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First
Visit to the Specialist
What can I expect during
the first visit
Couples are usually quite nervous
about their first visit to an infertility specialist. After all their inability
to conceive is a highly personal subject and something that most couples
are very sensitive about. The couple has nightmares thinking about all
those embarrassing questions that they will probably have to answer. They
cannot imagine discussing their sex lives with a complete stranger.
Actually, the first visit is rarely
the nightmare that couples expect it to be. It generally takes about half
an hour during which the doctor takes a full history, conducts an examination,
discusses the findings with you and outlines a plan of action. The doctor
will put you at ease by first questioning you about general medical facts
rather than immediately inquiring about the frequency of intercourse! You
will be questioned about your ages, the length of your relationship, and
for how long you have been trying to conceive.
Will previous pregnancies
be discussed
Yes. Previous pregnancies can provide
information that may help in determining the causes of infertility. You
will be questioned about the duration of the previous pregnancy, whether
it was normal, a spontaneous miscarriage or whether you have had an abortion.
You will be asked about the method of delivery, the outcome of the pregnancy
and any significant complications. For instance, the fact that antibiotics
were required for pain and a high temperature following a termination of
pregnancy, may suggest a problem with the tubes as being the cause for
your subsequent infertility.
Will contraceptives
that we have used also be discussed
Yes. The infertility specialist
will be especially interested if you have used an Intra-Uterine Contraceptive
Device (I.U.C.D.) or the combined contraceptive Pill. The I.U.C.D. can
sometimes be associated with inflammation in the uterus and tubes and the
Pill with prolonged intervals between periods after the need for contraception
has passed.
What will the doctor
want to know about my menstruation cycles
Menstruation plays a key role in
conception so you can expect the doctor to make detailed queries about
your menstrual cycle. The doctor will ask you how often you get your period
and whether you have a regular cycle. This will help the doctor whether
you are ovulating in every cycle. The heaviness of the bleeding and the
amount of pain are also to be considered, as these could be symptoms of
infertility. If your periods have become very scanty or have stopped altogether,
you will be asked whether you have recently gone on a crash diet as drastic
weight loss can cause periods to stop completely.
You will be asked if you are aware
of the fertile period during each cycle, i.e. when conception is more likely
to occur. Do not be ashamed to admit your ignorance. You are not the only
ones. The number of times a week that you have intercourse becomes important
in determining whether or not there is a reasonable chance to have expected
a pregnancy to have already occurred.
What will be asked
of our medical histories
Both of you will be asked to give
details of your past medical histories. In the woman all abdominal operations
and especially pelvic surgery are of interest. Conditions such as appendicitis
are very significant if associated with peritonitis. Among the Asian community
direct inquiry will be made into a history of Tuberculosis (T.B.) as this
can occasionally affect the uterus and tubes.
All medicines taken on a regular
basis should be mentioned. Heavy cigarette smoking (20 a day or more) either
by you or your husband may be very relevant. There is now evidence to show
that the fertility of women who are smokers is half that of non-smoking
women. Men who are heavy smokers may be reducing both the quantity and
quality of the sperm that they are producing. The operations in the male
of special interest are those in the region of the groin and scrotum. Operations
for undescended testicles and the ages at which they were performed are
of obvious importance.
Will they undertake
a physical examination of me
Once the doctor has taken down your
medical history, he will conduct a physical examination. He will first
take your weight. He will then move on to examine your breasts and abdomen.
A vaginal examination provides the
doctor with information about the size, shape and position of the uterus.
He will be able to determine if there is any reduction in the mobility
of the uterus, or if there are fibroids of the uterus or cysts on the ovaries,
any of which may indicate a cause of your infertility. He may also take
a cervical smear if this has not recently been carried out.
It is unlikely that your husband
will be examined at the first visit. This only becomes necessary if it
is obvious that there is a significant male infertility factor.
What will the doctor
learn from the first visit
After the history, general examination
and pelvic examination have been completed, the majority of patients usually
fall into one of the three broad categories:
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No apparent abnormality has been found
on taking your history or on examination.
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Periods are so irregular (or even totally
absent), that ovulation, if it occurs at all, is completely unpredictable,
e.g. periods occurring every 1-4 months.
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There are factors in your history or
examination indicating possible tubal damage, such as a history of peritonitis.
The vaginal examination may have revealed that the uterus is immobile because
of possible adhesions in the pelvis.
Your specialist will now decide which
investigations and/or treatments are indicated in your individual case.
This will, of course, be discussed with you and fully explained. If there
is any aspect of these investigations that you or your husband do not understand,
do not hesitate to clarify your doubts.
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