The practice of medicine involves two steps; making a diagnosis and then using that information to decide what, is any treatment is appropriate. The initial visit sets the stage for how the diagnostic evaluation will proceed. Some couples are just beginning the evaluation of their fertility issues while others have had extensive treatment and may be looking for a second opinion. The initial visit will look very different depending where you are starting from.
For about 30 percent of couples trying to get pregnant, several problems contribute to infertility. This fact is especially important to remember if one of you has a known factor, such as previous tubal surgery or a known sperm problem. Many couples come to a clinic and tell the staff, “I don’t need to do any testing — we already know the problem is him (or her).” You may think that you already know the problem, but keep in mind that for 30 percent of you, tests will reveal another problem, and pregnancy won’t occur until both problems are addressed.
A word about testing: The tests used to find a problem causing infertility are not what you might expect. For example, they rarely tell you exactly what is wrong. Many times, they are designed to identify a general area that may have an undefinable problem. This information can then be used to help make predictions about what might work and what might not work.
The history is important in determining what path to take. I will determine which tests are necessary. Since there is very little information, the visit may be quite short. Understandably couples may have a number of questions, but until enough information has been obtained, answering questions may lead to erroneous answers. Furthermore, in the COVID era, the initial consult may be done through video conferencing. Once the history had been taken, the physician will order a number of diagnostic tests that are fashioned for each patient’s specific needs.
While the initial appointment is important, it is the consult that follows the completion of the diagnostic testing is the most important visit. The data that has been collected can be assessed to identify a cause for the problem. At that point, two predictions can be made: what is the chance of getting pregnant without treatment and what is the chance of getting pregnant with treatment. Unless treatment improves the chances of getting pregnant, it is not useful.