We've made an appointment with a fertility specialist. What happens next?
You, your partner, and your doctor will all work together on your fertility problems. The male and female reproductive systems are extremely complex, and fertility specialists are trained to identify any glitches in this amazing machinery.
Fertility problems are a shared concern, so you and your partner should plan to go to the first appointment together. Have copies of your health records sent to the doctor ahead of time or bring copies with you to avoid the hassle and expense of duplicating medical tests.
Expect to be asked detailed questions about your menstrual cycle, including when you first menstruated, how often you get your period, whether it's heavy or light, whether you have premenstrual symptoms, and whether you experience significant pain before or during your cycle.
You'll also be asked specific questions about your sexual history, such as whether you've ever had any sexually transmitted infections, miscarriages, or abortions. You'll even be asked about your current sex life, including how often you have intercourse, whether you use lubricants, and more. Not much about your private life will be private anymore, so you'll want to find a doctor who makes you feel comfortable sharing intimate details.
What fertility tests will we have?
After looking over your medical history, your doctor will most likely do a complete workup on you and your partner. This initial assessment may include some or all of the tests described below. Bear in mind that many of the tests and procedures are performed in the early part of your menstrual cycle, so you may need to rearrange your schedules to make time for some of them.
For women
Ovulation predictor kits or charting basal body temperature (BBT): If you've been tracking your basal body temperature or using ovulation predictor tests to see when you're ovulating, bring the information to your fertility specialist. If you haven't been doing this, don't worry. Your doctor will run other tests to find out if you're ovulating.
To track your BBT, you'll take your temperature every morning – as soon as you wake up – for at least a month and record it on a BBT chart or phone app. When your body releases progesterone following ovulation your temperature will rise slightly.
You can also use over-the-counter ovulation predictor kits. The kits detect the telltale surge of luteinizing hormone (LH) in your urine just before you ovulate.
Some women use at-home fertility monitors, which use a computer to analyze both LH and estrogen levels. Other products for detecting ovulation rely on hormone-induced fluctuations in sodium chloride in saliva or vaginal secretions.
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Blood tests: You'll have several blood tests so your doctor can check your hormone production, including your levels of LH, thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), estrogen, prolactin, and sometimes androgens or progesterone.
Hysterosalpingogram (HSG): This X-ray procedure lets your doctor see whether your fallopian tubes are blocked. It can also show whether the structure of your uterus is normal or whether you have polyps, fibroids, scar tissue, or other uterine abnormalities that could affect your fertility.
Your doctor will inject a special dye through your cervix into your uterus and fallopian tubes and trace its movement by X-ray.
Laparoscopy: This outpatient surgery, performed under general anesthesia, lets your doctor examine your pelvic organs to check for scarring or endometriosis and treat any pelvic abnormalities.
Laparoscopy is usually reserved for women with an abnormal HSG, pelvic pain, or risk factors for pelvic disease, such as pelvic infections or prior surgery. Your doctor may also recommend this procedure if you don't get pregnant with initial fertility treatments, before trying IVF.
Transvaginal ultrasound: Your doctor will place an ultrasound probe in your vagina to determine whether your follicles are growing, count how many follicles are inside your ovaries, and also identify any problems in your pelvis and ovaries such as ovarian cysts or uterine fibroids.
Hysteroscopy: Your doctor may use this test if the HSG shows any potential problems. During this procedure, your doctor will place a tiny hysteroscope (a thin tube with a camera at the end) through your cervix and into your uterus to see whether you have fibroids, polyps, or other abnormalities that could impair your fertility.
The procedure doesn't allow your doctor to evaluate your fallopian tubes, but it does provide a clear picture of your uterus – and often the opportunity to correct problems at the time of the procedure.
Clomiphene challenge test: You may have this test to give your doctor more information about how well your ovaries function and measure their response to fertility medication.
You'll have a blood test on the third day after the start of your period to check your levels of follicle-stimulating hormone (FSH) and estradiol (a female hormone). Then, on the fifth day after the start of your period, you'll begin taking the fertility drug clomiphene citrate (Clomid) for five days.
Your doctor will retest your hormone levels on the tenth day of your menstrual cycle. The results will give some insight into how well fertility therapy may work for you and how aggressive it should be.
For men
Your doctor will ask you about puberty as well as your general health, such as whether you have any chronic illnesses, have a history of sexually transmitted infections, have had previous surgeries, or take any medications (including anabolic steroids). Among other questions about potential causes of infertility, your doctor will also ask you whether you use alcohol or recreational drugs, and whether you've been exposed to environmental toxins.
Then you'll be asked to provide a semen sample, usually by masturbating and ejaculating into a specimen cup. Your sample will be sent to a lab for analysis, where your sperm will be examined under a microscope for count, shape, appearance, and movement.
If your medical history or the semen analysis indicate a potential problem, your doctor may suggest further evaluation. For example, you may have to see a urologist to have a physical exam, blood tests, and ultrasound exam.
What if it's not possible to pinpoint a fertility problem?
In many cases, more than one factor causes fertility problems, and some are harder to detect than others, so a clear diagnosis isn't always possible. (See our articles on the most common causes of fertility problems in men and common causes of fertility problems in women.)
In about 15 percent of cases, testing reveals no abnormalities at all. Doctors characterize this condition as "unexplained infertility." Fortunately, even unexplained infertility can be treated.
