What to Expect When You’re Nowhere Near Expecting

If you were to Google “What happens during your first infertility specialist appointment” you would find a range of answers, but the best advice I can give is to call your clinic and ask what to expect. This is exactly what I did so I wouldn’t be caught off guard.

From my last post, you know how well (eye-roll) my vitals went, and how I felt our doctor was an angel among us, so I’ll pick up the rest of the story here. I’m sure you’ve learned by now that I’m a bit of an over-sharer and I immediately tell Dr. Freeman that Jeremy is a fainter just so he is fully prepared. (Luckily his office is pretty big, so J didn’t battle any claustrophobia this time.) Just a reminder, we already went over our names, so from here on out, we are mom and dad!

Dr. F starts by asking us to share our journey so far – I really appreciated that he wanted to hear from us and not just read our records. He took notes throughout me talking (you didn’t actually think I let J get a word in, did you?), and when I finally came up for air, he asked some questions. Normal things, how long are my cycles, how often do we have sex, am I tracking any other way than OPKs, drug or alcohol use, and if we are open-minded to treatments. Once we answer these questions, he glances over at my notebook and says “Mom, I see your list of questions. Want to go through them?” I responded by blurting out “I thought you’d never ask!” Remember, I went armed with 22 questions, I’ll share those at the bottom of this post. By the way, when he asked if there was anything we weren’t willing to do, he meant IVF due to how invasive and costly it is. We explained to him that we are willing to do whatever it takes to have a baby of our own.

I let him know that I had diagnosed myself with PCOS and although Dr. Bhogal ruled it out, I was still concerned, so he said we would test every level to know for sure. (This will be the first time I say this but definitely not the last – OBGYNs and REs are not the same.) Dr. B tested me for PCOS via an ultrasound and labs for my thyroid, LH, FSH and testosterone, but Dr. F explained that there are 18 levels tested in a PCOS panel. We were going to start with the main culprits and if it wasn’t clear from those levels, we would move on to the remaining ones.

Once we got through my list, and off on a few tangents, we discussed a few items again in length. A major question for me was if we would have Dr. F for all of our appointments, he explained this isn’t impossible, however, we should be prepared to have any of the other REs in the practice. I immediately became nervous (hello, White Coat Syndrome) and expressed my fears that if treatment were to fail, I would always feel it was because he didn’t do it. He acknowledged my fear but reminded me that before that very day, I didn’t know him either! Touché. Another big question was what we could expect him to do versus a nurse. He explained at the FIRM that REs do all appointments, including ultrasounds, and in his words “For this specialty and the price you pay, you want to have a RE doing it all.” This was so reassuring but frightening as I had never had a male doctor before! Lastly, I needed to know how necessary the HSG test was. I knew the answer to this and how important it was, but I had read so many horror stories so I needed to know what my chances were of getting out of this part! Now that all of our questions were out of the way, we moved on to what he saw as a possible treatment plan from our records and our conversation, knowing this could change based on my upcoming labs. We decided that we would try four or five intrauterine insemination cycles if necessary before moving on to in-vitro fertilization.

Another thing I should share with you from the question and answer portion of our appointment is about Dr. F’s recommended lifestyle or diet changes. First things first, cut out caffeine and alcohol, for obvious reasons but also because caffeine restricts blood flow to organs, including the uterus. Dr. F was very honest and although he wasn’t too concerned about our weight, he did explain that success increases as weight decreases. He would like for each of us to lose 10% of our body weight (did he not realize the holidays were right around the corner!?). This wasn’t going to be hard but ideally, I wanted us both to lose this weight before we started treatment to increase our chances, but this was just the first appointment and I had an extensive list of labs that had to be checked first. Luckily for J, he wasn’t given homework in the form of appointments as he already completed two SA’s.

You may not believe me, but this is exactly how we expected our first appointment to go as it was just a consultation. This is likely because I asked what our appointment would entail when I spoke with the scheduling nurse, I even asked her if I should expect to get undressed! (Over time, I would always ask as we would schedule our next appointment if it would be “clothes on or off”.)We expected answers to our questions, and scheduled blood work for further testing with a follow-up appointment. However, we didn’t expect to feel so comfortable within the first few minutes with Dr. F! Full honesty, we expected to be treated like a number and not humans. From this first appointment, it was clear that Dr. F treats you as if you are his only patient. And we definitely did not expect to be called mom and dad!

As the appointment came to an end, Dr. F shook Jeremy’s hand and asked, with a smile and finished with a chuckle, “Are you okay with another man getting your wife pregnant?” And if we didn’t already know, that moment solidified our choice to have him on our side!

Now, onto the good stuff – my questions! I hope that my list is a good starting point for you or someone you know battling infertility. If you have gone through this journey, let me know if you have any questions you would add to my list!

  1. What is the FIRM’s success rate for IUI, IVF and IVF with ICSI?
  2. How many patients do you treat on a daily basis?
  3. Who can we expect to see for appointments? At the FIRM, you always see an RE for appointments.
  4. Will we always see you (Dr. F) for appointments?
  5. What is the nurse to patient ratio?
  6. Who should we expect communication from? Doctor of nurse? Phone or email?
  7. Who performs ultrasounds?
  8. Is the FIRM open on weekends and holidays?
  9. What diagnostics are done at this office?
  10. How often would we have to travel to the main office?
  11. Are my most recent labs and ultrasound valid?
  12. What tests can be done to test for PCOS?
  13. Is an HSG required?
  14. Based on our medical history, what do you think our odds are of being successful?
  15. What is the success rate for IUIs?
  16. What is your recommended number of IUIs before moving to IVF?
  17. If a loss occurs, how long do we wait before trying again? What about for a failure?
  18. If we have a failure, how can we increase our chances for the next month?
  19. Do you always have to do a trigger shot?
  20. When do we graduate back to our OBGYN?
  21. How many appointments can we expect a month for an IUI?
  22. What diet and lifestyle changes do you recommend?