Conventional wisdom for male/female couples trying to get pregnant is if you are 35 or younger and have been having well-timed vaginal sex to completion for one year with no pregnancies, it may be time to see a Reproductive Endocrinologist (RE). If you are older than 35, conventional advice is 6 months.
Feel free to ignore this recommended timed sex waiting period if you know you and/or your partner has a medical issue that may impact fertility.
Feel free to ignore this recommended timed sex waiting period if you don’t feel it’s right for you. Most couples who do not need medical intervention and are trying for a pregnancy will achieve a pregnancy within 3 months. If it’s been more than 3 months, it’s perfectly ok to be proactive and get the ball rolling.
How to schedule an appointment & some insurance information
You may begin with an appointment at your primary care docto OBGYN and ask for a referral. Note that OB/GYNs are NOT fertility specialists and have a limit to their expertise in this field. Do not waste valuable time working with your OB/GYN if you suspect you need an RE.
Insurance coverage for infertility treatment varies widely. In the US, always check your insurance to see what is covered, and whether you need a referral before heading to an RE. Ask your insurance health plan contact detailed questions about what to expect. Examples include:
What does the plan cover for infertility diagnosis?
What does the plan cover for infertility treatment?
Does the plan cove offer discounts for medication?
Is pre-approval required?
Are certain treatments required (example: a certain number of IUIs) before moving onto other treatments?
Does the plan require a waiting period of trying before they will cover infertility treatments?
You may also want to speak to someone in the RE’s billing department before your appointment to get a costs breakdown.
RE reviews can be found on FertilityIQ, HealthGrades and Yelp. Clinic success rates can be found at SART.org
What you can expect at the appointment
You’ll likely first meet with RE in their office to review medical history (cycle length, previous pregnancies, any vitamins/supplements you are on), family history, discuss possible next steps and tests, and review any questions.
Female partner may possibly do some blood work and have a transvaginal ultrasound, depending on the cycle day.
Male partner may possibly produce a semen sample for semen analysis.
You may need to call back on Day 1 of your next menstrual cycle (CD1) to come in on/around Day 3 of your cycle (CD3) for blood work and a transvaginal ultrasound “baseline” to check your ovaries and Antral Follicle Count (AFC) and your uterine lining.
Common tests/ procedures during initial RE appointment for a female partner. (Note: some of these may have been done at an OB/GYN or primary care doctor prior to your RE appointment. If possible, it can be helpful to have these tests done at OB/GYN or primary care doctor prior to RE appointment so results can be discussed)
Anti-Mullerian Hormone (AMH)
Follicle stimulating hormone (FSH) - usually done on CD3
Hysterosalpingogram (HSG) and/or sonohysterogram (SHG) and/or saline infusion sonogram (SIS) - usually done between CD5 and CD12
Transvaginal ultrasound to check Antral Follicle Count (AFC), check for presence of cysts, and check uterine lining – usually done around CD3
Additional possible tests during initial RE appointment for female partner
Leutenizing hormone (LH) - usually done around CD14
Testosterone (if PCOS is suspected)
17-Hydroxt Progesterone (if PCOS is suspected)
Fasting glucose (if PCOS is suspected)
2 hour Glucose (after fasting) (if PCOS is suspected)
Endometrial biopsy (though no longer recommended, some doctors do this as part of their initial workup)
Vitamin D level
Progesterone level – usually done on CD21 to see if ovulation occurred
Saline infusion sonogram (SIS) – usually done between CD5 and CD12
Fragile X testing/ other chromosomal testing
Measles vaccine titers (to see if you need a MMR booster)
Endometrial biopsy for endometrial receptivity assay (if you have implantation failure)
If you are in a female/ female relationship, the non-carrying lesbian partner may need blood work done at your RE appointment to be checked for infectious diseases Common tests/ procedures during initial RE appointment for male partner
Semen analysis (SA). Some RE offices can do this in house; others will refer you to another office. You can check with your RE beforehand – many REs recommend a few days of abstinence (no sex/ no masturbating) before semen collection
Blood drawn (may be done at the RE office, or may get a referral to do elsewhere)
Additional tests for male partner depending on results of SA (Ask to be referred to a reproductive urologist)
Sperm DNA fragmentation
Scrotal ultrasound – checking for varicocele
Question checklist Medical
Do we need additional genetic testing to see if I/partner are carriers for recessive genetic diseases?
When can we expect medical intervention to start? (Time varies from first appointment with your RE to medical intervention.)
What, specifically, are our next steps? (Ex: more tests; timed intercourse with injectables; timed intercourse with Clomid/ Femara; IUI; IVF)
Do you recommend a “cooling off” period between medicated cycles?
How often can I expect to come in for monitoring appointments?
What is the process for setting up monitoring appointments?
(If you don’t live near your RE) Is there a lab/ another clinic where I can have monitoring appointments or blood work done during my cycle?
Do we have a diagnosis at this time (ex: Polycystic ovaries [PCOS], diminished ovarian reserve [DOR], premature ovarian failure [POF], male factor infertility [MFI], etc) or are we unexplained?
Do we need to get any vaccines/ boosters/course of antibiotics before beginning treatment?
If you need surgery (ex. polyp removal, tubal ligation/removal), is that done at this practice or are you referred elsewhere?
Should we be on any supplements?
Should we make any lifestyle changes?
What do you think my/ our odds are with __ treatment?
How many rounds of timed intercourse would you recommend for us before moving onto IUI? How many rounds of IUI would you recommend before moving onto IVF?
If donor materials (donor eggs, donor sperm, or donor embryos) are needed, does the clinic handle this in house?
About the clinic
What is the clinic’s success rate?
What is your (this specific doctor’s) success rate?
Who is our point of contact at this clinic? How can we reach the clinic after hours?
Does the clinic have any guidelines/ recommendations for attending counseling or a support group during treatment?
If we will need medication, do you have a suggestion for where to get meds? Does the clinic have back-up medications if we can’t have them shipped in time?
Does the clinic have any closing times to be aware of that might affect cycle timing? (Ex: closed between Christmas and New Year’s, closed in August, etc)
What is the payment structure/ payment plan?
Does the clinic participate in any discount programs?
Are there any clinical trials for treatments we could be candidates for?
Can any procedures/ monitoring be charged under diagnosis or treatment for another medical condition instead of infertility?
2013.05.28 03:58 KayGayOral Guide for Gay Bros: Eliminate Halitosis & Minimize STI Risks of Fellatio and Anilingus (or, a guide to better breath and safer blow jobs and rimming)
TL;DR: I tried to organize everything so you can just read whatever interests you and skip the rest.
NOTE: This is not a guide on how to perform oral sex! I've been hooking up recently for the first time and I've been running into two oral issues. 1) Lots of guys have bad breath and it's a major turn-off, and 2) we tend to not use condoms with oral sex because part of the fun are the tastes and smells, but you are not immune to Sexually Transmitted Infections with oral sex. I've researched these two issues and thought I'd share my findings. Some of this is common sense, but some of it is not. Disclaimer: I am not a doctor nor am I a sexual/public health expert. There may be mistakes here. If you catch any obvious ones, let me know and I'll update it. Do your own research, talk to a professional, and be as safe as possible.
Floss once a day. I know it's a pain in the ass, but it's important for getting rid of bad breath.
Scrape your tongue once a day. Tongues are the biggest culprit for bad breath, and it's amazing how many people don't scrape their tongue. This is what I use, but there are plenty of other decent scrapers out there. Most modern toothbrushes tend to have rudimentary tongue scrapers on the back of them as well. Note: Brushing your tongue is not as effective as scraping.
See a dentist regularly. They recommend every 6 months.
(Optional) Chew gum. Chewing gum helps break down shit stuck in your teeth in addition to giving you fresher breath
Oral STI Prevention
Ask your partner(s) about his STI and testing history AND sexual behaviors.
Look for obvious signs of infections (e.g., sores, warts, pus). Of course, not all infections are visibly obvious.
Get tested every few months. If you don't have the money, there are clinics that will do it for free.
DON'T brush your teeth or floss 30 minutes before or after oral sex. These actions will create small abrasions in your gum that will make it easier for you to get infected.
Spit or swallow, but don't let it wallow. I'm talking about cum here. The best thing to do is to not let him cum in your mouth. The second best thing to do is to spit it out if you let it in your mouth. Your stomach acids will kill MOST things if you swallow, but you're still ingesting it. The absolutely worst thing you can do is just leave the cum in your mouth, though! This gives it more time for it to be absorbed through your membranes.
Don't perform oral sex if you have any cuts, burns, or sores in your mouth
Wash your anus if you're expecting to be rimmed.
Enemas can also help clear out any fecal matter, reducing the risk of certain infections.
Vaccines for Hepatits A and B are readily available for everyone and there are two vaccines for HPV that are approved for those that 26 and younger. Cervarix protects against two strains of HPV that may cause cancer, and Gardasil protects against those same 2 strains and an additional 2 that may cause warts.
Oral STI Risks
Knowing what you are at risk for is part of the solution!
Oral Risk: Minimal transmission risk. Risk of HIV transmission through fellatio or anilingus is low, but still possible if there are cuts or sores in the mouth/anus/penis.
Treatment: HIV is generally incurable, but those that are positive are able to live full lives with modern anti-viral drugs. The problem is that these can cost a lot of money.
Herpes Simplex Virus (HSV-1 and HSV-2)
Oral Risk: High transmission risk.
Symptoms: Watery lesions in the skin around your mouth, anus, or genitals that come and go.
Treatment: HSV-1 and -2 are incurable. They can be treated with antiviral drugs which reduce the outbreaks and lower chance of transmission.
Gonorrhea (aka, the Clap)
Oral Risk: High transmission risk. Gonorrhea can spread from mouth to anus, mouth to penis, penis to mouth, and anus to mouth.
Symptoms: Painful urination and penile discharge are classic signs of gonorrhea for a guy, but you can also get it in your throat and anus. Oral gonorrhea can present itself with a sore throat and rectal gonorrhea can involve anal itching, blood or mucous in stool, and soreness. Both oral and rectal gonorrhea can be asymptomatic, however.
Treatment: Gonorrhea is a bacterial infection that can be treated with antibiotics, but the bacteria is mutating rapidly to become resistant to current medical treatment.
Oral Risk: High transmission risk.
Symptoms:Primary stage: An open sore on the initially infected area (lip, tongue, anus, penis, etc). Secondary stage: Rashes, swollen glands, headaches, and fever. Latent stage: No symptoms. Late stage: Organ damage, blindness, paralysis, and/or mental illness. Damage can result in death.
Treatment: It's a bacterial infection, so antibiotics will get rid of syphilis.
Oral Risk: Penis-to-throat and throat-to-penis transmission is possible
Symptoms: Usually no symptoms in the throat, but can cause a sore throat. If left untreated, chlamydia can cause eye problems.
Treatment: Chlamydia is also a bacterial infection and can be treated with antibiotics.
Hepatitis A, B, & C (HAV, HBV, & HCV) (Hepatitis is simply the inflammation of the liver. It can be caused by a number of things, but I'm focusing on the viral infections here)
HAV: High risk for the person performing anilingus on a person that is infected.
HBV: Low transmission risk because blood transfer is necessary
HCV: Very low sexual transmission risk, also because blood transfer is necessary
Symptoms:Jaundice, fatigue, loss of appetite, and nausea. Sometimes there are no symptoms (especially with HCV).
HAV: Your body usually fights it off within a couple of months with no lasting harm. There's also a vaccine.
HBV: Your body will fight it off, but it's a little tougher to do so than HAV. Vaccines are usually given in middle/jr. high in the U.S.
HCV: May be incurable, but sometimes your body fights it off over time and antiviral medicines help out tremendously. There is not a vaccine for HCV.
Human Papillomavirus (HPV)
Oral Risk: High transmission risk. HPV is spread through skin-to-skin contact.
Symptoms: There are many strains of HPV. Some cause warts, some may cause cancer, most of the time nothing happens. Throat, penile, and anal cancers are possible from certain strains of HPV, but are unlikely. This is the scariest part for me, albeit rare, is that you can get warts in your throat!
Treatment: Your immune system usually gets rid of the virus after a while. Warts can be removed with acids or freezing at home or with the help of a doctor. There's also a vaccine called Gardisil that prevents infection of 4 strains of HPV. Two of which cause 70% of cervical cancers (which can also cause cancers in men), and two of which cause 90% of warts. I'm looking into getting this vaccine as soon as possible.
Oral Risk: High risk for the person performing anilingus.
Symptoms: Symptoms may include diarrhea, fever, and stomach pain, but can vary depending on the parasite. For example, Pinworms will mainly cause anal itching.
Treatment: Varies based on parasite.
Other Bacteria (E. coli, salmonella, shigella, etc.)
Oral Risk: High risk for the person performing anilingus AND high risk of UTI for a guy who receives fellatio after person performing it performed anilingus (i.e., don't rim then suck).
Symptoms: Symptoms may include diarrhea, fever, and stomach pain, but depend on the infection.
Treatment: Typically antibiotics, but many varieties of bacteria are growing resistant to antibiotics.
Unprotected oral sex is much less risky than unprotected anal sex, but sex is never risk-free. Knowing what the risks are and how to minimize transmission is important to you and your partner's health. Also, bad breath is a turn-off, so do something about it!
In general STDs often coexist. You should ask to get screened for ALL of them.
STDs are reportable by law.
Syphilitic chancres are painless and often present on the penis as demarcated regions that do not have pus or pain but with small bubos (swollen lymph nodes). Syphilis and HIV together are a disaster. Syphilitic lesions increase the likelihood of the spread of HIV. HIV predisposes to neurosyphilis.
Chancroid (H. ducreyi) is painful, prurulent (has pus), with a jagged margin with large bubos.
Herpes (HSV2) is painful, oozes pus, has an ulcerating margin, but does not have a bubo. It is highly associated with relapse. Multiple vesicles ulcerate because of friction from underwear. Initial infection presents with systemic symptoms with enlarge regional lymph nodes. Subsequent bouts gradually become less severe. Shedding of the virus is possible even if no lesions are present.
Chlamydia causes LGV that is painless, with a huge bubo, presenting with thickening of the skin but no penile ulcer.
Men who have sex with men are more at risk of contracting painless STDs (e.g. syphilis) because the lesions can hide in your ass.
N. gonorrhoeae sucks because it a discharge with a lot of pus, usually. Can be asymptomatic. Can cause proctitis or pharyngitis. Your strep throat may not be strep throat. It could be gonorrhea! The pharynx of men who have sex with men were colonized in 5% of cases in a 2006 study (SR Morris, Clin Infect Dis 43:1284, 2006).
Reordered HSV to #2
Removed mouthwash from halitosis section
Added that oral & anal gonorrhea can be asymptomatic
Added information on Hepatitis B & C viruses
Added information about vaccines in the Oral STI Prevention section
Added a section from godot613. Thanks for the extra info!
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