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Houston Fertility Journal

What You can expect in a New Patient Consultation

[fa icon="calendar"] Nov 17, 2017 2:00:00 PM / by Center of Reproductive Medicine   

Center of Reproductive Medicine

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Once the decision has been made to try and have a baby, few things are as frustrating as the inability to conceive. The process of achieving pregnancy can be difficult for some couples, and it may be necessary to see an infertility specialist. One of the biggest concerns people have if their journey takes them to a fertility doctor, is what they should expect in a new patient consultation.

If you’re working with The Center of Reproductive Medicine, here is what you can anticipate at your first visit:

Before the Visit

To book an appointment you can fill out a simple form online. You’ll indicate that you’re a new patient, and you’ll fill out the questionnaire including your contact information, and a description of your current issue.

Once you’ve set your appointment, it’s a good idea to obtain relevant medical records from your primary care physician. This might help in the initial consultation as part of your appointment will include reviewing your previous history.

What Medical Records Should You Bring With You?

At a minimum, here are the specific records we’d like you to bring to your first visit with your fertility specialist:

  • Latest Pap Smear Results (Within the past 12 months)
  • Mammogram
  • Any Gynecology Operative Reports or Procedures
  • Documentation Notes from Office Visits
  • Fertility Therapy Documentation
  • Any Diagnostic Testing Already Performed
  • Any Lab Tests Performed in the Last 18 Months

What Happens at Your First Visit?

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During your first visit you’ll have the opportunity to share your fertility history, discuss your concerns, and learn a bit more about how we work. A new patient evaluation also includes:

  • Vaginal ultrasound to assess the lining of your uterus and your ovaries
  • Pelvic exam (similar to a pap smear)
  • Physician consultation

The fertility doctor will also review a standard fertility evaluation with you, which includes: ovarian reserve testing, hysterosalpingogram, and a semen analysis. You’ll also learn about additional testing and treatment options, and ultimately be given a custom fertility plan.  

We know that every patient is different, and no two cases of infertility are exactly alike. We also understand the main goal for you is to find the best pathway to achieving pregnancy and/or maintaining a pregnancy. Therefore, we’ll help you find a path forward that works for your individual needs.

It’s important to note that having an initial consultation with us doesn’t mean you are locked into starting treatment with us. Committing to working with a fertility clinic is a big decision, and there may be some significant costs associated with it. Although we would be honored to help you in your journey of starting or extending your family, the first visit doesn’t come with any kind of contract that forces you to go through with the fertility plan we suggest for you.

A Breakdown of the Initial Exams and Procedures

What causes many patients to be nervous at their first visit, is the fear of the unknown. With that in mind, we’re going to arm you with as much knowledge as possible. Below you’ll find a further breakdown of what each of the possible exams you may have at your first visit entails:

Ovarian Reserve Testing

The question that often comes up when a woman is trying to achieve pregnancy, but is struggling with it, is how many eggs does she have left. At its most basic level, ovarian reserve testing (ORT) can provide your doctor with an indirect estimate of how many eggs still remain. The ovarian reserve test can also tell your doctor how you will respond to some fertility treatments.

As a woman ages, the number of eggs that she has decreases. This is why it’s so important to see a fertility specialist as soon as possible if a woman is over the age of 35. Once a woman hits 35, not only are there less eggs available, but the quality of those eggs begins to deteriorate. The two most common ovarian reserve tests are the follicle-stimulating hormone (FSH) and the Anti-Mullerian hormone (AMH).

An FHS test measures how much follicle-stimulating hormone there is in a blood sample.  
  • FSH is produced in the pituitary gland
  • In a woman it helps control the production of eggs by the ovary as well as the menstrual cycle
  • High levels of FSH in a woman could be evidence of poor ovarian reserves, and low levels indicate strong ones.
  • FSH helps control the sperm that is produced in males.
  • High levels of FSH in a male could indicate that the testicales are not functioning properly, and low levels could mean that the man isn’t producing enough or any sperm.

An AMH test can be performed at any time throughout a menstrual cycle, and measures how much Anti-Mullerian hormone is in a blood sample.
  • Low AMH levels typically indicate that a woman will respond poorly to ovarian stimulation medication.
  • High AMH levels indicate a woman will have favorable ovarian stimulation results.
  • AMH tests can measure the size of follicles in the ovary, and determine egg quantity.

Vaginal Ultrasound

A transvaginal ultrasound means an ultrasound across or through the vagina. The ultrasound will use sound waves to create images of your ovaries, cervix, uterus and vagina. The test is not painful, and the results can help your doctor monitor follicle development and ovulation, and assess the lining of your uterus and ovaries.

Pelvic Exam

A pelvic exam is similar to a pap smear, and primarily involves examination of a woman’s reproductive organs - the vagina, the cervix, fallopian tubes, ovaries, and uterus. This should not hurt, and if it does you need to tell your doctor.

Hysterosalpingogram

A hysterosalpingogram or HSG is a dye test to assess uterine and tubal anatomy. The doctor will dispense an iodine dye into the uterine cavity through the vagina and cervix. The dye will flow into the fallopian tubes if they are open, and ultimately flow into the abdominal cavity. This test indicates to your doctor whether or not there is a blockage to your fallopian tubes.

Semen Analysis

As infertility is not solely a female problem, your male counterpart will have a semen analysis performed. Male infertility is typically related to sperm production or the flow of sperm/sperm transport. As many as one in 20 men can have trouble with fertility related to low sperm count in their ejaculate. With a semen analysis exam, your doctor can determine the volume, concentration, motility, shape, and motile count of sperm in a semen specimen.

What Kinds of Questions Should You Be Prepared For?

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Questions on your appointment form to schedule your first will be related to your ethnicity, nationality, marital status, your partner’s ethnicity. We must report some data to the Center for Disease Control and Prevention, but we will not report your name or contact information.  

There are also several questions your fertility specialist will likely ask of you during your first visit. Thinking about them ahead of time will better prepare you for your appointment, and potentially help your doctor get to the cause of your inability to achieve pregnancy that much faster.

Some of the topics for these questions will include, but aren’t necessarily limited to:

  • Your sexual history and the sexual history of your partner
  • If you or members of your family have a history of pregnancies, miscarriages, live births or stillbirths
  • If your family has a history of any genetic disorders or diseases
  • Whether you’ve ever had a sexually transmitted disease or infection
  • They types of contraception you use or have used
    • i.e. condoms, intrauterine device, patches/pills, etc
  • The date and results of your last Pap Test
  • History of vaginal infections or abnormalities
  • History of fibroids
  • Were there any health conditions you had at birth
  • Current lifestyle habits - for example do you:
    • Smoke? If so, how much do you smoke?
    • Drink alcohol? If so, how much do you drink?
    • Use controlled substance? If yes, what are they?
    • Exercise regularly, occasionally, or never?
    • Consume caffeine? If yes, how much?
    • Get enough sleep on a regular basis?
  • Job conditions and stress levels
  • Your daily nutrition such as whether you’re vegan or vegetarian, a healthy eater or consume a lot of junk food
  • The age of your mother at menopause
  • Is your menstrual cycle regular, irregular or nonexistent?
  • Whether or not you suffered before or suffer now from PMS symptoms
  • Whether you or your partner have parented any other children
  • History of infections, hernias, diseases, disorders or surgeries for both male and female partners
  • Current medications for you and your partner

You may be wondering what all these questions are for. Each one of them could be a factor in fertility. For example, smoking and some controlled substances have been linked with decreased sperm count, and poor sperm morphology. Genetic disorders and diseases, as well as many infections can also cause irregular and nonexistent menstrual cycles.

Even something you may think is trivial, could be the missing puzzle piece you didn’t even know was there. It’s better to be thorough and eliminate guesses and possibilities, than it is to be left with no answers as what is really causing your infertility.

Questions You Should Ask Your Doctor

Although your fertility specialist will likely be quite thorough in your exams, if these questions aren’t addressed, feel free to ask them.

  • What are the most successful types of treatments?
  • What types of treatments would you recommend first?
  • Are there less expensive treatments we can try instead?
  • What additional diagnostic tests should we consider?
  • In your opinion, will a treatment be successful?

Bare in mind, however, with all of these questions, there are no guarantees. The sad reality is that one woman who seemed infertile could miraculously achieve pregnancy, and the very next could seemingly have nothing wrong and struggle to get pregnant.

On the other hand, here at the Center for Reproductive Medicine, we will do everything we can to help you achieve your goal of getting pregnant. We will explore any and all options available to you. Our compassionate staff knows how important this is to you, and we understand exactly what you’re going through.

Will My First Visit Be Covered By Insurance?

Unfortunately, most insurance plans will not cover fertility treatments and/or any visits with a fertility specialist. However, there are some plans that cover at least the initial consultation. You will need to ask your insurance company about coverage that may be available to you.

It is true that many fertility treatments can be on the expensive end, and it’s important to know all of these costs up front before making a decision. Our staff understands how hard it is to decide between saving money and starting or expanding a family. Because of this we have financial counselors on hand who can explain all of your options to you, and help you decide what choices are best for you without pressuring you into any decisions.

Should I Wait to See a Fertility Specialist?

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This is a personal choice that no one but you and your partner can make. We would be doing you a disservice though, if we didn’t tell you that there is in fact a biological clock that is ticking. Although men can produce sperm for their entire lives barring any disorders or irregularities, every year a woman waits could mean she is getting closer to never being able to achieve pregnancy.

Once a woman turns 35 her clock starts ticking faster, and the onset of menopause gets closer, making it that much harder for her to ever have a baby. Though the age of 35 doesn’t mean all hope is lost, if you are at, near or over that age, you should see a fertility specialist sooner rather than later.

What Are You Waiting For?

By now you know everything you can expect in your new patient consultation with the infertility specialists of the Center for Reproductive Medicine. Now all that is left to do is book the appointment. Stop waiting and wondering why you can’t achieve pregnancy. You deserve the answers, and we can help you get closer to finding them. 

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Topics: Infertility, Fertility Clinic

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