The journey to get pregnant isn’t easy for everyone. Infertility is generally defined as not being able to get pregnant after one year of unprotected sex. For women over age 35, it’s often six months of trying. But the good news is that a reproductive endocrinologist, an obstetrician-gynecologist (ob-gyn) with special training in reproductive medicine, has more medical options available to help you conceive, and knowing what to expect at a fertility consultation can help you feel prepared for your first visit.
Roughly nine percent of men and 11 percent of women experience fertility problems in the U.S., reports to the Centers for Disease Control and Prevention (CDC). As we age, fertility declines for both women and men, but it happens faster with women. For most women,by their mid-30s fertility starts to decline compared to their teens and early 20s, and the chance of conception drops significantly after age 45, according to The American College of Obstericians and Gynecologists.
Though generalist doctors can order some fertility medication to increase egg production, they don’t always know when to move on from front-line treatment, according to Elisabeth Ginsburg, MD, a reproductive endocrinologist and director of the Reproductive Endocrinology and Infertility Program at Brigham and Women’s Hospital and a Harvard Medical School professor in obstetrics/gynecology. “The tricky thing is knowing what treatment is appropriate for what patients and it depends on what is happening to the couple. It is not one size fits all. If you haven’t tested the partner’s sperm, you don’t know if a treatment will be appropriate yet. To find out three, six months, or a year later that the sperm count is significantly low can be frustrating to think of all that time wasted.”
What to expect at a fertility consultation
During the consult you’ll share your timeline of how long you’ve been trying to conceive and other personal information. It’s helpful to bring the medical and surgical history for you and your partner, any medication and supplements you each may take, and results of any previous testing. You’ll do lab work, which may involve blood and urine tests.
“We go through what testing needs to be done, and we explain each test,” Dr. Ginsburg says. “If your doctor is rattling off information quickly, ask what you can learn from each test.”
Keep in mind that the reproductive endocrinologist may go over various possible tests and procedures, but that does not mean that you would have all of them.
Your reproductive endocrinologist may ask questions like:
- Do you have regular menstrual cycles?
- How frequent do you have intercourse?
- Do you have any difficulty with intercourse?
- Does your partner have erectile dysfunction?
- Is intercourse painful?
- What is your medical history?
- Have you had any surgeries?
“I often ask women if there are any specific concerns or factors that may be impacting their fertility,” Dr. Ginsburg says. “Some have worries from the past. If a woman had a termination of a pregnancy for example, she may think that she did damage to her body that would impact fertility, which is not the case, but it’s a common concern.”
Other women assume that they need to stop taking antidepressants or anti-anxiety medicine if they are trying to get pregnant. “But they don’t,” says Dr. Ginsburg. “Infertility can heighten the anxiety or depression on top of a career and the part time job of fertility treatment. We worry about the health risks if you take the medicine away.”
What tests can I expect at a fertility consultation?
Testing will often include a uterine exam, screening for infectious diseases, and a semen analysis if you’re exploring fertility treatment with a male partner.
Your doctor may discuss the need for the following assessments as well.
Blood tests
These can determine the quantity and quality of your eggs. Your doctor will look at the levels of the follicle-stimulating hormone (FSH), estradiol (estrogen) hormone level, and anti-mullerian hormone (AMH) in your blood roughly the first few days of your period. “Other hormones we look at are thyroid function,” says Dr. Ginsburg. “We also make sure you’re immune to German measles, chicken pox, and have no sexually transmitted diseases.”
Hysterosalpingography
An X-ray procedure of the uterus and fallopian tubes to check for blockages. A radiologist injects dye into the uterus through the cervix and if the dye moves freely the fallopian tubes are open.
Sonohysterography
A procedure to check the inside of the uterus. Sterile fluid is injected into the uterus through the cervix while ultrasound images are taken.
What will my test results tell me and what’s the next step?
When you have your follow up visit, your doctor will go over the findings of the tests, what the results mean, and what the appropriate treatments are. “A high percentage of the time the tests find a reason for problem, for example, a large polyp in the uterus that can be an easy surgical correction, or maybe the sperm is not moving as well as should be,” says Dr. Ginsburg. “About 20 percent of time everything looks fine according to tests, and we are not showing a cause [for infertility].”
After any potential hinderences are addressed, your doctor may suggest intrauterine insemination (IUI). Often called artificial insemination,the procedure is done near the time of ovulation and places the sperm directly into the uterus through the cervix using a catheter. It may be tried for six months, depending on the woman’s age.
Dr. Ginsburg says common reasons to go the IUI route, along with oral fertility medication to increase the number of eggs released, include mild male factor infertility, sexual dysfunction, unexplained infertility, or if the woman had small amount of endometriosis.
If that’s unsuccessful, the next move is usually to invitro fertilization (IVF) so eggs can be surgically removed from the body and mixed with sperm in a lab to createfertilized eggs (embryos). After about 40 hours, the embryos are placed in the women’s uterus, without having to travel through the fallopian tubes. Reason to go right to IVF may include, poor sperm quality, blocked fallopian tubes, and sometimes advanced maternal age.
“At this point if a woman is 40 or over, it’s best to go to IVF,” Dr. Ginsburg says. “There is even a difference between age 40 and 41. Population studies of live birth rates are lower at 41 than 40. As women get older in general the number of eggs is lower. The drop-off of eggs is rapid in the 40s, and the older the egg, the greater the risk of chromosomal abnormalities.”
How to know if your doctor is a good fit after a fertility consultation?
Finding a doctor that is a good fit for you is important. Knowing if they are the right fit can be determined by a few key factors. Firstly, they should be willing to teach you during your consult and make sure that you understand what is going on. They should also make you feel comfortable and provide you with the time to voice any of your concerns that you have. Finally, they should be happy to answer any questions that you have without hesitation.
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