Your First Fertility Appointment: What to Expect and What to Ask

When to Book

Standard guidelines: after 12 months of well-timed intercourse if you’re under 35, or 6 months if you’re 35+. But there are situations where you should go sooner:

• Known PCOS, endometriosis, or other diagnosed conditions
• Very irregular periods (cycles >38 days or <21 days)
• History of pelvic inflammatory disease, STIs, or abdominal surgery
• Known male factor (previous abnormal semen analysis, undescended testicle history, etc.)
• Two or more miscarriages
• You just want answers — there’s no penalty for going early

OB-GYN vs. RE: Where to Start

Your OB-GYN can run initial tests (bloodwork, basic imaging) and refer you to a reproductive endocrinologist (RE) if needed. Going directly to an RE saves time if you’re 35+ or have known risk factors. An RE specializes exclusively in fertility — it’s their entire practice.

To find a board-certified RE near you: check the SART (Society for Assisted Reproductive Technology) directory at sart.org. SART members report clinic success rates, so you can compare local options.

What to Bring

• Cycle tracking data: Any BBT charts, OPK results, or app data from the past 3–6 months. This is incredibly valuable for your provider.
• Medical history: Previous surgeries, STI history, current medications, family history of fertility issues or early menopause.
• Your partner’s info: They should ideally attend. If not, bring their medical history and medication list.
• Insurance card + questions about coverage: Fertility testing coverage varies dramatically. Some plans cover diagnostics but not treatment. See ConceiveGuide’s HSA/FSA guide.
• A list of questions. You will forget them in the moment. Write them down.

What Happens at the Appointment

For Her

• Detailed history: Cycle length, regularity, flow, pain, sexual history, TTC timeline, lifestyle factors.
• Bloodwork (usually day 3 of cycle): FSH, LH, estradiol, AMH, TSH, prolactin, vitamin D. These establish your hormonal baseline and ovarian reserve.
• Ultrasound (transvaginal): Antral follicle count (AFC) — counts visible follicles on each ovary. Combined with AMH, gives a picture of ovarian reserve. Also checks for fibroids, cysts, or structural issues.
• HSG (hysterosalpingogram): Usually scheduled separately. X-ray with contrast dye to check that fallopian tubes are open. Mildly uncomfortable but quick. Some studies show a small fertility boost in the months following an HSG.

For Him

• Semen analysis: The single most important male fertility test. Measures count, motility, morphology, volume. Results in 1–2 days. Requires 2–5 days of abstinence before the sample. Can be done at the clinic or at home with a collection kit.
• If abnormal: Repeat in 4–6 weeks (one test can be anomalous). If still abnormal, referral to a reproductive urologist for further workup.

Questions to Ask Your Doctor

1. “Based on my results, what’s your assessment of our situation?” (Direct. Gets you to the point.)
2. “What are the potential causes and what are the next steps to investigate?”
3. “What are our options, and what does each one cost with and without insurance?”
4. “What’s the typical timeline from diagnosis to treatment?”
5. “Are there any lifestyle changes we should make that could improve our chances?”
6. “What are the success rates for [recommended treatment] at your clinic specifically?” (SART publishes national data; ask for their clinic’s numbers.)