Silly Question - How to explain you need an appointment for a "second (or third) opinion?"

[Anonymous]

By way of background, I'm 34 and have one healthy child, who was conceived one month we were not preventing (not even trying). Now, we want a second and have been TTC for a year. I have undergone bloodwork, post-coital test, endometrial biopsy, HSG, and ultrasound with my OBGYN, and my DH had a sperm analysis with a urologist, all of which have been normal. He has recommended a laparoscopy as my next step. Before doing that, I wanted a second opinion. So, proceeding on the advice of many posts from the archives, and based on insurance issues and location, I went to see Dr. Widra at Shady Grove. When I made the appointment I asked for a 'consultation.' I went in there and after he reviewed my test results (although seemingly NOT my doctor's notes regarding proposed next step of the lap) he leapt directly into what protocol they would recommend (clomid + ovidrel + IUI) after , etc. I stopped him and noted the recommendation I'd received and he rejected it, saying it would be 'bad medicine' to operate on someone who had no symptoms of endometriosis, that it wouldn't help with conception if they did find something and 'fix' it anyway, and that instead I should do what he said. I know that I was headed for receipt of conflicting information, but left there feeling a bit like he had looked at my stuff, made up his mind, and the questions I asked threw him for a loop.

I am wondering if part of the problem is that he thought I came in for advice on how he could get me pregnant the fastest, not on whether the advice I had received from another doctor was right. When I've tried to make appointments for second opinions in other specialties, I've called and said I wanted a 'second opinion,' and have been told the doctors did not see patients for that purpose. That is why I asked for a "consultation" when I called Shady Grove. So, my question is, for those of you who have sought out second (or third, or fourth) opinions in the infertility area, how have you done it? Have you just said what you wanted and successfully gotten an appointment? I feel so silly to be asking this question, but as many of you probably know it's hard even to pick up the phone to make these calls sometimes, and I really can't take the prospect of another doctor breezing past the reason why I'm there and leaping right to actual treatment without so much as a discussion.

[Anonymous]

I've never had a doctor tell me he won't give me a second opinion. Having said that, I'm pretty sure I never used those words while making the appt.

Just call and say you have been TTC for more than a year and want to make an appointment with the doctor. You can try for just a "consultation" but most doctors will want to examine you themselves - not just analyze your records.

More importantly, I think Dr. Widra is right. Why in the world would you need a lap in your case???

I highly recommend you visit www.resolve.org and post your question there - there are thousands and thousands of women there who could answer the lap issue. I am very surprised that a doctor would recommend surgery over clomid when nothing seems to indicate you need the surgery.

Also, by way of disclosure, I went through TTC for five years. I wasted a lot of time with my OB, who loved spacing out my diagnostic tests, and who had me chart my temps for years. He mentioned once that I could have a lap, but then pointed out that it was invasive surgery and there seemed to be no reason to do it - and then he released me to Shady Grove. Three months later I was pregnant. No surgery necessary. And I got pregnant on my own the second time - I now have two kids.

[Anonymous]

My thoughts on a lap. I think the general thinking these days is that even if you find something in a lap, it's not likely to change the course of treatment anyway. That said, my ob/gyn did a lap and found a polyp, which he removed, and 4 months later I was pregnant (on SG's clomid/iui protocol). So who knows? I think you just need to be clearer with your next "second opinion" right at the beginning of the meeting. Otherwise, they're usually pretty much on autopilot, assuming everyone wants to get pregnant ASAP and might not be that concerned about what is causing their issues.

[Anonymous]

I think you did get an opinion from Dr. Widra in that he didn't just say "IUI plus clomid and ovridrel is my rec. now goodbye" but he did give his opinion that a laparoscopy was unwarrented and he gave you reasons why. I don't understand how this wasn't a second opinion? Perhaps you only wanted a second opinion that agreed with the Ob/gyn? I'm confused.

It seems like Laparoscopy has fallen out of vogue in general with the RE community. It is invasive (and can have complications) and doesn't show increased pregnancy rates. Dr. Widra's job is to get you pregnant and he wants to do it in a way that has the least amount of potential complications. From my reading, it's only ob/gyns that do laproscopies anymore and very few of them at that.

[Anonymous]

OP here -

Thanks for the responses. Let me clarify, it wasn't that I feel I didn't get a second opinion from Dr. Widra, just that I left wondering whether the fact that it hadn't been clear when I walked in there that a second opinion was what I needed had colored his analysis. From what you all say, what he said substantively sounds like it is accurate. My husband wants me to get another opinion because he too felt like Dr. Widra hadn't really understood why we were there and thought it might have influenced the answer to the question we were really there to get - did it make sense for me to have a lap.

You're all probably right, that it's my fault for not making it clear when he walked in and introduced himself, but as those of you who've seen him might have experienced his manner seems just to jump right in and I felt weird interrupting him. Guess I have to get over that, particularly if in the end he is going to be my doctor!

[Anonymous]

PS: OP here again -- Dr. Widra did NOT examine me himself - reviewed the reports I had from my doctor and went on to diagnose me with secondary infertility and possible ovulatory dysfunction. That could be b/c I had just had all of the testing done and there is no reason to repeat some of the stuff, but that he didn't even suggest any further tests also made me a little bit weary. Now, I certainly don't want to have another HSG for the heck of it or further delay this process, but I was a little thrown off by that too.

[Anonymous]

that he didn't even suggest any further tests also made me a little bit weary.

If you've had an hsg, cycle day 3 bloodwork and your husband has had a sperm analysis then you've pretty much had all the tests. Repeating any of them wouldn't make sense if you had them all within the year.

Unfortunately, a lot of infertility is not diagnosable by the testing that is currently available. My doctor always says that the infertility community knows how to test for about 4 things when in reality there are likely hundreds of things that need to align correctly for conception to occur. In most cases, it makes sense to treat first without a concrete diagnosis. And in many cases, TREATMENT is what gives more answers then any "tests". For instance, the process of IVF can be highly diagnostic and can tell a doctor quite a bit about your egg quality, ability of the sperm to fertilize eggs, etc.

Good luck!

[Anonymous]

Anonymous wrote:PS: OP here again -- Dr. Widra did NOT examine me himself - reviewed the reports I had from my doctor and went on to diagnose me with secondary infertility and possible ovulatory dysfunction. That could be b/c I had just had all of the testing done and there is no reason to repeat some of the stuff, but that he didn't even suggest any further tests also made me a little bit weary. Now, I certainly don't want to have another HSG for the heck of it or further delay this process, but I was a little thrown off by that too.

You don't need any more testing. You need to decide if you want to get pregnant or not.

If so, I would go with the more effective and less invasive way: hormones and IUI.

[Anonymous]

Hi OP -Unless you have symptoms that something is really off (i.e. endometriomas showing up on ultrasounds, bladder or intestinal issues, severe pain), the lap is probably not necessary. I had a lap for severe endo, but the symptoms were out of control -16 day cycles (during which I either bled or spotted black blood the entire time), overactive bladder (it was coated with endo), and bowel issues (I thought I had irritable bowel...it was just adhesions acting up), plus endometriomas viewed via ultrasound that grew bigger by the week. In this type of case (which was shockingly aggressive), a laparoscopy is probably necessary -you could never touch fertility meds without causing many, many more problems while all those growths are active...the lap buys you some time and alleviates terrible symptoms. However, Widra's advice seems spot on for a patient who has no apparent symptoms.

That being said, there is nothing wrong with seeking a second opinion. I agree with the poster who said just ask for a consultation. Sadly, infertility practices are huge money makers, and I have sometimes gotten the impression that unless you are there to feed the beast, they would prefer you see somebody else. By not mentioning "second/third" opinion, you are more likely to get what you want. By the way, having been through the mill with regular gyns and REs, when it comes to infertility, I would stick with the RE -they are sales people of sorts, but their training is far superior to the average gyn in fertility matters. Whatever you ultimately decide, you and your husband should feel comfortable that the doctor has listened to you. Good luck to you -I know this is a tough journey.

[Anonymous]

I also went for several opinions after some frustration from my RE. In my case, I wanted a Lap but my doc didn't see the need. I showed no signs of endomitriosis on ultrasounds, but have had debilitating cramps my entire adult life with the exception of the years I spent on the pill. Anyway they did find level 2 endomitriosis and it was completely surrounding one of my ovaries. My only point is this is that if the Lap would be for that reason, things don't always show up on a sonogram. In that case my RE was wrong. I did meet with doctors at 3 other practices and two of them also did not suggest it for the same reasons that the posters have mentioned above. I went with a doc who was on the fence but thought it couldn't hurt and in my case it didn't. Complications are always possible, but it is an easy surgery and they are slim. Still a second or third opinion is always best.

I believe I asked for a consult with each appointment and none of the docs asked to examine me, they simply reviewed my records and gave me their thoughts and what they would suggest if I were to become their patient. I met with Dr. Osborne at Shady grove early in my search for a doctor and her response sounded very similar to Dr. Widra's and I was completely put off. When I was looking for second opinions, and a new RE (10 months later) I met with Dr. Greenhouse at Shady Grove and he was completely different, very personal and really listened to my concerns.

Good luck and definitely set up as many 'consults' as you need to feel comfortable. All doctors offices will welcome a new patient!