Infertility question...

Q: I am having a difficult time getting pregnant. Do I need to make an appointment with you? Should I bring my husband to the appointment? What should I expect at the appointment?

A: Yes, an appointment is an appropriate first step in evaluating fertility problems and I encourage you to bring your husband. The appointment will usually consist of a discussion (history) and a physical.

I will start by asking questions about your health history, such as:

General: General health, Past obstetric, medical and surgical history; medications and allergies.

Menstrual history: age of onset, regularity and pain. If you have painful or irregular periods what tests, procedures or surgeries have been performed to work up the pain or irregularity? They might include things such as hormone testing (including thyroid function tests), pelvic ultrasound, hysterosalpingography (HSG), laparoscopy, hysteroscopy, etc? Have you been given a diagnoses that might affect fertility such as polycystic ovarian syndrome, endometriosis, uterine malformation, pelvic inflammatory disease or history of sexually transmitted infections? Have you had problems with facial acne, dark hair growth or weight gain? Do you have PMS or any other problems associated with your cycle? How long have you been trying to conceive?

Ovulation: can you tell when you ovulate, have you documented ovulation using an ovulation predictor test or basal body temperature charting? Have you tried any treatments for infertility (such as Clomid)?

Intercourse: do you experience pain with intercourse? If so, is it with initiation (vaginal pain) or deeper inside (like something is being hit)? do you understand when you should be timing intercourse when you are trying to conceive?

Contraception: What forms of birth control have you used and when did you discontinue use? Some medication (such as Depo Provera) may cause a short term delay in fertility (up to 18 months after stopping use).

Preconceptual meds/vaccines/counseling: Have you been taking a prenatal vitamin with folic acid (for atleast two months preconceptually) to decrease the risk of open neural tube birth defects? Have you had chicken pox or the vaccine for chicken pox? Have you had two MMR vaccines? If not, checking titers and/or giving vaccines are appropriate before trying to conceive.

Genetic/Obstetric history: Do you have a family history of genetic disorders that you want preconceptual counseling for prior to becoming pregnant? Any risk factors for a high risk pregnancy (i.e. personal or family history of blood clots, gestational diabetes, high blood pressure, obesity, preeclampsia or other pregnancy or birth complications?

Mental health: History of depression, anxiety or other mental health disorders? Past/current treatments? How are you and your husband coping with the fertility issues you are experiencing?

Questions specific to your husband's health:

General health including medical and surgical history and medications. Do you have a history of diabetes, hypertension or depression? Are you taking medication for any of those conditions? Do you have any problems with erection or ejaculation? Do you have any lumps or pain in your scrotum (around your testicles)? Have you ever been diagnosed with a varicocele or hernia? Have you fathered children? Any past illness that resulted in high fever? Any recreation that may cause heat to testicles such as frequent use of hot tub or avid bicycling? Do you use steroids (i.e. testosterone), elicit drugs, alcohol and/or caffeine?

I will examine you (need current exam/pap) and order diagnostic tests as indicated by the history and physical.

I will encourage you to test for ovulation if you have not prior to the visit and I would recommend a semen analysis on your husband. I may consider ordering a HSG to rule out uterine abnormalities and/or blockages in your fallopian tubes. Please start or continue taking a prenatal vitamin with 800-1000 mcg of folic acid daily.

After the initial work up (history, physical and diagnostic tests) we will meet again and discuss your treatment options. This is an exciting time but it can become very stressful. If you get frustrated with the process please schedule an appointment, call or email me. Communication is very important and the speed with which we proceed is largely up to you and your husband. If, at any time in this process, you want a referral to a fertility specialist (Reproductive Endocrinologist) I would be happy to make a referral for you. I am here for you and your family. I appreciate the opportunity to help you achieve your pregnancy goals. ~Lisa