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What to Do Before and During Your First Fertility Appointment

What to Do Before and During Your First Fertility Appointment

The lead-up to your first fertility appointment can be both an exciting and anxiety-inducing time. You might be looking forward to getting started with a reproductive endocrinologist (RE, a fertility doctor), but you may also have mixed feelings that you’re at this stage at all.

Once you’ve found a fertility clinic, you’ll have an initial consultation with your RE. To help you avoid feeling overwhelmed, we asked RE and Bird&Be chief medical advisor Dr. Dan Nayot how to prepare and what questions to ask during your first fertility appointment.

Make sure your pap tests and immunizations are up to date.

Has it been over three years since your last pap? Book it in with your family doctor. Likewise, because fevers and certain viruses can pose a heightened risk during pregnancy, check with your doc that you’ve got all your shots. Some vaccines shouldn’t be given once you’re pregnant, so this is the ideal time to make sure you’re up to date.

Switch off any medications that aren’t recommended for pregnancy.

If you take any prescriptions that are a no-go for pregnancy, such as certain antidepressants or blood pressure medications, it’s a good time to talk to your doctor about an alternative plan.

Optimize your general health.

If you deal with any chronic medical issues, you’ll want to make sure you’re in a good spot with it. For example, people with diabetes will want to have their sugars under control, or those with multiple sclerosis will want to be outside a flare-up. Being at your peak health is a good rule of thumb for everyone, says Dr. Nayot: “Be the best version of yourself mentally, physically, sleep-wise.”

Track your cycles and your TTC history.

Your first fertility appointment will likely start with your RE taking the lead in asking you a bunch of questions. Be ready to talk about your medical history, as well as your reproductive history. It helps if you’ve been tracking your cycles (we love using apps like Clue or Fertility Friend), so you easily know how long yours tend to be or what day you’re on. If you’ve been trying at home via intercourse, it helps to note that info in the app as well. Take note of any patterns you’ve uncovered such as spotting before your period or pain around ovulation time.

If you have a partner, bring them along.

If you’re trying to conceive as a couple, treatment will involve both of you, so you’ll both want to be present at the first appointment. “Since information will be shared and decisions will be made that impacts all parties, it’s very important to have your partner join you,” says Dr. Nayot. “Usually after the appointment, you’ll have big discussions about how it went.” If you’re conceiving without a partner, it may still be helpful to bring a support person—two sets of ears are better than one.

Grab a notepad or recorder.

You’ll likely get a lot of information all at once, and it can be a little overwhelming. Take notes or record the session so that you can go back to it to fill in any memory gaps afterwards if needed.

Cover off your list of questions.

The appointment will likely start with your doctor asking most of the questions, but you’ll get your turn to ask yours too. It helps to come prepared with a list. Unless you’re going into this first appointment with insights into your particular fertility situation (for example, maybe you already know there’s an issue with sperm, or that you’ll be using donor eggs), Dr. Nayot recommends that at this stage, you focus on questions about the clinics processes rather than about specific treatment options. For many of these, there’s no right or wrong answer, but you might be more comfortable with certain approaches.

Questions to ask at first fertility appointment

  • “Who do I reach out to if I have questions along the way? Will I have a dedicated nurse?” When questions pop up during treatment, they can feel really urgent and stressful—knowing how you’ll be supported can be helpful.
  • “Is the care a team system or will I only have my one doctor overseeing me?” Some clinics will share chart reviews or procedures between doctors who are working that day, while others will only ever have your actual doctor taking care of you.
  • “Is monitoring scheduled or first come, first served?” Fertility treatment often involves many early-morning monitoring appointments, so it’s worth thinking about what might work best for your lifestyle.
  • “Are you open on weekends? What about after-hours?” You’ll want to know what sort of office hours you can expect for when questions or concerns inevitably pop up.
  • “Who communicates bad news?” Getting a call that a cycle didn’t work can be devastating, and you may have a preference on whether it’s your doctor, nurse or someone else from the clinic who shares that information with you.
  • “How do you minimize time delay?” Waiting can be one of the hardest parts of a fertility journey, so you might want to know what strategies your doctor might use to lessen downtime (such as pre-scheduling follow-ups, using birth control to trigger cycles, etc.).
  • “Do you work with complementary medicine?” If you’re interested in supporting your journey with acupuncture, supplementation, massage, etc., it’s worth gauging your doctor’s openness to naturopathic approaches.
  • “Are lab procedures done here or offsite?” Some clinics have their own bloodwork and embryology labs, while others send the samples off-site to be analyzed. You might want to learn more about where these procedures will take place.
  • “What donor/surrogacy agencies do you work with?” If you already know that your treatment will require donor eggs, sperm or embryos, or a surrogate/gestational carrier, you’ll want to know more about your clinic’s network early on.
  • “What are your live birth success rates for people in my age group?” This one comes with a huge caveat: “How success rates are presented can be very confusing,” says Dr. Nayot, noting that there’s variation in what’s considered a “success” in the calculation (is it a positive pregnancy test, a pregnancy confirmed by ultrasound, or a live birth?) as well as what base number is being considered (all patients who start IVF, or only those that get to an embryo transfer?). There are so many factors that influence success rates—for example, if a doctor is a proponent of transferring two embryos at a time during IVF, that could lead to a higher success rate but create more risk for patients. So, this question is one that many patients want to ask, but know that comparing stats isn’t always apples to apples.
  • “What kind of testing do you recommend?” Clinics should start by testing female hormones, fallopian tubes, uterus, ovarian reserve, and general wellbeing. On the male side, there should be some sort of semen analysis (red flag if not!).
  • “What are the testing costs and what’s covered by insurance?” You’ll want to start thinking through the financial aspect of treatment. Find out about insurance coverage, payment plans, accepted forms of payment, etc.

After this initial appointment, if you proceed with the doctor/clinic, you’ll have tests ordered and will then have a follow-up to review them. That’s when you can get into specifics about the recommended treatment plan. “I would ask, ‘what are our options?’ and for each option, ask about the chance of success per cycle and the estimated cost,” says Dr. Nayot. You can also ask if there’s other testing that would be helpful at this stage, or if any should be repeated before proceeding with treatment. (Pro tip: Keep track of all your test results. It’s a great way to stay organized and feel involved. It will also be helpful if you ever want to get a second opinion along the way.)

Fertility treatment can be taxing physically, mentally, emotionally, and financially. The first appointment is a great opportunity to ask key questions, but remember that at any point in the journey, you can request more information and advocate for yourself.