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Getting Started with a Fertility Specialist

When a patient receives an infertility diagnosis – and requires the care of an infertility specialist – acting quickly is important. However, one shouldn’t move so fast that they overlook the basic essentials of:

1) Undergoing an initial workup

2) Verifying the extent of infertility insurance benefits (if any)

This shouldn’t be a big revelation. In fact, at some point a fertility specialist will go over these items with patients. Nevertheless, addressing these two items in advance of an initial appointment with a fertility specialist can go along way toward streamlining the intake process and helping minimize financial stress.

Initial Work-Up
Having results from the initial infertility workup gives the fertility physician information needed to facilitate proper diagnosis and determine appropriate treatment protocols. I can’t speak for every fertility clinic in the U.S., but at our center we always recommend a patient get their FSH (follicle stimulating hormone) and estradiol tested. This is a blood draw on the 2nd or 3rd day of your period.

As background, in the beginning of the menstrual cycle (cycle days 1-5), the pituitary gland in the brain secretes Follicle Stimulating Hormone (FSH) to stimulate the ovaries to select and grow an egg for the cycle. Measuring the levels of FSH and Estradiol (estrogen) on cycle day 2 or 3 (first day of FLOW is cycle day 1) provide us with an assessment of the quality of the eggs.
A semen analysis for the male partner should also be performed. The semen analysis is the measurement of 4 different properties of a single ejaculate:

1. Volume – the amount of the ejaculate measured in cubic centimeters (cc’s).

2. Count – the concentration of sperm, measured in million of sperm/cc.

3. Motility – the percentage of sperm that are moving, i.e. living.

4. Morphology – the percentage of sperm that are normal in shape.

FSH, estradiol, and semen analysis testing can be ordered by a gynecologist and give the fertility physician an idea of how well the female patient is ovulating and the quality of semen the male partner is producing. These tests are what I would describe as the “bare minimum” and a physician might order additional tests after evaluating the patient’s individual case.

Insurance Coverage
Infertility insurance coverage is a complex issue and a detailed discussion is beyond the scope of this post. (For more info, read my recent post, “A Guide to Infertility Insurance”.) However, I did want to remind patients of the importance of researching their insurance company and/or employer as to the extent of fertility coverage, if any. The outcome might be good (patient has infertility benefits) or bad (patient does not have infertility benefits). Either way, one will know what to expect when the bill arrives, which can help financial planning. The way I see it, outside of winning the lottery, most “surprises” involving money are not welcome.
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About the Author

Dr. Herbert is a fertility expert and an innovator in the field.