First impressions: What to expect at the fertility clinic
The path that brought you to the fertility clinic was probably fraught with some challenges and disappointments, and feeling nervous about your first visit is normal. The inner voice in your head may be saying, “I wish I didn’t have to be here.” “Who am I going to meet?” “What tests am I going to have to do?”
First of all, know that you’re not alone. One out of every six couples experiences difficulty getting pregnant. In Canada, consultations on and treatment for fertility are on the rise. Infertility awareness is increasing in today’s society, with 1 to 5% of all babies born as the result of some form of fertility treatment.
However, despite the common nature of this issue, many couples choose not to disclose to their family and friends that they are having trouble conceiving. This can lead to feelings of isolation, on top of other emotions such as disappointment, regret and lack of control.
It is normal to carry some of these emotions into your first consultation, but rest assured that fertility clinic staff are sensitive and understanding about this.
The fertility doctor you meet will likely be an obstetrician/gynecologist (OB/GYN) who has completed further specialty training in reproductive endocrinology and infertility. Most of them focus on providing fertility treatment, but some still practice gynecologic surgery and/or obstetrics.
Some reproductive endocrinologists (REs) have university affiliations and may be involved in teaching and research, which is great because that means they are on the cutting edge of what is happening in the fertility world and can bring you the most advanced treatments out there!
On the first visit, your fertility doctor will spend time getting to know you (and your partner) and explore the history of your fertility issues. He or she will likely propose some tests to find out if there are any obvious barriers to fertility.
This is a great time to “feel it out” and get to know your doctor and decide whether he or she and the clinic are the right fit for you.
The initial testing focuses on the following trifecta:
What’s important is not just how many you have, but also if you are ovulating. If you have regular monthly periods, chances are you are ovulating regularly, and your fertility doctor may decide it is not necessary to confirm this.
However, if you have irregular periods, then hormonal blood tests and “cycle monitoring” with ultrasound may be recommended to check if you ovulate. The other component of testing is measuring your egg reserve.
This is done by a hormonal blood test called an Anti-Müllerian hormone (AMH) level and by an ultrasound on day three of your cycle to count the visible egg follicles, known as your “antral follicles.” These two measurements will give you and your fertility doctor a sense of your egg quantity and help you to make decisions about treatment.
The AMH is perhaps the most important and most reliable test to look at how fertile you are, so we recommend this test be done on almost every woman who goes to the fertility clinic.
Fallopian tubes, or the pathway for eggs and sperm to find each other!
If your tubes are blocked, then your eggs and his sperm aren’t able to meet naturally, much less result in a pregnancy.
Fallopian tube testing is a necessary evil. It is an important preliminary test but, unfortunately, may be a little uncomfortable. Depending on your RE’s preference, either a sonohysterogram or a hysterosalpingogram will be ordered. The former is an ultrasound-based test, and the latter is a x-ray-based test. They both involve inserting a catheter through the cervix and flushing fluid through the uterus to confirm if the fallopian tubes are open. Discomfort can be reduced by taking pain medications such as Tylenol or anti-inflammatories prior to the procedure, which is highly recommended.
Male partners are asked to produce a semen sample. The sample is analyzed for volume, sperm count, motility and morphology (shape), and is compared against standard references. Reassure him that most fertility clinics offer discreet, clean and comfortable rooms for sample production.
“Are my hormones in check?” Many women ask us this. Many women see naturopaths and alternative medicine doctors to help “balance their hormones” to conceive. While there is some data to support this type of alternative medicine, the scientific truth is that there are a few hormones that really matter to getting pregnant.
These are thyroid hormones (TSH, which is responsible for metabolism in our bodies), prolactin (which makes breast milk but can be elevated and cause fertility issues) and male hormone levels, to name a few. Your doctor may check these levels on your initial visit, depending on your history.
Remember to ask for as much written information as possible. The first visit can be a whirlwind experience, and it is not uncommon to get home and say, “What did that doctor ask us to do again?”
Also, remember that the first visit is a chance for you to see if the clinic is the right fit for you. The first visit and initial testing may feel a little generic. However, after all the testing is done, you will get a chance to see the RE for a review appointment to discuss your individual results. That’s when your treatment plan will be personalized to you and your partner.
At the end of your consultation, your doctor will most likely suggest possible treatment options. Remember that there isn’t only one path to pregnancy, and often times it’s about a treatment that makes sense and works best for you.