Recommendations provided here are not intended to replace conversations with your own medical care provider.
You want to get pregnant. You have all the necessary male and female reproductive parts needed to support a pregnancy. But you still aren’t getting the results you expect. It’s time. What to expect from your visit with an infertility doctor.
If you’re part of a straight couple, maybe you’ve tried to get pregnant the fun way and haven’t been successful. Maybe you already have a child and find yourself unable to get pregnant again. If you’re single or in a same-sex relationship, you may not have all the required ingredients to attempt conception on your own. There may be a medical reason that you can’t conceive on your own. In any case, you’re ready to look into medical options for determining if you’re able to have a baby.
Initial Visit: information gathering
The first step is usually to meet with a specialist, either a gynecologist or a reproductive endocrinologist (the infertility docs). Be prepared to answer some very specific and potentially embarrassing questions. You’ll be asked all about your menstrual cycle, and no detail will be too small. If you’ve been trying to get pregnant for a while, you’ll probably already be tracking your cycles.
Your infertility doctor will likely ask you some of the following:
- How long your cycles are — from the first day of one period to the first day of the next. There are many free apps that can help track your period.
- How long your actual period lasts.
- If you’ve tracked when you ovulate, whether by using your physical symptoms or by using ovulation predictor kits, around what cycle day your ovulation occurs.
- If you’re in a straight relationship, your provider will want to know if you’re having intercourse at the right time in your cycle and with the right frequency.
- What medications you and your partner are taking or have taken in the past, whether either of you uses drugs recreationally, or if you have been exposed to toxins in your home or work environments.
Please don’t be put off by these questions. Everyone is asked the same things, and this information is purely related to your health and fertility. Your provider may also do a physical exam. Some conditions that affect fertility can also impact other body systems, and providers may look for certain physical characteristics of those conditions.
Blood Tests: measuring hormone levels
Your infertility doctor will order blood tests to look for certain hormone levels that can give more insight into potential fertility problems. A provider may order more in-depth tests depending on your specific situation. There are a few hormone tests that are standard in most basic infertility workups. If you have menstrual cycles, even if they aren’t regular, you’ll be asked to contact your provider when you start a period. Some of these hormone level tests give the most information when done at the beginning of the cycle, and a few can be done anytime during your cycle, so you’ll likely get them all done at once.
A few standard hormone tests include:
- Follicle-stimulating hormone (FSH). This hormone does exactly what its name says: stimulates follicles in the ovaries to release an egg. This test is most accurate in determining fertility when it’s drawn 2 to 3 days after your period begins (around cycle days 2 or 3.)
- Anti-mullerian hormone (AMH). AMH is produced by certain cells in the ovarian follicles that are still too small to respond to the other hormones that cause a menstrual cycle to occur. It can be drawn at any time in the cycle.
- Thyroid-stimulating hormone (TSH). Thyroid function can affect fertility and pregnancy outcomes. The range for “normal” TSH in fertility is much narrower than it is for people who aren’t trying to get pregnant. Even if you have a technically normal TSH level, it may be higher than your provider’s cutoff for fertility. You may be asked to start medication to lower your levels.
Imaging
A lot of information can be gained from actually taking a look at the reproductive organs. Some of the ways that this information can be obtained are:
- Transvaginal ultrasound. An ultrasound is a minimally invasive way of evaluating the uterus and ovaries. Counting the small resting ovarian follicles helps determine ovarian reserve and potential response to fertility treatment. The provider evaluates for certain structural abnormalities like uterine fibroids as well.
- Sonohysterogram (SHG). Most of the time, the uterus looks a little like a deflated balloon. The provider inserts a small amount of fluid into the uterus to inflate it and evaluate the actual cavity. The goal is to make sure that there are no structural defects that are affecting fertility. By adding air to the fluid, bubbles can then be tracked into the fallopian tubes to make sure that they are open. This allows eggs to pass from the follicles to the ovaries to the fallopian tubes to the uterus.
- Hysterosalpingogram (HSG). This test is similar to SHG, but uses X-ray and iodine liquid to highlight the uterine cavity and fallopian tubes.
- Surgical procedures. Hysteroscopy and laparoscopy use small cameras to produce a live video of the reproductive organs and highlight any possible abnormalities.
Semen Analysis
In straight couples, the male partner produces a semen sample to be analyzed as part of the workup. The analysis will include information about the number, motility, and shape of the sperm. All of these factors can affect the ability of the sperm to travel to the released egg in order to fertilize it.
It’s important to remember that every infertility doctor and facility do their evaluations differently. This post serves as a guide for some of the most commonly ordered tests to assess fertility. Depending on the specific information you provide, you may have to do more or different testing than what has been described. This is in no way meant to take the place of any medical advice or recommendations that you’ve received from the providers you’ve worked with.
Vermont Mom would like to thank Vermont Surrogacy Network for making this series possible.
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