First consultation with a fertility specialist - what to expect?
November 27, 2015 7:21 AM Subscribe
The Mister and I are having our first consultation with a fertility specialist next week. What should we expect to have to talk about or do?
We've had more than 12 months of trying and failing to conceive. I'm 40 and he's 42. I'm very anxious about the visit because I don't know what to expect and I'm worried about being told there's no hope. I also tend to cry when I have to talk about difficult things and the Mister tends to get defensive towards whoever is upsetting me, so I think it would help to be able to prepare ahead of time.
What sort of questions are they likely to ask? What should we be prepared to talk about? Are they likely to do test or examinations on us then and there? What other things should we know about?
Our regular physician sent us for blood tests and a sperm quality test already, so the specialist will have those.
We've had more than 12 months of trying and failing to conceive. I'm 40 and he's 42. I'm very anxious about the visit because I don't know what to expect and I'm worried about being told there's no hope. I also tend to cry when I have to talk about difficult things and the Mister tends to get defensive towards whoever is upsetting me, so I think it would help to be able to prepare ahead of time.
What sort of questions are they likely to ask? What should we be prepared to talk about? Are they likely to do test or examinations on us then and there? What other things should we know about?
Our regular physician sent us for blood tests and a sperm quality test already, so the specialist will have those.
I went solo to my first consult (husband is a teacher and it's hard for him to get out of work) and it was mostly an information gathering session by both the doctor (and his resident who was with him the whole time) and me. He told me about treatment options, what they *could* find, etcera. My age (40s) came up, but there was no age or weight (I'm rounder than I could be) shame at all. Period regularity and intercourse frequency came up, and I talked about the various ovulation predictor devices I had been using. Positioning did not come up, and I was thankful for that. They had a box of tissues handy and I was thankful for that too. There is no shame in crying, by the way. It's tough, unfair situation and you're just mentally TIRED of all of it before you even step in the office.
The only thing that caught me off guard was that because my period was scheduled to start within the week, after the consult I went to an exam room and had the pelvic ultrasound done right away since the timing was right for that. You might have an HSG within the month so you'll receive that prescription/referral.
Here's the rub, there is always hope. That's sounds great, but that also means it's up to you to make the decision on when to 'call the game' if things don't work.
Lots of warm thoughts heading your way, OP, especially this time of year.
posted by kimberussell at 8:08 AM on November 27, 2015 [2 favorites]
The only thing that caught me off guard was that because my period was scheduled to start within the week, after the consult I went to an exam room and had the pelvic ultrasound done right away since the timing was right for that. You might have an HSG within the month so you'll receive that prescription/referral.
Here's the rub, there is always hope. That's sounds great, but that also means it's up to you to make the decision on when to 'call the game' if things don't work.
Lots of warm thoughts heading your way, OP, especially this time of year.
posted by kimberussell at 8:08 AM on November 27, 2015 [2 favorites]
Mod note: This is an answer from an anonymous commenter.
There is the possibility that they will have some sort of results to speak to you about since you have already gone for blood and sperm analysis. However, it is highly unlikely they will be prepared to talk to you about final prognosis. Blood tests, however negative they sound, will only tell you how high the mountain ahead of you is. Until you start some actual treatments, they can't really say that you can't climb it.posted by cortex (staff) at 8:58 AM on November 27, 2015
They will more likely talk to you about various options that could be on the table for you and what they each entail. You may even get to the point of deciding which path to take. Which, if you think about it, is something to look forward to rather than be scared. At least now you will start hearing about what the next steps could be.
As others have noted, depending on where you are on your cycle they may schedule you for a vaginal ultrasound or try to get you in one right away (they are usually done on the first week of your period). This scan is to assess the condition of your ovaries and fallopian tubes. Depending on your treatment, you may have to do several of these to track the progress of your follicle growth. These are the results that gave me the most anxiety, and still do. If you are scheduled for this, ask lots of questions about what they are looking for and what the different results could mean. This may help prepare you.
If your partner's sperm checks out, it is very unlikely he will need to do anything else at this point. Which sucks because it's then the woman who has to undergo the rest of any sort of treatment ahead. But that means he can concentrate on supporting you, listening attentively, and asking questions (rather than just getting defensive). Maybe he can prepare by having a conversation with you about what kind of questions you have now and reviewing that list during the meeting?
From my experience, specialists have been empathetic. They really do understand how emotionally and mentally hard this is - in my experience, they convey some hope but are realistic at the same time.
I wish you all the best. It is a tough journey.
It may be that one or the other of you have a condition that has made conceiving difficult. From your description of your and your partner's personalities, I think you might find yourselves prone to some self-blame. Please try very hard not to beat yourselves up. It happens a lot, but hey: it's just biology, and you're there to fix it.
Be prepared for more blood and sperm tests. Your clinic will have access to tests that your GP probably isn't even familiar with. For example, a GP will likely just test sperm motility. There's so much more testing that can be done, such as do the sperm have small or weak drills that may make them unable to penetrate the egg.
You're also probably going to have to learn how to do lots of full-bladder ultrasounds. This includes gaining the ability to pee just a little with a very full bladder. Apparently this is tough stuff. :)
Good luck, and don't worry too much. Our doctor told us he's been doing this a long time, and he's hardly ever had to tell people there's not much hope. And definitely don't worry about your age. I see lots of folks who are older than you guys when I'm at the clinic.
posted by sincarne at 9:38 AM on November 27, 2015
Be prepared for more blood and sperm tests. Your clinic will have access to tests that your GP probably isn't even familiar with. For example, a GP will likely just test sperm motility. There's so much more testing that can be done, such as do the sperm have small or weak drills that may make them unable to penetrate the egg.
You're also probably going to have to learn how to do lots of full-bladder ultrasounds. This includes gaining the ability to pee just a little with a very full bladder. Apparently this is tough stuff. :)
Good luck, and don't worry too much. Our doctor told us he's been doing this a long time, and he's hardly ever had to tell people there's not much hope. And definitely don't worry about your age. I see lots of folks who are older than you guys when I'm at the clinic.
posted by sincarne at 9:38 AM on November 27, 2015
Assuming your blood and sperm tests check out, you will most likely discuss the tests that can be done next, things like an ultrasound to count the eggs and assess the growth of the one about to be released, and an HSG to ensure your fallopian tubes connect from point A to point B (among other things). If his sperm doesn't check out, then you'll be talking about the options and costs related to sperm banks and intra uterine insemination or intra cervical insemination (I believe).
One thing you might want to do ahead of time is find out what (if anything) your insurance will cover and begin to consider your budget. Treatments can get expensive.
Please know that lots and lots of people have been through this. Medical science is very good. If you haven't found the TTC (trying to conceive) forums and subreddits, look around; there is lots of info and support online. You can find stories of people overcoming some very serious challenges and then having a healthy baby. Good luck!
posted by ruff at 10:13 AM on November 27, 2015
One thing you might want to do ahead of time is find out what (if anything) your insurance will cover and begin to consider your budget. Treatments can get expensive.
Please know that lots and lots of people have been through this. Medical science is very good. If you haven't found the TTC (trying to conceive) forums and subreddits, look around; there is lots of info and support online. You can find stories of people overcoming some very serious challenges and then having a healthy baby. Good luck!
posted by ruff at 10:13 AM on November 27, 2015
Something I wasn't expecting at our first appointment were the detailed questions about sexual history for both of us. Ever been pregnant or impregnated someone? Ever had an STD? Etc. In retrospect, I should have expected that, but I didn't and there were revelations for both of us.
Our doctor laid out all of our options and said he'd be willing to go as low or high intervention as we were comfortable with, but since I was 40 he recommended that we skip clomid/IUI, or do those for just a cycle or two, and go straight to IVF.
posted by subluxor at 10:50 AM on November 27, 2015
Our doctor laid out all of our options and said he'd be willing to go as low or high intervention as we were comfortable with, but since I was 40 he recommended that we skip clomid/IUI, or do those for just a cycle or two, and go straight to IVF.
posted by subluxor at 10:50 AM on November 27, 2015
My partner and I are also both 40; we went in to discuss fertility, my doc sent us there without doing any prelim testing. Before the first appointment I had to fill out a 10-page form including sexual history questions, cycle regularity, family medical history, the kind of genetic questions that would really only be a thing if we were actually pregnant... a bunch of questions. First appointment was a discussion where the doctor read over those forms, explained all the steps of the testing process, and what the rough result was if those tests came back out of the "average" range. I then came back for blood tests drawn on specific days of my cycle, and with clomid (the "stress test" version of ovulation and hormone levels). I had the HSG ultasound, partner did a sperm check. So that was ~5 nurse visits during a month, then we went back and talked to the doctor, who went over the results with us.
Doctor was kind and accustomed to emotions, the office well-stocked with tissue boxes in all waiting areas, exam rooms, nurse stations, and office rooms. There was an air of privacy to the check-in and reception area that meant we would see other emotional-looking couples coming in and out, but never even heard the receptionist call out more than a first name, much less to know what type of testing was going on.
The results were that there's no reason we weren't getting pregnant, everything was basically fine, so we could just keep trying. But given our ages, they would recommend just jumping straight to IVF. Be prepared for that to be your answer, and know what that involves and whether that's what you want to do.
posted by aimedwander at 12:49 PM on November 27, 2015
Doctor was kind and accustomed to emotions, the office well-stocked with tissue boxes in all waiting areas, exam rooms, nurse stations, and office rooms. There was an air of privacy to the check-in and reception area that meant we would see other emotional-looking couples coming in and out, but never even heard the receptionist call out more than a first name, much less to know what type of testing was going on.
The results were that there's no reason we weren't getting pregnant, everything was basically fine, so we could just keep trying. But given our ages, they would recommend just jumping straight to IVF. Be prepared for that to be your answer, and know what that involves and whether that's what you want to do.
posted by aimedwander at 12:49 PM on November 27, 2015
In addition to what others have mentioned, our doctor was able to suggest a preliminary treatment plan for fertility. The source of my fertility issues were apparent (No periods or ovulation) but they did all the blood tests to be on the safe side and I got my first of many transvaginal ultrasounds to check out my follicles.
Finances came up in terms of average treatment cost and what insurance, if any, we had to pay for our care. I got the impression that most people also talked with the financial advisor with their first visit but our insurance covered fertility treatment up to an annual cap. It'll be helpful to know what your spending limit is going in.
They will throw a lot of fertility terms around and usually won't explain them unless asked. Definitely ask while you're there instead of doing a frantic search later on.
Best of luck.
posted by toomanycurls at 4:20 PM on November 27, 2015
Finances came up in terms of average treatment cost and what insurance, if any, we had to pay for our care. I got the impression that most people also talked with the financial advisor with their first visit but our insurance covered fertility treatment up to an annual cap. It'll be helpful to know what your spending limit is going in.
They will throw a lot of fertility terms around and usually won't explain them unless asked. Definitely ask while you're there instead of doing a frantic search later on.
Best of luck.
posted by toomanycurls at 4:20 PM on November 27, 2015
Be very careful and do a lot of research. Do not buy into whatever they sell you-it is a business and the medical field has become a bigger business than most. Get 2 or 3 opinions (that goes for anyone who needs medical care of any sort). I could write a thesis on how messed up medical care is today but that would be for another forum. I actually nearly died on the operating table (it was surgery by a fertility specialist) but that was my personal experience and your results may vary.
Please question everything-ask tons of questions, don't just buy into whatever they tell you. And do your own research, PUBMED is a good place to look things up.
posted by stepup at 8:24 PM on November 27, 2015
Please question everything-ask tons of questions, don't just buy into whatever they tell you. And do your own research, PUBMED is a good place to look things up.
posted by stepup at 8:24 PM on November 27, 2015
From an anonymous commenter:
Similarly to what everyone else has said, be prepared for invasive tests! I went expecting just a chat and questioning and maybe some more blood tests, but the doctor wanted to do a vaginal ultrasound and a manual internal exam too. This threw me a bit! It was fine, and there was a female nurse in the room along with the male consultant, but obviously it was a little awkward. I figured it was probably the first in a long line of similar tests, so I'd better get used to it!posted by taz at 3:15 AM on November 28, 2015
The other thing I wanted to mention, since nobody has yet, is the possibility that the consultant might schedule you for an exploratory operation. I have irregular cycles and when he did the ultrasound he thought he might have noticed something unusual, so he scheduled me for a hysteroscopy and a dye laparoscopy, which are both minor operations done under general anaesthetic. This may not be necessary for you, but be prepared that it might be the next step. I was totally shocked as the idea of having to have surgery (however minor!) hadn't even occurred to me!
This thread is closed to new comments.
In my experience, they will likely ask you:
- About your cycles, how regular they are, etc.
- How long you have been trying to conceive
- Any irregularities in your gynecological health
They will review the test results they currently have, and likely order more tests for you. At my first appointment, they did an impromptu vaginal ultrasound to count how many antral follicles I had (this would depend on what day of your cycle you are on when you visit). They may also require more blood tests to be done during this first appointment.
Be prepared to talk about anything and everything related to conception, as well as your entire health history. They have seen it all before, so they are prepared for sensitive and weepy people. Your feelings are entirely typical for a couple about to see their first fertility specialist.
It will be okay. Try to think of this as the first step to becoming parents!
posted by barnoley at 8:02 AM on November 27, 2015 [1 favorite]