The initial fertility consultation typically lasts 30 to 45 minutes
Infertility affects approximately one in eight couples in the United States. Infertility was originally thought to be a woman’s disease. However, studies now demonstrate that infertility actually affects both men and women equally. It is very important that both members of a couple attend the initial fertility consultation. Your TFC physician will walk you through the fertility evaluation, diagnostic possibilities, and options for treatment together.
Your first visit to the fertility doctor will begin with a complete medical history of both partners.
Your physician will want to know details about your menstrual cycle. We will also want to know about any previous surgeries, infections and pregnancies that you have experienced. The male partner will be asked about similar questions about his previous fertility. We will also ask about any medical and surgical illnesses, and medications he may be taking. Previous fertility evaluation or treatment that he has undergone is also very important. Each partner will also be asked about any other health conditions that can impact your fertility. These details are all important, and each can play a role in causing infertility.
There are five basic factors involved in fertility, and the history represents the first step in the diagnostic process.
Ovulation: Important aspects of a woman’s history include such things as details about your period – are your cycles regular? Do they cause much cramping? Have they changed in duration, frequency, or amount?
Fallopian tube function: Clues to abnormal fallopian tube function include such things as previous pelvic infections or surgeries.
The uterine cavity: Uterine cavity abnormalities often present as changes in menstrual flow (heavier or lighter), duration (longer or shorter), or timing (spotting before or after the period or in the middle of the cycle). A history of previous miscarriage(s) may also indicate a uterine problem.
Peritoneal factors, such as endometriosis and pelvic adhesions: Symptoms of endometriosis classically include increasing pain with periods, pain with sexual intercourse, or generalized pelvic pain. Pain with bowel movements and/or urination are often overlooked, but can be equally important.
Male factor: Men have their own set of issues, and their history is designed to explore anything that may interfere with their libido, sperm production, or sexual function. Specific examples include changes in their ability to achieve or maintain an erection, medications they are taking, excessive use of alcohol or recreational drugs, and any previous scrotal trauma or surgery. While some causes of male infertility are well recognized, others such as diabetes or the use of certain anti-hypertensives are not.
Preconception counseling regarding lifestyle and health factors including smoking, alcohol consumption and exercise are also addressed at the initial visit.
Following the history, a physical examination of the female is performed.
In addition to assessing general health, this examination is focused on evaluating several specific causes of infertility, including thyroid disease, uterine enlargement, and abdominal or pelvic tenderness. A transvaginal ultrasound examination looking at the uterus, ovaries, and surrounding pelvic structures completes the initial visit. The combination of a thorough medical history, a problem oriented physical examination, and a high quality transvaginal ultrasound examination will frequently help the physician direct his or her focus and shorten the time to a correct diagnosis.
Another important component of the initial consultation is to educate the couple about normal reproductive function.
All too often, the last exposure that many couples had to any formal information about sexual health and function was during high school sex education classes. Much of their current knowledge about reproduction may not be based on fact. Credible sources of information may be hard to find and, coupled with the embarrassing nature of this topic, often leads couples to the internet to search for answers. While there are many good things about the internet, it unfortunately also propagates many myths and misconceptions about fertility. These misconceptions need to be addressed and corrected in order to help a couple understand normal reproductive physiology.
During a first visit to the fertility doctor, the physician should review this information with each couple. An understanding of normal fertility helps explain how (and often why) things can go wrong. It also puts fertility statistics into perspective.
Most couples don’t realize the normal chance for conception. The average couple has the following percentages to conceive naturally.
- a 20% chance of conceiving in any given month
- a 50% chance of conception in six months
- an 88% chance of conception in an entire year
Understanding these statistics helps couples level-set their expectations and also puts statistics associated with the various fertility treatments into context.
The goal of the fertility evaluation is to identify a specific cause or causes of infertility, and to then recommend appropriate targeted treatments.
Based on the results of the initial visit, the physician will develop a plan to evaluate all pertinent fertility factors. A standard plan typically includes
- fertility blood tests of either (or both) partner(s)
- a hysterosalpingogram (HSG – an X ray that evaluates the uterine cavity as well as the fallopian tubes)
- genetic carrier screening
- and a semen analysis with Ovation Fertility.
Other testing may be ordered based on the history, examination, and ultrasound. Once the evaluation has been completed, the couple will return to meet with the physician to learn the results of the evaluation as well as for a discussion of treatment options.
Contact our office to schedule you initial fertility evaluation.