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What Happens in Your First Visit to a Fertility Doctor?

by Dr. Eric Levens

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.

13 Comments

  1. Ashaunti

    November 8, 2017 - 2:22 am
    Reply

    Hey I’m 20, and I’m going to the infertility doctor on tomorrow and was wondering what do they do at the first apppointment? And I wanted to know can I still get pregnant at my age and how?

  2. Amber

    July 25, 2017 - 8:50 pm
    Reply

    I am 26 and i have always had irregular periods. I have 1 ..6 year old daughter just lost a baby due to ectopic pregnancy and had to get my right tube removed..is it going to be really difficult to get pregnan??

  3. Scott

    February 21, 2017 - 3:44 pm
    Reply

    This was a very insightful article. My wife and I have been trying to have a child for about 10 months now and have considered visiting a fertility clinic. It was nice to know that I will also need to be tested to see if something is wrong on my end. I’ll be starting to look around for a local clinic to go to if nothing happens after two months.

  4. lauren

    September 20, 2016 - 7:29 pm
    Reply

    Just curious. I’m going to a fertility Dr tomorrow – my husband has low T we found out – I’m over 35…do you know what kind of treatment we will receive? I am close to 40 and really want to have a baby – I hope they don’t make us do a bunch of stupid stuff or tell us to wait 6 more months.

  5. Heather

    April 25, 2016 - 4:07 am
    Reply

    I had a child in 2010 now I am unable to get pregnant

    • carrie

      April 26, 2016 - 6:54 pm
      Reply

      Hello Gloria,

      I write quite a bit about fertility, so while I am no doctor – I have learned a TON about the subject.

      You didn’t say how old you are, but age plays a HUGE role in female fertility. If you are over 35, egg quality and quantity diminish, and this can make it increasingly difficult to conceive without some type of fertility assistance.

      This may seem like a “Duh!” question, but are you timing intercourse correctly? Many couples think you have to wait UNTIL you ovulate to start having sex. This is not a good idea b/c the egg only lives for about 24-hours, tops, once it’s released from the follicle. Thus, your best bet is to have sex every day or every other day for the few days preceding ovulation. Healthy sperm live for up to a few days or even longer, so the more sperm that are waiting for the egg when she’s released – the better! There are ovulation timing apps for phones and over-the-counter ovulation predictor kits are very accurate as well. The better you get to know your personal cycle, the better chance you have of conceiving naturally.

      Do you have regular periods? Are they exceedingly painful? Are they unusually light or heavy? Skipped or irregular periods indicate you’re not ovulating, and that’s a problem if you’re trying to get pregnant. You may have undiagnosed endometriosis or PCOS (polycystic ovarian syndrome), two very common causes of female infertility.

      Have you had recurrent miscarriages? Sometimes the shape of the uterus can affect a woman’s ability to conceive and/or carry a baby full term. Blocked fallopian tubes also pose a problem. Your OB/GYN can use imaging to partially figure this out, although more specific tests may be required if imaging isn’t detailed enough to provide a clear picture of what’s going on (or not going on) in there.

      What does your OB/GYN say? If you don’t have a good one, it’s worth it to visit a few and choose the one you like best so you have someone who you’re comfortable with and who will go to bat for you. That would be your first rung of the ladder, because your OB is already covered by insurance. While they aren’t experts at infertility diagnoses, a good OB can certainly rule out some of the most common causes for why fertility seems to be an issue for you.

      If your OB has done all she can and you still aren’t able to be pregnant, a consultation with a fertility clinic would be the next step if you really want to get pregnant. Again, if you’re 35-years or older, time is of the essence!!

      Good luck!!!

    • Danielle

      September 18, 2016 - 7:36 pm
      Reply

      I’m dealing with the same. Secondary infertility

  6. Gloria

    November 29, 2010 - 8:16 pm
    Reply

    I just curious ask you question about IVF and Eggs Donor how to work. I alway hope so get pregnancy futuer

    • Shady Grove Fertility

      November 29, 2010 - 8:29 pm
      Reply

      Gloria – People experience infertility for a number of reasons, and many depend on IVF or Donor Egg procedures to conceive. In either case, your doctor will retrieve eggs from you (or a donor) and fertilize the eggs with your partner’s (or donor’s) sperm. Once fertilized, the embryos will develop for a few days and then transferred back to you to carry throughout the pregnancy. You can learn more at https://www.shadygrovefertility.com/ivf

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