Infertility: What to Expect From Your Reproductive Endocrinologist
Deciding to see a specialist is a major step in the journey to conceive. Most women are so unsure of what is involved, that the feelings of uncertainty and fear prevents them from ever making an appointment with a specialist. In reality, there is nothing to fear. Please note though, that every Reproductive Endocrinologist (RE) has his/her own standard protocol. This article is only intended to be a basic guideline. If your referring healthcare provider has not already informed you of the best time to make the appointment, keep in mind it is best to schedule it during the first week of your cycle--so no time is wasted. Routine hormone tests are usually performed during a very small timeframe--many during week one of your cycle.The First Visit
At the first visit--which is usually just a consultation--routine screenings may be performed, including HIV/AIDS and Hepatitis. Medical histories will also be taken for both you and your partner, so it is advisable that your partner attends the appointment with you. Try to keep track of your menstrual cycle before the visit. Charting is very helpful, and might be able to answer some questions--preventing unnecessary tests and procedures. For your partner, a Semen Analysis might be scheduled. However, this may be delayed if he has fathered children in the past.
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After the RE has gathered the necessary health information and background, s/he will most likely share with you the tests and/or procedures to be performed. The RE should also ask you to voice any concerns or questions that you have; don't be afraid to say what is on your mind. There are no stupid questions, and I can assure you that you cannot make an RE uncomfortable! Typical Tests and Procedures
The types of tests that your RE might want to immediately schedule are:
Cervical Mucus Test
This is performed to assess the probability of sperm survival, and the ability of sperm to move through the vaginal canal, cervix, and uterus.
Ultrasound Exams
Ultrasounds are painless, and performed to assess your endometrium (uterine lining), monitor follicle development (are the eggs maturing as they should be?), and assess the condition of your ovaries.
Hormone Tests
These tests are performed by drawing blood (usually about three to five tubes). Most likely, your RE will want to check the following: Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Estradiol, Progesterone, Prolactin, Free T3, Free Thyroxine (T4), Total Testosterone, DHEAS, and Androstenedione. Make sure to ask your RE what your levels are, and what is considered the "normal range".Additional Tests And Procedures
These may be performed after the initial testing has been done:
Hysterosalpinogram (HSG)
This test is used to examine your uterus and fallopian tubes. It essentially checks to see if there is blockage in your fallopian tubes or any uterine abnormalities. The test is performed by inserting dye into the uterine cavity, through a catheter placed through the cervix. The amount of discomfort varies from woman to woman. Usually, the results of this test can be shared with you immediately.
Hysteroscopy: This test is performed by inserting a thin telescope, equipped with a fiber optic light, through the cervix, and into the uterus. This enables the doctor to see if there are abnormalities that could not be detected through an ultrasound.
Laporoscopy
Also performed with a fiber optic telescope, this procedure is done through a small abdominal incision (or through the navel). The benefit of this procedure is the ability for the RE to correct any problems he finds immediately.
Endometrial Biopsy
In this procedure, the doctor snips a small amount of tissue from you endometrium (uterine lining). This procedure is usually performed during the first half of a cycle, to ensure a pregnancy has not occurred. This test is able to detect things such as hormonal imbalances, endometrial thickness, and the presence of cancerous cells.
After all of these tests are complete, you will have another consultation with your RE to discuss the results, and determine a course of treatment.
Taking the step to seek help from a specialist can be one of the hardest steps you can make when trying to conceive. Many women feel it is an admission of failure. But it is not a failure--it is a woman taking action, and becoming integral in discovering any problems or issues facing her fertility. Once you see a specialist, it is often just a matter of having one test after another, and making time for the appointments. The rest is left up to the RE. In the end, most of us are happy to finally better understand what is going on with our bodies, instead of guessing cycle after cycle. 
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