Dr. Nicole Noyes

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

Fertility Consultation

 

Your initial fertility consultation begins 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.) with me in my office. I will then conduct a complete physical examination that includes assessing your uterus and ovaries (if they are present) through the use of a sonogram (ultrasound). The sonogram allows me to better examine ovarian antral follicle count and may uncover uterine, fallopian tube and/or ovarian issues that may be present.

 

Either prior to your consultation or as a result of any findings during the exam, several laboratory tests are often ordered. 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 you experience menstrual periods). An antimullerian hormone (AMH) level will also be done. These blood tests help to gauge how the ovaries are doing relative to age (i.e. assess "ovarian reserve"). Ovulation will be assessed. if there is a male partner involved, a test of semen quality will be ordered. Single, same-sex and transgender patients are welcome in my practice with the evaluation and care individualized to the situation.

 

To assess the uterus, if not already performed, a hysterosalpingogram (a special x-ray test often referred to as an "HSG") or a 3D-saline sonogram will be ordered or performed. These procedures 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). 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 reproductive structures that serve as conduits between the uterus and ovaries and allow the male sperm and female egg to meet - they are where fertilization naturally occurs. If the fallopian tubes become damaged, usually either through a prior pelvic infection or endometriosis, 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.