Fertility First Visit

Your ObGyn Can Help With This

Many patients are told their regular ObGyn "doesn't do fertility." That is often simply not true. Your ObGyn is trained to evaluate fertility concerns, order the right tests, and guide you on next steps — before any specialist is needed.

Why patients get turned away: Insurance billing codes for "infertility" can trigger refusals or prior authorization requirements. This tool helps you understand what questions to ask and what workup to request — framed as routine gynecologic evaluation.

Answer these questions — the same ones a good ObGyn would ask at your first visit

Get a personalized summary — what your ObGyn should assess and what tests to request

Print or save your plan — bring it to any appointment as a clinical conversation guide

Question 1 of 9

How old are you?

Age is one of the most important factors in fertility planning — it shapes the timeline for evaluation.

Under 30

30 – 34

35 – 37

38 – 39

40 – 42

43 or older

Question 2 of 9

Where are you in your fertility journey?

Choose the option that best describes your situation right now.

Not trying to get pregnant soon

Planning to start trying in 1–2 years

Trying to get pregnant — less than 6 months

Trying to get pregnant — 7 to 12 months

Trying to get pregnant — over 12 months

Question 3 of 9

Have you ever been pregnant?

This helps determine whether this is primary or secondary infertility, and whether a pregnancy loss evaluation is needed.

No — never been pregnant

Yes — one or more live births

I have carried a pregnancy to delivery before

Yes — one or more pregnancy losses

Miscarriage, ectopic, stillbirth, or termination

Yes — both live births and losses

Question 4 of 9

How would you describe your menstrual cycles?

Regular ovulation is essential for conception. Cycle patterns give important clues.

Regular — predictable every 24–38 days

Comes within a few days of the expected date each month

Somewhat irregular — varies by more than a week

Sometimes on time, sometimes early or late

Consistently irregular or unpredictable

Hard to predict, often more than 5–7 weeks apart

Absent — no periods, or very rare

Fewer than 6 periods per year

Not sure / on hormonal contraception

Question 5 of 9

What is your partner situation?

Fertility involves both partners. Up to 40–50% of fertility challenges involve a male factor — easy to check with one test.

I have a male partner

Semen analysis is an essential part of the evaluation

I have a female partner

Using donor sperm or planning to — focus is on your cycle and uterine health

Single, using donor sperm

No partner / not applicable right now

Question 6 of 9

Has your partner had a semen analysis?

A semen analysis is the single most important male fertility test. Every major guideline — AUA/ASRM, NICE, WHO — recommends it as a first step. Male factor is involved in 40–50% of all fertility challenges. If there is no male partner, select "Not applicable."

No — not done yet

This is the most common gap. Your ObGyn can order it directly.

Yes — results were normal, within the last year

All parameters within WHO 2021 reference values

Yes — results were normal, but over a year ago

Semen parameters can change — a repeat test may be warranted

Yes — low sperm count (oligozoospermia)

Concentration below 16 million/mL or total below 39 million per ejaculate (WHO 2021)

Yes — poor sperm movement (asthenozoospermia)

Progressive motility below 30%, or total motility below 40% (WHO 2021)

Yes — abnormal sperm shape (teratozoospermia)

Normal forms below 4% — Kruger strict criteria (WHO 2021)

Yes — no sperm found at all (azoospermia)

Zero sperm in the ejaculate — requires urgent specialist evaluation

Yes — abnormal, but I don't know the specific values

Not applicable — no male partner

Question 7 of 9

Have you had any tests done?

Select everything that has already been done — even if results were normal. This helps identify what still needs to happen at your next visit.

Select all that apply — or "None yet"

Basic blood work

AMH, FSH, LH, estradiol, TSH, prolactin, or similar hormone/ovarian reserve tests

Pelvic or transvaginal ultrasound

Including antral follicle count or uterine anatomy review

HSG (hysterosalpingogram) — tubal X-ray

Checks whether fallopian tubes are open

Ovulation testing

OPK strips, midluteal progesterone draw, or basal body temperature charting

Laparoscopy or hysteroscopy

Surgical evaluation for endometriosis, fibroids, or structural issues

IUI (intrauterine insemination) — one or more cycles

IVF (in vitro fertilization) — one or more cycles

None yet — no testing done

Question 9 of 11

Are you experiencing any of these symptoms?

These can signal perimenopause, premature ovarian insufficiency (POI), or other hormonal changes — all of which your ObGyn needs to know about. Select all that apply.

Select all that apply — or "None of these"

Hot flashes or sudden heat sensations

Waves of warmth, flushing, sometimes sweating — day or night

Night sweats or disrupted sleep

Waking drenched, or sleep that is consistently poor or unrefreshing

Cycles becoming shorter, longer, or skipped entirely

A change from your usual pattern — especially cycles suddenly shorter than 25 days or skipped months

Vaginal dryness or pain with intercourse

Genitourinary symptoms can be an early sign of estrogen decline

Mood changes, anxiety, low mood, or irritability

New or worsening — not explained by life events alone

Brain fog, memory lapses, or difficulty concentrating

Noticeably decreased sex drive

Family history of early menopause (before age 45)

Mother, sister, or maternal aunt with premature or early menopause

None of these apply to me

This tool provides general clinical education and is not a substitute for evaluation by a licensed clinician. No personal data is collected or stored. Bring this summary to your appointment — your clinician makes all final recommendations.

Clinical Definitions & Guidelines

Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2020;113(3):533–535.

Source for clinical definition of infertility: 12 months for women <35, 6 months for women ≥35.

ACOG Committee on Gynecologic Practice and Practice Committee. Female Age-Related Fertility Decline. Committee Opinion No. 589. Obstet Gynecol. 2014;123(3):719–721. Reaffirmed 2022.

Source for age-related recommendations and earlier evaluation for women ≥35, ≥40.

Thoma ME, McLain AC, Louis JF, et al. Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertil Steril. 2013;99(5):1324–1331.e1.

US infertility prevalence data used to contextualize how common these concerns are.

Sharlip ID, Jarow JP, Belker AM, et al. Best practice policies for male infertility. Fertil Steril. 2002;77(5):873–882.

Male factor accounts for 40–50% of fertility challenges — basis for recommending semen analysis as a first-line test.

Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015;103(6):e44–e50.

Source for recommended initial diagnostic workup in the ObGyn office setting.

Mumford SL, Steiner AZ, Pollack AZ, et al. The utility of menstrual cycle length as an indicator of cumulative hormonal exposure. J Clin Endocrinol Metab. 2012;97(10):E1871–E1879.

Basis for using cycle regularity as a clinical proxy for ovulatory function.

Practice Committee of ASRM; Practice Committee of SART. Mature oocyte cryopreservation: a guideline. Fertil Steril. 2013;99(1):37–43.

Basis for fertility preservation counseling recommendations included in this tool.

ESHRE Guideline Group on POI; Webber L, Davies M, Anderson R, et al. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum Reprod. 2016;31(5):926–937.

Diagnostic criteria for POI: FSH >25 IU/L on two occasions ≥4 weeks apart, before age 40. Basis for POI evaluation pathway in this tool.

Harlow SD, Gass M, Hall JE, et al; STRAW+10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159–1168.

STRAW+10 staging system for the menopausal transition — framework used for perimenopause classification in this tool.

Nelson LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med. 2009;360(6):606–614.

Prevalence (~1% under 40, ~0.1% under 30), spontaneous conception rate (5–10%), and long-term health implications of POI including bone and cardiovascular risk.

Brannigan RE, Hermanson L, Kaczmarek J, Kim SK, Kirkby E, Tanrikut C. Updates to male infertility: AUA/ASRM guideline (2024). J Urol. 2024;212(6):789–799. doi:10.1097/JU.0000000000004180

Strong Recommendation (Grade B): one or more semen analyses required during initial male fertility evaluation. Revised thresholds for karyotype testing, indications for pelvic MRI, and guidance on testicular sperm in non-azoospermic males.

World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen. 6th ed. Geneva: WHO; 2021.

Current global standard for semen analysis interpretation. Lower reference limits used in this tool: volume ≥1.4 mL, concentration ≥16 million/mL, total sperm ≥39 million, progressive motility ≥30%, total motility ≥40%, normal morphology ≥4%, vitality ≥54%.

National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment. Clinical guideline CG156. London: NICE; 2013 (updated 2017).

Recommends semen analysis interpreted against WHO reference values. If first result is abnormal, repeat confirmatory test 3 months later to allow completion of spermatogenesis cycle. Earlier referral for women ≥36 years or known predisposing factors.

This tool was developed to address a documented access gap: patients with fertility concerns are frequently denied ObGyn appointments due to insurance coding issues, despite guidelines recommending that the initial fertility evaluation take place in a gynecologist's office. The tool walks patients through the clinical questions their ObGyn should ask, generates a personalized summary of appropriate initial tests, and identifies the minority of cases where direct specialist referral is appropriate. No patient data is collected, stored, or transmitted.