Your First Fertility Visit
Who are you seeing?
At most clinics, you should be seeing a fertility doctor. That's not the case everywhere. So number one, you want to know who you're seeing. Do you get to choose your doctor? Was this doctor referred to you by a friend or your OBGYN or internet research, or are they putting you with the next available? Do you get any say in the matter? Next question: Is it a doctor, or is it a nurse practitioner or a PA or general OBGYN, and not a fertility doctor? Every clinic is structured different and some places are not transparent. There are pros and cons to all of the other scenarios, and I'm not saying one's better than the other. I'm saying you deserve to know who you're seeing and what their training is. In order to be a fertility doctor, you have to do medical school, a four year OB/GYN residency, and a three year reproductive endocrinology and infertility residency. You have to sit for different boards, oral and written for each one, for OBGYN and for REI. So to be a true double board certified OBGYN and REI, you do thousands of IVF cycles. You've seen lots of fertility patients. You have a bulk of experience. You've passed tests, and you've had to do significant research in the field, proving you know how to understand it. You deserve to know who you're seeing. So number one, who are you seeing?
Set them up for success
No matter who they are, data in equals data out. Have you ever heard that? We use it a lot in research. If you have really poor data. you're not going to be able to trust your result if you are not giving your doctor all of your information, and then you're throwing it at them in the middle of the consult. Things like “Oh, I also had this test.” “I did an IVF cycle in this place.” “What do you think about my embryo transfer?” I don't know anything about it unless you gave it to me already. So if you want my opinion on your cycles in the past or on your medical labs or what that semen analysis looks like, or what I would change, you've got to give me the records. Sometimes people get really weird about this. They don't want to ask for records from other clinics. It is very common in our field for people to get second opinions. That's not strange. You don't need to feel like you're hiding anything and you deserve this is your healthcare, not mine, not your other doctors. This is your journey, your time to have a baby or have a family. So what you need to do is make sure that you are advocating for yourself the best, and part of this is giving whoever is seeing you all the data that exists. I can't tell you how many times somebody fills out their health history questionnaire, and they just fly through it to try to get through it, and then they're telling me a completely different story. We don't get through all that training, and you don't go into this field with hormone minutia and IVF unless you really obsess about details that makes us so good at our job. You have to give us the details in order for us to make decisions, and I like the full picture. So fill out the paperwork to the best of your ability. Give your full medical history if the questions are asking it. If you have had any fertility evaluation or treatment, get the records, give them to the person who's seeing you. Blood work, ultrasounds, HSG, testing, semen analysis, prior IUI cycles or ovulation induction or IVF or surgery, give me the data so I can make the best decisions, and I can counsel you to the best of my ability, another thing just to think about in preparation for your visit.
Where is the visit?
I know maybe that seems crazy, but a lot of people are still doing telemedicine. Some offices have multiple locations, and just make sure you're prepared if you're driving to a location. Make sure you know where it is. Get there on time. Fertility clinics, not all of them, but most of them, run very specific on timing because of the time sensitive nature of so much of what we do. So get there early. Be prepared if it's on telemedicine. Do you have internet connection? Have you tested the platform? I have done so many virtual consults with people in their car or somewhere where they have terrible reception or terrible noise, and that's just not the easiest and the best environment. A lot of your consults going to be education. So your doctor is going to be talking a lot and trying to explain things to you, and if you can't hear them, or you're easily distracted, or the internet's not very good, that's going to be an issue. Personally, I love telemedicine. I think it's the great neutralizer. There's nothing strange about waiting in the waiting room. If you have a partner, you often can join from different locations. There's no drive time across town or showing up to the wrong clinic, and it just seems like a more neutral place to really have somebody's one to one focused attention and be able to dive in. I have not found that it makes this process any less personal. We've been doing virtual consults exclusively for four years at fora, and I love it. I don't think it will change, but you should know, is it virtual? Is it in person? Do you have a choice? Where is it? Where do you need to go?
Questions your proivder may ask
So when you sit down with your doctor, wherever you are, the first thing that should happen is a review of your medical history. Now, it might be extremely complete. It might be just hitting the high points, but you should be prepared for the following. How are your periods? Are they regular? Are they painful? Are you tracking your cycles? Have you been on any form of contraception? Have you had any pregnancies in the past. What was the outcome of those pregnancies? Have you had any surgeries? Are you currently taking any medications? Is there any difficulty determining when you ovulate? Have you had time to intercourse? Any issues with libido, erection, ejaculation? What medications is your partner on? Any significant medical problems either of you may have, like thyroid disease or high blood pressure, anything in that realm, if you carry any genetic diseases in your family, like cystic fibrosis? Something like, “my brother has a child with cystic fibrosis.” is highly relevant information to let somebody know. So the first part will be all just talking and going through medical history, any procedures on your uterus are important to things like prior IUDs or if you had a surgical termination that should be relayed because that might be relevant, depending on what's going on. Then your doctor will probably walk you through some basics about fertility and discuss the next steps involving testing.
