What to Expect at your Consultation with a Reproductive Endocrinologist

After unsuccessfully trying to conceive for 6 months, a fertility consultation with my gynecologist, and some basic fertility testing completed, my gynecologist decided that I should go straight to a Reproductive Endocrinologist (RE). Due to my age and diagnosis of Diminished Ovarian Reserve (DOR), she said that I needed assisted reproductive technologies (ART) if I was going to get pregnant. And since fertility treatments that have the highest rates of success such as IUIs and IVFs can only be performed by a Reproductive Endocrinologist, it was time to schedule a consultation appointment.

Luckily, my gynecologist provided me with referrals to two fertility clinics near me. One of the clinics she highly recommended over the other as that was the clinic that assisted her in getting pregnant with her twins. So I went home after my appointment and immediately called the RE’s office to set up a consultation appointment.

THE CONSULTATION APPOINTMENT

I arrived at my consultation appointment on a Monday afternoon. It was earlier in the afternoon than I preferred since I work full time, but I would have had to wait a month if I wanted an appointment time that was more convenient. When I arrived, I went up to the front desk to check in. The woman at the front desk asked for my name and then handed me some medical forms to complete. I took the forms from her and she asked if my husband would be joining me. I said he was not coming and she was very surprised. In all honesty it really did not cross my mind to bring him. He has less vacation days than me, so I did not think it made sense for him to use a half day on this appointment. Since the problems we were having conceiving laid with me, I figured I could meet with the doctor on my own and report back to my husband that evening. However, I quickly learned from everyone that husbands are kind of expected to attend all of the major appointments.

After getting checked in, I took a seat in the waiting room. I only had been waiting for a short period of time when I was called in by one of the technicians. She told me they wanted to weigh me first and then would take me into a room for an ultrasound. After giving me some privacy to prepare myself, the technician inserted the wand to look at my uterus, lining and follicles. While I was getting my ultrasound, the doctor came into my room and introduced himself. I was already hesitant that I had a male doctor instead of a female, so meeting him while I was in the middle of an ultrasound was a little awkward. He asked the technician how everything looked and she told him I had two follicles in my left ovary and one in my right ovary. He bluntly told me that was not good and that his younger patients typically have 6-8 follicles in each ovary. Further confirmation of my DOR diagnosis. He told me to finish up my ultrasound and then he would meet me in his office to discuss next steps.

After the technician finished my ultrasound, I redressed and was escorted to the RE’s office. He offered me a seat and he immediately jumped into the consultation. Other than asking me my age and how long I was conceiving, he asked me very few questions and just started explaining next steps. He said my FSH result (tested by my gynecologist) was high. That paired with the few follicles my ovaries currently contained he felt confirmed that I did have DOR and he informed me forthright that it would be more difficult for me to get pregnant, even with assisted reproductive technology.

He said I should call the office on the first day of my next cycle to come in for more blood work on day 2, 3 or 4 of my cycle. This time he was going to conduct an Ovarian Assessment Report. He said he wanted to know what my AMH was and wanted to see if my FSH would decrease below 10 after taking some supplements. For Diminished Ovarian Reserve he told me to take 200 mg of Ubiquinol two times a day and 25 mg of DHEA three times a day in addition to a Prenatal Vitamin and Vitamin D. He then told me we would try three rounds of medicated IUIs with Clomid and if that did not work then we would move onto IVF. He also told me I needed to lose weight and set a goal of 15 pounds. With that information he quickly rushed me out of his office to meet with a nurse to answer any questions I had.

The nurse had a packet of information for me and a list of tests that needed to be completed before I started a cycle. I had already completed most of the tests, but found out I needed to have a hysterosalpingogram (HSG). Then she handed me my packet and I was on my way.

WHAT TO EXPECT AFTER YOUR CONSULTATION

Since my first consultation appointment, I have not seen my RE at any of my follow up appointments. While the nurses and technicians that work at my clinic are very nice, I do often feel like a number rather than a person in their care. This is a very emotional process and sometimes I want a little warmth and compassion and a moment to learn more from a live person. Instead, my clinic is like a smooth running assembly line. All of my communication with the team is through an online portal. My test results, appointments, and any instructions or questions all go through the portal.

I have realized through this journey that I need to research and read up on fertility because the office provides me with very little information. I also have become an advocate for myself and I question things that I feel are overlooked.