Founder's Notes

Telehealth and Initial Consultations

Here we discuss remote consultations with Dr. Chantel Cross, infertility specialist and Associate Director of Reproductive Endocrinology and Infertility Fellowships at John Hopkins Medicine.

We’ll address what gets covered in an initial consultation, what information is needed beforehand, what happens thereafter, as well as the tradeoffs of doing this remotely versus in-person.

Information To Have Handy

Show up (whether in person or virtually) prepared with your background medical history. This includes:

  • Details around your typical cycle (how many days in your average cycle, do you know if you ovulate).

  • Past gynecological and obstetric history (have you ever been pregnant, had an abnormal PAP smear, etc).

  • Information on past surgeries or other current or chronic conditions for both partners.

  • If you’ve completed previous fertility tests or have undergone fertility treatments with another clinic, make sure you have those records handy too.

The more information you have at your fingertips, the easier it will be for the doctor to decipher what may be happening. Also, providing this level of detail may save you from having to repeat tests unnecessarily.

If you have a partner, this process will go much more smoothly if they join from the outset.

Covering The Basics

Most fertility consultations include a rundown of how natural fertility works, the tests to gauge what may be problematic, and the ways in which various treatments address challenges.

It can be a lot to process and yet it’s helpful for you to build a foundation on the subject matter sooner-rather-than later.

Fertility 101

How Are Telehealth Consultations Unique

Positives

The upside of telehealth consultations are scheduling flexibility, the comfort of being in your home - and at this time, of course, minimizing your risk of being exposed to a viral infection.

You may be able to record the session (on your computer) should you want to revisit it or in case a partner can’t join you live.

Negatives

The downside is that you may not get a sense for the office and it can be harder to build a rapport with your doctor.

As you can see in our published data, whether your doctor treats you “as a number or as a human being” is a crucial determinant of how you’ll come to regard the decision.

Doing any physical exams (customary during an in-person initial consultation) are off-the-table with a video or phone consultation. This will make the post-consultation process slightly less efficient.

What’s more, patients who have fertility coverage report a very mixed track record getting their telehealth sessions paid for by their carrier.

(Some plans, like Progyny, have confirmed for us they cover telehealth for all their members)

Determining If The Doctor Is a Good Fit

An initial consultation is an opportunity to gauge whether you want to work with a clinic or provider. Whether your consultation is in-person or done remotely, here’s how you’ll want to flip over this card.

We think of picking a fertility doctor as a matching issue: what’s a good match for one person might not be the best match for another. Are you seeing a solo practitioner or is your doctor part of a group practice? What do the practice dynamics look like? Are you assigned a nurse to manage your care or does the clinical staff work as a team - and what will all this mean for you?

Apart from considering if you have a good rapport with the doctor, colleagues, and other staff - it’s also important to think about the quality of the lab, particularly if you plan on doing IVF or egg freezing.

The research shows that the difference between a great lab and a mediocre lab may change your chances of success by up to twofold.

If the data provided by the lab doesn’t seem to indicate it’s high quality, it’s worth having a second conversation with your doctor to ascertain why.

Namely, is this a reflection of lab quality or another factor, like treating a more challenging patient population.

Lab

Considerations When It Comes to COVID-19

With many cycles and procedures being cancelled or postponed, patients may wonder if it’s even a good time to book an appointment with a fertility clinic.

Though it’s unlikely you’ll be able to move forward with a full fertility work-up, getting set up with an initial telehealth consultation still has benefits. Namely:

  • It allows you to get a plan in place for when in-person appointments begin again and you may still be able to get blood testing in the meantime.

  • There is likely to be high demand for appointments once clinics open back up (and many clinics may be capacity-constrained): having already started the process may improve the odds you can enter treatment faster**

  • There may be diet and lifestyle adjustments your doctor can suggest that might improve the odds treatment works or reduce the need for treatment in the first place.

** Remember, fertility workups and treatments, in general, are very much a waiting game. For many procedures you need to wait until a specific cycle day to be seen, so even without the delay caused by COVID-19 there is still a chance there would be a waiting period between your initial consultation and further appointments.

Effect of delayed transfers for previously frozen embryos or eggs

If you’ve already frozen eggs or are awaiting a frozen embryo transfer, there is little reason to believe that the delay in treatment caused by the COVID-19 crisis will have much effect on your likelihood of success in most cases.

While the date of transfer could be complicated by other disease states (such as fibroids) that a patient may need to schedule around, for many patients a delayed transfer is mostly an inconvenience as well as a severe disappointment.