We as fertility specialists have always likened ourselves to the dentist. (No, your eyes are not deceiving you; we did say “dentist”!) This is not because we know anything about teeth or work even remotely around the same part of the body, but because seeing a fertility specialist like the dentist is usually something most people dread, delay, and don’t really want to do. Who likes going to the dentist? (Sorry to all of you dentists out there. It’s not personal; we just have very bad teeth!) What will they say, what does it mean, and what will it cost? The anxiety of “could be” can paralyze you and keep you from simply making, let alone keeping, an appointment until you are way past due. But just like that hot/cold sensation you have ignored, unprotected intercourse without a pregnancy for months, maybe even years, means something is not right. Cue the fertility specialist.
Whether the pain will wind up being a simple cavity, a root canal, or an extraction, you won’t know until you come in. But unlike those yearly “time for a cleaning” reminders your dentist sends, you won’t hear from us unless you come here to see us. The onus is on you. And knowing when to call it quits with the natural way can be confusing. To alleviate some of that anxiety you feel when putting us in your Google calendar, let us prepare you for what to expect when you finally sit in the chair.
First and most importantly, by admitting that there might be something wrong and making and keeping the appointment, you have already made some serious progress. You should stop, take a deep breath, and pat yourself (and your partner on the back) just for walking through those doors. It takes a lot of courage. In many ways, the first meeting may be like pulling teeth: talking about sex, timing, frequency, pelvic pain, periods, bleeding, and erections can be hard (to say the least).
And in order to have a good idea about what may be causing the fertility problems, we need to hear it all. Although we won’t fill your mouth with cotton and wax and then ask you questions (why do dentists do that?), the conversation can be somewhat difficult. Couples often feel shame, anxiety, and embarrassment when dealing with infertility. But you need to let these emotions go (admittedly easier said than done!). They will only hinder your ability to find out what’s going on and to treat it.
One of the most crucial parts of this first meeting is to make sure you feel comfortable with the doctor you have chosen. If it feels off, then you should probably go elsewhere. This relationship can be a long and winding road. Make sure you are comfortable with those driving the car. After we chat, we will usually start the checking process. In most fertility clinics, the doctor will do an ultrasound to look at your ovaries and your uterus. They are checking for things like antral follicle count, ovarian cysts, uterine fibroids, endometrial polyps, and what we like to call “other intruders.” The “other” category consists of abnormal things (fallopian tube dilation, pelvic fluid, masses) that shouldn’t be there. While many of these abnormalities are common and nothing to go crazy over, they can impact your fertility. Identifying them early in the game can limit the amount of time we are playing this problem out.
Following the ultrasound and physical exam, we will recommend a slew of blood tests (close your eyes, needle-phobes!). These will allow us to have a better understanding of things like ovarian reserve (how many eggs are remaining in the ovaries), ovulation, and thyroid function. Think FSH, Estradiol, AMH, TSH, prolactin, and progesterone. In our attack plan, these are like pieces of intelligence that shed light on where the enemy is hiding. They are essential to completing the full fertility evaluation. Rome was not built in a day. Similarly, the fertility work-up can take about one month to complete. Many of the tests (blood and other) must be done on a specific day of the menstrual cycle. Your time and our time may not be fully in sync when we first meet, and as a result, it can add a few weeks to the evaluation process.
In addition to talking and checking blood levels, we are also going to want to check your fallopian tubes and uterine cavity (test: hysterosalpingogram) as well as your partner’s sperm (test: semen analysis). While in certain circumstances, the diagnosis is clear after our first discussion (e.g., female age, no periods, or no male partner), completing the whole fertility work-up up front is really the most efficient, most effective way to go about it. Just because you don’t get regular periods does not also mean that your fallopian tubes can’t be blocked. It’s better to know all the demons you are dealing with before deciding on a treatment option. While your doctor should be in touch as the “deets” come back, you should plan to sit down for a debrief once the work up is complete.
Unlike dentists, there is not much we can do on a daily basis to prevent future fertility problems. There is no fertility equivalent to flossing, brushing, and whitening—daily maintenance will likely not change what happens in the future. While healthy living, eating, and exercise is good for all parts of the body, they may not protect your reproductive organs. However, knowing that things can decay and need attention is half the battle. If pregnancy has not happened after six to twelve months of trying (depending on age and other medical factors), it’s time to schedule that cleaning. And if you have certain risk factors for infertility (endometriosis, family history of early menopause, irregular periods), you should go even sooner. While we may find nothing other than 32 pearly whites (or the equivalent in the fertility world), it’s important to have an evaluation, at the very least. Early attention can prevent cavities from becoming root canals! Let us take a look and see what’s going on.