by Iris Waichler, L.C.S.W.
One of the most important aspects of riding the infertility roller coaster is partnering with the right medical doctor to help your parenting dream become a reality. Many people have long standing relationships with their obstetrician/gynecologist and choose to stay with this physician as they try to build their families. Sometimes it is difficult to determine who is the right specialist for you?
Gynecologists specialize in working with women who have medical problems and disorders relating to women’s reproductive organs. The focus of obstetrics is to treat women who are pregnant and monitor and maintain the health of the mother and the unborn child throughout the pregnancy and after the birth of your child. Many physicians have both of these specialties.
A physician who is a Reproductive Endocrinologist initially trains as an obstetrican/gynecologist. Following this training there is a 3 year period where they learn about hormone production, male and female infertility, and they specialize in reproductive systems. Your RE will help try to determine the cause of your infertility. If that is determined the RE will determine if surgery, medication, or in vitro fertilization techniques can be used to treat your infertility.
If you find that you are having multiple miscarriages (3 or more) or after a year if you are under 35 years of age and you are still unable to get pregnant, your obstetrician/gynecologist should recommend that you see a reproductive endocrinologist for a complete assessment and treatment options for you and a male partner if you have one. If you are over 35, you should not wait more than six months to see an RE. Many people are surprised to learn that approximately 40% of the time there is a medical problem with men that impacts fertility. Sometimes an assessment shows there is a medical issue with both the man and the woman. In approximately 10-20% of cases of infertility, the exact cause for infertility is not able to be determined. This can be the most painful scenario to cope with.
It may be difficult to imagine leaving your ob/gyne if you have been a patient over an extended period of time. Once you begin to see a reproductive endocrinologist you will find that you are coming to the office on a very frequent, at times, almost daily basis. You will see several members of your treatment team including your RE, a nurse, the technician drawing your blood (phlebotomist), and perhaps an embryologist. You will see team members like the RE, nurse, and the phlebotomist often and you will find that you can quickly develop a relationship with them. The frequency of your office visits in conjunction with the stress of the diagnosis of infertility can create a close bond between you and a compassionate healthcare provider. For many the necessity of frequent ongoing monitoring needed during infertility treatment creates a sense of comfort and a close relationship between practitioners and patients.
The good news is that if your treatment is successful and you become pregnant the frequency of your visits will decrease. You initially will probably have weekly ultrasounds to monitor your pregnancy. It is incredibly reassuring to have the opportunity to see your baby, hear the heartbeat and be told your pregnancy is progressing in a normal way.
Approximately 7-9 weeks into the pregnancy your RE will recommend you return to your ob/gyn or to a high-risk ob/gyn in some cases. The transition from your RE back to your ob/gyne can create some anxiety. People who have had trouble conceiving or experienced miscarriages naturally have concern about the health of their baby throughout the pregnancy. You will not need to see you ob/gyne as frequently as you saw your RE. For some the extended period of not seeing a healthcare provider can be a bit frightening.
If you do make the transition from your RE back to your ob/gyne consider taking some time discussing any concerns you have about the change in frequency of visits. You may want to have the option of doing a phone call or at least initially being seen more than once a month which is a standard treatment time frame. Ask your ob/gyne about his/her suggestions about how to approach the transition in a way that will offer you some reassurance.
Remember to make time for yourself to enjoy your pregnancy. Don’t assume because you had health issues in the past that the same will be true for this pregnancy. A surprising number of people who get pregnant after infertility get so fearful about potential problems that might arise during their pregnancy. They don’t allow themselves to celebrate their pregnancy. Celebrate milestones and follow recommendations that your physician will make about how to maintain a healthy lifestyle and pregnancy.
Iris Waichler, MSW, LCSW, has a Master’s Degree in Social Work and has been a licensed clinical social worker for over 30 years. She has done workshops, individual, and group counseling with people experiencing infertility. Ms. Waichler is the author of the award winning Riding the Infertility Roller Coaster: A Guide to Educate and Inspire. She currently writes freelance infertility and health related articles.