where to go for fertility evaluation if ivf is not for us?

[Anonymous]

My husband and I have TTC'd for several multi-month stretches over the last two years without success. At this point, we are thinking it would be a good idea to have some fertility evaluations done, however we agree (for now) that we do not want to go down the IVF path, for our own personal reasons. We are more interested in having the tests and addressing any underlying issues that may be getting in the way of conceiving naturally. I'm thinking screening for yeast and low-grade bacterial infections, asymptomatic endometriosis or fibroids, hormone level testing, semen analysis, etc.

For those of you with some experience dealing with doctors and practices in this area, do you think it would be best to start with a regular GYN for me and a urologist for my husband, or would it be better to go straight to an RE? Has anyone found an RE in the area who routinely does this kind of thorough work-up, or do they just push for the ART procedures? Would I be better off with an RE's office that is used to setting up appointments timed to various parts of a patient's cycle, or would an OB/GYN be better because s/he would have no attachment to our following through with ART? I'll note here, also, that I've had a hard time finding a GYN I like since moving to this area, so I'd be open to rec's in DC or Arlington.

Thanks in advance for sharing your thoughts.

[Anonymous]

I'd go to an RE and just be honest about what you are looking for. I know several of the RE's I saw mentioned adoption as a possible 'treatment" option, so they do realize that IVF isn't for everyone.

I really liked Dr Frankfurter at GW for his bedside manner. I chose not to do IVF there, but for an evaluation, I think he's great.

[Anonymous]

Would not go through an OB/GYN -their knowledge of fertility issues is typically pretty limited.

Sacks or Rifka at Columbia Fertility will do a workup.

Noone will even mention IVF (at least in my experience there) until they have a better idea of what is or isn't going on.

[Anonymous]

Anonymous wrote:Would not go through an OB/GYN -their knowledge of fertility issues is typically pretty limited.

Sacks or Rifka at Columbia Fertility will do a workup.

Noone will even mention IVF (at least in my experience there) until they have a better idea of what is or isn't going on.

Agree with this. I went to Rifka and he didn't want to try anything before doing an evaluation (of both me and my husband) and after that he did recommend treatment, but not IVF. Just injectable drugs and old fashioned hanky-panky (which worked.)

[Anonymous]

Go to an RE, not an OB, and get a basic fertility workup. All REs do this before discussing any kind of treatment options

This consists of:

1. bloodwork and ultrasound for you on day 3 of your cycle - b/w will check hormone levels, and u/s will check your ovaries to see how many follicles you have (AFC, antral follicle count)

2. semen analysis for your husband

3. HSG test for you - to check that your tubes and uterus are clear & free of abnormalities

Depending on those results, you can make decisions with your doctor on how to move forward. If you are opposed to IVF, just let them know that up front. There are other options.

[Anonymous]

Another vote to see an RE. An OB/Gyn won't be able to evaluate all the pieces, and doing it half-way will likely waste a bunch of time.

We did our initial testing and evaluation with Dr Gordon at Dominion Fertility. He communicated well at every stage -- helped us understand our results and our options.

At no point did we feel pressured to do IVF (Natural Cycle or Regular). He's fluent in all the other possibilities and did not "hard sell" IVF in any way.

Overall, I've had a great experience with Dominion. Highly recommend.

[Anonymous]

And yet another vote for an RE... OBs seem really in the dark about fertility (understandably-- it's not their speciality) and sometimes it seems aren't as upfront about this as would be helpful.

An RE's job includes diagnosing and treating infertility... I think it's perfectly legit (and probably very common) to go with the diagnosis and not the suggested treatment (which by the way may or may not include IVF).

But what about yeast and fertility? Can you explain more?

[Anonymous]

I'm not going to recommend or not recommend anything, but just wanted to share my story. We saw Dr. Gindoff, who did several IUIs with us, but in the end, told us that we would need to do IVF. Fair enough. However, even after we repeatedly told him we were not interested in IVF and would instead happily adopt, we felt he pushed IVF numerous times. I understand he's in the business of getting women pregnant, but definitely felt the hard sell of IVF.

[Anonymous]

I'd appreciate hearing mroe about low-grade infections and the yeast connection.

[Anonymous]

OP here - thanks so much for all the helpful input; looks like an RE is clearly the place to start.

Regarding infections and infertility, the book Making Babies, written by an RE and an acupuncturist, describes how the presence of low-grade or unrecognized bacterial and yeast infections can interfere with fertility by damaging sperm or inhibiting motility as well as by causing problems in the female reproductive system. Their references are listed here: http://www.makingbabiesprogram.com/resources.html
Scroll down almost to the bottom and look under "Chapter 16."

I've seen yeast mentioned in several places as a contributing factor to hormonal imbalances and endometriosis (not to mention fatigue and nutrient malabsorption), but am still searching for the research. I did find one study suggesting that it inhibits sperm motility: http://www.ncbi.nlm.nih.gov/pubmed/335090

Hope this is helpful

[Anonymous]

I think Dr Sacks at Columbia Fertility Associates would be a good choice for this. I did a lot of cycles with him over a 2 year period and he never pushed IVF.

[Anonymous]

My DH and I are at Dominion and we just finished the evaluation stage, like you we do not want IVF and the RE, Dr. Reh hasn't pushed it. She takes a lot of time answering questions and we feel confident moving forward with IUI.

[Anonymous]

I am seeing an RE at Shady Grove and we are NOT pursuing IVF. We are in the middle of a full workup (bloodwork, ultrasounds, etc) and then our treatment plan begins with IUIs and ends with donor sperm (due to our specific issue). We have not faced any IVF pressure, at least yet. So I guess I am another vote for - see an RE to get a work up, and it shouldn't be an issue, at least initially, that you don't want IVF. Though you may learn in the process that IVF is the best option, but you can cross that bridge when you get there.

[Anonymous]

Anonymous wrote:I think Dr Sacks at Columbia Fertility Associates would be a good choice for this. I did a lot of cycles with him over a 2 year period and he never pushed IVF.

As for RE vs. GYN, definitely RE. I went to a GYN for a few months and I really wish I had that time back to spend on therapies that could actually help. My gyn really didn't know anything more than the basics, the lab for the semen analysis was terrible (and that can mess up the analysis) and she didn't monitor me, so we didn't know if anything was working or if ovulation was occurring. It was very unhelpful.

I am now going to Dr. Sacks and I think he's wonderful. He hasn't once mentioned IVF and hasn't even mentioned IUI. My husband and I have gotten full "work ups" and I have a diagnosis (PCOS) and he started me out on a basic clomid/HcG trigger cycle. Now that that isn't working, we're moving towards injectibles, but he still hasn't mentioned any ART. We made it clear at our first meeting that we weren't sure we wanted to do IVF and would weigh that with adoption before making any decisions, but so far it hasn't come up. We've been TTC for 15months.

[Anonymous]

I initially saw Dr. Gindoff at GW, who totally pushed IVF before he even read my history. IAgree with 15:33 above!) Even though we were open to IVF, I thought it was putting the cart before the horse.

Next, went to Dr. Nair at SGF (K Street) and was/am very happy; she outlined a thorough workup. After each set of tests, she explained how this or that ruled things out. For us, IVF was a last resort and she really exhausted every last viable alternative before IVF, including a referral to a perinatologist. That was the key. Her entire approach was about helping me have a healthy pregnancy; not just getting another patient in SG's IVF program.