There are a few things you should know that aren’t necessarily common knowledge about a fertility consultation. Before we get into that, let’s review the basics, shall we?
Although clinics can vary in what they include in a consultation (some are just conversations, others will include exam), in general, you will review your fertility history, any previous treatment you’ve had that’s relevant, and your family building goals.
For female patients, part of the consultation might include a physical exam that will take a look at your uterus and ovaries via transvaginal ultrasound. (This is often nicknamed “wandie.” I know. Not the medical term, but it’s important to keep a sense of humor!) The ultrasound will provide an “antral follicle count” which means how many follicles you have on each of your ovaries. The follicle counts correlate with the number of eggs you have.
Depending on where you are in your cycle, blood work will be taken to review your hormones. This includes your Follicle Stimulating Hormone (FSH) which must be checked early in cycle, day 2 or 3 of your menstrual cycle. Your FSH gives some insight into how many eggs you have. They will also test your Anti-Mullerian Hormone (AMH) which can be tested at any point in your cycle. It will provide an idea of the quality of eggs you have.
For men, there usually isn’t a physical exam at the consultation for you, but a sperm analysis may be recommended. A sperm analysis will evaluate Volume, Count, Motility (how well the sperm are swimming) and Morphology (shape of the sperm).
Now that we know the basics, here are some things to remember or be aware of:
- While some don’t require your husband, spouse, or partner to attend the consultation, I recommend it. Sometimes, these appointments can be overwhelming, so it helps to have someone to turn to afterward to ask, “Wait… what did they say about my cervical mucus again?”
- It’s not often that doctors have read your file before they see you. There’s some debate on whether or not this is appropriate, but some doctors genuinely want you there to discuss what they are looking at as opposed to just reading the file on his/her own. I wouldn’t be too offended about this.
- It’s SO easy to forget a question you want to ask in the moment, so if there’s something super important to you, make sure to write it down ahead of time. Some questions you may want to ask are:
- Do you have an idea of why we haven’t conceived yet?
- What testing do you recommend we do to provide insight into our fertility health?
- Which treatment do you recommend we start with first?
- What are my chances of conceiving given my age, diagnosis, and fertility history in general?
- How easy will it be for me to access you or your team while going through treatment?
- What is the best way to communicate with you and your team?
- Just to manage expectations, being that this is your very first appointment, you should be aware that odds are you won’t get ALL the answers to why you haven’t conceived yet. The consultation is to get to know the doctor, for the doctor to get to know you, and do his or her due diligence to put the pieces of the puzzle together so that they can get an assessment of your fertility health. Between what’s discussed, your comfort level, your finances, and what the test shows, the doctor will then put together a protocol in how best to proceed.
- This seems obvious but I can’t tell you how many times I tell this to people on a daily basis: The best gauge for how good a reproductive endocrinologist is how YOU feel about them. Whether you have insurance or not, fertility treatment is expensive. It doesn’t matter where they went to school, what your best friend’s sister said about the clinic, or even what their success rates are (because success rates can be manipulated). What matters is that you feel enthusiastic about the doctor and hopeful about the protocol they are recommending.
- After the consultation, if there are some suggestions as to what the doctor is recommending (Insemination, IVF, etc.), if you have insurance, you should call them to ask specifically what your fertility coverage is and if you have any out of network benefits. Although a financial team at a clinic can help, it’s important that you, as the patient, know your benefits so you can advocate on your behalf.
- And remember to breathe. This is the first step on a journey. Have patience with yourself and your partner and take each day as it comes.
The goals with a consultation is to see if the doctor, clinic, and protocol are a fit for you and that you feel like you’ve left with some insight, options, and maybe even a little hope too!