By Jackie Gutmann, MD
Published in Resolve, for the journey and beyond, Spring 2013 issue
First you realize that you are having trouble getting pregnant. This creates anxiety. Then, your doctor suggests that you see a reproductive endocrinologist (RE, a.k.a. fertility specialist). While you are likely approaching this visit with hope, there is anxiety that the treatment will not be successful, anxiety of seeing a new doctor, anxiety about the cost, and anxiety about what to expect.
Once you start seeing your RE, you quickly find out just how hard fertility treatments are. It is emotionally stressful and also physically challenging. Fertility treatments typically require frequent, occasionally almost daily, office visits. Then there are the medications and invasive procedures.
If all goes well, your fertility treatments will be successful. Once you are pregnant, you will initially have blood work every 2-3 days to ensure that the pregnancy hormone level (beta HCG) is rising appropriately and that progesterone levels are adequate to sustain a pregnancy. At approximately 5 ½ weeks pregnant, you will have an ultrasound to see that everything is progressing normally, and to check for a multiple pregnancy. Typically, you will have ultrasounds weekly to evaluate the progress of the pregnancy. You will be able to see the embryo growing and hear the heartbeat. Needless to say, these visits are reassuring and comforting.
You will continue to see your RE until you are approximately 8-10 weeks pregnant. And then you will “graduate” and be discharged to the care of your OB/GYN. And though a happy time, this transition can also create anxiety. Because of the intense nature of fertility treatments, you often develop close relationships with the fertility team. In addition, you become accustomed to and comforted by the constant feedback on how your treatment is progressing. The bond that you develop with your RE or Nurse may make it hard for you to move to the next phase of your fertility care.
Once you start seeing your OB, you will be seen every four weeks. This is normal. You do not need to see your OB as frequently as the RE. Despite all the things that you went through to achieve this pregnancy, you are not at significantly greater risk for miscarriage or other complications than those women who had no difficulty getting pregnant. Your pregnancy may be classified as high risk due to advanced maternal age, multiple gestation, or other factors such as a chronic condition that you may have (diabetes, obesity or high blood pressure, for example) but not because you conceived using fertility treatment. Unless you have one of these conditions, you typically will not need to see a high-risk OB.
There are also many practical things to consider as you make the transition to your OB. Typically, it takes time from when you call the OB to when they have an available appointment. You should call for the appointment when you are about 7-8 weeks pregnant (before you are discharged from your RE), so that you have your first visit at around ten weeks. This will give you the opportunity to meet with your OB and schedule genetic counseling and testing as appropriate. You should get a copy of your records and blood work, particularly since you may have already had much of the testing that your OB needs. You should ask that your records be sent to you — that way you will always have a copy. You should confirm your due date with your RE, as the traditional method of calculating your due date using the date of your last menstrual period will not necessarily be accurate if you conceived with IVF or even insemination.
So as you sit anxiously between visits, particularly before it is too early to feel the baby move, try to remember that it is okay to not to see the OB more frequently than every four weeks. The job of your OB is not the same as the job of the RE. Try to check your anxiety at the door. If you do have questions or concerns, just pick up the phone and reach out to your OB. They are there to help.
Jackie Gutmann, MD, is a graduate of Yale University School of Medicine. She completed her residency in obstetrics and gynecology and a fellowship in reproductive endocrinology and infertility at Yale-New Haven Hospital. Dr. Gutmann is Clinical Associate Professor of Obstetrics and Gynecology at Thomas Jefferson University and a partner at RMA of Philadelphia. She has published numerous articles on infertility, polycystic ovarian syndrome, assisted reproductive technology, and complementary and alternative medicine in infertility. Dr. Gutmann has held numerous leadership positions in local and national professional organizations and has served on the medical advisory boards of several patient advocacy groups.