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Written by TTC Couples.

 

Infertility FAQ for Women of Size -- Question to Ask the Doctor

Screening Infertility Doctors & First Consultation

This page has been added to the Infertility FAQ for Women of Size as a way of helping women come up with questions and a battle strategy of sorts for first finding a physician who is not fat-phobic, and second making the most of the initial consultation. Please note that this information is just a start to give you ideas to build upon.

The page is broken into five categories:


 SCREENING FOR FAT PHOBIA BEFORE INITIAL VISIT

    These questions can be asked of a nurse before your appointment, or can be sent ahead of time in a letter or fax to clinics and practices you are considering. Some people have taken the time to write letters explaining their weight and history and asking if a doctor would call or write if willing to take their case . . . this may be the easiest way mentally, but not necessarily that quick.

    1. Is there a weight limit that I must be under to start treatment? (Some places have weight cutoffs of 200, 250 or 300 pounds.)

    2. Is it suggested that overweight patients try to diet before receiving treatment, or will I be allowed to go ahead immediately?

    3. Would I be denied certain tests or treatment because of weight? (Laparoscopy, IVF, etc.)

    4. Does the doctor/clinic treat many overweight/obese patients? If so, do you have any idea what percentage?

    5. Are large blood pressure cuffs available and used routinely on large patients?

    6. Are plus-size hospital gowns available? (You can expect a bit more acceptance from a place that plans ahead).

    7. Is the doctor familiar with polycystic ovary syndrome (PCOS)?

    8. Is the doctor familiar with insulin resistance testing and treatment?

    9. Will my initial visit include time to talk in the doctor's office fully clothed?

    10. Is the physician board certified in Reproductive Endocrinology? What about the other physicians in the practice? (Some people find this qualification important though others feel an OB/GYN is just as good as an RE -- it really depends on whether you are starting out and what the doctor's other qualifications may be. There are some doctors who have been doing IVF since the 1970s, but they are not REs because the specialty did not exist back then.)

 SCREENING FOR FAT PHOBIA AT INITIAL VISIT

    1. What do you consider the obstacles of being overweight and seeking infertility treatment? (The answer of a non fat-phobic doctor should be that weight isn't much of an issue other than possibly making a few tests a little harder logistically, and that you may need more medication than a thinner person.)

    2. Will I be treated with respect by all office personnel and medical staff? For example, if I need to see a doctor on call, will s/he treat me with the same respect that you will?

    3. Are there any procedures that will be denied to me because of my size? If so, why? (Laparoscopy, IVF, etc.)

    4. Will I be weighed at most appointments? If so, why? (There are some valid reasons to weigh patients, but it shouldn't be something needed at each appointment.)

    5. Does your facility supply large enough hospital gowns for overweight patients, or do I need to bring my own?


 TIPS FOR PREPARING FOR INITIAL CONSULTATION

    1. Send or take with you any previous medical records concerning fertility tests. If you have had hysterosalpingogram, the film is more valuable than the printed report.

    2. List out your concerns about your cycles - whether you are regular, have a short luteal phase, lack mucus, get positive ovulation predictor tests, etc. Include basal body temperature charts if you have them, and with as much detail as possible. If you are switching fertility doctors, be prepared to list what you have tried and how you responded -- include all meds.

    3. Make a list of all your questions - it will actually speed things up even if you have a long list because you won't fumble around trying to remember what you want to ask.

    4. Consider typing your list of questions and handing a copy to the doctor. You can even consider faxing or mailing this ahead of time, but you will probably have a bunch of things to add at the last minute.

    5. Don't worry about asking "intelligent" questions . . . you should ask anything and everything you want answered.

    6. Be prepared to discuss some family medical history, including preganncy problems, lupus, diabetes, high blood pressure, and cholesterol problems.

    7. Consider saying that you are trying to be an informed patient and would like to be a partner in your own treatment.

    8. Besides reading through the rest of this page and main part of Infertility FAQ for Women of Size, visit some web sites about infertility . . . I would suggest reading the general Infertility FAQ, and the Recurrent Pregnancy Loss Testing page for anyone who has had one or more miscarriages (many of the tests are the same, so you might as well find out what will help you look into both issues at once). These pages start at http://www.fertility-plus.org along with some other patient FAQs. From there check the PCOS FAQ on INCIID http://www.inciid.org/faq/pcos.html and http://www.inciid.org/bastest.html. This site talks about initial testing and will give you an idea what to expect. Generally speaking, overweight women should have all the tests for PCOS as it is a very common endocrine disorder and about 50% of the overweight women on the OASIS listserv have PCOS. For those looking at the higher end of infertility treatments, you should also check http://www.inciid.org/chart.html.


 QUESTIONS TO ASK ABOUT FERTILITY ISSUES, TREATMENT PROTOCOL

    1. Will both my partner and I (assuming heterosexual couple) be evaluated at the same time? (A woman really shouldn't take meds or submit to invasive tests without having the male doing a semen analysis first.)

    2. What tests would you recommend I start with? (See if this one matches what you were thinking . . . if it doesn't, ask about the tests you think you should have. For example, LH and FSH testing should be routine, and should be on day 3 to matter.)

    3. Will my treatment be individual, or do you follow set protocols? (There should be similarities in how patients are treated, but it is better not to have strict cookie-cutter approaches.)

    4. Given my age, weight and medical history, what are my realistic chances of achieving a successful pregnancy?

    5. Are ultrasounds, IUI, etc., performed on the weekend? (If not, go elsewhere because you may miss cycles if you ovulate on the weekend, which is a common problem.)

    6. Can all of my testing be completed within one or two cycles?

    7. What kind of monitoring should I expect with a medicated cycle? (Ultrasounds, hormone levels, etc.)

    8. How long do blood tests and other test results take to receive? What is the procedure for getting the results? (Expect a call from nurse, call clinic after certian hour.)

    9. How open are you to discussing information and protocols I may learn about from other sources? (The Internet, Resolve support groups, etc.)

    10. How do you feel about utilizing supplemental forms of treatment along with medications? (Vitamins, acupuncture, hypnosis, therapeutic massage, herbs, etc.)

    11. What type of counseling/support services are offered to women with infertility? Are there support groups offered through the practice?


 QUESTIONS TO ASK ABOUT HOW OFFICE OPERATES

    1. What is the procedure for getting questions answered between appointments? Can I call, fax, or e-mail and expect a prompt reply? (Almost everyone goes to a first appointment and finishes thinking they asked everything, but they end up having something new to ask by the end of the day. The doctor should be able to address your concerns in a timely manner.)

    2. What is the standard callback time, and does it vary depending on the urgency of the call?

    3. I understand that many of my questions can be answered with a callback from a nurse, but if I need to speak with a doctor how do I make that clear?

    4. What do I need to know about scheduling weekend procedures?

    5. What is the phone number for off-hours problems?

    6. Is there a directory of phone numbers for office staff and doctors? (For example, some clinics will give you different numbers for contacting a nurse, getting lab results, discussing billing issues, etc.)

    7. How willing is your office to work/fight with my insurance company to deal with the coverage I have?

    8. Is it possible to setup payment plans for things not covered by insurance?

    9. Is there a possibility of getting leftover meds donated through the clinic or of applying for hardship assistance through some of the drug companies? (Serono, for example, has a program for Gonal-F, but your doctor needs to apply for the meds for you.)



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