By Kristen Wright, MD, Reproductive Science Center of New England. Dr. Wright is a speaker at RESOLVE New England’s upcoming 20th Annual Fertility Treatment, Donor Choices, and Adoption Conference on Saturday, November 2, 2013.

It is important that fertility treatment plans are constantly evaluated by managing physicians so that adjustments can be made when treatment isn’t working. When you have undergone a fertility treatment that has not been successful, consider asking your doctor the following:

  • What about this treatment went well? If doing an IVF cycle, consider hormonal profiles during the stimulation, number of eggs retrieved, fertilization rate, embryo development, ease of embryo transfer, availability of extra embryos for cryopreservation. If doing an IUI cycle, consider hormonal profiles during the stimulation, number of mature follicles produced, sperm parameters on IUI.
  • What about this treatment could be improved upon or what alternative treatments would you suggest? If doing an IVF cycle, consider medication protocol adjustments, method of fertilization, number of embryos to transfer, adjuvant procedures such as assisted hatching, methods to improve the embryo transfer technique.
  • What is the long term plan in terms of number of cycles of a given treatment that you would suggest prior to moving on to other treatments or alternatives for family building?

Keep in mind that even the most advanced fertility treatments in best prognosis patients only result in a pregnancy < 50% of the time and many people’s chance for success with a single treatment cycle is much lower than that. It is important to view achieving a pregnancy as a long-term goal and to recognize that multiple treatments may be necessary to achieve that goal. If you are self-paying for IVF treatment, you may want to consider course-of-treatment programs, such as Attain IVF, where you pay a single, discounted fee upfront for a predetermined number of IVF cycles. This eliminates the unknown financial aspect of treatment, and allows you to focus on your long-term goal. Studies show that people who commit to these types of programs double their chance for having a baby.

It is reasonable to seek a second opinion if:

  • You have done multiple treatment cycles without success
  • You don’t feel that you have a good relationship with your doctor or fertility team
  • You just want reassurance that you are on the right path

Ways to seek a second opinion:

  •  If you are seen at a group practice, you may ask to see another physician in that practice for a second opinion
  • You make seek a second opinion at another fertility center. In this case, you will need to be sure to request that your records be sent to the center where you are getting the second opinion. Keep in mind that this may involve requesting records from multiple sources including your ob/gyn, any fertility specialist that you have seen and any hospital where you have had studies or tests done. It is important for the physician to be able to view any diagnostic testing including hormone levels, imaging studies and semen analyses as well as the “stimulation grid” and embryology sheet for any treatment cycles you have had. You and your partner (if applicable) will usually need to sign a medical release to have these records sent.
  • Most group practices will have periodic physician meetings where unusual, controversial or challenging cases are presented to a group of physicians for discussion. If you have a specific question that you and your doctor are undecided about (or maybe one that you disagree about), it may be reasonable to ask if this question could be presented to the group for discussion.

If you have done multiple fertility treatment cycles without success, it may be time to consider adjuvant treatments that are not as well studied as traditional treatments. For example, in poor responding patients at IVF, adjuvant treatments such as DHEA-S, dexamethasone, patch protocols, CoQ10, acupuncture or growth hormone are sometimes considered. It is important to recognize that these treatments have some scientific validity but are not as well studied as traditional treatments. Therefore, they should only be considered after careful consideration of the risks and benefits and if traditional treatments have been tried and been unsuccessful.

If you are not responding well to treatment or if you have done > 4 IVF cycles with your own eggs without success, it may be time to consider using donor eggs or other methods of family building such as traditional or embryo adoption. Ask yourself what your stopping point is. Many individuals are more comfortable moving on to these other options only after they have given a reasonable attempt using their own eggs. However what defines a “reasonable attempt” will vary from individual to individual and often couples will disagree about what their stopping point is. If you experience this, speaking with a counselor experienced in helping couples with infertility may be a benefit to you.

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