Bad Advice, Good Intentions: When Fertility Reassurance Becomes a Delay

Fertility advice can be wrong even when the person giving it meant well. In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols explores how reassurance, incomplete evaluations, and well-intentioned attempts to “save money” can sometimes delay the fertility care patients actually need.

This episode looks at the emotional stress patients feel when they realize they may have lost time, the difference between bad intentions and bad outcomes, and why advice like “just keep trying,” “your labs are normal,” or “at least you can get pregnant” can sometimes miss the bigger picture.

Dr. Amols also discusses when OB/GYNs can appropriately help with fertility concerns, when referral to a fertility specialist matters, and why good advice should include a reason, a timeline, a next step, and a point where the plan changes.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com.

Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.

Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

>> Dr. Mark Amols: 0:01

Today we talk about what happens when fertility advice is wrong, even when the person giving it meant well. Because in fertility, good intentions can still cost patients time, stress, and sometimes options. I'm Dr. Mark Amols, and this is Taco Bout Fertility Tuesday. Today we're going to talk about something a patient said to me that really struck. We were talking about her history, and she was telling me about the advice that she received before seeing me, and that, advice when she, looking back, really delayed her care and really was given advice that probably wasn't in her best interest. And that advice not only cost her time, stress, as well as options that she could have had. But then she said something really important. She said, I don't think they were being malicious. I think it was just bad advice. And I thought, that is such a mature and honest way to say it. Because in fertility, bad advice is not always cruel. It's not always dismissive on purpose. It does not always come from someone who does not care. Sometimes bad advice comes wrapped in reassurance. Sometimes it comes from someone trying to calm you down. Sometimes it comes from a doctor who means well but does not specialize in fertility. And sometimes it comes from advice that was reasonable for one patient but completely wrong for another. So what I want to address today is I want to talk about the differences between bad intentions and bad outcomes, because those are not the same. And for patients, that difference matters. I want to start by saying something clearly. Most doctors are not trying to hurt patients. Most physicians go into medicine because they want to help people. They want to reassure. They want to prevent panic. They want to avoid putting someone through unnecessary testing or unnecessary treatments. But here's the hard part. Good intentions do not automatically make the advice good. A doctor could mean well and still give advice that causes harm. A doctor could be kind and still be wrong. A doctor could be trying to reassure you and still, accidentally delay the care you needed. And infertility delay is not just an inconvenience. Time is biology. If you're 28, that's not the same as being 38. Six months may mean more to someone who is a little bit older. If your ovarian reserve is poor and that wasn't picked up, that time loss could be the difference of different options. So when the patient is told, don't worry, just keep trying, and then later finds out there was a real issue, that's not just frustrating. That can feel devastating because the patient's not only dealing with infertility, they're also dealing with the thought, did I Lose time because I trusted the wrong advice. And that's heavy to think about. See, one thing I think we underestimate is the emotional fallout that happens when, patients realize they may have been given the wrong guidance. The patient may feel angry, maybe even embarrassed. They may even feel betrayed. And then they may start replaying every appointment in their mind. Should I have pushed harder? Maybe I should have got a second opinion. Maybe I should have went to a specialist sooner, or maybe I should have just known better and did I just waste my best chance? And I want to be very clear here. If you trusted a doctor, that does not make you foolish. That is what patients are supposed to do. You should be able to go to someone with medical training and feel like the advice you're getting is thoughtful and appropriate for your situation. So if you were told to wait, or reassured that everything was fine, or told that your symptoms did not matter and you believed that advice, that m is not a character flaw. That is not you being naive. That is you doing what patients were asked to do every day. Trust the system. The problem is, is that fertility does not always tolerate vague reassurances very well. Fertility needs timelines. It needs context. It needs a plan. Now, I'm not against reassurances. Patients need reassurance. Fertility treatment is stressful already. Nobody needs a doctor making everything sound like a five alarm fire when it's not. But reassurances have to be paired with a plan. There's a big difference between saying everything is probably fine, just keep trying, and saying based off, of your age and history, it's reasonable to try for three more months. But if you're not pregnant by then, here's the testing I would recommend. As you see, that second version gives reassurance, but also gives structure. It gives a timeline and gives next steps. It gives the patient a way to know when waiting is still reasonable and when waiting has turned into delay. That is the part that is often missing the just relax or just give it time. You're so young. Oh, you've been pregnant once before, or those labs look normal, or your periods are regular. All of those can sound reassuring, and sometimes they are. But none of those statements should replace a real evaluation. When the situation calls for it, reassurance without a plan becomes a, very polite way of losing time. Let's go through a few examples because this is where patients may recognize themselves. One common one is you are young. Just keep trying. Now, sometimes that is very reasonable. If someone is 27, has regular cycles, no risk factors at all has only been trying for two or three months. It is completely appropriate to keep trying. But if that same patient has irregular cycles, endometriosis, a history of pelvic infections, or known male factor concerns, or has already been trying for a year, then you are young is not enough. Young does not mean immune to infertility. Another one is your periods are regular. So you're ovulating, so everything's fine. Well, regular periods are helpful information. Of course, they often suggest ovulation. But fertility is not just about ovulation. There's tubes there, sperm, egg quality. There's even endometriosis or uterine anatomy. There's a lot of moving parts. So saying you ovulate is not the same thing as saying, we have evaluated fertility. Another common one is AMH advice. Some patients are told your AMH is normal, so you have plenty of time. That's not exactly true. AMH does tell us about your egg quantity, but not your egg quality. Age is still one of the biggest drivers of egg quality and embryo chromosome risk. On the flip side, some patients are told your AMH is low, so you cannot get pregnant. You need donor eggs. That may also be extreme because low AMH can mean fewer eggs in the IVF cycle. It can mean we need to move more urgently. But what it does not mean is that spontaneous pregnancy is impossible, or that you need to rush to donor eggs. As you can see, the same lab amh, but two different bad interpretations. Fertility is fun like that. And by fun, I mean mildly offensive to everyone's nervous system, causing us a little bit of stress. Another one I hear is after miscarriage, at least you can get pregnant. I get it. I understand what the doctor's trying to say. They're trying to say, hey, here's some hope. And yes, the ability to conceive can be meaningful information. But to a patient who just had the miscarriage, that phrase can be a little bit dismissive. It could sound like, do not be too upset. Yet, medically, if there are repeated losses, advanced maternal age or other risk factors, we may need to look deeper. Hope is good, but diminishing grief is not. So then the question comes, why does this happen? Are just all these doctors bad? Well, I, don't think the answer is usually that someone does not care. I think it happens for a few reasons. First, fertility medicine changes quickly, and I mean very quickly. What we know about ovarian reserve or embryo development, genetic testing and male factor infertility changes a lot. Literally, yearly. I'm learning new things because it's Constantly changing. Second, not every doctor lives in fertility every day. And OB/GYN has a very broad job. They gotta deliver babies, deal with abnormal bleeding, they need to deal with gynecology, treating menopausal symptoms. They see hundreds of different issues a week. Fertility is just a very tiny portion of that. And REI is looking at fertility all day. We think about age and ovarian reserves, sperm tubes, uterus, embryos, everything you could think of. Because that's what we do every day. We look at how long it takes to get from point A to baby. So, as you can imagine, these are different lenses. Third, population level advice does not always fit an individual patient. The classic rule is if you're under 35, trying for 12 months, if you're over 35, then six months before evaluation. And that's a decent starting point, but it's not the law of physics. If you have irregular cycles, known endometriosis, pelvic inflammatory disease, multiple miscarriages, painful periods, prior chemotherapy, so many different things like low amh, male factor, or even just a history of taking a long time to get pregnant with your first child. The standard timeline may not apply to you. And these details matter a lot. And finally, doctors often want to reassure patients, and that's human. Nobody wants to create anxiety unnecessarily. But sometimes, in trying to reduce anxiety today, we actually create a bigger problem later. I actually hear this a lot when it comes to OB/GYNs. Many OB/GYNs will try to help a patient before sending them to a fertility specialist. And I want to be fair here, they're doing the right thing. They know that fertility treatments can be very expensive. They also know that patients are usually scared of having to be referred to a fertility clinic. So they think, hey, let's try something simple first. And maybe this can save the patient money and maybe some stress. So the intention is good. But this is where things can get a bit tricky. Because sometimes trying to save a patient money in the short term can cost them more in the long term. If a patient spends six months, nine months, or even a year doing incomplete treatment, and then later finds out the tubes were blocked, or the sperm count was severely abnormal, or age was a bigger factor than anyone discussed, that patient didn't save money, they lost time. They potentially even spent money on treatments that were never going to work. And now it may require more aggressive treatments that would have not been needed if they would have attempted them earlier. So the problem is not that OB/GYNs should never help with fertility. That's too simplistic. There are situations where OB/GYNs can appropriately start an evaluation and even treat basic stuff, but that help needs boundaries. If someone's young, has regular cycles, no major risk factors, and has things like a normal semen analysis, open fallopian tubes, and hasn't been trying that long of a time, then a limited plan may seem reasonable. And it is. But if the workup is incomplete, if there are red flags, if the patient is 35 or older, especially if they're over 40, if they have other factors such as endometriosis, irregular cycles, or recurrent pregnancy loss, then continuing to just try a little bit more can become a delay. And again, this is not usually malicious. It is often the opposite. It is someone trying to spare the patient the cost and stress of fertility care. But here's the thing. In fertility, the least expensive path is not always the path that starts with the cheapest option. Sometimes the least expensive path is the one that gets you to the right diagnosis early, avoids wasting cycles, and moves the patient to treatment first. Because that's what fits the situation. And that is the hard but important truth. Good care is not just about doing something. It's about knowing when the most helpful thing you can do is refer to someone else. In the end, a cheaper treatment is not cheaper if it was never the right treatment to begin with. So what can patients do with this? Well, I don't want the takeaway to be do not trust doctors. That's not helpful. That just turns every appointment into a courtroom cross examination. And nobody wants that. Well, maybe some do, but those people should probably consider law school. The better takeaway is ask for the plan. If someone tells you to keep trying, ask, well, how long should we keep trying before we do testing? If someone says your labs are normal, ask, do these labs tell us about egg quality, egg quantity, or both? If someone says everything looks fine, then ask, have we checked sperm and tubes? Or are we mainly talking about ovulation? If someone reassures you, ask, what would make you change the plan? That is such a powerful question. What would make you change the plan? Because good medical advice should have a threshold. It should have a point where we say, okay, this is not working and now we need to do something different. And patients should not be left floating in the land of just keep trying forever infertility. Good advice usually has four parts. It has a reason, it has a timeline, it has a next step, and it has a point where the plan changes. So instead of saying just keep trying, a more helpful version might be based on your age, regular cycles and how long you've been trying, I think it's reasonable to try for three more months. And if you're not pregnant, then I would recommend a semen analysis, ovarian reserve testing, and a test to make sure the tubes are open. That's advice. That's not just reassurance. That's a roadmap. And patients need roadmaps because infertility, already makes people feel like they are wandering in the dark. The least we can do is give them a flashlight and say, here is where you're going next. I want to go back to what the patient said. They were not malicious. It was just bad advice. That statement holds two truths at the same time. One truth is that the doctor may have meant well. The other truth is that the patient still experienced harm. And both can be true. Now, you don't have to turn every doctor who gave you bad advice into a villain. But you also do not have to minimize what it costs you. If you lost time, that matters. If you felt dismissed, that matters, too. If you were reassured when you needed evaluation, that also matters. And if now you feel anxious and distrustful because of what happened, well, that makes sense. But the goal is not to live in blame. But we also do not heal by pretending something did not hurt. Now, from the physician side, I think this is a reminder for all of us. Every doctor, including myself, has probably given advice at some point that could have used more nuance. Medicine is complicated. Patients are extremely complicated. And fertility is especially complicated because the same recommendation can be perfect for one and completely wrong for another patient. So this is not about pretending any one doctor has all the answers. It's about being careful with broad reassurance. It's about remembering that normal does not always mean complete. It's about m. Remembering that wait should usually come with a timeline. It's about recognizing that when patients ask questions, they're not being difficult. They are often trying to protect themselves from losing more time. So here's the takeaway. Bad fertility advice does not always come from bad people. Sometimes it comes from good people trying to reassure you, working with incomplete information, or using advice that does not fit the patient in front of them. But if, that advice delays your care, increases your stress, or made you feel diminished, that experience is real. You are allowed to say, I don't think they meant to hurt me, and also say, that advice hurt me. The goal is not to distrust every doctor. The goal is to know when reassurance needs a timeline, when waiting needs a plan, and when it's time to ask for a second opinion because in fertility, kind words are helpful, but kind words with a plan that is much better medicine. I really appreciate that patient today for saying that. It really opened my eyes and is the reason for this podcast episode tonight. I was actually thinking about doing one on transfers, but we'll save that for next week. As always, greatly appreciate everyone listening to this podcast. If you found this episode helpful or do you think a friend may find this helpful, tell them about it. Give us a five star review on your favorite platform. But most of all, keep coming back. I look forward to talking to you again next week on Taco Bout Fertility Tuesday.