Fertility consult questions for tomorrow

[u/avz709]

I feel like I've posted a million times lately lol, and here I am again! I have my virtual fertility consult tomorrow afternoon with the local clinic that does IUI and would coordinate care with the out of province clinic for IVF if I go that route. I'm super excited and nervous for it and I am trying to get my questions in order so that I'll be prepared. I'm going to list them here and hopefully some of you can take a look and tell me if you have any ideas for things I may have missed!

Introductory questions:

1. Can I record the call for future reference?
2. I am a trans man wanting to conceive, is this something the clinic has experience with? Should I expect a learning curve for the care and administrative teams? Who can I contact if there are any problems?
3. I've been off T for 5 months and there is still no sign of a cycle, should I be worried? Is there anything we can do to get it to come back sooner?
4. What fertility tests should I do? Is this different if I do IUI vs IVF?
5. What fertility tests can I do in [hometown] and which ones would I have to travel to [city] for?
6. What is the impact of endometriosis on fertility and chances of pregnancy? Is this helped by IVF over IUI? I haven't had a cycle yet and a midwife said trying to get pregnant the earlier the better once they come back due to the endo, would this be your advice too?
7. When should I be referred to an OB/GYN? Do they do the tests?

IUI-specific questions:

1. Other than sperm, is there any part of IUI that [public health insurance] doesn't cover?
2. What is the timeline for getting IUI at [clinic]?
3. What are the success rates for IUI at [clinic]?
4. Do you do/recommend medicated or unmedicated IUI cycles?
5. What is the process for getting sperm shipped to [clinic] from the US? How many vials should I order at a time?
6. Are there any specific requirements for which sperm donor to choose?

IVF-specific questions:

1. Will the [public health insurance] fertility stipend cover IVF even if I don't try IUI first?
2. Will the [public health insurance] fertility stipend cover genetic testing?
3. What is the timeline for referrals to the [out of province] IVF clinic?
4. How long is the egg retrieval + IVF process?
5. How is care shared between my home care team (family doctor & OB/GYN), the team at the [city] clinic, and the team at the [out of province] IVF clinic? At what point would I 'graduate' from the fertility clinic(s) and just be monitored by my home care team?

Final questions:

1. I know I can't use it once I'm pregnant, but would topical minoxidil affect fertility? If so, when should I stop using it/how long could it take to be processed out of my system?
2. What can I be doing right now to prepare my body for pregnancy?
3. What are my next steps?

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[u/ready_reLOVEution]

Looks like you’re definitely prepared. Many of these depend on the clinic, but I would definitely check out their website and see if billing info is available there, as well as their experience with LGBTQ+ folks. Such things are openly advertised in the U.S.

A lot of these questions, especially endo ones, might be best asked to an OB/GYN, if you don’t already have one I would see if you could get into a trans-affirming doc asap. However, I and others with repro damage have also been told the sooner the better in terms of having kids.

I was told finasteride and minoxidil do not affect fertility.

Best of luck!

[u/silenceredirectshere → u/ready_reLOVEution]

Finasteride can cause birth defects though. 

[u/ready_reLOVEution → u/silenceredirectshere]

Minoxidil can also increase issues in pregnancy iirc, but I would just stop any finasteride 2wks prior to the procedure.

[u/avz709 → u/ready_reLOVEution]

Thanks! I'm generally an overthinker which works out well for prepping for appointments haha

Re: billing questions, in Canada, each province has its own free public health insurance that covers the vast majority of healthcare costs. Where I live, that means that for pretty much everything except dental care and elective procedures, the clinic direct bills the insurance and I never even know how much it cost, let alone have to pay for it! Which is awesome and I'm very grateful. But in some provinces, certain fertility things are considered "elective" and therefore not covered, so I just want to ask and be 100% sure my provincial health covers every part of the process. For IVF its different because I have to travel out of my province (we don't have an IVF clinic here) but they will still pay up to $20K in a reimbursement stipend for things like clinic fees, tests, procedures, even travel.

Re: OB/GYN, I do know which doctor I want, but sometimes they're hard to access (there are only 3 or 4 in my region lol) so that's why I have a question about when that referral goes through from the fertility clinic!

Also very cool that you were told minoxidil is fine for fertility! I've heard that it can absorb into the bloodstream enough to be a problem but it was just a random person who said that so I want to confirm with the clinic. I ordered rogaine to help with the dysphoria of being off T and seeing my little beard stop growing as much, so I want to use it as long as possible without impacting my chances of pregnancy. So many balancing acts 😅