The New Patient Consult: What to expect?
Welcome to another episode of Dr Sueldo's YouTube channel. I am very happy that you are here. As I mentioned in my intro, I am passionate about empowering women through education about their fertility and that is the reason why I decided to be on this space. That is the reason why every week you will be getting about a ten-minute video from me on something related to fertility and women's health. So episode one was the introduction where I just told you a little bit about my journey and how I got to where I am.
Today: Episode Two. We're going to start talking about the new patient consultation.
I think it's really important for patients to understand that the new patient consultation is not a big, scary thing. I think people worry that they're going to have to go straight to IVF, that the doctor is not really going to understand them, that if they have to see a fertility specialist that somehow they're at the end of the road and that just couldn't be further from the truth. I think it's important to understand when you want to see a fertility specialist and what to expect for that consultation, so that's what we're going to be talking about today.
Important things: When to see a fertility specialist? If you read the textbooks, there are two definitions, and that's based on timing. So if you're a woman under the age of 35, we typically recommend unprotected intercourse for over a year. If you've been timing intercourse for over a year, then it's time to see somebody. If you're a woman over the age of 35, then we cut that time frame down to six months. So timing is typically the one that most people are familiar with. However, it's important to understand that there are several other reasons why you may see a fertility specialist sooner than 6 months or 12 months, so one of those is if you have irregular periods. If patients go 3 to 4 months without a cycle, we know that they're not ovulating regularly. So the next step is to figure out why, and that's where seeing a fertility specialist could come in handy. The next one is if you have known underlying medical conditions that could impact your fertility. For example, if you have extremely painful periods, extremely painful intercourse, a known history of endometriosis, if you have a prior history of severe pelvic infection and you're concerned that your fallopian tubes might be impacted. If you have a history of fibroids and you think those might be impacting your fertility. If you have a male partner and he has some sort of risk or exposure such as prior testicular cancer with treatment. Those are all reasons why you may want to seek out care sooner rather than later.
But to be honest I also include a 5th one and that one is, if you are anxious about your fertility and you want to know more, that is enough of a reason to see a fertility specialist to understand your fertility and to understand what your options are. I think it’s extremely important for every woman and for every couple that I see. So while all of these things are what we look to, as far as, classic recommendations or referral from the OBGYN being anxious about your fertility or wanting to understand your fertility is reason enough to also make a consultation.
As far as what to expect, every clinic is a little bit different in how they proceed with the new patient consultation. The way that generally speaking it is done is you will call the clinic, schedule an appointment. That scheduling time may vary depending on the clinic and your geographic location. It also may depend on whether it's telehealth or in person. Now with COVID. I would say that most clinics are doing the majority of their consults telehealth. There's a lot of convenience that comes from that, patients typically don't have to take time off of work or don't have to drive far to see their provider.
If it is telehealth or if it is in person, what's going to happen prior to the appointment is that you're going to be sent paperwork, including all your demographic information, your age, your address, your insurance, your partners information. You'll also be asked for your insurance information. There are going to be some consent forms: you have to sign consents to be treated by the clinic, consent for releasing information from your OBGYN or other providers to obtain information from them, and other things that we may talk about is any records that we want to get ahead of time. So if you've had a Pap smear recently, if you've had any infectious disease screening recently, if you've had any fertility testing recently and other things may also be important. For example, if you have had a major surgery that has impacted your fallopian tubes or your ovaries, that would definitely be pertinent for that new patient consultation and is definitely something that your provider would want to know. So all of these things we want to try and put those together ahead of time so that the clinic and the team has a chance for the doctor to review those before your appointment.
So once you reach the day of your appointment if it's telehealth, there will be no physical exam. If it is in person, some providers do still do a physical exam, not many, but it's definitely something that you can ask about, so that you know what to expect. Some people will also do a vaginal ultrasound the day of the new patient consultation. Again, another question to ask what to expect the day of your visit.
When you meet with your provider we will be doing a deep dive into your medical history. The goal is to try and extract as much information as possible to try and understand what risk factors you might have for infertility. For example, do you have any medical illnesses that could be pertinent? Things like poorly controlled diabetes, chronic lupus, any number of medical diseases could potentially impact fertility. We also ask about surgical history as I mentioned earlier, are there any surgeries that you've had that could potentially impact your fertility? Family history: Is there anyone in the family with any genetic conditions or any history of infertility in the family? Exposures: such as tobacco, caffeine, alcohol, recreational drugs like marijuana and its friends? We want to try and understand if the patient had any exposures that could potentially impact fertility.
And we're going to do a deep dive into your menstrual history and your pregnancy history. We really want to understand: Is this patient having regular cycles? Is there anything that is not normal about her periods? Are they very painful or is intercourse very painful? These could all be signs or red flags for us that there's something else going on that might be related to the patient's infertility. We'll also ask about your partner, whether male or female, we’ll want to understand what their role is and what potential risk factors they might have. And lastly, we want to talk about testing and treatment that you've done. If you have done none, then the first step is what I call the testing phase, where we will go through and outline all the tests that are recommended to try and assess your fertility.
Typically these will include a semen analysis if you have a male partner, a vaginal ultrasound while on your period. I know people tell me all the time it's very uncomfortable. But when you're on your period is when you’re at baseline, everything is at rest, your pelvis is at rest, the ovaries should be quiet, the uterus should be quiet, so it gives us the best assessment of the pelvic structures.
We also talk about blood work for hormone testing. We typically will do an assessment of the Fallopian tubes, and lastly, we'll talk about genetic carrier screening. Now, each individual case may require slightly different testing depending on that particular patient or that particular couple. And we're going to do a whole series of videos on testing, so I don't want you to worry. I don't want you to feel overwhelmed, but just getting a sense of what to expect.
And then in terms of treatment, treatment is a whole chapter in and of itself. But treatment I like to talk about in three forms, so one is lifestyle: Is there anything that needs to be adjusted or optimized there? That's super important. I would say it's just as important as anything else we're doing in the fertility clinic. Number two is supplements, so when we do your history, we're going to review any vitamins, any herbs, any supplements that you're taking, and how those may or may not impact fertility. We also review your medication list, are those medications safe in pregnancy or do they need to be switched before we jump into fertility treatment.
And lastly, will be the actual fertility treatment itself. Broadly speaking, those are divided into oral medications or injectable medications, intercourse or IUI, also known as intrauterine insemination or artificial insemination and IVF, or in vitro fertilization. Don't worry. We're going to go into all of that today is just getting an understanding of the new patient consultation and what to expect. So again, all that prep work ahead of time from the moment you call the clinic, getting any pertinent records to the clinic before your appointment. So they have a chance to review.
The day of the visit you'll meet with the provider they'll talk you through and do a deep review of your history and then they'll talk to you about any testing that may be recommended. Depending on how much testing may already be done, they may start to talk about treatment options. If not, those will be discussed at the follow-up visit.
I hope you've enjoyed this entry about the new patient consultation. Again, my goal is to demystify it. Make sure that patients know that they can ask for help, that they can seek the help of a fertility specialist and they don't have to wait for things to get to dire straits.
*This content is intended solely for educational purposes and is not to be construed as medical advice. For personalized recommendations concerning your specific healthcare needs, kindly consult with your healthcare provider.
