Your Initial Fertility Consultation

Your Initial Fertility Consultation

Written By: Allison Esses and Sarah Savdieh

Medical review by Dr. Rob Setton and Dr. Susan Lobel

Seeing a specialist can be scary! We get it. We’ve been there. Below, you’ll find a general introduction of what you may expect at an initial consultation with a fertility specialist, also known as a Reproductive Endocrinologist. 

When should I see a Reproductive Endocrinologist?

According to the American Society for Reproductive Medicine (ASRM), if you have regular menstrual cycles and you are under the age of 35 and have been actively trying to conceive after 12 months of unprotected intercourse, or after just 6 months for women over the age of 35, you should see a Reproductive Endocrinologist. 

In addition, you should see a specialist if:

• your menstrual cycle is irregular 
  • an irregular cycle is one that is completely unpredictable, or there is less than 21 days or more than 35 days between periods
• you do not get your period
• you or your husband have a known condition that may make it difficult to conceive

How do I find a Reproductive Endocrinologist?

SBH Fertility is here to help! Give us a call (718-787-1100 ext. 517) or send us an email (fertility@sbhonline.org). Our team will coordinate with the SBH Medical Division and their team of medical professionals to provide you with various medical referrals to choose from.

Keep in mind that your insurance may cover your visits and any treatment or medication needed. We’ll help you connect with your insurance company to understand your benefits in totality. 

What should I do before my initial consult?

Make sure to gather any related medical records prior to your visit. Sometimes, it can take a few weeks for your prior doctor’s office to gather and send this information to the specialist. Be sure to request a copy of any records for yourself as well.

What can I expect at my initial consult?

During your initial consultation, your doctor will review both your and your husband’s medical and sexual history. This is a time for you to bring up your questions and concerns, so be sure to make a list before your visit. It is important to understand that you and your doctor have entered a confidentiality agreement and you can be completely open and honest with them.

Will the doctor do any type of exam?

After discussing your medical history, your doctor may request to perform a physical exam which includes three components of an internal exam: 

• Speculum examination (using an internally placed instrument as is done for a Pap smear)
• Manual examination
• Ultrasound using an internal transvaginal probe in order to see your uterus and ovaries clearly. In some cases, a breast examination may be warranted as well.

What else should I expect?

Your doctor may request a panel of bloodwork to evaluate your hormones. Hormone evaluations tell physicians a lot about your body. Some hormone measurements need to be done at a specific time during your menstrual cycle. Remember, some of these tests take time and you may not get the results right away. 

Ever wonder what your doctor is looking for in your bloodwork? They’re usually evaluating your hormones. Below you will find more information on the types of hormones that are evaluated. 

The following hormones are tested to indicate Ovarian Reserve (quantity of eggs):

• FSH (follicle-stimulating hormone): stimulates the development and maturation of the egg in a follicle
• E2 (estrogen): produced by the follicle in the ovary to stimulate the growth of the uterine lining for later implantation 
• AMH (anti-Müllerian hormone): an indirect indication of the number of follicles remaining in the ovary
• In addition, during the transvaginal ultrasound, your doctor will be able to count the number of developing follicles which can also be used as a marker of Ovarian Reserve

The following hormones are tested because they control ovulation and fertilized egg implantation:

• LH (luteinizing hormone): stimulates the release of the egg from the follicle (ovulation)
• Progesterone: stabilizes and prepares the uterine lining for implantation of a fertilized egg and supports early pregnancy

What about genetics?

Your doctor may offer you and your partner the option to get genetic carrier screening blood tests. 

What happens after my initial consultation?

After your initial consultation, further tests may be required to make a diagnosis including:

• Hysterosalpingogram (HSG) – An x-ray that lets your physician examine the inside walls of your uterus and Fallopian tubes. Physicians perform an HSG for three primary reasons:
  • To see if a patient’s Fallopian tubes are open and of a normal size
  • To assess whether the uterus has a normal shape
  • To confirm that the uterine cavity is not affected by fibroids, polyps, or scar tissue
• SIS (Saline Infused Sonogram) – Similar to an HSG, this test focuses on the uterus rather than the fallopian tubes.

Your male partner may need a semen analysis to evaluate his sperm.

In some cases, the cause of infertility will be identified quickly, but in other cases it may take several weeks to determine the cause. If all available testing is normal, you may be categorized as having “unexplained infertility.” 

Receiving a diagnosis, no matter what it is, can be hard to grapple with. SBH Fertility has various resources to ensure you feel heard and supported during this time. We are here for you. 

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