If you have a known issue or suspect that you have an issue, do not hesitate to talk to a health provider as soon as you are considering trying to conceive. This can include any previous condition or concern with the reproductive organs of either partner, or irregular or infrequent periods for the female. At the least, they can guide you through a basic preconception workup and give you guidelines when to ask for help in the future.
If you are approaching the year mark if you're under 35, or the 6 month mark if you're over 35 and are not sure where to begin, first, check your insurance. Not every insurance is the same, even if it is through the same insurance company so call them to find out exactly what is and is not covered. This really is the best and only way to know for sure. Call more than one time, as one representative may not be as thorough as the next.
There are 15 states in the United States that mandate insurers and companies offer infertility coverage. Each mandate within each different state is different so be sure to check what your state requires. There are also loopholes to these mandates, so never assume you are covered.
For information on mandated states:
RESOLVE: state mandates and coverage
For questions to ask your employer and insurer:
important questions to consider (Attain Fertility)
benefit checklist (San Diego Fertility Center)
For more information:
INCIID: PAGE 1, PAGE 2, PAGE 3
RESOLVE on insurance
ASRM on insurance
Unfortunately there are many people who do not have any insurance coverage. Resolve offers some information and strategies to look into. Not one plan is right for everyone.
Who should you see for treatment?
A board certified Reproductive Endocrinologist (RE) is an Obstetrician-Gynecologist with advanced education (a mandatory three year fellowship) and research in Reproductive Endocrinology. These highly trained and qualified physicians treat Reproductive Disorders that affect children, women, men, and the mature woman. They are certified with the American Board of Obstetrics and Gynecology in the Sub-Specialty of Reproductive Endocrinology and Infertility. It is important to find a doctor who responsive and well matched to your needs and diagnosis. Most importantly, a reproductive endocrinologist specializes in treating infertility, and is far more likely to have the experience necessary to identify and treat your problem than an OB/GYN who treats only a few infertility cases each year. It is ideal to have a clinic that is open 7 days a week, for optimal procedure timing.
Again, check with your insurance to see if you need a referral to see a Reproductive Endocrinologist (RE), some insurance do require referrals either through your primary care physician (PCP) or a gynecologist (GYN), if that is the case make an appointment with them to get a referral. Some plans also require a pre-authorization prior to a consultation, or prior to any diagnostics and treatment. The only way to know for sure is to call and check what your plan covers.
Call the RE you are interested in seeing and confirm that they take your insurance. If they are part of a larger group of REs, see if the entire group is covered. Sometimes REs not listed under your plan are actually within your network, and vice versa.
Dr Geoffrey Scher article: How do I choose the right RE and IVF program?
Which includes how to interpret those CDC and SART outcome statistics.
If you have no coverage at all you need to make a difficult decision because RE's can be more costly then GYNs and GYN appointments can squeak through the cracks and be covered before diagnosis of infertility. If that is the case, please be proactive and choose your GYN very carefully for the reasons mentioned above. You don't want to regret your choice, and think, "I wish I hadn't spent all that time and money with my OB/GYN." It can be a tremendous waste of time, and money that you could put toward treatment with a specialist who can get to the root of your problem.
Some indications that your GYN is not giving you the same care that an RE would be: If you are starting treatments and neither you or your partner have had a comprehensive workup (please see TESTING), you should closely scrutinize your choice to proceed. Same with undergoing a treatment cycle and having minimal or no monitoring. Frequent monitoring (blood work and ultrasound at the start of your cycle, repeating every other or every day from cd7 or so until ovulation) on any fertility medication is important to your health as well as to the success of your cycle. Fertility drugs are not miracle drugs that will fix all issues of infertility. Being thoroughly tested and going through properly controlled treatment cycles will save you both time and money in the long run.
It is helpful to have all your previous medical records forwarded to your RE; some REs only need you to bring them the day of the appointment, others want them in advance, so call and confirm when this needs to be done. It is wise to have all records sent to you, and to make copies to give to your RE's office. This way you avoid costly handling fees, plus you have your records on hand should you ever need to reference them, or give them to another doctor, since doctors cannot forward records previously given to them by another doctor or by the patient.
Your first appointment will involve a lot of discussion about your background, your family history, your partner's background and his history. It is not required that your partner attend this meeting, but it is highly beneficial for everyone involved to be present. You may have an internal ultrasound at this visit, and diagnostic testing may be scheduled or performed. Please see the THIS post for more information.
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EMD 03.19.11
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