Communicating with Physicians

  • EFFECTIVE COMMUNICATION WITH YOUR FERTILITY SPECIALIST, by Dr. Brian M. Berger
  • EFFECTIVE COMMUNICATION WITH YOUR MALE INFERTILITY DOCTOR, by Dr. Edward D. Kim

EFFECTIVE COMMUNICATION WITH YOUR FERTILITY SPECIALIST

Visiting a fertility specialist (reproductive endocrinologist) for an initial appointment can be a daunting task. Knowing what to expect and what to ask your doctor ahead of time will help to decrease stress/anxiety and also help ensure you get the most out of your visit.

First, it is important to know that you and your physician need to be a good “match”. Keep in mind, there are many doctors who are highly competent at what they do, but may not necessarily be a good fit for you.  The relationship that you have with your fertility specialist is unique and requires a close partnership with outstanding communication. This partnership goes beyond the experience, know-how, or even knowledge/intelligence of the physician. This is what some like to call the “art” of ART (Assisted Reproductive Technology), and while it defies definition, to paraphrase Supreme Court Justice Stewart, “you’ll know it when you see it”.

Many people are shy about asking questions, but you shouldn’t be. Your doctor wants to make sure you understand your diagnosis and treatment options too. And if you don’t understand the answers, don’t hesitate to ask your doctor to repeat them.

Before going for the initial appointment, make sure you know the answers to the following questions:

  1. How long you’ve been trying to conceive (remember, having unprotected intercourse, even if you’re not really “trying” to conceive, still counts)
  2. Your medical/family history, including any history of:
    • endometriosis
    • polycystic ovarian syndrome (PCOS)
    • sexually transmitted diseases
    • smoking
    • premature menopause
    • cancer treatment
    • surgery
    • medications

Based on the information you provide, your doctor should have a sense of whether or not you are at particular risk for having a fertility problem. You can then begin to discuss your potential testing and treatment options. Here are some of the things that should be covered by your fertility specialist:

  • Your individual risk factors for infertility and/or miscarriage
  • Specific tests to diagnose causes of infertility/miscarriage (male and female)
  • Cost for any of the tests involved
  • Timeline to diagnosis
  • Based on the results of those tests, possible treatment options
  • Communication during this whole process
  • Emotional counseling options offered by the clinic

Sometimes, it can help if you write everything down in advance. That includes medical histories and questions you want answered. I’m sure we’ve all left a doctor’s office only to remember a question we meant to ask but forgot! While being prepared with your previous history as well as questions about your treatment, it is also important to allow your doctor to ask questions and explain the work-up and treatment options completely; inopportune questions can have a deleterious effect by interrupting the flow of ideas or the clinician’s train of thought. If necessary, refer to your list at the end to make sure that all of your concerns were addressed.

To summarize, treating conception difficulties is not all about medicine. You’re in a very personal, often emotional phase of your life that involves making major time and possibly financial commitments. With the right approach, you can take control of your situation by working with your doctor to draw up a fertility plan together.

Dr. Brian M. Berger

by Brian M. Berger, MD

Director, South Shore Center, Boston IVF

Fertility Within Reach Patient Advisory Council Member

YouTube video of Brian M. Berger, MD

EFFECTIVE COMMUNICATION WITH YOUR MALE INFERTILITY DOCTOR

 

Infertility is a disease, defined by the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35 years.  A common misconception is that infertility is a woman’s problem.  However, a male factor may be contributory in to up to 50% of infertile couples.  Most commonly, urologists evaluate and treat conditions associated with male infertility.  If there is a significant abnormality identified on semen testing, request an evaluation with a male infertility specialist to determine if there is a correctable or reversible underlying cause.

The purpose of the male evaluation is to determine:

  1. Is there a problem with the male that is contributing to infertility?
  2. Are there any underlying causes for such abnormalities?
  3. Can any of these causes be treated?
  4. What method may be best for utilization of the available sperm?

Preparing for the Initial Visit:

-The initial consultation with a male infertility specialist can be more productive for you and your physician with these helpful hints:

  1. It is not uncommon to be nervous at the first visit.

Often times, men of reproductive age do not see doctors on a regular or annual basis and are not used to being in a physician’s office.  The sensitive nature of the issue at hand and concerns about the examination may contribute to the apprehension. This article will hopefully alleviate many of these concerns.

  1. Bring copy of any prior semen analyses and laboratory testing, if available, to your initial visit.

Many men will have prior semen analysis testing that is abnormal prior to referral to a male infertility specialist.  Your doctor will then be better able to direct further evaluation and treatment recommendations.  Don’t assume that all the testing has been faxed or sent prior to your visit.

  1. It is very helpful to have your spouse at the visits.

Your spouse can provide answers to many of the essential questions necessary for the evaluation of the infertile couple.  For example, who is her gynecologist?  Does she have normal menses?  What evaluation has she had performed?  What fertility medications has she used?

  1. Make sure the physician you are consulting with is comfortable with the evaluation of the subfertile male.

Urologists with fellowship training (advanced education beyond a urology residency) in male infertility will have a detailed knowledge of conditions that may be contributory to the infertile couple.  The availability of male infertility specialists varies considerably on a regional basis.  For many urologists, male infertility is an infrequent urological condition seen in daily practice.

-Common questions asked at the first visit include:

  1. How long have you been trying to initiate a pregnancy?  Do you have children?
  2. What type of contraception have you used, and how long have you stopped using this form of birth control?
  3. What type of prior evaluation have you had?
  4. What pertinent medical/family history is present?
    • Prior surgery/trauma to the scrotum or lower abdomen
    • Smoking and occupational/environmental toxin exposures
    • Use of testosterone therapies and other medications
    • Cancer treatments
    • Prior diagnosis of a varicocele

-The examination focuses on the penis and scrotum.  The doctor will carefully assess for

  • Testicular size and consistency
  • Status of the epididymis and vas deferens
  • Varicocele (dilated veins within scrotum)
  • Abnormalities of the penis
  • Virilization and general medical status

-Laboratory testing is typically initiated with 2-3 semen analyses and a serum (blood) testosterone and FSH level for hormonal evaluation.  Semen analyses should be obtained after 2-3 days abstinence.  Ideally, the semen analysis should be kept at body temperature and checked within an hour of collection.  The basic components of a semen analysis are

  • Sperm count/density   How many sperm are present per milliliter
  • Motility                          What percentage of the sperm are swimming
  • Forward progression   To what degree are the sperm moving forward
  • Morphology                   What percentage of the sperm are normally shaped

Treatments:

While a discussion of treatments is beyond the scope of this article, the key is the making the proper diagnosis.  For example, men with severely impaired sperm counts may have an underlying genetic abnormality.  In contrast, men with varicoceles may benefit from a minor outpatient procedure of surgical correction.  Men with no sperm in the ejaculate may benefit from the surgical expertise of the urologist in retrieving sperm.

Conclusions:

A visit to the male infertility specialist can be more rewarding and less stressful once the basic steps of an evaluation are understood.  These steps include a detailed history and physical examination, as well as semen analysis and hormonal testing.  These findings will guide further evaluation and therapy.

Dr. Edward D. Kim

By Edward D. Kim, MD

Past-President, Society for Male Reproduction and Urology

Professor, Division of Urology, University of Tennessee Graduate School of Medicine

Fertility Within Reach Medical Advisory Council Member