A reproductive endocrinologist is a specialist in managing infertility, recurrent pregnancy loss and other diseases that may interfere with women and men reproductive functions. Reproductive endocrinologists receive further training after hospitalization that enables them to effectively handle problems related to female hormones and achieving pregnancy. Couples of opposition or same sex, single women and single men consult with reproductive endocrinologists for a multitude of reasons. Here, I describe a structured approach for consulting with your reproductive endocrinologist, to realize maximum benefit from consultation, in the shortest period of time.
The first step is answering this question-why are you consulting with a reproductive endocrinologist? People seek advise for the following reasons
1. Infertility-defined as inability to conceive with regular unprotected intercourse for 12 months or earlier if medical history, age or finding indicators earlier evaluation. Its prudent for women 35 years or older to seek consultation after 6 months. Keep track of how many months you were exposed to pregnancy without using any method of contraception. Also keep track of how many months did you use the ovulation predictor kit to time intercourse, especially if you are having an interval less than 2 to 3 times per week.
2. Couple at risk for infertility due to disease or disease treatment. Women, men and children diagnosed with cancer especially if they require chemotherapy, those diagnosed with lupus or similar diseases and require chemotherapy for treatment, women carrying mutation for BRCA1 or 2 and will undergo risk reducing procedure through removal of the ovaries, to mention few examples .
3. Couple carrying disease mutation with risk for transmission to future children
4. Single women or men or same sex couple interested in third party reproduction-donor egg, donor sperm and / or gestational carrier.
5. Recurrent pregnancy loss-repeated miscarriages after establishment of pregnancy in the first or second trimester.
6. Other indications as fertility extension through egg or embryo freezing, sex selection, reversal of tubal sterilization, thyroid or prolactin disorders, excessive hair, amenorrhea, irregular cycles ..
7. Reproductive surgery.
After defining the reason for consultation start collecting your records including prior semen analysis, HSG reports and films, lab tests, ultrasound reports, prior IVF or IUI cycles, genetic counseling or genetic test results, operative reports as hysteroscopy, laparoscopy or tubal sterilization report.
Ask for office forms to be e mailed or sent to you to fill prior to the visit. Medical forms typically include questions about menstrual history, male history, prior medical or surgical interventions and family history. Family history is an important component of the visit and may point to a specific genetic problem. Commonly, the office ask for a form of identification for you and one for your partner in addition to insurance cards. Come with a notepad if you want and write down the main questions you want to ask your doctor.
Timing of consultation
Ask for a time that is convenient for you if possible. In some circumstances time is of essence eg women seeking advice about preservation of fertility prior to cancer treatment. Your reproductive endocrinologist should be able to make an appointment for you with 24 to 48 hours. I recommend that you schedule the appointment if possible on the second or the third day of the cycle if possible as this will give an opportunity to draw basal serum FSH, LH and estradiol as well as visualize the ovary using ultrasound in early in the cycle. Also if male partner intends to submit semen for analysis, he should have stopped medications if possible and have abstained for 3 days. All this is simple but can save your time if did not undergo any fertility testing in the past.
A proper consultation with a reproductive endocrinologist takes about 90 minutes and include several components- 1. clinical interrogation in relation to ovulatory, tubal, uterine, cervical and male factor infertility, past medical, surgical, obstetric, social and family histories, medicines, allergies , contraption, breast and prior fertility testing and treatment. The aim is to identify most likely factor of infertility as well as the safety of getting pregnant. In addition one aim at evaluate prior treatment and how can it be improved. Improvement can include ovarian stimulation method, 2. general and pelvic examination and 3. vaginal ultrasound. Ultrasound aim at detecting the size and position of the uterus, map the cervical canal, abnormalities of the lining of the uterus, accessibility and size of the ovaries as well as estimating ovarian reserve.
The reproductive endocrinologist then will give you his impression of the next steps including further tests and plan of treatment. These may vary from the most simple as timed intercourse to the most sophisticated as IVF with ICSI or preimplantation genetic diagnosis-PGD. The potential for success and possible complication of treatment as multiple pregnancy or ovarian hyperstimulation syndrome are discussed. Some of the tests as blood draw or semen analysis may be done after the visit.
After hearing the plan you should be given adequate time for questions. Do tell your doctor what you would accept based on your value system and moral commitments. Other information or people you may meet after the consultation include financial and psychological consultation, third party reproduction team and genetic counseling.
If you chose to follow the plan outlined by your infertility specialist, you may be able to conclude all the required fertility tests within 10 days. This would be he time for a follow up visit or phone discussion with your reproductive endocrinologist to finalize or modify the plan of treatment. In conclusion preparation for the visit by the couple attention to details and providing adequate time for discussion as well as close follow up by the reproductive endocrinologist can maximize the benefits from the consultation, shorten the preparation phase before treatment. It also institute the basis for trust and a strong relationship between the couple and their reproductive endocrinologist.