Your First Fertility Consultation
The first consultation is where months or years of trying become a plan. You sit down with a fertility specialist, often a reproductive endocrinologist or a gynaecologist who works only in fertility, and leave with a clear picture of what is happening, what to test next and which treatment gives you the best chance.
It is also where a lot of people feel rushed. There is a great deal to take in, and the questions that matter most often come to mind on the way home. I have sat in on many of these appointments, and the couples and single patients who get the most from them arrive prepared, with their results in hand and their questions written down.
Arriving prepared changes how the hour feels, too. Instead of trying to keep up, you are helping to build the plan, and you walk out knowing what happens next.
On this page
What happens in the room
The appointment usually starts with a long conversation. Expect questions about how long you have been trying, your periods, any pregnancies or miscarriages, past surgery, infections, medicines, weight, smoking, alcohol and your family history. If you have a male partner, the doctor will want the same picture from him, because a male factor plays a part in something like a third to a half of cases.
Most clinics then scan you. A transvaginal ultrasound shows the uterus and ovaries, and the doctor counts the small resting follicles in each ovary, the antral follicle count. Together with an AMH blood test, it is the best guide to how your ovaries will respond to IVF drugs. The scan also looks for fibroids, polyps, cysts and signs of endometriosis.
Then the doctor goes through any results you already have and orders what is missing. That usually means ovarian reserve testing, a check that you ovulate, a tubal test, a semen analysis and infection screening for both partners. Many clinics can do most of this on the same day or within one cycle.
What you should leave with
A good first consultation ends with a plan, even if the plan is "these three tests, then we decide". You should know what the doctor thinks is going on, what they want to find out, and what they would recommend if the tests come back as they expect.
If treatment is already clear, the plan names it. That might be ovulation induction with tablets, IUI, IVF or IVF with ICSI, and for IVF, the drug protocol, roughly when you would start and how many embryos the clinic would transfer. Most leading clinics now recommend transferring one embryo at a time, and freezing any others.
You should also leave with a written estimate of the cost for the next step. If you do not, ask for one before you book anything.
Before you leave the room
Ask the doctor to summarise the plan in two or three sentences while you write it down. Reading it back that evening, you will know straight away whether anything was unclear, and you can ask while it is still fresh.
What to bring
Bring every result you have, as numbers rather than a letter saying they were "normal". The ones that travel best are:
- AMH, with the date and the units it was measured in
- Day 2–5 hormone tests (FSH, LH, oestradiol) and any progesterone result
- Scan reports, especially an antral follicle count
- Semen analysis reports, with the count, motility and morphology figures
- Records of any earlier IVF or IUI cycle: the drugs and doses, how many eggs were collected, how many fertilised, and the embryo grades
- Notes from any surgery on the uterus, tubes or ovaries
Add a list of your current medicines and supplements, and the dates of your last few periods. If you track ovulation, bring that too.
Questions that get straight answers
These are the questions I would want answered before leaving a first consultation:
- What do you think is the most likely reason we have not conceived?
- What is your clinic's live birth rate per cycle started, for someone my age?
- Why this treatment rather than the one below or above it on the ladder?
- How many embryos do you usually transfer, and why?
- Do you freeze all embryos and transfer later, or transfer fresh? What decides it?
- Which extras or add-ons do you recommend for me, and what is the evidence for each?
- Who will I see at each appointment, and who does the egg collection and the transfer?
- What happens if the cycle is cancelled, or if no embryos reach transfer?
A great clinic will answer all of these readily. The live birth rate per cycle started, by age, is the figure that answers the question you are actually asking. See choosing a fertility clinic for how to read it.
The night before
Write your three most important questions at the top of the page, above everything else. If time runs short, those are the ones you will have asked.
Going together, or going alone
If you have a partner, go together, even if the tests so far point to one of you. The plan affects you both, and a semen analysis on the day can save weeks.
If you are going alone, as a single woman, or because your partner cannot get away, take someone with you if you can, or ask whether you can record the conversation. Most doctors are happy with that. A second set of ears catches the half of the conversation you miss while you are still taking in the first half.
Video consultations work well for a first conversation, especially if you are planning treatment in Thailand or anywhere else away from home. The scan then happens on the first visit, or at a local clinic beforehand.
Frequently asked questions
How long does a first fertility consultation take?
Usually 30 to 60 minutes, longer if a scan is done on the day. See what happens in the room.
Should my partner come to the first appointment?
Yes, where possible. Both partners are assessed, and a male factor is common. See going together.
Do I need test results before the first consultation?
No, but bringing any you have saves time and money. See what to bring.
Can the first consultation be done online?
Many clinics offer it by video, with the scan and tests done on your first visit or at a local clinic beforehand.