My Own Advocate

If you haven’t listened to the Bitter Infertiles podcast, I strongly recommend you stop reading right now and go listen (don’t forget to come back!). The hosts are incredibly smart, funny, and strong women who know just about everything there is to know about infertility, miscarriage, fertility treatments, and how to cope with the crapfest that is miscarriage and infertility. Today’s blog post is brought to you by Episode #13, in which the brilliant hosts discuss being your own advocate and how to deal with doctors.

I have a problem. Well, not at the moment, but it’s entirely possible that I could have a very big problem some day soon. You see, in my state (the booming state of North Dakota), we have only two REs (reproductive endocrinologists, doctors who specialize in getting women pregnant). That’s right…. Two REs for the entire state. (There may be doctors from neighboring states who serve the border communities, but only 2 are based in ND.) What’s more, they both work for the same practice and follow the same protocols. When one isn’t available, I will see the other (via video chat). Because they are interchangeable, it’s pretty much like having one RE. It doesn’t matter if I don’t like them or if they treat me like crap, I’m stuck with them if I want to get pregnant. The good news is I don’t hate them.

So, it’s even more important that I work hard at being my own advocate. It’s not easy. I’m not a pushy person. I’m intelligent, but I’m no doctor. I may know more about infertility and treatments than some doctors, but I’ve only just started on this journey, so I’m not very confident with my knowledge. Furthermore, it seems every time I’m in the same room as a doctor, what little confidence I may have had disappears and I find myself nodding in agreement with everything she is saying. Any questions I had prepared stay in my purse for fear of insulting the medical professional across from me, who spent many years and many thousands of dollars getting an education, a doctor who has had far more successes than failures when it comes to helping women like me realize their dreams of becoming pregnant. Who am I to question her expertise?

First of all, I need to stop looking at it as questioning her expertise. As discussed in the podcast, a good doctor who knows her stuff will welcome questions and will take the time to explain things. She will not be insulted. If she is, she’s probably not the doctor you want treating you.

Second, I need to remember that it’s my dollars, my body, my future in question. I have a lot at stake. I deserve to know why a specific treatment, procedure, or test is recommended (or not recommended), what outcomes are expected, and what will happen next if it does or doesn’t work out as expected. In a way, I’m asking my doctor to defend her recommendations. If she can’t or won’t, that’s a bad sign. A good doctor will not put up a wall. A good doctor will recognize that a patient who asks questions is a patient invested in her own care, a patient more likely to follow through with the agreed upon treatment.

I have managed to ask my RE a few questions about possible tests and treatments. I was careful to explain that I wasn’t asking her to order the tests I was asking about, just to explain if the tests would be helpful and why. She gave me great answers and was not at all put off by my asking. Still, I do have some unanswered questions, that I’m still working up the nerve to ask. Most important: IVF.

I came to my initial consult with a mile-long list of questions just about IVF. She never even mentioned IVF, and when I brought it up, she brushed it off as a very last resort. It was clear she didn’t want to talk about it. In a way, I was relieved, because she was so confident that I would get pregnant without IVF. Still, the planner in me wants to be prepared. I’m not even sure we can afford IVF or make it work with my work schedule (I’d have to travel 200 miles for egg retrieval and transfer, with little notice). Will I have to lose a significant amount of weight before I can start? What’s worse, because my doctor won’t have the conversation with me, I haven’t talked to my husband about it, either. We’re just taking it one cycle at a time, hoping we’ll never have to go down that road.

That may come to an end very soon, however. I’ve already resolved to talk to my RE about my options if this cycle doesn’t work out (I test on December 14, if I don’t get my period before then). I will ask her how many times we’ll do Femara and a trigger before moving on to other treatments, and what exactly the next treatment would be. I plan to ask her my questions about IVF, whether she likes it or not.

So, for now, I’m in a good place, as far as doctors go. It’s not an ideal situation, but it could be much worse. Now, if only I could be as confident as my RE that I’m going to be knocked up soon.

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