Selected Podcast
Patient Experiences- Avoiding Pitfalls of Evaluation and Treatment
Dr. Mary Hinckley describes patient experiences and how to navigate the fertility process to optimize your success.
Featuring:
Learn more about Mary Ramie Hinckley, MD, REI
Mary Ramie Hinckley, MD, REI
Dr. Hinckley is a board certified Reproductive Endocrinologist who completed her training at Stanford University Medical Center. She says her greatest joy is helping patients to realize their dreams in creating a family, but she also enjoys participation in clinical and laboratory studies.Learn more about Mary Ramie Hinckley, MD, REI
Transcription:
Bill Klaproth (Host): So what are some of the most common pitfalls of fertility evaluation and treatment? Let’s find out with Dr. Mary Ramie Hinckley, a physician at Reproductive Science Center of the San Francisco Bay Area. This is Fertile Edge, a podcast by Reproductive Science Center of the San Francisco Bay Area. I’m Bill Klaproth. Dr. Hinckley, it is always great to talk with you. So, let’s start with this. what are some of the most common pitfalls of fertility evaluation?
Mary Hinckley, MD, REI (Guest): Hi Bill. It is nice to be back with you again. And I’m happy to share some of the things that I like to talk to my patients about and how to get the highest success in the shortest amount of time by doing a proper fertility evaluation and ultimately treatments. So, one of the things I see a lot in patients that come to me is that they’ve made some mistakes in the early months or maybe early years that has really slowed them down and frustrated them. And so if I could help a patient by helping them avoid some of those common pitfalls, that would be my goal. And I think probably the number one thing I see that patients fall into by mistake, is doing an evaluation, a fertility evaluation that’s been ordered by a non-experienced fertility healthcare provider.
Oftentimes the wrong tests are ordered, maybe they are outdated, and they are ones that were used back in 1970 but we don’t do that anymore. Or maybe they didn’t tell the patient all the right information and did the test at the wrong time in their cycle. Or they had a procedure and it was done by someone who wasn’t as experienced and didn’t know how to look at the right things. Another classical example I sometimes get is a husband who has gone and done a semen analysis and their doctor looks at it and says it’s normal or looks at it and says it’s horrible and they come to me in a panic and I realize that wasn’t even the right information based on the semen analysis results.
Sometimes even they order the right test so the most common tests we like to order for women these days that are lab tests are the AMH test and the FSH and estradiol. But the doctors interpreted these wrong and the saddest part is when they’ve interpreted it wrong by telling the patient it’s fine and the patient’s waited another three or six months before they come see me and then I tell them no it’s not fine. This indicated that you needed to hurry and get to me quick. So, that’s probably the number one thing I see.
There are a couple other pitfalls I see. One may be not doing the recommended tests that the doctor orders, dragging their heels, maybe trying to save money and doing it in stages and just kind of dribbling through the tests so that we don’t have all the information we need when we’re trying to make decisions. And maybe poor communication. Just not asking. Maybe they have a question about how do I do this test, when should I do it and the patient doesn’t ask and just does it anyway and I think they need to know that we’re okay with you asking and doing it right the first time. I think those are some of the most common pitfalls. I think if you’ve done those tests, getting them to your doctor, your fertility doctor to review at your initial visit is key. Because we’re going to be the smartest if we can look at all that data at the same time and really synthesize what’s been going on and come up with the best plan. And if you see me and you don’t really have any of your records and you tell me your story but it wasn’t exactly right and then I get your records a couple of weeks later; it can be really hard to go back and change some of my initial opinions and ideas and to come up with a plan that really treats them for who they are.
So if you have those records, get them to your doctor when you show up the first time.
Host: So, three common pitfalls of evaluation. One, getting an evaluation from a non-experienced fertility provider. Two, not doing the recommended tests and three, not having everything ready for that initial review and that’s really important when you do that initial review, right, because you need to know everything you can at that point.
Dr. Hinckley: Exactly. And that’s going to help us make the proper evaluation so that then we can design a treatment that’s perfectly tailored for them.
Host: And then you mentioned something about questions. You really want people to ask as many questions as they have because you want them to be informed. Is that right?
Dr. Hinckley: I do. And I mean again, we only have a certain amount of time, but we usually spend a good hour trying to go over things at that first visit. But it almost is more when they go home, if they are wondering if something wasn’t clear, if they are not certain what I said or what the doctor that they saw said. Not to be afraid to call back to ask the nurse could you please clarify, could you help me understand when the best time to do this test is. Not guessing. I mean you’ve come to an expert for a reason, so use that expert to help you get the expert opinion you need.
Host: So, those are the pitfalls of fertility evaluation. Let’s turn to treatment now. So, where do patients and doctors go wrong in planning and executing treatment for patients?
Dr. Hinckley: So, this is the second thing that can slow people down to their goal to build a healthy, happy family. And there are places where patients can make some mistakes and there’s places where doctors could do a little better to help avoid some of the pitfalls. And so, here are just some of the common things I’ve seen. From let’s start with the patient side. I’ve seen that patients really don’t advocate for themselves very much. They sit back and they just kind of wait. They are not willing to make the call or to reach out if they need to ask a question. They don’t want to be seen as a squeaky wheel and so therefore, sometimes, something that they thought was wrong didn’t get addressed because they didn’t ask. They don’t call when they’re confused. They maybe don’t press their doctor or the clinic to do it the right way and so they try to tell their doctor to do it a different way. And while listening to that and coming up with an answer for why the doctor or the clinic may do it a certain way is invaluable and doctors should do that.
I think at the end of the day, if a patient chooses a doctor in a clinic, they need to know that the doctor knows what they’re doing in that situation and that they may have a protocol that’s best for them, that works with their lab and their ultrasonographers and their hormone assays and their embryologists. And so really to trust that process and not try to take a different doctor’s opinion and apply it to a different clinic.
And then sometimes they don’t shop around. They don’t shop around to find the best doctor. They don’t ask their friends, what their friends have been through and learn from their friends’ experience. They don’t do their own research. I’m one of those doctors whose not offended by patients being on Google and looking up things and asking me questions. I know some doctors are. But I think that in a well-informed patient, allows them to take control of their fertility journey and to try to get what they need out of it in the right time for them. So, I think being open about what you’re doing with friends and family to try to get advice can be helpful in certain situations and I think making sure you find the best doctor and the best clinic for you can be important.
So, those are a few things on the patient standpoint I think that can go wrong. From the doctor’s standpoint, I think some doctors don’t review all the options and their statistics. And the personal statistics for their clinic. It doesn’t do me any good to tell you the statistics that are nationwide statistics. They may not apply to you. Our field is very specific. Our embryology lab is very tuned towards you as a patient and the patients we see. So, you need statistics and options that I can provide at my clinic. And doctors sometimes don’t give that information to patients.
Sometimes they individualize treatment enough for a patient. They maybe don’t listen and take that into consideration and sculpt a perfect plan for the individual patient. I also think some doctors will find one thing that is wrong and then not look for others and truthfully that’s what they teach us in medical school. They teach us to find one problem and go with it. There usually aren’t two. But the truth is, for fertility, there’s two people, theirs an embryo involved, there’s a uterus, two ovaries, two fallopian tubes and millions of sperm. There are lots of things involved and sometimes there can be more than one problem.
And then I think some doctors don’t ask for help. They don’t use their colleagues when it’s a difficult case. I know in our practice here, there are a number of physicians and one of our go to things that we do is we have a urgent/nonurgent email system and even if we’re not in the same office or even if someone’s out of town; when we have a tricky patient or situation that we want advice on; we will email the group and then get feedback and we’ve all as physicians committed to answering those emails so that we can get feedback to each other to help so that you really have five or six different physicians taking care of you in our office and trying to give you the most optimal plan for success.
Host: So, where patients and doctors go wrong in planning and executing treatment is on the patient side, patients don’t advocate for themselves, they don’t want to be seen as the squeaky wheel, they don’t shop around, they don’t do enough research. And on the doctor side, sometimes they don’t review all the statistics or present all the options and they find one thing and don’t search for other problems and sometimes don’t ask for help. So, then what happens after treatment has started? What happens if the first cycle has not worked? What is the best course of action then?
Dr. Hinckley: Well, that’s a tricky one. Usually, at least in my situation, I’ve tried to pull out all the stops and think through everything and make the best plan the first go round. So, it’s not like I’m saving ideas to try the second or third try. However, sometimes it doesn’t work, and I think that’s where it is really important for both the physician and the patients to take some time. Sometimes, if I call a patient with a negative result, we want to jump right back into the cycle and move quick, quick, quick. And while that is important, because this is a long journey; taking time to think through it, list out your questions. I often will have patients take a few days, write down your questions. More will come to you tomorrow that didn’t come to you today. And then I can address those as we plan the next visit. And I think along with that comes, make a follow up visit. Patients don’t want to take time out of their schedule and sometimes it’s hard to get into a doctor’s schedule, but I think by demanding time and this is one of those where you can advocate for yourself; you become a real person to your doctor and your clinic. You have more of a story and we’re able to really think through and plan that next treatment and make sure we have accounted for everything that we may have learned from that failed cycle.
This might mean a video visit in the current state of healthcare rather than just a phone visit or it might mean taking the time to come into the office if you can do that and sit down and help your doctor get to know what concerns you have and think through the issues to make a good plan going forward. I do think, getting a second opinion can be important. So, if you are at a clinic that doesn’t use a couple of different doctors to help weight in on patients’ options; if you are struggling and you haven’t been successful, then shopping around and getting a second opinion from a different doctor can be valuable. You may still want to go with that first doctor’s options but at least you’ve heard what else is out there.
One other thing is to try to do a cycle that gets you more answers. So, you may have made some choices for your first cycle based on cost and convenience. But sometimes, when things haven’t worked the way you wanted; it may be important to get answers with your next cycle. And that could look like doing embryo biopsy or PGT. It could look like doing an ERA test, endometrial receptivity analysis. Or doing recurrent pregnancy loss labs. These are other tests that may give you answers for why it didn’t work and could better guide your treatment in the future.
Host: Well Dr. Hinckley, as always, thank you for your time. It’s always great to talk with you. Any final thoughts on common pitfalls of fertility evaluation and treatment?
Dr. Hinckley: Oh well Bill, you’re welcome and I’m glad to be able to do that and I think probably the most important thing I could leave patients with is don’t be afraid to try again. Because sometimes it’s that next try that actually results in the child that you’ve been longing for and we’re not so precise in this field of medicine that it works 100% of the time and when it doesn’t work it means it never will work. So, sometimes, just being strong enough to try again is going to be the answer.
Host: Don’t be afraid to try again. That is just a great encouragement. So, thank you for that Dr. Hinckley. And thank you again for your time. We appreciate it.
Dr. Hinckley: Okay Bill. Thank you. See you soon.
Host: That’s Dr. Mary Ramie Hinckley and to get connected with Dr. Hinckley or another physician please visit www.rscbayarea.com, that’s www.rscbayarea.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Fertile Edge, by Reproductive Science Center of the San Francisco Bay Area. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): So what are some of the most common pitfalls of fertility evaluation and treatment? Let’s find out with Dr. Mary Ramie Hinckley, a physician at Reproductive Science Center of the San Francisco Bay Area. This is Fertile Edge, a podcast by Reproductive Science Center of the San Francisco Bay Area. I’m Bill Klaproth. Dr. Hinckley, it is always great to talk with you. So, let’s start with this. what are some of the most common pitfalls of fertility evaluation?
Mary Hinckley, MD, REI (Guest): Hi Bill. It is nice to be back with you again. And I’m happy to share some of the things that I like to talk to my patients about and how to get the highest success in the shortest amount of time by doing a proper fertility evaluation and ultimately treatments. So, one of the things I see a lot in patients that come to me is that they’ve made some mistakes in the early months or maybe early years that has really slowed them down and frustrated them. And so if I could help a patient by helping them avoid some of those common pitfalls, that would be my goal. And I think probably the number one thing I see that patients fall into by mistake, is doing an evaluation, a fertility evaluation that’s been ordered by a non-experienced fertility healthcare provider.
Oftentimes the wrong tests are ordered, maybe they are outdated, and they are ones that were used back in 1970 but we don’t do that anymore. Or maybe they didn’t tell the patient all the right information and did the test at the wrong time in their cycle. Or they had a procedure and it was done by someone who wasn’t as experienced and didn’t know how to look at the right things. Another classical example I sometimes get is a husband who has gone and done a semen analysis and their doctor looks at it and says it’s normal or looks at it and says it’s horrible and they come to me in a panic and I realize that wasn’t even the right information based on the semen analysis results.
Sometimes even they order the right test so the most common tests we like to order for women these days that are lab tests are the AMH test and the FSH and estradiol. But the doctors interpreted these wrong and the saddest part is when they’ve interpreted it wrong by telling the patient it’s fine and the patient’s waited another three or six months before they come see me and then I tell them no it’s not fine. This indicated that you needed to hurry and get to me quick. So, that’s probably the number one thing I see.
There are a couple other pitfalls I see. One may be not doing the recommended tests that the doctor orders, dragging their heels, maybe trying to save money and doing it in stages and just kind of dribbling through the tests so that we don’t have all the information we need when we’re trying to make decisions. And maybe poor communication. Just not asking. Maybe they have a question about how do I do this test, when should I do it and the patient doesn’t ask and just does it anyway and I think they need to know that we’re okay with you asking and doing it right the first time. I think those are some of the most common pitfalls. I think if you’ve done those tests, getting them to your doctor, your fertility doctor to review at your initial visit is key. Because we’re going to be the smartest if we can look at all that data at the same time and really synthesize what’s been going on and come up with the best plan. And if you see me and you don’t really have any of your records and you tell me your story but it wasn’t exactly right and then I get your records a couple of weeks later; it can be really hard to go back and change some of my initial opinions and ideas and to come up with a plan that really treats them for who they are.
So if you have those records, get them to your doctor when you show up the first time.
Host: So, three common pitfalls of evaluation. One, getting an evaluation from a non-experienced fertility provider. Two, not doing the recommended tests and three, not having everything ready for that initial review and that’s really important when you do that initial review, right, because you need to know everything you can at that point.
Dr. Hinckley: Exactly. And that’s going to help us make the proper evaluation so that then we can design a treatment that’s perfectly tailored for them.
Host: And then you mentioned something about questions. You really want people to ask as many questions as they have because you want them to be informed. Is that right?
Dr. Hinckley: I do. And I mean again, we only have a certain amount of time, but we usually spend a good hour trying to go over things at that first visit. But it almost is more when they go home, if they are wondering if something wasn’t clear, if they are not certain what I said or what the doctor that they saw said. Not to be afraid to call back to ask the nurse could you please clarify, could you help me understand when the best time to do this test is. Not guessing. I mean you’ve come to an expert for a reason, so use that expert to help you get the expert opinion you need.
Host: So, those are the pitfalls of fertility evaluation. Let’s turn to treatment now. So, where do patients and doctors go wrong in planning and executing treatment for patients?
Dr. Hinckley: So, this is the second thing that can slow people down to their goal to build a healthy, happy family. And there are places where patients can make some mistakes and there’s places where doctors could do a little better to help avoid some of the pitfalls. And so, here are just some of the common things I’ve seen. From let’s start with the patient side. I’ve seen that patients really don’t advocate for themselves very much. They sit back and they just kind of wait. They are not willing to make the call or to reach out if they need to ask a question. They don’t want to be seen as a squeaky wheel and so therefore, sometimes, something that they thought was wrong didn’t get addressed because they didn’t ask. They don’t call when they’re confused. They maybe don’t press their doctor or the clinic to do it the right way and so they try to tell their doctor to do it a different way. And while listening to that and coming up with an answer for why the doctor or the clinic may do it a certain way is invaluable and doctors should do that.
I think at the end of the day, if a patient chooses a doctor in a clinic, they need to know that the doctor knows what they’re doing in that situation and that they may have a protocol that’s best for them, that works with their lab and their ultrasonographers and their hormone assays and their embryologists. And so really to trust that process and not try to take a different doctor’s opinion and apply it to a different clinic.
And then sometimes they don’t shop around. They don’t shop around to find the best doctor. They don’t ask their friends, what their friends have been through and learn from their friends’ experience. They don’t do their own research. I’m one of those doctors whose not offended by patients being on Google and looking up things and asking me questions. I know some doctors are. But I think that in a well-informed patient, allows them to take control of their fertility journey and to try to get what they need out of it in the right time for them. So, I think being open about what you’re doing with friends and family to try to get advice can be helpful in certain situations and I think making sure you find the best doctor and the best clinic for you can be important.
So, those are a few things on the patient standpoint I think that can go wrong. From the doctor’s standpoint, I think some doctors don’t review all the options and their statistics. And the personal statistics for their clinic. It doesn’t do me any good to tell you the statistics that are nationwide statistics. They may not apply to you. Our field is very specific. Our embryology lab is very tuned towards you as a patient and the patients we see. So, you need statistics and options that I can provide at my clinic. And doctors sometimes don’t give that information to patients.
Sometimes they individualize treatment enough for a patient. They maybe don’t listen and take that into consideration and sculpt a perfect plan for the individual patient. I also think some doctors will find one thing that is wrong and then not look for others and truthfully that’s what they teach us in medical school. They teach us to find one problem and go with it. There usually aren’t two. But the truth is, for fertility, there’s two people, theirs an embryo involved, there’s a uterus, two ovaries, two fallopian tubes and millions of sperm. There are lots of things involved and sometimes there can be more than one problem.
And then I think some doctors don’t ask for help. They don’t use their colleagues when it’s a difficult case. I know in our practice here, there are a number of physicians and one of our go to things that we do is we have a urgent/nonurgent email system and even if we’re not in the same office or even if someone’s out of town; when we have a tricky patient or situation that we want advice on; we will email the group and then get feedback and we’ve all as physicians committed to answering those emails so that we can get feedback to each other to help so that you really have five or six different physicians taking care of you in our office and trying to give you the most optimal plan for success.
Host: So, where patients and doctors go wrong in planning and executing treatment is on the patient side, patients don’t advocate for themselves, they don’t want to be seen as the squeaky wheel, they don’t shop around, they don’t do enough research. And on the doctor side, sometimes they don’t review all the statistics or present all the options and they find one thing and don’t search for other problems and sometimes don’t ask for help. So, then what happens after treatment has started? What happens if the first cycle has not worked? What is the best course of action then?
Dr. Hinckley: Well, that’s a tricky one. Usually, at least in my situation, I’ve tried to pull out all the stops and think through everything and make the best plan the first go round. So, it’s not like I’m saving ideas to try the second or third try. However, sometimes it doesn’t work, and I think that’s where it is really important for both the physician and the patients to take some time. Sometimes, if I call a patient with a negative result, we want to jump right back into the cycle and move quick, quick, quick. And while that is important, because this is a long journey; taking time to think through it, list out your questions. I often will have patients take a few days, write down your questions. More will come to you tomorrow that didn’t come to you today. And then I can address those as we plan the next visit. And I think along with that comes, make a follow up visit. Patients don’t want to take time out of their schedule and sometimes it’s hard to get into a doctor’s schedule, but I think by demanding time and this is one of those where you can advocate for yourself; you become a real person to your doctor and your clinic. You have more of a story and we’re able to really think through and plan that next treatment and make sure we have accounted for everything that we may have learned from that failed cycle.
This might mean a video visit in the current state of healthcare rather than just a phone visit or it might mean taking the time to come into the office if you can do that and sit down and help your doctor get to know what concerns you have and think through the issues to make a good plan going forward. I do think, getting a second opinion can be important. So, if you are at a clinic that doesn’t use a couple of different doctors to help weight in on patients’ options; if you are struggling and you haven’t been successful, then shopping around and getting a second opinion from a different doctor can be valuable. You may still want to go with that first doctor’s options but at least you’ve heard what else is out there.
One other thing is to try to do a cycle that gets you more answers. So, you may have made some choices for your first cycle based on cost and convenience. But sometimes, when things haven’t worked the way you wanted; it may be important to get answers with your next cycle. And that could look like doing embryo biopsy or PGT. It could look like doing an ERA test, endometrial receptivity analysis. Or doing recurrent pregnancy loss labs. These are other tests that may give you answers for why it didn’t work and could better guide your treatment in the future.
Host: Well Dr. Hinckley, as always, thank you for your time. It’s always great to talk with you. Any final thoughts on common pitfalls of fertility evaluation and treatment?
Dr. Hinckley: Oh well Bill, you’re welcome and I’m glad to be able to do that and I think probably the most important thing I could leave patients with is don’t be afraid to try again. Because sometimes it’s that next try that actually results in the child that you’ve been longing for and we’re not so precise in this field of medicine that it works 100% of the time and when it doesn’t work it means it never will work. So, sometimes, just being strong enough to try again is going to be the answer.
Host: Don’t be afraid to try again. That is just a great encouragement. So, thank you for that Dr. Hinckley. And thank you again for your time. We appreciate it.
Dr. Hinckley: Okay Bill. Thank you. See you soon.
Host: That’s Dr. Mary Ramie Hinckley and to get connected with Dr. Hinckley or another physician please visit www.rscbayarea.com, that’s www.rscbayarea.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Fertile Edge, by Reproductive Science Center of the San Francisco Bay Area. I’m Bill Klaproth. Thanks for listening.