I will soon welcome patients to schedule an interactive consultation with me to discuss any and all fertility needs including fertility-enhancing procedures (insemination, IVF and frozen embryo transfers), fertility preservation (egg freezing and/or embryo banking) as well as disposition of already-cryopreserved eggs and/or embryos. Please check back again for an update.
Fertility Consultation
Your initial fertility consultation will most likely be virtual and will be tailored to your personal or medical situation. Sometimes the initial intake and discussion is performed by one of my associates and data is gathered before I connect with you. If presenting with a diagnosis of infertility, your consultation will begin with a discussion of your past history (how long have you been trying to conceive – if you have, do you experience normal menstrual periods, have you had any prior fertility treatments, etc.). Soon after the initial discussion, an appointment will be scheduled for a complete physical examination as well as ultrasound imaging of the reproductive organs (uterus, fallopian tubes and ovaries, if present). The sonogram allows for assessment of ovarian antral follicle count (AFC) and may uncover uterine, fallopian tube and/or ovarian issues that may serve as impediments to success. Either prior to or as a result of the initial consultation, several laboratory tests will most likely be ordered. These tests often include hormone levels. For a person with oocytes, an antiMullerian hormone (AMH) level will be done. Additionally, sometimes baseline follicle stimulating hormone (FSH) and estradiol assays are also ordered to be drawn on the second or third day of the menstrual cycle (if menstrual periods are occurring). These three hormone blood tests help to gauge how the ovaries are doing relative to age and function (i.e. assess “ovarian reserve”). Ovulation may also be assessed either by tracking the days/events of reproductive cycle, using an over-the-counter ovulation predictor kits or through a serum progesterone level assessed after ovulation was thought to occur. if a partner with sperm is involved, a test of semen quality will most likely be done. Single, same-sex and transgender people (including all LGBTQIA) are welcome in my practice with the evaluation and care individualized to the situation. Pregnancy is carried within a uterus (womb). To assess the uterus, if not already performed, a hysterosalpingogram (a special x-ray test often referred to as an “HSG”), a special 3D-saline sonogram or, if warranted, an MRI may be ordered or performed. These imaging modalities allow me to evaluate the status of the fallopian tubes and uterine cavity (the part of the uterus where pregnancy is carried and menstrual flow originates – see example below). The HSG and/or sonogram evaluation, can diagnose fibroid tumors or polyps in the uterus, as well as congenital uterine anomalies, all of which can hinder pregnancy efforts. Fallopian tubes are the female reproductive structures that serve as conduits between the uterus and ovaries and allow the male sperm and female egg to meet within the body – they are where fertilization naturally occurs. If fallopian tubes become damaged, usually either through a prior pelvic infection, endometriosis, or surgery, natural conception can become more difficult, if not impossible. Both uterine and fallopian tube abnormalities can be surgically corrected in some cases. Uterine polyps and fibroids are often removed. Some damaged fallopian tubes can be repaired, particularly if the problem is that they are bound to other pelvic structures by adhesions. However, if fallopian tube damage is significant, the non-functioning tube(s) are often surgically removed from the body. Removal can sometimes improve fertility treatment outcome and lower the risk of ectopic pregnancy (one that implants outside the womb). If both fallopian tubes are removed, in vitro fertilization (IVF) can be used to achieve pregnancy which bypasses the need for the tubes altogether.
I look forward to being your doctor!