We are excited to have Dr. Campbell, Reproductive Endocrinologist and Infertility Specialist, outline what to expect to encounter on your first visit to UAB Medicine REI.
Welcome to UAB Medicine Reproductive Endocrinology and Infertility! We are excited to work with you towards completing your family building and other goals.
As part of your initial visit to UAB Medicine Reproductive Endocrinology and Infertility, REI, you will be welcomed to our clinic and meet a variety of our team members. First off, and most importantly, please know that we are all here for you, our number one goal is for you to feel comfortable and secure in your provider and your plan of care going forward; and, we strive to ensure every patient feels heard at their initial visit and beyond.
Our entire team works hard to communicate often and clearly with our patients. We want to make sure all your questions are answered and you feel confident in each step of the process.
What to Expect
During the initial visit, you will sign in at the front desk of the 9th-floor clinics at the Women & Infants Center (WIC) and then come down to the Suite 6 waiting area. Shortly thereafter, you will be taken back to a consult room by a medical assistant (MA) who will begin the initial intake. This process involves basic questions and vital signs. Once the intake is complete, the MA will notify your attending physician that you are in a room and ready to be seen.
Side note from professional: As an attending physician, prior to each day of clinic, I like to sit down and review each patient’s chart—records, labs, imaging, goals of care—and formulate a basic plan based on this data. I review this plan with any residents who may be working with me during clinic in our “huddle.” This way, everyone involved in your care is on the same page regarding your basic plan of care.
The Initial Work-Up
The initial infertility workup is one of our most common visit types and involves a few steps. The basic history portion will include a discussion of menstrual history—age
of initial menses, how often menses occur, any prior contraception use, last menstrual period, and medical and surgical history. It’s particularly important to review abdominal/gynecologic surgeries and fertility goals.
We’ll discuss if you have been trying to conceive (TTC), any ovulation tracking that you have done (basal body temperature screening, ovulation predictor kit (OPK) testing, app tracking), prior fertility therapies you have tried and the result of these therapies, and any medications you are taking.
Further, if you have a male partner we will review his overall medical history as well, including any medications he is taking, prior surgeries, history of genital trauma, prior paternity, and prior semen analysis (sperm testing).
If you are a single female or in a same-sex relationship seeking the use of donor sperm, that is also an option and something we will discuss and review during this initial visit. If you have not had any prior fertility work-up, we will start from scratch.
This may seem like a lot of in-depth questions, and that’s because it is! We are generally able to review them in an efficient, yet thorough, manner before we discuss the next steps.
Diving Deeper
When reviewing the plan with patients, I like to break it down into five main areas we want to investigate.
1. Ovaries / Ovulation
In this category, I think about ovarian reserve testing as well as confirming if you are ovulating spontaneously or not. (Anovulation can be a leading cause of infertility in conditions such as PCOS, for example.)
To assess ovarian reserve testing, we obtain a blood test called the anti-mullerian hormone
(AMH) level. This is a hormone released by the antral (immature) follicles in your
ovaries and measurable in the blood. This test doesn’t predict your ability to get
pregnant, but it does give us an idea of your overall egg count. (Do you have a normal/average number of eggs or are you running out of eggs sooner than we would expect?)
Another way to assess the ovaries is on ultrasound imaging with a transvaginal
ultrasound (TVUS). We will visualize your ovaries and perform an antral follicle count (AFC) to further understand your ovarian reserve. We can also visualize on ultrasound if the ovaries appear to have PCOS or if there is a collection of endometriosis (endometrioma), etc.
This category also includes other hormonal testing, such as thyroid hormone and
prolactin, which if abnormal, can cause issues with ovulation.
2. Uterus
In this category, we will assess the uterine contour and structure by TVUS. We can assess for normal uterine lining thickness, as well as abnormal findings, such as endometrial polyps or fibroids. Both are benign conditions but may be a barrier to conception.
3. Fallopian Tubes
In this category, we will assess your fallopian tubes. The tubes are critical in the fertility process, as they are the site of fertilization where the sperm and egg meet. By doing an x-ray dye test called the hysterosalpingogram (HSG), we will be able to assess the patency of your tubes. This test can be both diagnostic and therapeutic, meaning that at times, by doing the HSG, we are able to flush menstrual debris out of the fallopian tubes. This may allow for a boost in fertility in the subsequent months.
You will have your HSG after menses and before ovulation (cycle day 6-12 usually).
You will let us know with cycle day 1 and we will get you set up for your TVUS (in the
WIC, in our clinic, it takes about 10-15 minutes) and the HSG (done at The Kirklin Clinic
of UAB Hospital in radiology). The HSG is done by me or one of my partners (for the pelvic exam portion), and the pictures are taken by a radiologist/radiology technician. You will get results of the HSG on the same day in real time.
In some cases (like if you are going straight to in vitro fertilization (IVF), for example) you will not need to complete the HSG since we would be bypassing your tubes with that therapy.
4. Sperm
We will be assessing a sperm source, either a partner or donor sperm (known donor or anonymous donor through a sperm donor bank). If you have a male partner, we will obtain a semen analysis to further understand sperm counts (concentration, total count), motility (how well the sperm are swimming), and morphology (the shape of sperm). Morphology is important as it predicts the sperm’s ability to fertilize the egg.
5. Preconception
In this category, I include preconception labs (blood type and blood counts, immunity to certain things such as varicella, and genetic screening). As part of the genetic screening, we offer carrier screening to be performed to test for a multitude of genetic conditions that could be passed down to your offspring.
Finally, we will, at times, obtain additional labs or imaging depending on your particular case and concerns. For example, if we suspect fibroids, you’d potentially need an MRI to further visualize the size and location. If male factor infertility, then we’d potentially give a urology referral for further work-up with our male factor urology specialist.
The End of the Visit is the Beginning
At the end of the visit, we will summarize your specific case, the plan, and which portions of the above five categories of testing we will be working on, along with the timing and type of your follow-up. We will answer any questions you may have and also talk about next steps in fertility goals. We will finalize and solidify these plans once we have all the results of the above testing at the results review visit.
We strive to make sure your voice is heard and make sure we are pursuing the plan and timeline that you are most comfortable with at all times. Your timeline is our timeline, and at times, we can start up treatment with your very next menstrual cycle, if you desire!
Last, but not least, we are fully aware of and understand that the fertility journey is much more than just a physical journey. The mental aspect of infertility can be daunting, and we definitely want to support you in that way as well, whether it be through local support groups, referral to a fertility counselor, or just by listening and acknowledging what you are going through. We are more than happy to help meet those needs as well.
I hope that this summary allows you to get a good glimpse into the initial visit at UAB Medicine REI and helps you feel confident and comfortable to take that first step to make an appointment whenever needed.
Dr. Sukhkamal Campbell from UAB Medicine REI is our guest blogger for this post.
We are thankful to work with UAB Medicine on our Lullaby Wishes series. Their position as a major center for research leads them to constantly investigate new advances in fertility treatment, but their team’s heart for the men and women affected by infertility is what truly sets them apart. 
