The first assisted reproduction consultation

It is considered that there is a sterility problem when, after a year of frequent unprotected intercourse, a pregnancy has not occurred. From this moment all professionals advise to attend a specialized consultation to assess the factors that may be responsible for this circumstance.

Below you have an index with all the points that we will discuss in this article.

Index

The first assisted reproduction consultation

• 1. Personal interview
• 2. Medical tests

Personal interview

In this first visit, an exhaustive clinical history and all the complementary tests that are necessary to reach a diagnosis that allows the correct choice of treatment will be made. For this reason, it is important that if it is a couple, the two people come, regardless of whether there is prior knowledge of who has the fertility problem.

The first part of this visit will consist of a detailed anamnesis in which all the medical history of the couple will be recorded, both related to reproduction and others, current or past treatments, surgical interventions to which they have been subjected, family history, hereditary diseases, etc. If you have previous medical reports on any aspect it is interesting to provide them in this first visit so that the history is as complete as possible and allows the specialist to act with good judgment.

This first part can take time since the doctor has to know and make sure that the health conditions of women are the best for a safe pregnancy without any type of contraindication. Questions will be asked about the life habits of the couple such as professional activity, taking contraceptives, smoking, alcohol, toxic substances, etc. Especially important will be the information related to the cycles of the woman, age of the first menstruation or menarche, regularity of the cycles, duration, etc. Information about previous pregnancies with the current partner or with a different partner is evidently very enlightening when determining the possible causes of problems to conceive.

Clinic history

Next it is usual to perform a gynecological examination and from here the doctor will determine that other complementary tests should be performed on the couple before making decisions about the steps to follow to achieve a pregnancy. In case the couple provide previous tests and provided they are valid for their characteristics and time, try not to repeat them since some of them may be annoying.

Once all this information is available, the specialist will be able to discern the factors responsible for this sterility. The causes can be feminine or masculine but in many cases it will be a mixed factor and can even be an idiopathic sterility for which a clear and definite cause is not detected. It is usual that there is no definitive diagnosis in this first visit since the doctor usually needs some results of the additional tests to assess the whole. The most common tests are usually the following.

Medical tests

Basal hormonal analysis

• Valuation of ovarian function: it is assumed that a woman ovulates when her cycles are regular (between 26 and 36 days) but in any case and before any doubt a more empirical assessment is necessary. This assessment can be done in three different ways:
  • basal temperature: it is a somewhat old-fashioned and imprecise and heavy method to perform for women.
  • Endometrial biopsy: this is the analysis of endometrial tissue that is used less frequently due to its low precision and because it is a test that can be painful.
  • hormonal analysis: it is the most practical and precise for assessment of ovarian function. It is a blood test for a specific day of the cycle in which the hormones related to ovulation will be determined: FSH (follicle stimulating hormone), LH (luteinizing hormone) and Estradiol in the first phase of ovulation; or Progesterone and Prolactin in the second half of the cycle.
• Baseline ultrasound study: it also allows us to assess ovarian function based on follicular development as well as detect any alteration at the level of ovaries such as cysts or tumors. It also rules out the presence of alterations also at the level of the uterus, such as fibroids or endometrial polyps. In case of detecting any anomaly and requiring more exhaustive information in this regard, you can go to tests such as endoscopy, laparoscopy or hysteroscopy.

Baseline ultrasound study

• Valuation of tubal patency: it is performed by a test called hysterosalpingography on the 8th to the 11th day of the cycle, it is a contrast radiograph in order to study the uterus and the tubes. The next step in case of anomaly would be to perform the study by laparoscopy plus chromopertubation.
• Request of a semengram: whether or not there is any anomaly in the semengram, it is convenient to refer the male to the andrologist, who will deepen the study of the patient to establish the cause of sterility and be able to draw up a treatment plan. In some occasions, it will be convenient to request complementary tests that will allow us to deepen in some aspects of the study carried out.