What to expect at your first IVF consultation

A first consultation at a fertility clinic is mostly a conversation, followed by an examination and a list of tests. It rarely ends with a treatment plan, because a plan depends on results that do not exist yet. Knowing that in advance takes much of the pressure off: the aim of the first visit is to be understood, to understand what happens next, and to judge whether this is a clinic you want to keep seeing.

This guide describes what usually happens at a first consultation, what the clinic will want to know, which tests are commonly ordered, and what the ART Act requires a clinic to tell you before treatment. It is a companion to the directory's first consultation checklist, which sets out what to bring and what to ask, and it is written for patients and for the doctors who refer them. It is not clinical advice, and it publishes no success rates and no prices, because this directory holds neither for any clinic. Everything it refers to can be found from the directory home.

When to book one

The ART Act defines infertility as “the inability to conceive after one year of unprotected coitus or other proven medical condition preventing a couple from conception”. The NHS gives the same threshold to patients in the UK: “See your GP if you have not conceived after a year of trying through regular unprotected sex.” Both leave room to go sooner. A known medical condition, a history of cancer treatment, irregular periods, or a concern about either partner's fertility are all reasons not to wait out the year, and the NHS notes that female fertility decreases with age, so an early appointment is better than a late one.

A first consultation does not have to be at the clinic that will eventually carry out treatment. Investigations and IUI can be done at a Level 1 clinic, while IVF needs a Level 2 registration. If you start at a Level 1 clinic, ask which Level 2 laboratory it works with in case you need one later. The guide to clinic levels explains the difference.

Go together if there are two of you

Infertility is investigated on both sides, and a consultation with one partner often has to be repeated with the other. The NHS puts it simply: “It's always best for both partners to visit the GP as fertility problems can affect either or both partners.” The same is true at a fertility clinic. Going together also means both of you hear the same explanation and can ask your own questions.

What the doctor will ask

Most of the first consultation is history. The NHS description of a first fertility assessment is a good outline of what to expect: “The GP will ask you about your medical and sexual history.” That covers how long you have been trying, any previous pregnancies, births or miscarriages, children from previous relationships, the contraception you used and when you stopped it, your periods, any infections in the past, and any operations, particularly on the pelvis.

You will be asked about medicines, and not only prescribed ones. The NHS advises: “You should mention any non-prescription medicine you're taking, including herbal remedies and supplements.” You will also be asked about smoking, alcohol, weight and stress. Some of these questions are personal, and the NHS's advice is direct: “You may feel uncomfortable or embarrassed discussing your sex life with the GP, but it's best to be open and honest.” Answers you hold back now can mean tests repeated later.

It helps to arrive with the facts written down: dates of previous tests and treatments, the names of any drugs used, and results in date order. The checklist lists what to bring.

The examination and the first tests

After the history, the doctor will usually examine you and order tests. Which tests depends on your history, so not everyone has all of these, but the common ones are well established.

For women. Blood tests check hormones; in the NHS's words, “Samples of your blood can be tested for a hormone called progesterone to check whether you're ovulating.” An ultrasound scan looks at the reproductive organs: “An ultrasound scan can be used to check your ovaries, womb (uterus) and fallopian tubes.” If there is reason to think the tubes are blocked, a dye test or an X-ray of the womb and tubes may follow, and some women are referred for keyhole surgery. Of that, the NHS says “Laparoscopy is usually only used if it's likely that you have a problem”. The laparoscopy and hysteroscopy pages explain those procedures.

For men. The basic test is a semen analysis. The NHS describes its purpose: “This is to check for problems with sperm, such as a low sperm count or sperm that are not moving properly.” The semen analysis page explains how the sample is collected and what is measured. A test for chlamydia is commonly done for both partners, because it can affect fertility.

Results take days or weeks, so the treatment conversation usually happens at a second appointment. Ask at the first one when the results will be ready and how you will hear about them.

What the clinic must tell you before treatment

The ART Act puts specific duties on clinics before any treatment starts, and the first consultation is a good time to see how a clinic approaches them. Section 21(c) requires a clinic to “provide professional counselling to commissioning couple and woman about all the implications and chances of success of assisted reproductive technology procedures in the clinic”. It must also “inform the commissioning couple and woman of the advantages, disadvantages and cost of the procedures, their medical side effects, risks including the risk of multiple pregnancy”, and “help the commissioning couple or woman to arrive at an informed decision on such matters that would most likely be the best for the commissioning couple”.

Those duties give you standing to ask direct questions. If a clinic quotes you its results, ask how they were counted, for which age group and over what period. This directory publishes no success rates for any clinic, and the how we rank page explains why. If it quotes you a cost, ask for it itemised and in writing.

The question of multiple pregnancy

One risk deserves its own conversation. The HFEA, the UK regulator, says “The main risk of fertility treatment is a multiple birth.” The ART Act sets an upper limit: “not more than three oocytes or embryos may be placed in the uterus of a woman during the treatment cycle”. That is a legal maximum, not a recommendation. The HFEA's view is that for most women a single embryo transfer is the safer choice: “For most women eSETs are far safer and just as effective as multiple embryo transfers, which is why we recommend them.” Ask the clinic how it decides how many embryos to transfer, and what happens to any embryos that are not transferred. The embryo freezing page explains how spare embryos are stored.

Who may be treated

The Act sets age limits for treatment. Section 21(g) says clinics shall apply assisted reproduction “to a woman above the age of twenty-one years and below the age of fifty years” and “to a man above the age of twenty-one years and below the age of fifty-five years”. If either of you is near one of those limits, raise it at the first consultation, because it affects what can be planned and when.

Consent comes later, in writing

You will not normally be asked to agree to treatment at a first consultation, and you should not feel you have to. Under section 22(1), a clinic shall not perform any treatment or procedure without “the written informed consent of all the parties seeking assisted reproductive technology”. Consent forms come once a plan has been agreed, and you are entitled to read them properly before you sign. As the checklist says, a first consultation is not a contract, and a second opinion is normal practice. The guide to your rights under the ART Act covers consent, confidentiality and complaints in full.

Questions to ask about the next steps

• Which tests do you need, which does your partner need, and why?
• When will the results be ready, and will they be explained at a follow-up appointment?
• Based on what is known so far, which treatments might be considered, and what would decide between them?
• Who will be your treating doctor from here on?
• If IVF may be needed, is the laboratory registered at Level 2, and where is it?
• How does the clinic decide how many embryos to transfer?
• What counselling does the clinic offer before treatment?

Choosing where to go

The clinics index covers every state, and city pages such as Pune, Kolkata and Chennai list the registered clinics in each place. Each clinic page shows the registration number recorded in the National ART & Surrogacy Registry extract, and the fertility doctors index lets you look a doctor up by name. The guide to choosing an IVF clinic sets out the checks to make, and the treatments guide and the treatments index explain what each treatment involves.

For doctors referring a patient

A referral letter that lists previous investigations with their dates, any treatment already tried, and relevant medical history saves the patient repeated tests and a wasted first visit. If one partner has already been investigated, say so, and name the other partner so the clinic can see both together. Where a patient needs IVF, refer to a clinic whose laboratory is registered at Level 2, or to a Level 1 clinic that can name the Level 2 laboratory it uses.

Where this guide comes from

Statements about the law are quoted from the Assisted Reproductive Technology (Regulation) Act, 2021. The description of a first fertility assessment and of common tests is quoted from the NHS, and the statements about multiple pregnancy from the UK's Human Fertilisation and Embryology Authority (HFEA). Practice in India differs in detail, and the clinic will tell you which tests it uses. Facts about clinics come from the National ART & Surrogacy Registry extract this directory holds and from each clinic's own website. Nothing in this guide is clinical advice, and nothing in it is sponsored.