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| |    The Fertility Work-Up by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. Going to the doctor for infertility is often emotionally difficult. Couples are faced with layers of implications that can be distressing. Some people find themselves wondering, Does being infertile mean I am less of a woman (or man) if I can't get pregnant (or get my partner pregnant)? Will the joys of sex turn into the job of sex? What will this do to our relationship? What tests will I have to endure? Will they hurt? How much invasion can I tolerate? And, of course, there are worries about how much the treatments will cost, the risks involved, and perhaps the greatest fear of all: What if nothing works? Coping with fertility evaluation and treatment Good communication, mutual respect between partners, and emotional support from the fertility team--as well as from friends and family--can help. But almost everyone who goes through infertility treatment finds it stressful. While the normal anxiety that people experience during fertility treatment doesn't seem to affect a couple's chances of becoming pregnant, severe emotional distress and depression can interfere with conception. Part of your job during this process is to monitor your own tolerance and to pace the evaluation so that you can handle it--even if it means taking time off from treatment periodically. For more information, or to find a support group near you, check out the website of the national fertility support group RESOLVE at www.resolve.org. What tests will be done? It's a good idea for both partners to participate in the first fertility visit. You will be asked to provide your medical histories and your family histories, and the woman may have a physical examination. Each doctor then proceeds through the fertility evaluation with slightly different priorities. Some of these variations may be rooted in the physician's beliefs and preferences; some may be based on his clinical judgment of the likelihood of different causes of infertility for the particular couple. Your gynecologist is usually the first stop for fertility evaluation. Most general OB-GYNs can do the first round of testing for fertility problems and can initiate treatment for many conditions. Fertility specialists, or reproductive endocrinologists, handle more complicated fertility problems and typically step in to assist couples in becoming pregnant if no specific cause of infertility has been found. Initial testing usually runs through two menstrual cycles. The tests assess a number of factors: ovulation, quantity and quality of sperm, whether there are barriers to the sperm reaching the egg, how well the sperm can fertilize the egg, and if there is adequate hormonal support for the early embryo. Each of the available tests checks out some aspect of this list. The results also tell the doctor which fertility treatments would be a waste of time, money, and effort and which are most likely to work. Our articles on infertility provide basic background information, but you should feel comfortable enough to ask lots of questions of the doctors and nurses as you experience your own emotional and physical ups and down of fertility testing and treatment. Financial costs Many insurance companies don't provide coverage for fertility treatments, which are quite expensive, so be sure to find out what is and isn't covered by your medical plan before you see a doctor for infertility. The good news is that there is a trend for states to require that health insurance cover at least some part of fertility treatment. Currently this includes (or will include in the near future) Illinois, Massachusetts, New York, New Jersey, Maryland, and Rhode Island. Read through the booklets that you received when you signed up, or call the company and ask about what's covered. Once the initial testing is done, your doctor will discuss treatment alternatives with you. Often you must choose between less expensive tests that have some chance of success and more expensive options that are more likely to succeed. Some couples choose a stepwise approach, working their way through a series of less costly methods in the hopes that one will work, while others go right to the most effective treatment. You and your doctor can decide what's best for your specific medical and financial situation.
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