The In fertility Evaluation and Treatment Plan: Defining Success
Dr. Gerard S. Letterie

Infertility treatment is unique in the spectrum of medical care.  Cooperation and synergy between patient and doctor should result in the most successful and balanced treatment plan, one that embraces medical, personal and emotional issues.  Several aspects of infertility evaluation and treatment contribute to a successful outcome.

Defining Goals
For any infertility therapy to be successful, you the patient must define a clear-cut goal.  My definition of that goal is to establish a family.  You can achieve that goal several ways: through the birth of a biological child using your own gametes ( sperm and/or eggs), through use of donor gametes, through adoption or by consciously choosing to exist as a childfree family.  

Whichever is the path you take, success is the ability to move forward with closure and satisfaction and toward a happy, healthy life as a family.  And I believe a family may be one, two or ten members, perhaps requiring us to redefine the word “family.” Let us address this a little bit later.

As a fertility patient on your own path, you should expect your medical team to help guide you through the maze of options and complex technologies to formulate a plan that is unique, personal and effective.  What every infertility patient needs to know at the start is that resolution is possible for everyone.  The events that contribute to this resolution may vary but the final outcome of treatment should be the ability to live life fully as a family and without regret.  

Achieving Your Goals
Information is the key to achieving your own family building goals.  It is only with as much information as possible that we can make informed decisions that ultimately lead to success.

I like to classify information into “hardware” and “software” categories.  Hardware is the aspect of the infertility evaluation that we can quantify and measure; it reflects the clinic’s medical expertise.  This is defined by success rates or pregnancy rates.  

Software is the qualitative and subjective part.  It is personal, may vary from patient-to-patient (and even between members of a couple), and influences decision-making and treatment choices as much as the hardware.

The Hardware of Infertility Treatment
Each year the Centers for Disease Control and Prevention (CDC) publishes fertility clinic-specific success rates as required by law using a standardized format.  In addition, the Society for Assisted Reproductive Technology (SART) has been collecting and publishing annual reports of pregnancy success rates for fertility clinics since 1989.  

Success rates can be accessed at the RESOLVE Web site (www.resolve.org) or the CDC Web site (www.cdc.goy/ART/index.htm).  Success rates are highly dependent on the technical skills of doctors and nurses and the laboratory team, as well as the fertility specialist’s clinical experience (number of years in practice, number of patients evaluated and in vitro fertilization cycles performed annually). All these factors are of extreme importance.  

Additionally, hardware includes the effectiveness of the fertility clinic’s administrative staff, on-time appointment rates, responses to questions within a reasonable time frame, and the availability of insurance and financial consultation. These factors also contribute to attaining your goals.  

Emotional support, either at the clinic or through an affiliated counselor, is essential for infertility patients, especially for those grieving a pregnancy loss.  For any infertility patient, familiarity with this information is the first step in the family-building journey and provides clues regarding clinical care.  It gives no insight, however, regarding the personal aspects of infertility treatment.

The Software: Communication, Collaboration, Personalization
Infertility treatments are unique to each couple; a cookie-cutter approach is inadequate.  Personalized care is the standard today.  You should expect an infertility practice to expend enough time and resources on providing you with information to meet your individual need-to-know.  

Communication from everyone at a fertility practice about success rates, costs and prognosis should be jargon-free and clear to you the patient.  Infertility therapies are by nature physically and emotionally intense, and effective communication between your doctor and you is the cornerstone of a successful treatment plan.  
The goal of the medical team should be to partner with you and craft a treatment plan that incorporates the best technical aspects of care while respecting your individual needs and goals.  Your doctors should give you a balanced view of success. For example, during treatment he or she should discuss what to do if things do not go well, when to continue and when to stop treatment.  

In addition, you and your doctor should formulate an exit strategy if you’re not able to conceive.  It is important to enter into a treatment plan with your eyes wide open.  To ensure that you achieve your goals, you must have adequate face-to-face consultations and an opportunity to express feelings and preferences.  
Back to the Beginning: Redefinition
Let’s revisit our goal:  family building.  We are redefining the term “family” as the end point of the infertility treatment plan.  

A Robin Williams’ movie sensitively does just this in a great scene in Mrs. Doubtfire, in which Williams plays the role as an out-of-work actor masquerading as a matronly female housekeeper. As Ms. Doubtfire, Williams is responding to a letter in which a child relates concern about what his family will become after an impending divorce.  

He explains that there are all sorts of families; some with one person; some with a grandmother and a granddad; some with a mom and a dad and no children; some with just a mom or just a dad.  The point is that family bonds are diverse and transcend so many conventional definitions.

How we get through the infertility maze to establish our families is the key to success.  It is clearly one event in our lives in which the process is as important as the end product.  

Dr. Gerard Letterie is the practice director at the Northwest Center for Reproductive Sciences, with offices in Seattle and Kirkland, Washington, and clinical associate professor at the University of Washington.