Your first fertility consultation

Your first consultation is a thorough conversation with Dr. Elassar about your history, your goals and the options in front of you. Whether you’re hoping to build your family now or preserve your fertility for later, you’ll leave with a clear picture of what comes next.

What the consultation covers

You’ll talk through any past fertility experiences and what you hope to achieve. Dr. Elassar explains your treatment options in depth, maps out a timeline and answers your questions, whether your goal is family building or fertility preservation through egg or embryo freezing.

The visit includes an ultrasound to assess your ovarian reserve and look for any abnormalities of the uterus. Depending on your situation, blood is drawn on site to check your hormone levels.

When to come in

There’s no harm in seeing a reproductive endocrinologist at any stage of your reproductive life, and a consultation can be very worthwhile. If you’re concerned about your reproductive age (ovarian reserve), polycystic ovaries, fibroids, endometriosis or any other fertility issue, it’s a good time to talk. Preconception counseling and labs can also uncover a significant problem that can be treated in the mother or prevented from reaching the baby.

Consider a consultation if you are:

• A couple who hasn’t conceived after one year of regular unprotected intercourse when the woman is younger than 35, or after six months when she is 35 or older. You’re considered to be trying to conceive whenever you aren’t using birth control pills or condoms.
• A woman with a known or possible fertility factor, such as no periods or irregular cycles, a history of pelvic inflammatory disease (PID), prior pelvic surgery, endometriosis or polycystic ovary syndrome (PCOS).
• A man with a known or possible fertility factor, such as erectile or ejaculatory dysfunction, retrograde ejaculation, reduced libido, a prior vasectomy, abnormalities of the penis or an abnormal sperm analysis.
• A woman interested in extending her fertility with egg freezing, or a couple interested in embryo freezing.
• A woman or man at risk of reduced fertility because of a disease or its treatment. This includes people diagnosed with cancer, people with lupus who need chemotherapy, women who need surgery for ovarian cysts or endometriomas, and men who need genital surgery.
• A woman or man who carries, or may carry, a genetic disease, has a strong family history of a genetic condition, or has had a child diagnosed with a birth defect.
• A woman with recurrent pregnancy loss, such as repeated first or second trimester miscarriages or repeated preterm deliveries.
• Hoping to conceive with donor sperm, donor eggs or a gestational carrier (surrogate).
• A same-sex couple.
• Hoping for a pregnancy of a specific sex for family balancing.

Before your visit

We want you to feel informed and prepared when you first come to see us. Good preparation helps you get the most from your consultation and helps us understand your needs, so our team is available by phone or email at any time before your visit to answer questions.

Plan to spend about 90 minutes with the doctor. That gives us time for a thorough exam and for all of your questions and concerns. Write your questions down beforehand and bring them with you.

To help us give you accurate, personalized advice, please bring records of any previous testing or treatment, including:

• Sperm analysis
• Hysterosalpingogram (HSG) report and films, if available
• Lab results
• Results of any previous genetic consultations
• Reports from your physician about any significant disease or health condition
• Operative reports from any abdominal or pelvic surgery
• Records of any prior fertility treatment, including ovarian stimulation cycle sheets and embryology records showing sperm quality, number of eggs retrieved, number of mature eggs, number of eggs fertilized, embryo quality, number of embryos transferred, and the number and stage of any embryos frozen

During your consultation

When you arrive, you’ll be taken to a private consultation room as soon as possible, usually right away. Your first consultation typically takes about 90 minutes and includes:

• A thorough medical and personal history. We review ovarian, tubal and male factors along with your medical, surgical and personal history. A detailed family and genetic history is essential for identifying, and possibly testing for, the risk of genetic disease. We also want to hear about your daily activities, work and relationship, and anything else on your mind.
• A physical examination, including a general, abdominal and pelvic exam.
• A pelvic ultrasound to look for abnormalities of the uterus, ovaries or pelvis. Ultrasound is also an excellent way to estimate ovarian reserve.
• Blood work at your first visit, if needed.

We’ll then talk about anything that may be reducing your fertility, the tests needed to investigate ovarian reserve and male and tubal factors, and the prenatal tests recommended before conception.

Finally, we’ll work together on a provisional plan to find the cause of your infertility and choose the right treatment. We’ll walk through each likely scenario and its treatment options, your overall prognosis and expected chances of success, and the possible risks of treatment, including the risk of multiple pregnancy. You can also review our SART-reported success rates.

After your consultation

Before making any treatment decisions, we’ll complete all required testing, including a sperm analysis, a test of whether your fallopian tubes are open (HSG) and tests of ovarian reserve. Additional prenatal tests, including reproductive hormone levels, an infectious disease profile and genetic screening, should also be completed before you try to conceive.

All required testing can usually be completed within 2 to 3 weeks of your first consultation, so you can decide on your next step promptly. We’ll then set up a follow-up consultation, by phone or in person, to go over your results, our recommended treatment plan and your chances of success.

Points to consider before starting treatment

• Time commitment. Fertility treatment may involve several visits over a number of weeks. We plan these visits around your schedule to keep disruption to your work and other activities to a minimum.
• Cost. Consider the full cost of treatment at the fertility center you choose. We work to make fertility treatment as affordable as we can, and we can work with your insurance, so contact our team for a review of your benefits.
• Risks, including multiple pregnancy. Look not only at the chance of pregnancy but also at the risk of twins or more. We make every effort to minimize undesired outcomes, especially multiple pregnancy. If you want a single pregnancy, we encourage you to lean toward IVF with single embryo transfer rather than ovulation induction with injectable medications. Before treatment, we’ll also talk about how you feel about fetal reduction, should it ever be needed.
• Surgery. If a procedure such as removing uterine polyps or fibroids is needed before fertility treatment, you’ll want to weigh its risks and benefits too.

This article is general information, not medical advice. Every situation is different, so talk with your doctor about yours.