One of the first things you
might face as a fertility patient is something called the fertility work-up.
It's basically an in-depth look at a couple’s overall health, reproductive
history, and a first pass at tests that might identify an easily “fixable”
problem that is keeping a couple from conceiving. While the process may
seem tedious when you desperately want a baby, the results of the work-up will ultimately
shape the course of your treatment and might save you valuable time and money
in the long-run.
While a doctor will order specific tests based on a couple’s history, some
components of a work-up are fairly standard. Here is what was included in our
work-up, but please keep in mind that every patient is different and your
doctor will order the right round of tests for you.
- Q&A: Your provider will likely ask a series of questions about your general health (do you exercise, smoke, drink, do drugs, etc.). He or she will then ask questions about your cycles, your use of birth control, your sexual history, and any past pregnancies.
- Physical: Your doctor may opt to do a shortened "physical" just to check for general health and well-being to rule out any obvious or glaring health concerns.
- Blood work: A fertility work-up often includes blood work panels, some of which are drawn at specific times in a woman’s cycle to test for certain hormone levels. Blood tests are usually measuring the levels of estrogen, FSH (follicle stimulating hormone), AMH (anti-Mullerian hormone), and LH (lutenizing hormone). Your blood work may also include a panel checking for more general health items like iron levels, and it will almost certainly include a screening for sexually transmitted diseases for you and your partner.
- Hysterosalpingogram (HSG): An HSG is an x-ray of a woman’s uterus and fallopian tubes. Mine happened in a hospital where a radiologist filled my fallopian tubes with dye while taking x-ray photos to make sure the tubes were not blocked. I was very scared while the procedure was happening - I had heard it was uncomfortable at best and painful for most. All in all my experience was not bad, although my tubes were open and many women who report pain have blocked tubes. I’d suggest talking to your doctor about taking some Tylenol to help with possible cramping, and taking lots of deep breaths while the test is happening. Keep in mind that this may also be one of the first tests you undergo in a hospital with x-rays, catheters, etc., so it's bound to be a little more intimidating.
- Ultrasound: A vaginal ultrasound gives your
doctor a chance to look for any abnormalities in the uterus or on the
ovaries, and it allows your doctor to rule out any major structural or
anatomical issues.
- Semen Analysis:The semen analysis is probably the quickest and easiest test in the work up (though your partner may say otherwise!). The doctor will analyze a semen sample and look for sperm count (the number of sperm in the sample), sperm morphology (the shape of the sperm in the sample), and sperm motility (the ability of the sperm to move and swim towards the egg in the fallopian tube.
- Genetic Screening: Some doctors and clinics will order genetic carrier screening during the initial fertility work-up. We did not do genetic screening as part of our work-up (though we did prior to starting our IVF cycle).
All of this might seem a bit overwhelming and daunting, but your physician will walk you through each step of the process, and many of the steps can be completed in one or two cycles. There isn't much you can do to prepare, but it is helpful to bring a calendar and notebook. You'll use the calendar to discuss your past cycles and to chart out the timing of your future tests as many of them are very specific to certain days of your cycle. The notebook is helpful to jot down information your physician shares, follow up question, or frankly words you just don't understand - fertility can feel like its own language when you start down this path! As an aside, please make sure you ALWAYS ask your doctor when you don't understand something. This process is tough enough emotionally, physically, and financially to have the added burden of anxiety because there is a test, a word, or a concept you don't understand. In my experience, your doctor wants to help you and they definitely want you to be knowledgable about as much of the process as possible.
Some additional resources and more information
about what might be included in a typical work-up visit can be found here and here. You can also check out this podcast and this YouTube show for
more on the types of questions and testing that might happen at your fertility
work-up appointment.
Please remember that I am NOT a doctor, and nothing in this post (or any of my posts) should supercede the advice of your doctor. It is so important to have a strong, solid relationship with your medical provider as he or she will know your history and goals, and he or she will provide advice and treatment personalized to YOU.
