When you and your partner have been trying unsuccessfully for a year (six months if you’re over 35) to have a child, it may be time to see a doctor to investigate what the problem may be. Although it can be upsetting to learn that you and/or your partner have a fertility problem, the good news is that as much as 85% of fertility problems can be found after the initial assessment. Even more encouraging is the fact that many fertility problems can be remedied fairly easily. So what can you expect at that first appointment?
Who To See
The best place to start your search for answers to your fertility problem questions is with your regular family physician. However, not all general practitioners are trained in reproductive and fertility issues. A woman’s gynecologist or a man’s urologist may be better suited to investigating the issue. But again, not all gynecologists or urologists will have the necessary training or experience to properly assess instances of infertility.
For some couples, it may be necessary to visit a fertility specialist. These doctors are trained specifically in the area of reproduction and infertility. If you and your partner have decided to seek out a specialist, make sure you find one that has been board-certified. This ensures that the specialist has received all the necessary training and education to make them an expert in their field.
The Female Experience
The ideal time to schedule your appointment for a fertility assessment is usually during the first week of your menstrual cycle (this is the week that you get your period). If you have been recording your basal body temperature, bring this information along with you. If you have also been keeping track of your ovulation cycle, it is a good idea to take your ovulation log to the appointment.
When you first meet with your doctor, she will want to discuss every single aspect of your past that relates to your current health, so make sure you bone up on your history! Topics that will be covered include your menstrual history (have you ever had irregular periods? How long do your periods last?); your surgical history; whether or not you’ve been pregnant before; what type of birth control you have used; if you have ever had a sexually transmitted infection (STI) or a pelvic infection; and your family health history. Of course, your doctor will also want to know all the juicy details about your sex life.
Your doctor will also likely have some questions about your health; if there have been any significant health issues in the past. It may help to bring your medical records with you to the appointment if the doctor you’re seeing isn’t already familiar with your medical history. Don’t forget to mention any medications you are currently taking or have taken in the past. There will also be some inquiry into your occupational conditions and lifestyle - how much exercise you do, how healthy your diet is, whether you smoke or use recreational drugs or how much alcohol you consume.
Next, there will be a physical exam during which your doctor will check your thyroid for any abnormalities, look for unusual or excessive hair growth as well as perform a breast exam. A pelvic exam will also be done to see if there is any evidence of an infection or abnormality. A sample of your cervical mucus may also be sent off for examination. Your doctor will likely want to order some blood tests to measure your hormonal levels among other things.
The Male Experience
Just like your female partner, your appointment will begin with an in-depth quiz about your past. Your doctor will want to know about your sexual history, whether or not you’ve ever had an STI, along with your family health history and your surgical and medical history, including any medications you are currently using or have used in the past. Be sure to mention if you’ve ever had any groin injuries, undescended testicles, surgery for a hernia or contracted mumps after puberty. And don’t forget to bring up any urinary tract infections, cases of prostatitis, or bouts with impotence or ejaculatory problems.
In addition to all this, questions about your lifestyle will be brought up. Do you smoke? How often do you workout? Do you eat a well balanced diet? How often do you drink alcohol? Do you smoke marijuana or indulge in other recreational drugs? It’s important to answer these questions truthfully. While you may be tempted to say you only eat non-refined, organic foods, it’s better to own up to the fact that you eat nothing but fast food all day long. Your working environment will also be discussed to evaluate whether you have been exposed to any toxins that could affect your fertility.
A complete physical examination will also be done. During this exam, your doctor will check your prostate and assess your penis and scrotum for any abnormalities. A semen analysis will also be done to evaluate the quality of your sperm.
The semen analysis is perhaps the most important part of the male fertility work up. You will provide a semen sample by masturbating or interrupting sex and ejaculating into a specimen cup. Your physician will provide you with full details as to just how you should provide your sample. The sample will then be sent off to a laboratory where it will be assessed on six different criteria:
- Motility (your sperms ability to swim)
- Morphology (the size and shape of your sperm)
- The total volume of your sample
- Sperm count
- How well your sperm can swim forward
- Liquefaction of your sperm (its ability to coagulate from a liquid to a gel-like substance)
The cause of male factor infertility can vary depending on what part of the semen sample is abnormal. For example, a low-volume semen sample suggests that there may be a blockage or a problem with the prostate gland or with the production of ejaculate.
Your doctor may also order blood tests to check your hormone levels. Additionally, a culture test may be done on the semen sample or on your urethral tract to see if there is any evidence of an STI or some other bacterial infection.
After The First Visit
Depending on your doctor’s level of expertise, additional tests may be done at your initial visit or at a following appointment. While the majority of infertility problems can be diagnosed after the first visit, some doctors like to order more blood tests to compare hormone levels. If your doctor suspects a particular problem, like polycystic ovarian syndrome, she may want to perform a more involved test, like a vaginal ultrasound. This will allow your doctor to give you a more definitive diagnosis and suggest a better course of treatment for you.
Revision date: June 21, 2011
Last revised: by Sebastian Scheller, MD, ScD