Episode 150: Fertility 101: Preparing for Your First Fertility Clinic Appointment

Dan Bulger: There is hesitation many feel when just the thought of seeing a fertility doctor comes up. And I want to start addressing this with Dr. Michael Drews from RMA of New Jersey, who shares that fertility doctors know that this can all be a very difficult process for people to really dive into. But that time and age, more specifically, are crucial elements to all of this. 

Dr. Michael Drews: We certainly see that this isn’t really a sort of one size fits all treatment plan, everybody’s a little bit different. The biggest decider as to what we recommend from the very first meeting is the age of the female partner, that’s the part we can’t change. And we know the egg is the most critical building block to this whole process. For men, sperm are made till the day they die. So, we will frequently suggest more conservative treatments for younger patients. Because there’s more time on the clock, we don’t really have to worry about that disappearing for our older patients, especially if they’re considering two or more children. Time is their most precious resource. So, we must step up our level of treatment to what really nature is calling for. So, when someone comes through the door and sees me at age 28, I’m going to be suggesting different treatments than I might for someone who is first starting their journey at age 38. And we talked about different ages. From all the statistics that we’ve gathered over the decades through in vitro fertilization, we know there’s certain ages where things take more precipitous decline, and that would be from 35 to 38, especially from 38 to 40. So, if someone is sort of hesitant to pursue treatment and comes through the door, say at age 38, or 39, and their doctor starts to talk about IVF right from the beginning. It’s not because that’s the only thing they do. We do all sorts of different things, and we love to see things happen more conservatively. What they’re trying to do is actually suggest the best treatment in the limited time it’s available to try to really take nature’s incredibly inefficient process of reproduction and try to squeeze the greatest efficiency out of it and nothing does that better than IVF.   

Dan Bulger: In order to really feel prepared for an initial evaluation with a fertility doctor, well, you must first understand what the initial evaluation entails. To help us with that we spoke with Dr. Jennifer Brown from Northeastern Reproductive Medicine. 

Dr. Jennifer Brown: So first, you will have a new patient appointment with your provider and at that point, the provider will review your history and find out if there are any individualized, you know, reasons something going on in your story that might be contributing to your lack of success at that point. You’ll design with your provider a plan for the next steps, which typically include an anatomical assessment of your uterus and fallopian tubes. This is done via ultrasound. So, this is a typically painless procedure where we can evaluate the uterus and fallopian tubes and ensure that the tubes are open, we can look at the uterus and make sure that it has a normal appearing cavity, a place where the embryo to later grow, and we can evaluate your ovaries for ovarian reserve, your partner will undergo a semen analysis. Additionally, we typically check some bloodwork on both you and your partner. For you, we might be checking your fertility hormone, which is called the AMH, assessing your ovarian reserve, you might have your thyroid checked, which does play a role in fertility and in miscarriage. So, we want to make sure that’s optimized. And you also might want to explore genetic carrier screening, which could tell you if you and your partner are predisposed to having a child with an autosomal recessive genetic disease that’s caused when you and your partner match up and carry this same genetic disease. 

Dan Bulger: Okay, so Dr. Brown laid it all out for you. Yes, there will be bloodwork so be prepared for that. We’ll go more into the history part in a bit, but one part I want to pause and discuss is the ultrasound. This is typically a transvaginal ultrasound. I’ve been told that it’s maybe a little uncomfortable. So, I asked the doctor if she had any tips for people to prepare for this part of the evaluation. Here’s Dr. Linnea Goodman from Virginia Fertility and IVF. 

Dr. Linnea Goodman: Ultrasound is a way to image the pelvis. So, there are many ways of looking inside the body. We generally use ultrasound because it’s not invasive, and there’s no radiation. So, we must use an ultrasound that goes through the vagina. So, this is a way for us to be able to get close to your anatomy and look without any sort of radiation. So, we do an initial scan at the baseline visit to be able to get a sense of whether there are things in the uterus such as polyps, fibroids, the shape of the uterus, and then we look at the ovaries to be able to see the antral follicle count. So that’s kind of a measure of how many eggs you have. And so, we usually do an ultrasound at the first visit and then subsequently, whenever we’re doing any sort of treatment ultrasound is used to be able to monitor the ovaries. We then follow up with transvaginal ultrasounds in pregnancy. So generally, your first couple of ultrasounds in pregnancy are transvaginal, once you’re about 10 to 12 weeks, the baby is big enough to be able to look up dominantly. And so that’s what you think of when you think of a standard obstetric ultrasound through the belly. And that happens after the first trimester. So, our initial visit, and ultrasound might take, you know, 10 minutes or so as we evaluate all of the anatomy, we take detailed measurements, once we get into treatment, it can be two to five minutes as we look for specific things like looking at the lining thickness, looking at the follicles that can be much shorter. 

Dan Bulger: Any pointers or tips for people who might not deal with these kinds of things well? 

Dr. Linnea Goodman: If you have discomfort with the ultrasound, someone will listen to music, so put headphones in. We always use lubrication for an ultrasound, but if you find that that’s not enough, you can ask for more or use your own lubrication prior. And then I have some patients that are really having a hard time with the ultrasound and so they’ll put the probe in themselves, which is a way to kind of take control over the situation and have a hand in that. 

Dan Bulger: It’s time to dive into some of the details of things you can do in advance of your first appointment in order to help the entire process go smoothly. For help with that, I spoke with Dr. Thomas Molinaro from RMA of New Jersey 

Dr. Thomas Molinaro: Ahead of time, it’s important to fill out any paperwork that your clinic asks you to. Many of these are now online, but they’re general questions about your medical history, how long you’ve been attempting pregnancy, what your menstrual history might be, etc. Secondly, it’s important to bring any prior testing that you’ve had with your OB-GYN or with a prior physician. It’s a good idea to bring copies of blood tests, ultrasounds, or other imaging that you’ve had done. During your initial visit, you will be asked questions about how long you’ve been trying and what treatments you may have already undergone. And what are your goals for the future. In terms of family building, and expected family size, there are no wrong answers to these questions. It’s just important that you’re open and honest with your responses. In some cases, it’s very obvious what treatment will be recommended. While in others, the diagnostic process will be necessary in order to determine the optimal treatment. 

Dan Bulger: I want to talk to you about lifestyle things. Just for some context here, this is Dr. Kathleen Hong from RMA of New Jersey. And for this part, we were actually talking about preparing for egg freezing. 

Dr. Kathleen Hong: People often ask about lifestyle changes when it comes to preparing for egg freezing or the process of IVF. And my recommendation is always to be the healthiest version of yourself. Not necessarily because that healthiest version of you will improve the overall odds that you have an egg that can become a person, but because if there’s any possible advantage in being healthy at the time of the egg retrieval, then you can achieve it. We want to make sure that your recovery from the egg retrieval process is as smooth as possible. And being healthy helps with that. But again, being the healthiest version of yourself can be a lot of different things. There’s not just one way to be healthy. So basically, just make sure that you’re doing all the things that you would do to optimize your general health and well-being. And you’re already taking that step by considering freezing eggs.