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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: 

  1. No apparent abnormality has been found on taking your history or on examination. 
  2. 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. 
  3. 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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