Infertility is a Business
When medical professionals decide on their career path, the path is laid with good intentions. Most want to help people and regard the Hippocratic oath as a solemn vow. Somewhere along the way, however, capitalism creeps in. Between the insurance companies, the competition for patients, and confusing medical billing, reproductive endocrinology centers are incentivized to make clinic numbers look as favorable as possible: out of X many cases, Y resulted in a successful pregnancy. The clinic with the best figures wins- more patients, more funding, better financial results for the clinic and RE professionals. The unfortunate part of all of this is that patients with the most challenging cases then become discouraged from trying again, so as to limit the impact to clinic numbers. When I finally understood this, it was revolutionary for me. I never considered that my chances of conceiving were being commandeered by the business of infertility. This is why, even though I was physically able to carry and bear three beautiful children into the world, I was actively discouraged from doing so, because my case was a bit more challenging.
Once you understand that there are certain protocols, and if you don't fit into those protocols you will likely be discouraged or turned away, it makes a world of difference. Understand that there may be nothing prohibitive about your biology, just a system that is based on speed, capitalism, and efficiency. This makes it all the more important that you understand your specific situation & find healthcare practitioner that works FOR YOU.
Another big mistake a lot of women make is relying on their gynecologist to be aggressive about their infertility- many women unknowingly make this mistake and waste months and years (while precious eggs/fertility is declining) before they take more aggressive steps. A gynecologist may be the first physician that a woman speaks to about her infertility, but gynecologists are not experts in fertility. Some are more informed than others, but most GYNs won’t even check an AMH level to see what the ovarian reserve levels are, and many aren't performing regular ultrasounds during treatment with Clomid, so they won’t even know if the female was ovulating during the cycle. Additionally, gynecologists have no financial incentive to send a woman to another provider who could do more for her- it is in their financial interest that you keep coming back after each unsuccessful attempt. I'm not saying doctors are bad people- I come from a family of them! - I'm just saying you need to understand how the game is played.
And don't be frustrated with your doctor-he or she isn't trying to thwart your chances of conception; they are simply operating within a framework. Sure, for you, the would-be parent with a broken heart over several failed rounds of Clomid, it would be easier on your heart if you knew up front it wasn't going to work because the bloodwork would have told you about X or Y thing. But spending $20-30K on lab work for every patient isn't reasonable and it’s not something most people or our healthcare system in the United States can bear. In medical school, they teach physicians to leverage the protocols that work for the majority of the population first. Clomid works for most women. So does IVF. If you fall outside of these ranges, just know that you still have options and that you need to get more aggressive quickly. Be frank with your physician and find a team that will work hard for you.
Known as the trend of individualized medicine, we now know that individual biology and DNA can necessitate care plans that are individualized to the patient. If you've gone to a RE clinic and been turned away, take heart. Almost 100% of the women I befriended throughout my IF journey that were struggling as well now have healthy, happy families. Just because you were told 'no' once before doesn't mean you should take it as gospel. In fact, it should fire you up to make your dreams of a family a reality!
When you are in the weeds of infertility, even the smallest of tasks feels monumental. Every dollar sunk into conceiving, every disappointment, every strained relationship all adds up to something that seems too great to bear. And if you've given it your best shot and still come up empty, there is no shame in charting an alternate course whether that be adoption, surrogacy, or something else entirely-only you know what is best for you. But as I've stated, there is no one else out there looking after your best interests the way YOU will. True, there are some infertility concierge services out there, but they are likely cost prohibitive for most people and still not widely available. Your best bet is to use your own knowledge, resources and burning desire to advocate for yourself. Ask to see your labs, get copies of everything, and develop an at home medical file of your own, so that when and if you need to change providers you can provide accurate information without waiting for medical records to transfer (and sometimes, there are additional fees for doing so). Brush up on your medical records before every appointment so when they ask you what your last TSH level was, you can answer confidently. Keep getting tested and retested, and if your doctor doesn't think you should, change doctors. Bring up bits of information that have been previously ignored- I can't tell you how many providers told me my MTHFR genetic mutation was 'not a big deal.' However, had I not continued to remind my medical team, I would not have known to take METHYLATED FOLATE as opposed to folic acid, as is regularly prescribed to expecting mothers, and likely would have ended up with a child with neural tube defects. This is because the MTHFR genetic mutation is not widely discussed or taught in medical schools- this, however, does not mean it does not have an impact on fetal development. RE is a rapidly evolving field, and while there are protocols that work for the majority of patients, there are new clinical trials and procedures being discovered every day. Get yourself aligned with a healthcare team that pushes boundaries, not just reports success cases on tried-and-true procedures. And while you're at it, build your own infertility team, comprised not only of your Reproductive Endocrinologist and nurses, but your holistic practitioners as well. My team consisted of my acupuncturist, masseuse, family, friends, energy healer, doula, etc. Ask questions and take knowledge from each of these resources to build a care plan that makes sense for you.