Dr. Nicole Noyes

Reproductive Endocrinologist
Specializing in Infertility,
In Vitro Fertilization (IVF),
Egg Freezing and Embryo Banking

 
Nicole Noyes, MD
Nicole Noyes, MD

As of 2019

Northwell Health
210-A East 64th Street
New York, NY 10065

Phone: 
Direct: (212) 434-4121
Main Office: (212) 324-2229 

Fertility Consultation

 

Your initial consultation will be tailored to your personal or medical situation. If presenting with a diagnosis of infertility, your initial 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.). A complete physical examination will then most often be conducted that includes, if appropriate, assessing the uterus and ovaries (if present) through the use of a sonogram (ultrasound). The sonogram allows me to examine ovarian antral follicle count and may uncover uterine, fallopian tube and/or ovarian issues that may serve as impediments to success.

 

Either prior to the consultation or as a result of any findings during the exam, several laboratory tests may be ordered on a person whose oocytes will be utilized to create pregnancy. These tests can include hormone levels, particularly baseline follicle stimulating hormone (FSH) and estradiol assays performed on the second or third day of the menstrual cycle (if menstrual periods are occurring). An antimullerian hormone (AMH) level may also be performed, if appropriate. These 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. if there is a male partner involved, a test of semen quality will 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 in a uterus (womb). To assess the uterus, if not already performed, a hysterosalpingogram (a special x-ray test often referred to as an "HSG"), 3D-saline sonogram or 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.