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What to Ask Your Reproductive Endocrinologist on Your First Visit

Preparing for your first visit to your Reproductive Endocrinologist (RE) can be a little nerve-racking. You've probably put quite a bit of time and effort into finding an RE who is the right fit for you, so if you feel somewhat anxious on the days leading up to your appointment, it's understandable. After all, your fertility is a very personal, sensitive topic and you want everything to go as smoothly as possible!

Having a list of questions with you at the appointment is the best way to guarantee you won't forget to ask about the things you may be unsure of. It would also be helpful to bring a small notebook. The RE will give you lots of information and it will be nearly impossible to remember everything without taking a few notes.

The following are a few topics you should discuss with your RE before you or your partner agree to proceed with any treatment:

Hours of operation - Ovulation doesn't wait for nine o'clock Monday morning! Be sure the clinic operates at times when you are available, such as during the evenings or on weekends. You will likely have to make several trips to the clinic for blood work and ultrasounds, so regular business hours often aren't enough. Plus, scheduling your work responsibilities around your RE's hours can be both challenging and frustrating.

• What are your office hours?
• Do you close during the holiday season?
• Who covers for you when you go on vacation?
• How will we communicate with you outside of the office? Do you offer phone consultations?
• Who can we call if we have a problem after office hours?
• Are you or another doctor on-call 24 hours a day, 7 days a week?

Testing - Your RE should go over the tests he or she might perform, as well as the order in which they will be performed. If you are unsure of what any of these tests entail, do not hesitate to ask your RE to explain the testing process in complete detail.

• Will I need to undergo a laparoscopy for diagnosis? If so, who will perform the surgery and where will it be done?
• Will my partner and I be evaluated at the same time?
• What other kinds of tests should we expect?
• How long will it take to diagnose our problem?
• Can all of our testing be completed within one or two cycles?
• How long do blood test and other test results take to receive?

Treatment sessions - You and your partner will probably have the most questions regarding the kind of fertility treatment you will receive. Discuss with your RE all of your options, as well as when you can begin treatment, as some clinics only accept a certain number of patients for specific treatments at one time, and many clinics have a waiting list. Your RE should also be able to give you an estimate of many times you will need to receive a particular treatment before you see results or move on to a new form of treatment.

• What are our treatment options?
• Will treatment be individualized, or do you follow set protocols?
• Can we begin treatment right away? Is there a waiting list?
• How will you monitor my treatment and how often?
• Will you always perform treatment monitoring or is it possible that on occasion another physician or a nurse might monitor?
• When do you prescribe progesterone support?
• Will I need to use fertility drugs, such as Clomid?
• What kind of advanced reproductive technologies (ART) do you offer?
• What are the qualifications for moving on to intrauterine insemination (IUI)? In vitro fertilization (IVF)?
• Who decides how many eggs are implanted during an ART procedure?
• Do you perform all egg retrievals and embryo transfers? If not, who else might?
• Do you have ties to a donor egg/sperm program?
• How many treatment sessions will we need before we see results?
• How many sessions will we need before attempting another treatment?

The lab - As one of the most important parts of a fertility clinic, the laboratory should be fully updated with all the available technology. It should have a trained embryologist and the technology to perform blastocyst transfers, assisted hatching and other advanced techniques. Equipment for ultrasound examinations, blood hormone testing, sperm preparation for insemination and all fertility procedures should be available on site whenever they are needed. Also, because some labs are closed during the summer months, it is important to ask about closures that could potentially interfere with your schedule.

• Is an up-to-date laboratory located on site?
• Can you perform ICSI and PGD at your laboratory?
• Are laboratory hours the same as clinic hours? Does the lab close for any period of time?

Rate of Success - It is very important that you know your clinic's success rates because you are eager to have a baby and want a fertility expert with proven success. An unusually high success rate might be an exaggeration in an attempt to gain business, so check with other sources, such as friends or your gynecologist, for more information about the clinic.

• What is your success rate with the treatment we will be receiving?
• How likely is pregnancy to result from the recommended treatment?
• How many pregnancies performed at this clinic have resulted from IUI? IVF? Egg donation?
• What are the chances that a multiple birth pregnancy will result from this particular treatment?

Cost - You should always know how much you will be expected to pay for something before you have it done, especially if your insurance does not cover infertility treatments. Try not to feel awkward discussing the costs of your treatment, lab work, office visits and medications with your RE. It is your right to know exactly what you are paying for.

• How much will treatment cost? Does that include lab work, procedures and medications?
• Will my insurance cover these costs?
• Are there extra costs for office visits or phone calls?
• Can you offer me discounts on medications?
• Do you offer payment plans or other financing options?

Counseling - It is common when undergoing infertility treatment to feel the need to speak with a professional for guidance or emotional support. Therapists and fertility counselors are knowledgeable about the subject and can help you and your partner choose the best treatment option if you are having trouble making the decision.

• Does the clinic have a full-time or part-time licensed therapist to help us cope with any emotional issues or concerns? If not, can you recommend a good fertility counselor in case we feel the need to talk to someone?

These are just a few of the many questions you may have for your RE. Jot down any others that come to mind, and never feel too embarrassed to ask any of them. No question is silly or stupid. It is your right as a patient to know every detail about your doctor, the clinic and any possible treatment you may receive.

If your RE seems to dismiss your concerns or makes you feel as if you cannot ask questions openly, you might want to consider looking for a new doctor.