so, it's a good sign that the clinic is concerned about ethical issues.
When you do an advanced procedure that involves fertilizing the eggs outside the woman and then planting them inside her, who decides how many eggs go back in -- the doctor or patient? Wisot recommends steering away from a clinic that gives complete control to the doctor. This is important because the more eggs planted, the greater the chance for multiple births.
How many cycles per year do you do? Wisot notes that some clinics handle so many patients -- each of whom may be treated for multiple menstrual cycles -- that patients end up feeling like a number.
What does treatment cost? While you don't want to choose strictly on price, it's good to know costs ahead of time so you know what you're getting into. Beware of clinics that offer a money-back guarantee if you don't get pregnant -- the doctor may have a financial incentive to treat you more aggressively than you want.