Once you have made an appointment, you will receive a set of medical and other questionnaires. Please look at these well in advance of your appointment to allow enough time for complete answers.
As family history is often very relevant, it is helpful if you gather information about your family history prior to the first visit.
During your first visit, we welcome you to our practice and initiate an ongoing plan to achieve your goal of pregnancy. During this visit we will gather information about your attempts to conceive, and take a comprehensive history regarding both members of the couple. We will also discuss your medical history, your reproductive history, and family medical history, as well as review lifestyle factors.
Bringing prior medical records and prior fertility evaluation and treatment records to the first consultation is very helpful, as it allows us to gather more information during this initial visit.
After reviewing your history, we will discuss the potential causes of your difficulty conceiving. We will then outline a directed infertility evaluation, along with the rationale for each test and a timeline for testing and initiating treatment.
It is important to us that you leave your first visit with a clear understanding of the plan for evaluation and future follow up. Please let us know if you have any questions so that we can address them.
Prior to conception, Advanced Reproductive Medicine patients will be asked about their personal and family history, as well as their ethnic background. It is advisable that certain ethnic groups be tested for particular genetic diseases, even if there is no history of the disease in their family. Two examples of this are testing African American patients for sickle cell anemia and testing Ashkenazi (Eastern European) Jews for a panel of genetic diseases including Tay-Sachs disease. Other genetic testing may be suggested for other ethnicities or if there is a family history of certain diseases. The physician will discuss this with the patient during the initial consultation.
Caucasian patients are advised to consider cystic fibrosis testing prior to conception. Cystic fibrosis is one of the most common genetic disorders among Caucasians. Usually, there is no family history of cystic fibrosis, but if both the male and female are carriers, they have a one-in-four chance of having an affected child.
Genetic testing can reduce, but not eliminate, the risk of certain birth defects. Other birth defects occur sporadically, not related to chromosomal or genetic conditions. Once a woman is pregnant following fertility therapy, she should consult with the obstetrician regarding tests performed during pregnancy. These recommendations are based on the woman’s age, personal history, and family history.
In preparation for your first visit with an Advanced Reproductive Medicine physician, you will be asked to fill out an extensive questionnaire relating to your past medical history, gynecologic condition, and lifestyle issues which may impact your fertility. Sometimes making lifestyle changes may be all that is necessary for a couple to conceive.
Timing of intercourse
The timing of intercourse can be a limiting factor for some couples. Studies show having intercourse three to four times per week is optimal for a couple’s fertility. If a couple generally has intercourse less often, they may be missing the woman’s ovulation window.
Determining the ovulation window is usually easy in women with regular cycles. Basal thermometers can be purchased at pharmacies. With several months of charting, most women will be able to predict their ovulation within a few days each month. Predictors based on urinary hormone levels are also readily available. These may be used during a cycle to determine ovulation for that month to help a couple’s timing.
Women with less regular cycles often have much reduced fertility, and medical help is usually needed to regulate ovulation.
One of the most important lifestyle issues affecting fertility is smoking cigarettes. It is very clear that smoking decreases fertility in both women and men. “Passive smoking” (being present when cigarette smoking is occurring) is also a health and fertility risk. If you need help quitting, the staff at ARM can assist you with this important goal.
Alcohol intake, even in low amounts, may reduce fertility in women. After ovulation, it is a good idea to not drink alcohol since it is toxic for fetuses. For most men, there is no harm in small to medium amounts of alcohol on a daily basis, but heavy drinking – even occasionally – is not recommended. For men with diminished sperm count, keeping alcohol intake to a minimum may be advisable.
Many women are concerned about exercise. Moderate exercise is healthy, improves your mood and coping abilities, and helps with weight control. However, excessive exercise may be associated with diminished fertility and even lack of periods. Please discuss the amount of exercise you perform daily with your physician.
Weight is an issue for both women and men. Women who are underweight appear to have a decreased chance at pregnancy and obese women may have changes in their cycles, increased miscarriages, increased birth defects, and increased pregnancy complications. Your physician can help you to get the resources you need to either increase or decrease weight. Eating disorders may have an impact on infertility and should be diagnosed and treated before pregnancy.
For more information please see nationaleatingdisorder.org.
Avoiding high caffeine intake (more than two cups per day) is advisable for women. Recent data regarding the “Fertility Diet” suggests that it is good to avoid trans fat, lower intake of animal protein, increase intake of vegetable protein, high intake of high fiber carbohydrates, and preference for high fat rather than low fat dairy products.
Read Healthy Place Eating Disorders for additional information on weight and fertility.
There is minimal data about stress and infertility, unless stressful events are disrupting a woman’s period. Infertility can certainly cause stress for a woman and the couple. Fertility counselors can help discuss coping strategies.