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What Happens in Your First Visit to a Fertility Doctor?

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a blog by Eric Levens, M.D., April 28, 2010

Welcome to my blog, The Fertile Future! I'm Eric Levens and I’m a board-certified infertility physician practicing at Shady Grove Fertility in the Washington, D.C. area. This blog will address many of the common questions and concerns that couples and individuals have when they consider whether to pursue fertility evaluation and treatment.

So let’s get started at the beginning! Many people are surprised to learn that infertility is a medical disease, defined as the inability to conceive after 12 months of unprotected intercourse (after 6 months for women ≥35 years of age).

For many having difficulties conceiving, one of the greatest hurdles is making the first step: Scheduling an appointment to see an infertility specialist. This is understandable, given so few other events in life are so deeply personal and, no-doubt, fundamental to our sense of self as our ability to reproduce.

As a result, making that first appointment to see an infertility doctor often seems like a gigantic leap. If you’re contemplating taking this step, it might be comforting to know the things that would likely occur at your first visit.

Your First Visit: What Happens?

Infertility may be the result of many different conditions, all ending up in that same frustrating situation: no pregnancy. To get a better understanding of your individual condition, some initial testing may be required.

For some women, it may be that ovulation (producing an egg) isn’t occurring on a regular basis. This may be the result of several conditions such as polycystic ovary syndrome (PCOS) or be due to an accelerated or age-related depletion of the eggs in the ovary. For others, ovulation may be occurring regularly, but the Fallopian tubes are blocked which means the ovulated egg isn’t getting fertilized by sperm in the tube. Another very common cause of infertility is that there are insufficient numbers of normal sperm to achieve a pregnancy.

At your initial visit, your physician wants to determine whether there are things in your or your partner’s history that may herald an underlying medical condition that is presenting as infertility that may require further evaluation. The next steps can be largely broken down into evaluating the following: 1) the ovaries; 2) the Fallopian tubes; 3) the sperm count.

Checking Your Ovaries

Without bogging you down with too many details, ovarian function is controlled by an area of the brain called the pituitary. The pituitary produces several hormones, but the one most critical to fertility is follicle stimulating hormone (FSH). This hormone stimulates the ovary to develop a follicle that contains an egg. If FSH is elevated too early in the menstrual cycle, it may indicate that the ovary is having a hard time responding to this signal. One way to test the function of the ovary is to determine the FSH hormone on day 3 of the menstrual cycle along with assessing the amount of estrogen (produced by the ovary) in the blood.

These hormones give an indication of how the ovaries are functioning, something we refer to as the “ovarian reserve” which is the quality of the pool of eggs within the ovary.

Checking Your Fallopian Tubes

Another important test is called a hysterosalpingogram. While this test may sound intimidating, it is simply an x-ray of the outline of the uterine cavity (where implantation of an embryo occurs) and the Fallopian tubes to determine if the tubes are open. If the Fallopian tubes are blocked, then in vitro fertilization (IVF) would likely be the most successful option for achieving pregnancy.

Checking His Semen

A semen analysis is another important component of the initial evaluation to determine whether there is a male partner component resulting in infertility and if so, whether it is treatable. Fortunately, with the development of techniques in the last two decades, the sperm from men with some of the most severe sperm abnormalities can be used to achieve a pregnancy. Once the results of these tests are available, an Infertility specialist can recommend an appropriate treatment for you.

With that, I want to thank you for reading my first blog! I look forward to any questions or thoughts that you may have and best of luck achieving a Fertile Future.

Comments

Hello, we've been trying for 11 months for baby # 2. I got pregnant with our first at 17, he is now 10yrs old. I never took "the pill", regular 26 to 30 day cycles. What should be my next step, is it time to see a fertility doctor?.

The rule of thumb is if you're under 35 and having been trying to get pregnant for one year, you should see a fertility doctor. Our Patient Care Advocates can help you find a fertility doctor in your area. Call or email us at 855-955-2229 or carecoordinator@fertilityauthority.com. Best, Claire

A fertility doctor can help you understand your situation. At 47 your chances of conceiving with your own eggs are slim. But there are options, such as donor egg. If you'd like more information, or to schedule an appointment for a consultation with a fertility doctor, please contact our Patient Care Advocates at 855-955-2229 or carecoordinator@fertilityauthority.com. We'd be happy to help you. Best, Claire

hi ive been trying to conceive with no positve outcome.im 47 my menstral cycle is fading away. i want to know is there a chance for me to conceive

The testing should be the same. But I would urge you to see a fertility doctor/reproductive endocrinologist rather than your gynecologist. Let us know if you'd like a referral: 855-955-2229 or carecoordinator@fertilityauthority.com. I wish you all the best!

I have an appointment to speak with my gyn later this week because my husband and I have been trying for over a year to conceive our second child. I'm just curious if the testing is the same when it comes to secondary infertility.

I am told that my fallopians are blocked. Is there any way you can be of help to me so that I can conceive. I am 47 years old.

Hi Joy, Given your age and the fact that your tubes are blocked, it seems you might be a candidate for IVF (though I am not a doctor). Give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertilityauthority.com and one of our Patient Care Advocates will connect you with a doctor in your area who can tell you for sure which fertility treatment is best for you. Best of luck! Kim

Hi I am 36 I have two daughters from my first marriage and never had any problem getting pregnant. I got re-married 3 years ago and we have been trying for to get pregnant since our honeymoon. I now want to see a fertility doctor but my husband keeps putting it off saying it will happen. Every month nothing is happening and I am getting older. His family and friends keep asking us when are we going to have a child? I have my girls but my husband has never been a father. He did a home sperm test and it said his sperm was ok but I don't know how reliable these tests can be. Would you advise I go alone and get all the tests done on myself?

Hi Nadine, I would definitely recommend going to the fertility doctor for an evaluation. If your tests come back normal, then you know the problem lies with your husband and it might serve as some motivation for him to seek an evaluation too. Give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertilityauthority.com and we can help you connect with a doctor near you. Also keep in mind that as we age, our fertility declines. You shouldn't put off a fertility evaluation because it is better to be aware and plan accordingly than to not know! Best, Kim

Hi MJALL,

I think your questions would be best directed to a fertility specialist. You can email me at carecoordinator@fertilityauthority.com and I can help you find a fertility doctor in your area.

Best,
Kim

I am 30 and my husband and I have been trying to conceive for 3 months. I have always had long cycles (7-8 weeks long typically) except for when I was on birth control and had exactly 28 day cycles. I have been off bc for almost a year now and have resumed abnormal cycles. It has been almost 4 months since my last period (which is quite a bit longer than normal for me). I have started to use Ovulation Predictor Tests periodically. Last month I had positive tests for over a week at a time. I have also been charting my bbt. I seem to have a fairly low temperature. I tend to average around 96.8 degrees, but it will dip from time to time and then maybe go as high as 97.3-97.5. My thyroid was recently tested and the results were normal (there is a high incidence of thyroid disorders in my family). I am always cold and I have irregular periods, but these are not new problems for me. Even though I have not been trying to conceive for a year, is a trip to a specialist warranted since there clearly is some kind of problem happening here?

Hi,

me & my husband have been trying for nearly 2 years. i have had 21 day bloods done, which showed an ovulation level of 30 (which the nurse thought was borderline) my husband has had a SA test, & everything has come back perfect. my cycles have changed the last 3 months from 28 days, to 31-35 days. i ovulate normally, as it is picked up on opk. our gp has written a letter to the fertility specialist, does this mean we are getting referred? or will i keep on trying?

I really enjoyed your blog. I'm 24 and My partner and I have been trying to get pregnant for about a year. I wasn't sure if the appointment I made for the infertility specialist was necessary but after reading your blog I know I made the right decision. Thank you!

hi
i m 27yrs old n trying to get pregnant for almost 1 year. i took all tests including hsg n all showing normal results. now i have taken clomid from last two months. after 1st month an egg has been found in one of my ovary but now recently in 2nd month no egg formed in any ovary. some physician says eggs formation is not necessary in every month. but what if after taking medicine same happens? plz help me

Hi we have been trying to conceive now since January. I have had my day 3 and day 21 labs done and my husband has had a semen analysis done. My labs showed my hormone levels ok and his semen analysis showed his motility and shape to be on the abnormal. However the urologist said it is not enough to not become pregnant. My OBGYN has now recommened I go see a fertility specialist. what will be the next steps taken?

The recommendations for future treatment will be largely dependent upon your history and the actual values of the semen analysis. A consultation with an infertility specialist is necessary to determine the next steps in your care. It may be that you will require IVF.

Very informative and helpful

Hi Christine, generally the test that is performed on Day 21 of your cycle is an assessment of progesterone. It's used to determine whether you ovulated. When the value is 3 ng/ml or higher, it is typically considered to indicate that you ovulated. The problem with determining whether you are ovulating with a single progesterone level is that it's produced in waves and you may have had it drawn at a low point.

As for whether to take Clomid, that decision is determined by multiple factors including your history and the laboratory evaluation. Seeing a fertility specialist to discuss your history would be the appropriate next step.

Dr.Levens ,
thank you for this blog ! it definately put my mind at ease and gave me good tips as of to what to expect when i go to my first appointment this week.
i do have one question. I took blood tests on my 3rd day and the 21st day of my menstural cycle and my CRNP told me it was border line almost a 4 . is this high enough to be ovulating? cause ive been told by other doctors that ideally it should be a 6. iam very confused about this , and she didnt seem to know the exact answer either. Should i be put on a prescription such as clomid?

thanks !
christine

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