How to get a second opinion on your infertility problem

Are you getting the best possible Infertility treatment from your doctor? Changing your infertility doctor is often a challenging task due to the rapport that is already developed with the current doctor. But often, getting a second opinion is recommended and here are some useful tips to evaluate the service you are getting and how to shift to a more efficient solution.

How to get a second opinion on your infertility problem

A common problem we have seen is that many infertile patients are very reluctant to change doctors, even when they are unhappy with their present doctor. Often this is because they prefer being passive and refuse to take matters in their own hands - "better the known devil than the unknown one". Some feel that their present doctor knows all their medical details, even though he may not be very competent, and they do not want to take the time and trouble to explain their problem all over again to a new doctor. They often don't even have copies of their medical tests and treatments, because many doctors refuse to give these to patients, so as to "hold on" to their patients. Unfortunately, this passive attitude means that you are depriving yourself of getting the best medical care, and reducing your chances of conceiving.

Here are two simple things you can do to empower yourself.

1. Make sure you keep notes of everything you have been through. While the doctor may have your medical records, you can keep a set of your own. You will find the Dr Malpani Treatment Cycle Chart very helpful - just keep one for each treatment cycle, and file them in reverse chronologic order. It's good idea to summarise your treatment cycles on a single page of paper, so it's easy for you to review.
2. You can get a free second opinion from me by filling up the second opinion form. This form acts as an excellent gauge for how well-informed you are about your treatment, and your options. If you cannot understand the terms, or find that you cannot fill up the form properly, this means you need to do more homework !

When to Change Doctors

Changing doctors is never easy, because, over a period of time you do build up a personal relationship with your doctor. However, you should consider changing doctors if you feel that :

• The doctor is incompetent (i.e., he has ignored obvious symptoms, missed a diagnosis, prescribed the wrong drug, or can't get to the bottom of your problem);
• The doctor does not communicate with you effectively (i.e., his explanations are not in lay person's language or no time is given to you to ask questions and bring up related problems);
• The doctor does not pay attention to your needs and concerns;
• You have lost confidence in the doctor's skill and ability.
• You find the doctor is too inconsiderate (i.e., he makes you wait a long time for an appointment, he fails to return your phone calls, he does not provide clinic time during evening or weekend hours); and
• Your doctor is too expensive.

Many patients are worried that if they go to a new doctor, he will insist on repeating all the tests all over again. While this can be frustrating and expensive, it can be helpful as well, because it allows the doctor to reassess your problem with a fresh perspective. Please ask your doctor to explain why he needs to repeat the tests, and how this will help in your treatment. If tests have already been done, but are more than a year old, or if they have been done from an unreliable lab, you may need to repeat some of these again.

When you change doctors, ask your old doctor for a copy of your medical records - remember that your medical records are your property, and you are entitled to a copy of them - you may have to assert yourself to get your rights !

You may find that your new doctor criticises the treatment your previous doctor provided. Remember that doctors do have big egos, and they are often intensely competitive and critical of each other. This can upset you, because you may start feeling that you were given substandard medical care. As long as you have a clear understanding of what was done to you and why, you should ignore this criticism - don't let it disturb you. Anyone can be wise with hindsight - and do remember that all doctors will try to do their best to help you to get pregnant!

Many doctors will repeat exactly the same treatment the previous doctor has administered - often because they have nothing better to offer! However, remember that even though you have changed your doctor, you have remained the same - and the purpose of changing doctors should be to allow you to progress further with your treatment.

Get a second opinion - this can never hurt and is always helpful. If you find two experts saying the same thing then you know you are on the right track! If, on the other hand, they disagree, don't get upset - there are few black and white areas in infertility, and doctors often have different ways of treating a particular problem. Ask questions of both of them and then choose the method which appeals to you - it's finally your decision!

What if you don't understand what the doctor is saying and are getting confused? This is not your fault. If you do not understand anything the doctor says - ask questions! If you still do not understand the fault is his - he is not explaining in terms which you can follow. Find another doctor!

Remember that you need to ask questions to get answers - your doctor cannot read your mind! But also remember that your doctor does not have all the answers - after all, medicine is still an imperfect science, and your doctor is not a fortune-teller. If he does not know the answer, he should tell you this as well.

How do we do a consultation in our practice? We first ask the couple why they think they have not been able to conceive, and how they expect us to be able to help them. The answers give us a good idea of how much the couple understands about their problem. It's often heartbreaking when we see couples who have been through 3 In Vitro Fertilization cycles, and don't even know how many eggs they grew or how many embryos were transferred each time - or even why the IVF was done in the first place. During a consultation, we first explain, using models, how babies are made.

We then review the medical records, and explain to the patient what we feel their medical problem is. We then explain to them what the treatment options are, and tell them to think about these and then make up their mind. In our clinic, we do not charge for a repeat consultation, in order to encourage patients to ask questions, and to give them time to make up their own mind. We take pride in the fact that our patients have a good understanding of their medical problem, and realistic expectations of how we can help them!

Remember that the purpose of a consultation is to get information. If you do your homework before going, you will be able to make better use of your doctor's time, since you can focus on the issues which are important to you. You then need to go home and process this information, so you can decide what to do. It's very difficult to think straight when you are sitting in front of the doctor, so it's usually a good idea to give yourself enough time to apply your mind and assimilate the information, before making a decision. There is usually no urgency, since infertility treatment is never an emergency. Beware of a doctor who wants you to decide on the spot - it's hard to do so under pressure, and you may end up making a decision in haste, which you may then repent at leisure.