Tips for Talking to Patients About Fertility

Jennifer L.W. Fink, BSN

Disclosures

September 12, 2016

Carefully Consider Fertility Tests

Tests of ovarian reserve, including blood tests to check follicle-stimulating hormone (FSH), estradiol, and anti-Müllerian hormone (AMH), as well as ovarian ultrasound imaging, can give a patient an idea of her fertility outlook right now, but they "can't predict what the future holds for that person," says Beth Rackow, MD, a reproductive endocrinologist at Columbia University Medical Center. That's why the American College of Obstetricians and Gynecologists (ACOG) only recommends ovarian reserve testing for women who are over 35 and have not been able to conceive after 6 months of trying, or for women who are at increased risk for diminished ovarian reserve.[3]

If a woman or couple has specific concerns and risk factors for infertility, ob/gyns may want to consider measuring the female's progesterone level in the second half of the menstrual cycle to check ovulation, Dr Rebar says. If there are concerns about the patency of the Fallopian tubes, a hysterosalpingogram and sonohysterogram can be helpful. Obtaining a sperm count from the male partner allows sperm count and motility to be checked. Patients with abnormal test results should be referred to fertility specialists.

Discuss Lifestyle Factors

Discussing modifiable risk factors with women throughout their reproductive years gives them a sense of control and may enhance their fertility.

"One of the most common causes of infertility is smoking," says Diana Ramos, MD, MPH, co-chair of the National Preconception Health and Health Care Initiative. "Women need to know that if they decrease smoking, then potentially their fertility could be improved." Similarly, "We know that if a woman is obese and loses weight, her fertility will go up," she says.

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