How do I prepare for my first fertility appointment?

Very important that patients provide all information about previous treatments. If they have done previous IVF attempts, it is very important protocol dosage, the description of follicles, how many eggs, how mature, the quality of embryos, and if the embryologist has done some specific interventions like oocyte activation or something else. It is important to know that it was done and also important to know the result of the genetic tests of their embryos. Good to know if there were some surgical intervention if a patient was operated on for an ovarian cyst or had laparoscopy for other reasons like hydrosalpinx or myoma. If a patient had a big myoma and was operated on and in some cases there is a risk of uterine rupture during the pregnancy so, we should know that and for example, may transfer only one embryo because with twins risk will be dramatically higher, etc. Also important to know all conditions concerning general health like infections or blood coagulation problems because if blood coagulation is increased there is a risk of thrombosis during stimulation of pregnancy. If blood coagulation is decreased there is a risk of heavy bleeding during the egg collection or for example, early pregnancy – these are very important things. If the patient takes some medicine also necessary to know because some of them may interfere with our treatment, and change the dosage of medication. Also important to know about diabetes, high blood pressure, and kidney problems. All problems with health are important: necessary to say all about health and about any conditions.

If a woman is healthy, if her ovarian reserve is normal, if sperm count and motility is normal, if tubes are permeable, normally, the probability of getting pregnant is good – around 15% per cycle. After the age of 35, half of all eggs have a genetic abnormalities, at the age of 40 it is around 80%, at age of 26 around 30% so, it increases with age and this may decrease the probability to become pregnant. It is individual because some women have less percentage of genetically abnormal eggs, some women have a higher percentage and also the probability of getting pregnant can decrease because of the partner of this woman. If the partner has bad semen parameters, it means that whatever the woman will do, she will not become pregnant with this partner.

Ladies, when they take the decision to go and see a fertility consultant or book up for a fertility consultation, they need to be prepared to ask because it’s a short period of time you will be meeting the clinician for approximately an hour and many a times you leave the consultation thing I forgot to mention this or I forgot to ask that question. It’s quite important to prepare for the appointment by the following: you should expect that the clinician will go into detailed questions mainly about your cycle – whether how long is your cycle, how frequent is your menstrual cycle, whether you experience any pain or bleed or heavy bleeding during the cycle and if you have suffered from any gynecologic problems as well or whether you had any previous operations to the uterus, ovaries or tubes. Besides you will be asked about your sexual history in the sense for how long have you been trying (if you are trying with a heterosexual partner), if you are not trying at all or if you are coming to see a fertility doctor for any other fertility reasons because these days we see patients – not only a couple, having fertility treatment. You might be a single lady coming to have fertility treatment, you might be same sex couple coming to have fertility treatment, you might be a person in transit to the other gender coming to have fertility treatment so, expect the doctor to start by asking you why you are coming to see me to start with. Besides going through your sexual history, the reasons why you are coming to see the doctor for fertility treatment, you will be asked to mention about your previous medical history. If you have any medical problems, if you have any previous fertility treatments because that will be quite relevant to learn for the future – to know what we need to do next or what kind of treatment we need to adjust for your future treatment. Besides, if you are having treatment with a partner, then you will be asked to provide or the gentleman is to provide a semen analysis to know what are the next steps when it comes to that.

Okay. I think that first infertility appointment it’s a really tricky one because I think people come with so many questions and I think, there’s a real risk of information overload and coming away with not a particularly clear picture, so I tend to try and focus in on the key factors and explain to the lady or the couple, that this is the beginning potentially of a journey and if you try and you can’t learn all about it in the first visit. I think that the first visit in this context is an information gathering exercise and there is an awful lot of background information that’s absolutely crucial to get that information across and on the record because if you miss that opportunity in the first consultation, then sometimes you don’t necessarily get the chance to pick up those really important things in subsequent visits. So, I very much concentrate on trying to make sure that we understand the background to the problem really well and that ladies, couples are fully aware of previous issues, of previous investigations, previous treatment they may have had. For me, it’s very much about collating that information, so I think for couples coming through, for ladies coming through, having that information to hand for the clinician is absolutely crucial because otherwise you tend to be saying: what if it would be possible for you to get hold of that information from this particular hospital or perhaps in a different country or these investigations that you have have had done. I think all the information that you have, that might be pertinent to this journey, bring that along. It’s much better to bring that information and let the clinical team then decide some of it may not be relevant but let’s have a look at it and let’s make that judgment properly rather than just saying “well that’s probably nothing”. So, I think, I wouldn’t worry too much about coming along armed with a million and one questions – there are opportunities over a period of time both with medical staff, nursing staff perhaps even subsequently embryology staff to fill in the very many questions and answers and queries that come through. I think the first initial consultation is about establishing war and having an initial plan for where we go beyond that in terms of initial investigations that haven’t been done or may need repeating or whatever. I think, there’s always this kind of pressure to sort of push on and push on and push on. The trouble is, if you just exceed that, you end up with missing things and not getting a complete picture and therefore perhaps not optimizing the pathway for the patient. So, I think, it’s useful for couples to jot down questions. Sometimes in my experience, some of those questions, I would back back and say look that’s something we’ll pick up subsequently, at this particular point let’s not worry about that, let’s let’s get everything set out at the ground level, let’s make sure we have this information, let’s explore which areas we need to get further information on, let’s build a proper picture that allows us to plan the best possible treatment for you and equally I sometimes say look, in the context of what we know so far, we will be rolling forward with further investigations but what so far there’s nothing to suggest that you might not get pregnant in this intervening time, but let’s not waste this time, let’s use it, let’s get various things ongoing, so that if you’re not lucky in the coming months, we’re in a position to plan moving forward really. So, yes, come armed with questions which are perfectly reasonable but perhaps be willing to understand that all of those questions may not be appropriate to answer at that initial consultation because there’s just so many different issues to cover.

Generally, it would be a lot of questions mainly about their general health, their general fitness, it will be about her periods, period frequency and any problems associated with that, like pain and sexual history which could be like pain and bleeding with intercourse or erection, ejaculation problems so, there could be some very sensitive and personal questions. Generally, the first appointment is a lot of questions to assess, if there is any obvious reason for the delay in conception but it is always dealt with in a very sensitive way, in an appropriate atmosphere so, they should feel comfortable in answering those questions.
They may have blood tests but generally the blood tests for fertility are timed to the day of the period cycle so, they may or may not have it in their first appointment. Some centers, like ours, where we have a chance we can get their vaginal swabs done to rule out infection and then at our center we also aim to do an ultrasound scan which is an internal ultrasound scan to get bit more information about the uterus and ovaries so, that can happen in the first appointment. In majority of the places, it’s generally a lot of questions about their general health, period problems, periods and sexual history.

I think the key is knowing where the problem lies by the end of all the investigations. Knowing what the options are and the success rate of those options and the way I kind of often inform people of things and goes back to the question that you should be asking of me is: what are my chances naturally with all the information that you now have and how does that compare to my chances of plan A and plan B working via IUI or IVF or Egg Donation for example. Once you’ve got all that information, then make an informed decision of what the right thing to do is, so what are the success rates of A,B,C and D; are there any other investigations that will help decide? What is the right course of treatment for me? What are the risks of those treatments? and potentially if it’s in the private sector, what are the costs? Once you’ve got all that information, then you can make an informed decision – what’s the right thing to do.

The first fertility appointment will be a comprehensive appointment; your doctor will ask you about your medical history, your gynaecological and menstrual history and about your periods.

It will be useful to track your cycle in the last six or eight months. Now with smartphones, we are lucky, most women have the date of their periods tracked on their phones. Most clinicians like to see that because we can assess the cycle length if there’s any problem with that.

If you have previous blood test results, try, and bring them to the appointment, that will be useful to the doctor. Recent swabs, especially chlamydia swabs but if that has not happened, that’s fine, the doctor will do that for you.

So just try to relax in the first appointment, it will be as questions and answers, and the doctor will plan your care, ask you to do certain blood tests (some on the second day of the period, and maybe another blood test later after ovulation day 21 or 23 to check your ovulation).

The doctor may perform an ultrasound scan for you to check your ovaries and the womb. That usually will be a transvaginal ultrasound scan. Don’t be embarrassed if that is during the period, because gynaecologists quite often perform what we call the baseline ultrasound scan during the period. So, we are used to that, it’s nothing to worry about if you’re on your period. The vaginal ultrasound scan is sterile or clean, and the probe is covered with a sterile cover as well. There will be a nurse with the doctor during the scan, that will help you and talk you through it. You may expect to have a vaginal intimate examination (with a chaperone) – by your doctor like a speculum examination to look at your cervix, you may also expect to have a cervical smear. If you haven’t had that done, please do have the smear with your doctor before or during your appointment.
So, that may happen in the first appointment just to put up a plan for you. In infertility setting, I always like to see the couple together. If you have a partner, it will be useful to come with you.

That’s it. Just try to relax and take it easy.