The doctor-patient relationship is unique when treating infertility. There’s an intense period of diagnostic tests, counseling, frequent visits for blood work, ultrasounds, procedures – and then it’s over. Most of the time it ends on a happy note with couples being shepherded happily pregnant to an OB/GYN who can manage the rest of the pregnancy and delivery.
We eventually get an update – maybe an excited phone call from the hospital, a birth announcement or holiday card, sometimes even an impromptu visit to the office with a newborn. Sometimes we find out what happened when we collect the data we must report to the Centers for Disease Control and the Society for Assisted Reproductive Technology (www.sart.org) on IVF birth outcomes. Sometimes years later a friend they referred here provides an update on how they’re doing.
Unlike most other medical specialties there are no scheduled follow-up visits after fertility evaluation and treatment. No annual physical exams or Paps to perform.
What about those couples who aren’t fortunate enough to conceive with our assistance or who choose not to pursue every option we have to offer such as egg, sperm or embryo donation or gestational carrier? They seemingly disappear from our practice. What happens to them?
Some may continue trying naturally and some may ultimately deliver. Some may adopt. Some may even discontinue their attempts to have children. We know some pursue treatment at other fertility clinics. We rarely hear back from these couples. I wonder about them from time to time and hope that their dreams are fulfilled, whichever path they chose. Ten years ago an article was published in Fertility & Sterility called, “When and why does the dream die? Or does it?” (http://www.fertstert.org/article/S0015-0282(03)02864-4/abstract) We still don’t know the answer in most cases. I think it would make me a better clinician to understand what happens when my patients choose to move on.
It must be difficult to revisit a physician, nurse, or clinic that was unable to provide exactly what that couple so desperately desired. I hope the relationship fostered by that intense early treatment period will engender enough trust that my patients feel comfortable dropping me an update any time in the future. When you say good-bye, it doesn’t have to be forever.
Blog post by Dr. Eric J. Forman, MD, FACOG
Reproductive Medicine Associates of New Jersey Morristown, NJ