You have tried unsuccessfully to conceive for more than 6 months. Deciding to see a board-certified reproductive endocrinologist is the first step towards finding a solution. Everyone is unique but your fist consultation typically lasts 45-60 minutes. During that visit, your infertility specialist will review your previous medical history including labs and treatments that you may have had in the past. Having those available will minimize the loss of time and precious financial resources for repeated diagnostic evaluation and therapy. The first visit is also a good time to discuss the emotional impact of infertility. Your partner is encouraged to share this initial experience that is best dealt with as a couple.
Your physician will review your history and ask questions to help identify potential causes for your difficulty in conceiving. Typically, routine ultrasounds “to check if everything is normal” are unnecessary and only increase your cost. The same goes for fluid ultrasounds, extensive blood work in the absence of irregular menstruation or routine laparoscopy (Laparoscopy: Avoid It If You Can!).
Because 35% of cases are male factor infertility, a semen analysis is typically requested first. This does not need to be repeated if one was ordered within the last year. If a previous analysis was abnormal, it is advised to repeat it prior to making a final diagnosis as it could have been a “bad day”. Similarly, 35% of cases are caused by tubal adhesions or scar tissue. A hysterosalpingogram (HSG), performed prior to cycle day 10, is advised to evaluate tubal patency and any potential uterine factor. It is also a good idea to request an AMH level to measure your ovarian reserve (Anti-Mullerian Hormone (AMH) – Not the Holy Grail, But the Best Test We Have).
It can be quite reassuring to find out you still have plenty of eggs and can proceed in a conservative manner. Have a copy of these films sent to your RE for review as false negatives are quite common. Hormonal testing is only indicated in the presence of known menstrual irregularities. A second consult, whether in person or over the telephone should then determine the best treatment option for your particular case. Establishing a definite diagnosis will save precious time on the long run. For example, treating irregular periods with clomid only to find out the tubes were closed 6 months later is quite frustrating. Most of all, your first visit is an ideal time to evaluate if your physician level of attentiveness, responsiveness and style of practice matches your personality.
A caring, honest and upfront provider who provide realistic expectations and favors cost-effective treatments can have a profound impact on your time to pregnancy by allowing you to choose the most cost-effective treatment from day 1. (When Does Artificial Insemination (IUI) Really Help?, IUI with Injectables – A Waste of Time and Money).