The first visit to a fertility clinic is usually considered a first contact between the patients and the professional who helps them.
Normally, in this first consultation, an evaluation of the patients is carried out and all medical, gynecological and/or andrological history is noted. In addition, the doctor will include questions to obtain family information and to find out if there are any diagnosed hereditary conditions.
Among the tests requested for a complete initial fertility study are a homonal analysis, a vaginal ultrasound, a semen analysis, etc. Other complementary tests may also be necessary in both men and women.
To facilitate the diagnosis and the choice of treatment, it is advisable to bring to the consultation all the reports and tests previously performed.
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Objective of the first visit
Infertility is considered to be a problem when, after a year of frequent unprotected sex, pregnancy has not occurred. From this moment on, all professionals advise you to go to a specialized consultation to assess the factors that may be responsible for this circumstance.
The aim of this first fertility visit is to get a global assessment of the situation and to start the study of the woman and her partner (if she has one). It also serves to plan any diagnostic tests that may be necessary.
Therefore, if you have previous medical reports on any aspect it is interesting to provide them in this first visit. In this way, the history will be as complete as possible and will help the specialist to act appropriately.
Dr. Valeria Sotelo details the tests and analyses that are carried out on both men and women on their first visit to a reproduction clinic. As Dr. Sotelo tells us:
In the evaluation of the infertile or infertile couple we must evaluate both members of the couple. Throughout the fertility study, we may encounter concomitant pathologies.
Personal interview
In this first visit, an exhaustive clinical history will be taken and all the necessary tests will be carried out in order to reach a diagnosis that will allow the correct choice of treatment. For this reason, it is important that if it is a couple, both people attend, regardless of prior knowledge of who has the fertility problem.
This part of the consultation can take time, as the doctor needs to know and make sure that the woman's health conditions are ideal for a safe pregnancy.
The specialist will ask questions about the couple's life habits, such as professional activity, contraceptive use, consumption of tobacco, alcohol, toxic substances, etc. It should be noted that information relating to the following aspects will be of great importance:
- Age at first menstruation or menarche.
- Length of menstrual cycles.
- Previous pregnancies.
- Prevention of inherited diseases
Basic fertility study
Once the amnanesis or medical history has been taken, it is usual for a gynecological examination to be performed and from here the doctor will determine other complementary tests for the couple before making any decisions.
There is a good chance that a definitive diagnosis cannot be made at this first visit, as the doctor usually needs some additional test results.
Each of the main tests that make up the basic fertility workup are listed below.
Ultrasound
Ultrasound is a basic diagnostic test and, therefore, should be performed at the first visit. To perform the ultrasound, the gynecologist inserts a probe covered with a condom and lubricating gel through the vagina.
Through this test, the doctor can assess ovarian function based on follicular development, as well as detect any alteration at the level of the ovaries such as cysts or tumors. In addition, the presence of uterine alterations such as myomas or endometrial polyps is ruled out.
The gynecologist also usually takes advantage of the time of the ultrasound to do a Pap smear or Papanicolaou test to see if there is any type of infection.
In case of detecting any anomaly and requiring more exhaustive information about it, the specialist will perform tests such as endoscopy, laparoscopy or hysteroscopy.
Ovarian function assessment
After taking a medical history, the doctor will know if the woman is ovulating. However, it is advisable to study it in depth by means of a hormone analysis.
In this analysis the hormones involved in ovulation are studied, i.e. follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol. All of them will be assessed between days 3 and 5 of the woman's menstrual cycle. Finally, the progesterone test is carried out on day 21 of the cycle to find out whether ovulation has occurred or not.
Another basic test to study a woman's ovarian reserve is the determination of the anti-Müllerian hormone. This hormone is an excellent marker, since it indicates in an approximate way the number of eggs that a woman has at a certain moment. Therefore, the AMH test can be performed at any time during a woman's menstrual cycle.
Other alternatives for the study of ovarian function include endometrial biopsy and basal temperature assessment, although these options may be uncomfortable for the woman.
Tubal patency assessment
The fallopian tube is the place where the egg and sperm meet. If they are obstructed for any reason, fertilization will not occur.
For this reason, the doctor will order a test called a hysterosalpingogram. This is a contrast x-ray to study the uterus and tubes. It is usually performed between the 8th and 11th day of the menstrual cycle. If there is a problem with tubal obstruction, the contrast fluid will not be able to flow through the tubes and into the abdominal cavity. Therefore, it will not be possible to observe the fallopian tube.
This diagnostic test is very feared by women due to the discomfort it causes during its performance and subsequent recovery.
Seminogram request
Seminogram is the essential test to evaluate testicular function. In addition, the concentration, mobility, vitality and morphology of the spermatozoa can be assessed.
If the woman has a male partner and he has not had a recent semen analysis, it is essential to have one.
For the results to be reliable, the World Health Organization (WHO) indicates that the semen analysis should be carried out after a period of sexual abstinence of between 3 and 5 days:
- If the period of abstinence is shorter: the seminal volume, sperm concentration, etc. will decrease.
- If the period of abstinence is longer: the number of dead sperm and the seminal volume will increase. It will also worsen sperm mobility and morphology
In addition, the semen will be collected by masturbation, after having washed your hands and genitals properly. The results of the semen analysis may or may not show any abnormality, it is advisable to refer the male to an andrologist, who will study the patient in depth to establish the cause of sterility and be able to develop a treatment plan.
Other complementary tests
Other tests that may be recommended after a first visit to an assisted reproduction centre in order to establish a more personalised therapeutic orientation are the following:
- Karyotype to study possible chromosomal alterations.
- Hysteroscopy or endoscopy of the uterus.
- Endometrial biopsy.
- Semen culture to rule out seminal infections.
- Sperm DNA Fragmentation.
- FISH to analyse the chromosomal content of spermatozoa.
- Testicular Biopsy.
In short, there are many useful tests but they are not routinely performed on all patients.
Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.
Tips for the first visit
Most people are nervous about going into assisted reproductive treatment. They tend to mistrust everything, forget the doctor's recommendations or guidelines, have absent-mindedness, misunderstandings, etc. For this reason, it is important to maintain fluid and sincere communication between doctor and patient.
Here are some tips to help patients come to their first visit more prepared, confident and at ease:
- Review medical and family history.
- Write down all doubts.
- Keep all tests performed and reports.
- Go to the consultation with a positive attitude, security and confidence.
- Do not withhold information from the doctor, as this would put your health at risk.
From this moment on, a path begins in which many doubts and fears will arise and will be resolved. The road will go on until the dream is fulfilled: to bring a baby into the world.
FAQs from users
Can I bring the tests done at another fertility clinic to the first appointment?
It is very common to go to a first fertility visit after having visited other centres. If you have had tests done at another clinic or have had previous fertility treatments, it is highly recommended that you bring all the reports with you.
The gynaecologist who is an expert in reproduction will be able to know your case in more detail and draw up a better diagnosis and detailed plan if he/she assesses all the tests or reports carried out during the first consultation.
The tests that we consider to be up to date are those less than a year old, but when in doubt it is better to bring everything that has been done previously.
What does the first fertility consultation consist of?
The first fertility consultation consists of assessing the patient or both members of a couple. To do this, the specialist will ask a number of questions to build a complete medical history.
Based on this information, the doctor will request additional tests in order to establish a diagnosis and the most appropriate treatment.
How should I prepare for my first assisted reproduction consultation?
It is important to go to the first reproduction consultation calmly and with clear ideas. In addition, patients should bring all the information they have, as well as previous reports of other unsuccessful treatments.
Is the first consultation at an assisted reproduction centre free of charge?
This depends on the individual fertility clinic. It is common for fertility clinics to offer the first visit free of charge, although this is usually only informative in most cases, so it is advisable to find out more before making an appointment.
When is the assessment of fertility test results carried out?
When all the tests have been done, the second consultation with the specialist consists of an evaluation of the results. During this visit, the doctor will detail the possibilities for achieving pregnancy and the most appropriate treatment for each particular case.
It should be noted that there are times when it is necessary to request other tests in order to be sure of the diagnosis. For this reason, the appointment to assess the results is not always immediately after the start of treatment.
Do I have to bring all my records to the first fertility consultation?
It is always advisable to bring all medical reports and results of previous tests to a first visit to a fertility centre. This will allow the specialist to get an idea of the situation and propose a therapeutic approach adapted to each patient.
If the specialist considers it necessary, during this first consultation, he/she will recommend additional tests to be sure of the origin of the infertility problem.
Suggested for you
When you have been trying to have a baby for a year without success, it is advisable to go to a fertility centre. You can read more about it here: When should you see a fertility specialist?
If you finally decide to go to an assisted reproduction clinic and you don't know how to choose it, I recommend you to visit the following article: How to choose the best assisted reproduction clinic for me?
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References
Childress KJ, Lawson AK, Ghant MS, Mendoza G, Cardozo ER, Confino E, Marsh EE. First contact: the intersection of demographics, knowledge, and appraisal of treatment at the initial infertility visit. Fertil Steril. 2015 Jul;104(1):180-7. doi: 10.1016/j.fertnstert.2015.04.002.
Stanford JB, Sanders JN, Simonsen SE, Hammoud A, Gibson M, Smith KR. Methods for a Retrospective Population-based and Clinic-based Subfertility Cohort Study: the Fertility Experiences Study. Paediatr Perinat Epidemiol. 2016 Jul;30(4):397-407. doi: 10.1111/ppe.12291.
Thomas FS, Stanford JB, Sanders JN, Gurtcheff SE, Gibson M, Porucznik CA, Simonsen SE. Development and initial validation of a fertility experiences questionnaire. Reprod Health. 2015 Jul 17;12:62. doi: 10.1186/s12978-015-0054-3.
FAQs from users: 'Can I bring the tests done at another fertility clinic to the first appointment?', 'What does the first fertility consultation consist of?', 'How should I prepare for my first assisted reproduction consultation?', 'Is the first consultation at an assisted reproduction centre free of charge?', 'When is the assessment of fertility test results carried out?' and 'Do I have to bring all my records to the first fertility consultation?'.
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