An individual or couple’s first visit to see an infertility specialist can make some patients quite nervous. After all, deciding to start a family is a big decision, which can become an even bigger decision if fertility treatments are added to the mix. In order to prepare for your first visit, or to better understand your treatment up until this point, here is a review of some of the vocabulary that is commonly used at fertility offices.
At your first visit, the doctor will likely recommend several ways to assess you and/or your partner’s fertility. These include:
Assessment of Ovarian Reserve: Ovarian reserve refers to the number of eggs (or oocytes, in medical terms) that a woman has remaining in her ovaries. A woman is born with a certain number of eggs; each month, the body recruits multiple eggs to grow and eventually releases one egg (or two, in the case of twins!). The remaining recruited eggs fade away and are lost. Naturally, as a woman ages, the number of eggs left in the ovary decreases. In certain conditions, the rate of egg loss can be accelerated, leading to unexpected infertility and even menopause.
The following are ways to assess Ovarian Reserve:
Anti-mullerian hormone (AMH): This blood test checks the level of the AMH hormone, which has multiple functions in the body. It is produced by the resting egg follicles; therefore, we expect the AMH level to be higher in women with good ovarian reserve and lower in women with diminished ovarian reserve.
Antral Follicle Count (AFC): The term AFC refers to the number of small follicles that are ready to be recruited to grow for that given month. We can determine the AFC by doing a transvaginal ultrasound at the beginning of a woman’s cycle. A higher AFC is a sign of good ovarian reserve.
Follicle Stimulating Hormone (FSH): This hormone, made in the brain, signals to the ovary to recruit egg follicles to grow each month. If the brain senses that not enough eggs are growing, it increases the level of FSH. Therefore, in women with diminished ovarian reserve, the brain releases increased amounts of FSH at the start of the cycle. We measure FSH at the beginning of a woman’s cycle to check ovarian reserve. A high FSH is a sign of diminished ovarian reserve.
Assessment of the Uterus and Fallopian Tubes: In order for pregnancy to occur properly, the egg that is released each month must travel into the fallopian tubes to be fertilized by sperm. The resulting embryo (what we call a fertilized egg) must then continue to travel through the fallopian tube and implant in the uterus.
There are a number of conditions that can decrease the ability of egg and sperm to meet, as well as embryos to implant. Your doctor may recommend one (or several) of the following tests:
A transvaginal sonogram (a.k.a. ultrasound): This is a basic imaging test that can be performed in the office. It can show the antral follicle count (as defined above) of the ovaries. It can also see if there are any anatomical problems of the uterus, such as fibroids.
A sonohysterogram (a.k.a. saline sonogram): This is similar to a transvaginal sonogram, but it involves placing a small amount of saline into the uterine cavity to better see if there are any polyps or fibroids impacting the cavity (which could alter implantation).
A hysterosalpingogram (HSG): This is an X-ray test that involves placing a small amount of dye into the uterus to see if the fallopian tubes are open or blocked.
Assessment of your partner’s sperm: It takes two to tango! Well, in the case of fertility, it takes a healthy egg and healthy sperm! So if you are in a relationship, then your doctor will recommend a semen analysis of your partner’s sperm. This will look at the number of sperm present, the shape of these sperm and how well they are moving, among other factors.
Obviously, this list is not all inclusive, but covers many of the topics that may come up at your first visit. If you hear other terms while researching your fertility journey, feel free to write them down and bring them to your next visit, so you may discuss them in person with your fertility specialist.
For more information, call 718-283-8600, or visit GenesisFertility.com
By Dr. Katherine Melzer-Ross, GENESIS Fertility and Reproductive Medicine