Difficulty conceiving is a common problem for couples in the United States. As many as one in eight women and their partners experience fertility issues. Until recently it was a topic relegated to the privacy of home or a doctor's office. You may not have a close friend that's experienced fertility issues, but I bet you've seen one on TV from Guiliana Ranic to one of the Real Housewives. Fertility affects so many families and for different reasons. Because each person is different, the idea of a "reasonable" time frame for achieving pregnancy without treatment will differ too. For most of us, seeking fertility treatment is not the way we envision our family beginning, but it doesn't have to be an overwhelming process. Here are some general considerations to help evaluate your personal situation and decide if a fertility specialist can help you grow your family.
When is it time to see a specialist?
Couples seek specialized fertility treatment for many reasons. There are some general considerations to help guide your decision as to if the time is right for you. Some of the signs it's time to visit a fertility specialist like myself include: if you are a woman under the age of 35 who has been unable to get pregnant after one year of unprotected intercourse, a woman 35 years old or older and haven't been able to get pregnant after six months of trying, suffering from irregular menstrual cycles or have been monitoring ovulation without a positive result, diagnosed with cancer during reproductive years who desire to preserve their ability to have children; or are delaying childbearing until after the age of 35. Additionally, there are some religious or cultural reasons that preclude intercourse during the peak time of fertility. Also, anyone for whom there is a known or suspected risk factor for infertility should seek medical advice once they decide to start a family.
What can you expect at the first appointment?
Your entire first appointment will probably last no more than two hours. Ideally, your partner should accompany you to the consultation. At the first visit, the physician will meet with you, review your history, develop a fertility plan with you and determine what testing is needed prior to deciding the best treatment available. If you have already had fertility testing performed prior to your first visit, a treatment plan may be able to be made right away. If not, a definitive plan will have to wait until more fertility test results are available.
To make the most of your first consultation, it is good to be prepared. First, make sure you have all your medical records. To ensure that your records have arrived by the time of your first appointment, it is good to bring them yourself. This not only empowers you in controlling your care but also helps eliminate any delays that may occur while records are being obtained.
Finally, come with the questions you want to ask, preferably written down so you don't forget anything. It is important that you leave the appointment with a better understanding of your situation and the steps involved to assist you.
Who is really there for your first appointment?
At your initial evaluation, you will meet with the physician who will review your history and develop a testing and initial treatment plan. Here at Shady Grove Fertility, we work as a comprehensive team to make sure we provide the best care possible. That is why, after your initial evaluation with the physician, you will be introduced to your nurse who will help you with every step along the way to make this process as easy as possible. Your nurse will assist you in scheduling testing and starting your treatment plan.
What initial diagnostic testing will be recommended and why?
After the initial visit, next steps will vary from patient to patient, but generally include diagnostic testing to acquire all the information needed to come up with an effective fertility treatment plan. Blood tests may be requested to help determine if a woman is ovulating regularly and how many eggs remain within the ovaries. A semen analysis may be ordered to look at the number of sperm and if they are able to move well enough to reach the egg for fertilization. Imaging studies may be recommended, such as a pelvic ultrasound to check for any physical factors in the uterus or ovaries that may be hindering conception or pregnancy and a special X-ray (HSG) to look inside the cavity of the uterus to determine if the fallopian tubes are open. In addition, all patients are offered the ability to obtain genetic screening to ensure they are not carriers of recessive disorders such as Cystic Fibrosis prior to becoming pregnant.
What can you expect at the follow-up appointment?
At the follow-up appointment you will meet with your doctor to review all of the testing results and formulate a fertility treatment plan. Based on all the testing results, you may require medication or surgery, or you may need fertility procedures such as intrauterine insemination (IUI) or in vitro fertilization (IVF). You will then meet once again with your nurse and the financial counselor to assist you in both planning and starting treatment.
How soon can you get started?
Timing to start will vary from patient to patient. In general it can take one to two months from the initial appointment to gather all the necessary testing to formulate a plan and then start treatment.
How much will it cost?
Undergoing fertility treatment can be expensive and it can be a confusing process to determine what, if any, coverage is available from your health insurance plans. Many fertility centers, including Shady Grove Fertility where my practice is, offer detailed financial plans and on-site financial counselors to assist you with the process.