Your Preconception Workup: What the Reproductive Endocrinologist Should Know

Your Preconception Workup: What the Reproductive Endocrinologist Should Know Your Preconception Workup: What the Reproductive Endocrinologist Should Know

When trying to get pregnant, it is wise to see a fertility specialist (either an OB/GYN or reproductive endocrinologist) for a preconception exam.

This preconception exam will let the doctor evaluate your overall health, pinpoint any potential problems, and provide advice on fertility treatments (if needed) to help you get pregnant.  

What is a preconception exam?
During a preconception exam, your doctor 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 (RE) 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 pre-pregnancy exams
Depending on your age and health history, your OB/GYN or RE may recommend some 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 scheduling your preconception exam, be prepared for your doctor to ask you questions about your health. Also, you should be prepared to ask your doctor questions of your own

  • 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?

Should I see a reproductive endocrinologist?
The rule of thumb in the fertility world is to see an RE if you are under 35 and have been trying to get pregnant without success for 12 months or more. Women over 35 should seek help from an RE after 6 months of trying to conceive. 

As we age, we face reduced chances of getting pregnant. Seek help from a specialist before it's too late. 

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.

Find a local fertility specialist

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.