Your Preconception Workup: What the Reproductive Endocrinologist Should Know
If you've been trying to get pregnant on your own without success, you might consider scheduling a thorough preconception exam. Whether you see your regular OB/GYN or a reproductive endocrinologist (also called a fertility specialist) this preconception exam will let the doctor evaluate your overall health, pinpoint potential or even serious problems, and provide necessary treatment before you get pregnant.
What is a preconception exam?
During the exam, your OB/GYN or reproductive endocrinologist will look for clues that may be keeping you from getting pregnant, including uterine malformations, autoimmune diseases, genital infections, or endocrine abnormalities. Finding these problems early will allow for treatment when it’s most effective.
Your OB/GYN or reproductive endocrinologist will obtain a detailed medical history, including any information on symptoms, how you feel, your activity level and diet, your home and work environment, and family history, and then do a thorough physical examination.
Basic tests with the preconception exam
Depending on your age and health history, your OB/GYN or reproductive endocrinologist may include any or all of the following tests:
- blood pressure
- complete blood count (CBC)
- blood chemistries including lipid profile and blood glucose
- urine testing
- pelvic exam with PAP smear
- colon cancer screening (if family history indicates)
- chest x-ray (if a non-pregnant smoker)
- breast exam and baseline mammogram at age 35 to 39 (or earlier if family history of breast cancer)
- bone density test to check for osteoporosis (in selected individuals)
*If you are over age 35, a baseline electrocardiogram, a rectal exam, and colon cancer screening may be done
Controlling risk factors for diseases
Your doctor will also review your personal risk factors for coronary heart disease, cancer, diabetes, and osteoporosis and discuss treatment options or how to control any of these risk factors.
Hearing, eye, or dental examinations, a skin test for tuberculosis, and other tests may be planned before you get pregnant.
Questions your doctor may ask
- When did you start menstruating (menarche)?
- Are your periods regular?
- Can you describe the frequency, regularity, duration, and amount of flow of your menstrual period?
- What are the dates of the last two menstrual periods?
- Do you have bleeding or spotting between periods?
- Do you have pain during periods, during intercourse, or under other circumstances?
- Have you had any gynecologic infections, injuries, or pregnancies?
- Have you been diagnosed with any reproductive disorder?
- Have you had surgery for any problem of the reproductive system?
- Have you ever had an abnormal Pap smear?
- Have you ever had breast problems--pain, redness, discharge from the nipples, growths, or specific areas of tenderness?
- Do you have PMS? What are your symptoms?
- Have you ever been diagnosed with a fibroid tumor
- Have you had pain and mucus changes at mid-cycle?
- What type of birth control have you used?
- Is there a family history of infertility, hormonal problems, long spacing between children, or female cancer?
When should I see a reproductive endocrinologist?
If you are not already seeing a fertility specialist, depending on the results of your preconception exam, your OB/GYN may refer you to one.
A reproductive endocrinologist has at least 10 years of education and specialized training after college.
Especially if you are 35 or older and are struggling with infertility, it is time to see a specialist. Couples that are not referred to one in time, face reduced chances of getting pregnant.
When you visit the reproductive endocrinologist
If your doctor refers you to a reproductive endocrinologist, be sure to have your medical records and test results from the preconception exam transferred to avoid unnecessary repeat testing. Knowing that you’re finally in the care of a fertility specialist can help ease your worries about getting pregnant and having a baby.
Sources: American Fertility Association “Worked up over the infertility workup?”CDC “2006 Assisted Reproductive Technology (ART) Report: Commonly Asked Questions.”Resolve “What is an infertility specialist?” “When to See a Specialist for Infertility.”Society for Reproductive Endocrinology and Infertility “SREI brochure” “Role of the OB-GYN And Reproductive Endocrinologist in Evaluating Fertility.”