After our first egg retrieval yielded zero embryos, Matt and I took a beat to assess our options. We discussed next steps with our doctor in the famed “WTF appointment”, and found ourselves frustrated when the few options that she shared did not align with our goals.
For example, she suggested we consider “mini IVF”, a protocol that uses a low dose of stimulation medication to intentionally retrieve fewer, but hopefully higher quality, eggs. With some back-of-the-napkin math, we realized it would be near impossible — or would at least take years — to retrieve the number of eggs that would hopefully yield sufficient embryos for the multiple children we wish to have.
It wasn’t that we didn’t trust her. We simply felt deep down that the options she shared couldn’t be our only options. We wanted to see what else was out there.
This combined with unclear expectations at the outset of our cycle and often inconsistent, slow, and impersonal communication from the nursing and financial office staff was enough to make us want a change.
We knew we needed to explore other options.
Have you ever caught yourself hesitating to ask your doctor a question because you don’t want them to think you’re doubting their expertise? Or avoided calling the clinic to check up on those results because you don’t want to be known as the pushy patient? Yeah, same.
This is where it gets sticky. I found I was nervous to tell my doctor that we wanted a second opinion. What helped me was this mindset shift:
Your IVF clinic and your doctor are at the center of your healthcare, but it’s just that — your care. You are paying for a service, and paying a premium at that. And it is nobody’s fault that not every doctor is a good fit for every patient. You deserve to seek out the best possible care for you.
An Exercise in Self-advocacy
Deciding to seek a second opinion was a moment of growth for me. This IVF journey has taught (forced?) me that I need to advocate for myself and my care, because no one in the clinic is going to do it for me. I am the one that knows the most about my unique situation; I need to speak up when I feel something is missing or unclear.
I am not sure that a younger version of me would have made the decision to step away from my first clinic when I knew it wasn’t right for me. I am proud of the person who made that decision, the person I’ve become.
When looking for our first doctor, I did virtually zero research. At the time, IVF was nowhere on our radar. We simply thought we would conduct a repeat HSG to confirm my scarring had been cleared by my hysteroscopy that took place before we moved to Los Angeles, then we would go on our merry way (turns out we were very wrong). I didn’t think we would be with that doctor long, so I didn’t invest in finding the right one for us.
This time around was different.
Research & Reviews
At this point, we knew that we would be with our next doctor for the long haul. We did our research and scoured provider reviews. The provider search on Fertility.IQ is an incredible tool that led us to our current doctor. It compiles scores for both doctor and clinic submitted by patients, as well as detailed narrative reviews. By reading about many patients’ positive reviews of my (now) doctor, I felt confident to move forward with a second opinion with him.
Importantly, I learned to deprioritize Society of Assisted Reproductive Technology (SART) scores in my decision-making. This may seem counterintuitive: SART compiles cycle success rates for clinics across the nation by age, diagnosis, and number of embryo transfers. Taken at face value, it seems like a great tool to assess clinics. But according to many doctors, including my fertility fairy godmother Dr. Natalie Crawford, “the data can be way behind, tough to understand, and often penalizes clinics who take ‘poor prognosis’ patients — this leads to many clinics cherry picking ‘best’ cases and turning others away.” The data can be skewed heavily by this, so approach with caution.
The First Meeting
I also came prepared to our first meeting with our prospective new doctor. I now knew what to listen for, what characteristics to look for in a provider (more on that below).
And thankfully, we were impressed. The doctor reviewed our files, asked us questions about our goals, and laid out what we could expect with incredible clarity: he shared that we would likely need three egg retrievals over the next 12 months to meet our goals of multiple children (turns out he was spot on). Importantly, he advised us that we should get started promptly but to “not cancel your vacations”. In other words, time was of the essence, but not to the point that we shouldn’t keep living our lives. This was some of the best advice we’ve received through this process.
We decided to move forward with transferring our care to his clinic.
Green Flags
When selecting your own provider for the first time, or considering a second (or third!) opinion, keep these concepts in mind.
Find someone you can relate to as a person, whose communication style resonates with you. Assume you’re going to be working with them frequently and for a long time.
Find someone you feel comfortable asking questions of and even pushing back on if needed. Bonus points if they encourage your questions and ideas.
On that note, look for someone who treats you as a partner in your care. You want someone who talks through their decision-making with you and doesn’t shut you down when you bring up ideas without listening first.
Find someone who personalizes your care for your unique situation. Remember that a first round of IVF is usually based on averages, but every round thereafter should be approached with personalization and care.
When to Look Elsewhere
Conversely, keep an eye out for these warning signs.
There is no discussion of changing protocol if a retrieval fails or performs significantly below established expectations.
They shut down your questions or make you feel less than for asking them.
Poor communication or feeling rushed through your appointments.
You feel pushed toward “hail mary” options when you feel it’s too soon. For example, you are told donor eggs or surrogacy are your only option before you have even discussed expectations for IVF with your own eggs. This is ultimately your decision about your family and you shouldn’t feel made to think that you don’t have options.
Lastly, you might simply want a fresh perspective on your situation. You can always go back to your first doctor.
Ultimately, your IVF care should feel like it is a service to you. If it doesn’t, you have the power to change it and get the care that you deserve.
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