Although each doctor has his or her own way of handling an initial consultation, there are few things that most of us would like to know at a first visit. Many centers ask patients to fill out extensive questionnaires prior to the initial visit. I will focus on the issues that are most important and universally desired.
Ages and length of infertility are two obvious pieces of information we need to know. In particular, the age of the female is tremendously important in defining the level of urgency for proceeding with evaluation and treatment. Six months of trying may be more significant to a 40 year-old, than to a 30 year-old woman.
Length of infertility many seem easy to define, but some couples get confused. We define it as the length of time of having unprotected intercourse. Frequently, couples tell me they stopped using contraception years ago, but they’ve only been “really trying” for 6 months. The prior years count!
Copies of pertinent lab tests, including hormone measurements, semen analysis, and hysterosalpingograms are very helpful. In general, most tests do not need to be repeated, unless certain hormone levels are over I year old. The hysterosalpingogrmam (HSG or x-ray dye test) should not need repeating, unless there has been an event like an ectopic pregnancy or surgery since the last test. Operative reports are also very helpful.
At the visit, the doctor will typically take a full medical history. Prior fertility in either partner is important, as are a history of any STD’s or pelvic/genital surgery. For women, specific details about menstruation may be asked, as well as other symptoms such as breast milk production or increased hair growth. Current medication use is important as are any prior fertility evaluations or treatments.
A physical exam on the female, including weight and blood pressure measurements, is often performed. We also perform an ultrasound to evaluate the uterus and ovaries. Occasionally, ovarian cysts or uterine fibroids are found, and their presence may change the direction of the conversation.
While not yet part of the routine process in all centers, some discussion of genetic screening should be included. The infertility experience gives patient a golden opportunity to look for possible unexpected genetic carrier states before conception. In the unlikely event a couple carries a recessive trait like cystic fibrosis, they can consider IVF with pre-implantation genetic diagnosis (PGD) to prevent having a child with a life-threatening condition.
At the conclusion of the visit, the doctor will usually discuss what testing is needed and may begin discussing treatment options, based on what has already been done, or on what further tests might reveal. Obviously, a treatment plan can be amended by new laboratory or imaging tests. Frequently, a financial person will discuss the expected costs of the upcoming tests or treatments.
We believe that it is important to work with patients in a partnership spirit. Make sure you are clear on what the doctor’s impressions are and what the plan is. You should be able to explain to someone else why you are having a particular test, operation, or treatment. If this is not clear, ask the doctor to explain it until you are comfortable with the plan.