You may feel nervous, anxious, or maybe even a little excited for your first visit at a fertility clinic. However you're feeling right now, having a physician and clinic that you trust will bring you comfort throughout the process. Getting a sense of your doctor, their bedside manner, and the clinic can help you feel confident about pursuing treatment with them.
While clinics may vary on exactly what the first visit will entail, I'm here as a fellowship-trained reproductive endocrinologist and infertility specialist and board-certified OB-GYN at Spring Fertility to help you get an idea of the typical flow of the appointment — and know what questions to ask — so you can be fully prepared.
Meeting your fertility doctor and reviewing your history
At the first consultation, you'll usually have between 30 and 60 minutes to meet your fertility doctor and have them conduct an in-depth review of your medical history:
- You'll be asked questions about both your medical and fertility history, including your menstrual cycles, experiences of pain during intercourse, any past fertility treatment, how long you've been trying to conceive, how often and when you're timing intercourse, and more.
- If you have a partner who has sperm, bringing them to your first appointment can be helpful since your fertility doctor can also ask questions regarding their health and history.
The transvaginal ultrasound is an important initial step in the fertility evaluation (though some patients are surprised by this portion of the exam). If you've never had a transvaginal ultrasound before, you can expect a little vaginal pressure, but typically no pain. How it feels is similar to a speculum exam or Pap smear.
Why transvaginal ultrasound instead of abdominal? A transvaginal ultrasound goes into the vagina and gives us a more clear and detailed view of the uterus and ovaries, which are extremely important as we assess your fertility. By looking at your ovaries and uterus, your doctor will be able to:
- Check your antral follicle count (a marker of your ovarian reserve)
- Assess for any fibroids or polyps (which may or may not have an impact on your fertility)
You might think you need to time this ultrasound around your period, but there's no need to — we can conduct it at any point during your menstrual cycle.
Other types of fertility testing that may happen at your first or subsequent visits include:
- Lab work: Your doctor may order blood tests to measure your reproductive hormone levels and identify any out-of-range hormone levels that could contribute to past or future difficulty getting pregnant. (This is the same test Modern Fertility offers.)
- X-rays: Your doctor might take a closer look at your reproductive organs using a hysterosalpingogram (HSG), an X-ray of your uterus and fallopian tubes to check for blockages of the tubes that may impact chance of conception.
Discussing treatments and asking questions
At your initial visit, your doctor will go over the best treatments for your individual circumstances, whether you're dealing with infertility, conceiving on your own, or conceiving with a partner who also has ovaries. This conversation is your time to get the information you need from your potential doctor about what working with the clinic may be like and what their success rates are.
In the weeks or months leading up to your appointment, start writing down any questions that come up so you can bring them to your fertility doctor. Preparing questions can help you make sure you leave your appointment feeling informed about your fertility and next steps. Remember that as a patient, it is your right to ask questions and it is our job as physicians to educate you (and your partner if you have one) on your options. Asking questions allows you to get a better understanding of your physician and their clinic — and can help you start to set expectations regarding your reproductive goals.
Since knowing exactly what to ask and when can be challenging, I've rounded up a few important ones to get answers to so you have all the info you need to make the right decision for you.
Your treatment plan
It's important to have the full story when it comes to the treatment options the clinic provides, from scheduling protocol to whether or not they can support you from start to finish.
When discussing your treatment plan with a potential doctor, it can be helpful to know your ideal timeline for pregnancy so everyone's on the same page. Another consideration for people using donor sperm and/or eggs or a gestational carrier is that the clinic may require a psychological consult before undergoing treatment. If you're using a known egg or sperm donor rather than an anonymous one, the clinic may also require a legal contract.
Questions to ask:
- If you're at the clinic because you've been experiencing infertility, is there an exact diagnosis your doctor can provide? And is that diagnosis something that can be treated medically or surgically — or is pursuing fertility treatment the best next step?
- What pre-treatment evaluations do they recommend for you? What about if you're conceiving with a partner who has sperm?
- What types of treatment options does the clinic offer? (These may include intrauterine inseminations, or IUI, IVF, genetic screening of embryos, embryo transfers, semen analysis, egg donor banks, etc.)
- Do they batch cycles (meaning in vitro fertilization, or IVF, only starts on certain days of the month — potentially reducing timing flexibility for you) or can you start when you're ready?
- Do they have age cutoffs for IUI, IVF, or embryo transfers?
- For embryo transfers, do they do mostly fresh or frozen transfers? If they mostly do frozen transfers, do they do:
- Programmed cycles, where you may take birth control pills, estrogen pills or patches and intramuscular progesterone.
- Modified natural cycles, which may involve monitoring a follicle during your cycle or taking an oral medication (like letrozole) to develop a follicle and grow the lining of the uterus.
- What makes the clinic unique compared to other clinics in the area?
- If you need an egg and/or sperm donor, does the clinic facilitate this process? Do they have specific agencies they work with?
- Are there any lifestyle factors you can address and possibly modify before treatment?
Potential treatment costs
This can be a major hurdle for individuals and couples pursuing fertility treatment. The average IVF cycle in the US costs approximately $19,000 — and, oftentimes, many standard insurers do not cover fertility treatment (but may cover the infertility workup). Some states require insurance companies to cover fertility treatment, including IVF, but may have pre-authorization coverage such as a minimum amount of time trying to conceive on your own or a requirement to have a certain number of IUI cycles before pursuing IVF treatment.
The insurance pre-requisite of "trying on your own first" isn't an option for people who are trying to conceive on their own or with a partner who also has ovaries. In either instance, this limitation of many insurance plans will impact the ability to get coverage for fertility treatment.
Questions to ask:
- While most physicians can give rough estimates of the different treatment costs, is there a finance team that you can direct your specific questions to?
- What are the costs of different treatment options, such as IUI, IVF, embryo transfers, and genetic testing of embryos?
- What are the costs of medications based on your dosing? (Sometimes the fertility injections used during IVF are not part of the quoted price you receive, and they can run around $2,000-$5,000.)
- Does the clinic accept insurance? If so, do they accept your insurance?
- Does your insurance cover the infertility workup and/or fertility treatment?
- Do they have package pricing if you need more than one IVF cycle?
- Do they have any IVF financing available?
- Do they offer shared-risk programs? (In these programs, you pay a specific fee for IVF which guarantees you a certain number of egg retrieval cycles and embryo transfers. They may also offer 50%-100% refunds if you're not pregnant by the end of treatment.)
Clinic success rates
The ultimate goal when starting treatment for infertility is to achieve a pregnancy, so it’s important to discuss success rates of different treatment options with your doctor so you can manage expectations.
Questions to ask:
- What are the pregnancy rates in the clinic for someone your age with your fertility diagnosis for various treatment options?
- What are the embryology labs’ rates for fertilization, embryo development, and pregnancy for embryo transfers for someone your age?
- What safety measures does the clinic have in place to prevent rare issues such as cryotank (where eggs, sperm, and embryos are stored) failures?
The workflow of the clinic
If you decide to proceed with fertility treatment, there's a high likelihood you'll be spending a good amount of time at your clinic while also balancing work and other priorities. It's important to understand what the day-to-day flow in the clinic is like so you know you'll feel comfortable and supported in the process.
Most ultrasounds for fertility treatment are done starting in the morning and ending in the early afternoon so blood work can come back the same day to facilitate the medication changes and trigger timing and prep. That said, different clinics will have different layouts in how their monitoring and procedures may work:
- Some clinics may utilize a “doc of the day” model where one doctor performs all of the ultrasounds or does all of the procedures (egg retrievals and embryo transfers) that day for everyone’s patients.
- In other clinics, it may be your own specific doctor who performs most of the scans and procedures as long as they're available.
- Other clinics may utilize ultrasound technicians, nurse practitioners, or a combination of all of the above for their monitoring.
Questions to ask:
- What time does ultrasound monitoring start in the morning?
- Who does the morning monitoring — your specific doctor, ultrasound technicians, or the doc of the day?
- How long are the monitoring appointments on average?
- Will your doctor be the one to do your IUI, egg retrieval, or embryo transfer?
- How does weekend monitoring work?
- If (when) you have questions, who can you contact and when are they available? Will it be someone who's familiar with your case?
- Will your physician be available via phone or email for communication?
Ultimately, you want to find a clinic that works with your schedule and matches your expectations during the fertility treatment process.
Above all else, make sure it's the right fit for you
If you don’t feel a connection with your physician or feel good about the clinic, don’t hesitate to get a second opinion regarding your care and treatment plan. You owe that to yourself. Your first appointment is your opportunity to vet your physician and the clinic to make sure you feel comfortable and supported.
The journey through infertility should be a partnership between the physician and the patient — and we, as physicians, want you to feel adequately prepared and informed for the process. Know that the right physician and clinic will have your back and support you every step of the way.