The Fertility Guide: Getting Started with Treatment

Once a couple decides they are concerned enough about their ability to conceive that they want to at least talk about it with a professional, the first step is to make an appointment with a physician. This doesn't necessarily have to be a specialist in fertility; many obstetrician/gynecologists and family practitioners are comfortable initiating a work-up. Sure, there are other things you can do. You can read a book; it may provide some useful information. You can talk to a friend, but be very careful! Sometimes the most well-intentioned advice from a friend such as, "Don't worry, just relax, it will happen," can hurt more than anticipated and be worth just what you paid for it. And you can certainly continue to try on your own. But if you're worried, it will help to get some answers.

In the history and physical, a clue or clues may be discovered that can direct the initial investigation in a particular direction. No physician can begin to formulate the plan of evaluation appropriate for a couple until the physician becomes familiar with the perspective of the couple, taking a history of their attempts to conceive as well as of their general medical health, and doing a physical exam. Remember: Not every couple needs every test. Evaluation must be tailored to the couple.

One thing the physician needs to try to understand is "where the couple is coming from." How long have they been married? How long have they been trying to get pregnant? Have they used contraception in the past, and if so, what kind(s)? What, if any, evaluation have they had so far? How anxious are they? How frustrated are they? How aggressive do they want to be? How much do they feel that they can tolerate? The point is this: The approach for a 25-year-old couple who have been trying for one year is going to be different than that for a 38-year-old woman and her 40-year-old husband who have been trying for three years.