Tips for Talking to Patients About Fertility

Jennifer L.W. Fink, BSN

Disclosures

September 12, 2016

Start the Conversation Early

When women enter their 30s, most assume that they have plenty of time to have children. And while that may be true, given the effects of age on fertility, it's imperative that physicians broach the conversation.

"There's a responsibility on our part to start the conversation in women's early 30s," Dr Ross says, whether the women are married, partnered, or single.

Marie Werner, MD, a reproductive endocrinologist with Reproductive Medicine Associates of New Jersey, suggests starting the conversation much earlier, when a woman is in her 20s and time is on her side, even if the woman is single or gay, she says.

Ask Open-Ended Questions

How to initiate the conversation?

"Start off asking a question," Dr Werner says. "Something as simple as, 'What are your thoughts about having a family in the future?' can go a long way."

These patient-directed conversations build trust between providers and patients, and enable providers to tailor future care and interventions to patients' needs. They also provide an opportunity to introduce fertility facts.

"I tell my patients, 'Guys are lucky; they produce sperm all the time. But because women are born with all the eggs they'll ever have, over time the quantity goes down, and often the quality does as well," Dr Werner says.

Listen to Concerns

"If anyone comes in who questions their fertility, don't dismiss them," says Robert Rebar, MD, former director of the American Society for Reproductive Medicine (ASRM). "If a woman is concerned because she's had a ruptured appendix in the past, or a man is concerned about his sperm count, you ought to listen and take a more detailed history to see if any tests are warranted."

Red flags to note include a history of abdominal surgery (because adhesions can interfere with fertility), endometriosis, menstrual difficulties, or a partner with a history of an undescended testicle. Additional tests, including imaging scans and laparoscopy, if warranted, can reveal fertility problems.

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