Fertility health care

My husband and I were only “infertile” for a few months, but that was scary enough.  I read in the Impatient Woman’s Guide to Getting Pregnant that the man should get a semen analysis right away so that there would be time to fix things if necessary.  We tried to follow that advice, but it was really hard to find a semen analysis anywhere.

The ironic part is that our fertility issue (other than our ages) seems just to be something very cheap to fix:  a $150-200 semen analysis + some blood tests + Clomid for him.  The imaging study that I had that month may have helped to clean things out either physically or with 3 days of antibiotics.  And knowing my exact ovulation date almost a week in advance also helped.  Regardless, much cheaper than ART.

First, I had to figure out where to find a semen analysis.  I tried calling the in-network lab for my insurance company, but their in-person locations were either far away or didn’t do semen analyses.  It took some googling to figure out that urologists were the type of doctor to see.  I called several urologists in our neighborhood and my husband’s work neighborhood, and made appointments, but appointments were more than 6 weeks out.

Second, I realized that I should probably find good urologist, not just a convenient one.  One urologist at a medical school faculty practice wouldn’t accept insurance for a semen analysis, so we put off that appointment.  That’s the urologist that my husband ended up seeing in the end, and we paid $157 out of pocket for the semen analysis even though we got semen analyses at REs for just a $20 copay.

Third, once I made an appointment with a reproductive endocrinologist, the RE would do the semen analysis, but only AFTER I went to see the doctor.  Even though my appointment wasn’t for a month, they couldn’t allow my husband to come in for the semen analysis before I saw the doctor.  My husband ended up getting one semen analysis there, but the RE didn’t refer us to a urologist.  I would have appreciated that option in case we wanted to switch from the current urologist that charges out of pocket for semen analysis.

We switched REs from one big-name university RE clinic to another big-name university RE clinic — the first had suggested unnecessary surgery, and had incredibly unhelpful office staff — and the second RE did their own semen analysis.  By that point, my husband had already seen his urologist 3-4 times, so we said we didn’t need a referral.  The main purpose of this semen analysis was to determine that we needed ICSI.

All together, my husband had 3 semen analyses:  2 at REs and 1 at a urologist. All showed the same diagnosis — morphology on the low side, but possibly made up for by other parameters — but only the urologist offered treatment.  REs are trained as gynecologists before their fellowships, so perhaps they aren’t allowed to treat males, but I would expect a closer alliance with urologists so that male partners can get treated at the same clinic.  I was very happy with our 2nd RE, but neither RE made sure that my husband was receiving adequate treatment for his diagnosis or that he had a good urologist.

About 1/3 of fertility problems are male-factor, so this situation is hardly rare.  We got pregnant naturally the month after an IVF cycle during a month before an intended frozen cycle.  While it’s rarely that extreme, it seems that health insurance companies should do more to encourage these linkages between REs and urologists to make sure that semen analyses aren’t only done for making the decision about IVF/ICSI.

Or maybe REs aren’t that interested in helping natural conception because the chances are so much lower than for IVF.  We were lucky in that our RE told us that we could definitely get pregnant on our own, but it might just take awhile.  That was reassuring to hear.

Others at the same clinic were not reassuring.  The nurse told us at the IVF class that we would have to take the month off if we did not get pregnant.  When I asked if a fertility monitor still worked normally in the month after an IVF cycle, the nurse looked at me quizzically.  She said that a fertility monitor would work, “if you still want to give that a try.”  She was clearly trying to be encouraging, but I think she thought that I was engaging in wishful thinking.

Doctors face a tough balance between pragmatism and hope.  Much has been written about this.  In some cases, though, there’s cheap treatment to be had, like a simple semen analysis and my husband’s Clomid.  If we could have done semen analysis as soon as I read about it, we might have gotten pregnant several months earlier and saved our insurance company the cost of a round of IVF/ICSI.

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