Maybe baby? Please?

November 17, 2011 3:31 PM

My partner and I have been trying for a while to conceive. We’ve used charting and ovulation predictors and, after six months, it’s not happening. I’m 38, he’s 37, and we want to get ourselves to a fertility clinic stat. Where we are, there are three to choose between. How do I make that choice?

We live in a remote area of Australia and our respective GPs are pretty useless. (GP: Have sex! Me: Uh... thanks. We'd thought of that actually.) We have no option to go to anyone else. Because there aren’t any other GPs here for us to change to.

There are no specialists where we live either – no IVF clinic, no reproductive endocrinologist, no gynaecologist, or, if we’re lucky enough to need one eventually, no obstetrician. All these things do exist about 400km away though. So it’ll be a 800km round-trip and leave from work for both of us to check these places out and then leave for me to go and get whatever treatment is needed. It’s doable, but I’d rather do as much research as possible over the phone before heading off.

But when I’m looking at information about the three clinics nearest to me, and phoning up to ask questions… what am I looking for? And what questions should I be asking? I'm stumped and so stressed about it I'm not really thinking clearly.

Added complication: I'd ask friends or family for referals, but I don't have either here.

Help. I'm quite stressed about making the right choice of clinic and, given our location, feel, well, pretty isolated.

posted by t0astie to health & fitness (15 answers total)

Do the clinics have literature or referrals you can look at?
posted by roomthreeseventeen at 3:35 PM on November 17, 2011

I'm not going to threadsit, but would just like to clarify: I'm asking for information on how to assess fertility clinics before I select one to go with, not advice generally about TTC. And yes, there is plenty of literature from all of them, but I don't know what I'm looking for in the literature!
posted by t0astie at 3:49 PM on November 17, 2011

Success rates? Can you speak directly to a medical professional on staff before making the appointment (rather than just the appointment-setter/receptionist)? Given the distance, how often would you be expected to come in (can you communicate via email or phone, for example)? Are there tests you could have run at the local doctor's, and then bring in, to make the best use of your time? Do they have a support group affiliated with the clinic, and can you speak with anyone in it? What about speaking to a past or current patient about their experiences with the clinic?
posted by Iris Gambol at 4:04 PM on November 17, 2011 [1 favorite]

I'm just a random pregnant woman (who had some challenges and dealt with some fertility doctors) in the US, but if I were you I'd be trying to get a phone consultation with a front-line provider of some sort at each of the clinics, even if all they'd give was five minutes with an intake nurse to ask some really basic questions.

Then I'd be asking essentially "What would you be looking for and doing first with a case like ours" and I'd go with the clinic who seemed most on the ball, willing to get started investigating before a year was up, and in line with my own feelings and philosophy. I'd google and look up papers to see if what they told me made basic sense and was evidence based.

Given the distance I think you have to push to talk to a human, even if only in very general terms before you make the trip, and I would be at least irritated by any clinic who didn't understand that.
posted by crabintheocean at 4:06 PM on November 17, 2011 [1 favorite]

then leave for me to go and get whatever treatment is needed

I think others can give you more all-encompassing answers, but one thing I'd guard against is making sure the clinic/doctor is focussed on both you and your partner, and that they don't assume it's definitely your physiology that's the cause. i really hope this isn't a problem anywhere...
posted by Tandem Affinity at 4:54 PM on November 17, 2011

I think the best thing you can do is talk to the physician(s) at each clinic. Ask them how they will go about deciding what treatment options to pursue. Ask how, at each step of the treatment, they will evaluate whether to switch to a more aggressive approach. At this point, go with your gut. Who do you feel most comfortable in terms of interpersonal interaction, aggressiveness of approach, and apparent competence?

You should also look at success rates for each clinic; these will probably be similar across the clinics, but if one looks exceptionally low, it might be a red flag.

As an additional note, the distance is possibly a real obstacle for you. Fertility treatments can require frequent visits from both partners over a period of weeks to months. You should make clear to the person who will managing your treatment exactly what your limitations are with regards to travel, and ask how they can best accomodate you.
posted by mr_roboto at 5:14 PM on November 17, 2011

Your location suggests you're in Port Douglas, is that not the case? If you are, then there are options in Cairns (many of them, although I'd be reluctant to deliver publicly at Cairns Base).
posted by coriolisdave at 5:25 PM on November 17, 2011

I have not been pregnant, but have had several friends who have ridden the TTC carousel.

After you check out whether it's a boy problem, girl problem or both (or neither), then you'll likely go ahead with various steps such as IUI and IVF. They are very different in terms of cost, comfort, hormonal stimulation, all that.

You should probably take stock of what you're willing to devote to this effort ahead of time. Then ask your prospective clinicians how they would walk you through this process.

How long/how many times would they try IUI (or another "first step") before they suggest moving on to IVF (or the next step)?

What IS their process?

How much would it cost, particularly in conjunction with how many cycles of Treatment A or Procedure B they'd recommend?

Let's say you need a surgical procedure such as removal of uterine polyps or having your ovaries "drilled" (sorry; that's how my friend described it). How would this clinic coordinate with the surgeons -- do they have the ability to perform these procedures themselves, could they coordinate with a local practitioner close to your home, or do they have relationships with specific practitioners they recommend?

What kind of treatment (injections, checkups, etc.) could be done in your home or with a clinician local to you? What would have to be done at the distant clinic itself?
posted by Madamina at 5:27 PM on November 17, 2011 [1 favorite]

Having dealt with doctors a lot (not for this, but other things) I would really encourage you to focus on how easy it is to get good, clear, helpful answers that make sense to you from the clinic staff. Chances are you're not going to be able to tell whether there's a magically awesome (or horrible) doctor at one or another of these places without being under their care. But you can absolutely tell if the overall operation is competent or not, and it matters a lot.

One of my doctor's offices is truly, legendarily terrible (as in, I've had providers I've never met before waxing poetic about how hard it is to get through to someone worth talking to, and people will email and text one doctor there, asking them to pass along a message to another doctor there, rather than trying to do it through the front desk.) From the very first phone call I made to this place it was quite clear: they put me on hold for ten minutes, they hung up on me, they took information down wrong, they didn't do what they promised they'd do, etc. It almost doesn't matter that the doctors are pretty good at what they do.

And unfortunately, in my (current - last contact was eight days ago, last major service failure was nine days ago) experience, the more rare a specialty medical service is, the more in-demand and overworked everyone is, and the more likely it is that spectacularly awful practices will be able to survive in their wretched, deplorable state.

(Also see if they've got clients who are willing to talk about their experience. It's a long shot due to the sensitive nature of the service, but it's possible. My best information about doctors has always come directly from their recent patients. You might look and see if there's a message board or email list that's for people with fertility complications in your region, actually.)
posted by SMPA at 5:28 PM on November 17, 2011

Some clinics supply success data; in the US thesis required. I don't know about AU.

I would ask them how many patients they see a year and how many procedures (IVF, IUI, etc.) they do weekly. You may be more comfortable with a smaller practice that can give you more individual attention or a larger practice that is more experienced.
posted by bq at 5:39 PM on November 17, 2011

Do be careful making a decision based just or mostly on success rates - there are ways clinics can manipulate them, like turning down cases they think will be tougher, or deliberately funneling single and lesbian or bisexual women into more interventions than are needed (ie clinic raises success rates for IVF by encouraging women who don't have fertility problems beyond access to sperm to try it first).

Not that you shouldn't find out everything you can, of course, but it's worth mentioning. If I were you my priority would probably be a clinic that would work with the distance issues and help you find ways to do some stuff locally or otherwise minimize the time and expense of traveling.
posted by crabintheocean at 6:41 PM on November 17, 2011

I found this site Access Australia and they have a list of infertility counsellors divided by geographic area. Perhaps they could be of help?
posted by treehorn+bunny at 7:04 PM on November 17, 2011

In addition to getting them on the phone for a short pre-consult, I'd see which ones would deal with me from afar: can they use my local GP and lab for anything? Can they use email or Skype for consultations if there is no medical/blood work to be done?

You should find some parenting or conceiving forums in Australia. I have no idea if they're good or if there are weird politics behind them but here are two:
- BubHub fertility assistance forum (there's another one for TTC in general)
- IVF Forum Australia - looks like you have to register
- BabyBelly - here's a forum for IVF Fertility Specialist/Centre recommendations. Again there are other TTC and IVF forums here.

Do any of these fertility assistance organizations have a list of recommended doctors or clinics?
posted by barnone at 7:37 PM on November 17, 2011

From IVF - Fertility: How to choose an IVF Centre?

Assisted Fertility forum at Essential Baby Australia - it looks fairly active.
posted by barnone at 7:41 PM on November 17, 2011

Thank you so much everyone, these are fantastic answers. I feel so much better prepared and so much less alone. Thanks too Tandem Affinity for reminding me it might be my partner who needs treatment.
posted by t0astie at 11:27 PM on November 17, 2011