Patients who consult with a reproductive endocrinologist for the first time may be nervous, confused and even ashamed. Fertility evaluation and assessment — of both the female and male partner — should be a thorough process that's done with compassion for their situation. Physicians should explain why every test is being conducted, how the test is performed and what the patient can expect.
Once the results are in, doctors must determine if the patient falls within the normal category and provide specifics rather than telling the patient that "everything looks great."
If the results are abnormal, doctors should provide a step-by-step plan and any necessary referrals, such as to a reproductive urologist. Additionally, physicians should communicate hope — reassuring patients that their journey to parenthood is not over. Consider the diagnostics below to assess fertility for both male and female patients.
Female Partner Diagnostics to Evaluate Fertility
When new patients call, the scheduling staff should book the appointment for the second, third or fourth day of the female partner's menstrual cycle. This allows the consultation with the reproductive endocrinologist to double as an initial fertility assessment. During the consultation, doctors should communicate the following:
- What it's like to be a patient at the clinic and who would be a part of the treatment team.
- Office hours for monitoring and other appointment types.
- How the clinic defines success.
- How the patients can reach someone if they have a question.
- What to do if the patient has an after-hours emergency.
- An overview of all treatments — from timed intercourse to IVF — provided by the clinic.
At this point, reproductive endocrinologists should move into the clinical discussion. This conversation should include:
- The female partner's medical, surgical, gynecological and obstetric history, as well as questions about her lifestyle.
- An overview of the diagnostic tests the doctor plans to perform.
- An anticipated timeline to conduct the tests and receive the results.
Physicians should leave her with a simple message: "We're going to help you become a parent, and I'm honored to play a role during such a special time in your life. I'm extremely hopeful for your future."
Assuming she is at the beginning of her menstrual cycle, the female partner should be sent for an ultrasound and blood work.
The sonographer should explain what the patient is seeing on the monitor, including an antral follicle count, follicle sizes, endometrium thickness and any abnormalities. If the clinic has a 3D ultrasound machine, the technician can evaluate planes of the uterus not available with 2D, allowing the diagnosis of any congenital uterine malformations.
Blood work should include AMH, DHEA-S, E2, FSH, free testosterone, LH, P4, total testosterone, vitamin D, T3, T4 and TSH. Additional scripts should be written for prolactin and any other tests indicated by the patient's history.
Before the patient leaves the office, she should schedule a saline infused sonography with sonosalpingogram — ideally prior to her expected ovulation — to further evaluate her fallopian tubes and uterine lining and structure. She should already understand the procedure, including the role ultrasound plays, from her consultation with the reproductive endocrinologist.
Male Partner Diagnostics to Evaluate Fertility
Ideally, male partners should attend the initial consultation, too. After all, while one-third of infertility causes can be attributed solely to the female partner, another third are tied solely to the male partner and an additional third are a combination of the two. When the conversation turns to the male partner, the doctor should discuss:
- The male partner's medical and surgical history, as well as questions about his lifestyle.
- An overview of the diagnostic tests the doctor plans to perform.
- An anticipated timeline to conduct the diagnostic tests and receive the results.
Some patients may have already had a recent semen analysis. If that's the case, the physician should discuss the results. If not, one should be ordered. Reproductive endocrinologists should explain the various aspects of a semen analysis, including concentration, motility and morphology.
If warranted, doctors should order hormonal blood work, such as E2, FSH, free testosterone, LH, P4 and total testosterone; a testicular ultrasound; or a transrectal ultrasound to uncover the reason for any male infertility.
While this can be a trying time for couples who are looking to conceive, having an informative and caring approach during the fertility evaluation process should make the process that much easier for everyone involved.
