Fertility Consultation with a Reproductive Endocrinologist

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.

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