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1.05 Where to get help when you are trying to get pregnant

Today we are going to talk about where to get help when you are having problems falling pregnant.

Not surprisingly, friends and family members are often the first you turn to when you're trying to get pregnant and it’s not quite happening the way you expected. Unfortunately, chances are you'll also be overwhelmed with tips and advice. The thing to remember here is that problems often not only run in families but also within social groups. Family and friends often live in a similar way – which is why they are friends in the first place- and so often have the same problems or are exposed to the same issues. Or they may just not recognise the problem. So, just because mum and aunt Emily have always had to take time off with their periods because of period pain, doesn’t make it normal. In the same way, because your friend got pregnant while on holidays in Bali, that doesn’t mean that’s is the way to fall pregnant. Fertility problems in particular, have a lots of causes and the solutions are often quite different.

The next obvious place people turn to is the internet or social media. While the internet is a fascinating source of lots of valuable information, it is important to understand that the advice is not necessarily appropriate or even correct. In fact, a study conducted in 2012 by Dr Rachel Moon of the Washington University showed that only about 4:10 websites provided information that was in line with current knowledge, while 1:3 provided advice that was just plain wrong. Government and organizational websites with .gov or .org extensions were more likely to be accurate, but still only about 80% of the advice was correct. Even more disturbingly, 1:5 sites had a clear commercial conflict, of which 4:5 contained inaccurate or misleading information.

Probably the most appropriate and accessible person to help is your general practitioner, primary healthcare physician or community nurse. Health care professionals have the appropriate background knowledge to assess and identify such issues. Not only will they often solve the problem but can also facilitate the next step, which may include referral to a specialist.

Specialists in obstetrics and gynaecology are specifically trained in the assessment and management of patients with infertility, including pregnancy management. There are of course different types of specialists. There are general specialists, who deal with all matters in women’s health, such as period or continence problems. Then there are specialists who have a specific interest in areas such as fertility. They may also have other qualifications in these arears, which makes them even more specialised.

At the top of the advice and treatment tree sits the subspecialist in reproductive endocrinology and infertility. You can think of a subspecialist as a specialist for specialists. In Australia and New Zealand, these specialists are identified by the letters CREI at the end of their qualifications. These qualifications mean that this person has had the most extensive training and the most specialised knowledge in this area. It aslo means that they have to continually refresh their knowledge to demonstrate that they can perform at a peak level.

Now, it is not necessary for every person to be seen by a subspecialist, and in fact, it is probably counterproductive. Specialists in obstetrics and gynaecology have been trained to manage all aspects of fertility and pregnancy, and resolve most problems that cannot be managed by your gp.

So, how do you find the right specialist? Well, again, your GP is the most appropriate person to provide a referral – googleing your specialist will give you information on their activity, gender and age profile, but don’t pay any attention to review websites. We know from a number of studies that review style websites are unhelpful with respect to health care – they are usually excessively positive or excessively negative - and have no correlation with outcomes.

Regardless of who you consult, there are some questions you should ask. Firstly, is there a problem? Fundamentally, you need to know whether there is a problem, or whether it is ok to just continue trying. If everything is ok, what can you do to increase your chances? For your guidance, we have addressed these points specifically in other videos in this series.

Secondly, you need to know what the problem is rather than just applying a one size fits all solution, like IVF.

Managing your fertility is a process, the first step of which is to fully investigate the underlying causes for your fertility problems. Your specialist will normally establish the cause, correct these problems, correct any lifestyle factors and offer the most appropriate management option in consultation with you.

Thirdly, you need to know what options are open to you.

Subspecialists have access to all treatment options, including medical management of hormonal disorders, ovulation induction, insemination, egg / embryo / sperm donation, surgery, and of course, IVF. Specialists are therefore optimally positioned to assess and manage all fertility, recurrent IVF and pregnancy loss conditions.

Next, you should be given some information on what the chances of having a single healthy baby are from one started treatment.

Success rates vary greatly depending on your individual circumstances and the causes of infertility. The individual success rates for your treatment should be discussed by your treating specialist.

Finally, you should be aware of the costs of your treatment, which will be in terms of time, emotional and financial investments. At least from a financial point of view, you should receive an appropriate cost estimate at the start of any treatment from your specialist. Your specialist will also address the time commitments for your treatment.

So if it hasn’t happened for you yet, there is a lot of help and information out there, you just need to go to the right source, and the fact that you have landed here means that you are on the right track!

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