Melanie Cole, MS (Host): The journey to fertility can be stressful, yet so exciting. So, what can you expect when you start the testing and fertility process? We'll find out more with Kelly Curtis, physician assistant at the Reproductive Science Center of New Jersey.

Intro: The Reproductive Science Center of New Jersey combines a commitment to sensitive care with a state-of-the-art program. We proudly present Fertility Talk with RSCNJ. Here's Melanie Cole.

Melanie Cole, MS: Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. Kelly, I'm so glad to have you with us today. I'd like you to start by telling us a little bit about yourself and how you came to work with the amazing Dr. Martinez and Dr. Ziegler at the Reproductive Science Center of New Jersey.

Kelly Curtis: Hi. Thanks for having me. Yeah. So, I am very happy to be with this practice. I've been here for almost two years now. I have always loved women's health and taking care of specifically the OB-GYN patients or the OB patients, I should say. And those trying to conceive has really been a population that I've loved to deal with. So, I joined this practice two years ago. I've been a PA for five years. I was in a surgical specialty prior to this. And ever since I've joined, it's been wonderful. The doctors are just amazing to work with. We're very excited to be part of the team.

Melanie Cole, MS: Well, thank you so much for telling us about yourself, Kelly. Now, tell us about the new patient evaluation. What's that like for couples that want to start the process of fertility?

Kelly Curtis: Yeah. So first and foremost, we bring you in as a couple, however you're wanting to conceive. Most of the time, both partners are present for the new patient evaluation. There's a lot of information that's covered. We answer any questions you may have. We get a past medical history, any sort of fertility treatments you may have had. If you're interested in just understanding the fertility process, this is all included in that first appointment.

Melanie Cole, MS: Well, what can they expect with that first appointment as far as testing? Can you please start with the male test, the specific test that you order? Because that's what's so interesting to me. What are you looking for?

Kelly Curtis: Sure. So, the male fertility patient, we always get a semen analysis. So first and foremost, this can tell us a lot about how things are functioning from the male perspective. This is a sample that is collected by masturbation within a certain timeframe, so the lab can process it to have the most accurate results. We also get an infectious disease blood work panel and a blood type as well, which is useful information to have when your partner may be pregnant. With the infectious disease testing, we just want to make sure there's no active disease going on, and also for our lab's sake and our practice's sake because we are handling the genetic and bodily fluids.

Melanie Cole, MS: That makes so much sense and so comprehensive. And now, what about the female partners? What specific tests do you do? Because I would imagine it's a little bit more, you know, involved than the males.

Kelly Curtis: Absolutely. It is very much more involved. So like the males, we do get just an infectious disease panel for the females. Again, for same reasons, we want to make sure there's no active disease as well as handling and storing of the genetic and bodily fluids and genetic materials.

And then, we also get hormonal panel for the females. So, the hormonal panel includes things such as the FSH and LH and estrogen levels. These are specifically timed with the menstrual cycle, okay? And then, we get what's called an AMH, anti-Müllerian hormone. This essentially tells us the ovarian reserve or the quality of eggs and essentially quantity of eggs that the females have. We couple this with the baseline ultrasound at the new patient appointment to get what's called an antral follicle count. So this, we look at the number of follicles on the ovaries to give us an idea of how your ovarian reserve, your ovarian age and what that is for us to help guide treatment.

And then, other hormones we get are the thyroid hormone. Specifically, we look at the TSH. So, TSH levels that are less than 2.5 have actually been showed to have lower rates of miscarriage. So, this is definitely something that is important for us to manage and keep within a normal range as women are trying to conceive or even during pregnancy. Then, we'll also look at the prolactin level. This is secreted from the pituitary gland in addition to the FSH and LH. So if the prolactin level is high, we do treat it to get them within normal limits. Depending on how elevated the prolactin level is, we can have luteal phase defects, so after ovulation, as well as have an effect on how the other hormones from the pituitary gland are distributed or dispersed.

Melanie Cole, MS: Wow. It's so much to think about. When you're working with these couples, Kelly, tell us a little bit about how they go to these tests and what it's like for them. You mentioned all these tests, but what is it really like for the couples? Do they seem nervous to you? Are they excited? What's it like?

Kelly Curtis: Yeah. So, with the blood work, that is not something that we generally do in our office. We will do some hormonal monitoring blood work, but we'll generally have you go to an outside laboratory, typically whoever your insurance covers. And then, right away, the patients are very excited. It's a lot of information that can be very overwhelming. The females have to wait for their menstrual cycle, so, it's important that they go during that small time period after their menstrual cycle starts.

And then, we also at that point do what's called a uterine evaluation. So, we'll either do an HSG or hysterosalpingogram to look at the uterine cavity and the fallopian tubes to see if there's any things such as a polyp, submucosal fibroids, any scar tissue or adhesions, and to check to see if the tubes are open. Sometimes, depending on your medical history, you can be at a higher risk for having damage of the tubes such as any intraabdominal surgery, any STDs, specifically chlamydia that may cause pelvic inflammatory disease. And then, we will oftentimes do that procedure in our office, not necessarily the HSG, but it's called a FemVue test where we will look at the uterine cavity and the fallopian tubes using saline and an ultrasound probe to capture the images. That is the test that the patients build themselves up for. It is uncomfortable for a few minutes. How this specific procedure is done is we place a catheter through the cervix into the uterus. There's a small balloon to keep the saline inside. Once we distend the uterus with the saline is when we will then use the ultrasound probe, get the pictures that we need, take a look at the uterine cavity, the contour and then we can look to see if the fallopian tubes are patent. And that is all real time, so you will know that same day, you know, if the test is normal or if there's additional imaging or procedures that need to be done.

Melanie Cole, MS: Wow, it's so exciting and so comprehensive. And it's really a time for couples when they're looking to the future, and I think that's what makes it such an exciting time. And your compassion and your passion for what you do and for the doctors you work with just always never ceases to amaze me. So before we wrap up, what would you like to tell prospective couples about fertility evaluations, how to tailor their expectations, but yet to remain hopeful and determined?

Kelly Curtis: Yeah. So this process, I will say, it takes longer, I think, than the expectations the patients have. So, it is based on menstrual cycles. So if we see you, depending at what point in your cycle we do see you, it could be three, potentially four weeks, before you go for blood work and then, an additional two weeks potentially for those results to come back.

And then, as I mentioned earlier, the prolactin levels, thyroid levels, if there's any abnormal testing done, then we generally will repeat the test to kind of see a comparison level to see if there's any intervention that's needed. And these things can take time, which, I guess, my biggest tip to new patients is, you know, stick with us. This is a big workup in the very beginning. But once you're through the initial workup, we can really sit you down, get all the puzzle pieces together and talk about what the potential cause is, why you're having trouble getting pregnant and what we're going to do about it to help you conceive.

Melanie Cole, MS: Kelly, thank you so much for joining us. You're such a lovely person, and I just know that patients really enjoy working with you. And thank you again for telling us about the new patient evaluation.

Kelly Curtis: Thank you so much.

Melanie Cole, MS: For more information, please visit fertilitynj.com to get connected with one of our providers.

That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. Thanks so much for being with us today.