A repro­duc­tive endocri­nol­o­gist is a spe­cial­ist trained in help­ing women / cou­ple get preg­nant. Care­ful prepa­ra­tion for fer­til­ity con­sul­ta­tion and ade­quate time devoted to the encounter itself can help iden­ti­fy­ing infer­til­ity fac­tors and point­ing to the most cost-efficient fer­til­ity treatment.

Who should con­sider fer­til­ity consultation?

1. Women or cou­ple not able to con­ceive after two years (female age <35 years), one year (female age >35 years) or 6 months (female age >40 years) espe­cially after repeated unsuc­cess­ful attempts at timed inter­course or sim­ple treat­ment (e.g clomid)

2. Women with known fer­til­ity fac­tor (no ovu­la­tion, endometrio­sis or tubal dis­ease / pelvic scar­ring, fibroids..)

3. Men with known fer­til­ity fac­tor (decrease count, motil­ity or mor­phol­ogy of sperm, dif­fi­culty with ejac­u­la­tion or erection)

4. Women or men who are at risk for reduced fer­til­ity due to dis­ease or dis­ease treat­ment (e.g. can­cer, can­cer treat­ment, chemother­apy, lupus, prior surgery, irreg­u­lar menses or absence of menstruation)

5. Recur­rent preg­nancy loss in the first or sec­ond trimester of pregnancy

6. Women or men known to be car­ri­ers of genetic dis­ease, con­ceived in a baby affected with a genetic dis­ease or with fam­ily his­tory of genetic prob­lems (e.g. chro­mo­so­mal abnor­mal­ity, sickle cell dis­ease, BRCA carrier..)

7. Other indi­ca­tions: same sex cou­ple, indi­vid­u­als desir­ing preg­nancy through donor sperm or donor oocytes, women desir­ing fer­til­ity exten­sion through social egg freezing

Prepa­ra­tion before fer­til­ity consultation

Col­lect prior med­ical doc­u­ments 1. Sperm analy­sis 2. Hys­teros­alp­in­gogram (HSG) report and films if avail­able 3. Lab tests 4. Genetic con­sul­ta­tions if any 4. Med­ical reports from your physi­cian about any sig­nif­i­cant dis­ease 5. Oper­a­tive reports of any abdom­i­nal or pelvic surgery. Allot 1.5 hours for the con­sul­ta­tion and write down any ques­tions that come to your mind.

Dur­ing Consultation

Struc­tured con­sul­ta­tion with  a repro­duc­tive endocri­nol­o­gist con­sumes approx­i­mately 60 to 90 min­utes. Com­po­nents of encounter include

1. His­tory: to review infor­ma­tion related to ovar­ian, tubal and male fac­tors of infer­til­ity as well as med­ical, sur­gi­cal and per­sonal his­to­ries. Detailed fam­ily and genetic his­tory is essen­tial to iden­tify and pos­si­bly test for risk fac­tors of genetic dis­ease in the newborn.

2. Exam­i­na­tion includ­ing gen­eral, abdom­i­nal and pelvic examination

3. pelvic ultra­sound aim­ing at detect­ing abnor­mal­i­ties in the uterus, ovaries and the pelvis. Ultra­sound is an excel­lent tool to esti­mate ovar­ian reserve-antral fol­li­cle count.

4. Explain­ing the required tests needed to inves­ti­gate ovar­ian reserve, male and tubal fac­tors as well as pre­na­tal tests required of any woman attempt­ing to conceive.

5. Out­lin­ing a pro­vi­sional plan for inves­ti­ga­tion and treat­ment of infertility.

All the required tests can be final­ized within 2 to 3 weeks, enabling the per­son or cou­ple to make informed deci­sion about the next step in fer­til­ity treatment

 After Consultation

Before mak­ing any treat­ment deci­sions con­cen­trate on com­plet­ing the required inves­ti­ga­tion includ­ing sperm analy­sis, test for tubal patency (HSG) and tests for ovar­ian reserve. Pre­na­tal tests before attempt­ing to con­ceive includ­ing repro­duc­tive hor­mone assay, infec­tious dis­ease pro­file and genetic screen­ing tests should also be obtained.

A sec­ond visit or phone call with your repro­duc­tive endocri­nol­o­gists out­lin­ing the results of fer­til­ity tests is highly advis­able. Based on the­ses tests, treat­ment plans are finalized.

Five points to con­sider before start­ing treatment

1. Time com­mit­ment: Fer­til­ity treat­ment may require mul­ti­ple vis­its over sev­eral months. Its impor­tant that vis­its are tai­lored around your sched­ule with min­i­mal time off work.

2. Cost is also an impor­tant con­sid­er­a­tion as well as resources avail­able to help you.

3. Poten­tial unde­sired out­come espe­cially mul­ti­ple preg­nancy. For exam­ple women desir­ing only a sin­gle­ton preg­nancy should lean towards IVF with sin­gle embryo trans­fer rather ovu­la­tion induc­tion with gonadotropin injections.

4. Risk of preg­nancy in older women and women with med­ical disorders

5. Is surgery required before fer­til­ity enhanc­ing treat­ment e.g. removal of polyps or fibroids

If you decide to pur­sue treat­ment you need to be advised of the sched­ule of treat­ment cycle, type and self admin­is­tra­tion of medication.

After achiev­ing pregnancy

You should undergo all rec­quied preg­nancy screen­ing includ­ing screen­ing for abnor­mal chro­mo­somes in the fetus, amnio­cen­te­sis of chori­onic vil­lous sampling-CVS even if preim­plan­ta­tion genetic diagnosis-PGD was done on embryos as well as con­sult with high risk obste­tri­cian if needed.