Finding the right IVF doctor can make a world of a difference to your IVF treatment, which is why spending time, money and energy hunting for the best IVF doctor in the best IVF clinic is vitally important for you. Unfortunately, most IVF patients don't know how to go about looking for the best IVF doctor, and often end up getting suboptimal treatment, because they are not taking treatment in a good IVF clinic.

Who is the best IVF doctor ? For every patient, their idea of the right IVF doctor will be different, which is why you need to invest time and energy in this pursuit. You need to have a plan of how to go about finding the right IVF doctor for yourself. Step number one is to start by preparing a short-list of possible candidates. You can phone or email the IVF doctors on your list. Telephone shopping can provide you with a lot of useful information about an individual doctor's practice, including details of clinic timings, fees, qualifications, hospital attachments, special interests. After all, if you are willing to research which travel agent will give you the best deal on a holiday trip, then isn't it worthwhile researching into whose hands you are going to put your life in? You can learn a good deal about the doctor and his practice, even before you actually meet him, by merely telephoning and asking the right questions.

While it is true that many mediocre doctors flaunt posh clinics, the setting in which the doctor functions can reveal a lot about him. Is the clinic located in a decent building? Is public access easy? Has the doctor bothered to provide the basic amenities you need (e.g., drinking water, comfortable seating)? What kind of reading material is kept in the waiting area? (Old and torn magazines should qualify as a negative mark. Patient educational literature and current issues of health magazines indicate that the doctor respects your waiting time and wants to use it to educate you). Are the office staff members helpful? How do they answer the telephone? How do they treat other patients? You can learn a lot about a doctor and his practice from the personality of his employees: remember that efficient, caring physicians tend to hire competent, friendly personnel!

While selecting a suitable doctor can be difficult, try to find answers to the following questions.

• Credentials - training and qualifications.
• Skill and experience.
• Accessibility (locations; clinic timings).
• Affordability (fees).
• Professionalism.
• Does he prepare for your appointment?
• Explain records and test results?
• Keeps appointments and values your time?
• Manage an efficient clinic?
• Review your status and progress periodically?
• Personality and style.
• Does he talk to you? Take time to listen to what you have to say?
• Does he show empathy and compassion?

A good infertility doctor will usually: involve both husband and wife in consultations, discussions and planning. Offer recommendations and choices. Since there are no right answers, he should allow you to choose your own course of action.. Tailor testing and treatment to your emotional needs and budget. Have time to answer questions and offer support. Chalk out a treatment plan for you, with a discussion of rationale, alternatives, costs, time limits and expected success rates.

Many patients are still not very sophisticated when it comes to selecting their doctor. Most Indians follow a herd mentality, and believe that a busy doctor must be the best - after all, if so many patients go to him, he must be good. However, remember that you need to be more critical when making such a crucial decision - after all, you have to trust that your doctor's skills will provide you with the best treatment for your infertility. There is little point in going to a doctor who is so busy that he has no time to talk to you, or who cannot even remember your name!

Most gynecologists can provide basic infertility workup and testing - but you may prefer to look for a specialised infertility clinic which will provide all the services you need under one roof, especially if you have a complex problem. Many gynecologists are not really geared up to providing the care which an infertile couple needs, and it's not much fun sitting in a room with pregnant women who have come for their obstetric care, if you are infertile.
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The risks of going to a general gynecologist for treatment are:

1. They may not have the expertise or specialised knowledge to treat your problem, since they may not be aware of recent advances in this field.
2. They may not have access to the specialised tools needed to treat you, with the result that you may have to run around from the doctor to the lab to the ultrasound clinic for your treatment.
3. They may not have a special interest in treating infertility, so that you may end up getting second class treatment.
4. A common mistake many gynecologists make is that they keep on repeating the same treatment again and again - wasting valuable time and money in the process.

We often find that by the time patients come to us, they are so fed up and frustrated, since they have wasted so much time and money on repeating ineffective treatments, that they have lost confidence in doctors - and in themselves as well! Don't let this happen to you! While going to an infertility specialist can help you to ensure you are on the right track, this does entail the risk of overtreatment as well. Unfortunately, many infertility clinics are happy to do IVF for all infertile patients who come to them, whether or not they really need this!

Getting a second opinion

Get a second opinion - this can never hurt and is always helpful. If you find two experts saying the same thing then you know you are on the right track! If, on the other hand, they disagree, don't get upset - there are few black and white areas in infertility, and doctors often have different ways of treating a particular problem. Ask questions of both of them and then choose the method which appeals to you - it's finally your decision!

What if you don't understand what the doctor is saying and are getting confused? This is not your fault. If you do not understand anything the doctor says - ask questions! If you still do not understand the fault is his - he is not explaining in terms which you can follow. Find another doctor!

Remember that you need to ask questions to get answers - your doctor cannot read your mind! But also remember that your doctor does not have all the answers - after all, medicine is still an imperfect science, and your doctor is not a fortune-teller. If he does not know the answer, he should tell you this as well.

How do we do a consultation in our practice? We first ask the couple why they think they have not been able to conceive, and how they expect us to be able to help them. The answers give us a good idea of how much the couple understands about their problem. It's often heartbreaking when we see couples who have been through 3 IVF cycles, and don't even know how many eggs they grew or how many embryos were transferred each time - or even why the IVF was done in the first place. During a consultation, we first explain, using models, how babies are made. We then review the medical records, and explain to the patient what we feel their medical problem is. We then explain to them what the treatment options are, and tell them to think about these and then make up their mind. In our clinic, we do not charge for a repeat consultation, in order to encourage patients to ask questions, and to give them time to make up their own mind. We take pride in the fact that our patients have a good understanding of their medical problem, and realistic expectations of how we can help them!

Remember that the purpose of a consultation is to get information. If you do your homework before going, you will be able to make better use of your doctor's time, since you can focus on the issues which are important to you. You then need to go home and process this information, so you can decide what to do. It's very difficult to think straight when you are sitting in front of the doctor, so it's usually a good idea to give yourself enough time to apply your mind and assimilate the information, before making a decision. There is usually no urgency, since infertility treatment is never an emergency. Beware of a doctor who wants you to decide on the spot - it's hard to do so under pressure, and you may end up making a decision in haste, which you may then repent at leisure.

As an infertile patient, you are very liable to being exploited and quacks in this field abound! Suspect your doctor's credentials when:

1. He promises too much.
2. He says things like - that's my secret.
3. He doesn't explain clearly what he is doing during treatment.
4. He advises too many tests and surgical procedures repeatedly.

When to Change Doctors

Because infertility is often a long drawn-out process, anger is a natural result - and often this is transferred to your doctor. However, constantly changing doctors or doctor-shopping can be counterproductive! If the quality of care you are receiving is good, be cautious about changing doctors - a doctor who knows you and your infertility problem well can be of significant help to you.

Changing doctors is never easy, because, over a period of time you do build up a personal relationship with your doctor. However, you should consider changing doctors if you feel that :

• The doctor is incompetent (i.e., he has ignored obvious symptoms, missed a diagnosis, prescribed the wrong drug, or can't get to the bottom of your problem);
• The doctor does not communicate with you effectively (i.e., his explanations are not in lay person's language or no time is given to you to ask questions and bring up related problems);
• The doctor does not pay attention to your needs and concerns;
• You have lost confidence in the doctor's skill and ability.
• You find the doctor is too inconsiderate (i.e., he makes you wait a long time for an appointment, he fails to return your phone calls, he does not provide clinic time during evening or weekend hours); and
• Your doctor is too expensive.

A common problem patients face is that when they go to a new doctor, he insists on repeating all the tests all over again. While this can be frustrating and expensive, it can be helpful as well, because it allows the doctor to reassess your problem with a fresh perspective. Please ask your doctor to explain why he needs to repeat the tests, and how this will help in your treatment. If tests have already been done, but are more than a year old, or if they have been done from an unreliable lab, you may need to repeat some of these again.

It is all too common to find that infertility clinics do not provide complete medical treatment details to their patients. They often do this in order to make sure that the patient remains with them, and does not go to another doctor. This is very unfair - remember that your medical records are your property, and you are entitled to a copy of them.

You may find that your new doctor criticises the treatment your previous doctor provided. Remember that doctors do have big egos, and they are often intensely competitive and critical of each other. This can upset you, because you may start feeling that you were given substandard medical care. As long as you have a clear understanding of what was done to you and why, you should ignore this criticism - don't let it disturb you. Anyone can be wise with hindsight - and do remember that all doctors will try to do their best to help you to get pregnant!

Many doctors will repeat exactly the same treatment the previous doctor has administered - often because they have nothing better to offer! However, remember that even though you have changed your doctor, you have remained the same - and the purpose of changing doctors should be to allow you to progress further with your treatment.

Choosing an Infertility Clinic

Many couples ask us whether they should travel abroad for treatment. Fortunately, the quality of medical care available in leading IVF clinics in India today is easily on par with the world's best clinics, since they use exactly the same equipment, and the same techniques. In fact, IVF treatment in India is an excellent bargain by international standards, since you are getting exactly the same quality of treatment you would get anywhere else in the world - at a fraction of the cost. This is why so many IVF clinics in India routinely treat infertile couples from overseas.

How does the quality of care in the smaller towns in India compare with that available in the metropolises? Do you always have to travel to a clinic in a large city for treatment? Since there are no standards or regulations (IVF clinics in India today do not need to meet any quality control criteria) you need to be an educated shopper! While the quality of care can be quite good in smaller towns, most of the reputed clinics are in the larger cities. These bigger programmes are usually better, because they are busier, and more experienced, and busy IVF programmes (which perform more than 150 treatment cycles per year) have been shown to have higher pregnancy rates. However, very busy clinics may not be able to provide you with the personalized care you need, and some can be quite uncaring, so that they make you feel that you are just a cog in a machine. For simpler treatment such as IUI, it is best to look for a good clinic in your own town. However, for advanced treatments, you may be better off going to an established clinic. While travelling can add to your stress and expense, many infertile couples actually prefer not having to take treatment in the city which they live, as they would like to protect their privacy.

The Need for Active Participation

Remember, you are in charge of your own medical care! Medicine, as both a science and art, often requires choices and there are no right answers - you need to make your own decisions. After all, it's your body and your life!

You have a vital interest in treatment decisions and outcomes but lack the medical knowledge and skill to decide alone. The concept of a team - the medical caregivers ( doctors, nurses, specialists) and you (the couple), working together, allows each to contribute to a successful outcome and offers you a sense of control over your infertility care.

Your role on the medical team is multifaceted - you need to wear many hats when you are an infertile patient!

Emotional Care

When confronted by infertility, you need more than just medical care - and a good doctor will help to provide you with emotional support as well. Unfortunately, doctors often end up amplifying the stress infertile patients find themselves having to cope with. Many doctors make patients long hours, for no good reason; and others are often insensitive to their emotional needs. Others may be quite thoughtless, and instead of trying to provide special attention to the needs of infertile couples, make them wait with pregnant mothers in the clinic. A good clinic, on the other hand, can help to alleviate your stress, by recognizing it; teaching patients that this is normal; and showing them how to cope with it. A good doctor will be able to establish a relationship with the couple, based on understanding and respect, to help them maintain and rebuild their self-esteem.

Questions to Ask Your Doctor

• Do you have experience in fertility treatment? When do you consult with an infertility specialist?
• Will you refer me to an obstetrician when I get pregnant or will you deliver the baby?
• Will you send me to any other physicians or laboratories for treatments or tests?
• Will you treat my spouse? If not, who will?
• Do you arrange for adoptions?
• Do you document surgeries with photographs or videotapes so I can see your findings for myself or provide them to other doctors?
• Which hospital(s) do you use?

Questions to ask about Tests, Surgery and Treatments

• What kind of procedure is it?
• What will the procedure tell you?
• What results do you expect?
• How long will it take?
• What will it cost? Does insurance cover it?
• Will it hurt? How will it make me feel afterward?
• Can you do it in your office? As a hospital outpatient?
• Will I be incapacitated? For how long? Will I miss work?
• Will my spouse be involved? How? Will he/she miss work?
• Will it interfere with our sex life? How?

Questions to ask about Medications

• How long will I take it?
• What will it cost? Does insurance cover it?
• Will it hurt or have side effects?
• Do I take it at home or at your office?

Remember that just finding a good IVF doctor is not enough. For an infertile couple, the doctor-patient relationship is the ultimate one-to-one relationship, in which you confide fully in your doctor and trust him to help you to conceive. You need to form a partnership with your IVF doctor, so that you can make the most of his skills and abilities.