Medical Contribution By Dr. Eric Levens
Every month you wait for that first, earliest day you can take a home pregnancy test. With every negative result, you feel disappointment and often, it grows as the months tick by. Finally, you accept what those pee sticks are telling you and say: “We need some help.”
You may start by going to see your OB/GYN, or maybe go straight to a fertility specialist. At the doctor’s office you learn that there are several treatment options that may help you. You begin to get excited again about the prospect of having a baby, and you prepare yourself for the treatment process to come.
This is the first of several transitions that most couples in fertility treatment go through. Other common transitions include: making adjustments to your treatment protocol after an unsuccessful cycle and deciding to move on to a different treatment if the original plan didn’t work. Each of these transitions can be challenging in their own way.
Dr. Eric Levens of Shady Grove Fertility’s Annandale, VA office believes that patients facing these changes need both information and support. With the right elements in place, he says patients can effectively manage transitions and maintain a positive, hopeful attitude throughout treatment.
Transitioning Between Doctors
Leaving your ob/gyn to consult a fertility specialist can be hard. In many cases, you have developed a trusted rapport with that physician and the idea of talking about an issue as personal as fertility with a stranger can be daunting. Dr. Levens suggests that staying focused on your goal can help.
“Fertility specialists can provide a greater array of treatments and can better tailor treatment to your individual response,” Dr. Levens explains. “So, even though it’s hard to start with a new person, keep in mind that we can probably get you to your goal of pregnancy faster.”
Often patients begin treatment with their OB/GYN using medications like Clomid and are unsure of when to stop trying that method and seek additional help.
Dr. Levens says, “Up through cycles three and four using Clomid, your chances of getting pregnant are increasing. But once you get into four to five cycles, the chances start to go down.”
He cautions that patients may have additional fertility issues that have not been diagnosed that are preventing the Clomid treatment from working.
“For patients who have done three unsuccessful cycles of Clomid, who have ovulated during those three cycles, my advice is to come see us for an thorough evaluation,” says Dr. Levens.
Once You’re in the Door
Many couples are apprehensive about seeing a fertility specialist because they feel that once they step through that door, they will be on an express train to IVF. Dr. Levens understands.
“It’s a common misperception that all patients in fertility centers are doing IVF,” he says. “However, there are other, more simple treatments you may try first. My philosophy is: have a thorough evaluation and know what your options are. That way, you can make the most informed decision possible.”
Patients also fear that they will be pressured into doing treatment right away even though they may not feel ready for it. Dr. Levens says his approach to this issue is shared by the other physicians at Shady Grove Fertility.
“We know that fertility treatments are a significant personal and financial undertaking for most patients, especially those who don’t have insurance coverage for treatment. Our job is to do what’s right for the individual couple, to inform them of the pros and cons of their treatment options, provide them with success rates, and discuss the time and emotional commitment to treatment so they can make the best decision for their family.”
Dr. Levens says that most patients find the initial consultation and diagnostic testing to be much less scary than they imagined. “My patients often say, ‘I wish I had come sooner.'”
Once a patient starts treatment, there may be changes made along the way – both during a treatment cycle and when beginning a subsequent cycle.
“Sometimes patients are anxious about changes we are making to their medications within a cycle or from one cycle to the next,” Dr. Levens explains. “What we’re doing is reacting to the results we get from blood work and ultrasounds about how an individual is responding to treatment, so we can get the best possible outcome.”
Patients can be equally confused when there are no changes made to their protocol after an unsuccessful cycle.
“Sometimes a patient responds beautifully to medication and has a very good cycle, but it still doesn’t result in a pregnancy. In this case, we would probably not make any changes and simply initiate another cycle. Patients should know that this is good. It means the treatment plan is on target. We just need to try again.”
He adds, “Fertility treatment can encompass the highest of highs and lowest of lows. Our advice to patients is to temper expectations because it may take more than one treatment type to reach your goal, but maintain hope because there is great reason to be hopeful.”
Moving to a New Treatment
Just as it was difficult to move from trying to conceive on your own to working with a fertility specialist, it can be difficult for patients to decide when to move to a new treatment plan. Dr. Levens explains that his suggestions, like all the doctors at Shady Grove Fertility, are based on data.
“We’re looking at the data about the success of treatment over time and with patients of different ages,” he says. “Just as with Clomid, we know that once we reach the fourth and fifth cycle of IUI, the chances of pregnancy are starting to diminish. That’s when we normally suggest the couple think about moving on to IVF.”
Age is an important factor in this decision. Dr. Levens says, “We have to remember that, as humans, we have a limited window for fertility. The older a patient is, the sooner we would suggest moving on to other treatments like IVF or even Donor Egg.”
Dr. Levens says that donor egg treatment is usually recommended with patients who have factors such as advanced age or poor egg quality, and can take longer to transition to than any other treatment type. He explains, “Transitioning to donor egg is very personal for a couple. I will always do my best to give the couple the best information I can, but I understand that there are many factors including cost, uncertainty about success, and the time and emotional commitment required to undergo treatment.”
Another factor to consider is the psychological toll that multiple unsuccessful treatments can take on patients. “We often talk about the ‘time to pregnancy’ as a factor in treatment. We want to get patients to their goal of having a baby with as few treatment cycles as possible, so that they don’t become exhausted by the process and feel they are spinning their wheels,” says Dr. Levens.
Getting Support for Transitions
Most of us know by now that the vast amount of information on the Internet can be both a blessing and a curse. Still, we frequently turn to the web for information and to read the first-person accounts of those who have gone through treatment. Dr. Levens cautions his patients about comparing themselves too closely to the patient accounts they read online.
“This is not a one size fits all situation. So much of the detail people read online is out of context of that particular patient’s history. It’s common for patients to tell me they read about a procedure and they are very anxious about it and once its over, they can’t believe how simple it was. Sometimes Internet research can cause a lot of anxiety and can even be a barrier to treatment.”
On the other hand, Dr. Levens believes that the support patients can give one other online can be tremendously helpful. “There is so much value in social media, in the connectedness that it provides. It’s important and comforting for patients to know that they’re not the only ones going through this. They can learn a lot from other, similar patients.”
Shady Grove Fertility Center offers support both on- and off-line. There are a number of support groups for patients as well as extensive online resources including webcasts where viewers can ask questions. Recently, use of the Shady Grove Fertility Facebook page has taken off and the community of users has become another great source of support and information for patients.
The right support system can help patients make smoother transitions, but Dr. Levens also stresses the importance of your relationship with your doctor, “Find someone who can provide compassionate care and listen to your concerns. A good physician will give you the information you need and let you make the decisions that are best for you.”