Part III: Testing for Infertility with Dr. Mills
May 18, 2022
By now you’re probably familiar with Dr. Ginevra Mills. She's an obstetrician gynecologist with a specialty in reproductive endocrinology and infertility, a special interest in PCOS and lifelong health, and she's got three young kiddos of her own! We’ve been talking to her about fertility: how it changes with age, causes of infertility, and today we discuss what the next steps look like if you’ve been referred to a fertility specialist.
- Initial Consultation: this initial meeting with a fertility specialist, such as Dr. Mills, will take approximately 30-45 mins and will largely be a discussion about your medical history. Have you had any surgeries, have you been pregnant in the past, have you or your partner had children before with other partners, have you had any terminations of pregnancy, and any history of sexually transmitted diseases, to name a few.
- Please know that none of these questions are asked with judgment - they are there to inform the specialist of what may be causing an issue today so it can be address. If you are uncomfortable sharing a piece of information in front of your partner should they be present, let the specialist know in advance. Usually a patient care coordinator will reach out in an intake call prior to the appointment - let them know a piece of information is confidential and they will make a note of it in your chart.
- Transvaginal Ultrasound: this is a highly specialized ultrasound looking for very specific things a general pelvic ultrasound does not, such as counting the follicles on your ovaries, looking to see if there are any types of cysts and where they might be located, etc.
- Note that this ultrasound may take place at the initial meeting, but due to Covid-19, the initial consultation may be done virtually by video, and the ultrasound scheduled afterward.
- Bloodwork: compiling the information thus far gathered, the specialist may then order a series of blood tests, specifically relevant to your needs. Primarily the blood tests will be looking at your ovarian reserve, the Anti-Mullerian hormone (AMH), and your thyroid. If you are presenting with certain things such as PCOS, other specific blood tests may be ordered, but the specialist is specific as to which tests are asked to be performed.
- Sperm Test: your partner’s sperm sample will be sent a lab for a semen analysis
- Hysterosalpingogram (HSG): this is a special test to make sure the fallopian tubes are open. By putting dye through the uterus and fallopian tubes, the specialist watches if it flows through correctly in an x-ray. The timing of this appointment is important and should occur in the first half of your menstrual cycle for a few reasons Dr. Mills & Dr. Alicia discuss in the podcast!
After all the findings and results are compiled and analyzed, about 85%-90% of the time the specialist will find an explanation and will recommend a treatment option specific to the case and cause of infertility. About 10% of the time, a clear reason for the infertility is not uncovered. Sometimes it’s just a matter of continual trying, making sure optimal timing and lifestyle choices are being made. A good rule of thumb is that any healthy lifestyle choices, such as reducing stress, healthy eating, low or no alcohol/drug consumption, will also be beneficial to fertility and conception.
And last but not least - time sex properly! Period tracker apps are not an accurate predictor of ovulation because everyone ovulates differently. The egg needs to be fertilized within 24 hours of release and sperm can last up to five days in the uterus. If you’re ovulating on day 14 of your cycle, you should start having sex on day 9, as your fertility begins five days before you ovulate (including the day of ovulation). An ovulation predictor kit is a more accurate way to know when you’re ovulating so you can optimize your timing!
Check out The Pregnancy to Parenthood Podcast Series! For the low, one-time cost of $47, get full access to over 40 informative episodes supporting you week by week, focused on the trimester and stage of pregnancy you are in. Tune in every week, or binge listen all at once and come back to the episodes you found most helpful as you move through pregnancy to parenthood!
IG: dr.ginevra.mills
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