Making good decisions about infertility treatment is crucial because the stakes involved are incredibly high. Having, or not having, a child is arguably one of the most life-changing decisions a person can make. In addition, infertility treatment is incredibly expensive—not just financially, but physically and psychologically as well. Being in infertility treatment (as you have probably already realized) can be quite physically uncomfortable and emotionally stressful. Most of us don’t have unlimited financial resources, and perhaps more importantly, none of us has unlimited physical and emotional energy to endlessly devote to treatment cycle after treatment cycle. So every cycle, every attempt must really count; every decision about what to do next is very important and must be treated as such. To make our very best decision in such a complicated situation, we must be functioning at our highest levels. If our emotions, as valid as they may be, are clouding our judgment, it can make it difficult to make the choices best for us.
In addition to having to make the best decisions for ourselves in the present, we also have to make sure we don’t look back at our current decisions years or decades from now and regret them. Infertility treatment, especially with your own eggs, has a time stamp on it, and we usually can’t go back years later and try again. So we must also think about what our future selves will feel about the decisions we make now. In my own case, I have done many rather difficult and unpleasant things so that 50-year-old Lisa won’t be upset, angry, and regretful (I sure hope she appreciates it!) I feel the regret factor is one of the most important decision-making variables we must include when making treatment decisions.
One of the most important infertility treatment decisions is choosing a reproductive endocrinologist or clinic. However, in my practice (as well as my own life experience) I have observed that this is one of the most common areas in which emotions may have a negative impact on the final decision. Too often, I see that the main criterion that people use to select an RE is that they want someone that really like and connect with emotionally. They want someone who is empathic and sympathetic, and who gives them a feeling of hope even if their diagnosis does not usually have a positive outcome. This is, of course, absolutely understandable. Usually, when we visit a RE, we are feeling sad, anxious, angry and scared, and finding someone that can understand, tolerate, and address these feelings feels good. However, (and I can’t stress this strongly enough) the purpose of your reproductive endocrinologist is not to make you feel better emotionally, but to provide you with the best information and treatment currently available. Thus, the main variables you should be looking for are how successful a particular RE or clinic is in treating your particular diagnostic, treatment, or age group category. Period. Anything else, like a nice relationship with that person, is a bonus.
Okay, so I know that seems like a pretty strong statement for a psychologist to make—that it shouldn’t matter if you like your RE or if you feel he or she cares about you. It’s a vastly different approach than I would suggest for choosing a therapist or an internist, because in those relationships you spend a lot of time with the person with whom you are working, and trust is a vital factor to successful treatment. But there are two reasons behind my thinking here. The first is that there is such variance between the number of cycles performed and the success rates of different treatment clinics. If you haven’t done it already, check out the success rates of the clinics in your area at http://www.sart.org/find_frm.html . You’ll see what I mean. In most cases, you are going to want to go a place that runs a lot of cycles and has good success rates. The RE’s who staff these clinics may, or may not be the type of person you’d love to hang out with, or wish lived next door. But again, that’s not really the issue--getting the best treatment possible, so you don’t waste your time, tears, and money, and don’t have regrets later, is the most important issue at hand.
The second reason I feel that it doesn’t matter too much if you don’t have a warm and fuzzy relationship with your RE is that you probably aren’t going to be spending a lot of time with them anyway. In most cases, you are going to have a lot more contact with the nurses, technicians and other staff, and often, these clinicians are more overtly empathic and understanding.
I should add that I think that getting emotional support about your infertility from someone who understands what you are going through is extremely important. But that support can come from a variety of other sources, like family, friends, support groups, and clinicians specializing in infertility like myself. In my opinion, it is unrealistic to also expect it from your RE, who should be focusing on the medical and scientific aspects of your case.
Another common problem I see is that sometimes people want to make the decision about treatment providers based on other variables like geographic proximity, because they want to lessen the “inconvenience” of infertility treatment. While nobody likes to have to commute out of their way morning after morning to go to monitoring appointments, or even cycle at a clinic in a different town, sometimes it may be a short-term but necessary evil in order to ensure that you are getting the best treatment and the best chances for having the family you desire. I once talked to a friend who was having difficulty getting pregnant. She was quite distressed that she had two failed IVF cycles at Clinic X, which had very poor success rates and did not do many cycles. When I suggest she move her treatment to Clinic Y, which had much higher success rates for her age group, she was very resistant initially because Clinic X was close to her house. Clinic Y was not, and she didn’t have a car, so she would have to take a taxi to her retrieval and transfer. I think she was a bit shocked by blunt question about what was more inconvenient to her—taking a few taxi rides, or not having a baby at all. But she did take my advice and switch clinics, and now a few babies later, I think she’s glad she did.
I think one of the reasons such seemingly irrational decisions occur is that people may not want to acknowledge the far-reaching impact of infertility on their lives. Somehow, commuting across town or even across the country for infertility treatment makes it seem all the more real and painful. The unfortunate truth, however, is that infertility affects us deeply, whether we consciously acknowledge it or not. And the consequences of our decisions are profoundly life-altering events which, one way or another, will shape the future course of our lives.
So if you find yourself unsure of what to do when choosing a treatment provider, make sure to take the time to try to really understand what you are feeling. Remember that picking your treatment provider is an incredibly important decision with far-reaching consequences, and that you definitely want to try to avoid having long-term regrets later in life. In order to give yourself the best chance of success, you may have to make choices that don’t “feel good” in the short term.
Although you may not be able to use your feelings as the sole basis of your decision, they are still very important to understand and process. It may be helpful to talk to someone else in order to clarify these feelings, such as your partner, a family member, a friend, or a mental health professional. By being more conscious of what your feelings are and how best to respond to them, you will be freer to make the best choices for you in the long run.