Dear Eggsperts—I saw the fertility specialist today and it was overwhelming. There was so much information that it made my head swim. At the end, I was given a lot of instructions for tests that need to be done before the doctor will start treating me. I’m healthy and I just want a baby. Why do I have to do all of these test—Frustrated in Florida
Dear Frustrated—We know the first visit to the fertility specialist can be confusing and overwhelming. And, we know that you were ready to be pregnant last year, therefore adding to your frustrations while you wait for test results. I’m sure to the heart, it may even feel like your physician is purposely delaying your treatment, even though your mind knows there is good reason for the test. There are a lot of things your doctor is evaluating to ensure the most optimal treatment and the best possible outcome for you. Let’s see if we can make sense of all the tests your doctor may have ordered.
- Ovarian Function Tests—There are a few blood tests that your doctor may order to assess how your ovaries/eggs function and will respond to treatment. Some of these can be drawn any time during your menstrual cycle (from the first day of one period to the first day of your next period), and some have to be obtained at specific times during the cycle. If you don’t have regular periods, other tests may be requested to see how other hormones in your body impact your fertility and health. These may need to be done fasting. Your doctor may even order an ultrasound of your ovaries to be done early in your menstrual cycle to assess your ovarian reserve.
- Anatomy Tests—It is important to know if there are any issues with your uterus or fallopian tubes that can impact your ability to get pregnant or carry a pregnancy. This usually involves a hysterosalpingogram (dye test) or saline-infusion hysterosalpingogram/sonogram (bubble test). For these tests, fluid is placed through your cervix and fills your uterus before flowing out the tubes. This can tell if the tubes are open and the general shape of the inside of your uterus. The saline sonogram can also look for abnormalities in the muscle of the uterus and details of the uterine lining, but the ability to see the tubes is less clear. If you have an x-ray hysterosalpingogram, a regular ultrasound may be requested to look at the uterine muscle more closely.
- Sperm testing—Almost 1/3 of couples who have trouble conceiving have a male issue. And another 1/5 may have both male and female issues. For this reason a semen analysis to evaluate the sperm count and shape and movement of the sperm. Low counts or problems with shape or motility may affect the ability of sperm to find or fertilize an egg. Sometimes, this is a hard test for couples. Many men find male fertility testing embarrassing. Ejaculating in a cup for a scientist to study is certainly less than sexy. Some men struggle to perform during an appointed place in a strange and sterile environment. Then, to find out that he doesn’t have enough or the right shape sperm…that would be a blow to any ego, even a healthy ego.
- Prenatal Tests—Finally, the goal of a fertility specialist is not just to help you have a baby, but to make sure you, and your baby are as healthy as possible. This may mean doing some basic health tests before conceiving. You may be asked to make sure your Pap smear is up-to-date and any abnormalities in your Pap are evaluated and/or followed. If you have medical conditions, testing may be requested so that those conditions can be optimized to protect your health and your baby’s health during pregnancy. Basic prenatal testing may be requested, tests that are often done at a first prenatal visit. Doing them while trying to conceive gives you and your doctor to optimize your health and protect your baby before you even get pregnant. If you need an immunization booster, or vitamin supplement, or hormone balancing, or treatment for infections that can impact your pregnancy, it’s better to take care of them in a preventive manner than worry about it during your pregnancy. The American College of Obstetrician Gynecologists and American Society for Reproductive Medicine recommends that women planning pregnancy also consider screening for medical problems that could have a genetic basis. These are usually conditions that you may not have, but if you have a gene mutation and your partner has the same gene mutation, your baby could have a significant medical condition. Testing before pregnancy permits people to make decisions about conception, and if mutations are identified, advanced gene testing of embryos prior to achieving pregnancy can be done to avoid any subsequent manifestation in the child.
We know all this testing is exhausting. Between ultrasounds, radiographs, pap smears, immunizations and a mammogram – who can keep up! Oh, and let’s not forget….the blood tests! If the blood tests were drawn in the clinic at your first visit, you may have felt like you needed a cookie afterwards. It is a lot of tubes. We know. Rest assured, your doctor wants you to have a baby as soon as possible. All of these tests are important, however. With these results, your doctor will then devise the best plan to help you conceive, have a healthy pregnancy and a healthy baby. And remember, you do have the right to decline some testing. You may be asked to sign a waiver. And your doctor may not have all the information needed to provide the best treatment for you.
We hope we met your Eggspectations—An Eggspert
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Disclaimer: All of the comments on this page are for basic information only. They are based on the opinions and expertise of the authors and are not meant to provide a substitute for medical care or specific treatment recommendations. Each person is unique and requires individualized diagnosis and treatment plans. Any specific questions should be directed to your personal healthcare provider