"It might be said that a reproductive medicine practice is only as great as the physician's supporting staff."

The All-Important Other Team Members:

Fertility Clinic Nursing Staff

Most people manage to get through young adulthood without a lot of attention from medical providers. Aside from an annual exam and an occasional minor illness or injury, the average person doesn't spend a lot of time interacting with doctors and their staff. All of that changes once you enter the realm of fertility treatment.

Depending on your situation, the path from initial consultation with a fertility specialist to a baby in your arms could involve anywhere from two or three appointments in an office and lab setting to several months of weekly contact by phone and in person. Part of this process that may take some patients by surprise, especially those who've never before experienced any kind of long-term treatment, is the amount of interaction with staff other than your physician. "It's commonplace in specialty areas of medicine to have more interaction with the nursing staff and only see the physician for procedural appointments or surgeries," explains Patti A. Bradley, MSN RNC, a Nurse Practitioner and one of two IVF Coordinators at Reproductive Resource Center (RRC) of Greater Kansas City.

The nursing staff at infertility clinics become the patients' most immediate and regular contact throughout the treatment process. As Cindy J. Young, RN at Fertility Centers of Illinois, sums it up, "There is definitely a close nurse-patient bond that is essential to the overall success of treatment." Young explains that nurses are the clinic staff assigned to the all-important initial step of helping typically overwhelmed new patients.

"The nurse is really key in helping get them through the process," says Nancy Sowder, RNC BSN of Atlanta Center for Reproductive Medicine. "They serve as a guide and a teacher and emotional support... so many things aside from assisting the doctor and taking their vitals."

"I like to think of the physicians as the decision-makers and care-directors," echos Cindy. "Once a treatment plan is laid out for a patient, the steps involved in reaching the goal of a 'baby' can seem overwhelming. I've heard patients say it was so comforting to have someone there to 'hold my hand' through the process. That's pretty much what we do."

A Demanding Job

Aside from the ever-important task of hand-holding, the more technical duties of a fertility clinic nurse vary widely. Nursing jobs are all about multi-tasking. According to JoAnne Brian, Practice Development Manager with Reproductive Science Center of the San Francisco Bay Area, a nurse's daily activities may include:

  • meeting with all new patients after their first appointment with the physicians
  • assisting with and coordinating all pre-cycle testing requirements
  • supplying the doctor with all testing results
  • collaborating with physicians to decide appropriate treatment protocol for patient
  • scheduling and coordinating IVF cycles, including ordering medication and follow-up visits
  • assisting in scheduling embryo retrieval and transfer as well as fertilization results
  • meeting with patients during their cycle monitoring visits
  • injection and medication instructions
  • coordinating clinical procedures with other members of the healthcare team
  • acting as a patient advocate and working with doctors on resolution of patient issues and concerns and handling of emergency situations
  • phone triage and post treatment follow-up

Because the very nature of fertility treatment is so highly dependent on the fluctuation of hormone levels in a woman's body, some diagnostic tests and virtually all treatment must be sensitively scheduled. Even in cases where the recommended treatment is to correct for male infertility factors in a couple, the woman's hormones call the shots, so to speak, when it comes to scheduling many procedures such as IUI and IVF.

Also, there is often more than one type of medication being used in any given treatment cycle, which can be confusing. Some may be oral, while others are injectable. Many fertility patients will be required to self-administer their medication, and that's a first-time experience for most.

Nursing staff members are the ones who will coordinate scheduling for tests and treatment, in addition to educating patients and their partners about the medications being used and how to administer them.

Partnering with Your Caregivers

The technical education of patients is an extremely important part of nursing in reproductive medicine. However, as Nancy Sowder points out, an equally important role of nurses is providing emotional support.

"The nurse is usually the primary person offering support to face something new and scary and challenging," says Sowder.

Cindy Young adds that in addition to the "quick questions that every patient has," the job of nursing is one that must include compassion and reassurance. "No question is considered 'silly'," she says, "if it causes the patient concern."

According to Mary Ann Sieban RN BSN, the IVF/OR Nurse Manager at Reproductive Specialists of New York, "The day of retrieval, for example, is a very emotional day for most patients. They're uncertain about what's involved with the procedure. The OR nurse's job is to be there, explaining the retrieval process and what the patient can expect to occur over the next few days."

At ACRM and some other large fertility centers, the usual procedure is to provide a "primary nurse" for each patient who will follow them through treatment. "We think that's key," Sowder explains, "to connect with someone who will help you along the way and understand what you're doing. It can make something that's so overwhelming feel a little easier to get through." Other staff is also available in the event the primary nurse is not, and at ACRM the entire medical team receives regular updates on each patient's situation so that treatment is consistent.

Whether a clinic utilizes the single case manager or a team approach, communication between patient and providers is key to making the experience as beneficial as possible.

Patti Bradley offers these how-to's for patients who want to feel informed, included, and empowered in their fertility treatment:

1). Know which nurse, coordinator or clinician you are supposed to call with questions or concerns.
2). Ask what lines of communication your center offers. Depending on the situation, you may prefer to contact your nurse by voice mail, e-mail, or via personal message through another staff. Many nurses are incorporating e-mail into their centers, which can be an effective way to prevent phone-tag and get questions answered.
3). Know your center's hours of operation and understand the time frames during which most calls are returned. Be patient and wait for a reply from your nurse or clinician. If your call is a true emergency, tell the receptionist you need a return call immediately. Otherwise, allow some time before your call is returned.
4). Make a list of questions prior to your call or appt. Try to be organized and get all questions answered at one time. Avoid calling everyday with continual questions that can wait for your next appointment.
5). Understand that your nurse is a vital link in the treatment process, providing patient care, education, emotional support and information regarding the infertility process. It is extremely beneficial to establish a good rapport with your nurse or clinician. You can develop a relationship that is mutually rewarding and this will help to make your infertility experience enjoyable.

Why They Do It

Helping people realize their family-building dreams by the birth of a child is, of course, a big reward for these highly-trained professionals. Even less eventful happenings in their daily work can provide warm feedback. Take the common occurrence of needle-anxiety in a fertility clinic setting where frequent blood draws are necessary for monitoring purposes. Cindy Young recalls a patient who initially warned staff that she was "extremely needle phobic."

"She had to lie down and would nearly hyperventilate with each blood draw," Cindy remembers. "I told her at the start of treatment that by the end of it all, we'd have her sitting up and relaxed. Sure enough, she is now able to sit in a chair and talk while her blood is being drawn." Small victories such as that are what give meaning to the job for this RN who spent five years in obstetrics before starting her infertility nursing career nearly ten years ago. Brandi Oude Link, MSN RNC, another Nurse Practitioner with RRC of Greater Kansas City, illustrates one of the best-case scenarios in her job: "Imagine what it is like for us to call a patient and say the words, 'Congratulations, you're pregnant.' We know those are the words they have longed for, and how special it is we get to deliver them. Patients tell us they'll remember that call and those words for the rest of their lives."

In addition to patient care, nurses also serve the community in several capacities including educating the public about infertility causes, diagnosis, and treatment and providing ongoing training to other professionals. Nancy Sowder, who is Director of Referral Services at ACRM, recently helped coordinate and spoke at a gathering of nurses from across the country on topics related to egg donor programs. It was one of many similar efforts to share with other clinics the knowledge and expertise gained through their successful fertility practice.

For Mary Ann Sieban and her co-workers, the novelty of reproductive medicine is a bonus to the tasks of patient interaction and teaching. "Nurses must continually stay on top of new techniques in assisted reproductive technology. It's an interesting field of medicine," she explains.

Nursing staff at most fertility clinics can be composed of individuals with LPN and RN credentials, as well as Advanced Practice Clinicians such as Nurse Practitioners and Physician Assistants. Many come from previous experience in obstetrics and gynecology practices. Most patients don't know that in addition to their technical training, nurses are required to be educated in related helping professions that ensure they will know much about their patient as a whole person. According to Sieban, "Registered nurses are required to take psychology classes, including introductory, developmental, family dynamics, and abnormal psychology."

"Many of us have chosen to practice in infertility," says Oude Link,"to be able to provide quality, compassionate care to couples in their time of need. It's a special vocation that allows us to participate in care that can actually change people's lives forever."