Seeking fertility services is a sensitive process for many people, and there are many things that we have learned from our patients since our practice’s founding in 1998. Our services and methodology have grown to better meet the standards of quality, efficiency, and honesty that our patients deserve.
Of course we need not only be competent, but actually better than average. It is only fair to expect us to be the best and to always aim for excellence. If we are keeping up to date and if we strive for excellence, it is a natural consequence that we will always have outstanding success rates. Practices that are average are just as close to the worst ones as they are to the best ones!
It is not unreasonable to expect that your caretakers have completed their training at approved Fellowships in Reproductive Medicine. At ACRM, not only has our medical and laboratory staff carried out their training at some of the finest institutions in the country, but we're also committed to continuing our education and training in any way possible. We attend the leading conferences in our field, participate in the national organizations, and even pay for our nursing staff to attend conferences in order to ensure that our patients will always receive the very best care available.
An infertility specialist needs to be able to provide state-of-the-art therapies. What was adequate therapy 5 years ago is probably not acceptable today. This field is changing so quickly that it is important that you receive the latest and most advanced treatments available because they will make a difference in outcome. Your physician should be able to review with you all the latest developments in the field and thoughtfully evaluate what's important and what's not. As a CCRM Network member, ACRM’s patients have access to ground-breaking technology and on-going research in the field of reproductive technology.
It is absolutely reasonable for you to expect to be seen by your physician. After all, that's what you're paying for! While it is sometimes appropriate to be seen by ancillary personnel, you should feel comfortable that your physician is on top of your case and will make themselves available. It is too easy to fall through the cracks and get lost in a system where the patient doesn't have access to her physician. Phone calls should be answered the same day—the next day at the latest in non-emergent situations. At ACRM our physicians are directly involved in all phases of treatment.
Without research, there would be no progress in medicine. It is imperative that we try new approaches in medicine. However, if a patient is being treated in an experimental fashion, that should be made quite clear to the couple. Furthermore, it is inappropriate to not make patients aware of the current success rates with these treatments. It is unethical to make a patient and/or their insurance company pay for experimental procedures used for research. Research funding exists for this very reason.
It's hard to say to someone that what we're doing is not working. The medical literature clearly shows that our therapies are successful quickly if they are going to work at all. If a couple has not been successful within a reasonable time frame, it is important to reassess and probably change approaches. Prolonged treatment with the same approaches may mean that no one is critically reviewing the data and it’s possible that your physician is attempting to take advantage of the situation.
Your physician must project out a reasonable and appropriate treatment plan. We find that patients are most comfortable when they know what we will be doing over the next 3-6 months. Your physician should make sure you understand your diagnosis and treatment plan. While it can be difficult to understand everything related to reproductive medicine without training, your physician should at least be able to make sure you know what the problem is and what the treatment approach will be and why.
Patients have repeatedly told us that they want to hear the truth. If a procedure is painful, say so. If something is expensive, don't hide it. It is unfair to say that a cycle of gonadotropin ovulation induction costs $1500-2000. The medications may cost that, but in order to carry out the cycle the patient will need ultrasounds, blood tests, and so on. The cycle as a whole may end up costing $4000. You have a right to know exactly what you’re committing to.
In order for a couple to make a decision regarding a given treatment, they must know the likelihood of success. A given amount of time, effort, and money may be worthwhile for a 60% likelihood of success but not for a 5% likelihood. It is in everyone's best interest that we provide a true assessment of the chances for success. Furthermore, we should always provide an estimate of the desired end-point, which is a healthy baby. Focusing on fertilization rates, pregnancies per transfer, and other assessments, which ultimately are not important to the couple, is misleading. To make an educated decision, a couple needs to know what is the chance that a given therapy will lead to a baby.
Unfortunately, there will be some couples who will not be able to get pregnant. As physicians, we are trained to always think of what we will do next. In reproduction, however, there are scenarios for which there isn't a next step. If a woman no longer has good quality eggs as a consequence of age, none of our therapies with her eggs will be successful at changing that reality. Although it is tempting to just repeat another cycle of treatment, we have a duty to inform our patients when the further treatments are not likely to succeed.
Our patients have told us that they would rather know up front if they aren't going to be successful. No one should invest their time, money, and emotional energy into a futile process. It is never pleasant or easy to deliver bad news, but it is our obligation sometimes and it is the only ethical way to practice medicine. Even if a couple is unable to get pregnant on their own, we may recommend using an egg donor for the process or refer them to an adoption agency.