Estimated reading time: 8 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
Doctor visits are an integral part of the infertility journey, not only do they provide the necessary medical insight, but it is important that you find a doctor who is open to listening to your concerns about your body and whom you feel comfortable with. For many women, the first step involves seeing a fertility specialist after months or years of trying to conceive without success. These visits include various tests for both partners to identify the potential causes of infertility.
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Meet Your Healthcare Team
Gynecologists
A gynecologist is a doctor who specializes in the female reproductive organs, and it is encouraged that women establish a relationship with a gynecologist before they turn 18 years old. Routine visits consist of pap smears to help prevent cervical cancer, birth control discussions, and testing for sexually transmitted diseases (STIs) like chlamydia or gonorrhea. This is also the time to bring up any irregular periods, changes in vaginal discharge, pain during sex, any rashes or bumps, symptoms of a urinary tract infection (UTI), and anything else that may be a concern to you about your body.
Many primary care teams can perform gynecology care like your pap smears, STI testing, UTIs, vaginal infections, and helping with birth control options.
What To Expect At An Appointment
After 6-12 months of unprotected sex without conceiving you should talk with your gynecologist. They will conduct a few tests to help narrow down the cause of infertility. Here are a few common tests include:
- Blood tests: Hormone levels, follicle stimulating hormone (FSH), luteinizing hormone (LH), Anti-Mullerian hormone (AMH), and Estradiol (E2)are tested. The FSH test helps diagnose polycystic ovary disease, ovarian cysts, and infertility. The LH test helps diagnose ovarian failure if the hormone levels are too high and if they are too low, it could indicate malnutrition, anorexia, or stress. Estradiol(E2) is another test for measuring your reproductive health.
- Thyroid function tests: Thyroid function tests are essential in determining if you are experiencing hypothyroidism which affects your ovulation cycle or hyperthyroidism which affects your period cycles.
Reproductive Endocrinologist
The thought of visiting multiple doctors can feel overwhelming, especially when navigating unfamiliar medical terms, tests, and given treatment plans. Your gynecologist referred you to a reproductive endocrinologist because the initial tests indicated a potential issue that needs to be investigated further. Reproductive endocrinologists are gynecologists who have specialized training in reproductive medicine, including infertility treatment and fertility preservation. Their goal is to learn as much about your health, reproductive history, and lifestyle as possible. All of this information is used to identify potential causes of infertility and create a treatment plan.
Common Questions to Expect From A Reproductive Endocrinologist
These questions are very personal and you might feel uncomfortable answering them so it’s best to be prepared. Some questions your doctor may ask include:
- How long have you been trying to conceive?
- Have you ever been pregnant before?
- Have you experienced any miscarriages or complications during previous pregnancies?
- Are your menstrual cycles regular or irregular?
- How long are your cycles and how heavy or light are your flows?
- Do you experience pain, cramps, or heavy bleeding during your period?
- How frequently are you having unprotected intercourse?
- Have you or your partner been diagnosed with any STIs in the past?
- Do you experience pain during intercourse?
- Do you have any medical conditions such as PCOS, endo, thyroid disorders, or diabetes?
- Are you taking any medications, including supplements or herbal remedies?
- Have you had any surgeries or medical treatments like chemo or radiation that may affect your fertility?
- Do you smoke, drink alcohol, or use recreational drugs?
- How is your diet and exercise routine?
- Do you or your partner have high levels of stress? (family life, work life, your relationship)
- Does infertility run in your family?
- Are there any genetic conditions in your family or your partner’s family that could impact fertility?
For LGBTQIA+2S individuals, you may also be asked the following specific questions:
- For transgender individuals: Have you undergone hormone therapy or gender-affirming surgery?
- Are you considering fertility preservation (freezing eggs or sperm) before starting hormone treatments?
- For same-sex couples: Have you explored using donor sperm, donor eggs, or a surrogate?
Your reproductive endocrinologist will also do the following tests.
- Ultrasound: A pelvic ultrasound is used to examine the ovaries and uterus to check for issues like PCOS or fibroids.
- Hysterosalpingogram (HSG): This test uses dye and X-rays to evaluate whether the fallopian tubes are open or blocked.
- Ovarian Reserve Testing: This test checks the quantity and quality of eggs, often measured through the Anti-Mullerian Hormone (AMH) blood test and antral follicle count via ultrasound.
Reproductive Urologists (male infertility)
A reproductive urologist focuses on the diagnosis and treatment of male reproductive and sexual health issues that may impact fertility. They collaborate with reproductive endocrinologists to provide comprehensive care for couples experiencing fertility issues.
The most common test for males is the semen analysis. You’ve probably seen this in movies and tv shows where a man is given a cup and a magazine while they head off to a private room. Comedic relief aside, this portrayal is pretty accurate, and a man is required to masturbate and ejaculate into a cup. It is then sent off for testing to assess sperm count, motility, and overall sperm health.
Inclusive Healthcare Considerations
The medical journey for same-sex couples or individuals involves unique pathways to conception. Same-sex couples may explore reciprocal IVF, where one partner provides the egg, and the other carries the pregnancy. Male couples, on the other hand, may need to consider sperm donation and surrogacy. Keep in mind there are also legal considerations that should be discussed with your healthcare team such as donor anonymity and parental rights.
For transgender men and women, you may want to consider fertility preservation, which could be egg freezing or sperm banking, before starting gender affirming surgeries or hormone treatments. It is an incredibly emotional decision so lean on your support circle and talk with your doctor to weigh the pros and cons.
Egg Freezing and Sperm Banking
Fertility preservation can be summed up as egg freezing and sperm banking. These methods allow individuals to store their reproductive cells for future family planning. You can use these methods if you’re facing medical treatments like chemo or hormone replacement therapy (HRT), or if you want to delay starting a family for a later time in your life. In any case, these procedures give you that flexibility and peace of mind if you want to have children later on in life.
In the case of egg freezing, you’ll want to start this procedure before you start chemotherapy or HRT. It is considered a safe procedure and some employers may even pay for it! The egg retrieval process takes about two weeks and you will be injected with hormones to stimulate your ovaries. They will be retrieved, frozen, and stored for future IVF use.
In the case of sperm banking, the process is relatively simple. Sperm is collected, analyzed and frozen, and then stored for future IUI or IVF use. Before our transgender friends undergo gender affirming care, it is suggested to sperm bank for future family planning.
Your Personalized Treatment Plan
This may feel like a lot, but all these tests are needed to identify what the specific causes of infertility are and determine the next best step in your personalized treatment plan. Depending on the results, doctors may recommend lifestyle changes, medications, intrauterine insemination or in vitro fertilization. All of which we will be exploring on a deeper level later in this series.
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Resources
Rmany. (2022, March 28). Know your numbers: Understanding AMH & Day 3 test results. Reproductive Medicine Associates of New York. https://www.rmany.com/blog/know-your-numbers-understanding-amh-day-3-test-results
American Thyroid Association. (2020, June 8). Thyroid function Tests | American Thyroid Association. https://www.thyroid.org/thyroid-function-tests/
American College of Obstetricians and Gynecologists & American Society for Reproductive Medicine. (2021). INFERTILITY [Report]. https://swhr.org/wp-content/uploads/2024/03/SWHR-Fertility-Patient-Resource-Guide-2-Understanding-and-Evaluating-Infertility.pdf
UC Health Center for Reproductive Health. (2021). Guide for your fertility journey. In UC Health Center for Reproductive Health. https://www.uchealth.com/wp-content/uploads/sites/66/2018/04/CRH_Guide_to_Fertility_Download.pdf