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At what point should I see a reproductive endocrinologist?
*You are 35 years of age or older;
*You have been trying to get pregnant for at least one year;
*You have been receiving infertility medical treatment for approximately
one year and have not gotten pregnant;
*You have a history of irregular menstrual cycles, sexually transmitted
disease, pelvic infection, hormone problems, excessive weight gain, endometriosis,
fibroids, chronic pelvic pain, DES exposure, excessive facial or body
hair, adult acne, or your male partner has been diagnosed with infertility
issues;
*You have had two or more miscarriages;
*You are about to start injectable infertility medications;
*The doctor you are seeing does not offer holiday or weekend office
hours for ultrasounds, blood work and inseminations;
*The doctor you are seeing is only using abdominal ultrasound and not
transvaginal ultrasound scans;
*The doctor you are seeing does not check your ovaries and hormone levels
while on clomiphene (clomid) to monitor the size of your ovaries, your
response to the medication and to determine when or if ovulation occurs;
*You have been on clomiphene (clomid) for several months and have not
gotten pregnant, and there is no change in your future treatment plan;
*You have been on clomiphene (clomid) for several months and your dosage
is simply being increased without any monitoring to determine how your
body is responding to the increased doses;
*Intrauterine insemination is not an option at your present doctor's
office;
*You are considering a laparotomy or laparoscopy;
*You have pain, prolonged bleeding and/or bowel or bladder symptoms
around the time of your period and your doctor doesn't suggest having
a hysterosalpingogram (HSG), a hysteroscopy or a laparoscopy to determine
the cause of the symptoms;
*A fibroid, polyp, uterine anomoly or tubal blockage has been noted
on a hysterosalpingogram (HSG)--ideally, you want to see the film yourself
with the doctor showing you the exact problem noted.
*You or your male partner have been diagnosed with a significant infertility
issue (consistently abnormal semen analyses, severe endometriosis, blocked
fallopian tubes, etc.) and in vitro fertilization is not offered as a
treatment option by your doctor.
What is a Reproductive Endocrinologist?
A reproductive endocrinologist is a subspecialist physician who has
received residency training in Obstetrics and Gynecology and advanced
training, a fellowship, in the treatment of infertility, recurrent miscarriages
and hormonal disorders in women. A typical Ob/Gyn resident receives between
5 and 12 weeks of training in Reproductive Endocrinology and Infertility,
while a fellow has that initial residency experience and then dedicates
2-3 years to the field after completing that residency. Reproductive
Endocrine fellows are trained in advanced procedures necessary for difficult
infertility surgeries, with a focus on minimally invasive laser surgery
that allows the woman to return to her regular schedule quickly and can
save precious months of fertility that would have been spent recovering,
procedures to reverse tubal ligation, injectable fertility drugs and
Assisted Reproductive Technologies such as in vitro fertilization (IVF). Although
the emphasis of most Reproductive Endocrinology and Infertility
fellowships emphasize infertility, training also focuses on hormonal
problems associated with menopause, abnormal menstrual cycles, polycystic
ovary syndrome, endometriosis, pelvic pain and recurrent pregnancy loss. During
the course of their training, reproductive endocrinologists gain a comprehensive
exposure to diagnostic tests, learn to manage ovulation induction, receive
training in surgical techniques relevant to reproductive endocrinology
and infertility, and are trained to provide the assisted reproductive
technologies (ART), including in vitro fertilization. Most importantly,
they are trained to manage potential side effects and complications that
may result from these treatments and procedures. To obtain Board Certification,
Reproductive Endocrinologists must publish a thesis and pass separate
written and oral examinations. Prior to taking the Reproductive Endocrinology
and Infertility examinations, they must successfully pass the written
and oral examinations to earn Board Certification in Obstetrics and Gynecology.
Most Reproductive Endocrinologists are equipped and capable of caring
for the problems of over 95% of the patients seen. For the patient who
has an unusual problem requiring special care, the Reproductive Endocrinologist
is likely to know where to find unique treatment and expertise, and can
facilitate seamless coordination of care.
What is the "official" definition
of infertility?
In general, infertility is defined as one year of unprotected intercourse
without conception. For women over 35, it is six months of unprotected
intercourse without conception.
What if I don't know what
my insurance covers?
When you come to the Center, after meeting
with Dr. Mersol-Barg, you will receive a personalized financial consultation
with one of our front office coordinators. At that time, we will look
at what Dr. Mersol-Barg is recommending, what options you are considering,
what type of insurance coverage you have, and what may or may not be
covered. With all of this information, we will work with you to develop
a detailed cost-effective plan. At that time, we will give you all the
information and codes you need to understand what your specific insurance
policy should cover in case you need further details from your insurance
company or if something gets wrongly denied and an appeal is necessary.
We are with you every step of the way. Our goal is to help you have a
baby and still have money for a beautiful new nursery or a nice
vacation!
What if I don't have
insurance?
We will work with you to develop a
personalized plan to pay for the services you need. We can look at discounts
and/or health care financing. We can also research organizations
that offer infertility "scholarships" for certain situations. Once you
have met with Dr. Mersol-Barg, we will work with you to make the services
you choose as affordable as possible.
Do you offer services for single
women or same-sex couples?
Yes. Since we opened our doors in 1998,
we have never discriminated against anyone based on marital status or
sexual orientation. In 1993, shortly after he completed his fellowship,
Dr. Mersol-Barg published an article in "Postgraduate Obstetrics
and Gynecology" recommending that physicians should treat single
women who are seeking fertility options. We have shown our support for
the LGBT community by contributing to the opening of Affirmations in
Ferndale along with regularly advertising in "Between the Lines" and "PrideSource"
publications. Dr. Mersol-Barg has also been featured in a 2006 article
published by "Between the Lines." Possible treatment options
for single women or same-sex couples are: egg freezing, donor sperm insemination,
donor sperm IVF, donor egg IVF with a gestational carrier, or perhaps
an IVF cycle using frozen donor eggs. When you meet with Dr. Mersol-Barg,
he will review your history and develop a personalized treatment plan
to fit your needs.
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