Sunday, August 28, 2005

Big plans, many questions

This is a big week - we have new patient consults with two clinics (Monday and Wednesday) and in between I have my first (and very full day) at my new job. All of which have the potential to be good. I’m trying not to think about the job until then - trying to savor the last days of a summer in which I should have accomplished more. So instead, I thought I’d share the absurdly long list of questions we’re taking with us to the consults. I suspect much of this will get covered in the consult, so I won’t actually have to ask, but since we’re trying to decide between two clinics, I figured we should have a comparable dataset from each clinic from which to work. Except that I suspect it will, in the end, come down to the things that are peripheral to the list - the vibe, the feeling we get from the staff, the feeling we get from the doctor. Both clinics are highly regarded. Both have good success rates on the (totally out of date) CDC statistics. Both are in town (though one is more convenient than the other). Both clinics seem to do lots of ICSI, blast transfers, and FETs. Both have well-trained embryologists on staff. In the end, only a few of my questions will be deciding factors. Based on my initial dealings with them, I already have a tentative preference. But I’m trying to keep an open mind until Wednesday. And then I’m all about choosing one and moving on.

Without further ado, here’s the list of questions:

Ambiance (to observe, not to ask, obviously)

  • What's in the waiting room? (Are there pregnancy magazines? Toys? Comfy chairs? I will spend a lot of time here - how does it feel?)
  • Is the receptionist friendly? (Also all other staff I meet?)

Procedural

  • Number of patients cycling each month? How many retrievals and transfers do you do each week?
  • What are the embryologist's qualifications: degree, experience, etc.?
  • Are there any times when they don't do cycles (holidays, etc.)?
  • Will we be working exclusively with one doctor or will we rotate depending on availability?
  • Who does morning ultrasounds? What are the hours for labs/monitoring? How long should I expect to be here each morning for monitoring?
  • How often do you perform ICSI? Blastocyst transfers? Frozen embryo transfers?
  • Do you have specific expertise with PCOS? What kind of protocol might you suggest to reduce the risk of OHSS? What percentage of your patients experience OHSS?
  • What are your criteria for canceling a patient's cycle? Who has the final say - the RE or us? (Thanks, unfortunately, to InSpring and Thalia for this one.)

Communication

  • Who does callbacks with instructions? With good or bad news? If we have questions the nurse can't answer? How long does it take to get a call back from the doctor?
  • Will we have emergency access to the doctor after hours (on call)? By phone or email?
  • Is there a nurse or coordinator I'll be able to speak with consistently (same person throughout the cycle)?

Specifics

  • How do you feel about the use of acupuncture in conjunction with an ART cycle? Do you allow the acupuncturist to do treatment on site before or after transfer?
  • What do you think our prognosis is? What kind of protocol do you recommend for us? How many embryos would you recommend we transfer in an IVF? Is there any merit in doing another IUI? What medications would you use in an IUI or IVF?
  • Do you prefer patients who ask detailed questions about treatment, diagnosis, or symptoms? Are you comfortable with patients requesting detailed information about their treatment? (In other words, how do you deal with involved, well-informed, detail-oriented patients... patients who bring in obsessively long lists of questions they’ve vetted with their infertile friends...patients who aren’t going to stop asking questions even after choosing a clinic...patients with no patience like me?)

Given the ridiculous length of this list, I’m not so worried I’ve forgotten something anymore, but if I have, please tell me. What would you ask?

7 comments:

  1. Yeesh...that seems a pretty comprehensive list of questions to me. I feel like a complete imbecile for having no such list myself. When I'm asked "Any questions?" I shrug and look blankly at my husband. This may be why nothing has worked yet, hmm...

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  2. Good questions. I would add just a couple:

    1. Do they have more recent stats than the ones published on the CDC? (My clinic gave me their 2003 stats, which they thought should be published soon.)

    2. What are their thoughts on day-3 vs. day-5 transfer? If they do both, what criteria do they use to determine which day to use? (For example, my clinic had a cut-off number--if it was below 8 or 9 embryos, day 3, otherwise, day 5.)

    3. I think you touched on it with your question about information dissemination, but you might want to ask about what level of detail you'll get from the nurses/docs--ie, will they tell you that your E2 was 600, or will they just say it was "good"?

    Best of luck to you, sweetie--hope these questions are moot!

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  3. What a great list, cass. You should bookmark this post like Tertia does as a "popular post" so ppl can come back to it when they need it. Thanks for putting it together and wish I'd had it handy (or even known I'd had a choice!) a few months ago.

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  4. Definitely an amazing list. I never would have thought of those questions.

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  5. Wow, amazing! I agree with Thalia, this should be a reference for others - great work. All I can add it the SART has recent CDC #s. Check out this website http://sart.org/servlets/listclinics?state=CA

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  6. Gracious! Can I take you with me to my doctor's appointment?
    Hoping things go/went well at your new job and the consults...

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  7. I wish I had had this list when I chose my clinic! The only thing I might ask is what pharmacy they use, and how fast is delivery - my RE's office uses only one pharmacy and it takes days to get medication from them - a problem when you have to start a med and the pharmacy is swearing it will be delivered 'in the next few days".

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