After months of trying to become pregnant on your own, you’ve made the choice to meet with a reproductive endocrinologist (REI). This is an important step on your fertility journey.
You may be feeling both anxious and hopeful leading up to your first appointment, but the good news is you’re in the right hands. REIs are specially trained in the diagnosis and treatment of infertility in both men and women, making them the most appropriate doctors to see for conception challenges.
Your first visit will likely include a combination of conversation and examination that will give your REI important information about your and your partner’s medical histories, lifestyles, and physical attributes. Try to be as open as possible during your discussion—your honest answers give your doctor the best chance at determining the cause of your fertility challenges, and the best treatment for you.
Over the next months, you’ll visit your REI many times for numerous examinations, tests, and procedures. Depending on your diagnosis, additional visits for advanced testing may also be necessary. Your treatment plan will be tailored to the results from these visits, whether an underlying problem is found, or your infertility is categorized as “unexplained.”
What women can expect from an REI
Your doctor will ask about your medical history, including details on:
- Your period
- Past pregnancies
- Birth control use
- Sexually transmitted diseases
- Prior surgeries
- Medication use
- Other significant health problems
You’ll also discuss your diet, exercise habits, work environment, and current sexual practices.
Depending on your experience, you may need to repeat tests or procedures several times throughout your treatment journey.
In order to become pregnant, a woman must have working ovaries, fallopian tubes, and a uterus. Your doctor will need to examine your body and perform a series of tests to identify reproductive system conditions or abnormalities that may be contributing to fertility challenges.
Procedures may vary by clinic, but will likely include:
- Physical examination
Weight and body mass index (BMI) will be measured. Your doctor will also inspect your face and body for unusual hair growth patterns, which could point to a possible increase in male hormones that affect fertility. - Pelvic and genital examination
Your doctor will inspect the shape and size of your uterus, and check your cervix for growths, sores, or infection. Discharge and cervical mucus may also be examined. If a routine cervical screening (pap smear) hasn’t been done recently, a new test may be performed to check for abnormal cell growth. - Breast examination
The shape and size of your breasts will be examined. Your doctor may also squeeze your breasts to check for liquid discharge, which could indicate high levels of a hormone called prolactin that can keep you from ovulating. - Thyroid examination
The size of your thyroid will be checked for any abnormalities.
- General health tests
Your doctor may test for rubella (German measles), chlamydia, hepatitis B and C, and human immunodeficiency virus (HIV). Depending on your heritage, you may also be tested for diseases or disorders that are more common among certain ethnic groups, such as sickle cell anemia or cystic fibrosis. - Screening blood and urine tests
These tests, some routine and others investigational, vary from clinic to clinic. Ask your doctor for more information about what you can expect. - Ultrasounds
Your doctor may conduct ultrasounds throughout your menstrual cycle to examine the condition of your uterus and ovaries. Ultrasound may be used to monitor the thickness of the lining of the uterus, whether or not you’ve ovulated, and the growth of follicles (immature eggs) in your ovaries.
Depending on your experience, you may need to repeat tests or procedures several times throughout your treatment journey.
Depending on the results from your preliminary discussion and examination, your doctor may order additional fertility tests and procedures to get a better picture of how your reproductive system is functioning.
- Hormone blood and urine tests
These tests help determine if you are ovulating, and the quality and quantity of the eggs you produce (also known as your ovarian reserve). This can help predict how your ovaries will respond to fertility treatment cycles in the future.
Blood tests include:
- Follicle stimulating hormone (also called FSH)
Higher levels may indicate a decrease in the production of quality eggs. Taken on day 3 of your period. - Estradiol (estrogen)
An increase may indicate a decrease in egg quality. Taken on day 3 of your period. - Inhibin B
Inhibin B is a potential marker for ovarian function and follicular content. Low levels have been associated with a decreased response to certain fertility treatment medications. Taken on day 3 of your period.
- Progesterone
High levels indicate that ovulation has occurred. Taken approximately one week prior to expected period. - Additional hormones
Your doctor may also conduct additional lab work to measure the amount of luteinizing hormone (LH), prolactin, androgen, anti-mullerian hormone (AMH), and thyroid stimulating hormone (TSH) in your blood.
- Antral follicle count (AFC)
This internal ultrasound scan is used to monitor the number and size of follicles present in the ovaries. - Hysterosalpingogram (HSG)
Your doctor will use contrast dye and an X-ray to check the shape and size of your uterus and fallopian tubes. This test is used to identify tubal blockages or cysts. - Hysteroscopy
This test is used to diagnose or treat problems in the uterus. Through your vagina, your doctor will insert a tiny, lighted telescope that projects images of inside your uterus onto a screen. Endometrial biopsy—the removal of a small piece of tissue from the lining of the uterus—may be performed at the same time.
- Laparoscopy
Your doctor may use laparoscopy to check for blockages, growth, or signs of endometriosis around the uterus and fallopian tubes. This procedure involves the insertion of a small, surgical scope into the abdomen under general anesthesia. - Sonohysterogram
For this special ultrasound exam, saline solution will be used to expand your uterine cavity, giving your doctor a more detailed view of the uterus than traditional ultrasound can.
Depending on your experience, you may need to repeat tests or procedures several times throughout your treatment journey.
What men can expect from an REI or urologist
Your doctor will ask about your medical history, including information on:
- Athletic injuries to the groin
- History of undescended testicles
- Urinary tract infection
- Prostatitis
- Impotence or ejaculatory problems
- Sexually transmitted diseases
- Prior surgeries
- Medication use
- Other significant health problems
- Mumps after puberty
- Hernia repairs
Similar to females, you’ll be asked to share details about your lifestyle, including your diet, exercise routine, work environment, and current sexual practices. Your doctor will also ask if you smoke, drink, or use drugs.
In order to father a child, a male must have the right balance of hormones for sperm to develop, sperm of healthy quality and quantity, a functioning reproductive tract, and unblocked sperm ducts. Conducting examinations and tests will help your doctor diagnose and treat male factor infertility if it exists.
Expect your doctor to conduct the following:
- Physical examination
Your doctor will usually examine your penis, testicles, and prostate gland (via your rectum) to check for any abnormalities. Your scrotum will be examined for varicose veins, which can affect fertility. Your doctor will also confirm your sperm ducts (epididymis and vas deferens) are present and intact to ensure a healthy, functioning reproductive tract. - General health tests
You’ll be tested for hepatitis B and C, and human immunodeficiency virus (HIV). Depending on your heritage, you may also be tested for diseases or disorders that are more common among certain ethnic groups, such as sickle cell anemia or cystic fibrosis. - Hormone blood and urine tests
These may be done to test certain hormones, such as FSH, testosterone, and prolactin. Fertility may be affected if levels are outside the normal range.
- Semen analysis
You may be asked to provide a semen sample. This is done by masturbating either at home or at your clinic. The quality and volume of semen will be tested, including sperm count, concentration, movement (motility), size, and shape (morphology). - Testicular biopsy
Your doctor may perform this test if there are no sperm present in your semen sample. After being given an anesthetic, your doctor will remove a small sample of tissue from one of your testicles, which will be tested to see if it contains any sperm that can be used in fertility treatment.
After reviewing results from this initial visit, your reproductive endocrinologist (REI), andrologist, or urologist may want to proceed with future testing. Advanced tests and procedures for men include:
- Transscrotal ultrasound
This scan is used to identify blockages or varicose veins around your testicles or sperm ducts that could be causing infertility. Your doctor will pass a small device back and forth over your scrotum to pick up soundwaves, which are converted into an image. - Transrectal ultrasound
Your doctor will use this scan for thorough overview of your prostate, the semen-producing glands (called seminal vesicles), and the duct that carries sperm from your testicles to your seminal vesicle and urethra (called the vas deferens). A thin probe will be inserted into your rectum while you lie on your side. Most men find this uncomfortable, but painless.
- Repeat semen analysis
If your initial semen analysis results are abnormal, you may need to provide another semen sample. Your doctor will check that enough sperm are alive, and that there are no antibodies or infections in your semen. - Advanced sperm testing
Your doctor may order additional sperm analysis if preliminary examination indicates there may be a problem. These tests provide more details on the motility of your sperm.
Planning your first conversation with an REI
Before your appointment
- Make a list of questions or concerns
- Know the names of all prescription, over-the-counter, and herbal medicines you take
- If you’re a woman, begin tracking ovulation
During your appointment
- Plan to take notes
- Ask how the clinic runs
- Be open about your medical history, including STIs, past surgery, and any birth defects in your family
- Share medication lists and ovulation charts
- Verify how you can reach your doctor if questions arise later
4 fertility experts that support you during treatment
FERTILITY NURSE
Fertility nurses conduct initial interviews and assist with procedures. They may also perform monitoring procedures like ultrasounds and blood tests, which are done frequently throughout each treatment.
When beginning a new treatment cycle, fertility nurses will prepare you for what to expect, teach you how to inject medication, and answer questions.
REPRODUCTIVE ENDOCRINOLOGIST (REI)
These specialists assess or confirm infertility causes in both males and females and propose a fertility treatment plan. They may prescribe hormonal medication, attend ultrasounds to review your response to treatment, and adjust your treatment plan as needed in your cycle.
REIs oversee assisted reproductive technology (ART) treatment cycles, including the collection of eggs and the transfer of embryos to the uterus. They also discuss the results of pregnancy tests.
EMBRYOLOGIST
Embryologists work in your fertility clinic’s lab. They are responsible for assessing collected eggs, evaluating sperm quality, and preparing sperm for fertilization. They also perform the fertilization procedure.
After in-vitro fertilization (IVF) procedures, these specialists carefully monitor the development of embryos (incubation) and help make the decision on which (and when) to transfer.
MENTAL HEALTH PROFESSIONALS
Mental health support staff may conduct initial assessments of your emotional well-being prior to advanced fertility treatment cycles. They also provide ongoing counseling and support before, during, and after treatment.
