Questions to Ask During Your First Fertility Workup

Going in to see a specialist for your first fertility workup can be a daunting prospect. We are here to decode the experience, so you can focus on talking to and listening to your doctor.

By Halle Tecco, MBA, MPH

If you’ve been trying to get pregnant, and haven’t been able to yet, going in to see a specialist for your first fertility workup can be a daunting prospect. We want to help decode the process for you, so that you can be less nervous that day, and can focus on talking to and listening to your doctor. We’ve written a more detailed book to getting pregnant here, but for now, we’ll focus on the first appointment.

When to seek an infertility workup

We hope that in most cases, you will have already seen your OBGYN for a preconception visit and have a relationship established. If you’re under the age of 35 and haven’t been able to get pregnant after a year of trying or if you’re 35 and over and have tried for six months, talk to your OBGYN about starting a workup and getting a referral to see a reproductive endocrinology and infertility specialist (aka an REI). An REI is a doctor who completed four years of medical school, a four-year residency in obstetrics and gynecology, and then a three-year fellowship in reproductive endocrinology and infertility. Your fertility workup will likely involve blood work, imaging studies, and a semen analysis for males. 

Dr. Meera Shah’s explains more about how to know the right time to seek fertility help, plus tips on how to choose the right doctor and clinic, in her article, How to Know When It’s Time to See a Fertility Specialist.

How infertility works

Generally, the medical community divides the causes of infertility under “female factors” or “male factors.” Sometimes, infertility results from a combination or, frustratingly, can be unspecified.  

Female infertility can take many forms. REIs like to break it down by looking into female anatomic factors versus hormonal factors:

• Anatomic factors: In terms of anatomic factors, the fallopian tubes may be blocked or scarred, or there may be findings in the uterus that make implantation difficult (for example, fibroids). 
• Hormonal factors: Hormonal factors consider the relationship between the hormones released by the brain and ovaries and how they are affecting ovulation. 

Male infertility usually takes the form of either sperm count/volume issues (not enough sperm) or sperm motility issues (sperm that don’t move well enough, for a variety of reasons). Lifestyle issues are a common factor, as are certain diseases. 

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It’s your REI’s job to consider these possibilities, determine the etiology, and discuss management or solutions for  you and/or your partner. For more information, check out REI Dr. Dana McQueen’s Q&A, Preparing for Your First Fertility Clinic Appointment.

Some tips for preparing yourself for that appointment

Keep in mind that “infertility” doesn’t mean that you’re irreversibly unable to get pregnant—instead, it means that you’ve had some difficulties getting pregnant. Some forms of infertility are treatable and reversible. Your doctor will help you figure out the cause(s) of your fertility issues and offer solutions or recommendations for moving forward.

We hope there is also a sense of relief in taking that next step to figuring out the path forward.

It’s natural to feel emotional about seeking help from a fertility specialist. For some people, this manifests as anger; for others sadness or anxiety. Sometimes it’s a combination of everything. But we hope there is also a sense of relief in taking that next step to figuring out the path forward. Hopefully, you will find yourself working with a compassionate doctor who is able to help you navigate this difficult process. 

It can be hard to retain all the information that’s given to you at an appointment. Here are some tips to prepare:

1. Consider going with a partner, a family member, or trusted friend. They can be an advocate and an extra set of ears, asking questions you may feel uncomfortable asking or that you didn’t think of.
2. Take notes. 
3. Write questions down in advance (suggestions on what to ask below).

Questions to ask during your first appointment

Once you are in the appointment, you may feel overwhelmed with information and forget all the questions you had in mind beforehand. We recommend writing your questions down in advance and taking them with you to the doctor’s office.

Everyone’s experience with infertility is unique, but we’ve included some questions you may want to address during your time with the doctor:

1. What types of tests will I need to have done?
2. What types of tests will my partner need to have done?
3. When will I be able to have a treatment plan?
4. What is the success rate of IUI and IVF at your clinic?
5. What are the risks of the potential treatment(s)?
6. What, if any, lifestyle suggestions or changes should I implement?
7. How much will treatment cost? What financing options does your clinic offer?
8. Who do I call with questions?
9. What’s next?

We hope this helps you feel prepared for your first fertility workup. You can learn more about specific fertility treatments here.

Some additional helpful resources for people interested in learning more about fertility treatments are The American Society for Reproductive Medicine and FertilityIQ.