WHEN: April 24, 2010
8 to 10 a.m. or 10 a.m. to noon (attend either session)

WHERE: Banner Thunderbird Medical Center
5555 W. Thunderbird Road, Glendale AZ 85306
Lower Level Conference Center, east side of campus

Presentations by Dr. Vladimir Troche and Dr. Diana Heard-Vaughn and their staff. These experts will help you understand why it may be more difficult to conceive than you thought.

Register for either the 8 a.m. or 10 am. session by calling 230-CARE.

Presented live by one of the country’s leading reproductive endocrinologists, Glenn Schattman, MD, from Cornell University. This event is free and made possible by one of WEGO Health’s sponsors.

Webinar attendees will gain:
• Valuable insight to help women you know online to make informed decisions
• In-depth medical updates – usually reserved for physicians – about the factors that all TTC women should consider
• Exclusive direct access to Dr. Schattman during our live Q&A session

This one-hour webinar is offered at four different times on Wednesday, November 4th: Noon, 4PM, 6PM and 9PM (all times are EST)

Attendance is limited, sign up today!
To RSVP, please complete this brief survey and someone from WEGO Health will email you the logistical details shortly: http://www.surveymonkey.com/s.aspx?sm=8NCFzllsfKeB9mFuhTG37w_3d_3d

Earn $5 for RESOLVE:
To help incorporate participant ideas and feedback into later programs, WEGO Health will invite all webinar attendees to participate in a brief follow-up survey. For every attendee who completes this short survey, WEGO Health will make a $5 donation to RESOLVE: The National Infertility Association.

Questions? Contact WEGO Health at (community@wegohealth.com)

Posted with permission from WEGO Health.

But most of all, I witnessed this miracle when my daughter Copy Cat was sick after she was first born. I credit the great care of the doctors and nurses for her survival, but I know that the time she spent in my arms played a huge part too. Studies show that when a baby is held skin-to-skin, called Kangaroo Care, by one of its parents his/her heartbeat stabilizes as does his/her body temperature.

Whether it is your baby, spouse, mother, father, friend, family member, etc. a simple gesture, such as a hug can do wonders. Give it a try today.

I’ve created the 3 C’s that I use now when assessing my health providers:

1. Are they compassionate?
2. Do they display their competence openly to me?
3. Will they work in collaboration with me in my health?

Although these 3 C’s may seem basic, I’ve used them to make decisions for me and my family. For example, whenever my daughters are ill we go to the same doctors office, but it’s often difficult to schedule an appointment with my girls primary care physician on short notice. Therefore, often times we see one of the other doctors in the office. So far I have been impressed with the display of compassion by all of the doctors in this group. They truly seem to feel sorry for the sick child, my child.

The item of competence is assumed by us whenever we visit a doctor. What I like is when the doctor describes why they are doing a procedure or prescribing a particular medication. Or discussing how my illness will progress until I get better. In December my doctor was concerned about one of my eyes. She made it clear that it was imperative I visit an eye doctor ASAP. When she explained why it was so important, I scheduled the appointment within 30 minutes of leaving her office. I will no longer accept a doctors instructions without an explanation as to why it is critical that I do something. I need to know the consequences of my actions or the medications I am taking.

The third item is the most important, at least in my opinion. If my doctor doesn’t treat me as a critical member of the team than I go find a doctor that will. About one year ago I made the decision to leave my Ob/Gyn who I had been seeing for more than 5 years because he wouldn’t run a simple test for me. He discounted my opinions and my need to know the status of my pituitary tumor. My current Ob/Gyn ran the test for me after I explained to her why it was important for me to know the results. I know my body better than anyone else, and I should be treated as such.

What are your requirements for your health care provider?

If you have ever completed an application for an RE’s office, it’s more like an interrogation than an application. There are so many questions, so much invasion into your private life. Then there is counseling, oh my. During one of my first therapy sessions, which started during our infertility, my counselor asked me if there was any abuse or neglect during my childhood. My quick reply was, “No. Not that I can think of.” Of course, I was lying or at least not telling her the whole truth. In a sense, I was protecting myself. By not admitting I had demons from my childhood I didn’t have to deal with them as an adult. Also, by not sharing this information with her I was able to keep her at a distance that was comfortable for me.

About 18 months ago a huge demon from my childhood reared it’s ugly head and I could not longer ignore it. The dream that I wasn’t sure was real or not finally hit me in the face with its reality and I had to deal with it. The relationship between me and my mom became tense. I made the decision to no longer associate with my biological brother. It was just too hard, I was tired of the same old struggle, and no longer interested in being degraded in order to keep the family ties.

My husband was confused. Poor guy. So, one day I am visibly flustered and he is concerned about me. He wants to know why I am upset and I had debated all day about how much I should tell him. The truth came out and after 8+ years of marriage he learns one of my most sacred family secrets. Whoa! Now he is upset and not sure how to react. Not that I blame him. I had never expected all of this to come out for him, or anyone else, to know. Was I protecing him or me or his opinion of me? I’m not sure.

Although sometimes I wish my secret was still safely locked up, I am thankful for the freedom I now feel. Now I’m back in counseling to deal with all the bad stuff from my childhood. How much easier it would have been had I just addressed them at the get-go. Yes, 5 years ago! I could have made so much more progress on insecurities that have shaped me, have burdened me, and have made it difficult for me to truly be happy.

So, what about those white lies, half-truths or unspoken truths? Are they protecting you? At least for today?

Is this a silly reason to change doctors? Maybe. But it is my opinion that I have a right to know what is going on with my health, my body. I recognize that doctors don’t want to run unnecessary tests, but this is something that probably should be checked every year or at least every other year.

I suppose it was more than the denied request for this test. One year after the birth of my twins he had made a comment about my weight. I was still heavy from my pregnany and I wasn’t one of those lucky ladies that lost all her “baby” weight breastfeeding, in fact my body was holding on to all that weight – it sucked. Anyway, he lectured me about how I needed to loose those extra 20 pounds (beleive me I would have loved to) and that I obviously wasn’t exercising enough. I was irritated but went back for my annual exam one year later.

In the new consumer driven market, I would think more doctors are going to see patients leave for better care or more caring doctors. See Julia’s comment on the How Integrated Are You? post. Truly, if you lack compassion for your patients you are in the wrong profession!

But it is not just the doctors that sometimes communicate poorly with us. I know that I’ve been guilty of not sharing all of the facts or relevant details around my health with my doctors.  However, I am an open book now. I now know that they can do a better job of assessing my issues if I give them all of the facts, even the details that I think might be insignificant. Although they might not always pick up on those details…a recent illness of mine proves they are not infailable as my doctor missed the start of Shingles, even though I pointed out the bumps on my face during an exam. Oh well.

Just like with your marriage; communication is the key to a successful relationship. I forgot to apply this logic before we experienced infertility. I am now a much more educated health care consumer and require my providers give me all of the relevant facts, or even the details they might think are insignificant.

What steps are you taking to ensure you receive good care?

Joanna addresses:

• How long do you need to receive acupuncture treatments in order for it to help you achieve your dream of becoming a mom?
• How do you find an acupuncturist?
• Can acupuncture help male factor infertility?

And much more in this interview.

Creative Commons image courtesy of hradcanska.

During break I approached him to discuss the problem of twin pregnancies and the risk of premature birth. I mentioned that RE’s don’t do a very good job of communicating the risks of multiple gestation pregnancies to their patients, to which he agreed but stated that it is his goal to get patients pregnant otherwise he wouldn’t be in business.

Then I mentioned that I thought that insurance coverage would help with this issue since the insurance companies could put guidelines around fertility treatments and what they would and wouldn’t cover. His response, “Insurance is the worst thing that we could do in this industry. It doesn’t work and fails in the states where it is currently offered.” Our conversation turned a little heated after this. We discussed the State of Illinois, which offers mandated insurance coverage. He said it doesn’t work there because a woman who is unlikely to get pregnant with IVF will “use” her 3 cycles and then a woman who has a chance won’t get the coverage because it was used by the first woman. I said, “Maybe the mandates were written poorly or the insurance guidelines could be changed so that it works better.” He quickly disagreed that insurance coverage of any kind would work in this “industry.”

We argued about how if I was to be diagnosed with cancer my insurance policy would pay for my treatment. To which he argued not everyone has insurance coverage or sometimes cancer is considered a pre-existing condition. Okay, I agree with that. But if my policy covers treatment options, my cancer will be treated whereas infertility treatments are not. His argument was that if everyone had cancer coverage the insurance companies would have to raise their premiums so much that no one would be able to afford insurance. To which I argued that if the rate of premature birth was to decrease from multiples that are the result of fertility treatments the insurance companies could stand to save A LOT of money. Caring for a premature baby is substantially more expensive than a few fertility cycles.

I mentioned the financial stain of fertility treatment and how it wasn’t fair that someone had to choose between adoption or an IVF cycle because they only had money to cover the cost of one of those options. And that it wasn’t fair that infertility, which is a disease, wasn’t covered like most other illnesses. His response, “The cost of an IVF cycle is less than that of a car. If people really want a baby bad enough they’ll come up with the money. It’s only 10% of the cost of raising a child, which over a child’s lifetime is minimal. People who cannot afford cosmetic surgery find the money and cosmetic surgery is more expensive than an IVF cycle.”

If you have read the book, When Nature’s Not Enough by Diane Glick, you’ll remember the stories of the couples struggling to “find” the money to continue with treatments. In that book there are two couples who lost the fight to have a child because they ran out of money. One couple spent over $100,000 trying cycle after cycle to get pregnant. Now that is a lot of money to ask a couple to “come up with.” Another younger couple could only afford to purse one treatment cycle because their jobs didn’t provide the financial means to continue “coming up with the money.”

Are you floored? I was. The debate continued. I said, “Everyone has to pay for a car, but not everyone has to pay to have a child.” He continued with, “People will find the money.” …What I wish I would have said in response is, “Yeah. But when I fork down $15,000 for that car I drive away in a car, but when I fork down $15,000 for an IVF cycle all I walk away with is hope that it works.” Not only that, people need a car to commute to work, buy groceries, etc. It’s not a valid comparison. I must admit I was shocked by the lack of care or concern for couple’s and their financial struggles in addition to their emotional stress.

We finally had to agree to disagree.

This doc is “world renowned” for his expertise and success rates. I’m sure that when you are his patient he is a very nice guy and works in your best interest to get you pregnant. He even stated that his clinic has the lowest number of multiple gestation pregnancies in the State of Arizona, which is good to hear. However good he may be, I’d be hard pressed to recommend him to anyone going through infertility treatments. His lack of concern for the financial aspect of treatments hit a cord – it was one of the points that almost lead to me and my husband divorcing during our infertility struggle. These RE’s are the highest paid docs in the business because there is no insurance component. Is it greed or true lack of concern for couples struggling with infertility?

Does anyone know how the insurance industry works? I’d love to learn about these “pools of money” I keep hearing about with regard to how one person will receive coverage while the next person won’t. Please contact me.

Help support my efforts and my blog. Buy a copy of my book Tiny Toes.

Mary Ann is a Physician’s Assistant with the Center for True Harmony Wellness & Medicine. Prior to joining True Harmony, she worked with two different RE clinics. She gained insight from those experiences and determined that women need to be educated about their family building options before they seek the help of a RE to help them become pregnant (and at a much younger age).

True Harmony is a truly unique medical practice. They desire to help the whole woman by offering massage, acupuncture, Reiki, dance, and other alternative medicines along with traditional OB/GYN services. They offer a Fertility Assistance Program that includes massage, acupuncture, nutrition & IV therapy, and consults with the physicians.

If you live in the Phoenix Metro area I suggest you contact True Harmony. If you are outside the Phoenix, AZ area I recommend you locate a facility like True Harmony.

For more ideas about how your OB/GYN can assist you in your family building efforts, click to read the article 10 Questions To Ask Your OB/GYN When You Are Trying To Conceive.

Center for True Harmony Wellness & Medicine located at: 2152 S. Vineyard #138, Mesa, AZ 85210. ph 480-539-6696.

Reproductive Endocrinologist Jeffrey Fisch , M.D.

Welcome to episode 2 of the Twin Peas Podcast. This episode features 4 great tips to help you select the best fertility doctor for you!

In today’s episode, I discuss how my husband Dave and I navigated finding an RE (Reproductive Endocrinologist) for our IVF treatment. I recommend talking with more than one doctor. Each RE has different opinions about how to approach treatments. Also, talk to other people to find out if the doctor you are thinking about using has a good reputation. Some doctors are known for good and some for bad practices.

In this podcast, I mention Dr. Jeffrey Fisch at the Sher Institute of Reproductive Medicine in Las Vegas, Nevada. Check out the website for SIRM at www.haveababy.com.

Did you miss anything I said? Don’t worry, there’s a full transcript waiting for you — just click the following link!

TRANSCRIPT of episode 2:

Navigating Infertility Doctors

Choosing an infertility doctor, i.e., Reproductive Endocrinologist (RE) might be one of the most important decisions of your life. Your selection may impact whether or not you become pregnant. In this episode, I’ll describe how we chose our doctor and give some tips that we learned that might be helpful to you in your search.

We found three doctors in our local area by asking our others for recommendations. By opening up with everyone we knew we were able to get the names of two of the top local doctors as well as a referral for one doctor with a questionable reputation. Since we didn’t know which doctor might be the best one for our situation, any information was good information to have at the start of our search.

With a few doctor’s names in hand, we did some research on the doctors by visiting their websites and asking people about their experiences. Did they become pregnant, what they liked about the doctor, what they didn’t like about the doctor or their staff, etc. We looked at their success rates, costs of treatments, and payment plans. Most of the doctors we looked at were competitive in most areas such as success rates and costs. No RE’s were covered under our health insurance policy so the choice was ours to make.

We decided to scheduled appointments with two of the three doctors we researched. The first RE was great. He gave us a lot of information about our options based on our medical status and discussed how long each procedure might take and when we could schedule an IVF treatment. He even got us started that same day on a Clomid Challenge because the timing was just right in my monthly cycle. During his exam, he noticed that I was lactating. Odd for a woman who hadn’t yet delivered a baby to be lactating! Come to find out my Prolactin levels were elevated so my body mistakenly thought I was breastfeeding.

We kept our scheduled appointment with the second RE just-in-case we ended up liking him better. We already knew what to expected, to some extent, and we were excited to get our opinions on a second doctor so that we could start our treatments. After more than 60 minutes of waiting in the lobby without any communication from his staff, we left. Dave is not a patient person and he was counting the hours he was missing work, especially since we had liked Dr. #1. Dr. #2′s office called us to try to reschedule, but they weren’t as flexible as we needed them to be to squeeze us in, so we told Dr. #2 no thanks.

We were all set to move forward with Dr. #1. We completed our application and we were about to schedule our first IVF cycle when a friend of mine contacted me with life changing information. The doctor we were about to use was part of a multiple-practitioner office. My friend, Kelly, informed me a woman she knew used the same RE’s clinic, but not the same doctor -keep in mind, and experienced two failed IVF attempts. The news really only mattered to me because our condition was almost an exact replica of this woman and her husband. This same woman went out of town, to Nevada, to become pregnant and did become so with twins at this clinic. So, I needed to learn more.

Not really wanting to repeat the process of completing another application or hassling with an out-of-town treatment I almost ignored the well meaning advice from Kelly to check out this new clinic. But, after checking out their website I was hooked. Some of the information I’d been longing to find in other places was right in-front of me. Something told me it would be worth a telephone interview with a doctor from this clinic.

The interview with Dr. Jeffrey Fisch changed our lives. After looking at my test results, Dr. Fisch made a comment that he thought I might have a pituitary tumor because of my excess prolactin. What? Dr. #1 never mentioned anything about a pituitary tumor. In fact, he downplayed my prolactin levels after receiving my blood work reports. A pituitary tumor is a non-cancerous brain tumor and they are very common in women. Dr. Fisch recommended an MRI to confirm a tumor because he would need to know this information to determine how to treat my prolactin during an IVF cycle.

We talked with Dr. #1 about my possible tumor and he didn’t really think an MRI was necessary and he didn’t think he would treat my elevated prolactin during an IVF cycle. We followed the advice of Dr. Fisch and schedule an MRI. Mainly because Dave and I wanted to know if I did in fact have this odd non-cancerous tumor that can cause blindness or severe headaches. The MRI showed that I did indeed have a small tumor.

With results in hand, Dr. Fisch told us he would treat my prolactin levels to minimize any possible problems during an IVF cycle. Dr. #1 still said he wasn’t going to let the levels impact his decision not to use any medication. However, before making our final decision on which doctor to use, I perused the cost of their plans and the terms they used to describe a successful procedure. Dr. #1′s office used a 23 week pregnancy as a success milestone. Dr. Fisch’s office, on the other hand, doesn’t deem a procedure successful unless it ends with a live birth.

We decided to go with Dr. Fisch because he seemed to be a more thorough doctor and because the goal of his clinic was for us to end up with a baby, not just a pregnancy. Using an out-of-town doctor wasn’t the most convenient choice, but since he diagnosed my tumor over the phone with a few test results in hand, I figured it would be worth the hassle.

Some of my recommendations to you: 1) get more than one opinion on your medial status or your results because their might be one doctor who is more competent than another, 2) find out as much information you can about your options based on your infertility so that you can talk intelligently with an RE about what treatments might be best for you, 3) research the doctor to determine what they deem a success, is it a pregnancy or is it a child, 4) ask others their opinions on which the doctor’s they’ve used. I was part of a support group meeting where a woman made the decision to change her doctor based on the comments from the other women in the group about their doctors. The opinions of others can make a difference.

Dr. Fisch practices at the Sher Institute of Reproductive Medicine (SIRM) in Las Vegas. SIRM has offices nationwide. I’m not advocating they are the only RE clinic to use, but their website, www.haveababy.com is full of great information. Patients travel from around the world to use their services.

Good luck in choosing your doctor. It is a tough decision and one to be taken seriously, especially when it’s your dime.

In my next episode, I’ll talk about how to manage some of your relationships during your infertility journey.

Text copyright 2008 Twin Peas LLC, Music copyright 2008 Disc of Light Media.