Hi,

We have been TTC #1 for almost 12 months. I saw my GP last week and she referred me to a fertility specialist. I was wondering if anyone could tell me what to expect at the first appointment and what happens from there? DH and I have been asked to come to the appointment together and my dr mentioned an ultrasound?

Any info you could offer would be appreciated.

Hey pinkblue!

When I went, there was an internal ultrasound to have a quick look at the uterus and ovaries to see if there was anything immediately obvious. mine also did a quick breast exam as well which happened without real consultation He also did a pap smear. Other procdures include both DH and I having heaps of blood taken for various tests. This happens after the consultation, when you're with the nurse.

What gets discussed in your consult depends on your particular problem, and how proactive/forceful for FS is. The first one I went to didn't want to know about charts or anything much of anything. He just heard my age and went straight to "do IVF, it's you're only chance". Many people I know go to him, but I couldn't stand him. I then went to someone else, and he actually waited until he saw the results of the tests before making a diagnosis. Despite not yet being pregnant, I feel much happier with my second FS.

Anyhow... the FS should explain some anatomy, explain what MIGHT be happening in your case and discuss a range of options you might consider, based on the results of your tests. Your DH will also need to give a sample for morphology/motility and DNA fragmentation tests. That will most likely happen on another day coz you'll need to abstain for a few days. They'll give you heaps of brochures on technologies and procedures. When you see the nurse, they'll give you more details on the "how to" aspects of any procedures, and give answers to some of your more specific questions. All of it will go in one ear and out the other Which is also why it's so importnat for both you and your DH to go. Be prepared to get upset, possibly even cry during the appointment. That's OK. But if it's the manner of the FS that makes you cry, then it's OK to go shopping for another FS, either within the same practice, or at another one. You need to respect and feel good about your FS. You shouldn't dread having to deal with your FS during this emotional merry-go-round!

After the appointment, the next step will be up to you. It may all be too much and you choose to wait a bit longer. Or, you make a followup appointment to see what the tests had to say and make more definite plans about what to do next. Or get your results sent on to your new FS

no answers, just to let you know that ill be watching everyone's replys as i think this may be us aswell

I know for us when we went to see our FS for the first time, the very first thing they did was set up an appointment to get a sperm sample from DH...their reasoning was that that is a quick and easy test that can find or rule out some issues before going into the more invasive testing that a woman has to have. We also got weighed, had blood tests, I had an appointment set up to get an ultrasound to check out my uterus and ovaries, and also an appointment to go get a test combined with an xray to check that my tubes were open (that last one is rotten, but on the upside they can give you good or bad news straight away) After ALL of that, once the results were sent back to our clinic we went back there and talked about what had been found and what our options were.
Most of it wasn't that bad, and I actually liked finding out what was going on, even though it was DH who pushed for the testing as he thought something was wrong (and it was)

OP, I've just been referred as well so am reading replies with interest.
Sorry for thread-jacking with this question: I've made the appointment just for me to attend as my GP and receptionist at the clinic didn't mention DH. I assumed that I'd just go and give him my ultrasound results (done a few months ago) and talk options. Should I be ensuring that DH comes with me that day? Obviously they'd want a sperm sample to test but I assumed the FS would just tell me to get DH to get that done asap at x place and then do y with it. (sorry I'm hazy on those details )

On our first appointment the FS asked us about our history and made sure that we understood basic lifestyle stuff like food, alcohol, exercise, when to BD etc. I had an examination including internal and breast exam. I was given some blood test forms to track the next cycle and check the hormone side of things was working properly, made an ultrasound appointment, and DH was given a sperm analysis form. The ultrasound and sperm analysis were both done later, not at the first appointment.

Sperm analysis requires abstinence for a few days to ensure there is enough sample. It is also important it is fresh - some places will let you do it at home but it needs to be transported to the lab immediately or it won't be accurate.

From there it depends on your situation as to what tests they will do. The next things for us was a tracked cycle at that point so the FS rang us up and told us when to have sex - kind of weird!

at our first appt he took down our history and then arranged a sperm analysis for dh and a hycosy for me to check my tubes were ok.

good luck

Thanks for your replies. When made the appointment they said they had made a 11am appointment for me to have an ultrasound, then an 11.15 appointment for DH, then an 11.30 appointment for both of us to see the FS. I hadn't realized the ultrasound would be internal. Do they only do internal ultrasounds? I had to have my last pap smear under sedation so I don't think I'd cope with an internal ultrasound

Honestly? It's the best way for them to be able to see the ovaries and uterus. If you have problems with this sort of this you will need to talk to your FS, and so many reproductive therapies are a little or quite invasive in that way....you do get used to it after a while, but if you are starting out scared of it, it will be difficult.

OUr first FS appointment we didnt have any tests. it was just a chat. But our GP has already sent me off for a blood test and scan (it was vaginal but only because I hadnt drank enough water so they couldnt get a good view as my bladder was in the way) and DH had done a Sperm analysis.

So the FS just reviewed the preliminary results of the GP tests and basically gave us some options of next steps we could take. He said we could take some time to think about it or we could get started straight away. We said we would go away and have a think about it all, and we ended up coming back about a month later for a laparoscopy the check that all was good with the tubes etc. About a year later we came back to start IVF.

Happy Womble is right - be prepared that you might cry in the appointment - and it is ok to do so. I like our FS. He apologised once when I started to cry in an appointment. He joked that his office has that affect on couples, and I shouldn't feel like I have to hold it back.

All the best OP. I know it can be daunting

This is going to be so hard

If I can't even have a pap smear done then I don't know how I'm going to cope with all these invasive tests and procedures

Has anyone gone through something similar?

Seeing a fertility specialist is definitely the fastest way to conceive - it took 6 months with no. 1 and only 1 month for no. 2 no IVF either time.

Please understand, that you will likely to have internal exams every time you see the specialist. It really is the only way they can check to see if you are ovulating, how many eggs are being produced and if they are mature. Sure it is a little bit uncomfortable, but certainly not traumatic, and not quite as uncomfortable as a pap smear. I also had internal exams at 6 and 8 weeks of pregnancy to see how bubs was progressing.

Good luck.

Yes - make sure you each have separate referrals as you will do that initial consult together. It is important for the FS to go through vital stats, medical history and lifestyle questioning etc for both partners as infertility is an issue that affects couples, not just women. You will cop the brunt of all the testing and procedures though - the men tend to get off pretty light



I hate to say this pinkblue but many of the testing and treatment procedures are quite invasive and internal ultrasounds are just the tip of the iceberg. I actually found that I became rather desensitised to them after a while and it became much easier. Modesty becomes less of an issue and the procedures themselves are tolerable - you will surprise yourself with how resilient and strong you can be when circumstances leave you no other choice.

With AC I actually found the mental and emotional side of things much harder to deal with than all the physical procedures. Either way, it is a very tough journey and I wish you all the best. You can do this. The fear is usually worse than the actual thing you are afraid of.

** pregnancy mentioned **

I saw a gyno for my issues, so a bit different.

First DH and I both had routine bloods, DH sperm count was tested. I had an internal ultrasound and then we started a treatment plan.

After a few months DH was tested again, I had dye put through my tubes and we continued with treatment.

After awhile I got used to tests, scans, internals etc you just do what you have to do to get the job done. If you have issues you need to let your FS know.

Even in my pregnancy I have had issues with my cervix which means I have had to have internal scans fortnightly since 19 weeks, so it's better to try deal with it now.
However, you might not find a internal scan painful. For me it is different than having a pap smear.

I think the wand used for the internal U/S is far easier than a pap smear that scrapes cells from your cervix. The wand doesn't go that far and you're covered up with a sheet as well.
At your appointments, ask LOTS of questions if you have any. I learnt a LOT during my 3 years of AC. Not always that relevant to my situation but all sorts of stuff about the technologies used, what you can see in the ultrasounds...
The nurses are there to help you, and all the ones I met were really gentle and did their utmost to relax and inform me.
You do get used to all the uncomfortable procedures, after all it's for the best reason, having a baby. If you focus on WHY you're there it should help. Maybe try relaxation techniques as well.
This forum is full of very helpful understanding women who've been through it all as well.

My first appointment was talk about history, then be sent away for a bunch of tests, so B/T tracking over next cycle (basically every 2nd day after ovulating) with other bloods in there, DH had to do a sperm sample, I also had a U/S which was internal, then when they came back clear I was sent off for a HSG - which is dye in the tubes and xray to make sure they are clear - that one was painful, but at least confirmed my tubes were clear which was the main point.

My second clinic (I tried one FS who was basically if clomid doesn't work do IVF and wouldn't even test me for progesterone issues even when I thought there might be a issue, my second clinic was fantastic and did the tests etc) also did charting, so had to do lessons again with charting etc. Dh was told to come to the first appointment as they wanted him to also learn charting. They also went over how things happen, when it happens and even CM with DH, Dh is a nurse and alot of it came as a surprise to him and opened his eyes to how does pregnancy even happen. They liked to inform DH so they could understand where their wives were coming from, and understand why it doesn't always 'just work'.

After about 3 appointments DH didn't have to come anymore as they found my issue and how to fix it which once explained to DH didn't need his input, just me to come in and pick up drugs, go through charts and see how I was travelling emotionally. Dh did enjoy being involved by that clinic and not made to feel like a sperm donor.

As for internal U/S - really they do earn their nickname - 'dildo cam' as really they look and are sized like a dildo with a cable on the end. Its not any bigger than a average penis and doesn't go in any further than a penis when BD - if you are fine BD (with no pain as I know some women still do) then having a internal U/S really is nothing. Pap smear is very different to a internal U/S, as its goes past your cervix and is gathering a sample - which a internal U/S doesn't do.

Good luck with it all.