In an infertility consultation, questions are not simple formalities. They are the first tool through which I try to understand whether we are dealing with an ovulation problem, a male factor, a uterine condition, a tubal cause, age, a relevant medical history or several overlapping elements.
I frequently explain to patients and couples that there is no question “too small” when we talk about fertility. Sometimes, an apparently secondary detail, such as a cycle that has become shorter, ignored menstrual pain, an old infection, surgery or a test performed a year earlier, can guide the evaluation in a much clearer direction. This is why, before recommending new investigations, I try to understand what has already happened and what information is missing.
In many cases, the infertility consultation comes after months or years of trying, after tests performed in fragments or after recommendations received from several sources. Precisely for this reason, the first step is to place the case in medical order. Depending on duration, age and history, I may recommend a basic evaluation or complete the investigations that already exist. I have explained this pathway in more detail in the article about the first tests I look for in fertility evaluation.
Why the consultation begins with questions, not directly with treatments
In my practice, the infertility consultation does not begin with the idea that treatment must be started immediately. It begins with clarification: what is the real problem, how long has it existed and what do we already know about it? Without this stage, there is a risk of repeating unnecessary tests, rushing decisions or, on the contrary, losing important time.
Questions help me separate situations in which it is reasonable to continue monitoring from those in which evaluation should be accelerated. A 29-year-old woman, with regular cycles and no significant medical history, is not in the same situation as a 38-year-old woman with irregular periods or previous pelvic surgery. Both may come to an infertility consultation, but the medical plan should not be identical.
Questions also help in understanding the couple, not only the patient. Infertility is not a problem that should automatically be placed on the woman. This is why the partner’s history also matters in the evaluation, along with any semen analyses, infections, treatments, interventions or exposures that may influence male fertility.
Questions about time, age and attempts so far
One of the first questions is: how long have you been trying to conceive? The answer changes the context significantly. If the attempts have lasted a few months, the approach may be different from a situation in which 12 months, 18 months or more have passed. After the age of 35, time becomes an even more important factor, and evaluation should not be delayed unnecessarily.
During the infertility consultation, I also ask how regular the attempts have been. Sometimes, the couple feels they have been trying for a year, but intercourse was not correlated with the fertile window or there were long breaks for personal, professional or medical reasons. Other times, the attempts were regular, but there has never been a pregnancy, not even a biochemical one. These differences matter.
I also look at whether there have been previous pregnancies, pregnancy losses, ectopic pregnancies or pregnancy terminations. I do not ask these things to invade the patient’s privacy, but because they may offer information about the fallopian tubes, uterus, ovulation, implantation or early pregnancy development.
When the duration of trying already raises the suspicion of a fertility problem, I also discuss the moment when it is appropriate not to wait passively anymore. For this decision area, I have explained separately when delayed pregnancy justifies medical evaluation.
What menstrual cycles, ovulation and overlooked symptoms can tell me
The menstrual cycle is one of the most important sources of information in the infertility consultation. I ask whether periods are regular, how many days apart they occur, how long they last, whether they are very painful, very heavy or whether they have changed in recent years.
A regular cycle may suggest ovulation, but it does not guarantee on its own that everything is normal. A very long cycle may raise the suspicion of ovulation disorders, including in the context of polycystic ovaries. A cycle that becomes shorter may be relevant for ovarian reserve, especially at certain ages. Significant menstrual pain may guide the discussion toward endometriosis, especially if it is accompanied by pain during intercourse, chronic pelvic pain or cyclic digestive symptoms.
Symptoms that seem minor, but can change the direction of the evaluation
I frequently tell patients that symptoms ignored for years deserve to be discussed. Not every symptom automatically means a cause of infertility, but some signs may justify additional investigations.
During the infertility consultation, I ask about repeated genital infections, changes in vaginal discharge, pelvic pain, procedures involving the cervix or uterus, curettage, complicated appendicitis, abdominal surgeries, thyroid disease, weight changes, severe acne or excessive hair growth. These details may seem unrelated, but fertility is influenced by several systems, not only by the ovaries.
I am not looking for one quick answer. I try to see whether there is a pattern. Very often, the case becomes clearer not through one isolated test, but through the way the history, symptoms and results fit together.
“You deserve to be heard, seen, treated with respect and supported throughout your life.”
Tests, previous treatments and documents that matter
An important moment in the infertility consultation is reviewing the tests that have already been performed. I recommend that patients bring hormonal results, ultrasounds, semen analyses, infection tests, fallopian tube investigations, surgical reports, histopathology results, stimulation protocols or documents from previous treatments.
Not all older tests are still useful, but many can help avoid unnecessary repetitions. For example, an abnormal semen analysis must be interpreted in context and, sometimes, repeated correctly. An AMH value must be correlated with age and ultrasound, not viewed on its own. An older ultrasound may show the presence of a fibroid, an ovarian cyst or a suspicion that deserves to be checked.
I also ask which treatments have been tried: ovulation monitoring, ovulation induction, intrauterine insemination, surgery, hormonal treatments or In Vitro Fertilization procedures. In the case of previous procedures, I am interested not only in whether they succeeded or not, but in how the body responded: how many follicles developed, how many oocytes were retrieved, how fertilization occurred, how the embryos evolved and whether there was an embryo transfer.
These details are essential when discussing the next step. Sometimes, IVF is a logical direction, while in other cases the evaluation needs to be completed before moving forward. This is why I approach carefully the moment when I explain in which situations IVF may become an appropriate medical option.
How the answers become a realistic medical plan
The purpose of the consultation is not to place a quick label, but to build a plan. After gathering the important information, I try to establish what we know for certain, what we assume and what needs to be checked. This difference is important, because fertility medicine should not be based on assumptions when there are reasonable ways to clarify the situation.
During the infertility consultation, the plan may include hormonal tests, transvaginal ultrasound, ovulation evaluation, semen analysis, infection tests, fallopian tube assessment, uterine investigations or lifestyle recommendations. In other cases, if the investigations are already complete, the discussion moves toward treatment options: monitoring, ovarian stimulation, insemination, In Vitro Fertilization or other solutions adapted to the case.
I consider it important for each couple to understand why I recommend a certain step. It is not enough to say “we will do more tests” or “we will start treatment”. There must be a medical logic: what we want to find out, what result would change the decision and how much time is reasonable to allocate to each stage.
In some situations, the decision is not whether IVF is possible, but whether it is the right time for it. I have explained this difference in the article about when it is worth starting IVF and when it may be better to wait a little longer.
Frequently Asked Questions
What should I bring to the infertility consultation?
I recommend bringing all relevant tests and documents: hormonal results, ultrasounds, semen analyses, fallopian tube investigations, medical reports, previous treatments and information about menstrual cycles. Even if some results are older, they can help understand how the case has evolved.
Is it necessary for both partners to come to the first consultation?
In many cases, yes, it is useful. Infertility may involve female, male, mixed or unexplained factors. The presence of both partners helps create a complete discussion about history, tests, lifestyle and the next steps.
If I have regular cycles, can I still have fertility problems?
Yes, it is possible. Regular cycles may suggest ovulation, but they do not exclude issues related to the fallopian tubes, semen analysis, endometrium, endometriosis, age or other causes. This is why the infertility consultation looks at the case as a whole, not only at menstruation.
Are the same tests recommended to all patients?
No. There is a basic evaluation that is frequently recommended, but investigations must be adapted according to age, duration, symptoms, medical history and previous results. A good plan avoids both insufficient investigations and unnecessary tests.
Does the consultation automatically mean that we will start IVF?
No. An infertility consultation does not automatically mean In Vitro Fertilization. Sometimes, additional investigations are necessary. At other times, simpler options may exist, and in certain cases IVF becomes the most appropriate direction. The decision depends on medical data, not on a general rule.
How quickly can a plan be established after the first consultation?
Sometimes, the plan can be outlined during the first meeting, especially if there are recent and complete test results. At other times, a few investigations are necessary before a clear recommendation can be made. I prefer a well-founded plan, not a rushed decision.
The role of Dr. Andreas Vythoulkas in the infertility consultation
My role in the infertility consultation is to ask the right questions, interpret the answers in context and turn the information into a coherent medical plan. I do not look at infertility as an isolated diagnosis, but as a situation that must be analyzed through the duration of trying, age, ovulation, semen analysis, uterus, fallopian tubes, medical history and previous treatments.
From my clinical experience, patients need clarity, not pressure. This is why I explain what we know, what we do not yet know and why certain investigations or treatments make sense in one case, but not necessarily in another. A good consultation is not limited to standard recommendations, but helps the couple realistically understand where they are and what comes next.
In my practice, I aim for each decision to be proportional to the medical situation: not delayed unnecessarily, but not rushed without justification either. When treatment is needed, I discuss it in stages, with limits, benefits and alternatives. When investigations are needed, I explain what each of them may clarify. This approach makes the infertility consultation not only a first medical meeting, but the starting point of a correct plan.
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Sources
- World Health Organization — Infertility Fact Sheet
- American Society for Reproductive Medicine — Fertility Evaluation of Infertile Women
- NICE — Fertility Problems: Assessment and Treatment
- European Society of Human Reproduction and Embryology — Unexplained Infertility Guideline
- CDC — Infertility Frequently Asked Questions
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