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What It’s Like to See a Fertility Specialist

This is what to expect when you want to be expecting.

Photo credit: Getty Images
A woman in a blue shirt talking to her fertility specialist

Make an appointment - fertility

Maybe you’ve tried for months and aren’t pregnant ... or you lost a pregnancy ... or you can’t seem to conceive baby number two. Don’t despair, you’re not alone. Roughly 10% of women of childbearing age have trouble getting or staying pregnant, according to the U.S. Department of Health and Human Services. But for many, it’s a temporary rough patch: Fertility treatments have helped millions of women in the U.S. have a baby.

When we think of fertility treatments we tend to think of in vitro fertilization (IVF), but solutions run the gamut from simple (thyroid medication) to staggeringly complex (uterus transplant). A big part of what fertility doctors do is listen, diagnose, and find a solution.

The goal is generally to speed up the time to pregnancy (since the biological clock is real). “Within one to two ovulation cycles, we can usually get the information we need to be able to say, ‘This is what you should do,’” says Nicole Noyes, MD, system chief of reproductive endocrinology and infertility at Northwell Health.

How do you know when to see a fertility doctor? And how can you find the right treatment for you? To help you feel confident and in control, Dr. Noyes answers common questions about fertility treatments.

When should I see a fertility doctor?

“If you don’t have regular periods, you should go to a fertility specialist right away,” advises Dr. Noyes. Anovulation—the medical term for when a woman’s ovary doesn’t release an egg—is often a hormonal problem with different root causes. You should also see the doctor right away if you know you have fibroids, as they may be impeding implantation and thus need to be removed to clear the way for conception.

Beyond that, consider your age a roadmap for how fast to seek help. “You lose a little fertility each year,” Dr. Noyes says. If you are in your early 30s, see your doctor if you’ve been trying for three to six months without getting pregnant. By the time you hit 38, Dr. Noyes recommends going to the doctor within a month or two. Since time is of the essence, you want to quickly bypass any fertility roadblocks and figure out the best and straightest path to pregnancy.

Should I see a doctor before I even start trying?

More and more women are visiting their OB/GYN or a fertility doctor for pre-baby planning, officially known as procreative management. “There’s even a diagnosis code for this preventative care, meaning most insurance will cover the visit,” Dr. Noyes says. Think of it as your chance to strategize about conception and discuss lifestyle habits that might help ensure you have a healthy pregnancy (such as getting to a healthy weight, eating less sugar, not smoking, and decreasing alcohol consumption). The doctor may also do basic fertility checks to rule out problems that could stand in your way. “It’s a shift, a really good shift, in mindset from ‘I have a problem, help!’ to ‘I'm thinking about having a baby, what advice do you have for me now?’” she says.

What can I expect at my first fertility appointment?

First, a fertility doctor will take a thorough medical history, so it’s helpful to come prepared with details about your gynecological history and any questions you have.

Your doctor may ask:

  • Do you get your period every month?
  • Have you had any abdominal or GYN-related surgeries? (These sometimes cause scar tissue to form, which can affect reproduction.)
  • Have you had previous pregnancies and what were they like?
  • Have you ever had a sexually transmitted infection or another infection near the pelvis, like appendicitis?
  • Are you having unprotected sex at the optimal time each month?

What ovulation tests should I have done?

Your doctor will also run some tests to see how your ovaries are doing. You may have already done some ovulation prediction testing. “Patients are often so on top of their game that they've already done three months of ovulation predictor kits before they come into my office,” Dr. Noyes says. Ovarian reserve testing will most often also be performed. These include measuring blood levels of anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH), and estradiol. “These tests give a broad sweep of how your ovaries are doing relative to age,” Dr. Noyes explains.

Will my reproductive organs be evaluated?

Doctors use a transvaginal ultrasound to assess your reproductive organs and make certain they are free of problems that might interfere with conception or pregnancy—for instance, that you don’t have fibroids (benign uterine growths), endometriosis (when tissue that lines the uterus migrates to other parts of the reproductive system), scar tissue, or ovarian cysts. If one of these shows up, the solution may range from surgery to in vitro fertilization—in which egg and sperm are fertilized outside the body and implanted into the woman’s uterus. During the sonogram, your doctor may perform another measure of ovarian reserve, known as the antral follicle count (AFC) where the number of baseline physiologic cysts present in each of your ovaries is assessed. This can help predict how many good eggs remain to create pregnancy.

What about his fertility?

Roughly one-third of the time, if there is a male partner involved, his sperm may represent the fertility issue. If you are trying to have a child with a male partner, your doctor will want to check his sperm count and motility—how many are there and how many are swimming. If the count or motility is low, couples often proceed to artificial insemination, which involves injecting his sperm into your cervix or uterus while you’re ovulating, or IVF, where eggs are removed from the woman’s body and are fertilized in a petri dish.

What if they can’t figure out our fertility problem?

About one-third of the time, there is no clear problem. “Or it's a combination of little things,” Dr. Noyes notes. “If there is a male partner, one of you may travel a lot and thus miss having sex around ovulation. It may be that many of the eggs being released aren’t good enough quality to produce a healthy embryo. Or that the sperm quality is a little off. A few smaller issues can add up and be enough to make you unable to conceive.”

Depending on age, you may be advised to go straight to an odds-upping procedure, such as fertility shots (like follicle stimulating hormone) to stimulate the ovaries to work harder. “If you use fertility drugs and you release three eggs instead of one, it's like three months of trying at once,” Dr. Noyes says. The shots are sometimes combined with artificial insemination to bring the most concentrated sperm to the target at the right time. Or, a cycle of IVF may be the recommended first course of action because it has the highest chance for pregnancy in a given month. This is more often the case when a woman is age 38 or older. “Certainly, if the fallopian tubes are found to be the problem—if they are blocked or not working properly because of scar tissue or a previous infection—then we indirectly treat that by moving to in vitro fertilization and bypassing the fallopian tubes altogether,” says Dr. Noyes. “There are a lot of workarounds that end up being fertility treatments.”

Will my insurance pay for fertility treatments?

Here’s some good news: Dr. Noyes says that up to 60% of working people in the United States now have some form of fertility treatment coverage as part of their plans, a huge increase over years past. But the specifics vary, so definitely double check your own coverage—some plans pay only for the initial evaluation, others, up to a certain dollar amount of fertility treatment, while some pay for a full round or more of IVF or only certain parts of the treatment.

Can I get pregnant in my mid-40s?

While your chances of getting and staying pregnant on your own are almost zero once you hit 45, Dr. Noyes explains, there is an option: Donor eggs, used along with assisted reproductive technology, can greatly increase your odds of becoming a parent. “There is a 50 percent chance of pregnancy every time you implant an embryo made with young donated eggs,” says Dr. Noyes. “Donor eggs get you back up to the chances of a young woman.” The age of the egg is one of the most common reasons for infertility. That’s why so many women are now choosing to freeze their own eggs at a young age (20s and 30s)—and use them when they are ready to become a parent.

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Published May 28th, 2019
A woman in a blue shirt talking to her fertility specialist

Make an appointment - fertility