I did not have a positive experience with the fertility specialist I was sent to. There are several reasons why I feel that it was not a positive experience, but my take away is that it was not something I felt had any value.
After two years of trying to conceive with no success, and no useful information aside from my probable PCOS coming from any of our tests, my husband and I did get a referral to the fertility clinic in our area. I am thankful that in Canada, the initial doctors visits, testing, etc. is all covered by our public medical system. I am less thankful for the fact that that privilege comes with long wait times. It was about seven months from the time our referral was sent in to our actual appointment date, despite my calling and asking to be placed on a cancellation list just in case. Prior to our appointment, we were asked to fill in detailed medical histories, and provide an abundance of additional information. I assume this is to avoid filling out extra paperwork at the time of the appointment, and ideally to give the specialist time to look through our file and stats ahead of time so that he can enter the treatment room well informed. The specialist we were going to see came very highly recommended, both personally and professionally – and happens to be at the only fertility clinic in town, so there really are not a lot of options.
I will admit that, going into the appointment, I had certain expectations: I figured that someone dealing with such a personal subject on a constant basis would be sensitive to the emotional aspects of the process. Also, as I work in active rehabilitation and have my own caseload of patients, I expected him to have reviewed our file, as I would when I get a new patient. I should also add that, although I am hardly what you would think of as obese, I am built sturdy – think how you would picture a viking’s wife. I row, run, and hike over mountains recreationally, but I am far from slender.
The day of the appointment arrived, and I was a bit of a basket case – the long lead up had definitely heightened my expectations, and I was hoping that he would be able to offer some insight into what our next step should be. I knew I would have to have another trans-vaginal ultrasound, which is not a lot of fun. It’s uncomfortable and slightly degrading, but this time I asked my husband to come in with me, which I think was an eye-opener for him. He hadn’t come with me to any of the lead up tests, so he had not had the visual of exactly how… awkward… the whole process can be. The specialist confirmed my probable PCOS and then I got cleaned up for the actual consult.
The consultation is when the whole thing went sideways: It turned out that the specialist had not read our file, knew nothing about us or what had been tried so far (I.e. the abortive metformin use), nor was he aware of any of the testing we had undergone to date. After I pointed out to him that I had recently had an ovulation test done, he confirmed that I do ovulate, so that was a slight relief. He then suggested that he would also use metformin as a front line drug, ignored me when I pointed out that my body had reacted almost exactly in opposition of what was expected, and suggested a medication that would force my body into hyperovulation. When I queried his suggestion on the grounds of A) I had just taken a test that indicated that I do ovulate, and B) My body does not seem to respond to fertility treatments as expected, so C) I was very concerned that I would have an adverse reaction and would like a better rational for being prescribed a medication than “this is what we do for people with your diagnosis”, he got a bit snippy, dismissed me and my concerns, and wrote the prescription anyways. By the way, said prescription comes with a waiver that must be signed before you take it, absolving the doctor and his clinic of all responsibility for any consequences of the medication. The side effects were listed, were brutal, and were common – over 50% of individuals who take that drug exhibit one or more side effects.
This is when for me it gets really fun: Without having asked one single lifestyle question, taken my blood pressure, checked my health markers – the darling doctor suggested that I lose weight, and in epic 90’s loyalty, recommended the zone diet. Also worth mentioning here is that I have a history of disordered eating, and I have worked hard to correct my eating habits to the point that I am quite happy with both the nutritional content of my food, and my body. It does, unfortunately, remain a sore spot for me. At this point, between the stress and the rudeness of his suggestion, I was holding in tears. I suggested to the doctor that, since he knew nothing of my fitness or health background, and he hadn’t seen fit to ask, it was a poor suggestion. I also asked if he really thought that loosing weight had never occurred to me, seeing as I literally work in the fitness/rehabilitation field. He got huffy, made a non-apology for the possibility of his having offended me, and wrote on a prescription pad that I should try to zone diet, just in case I wouldn’t remember.
We left the office minutes after that, and I burst into tears in the elevator. Being offended was part of it, but I think the larger part was his lack of preparation or any apparent empathy. Maybe for him this was a run of the mill, uninteresting case of an apparently chubby girl with PCOS, but he badly missed the mark with me. I have neither signed the waiver absolving him of responsibility, nor filled the prescription for the medication he prescribed. I did not, and do not, believe that he gave our case any actual thought. Although I am sure that there are people for whom it would be effective, my knowledge of my own body, and experience with previous medications, makes me think that it was a poor choice for me.
At this point i’m 30 – other than the fact that we haven’t been able to conceive after three years, we are not actually in any statistically significant time crunch. If I do need large scale medical interventions (IVF, IUI, etc.) They are just as likely to be effective in 5-10 years as they are now. And if I do choose to go that route, I will find another specialist, including if I have to travel to do so. In the meantime I am exploring other, less invasive, options.
As I said, not a positive experience. My personal hurt and sensitivity about my weight aside, from a professional standpoint, I remain unimpressed that he was so poorly prepared, and unwilling to listen to what I had to say about my own body. In “When Breath Becomes Air” by Paul Kalanithi, he talks about Doctors who remove themselves and just dictate to their patients compared to those who work in a collaboration. The reality is health care is a customer service – it aims to provide solutions for what ails you. This specialist clearly had bought into the god complex dictation of action, and missed the mark on being able to collaborate. My choosing not to go back and see him will have no effect on his life, he will remain busy and probably finish his career with distinction. Which is nice for him, but I am unwilling to give him the opportunity to make more of a mess of my hormones than they already are.
So no, as my husband calls them: “Crazy-making drugs” for me any time soon.