Making the decision to start or expand your family can be exciting but daunting. You may have questions about your fertility options, fertility assessment and testing, and how your age affects your ability to become pregnant. Dr. Butt will review your pertinent medical history and provide a personalized assessment and plan to help you meet your family-building goals.
Just under half of all pregnancies that occur each year are unplanned, however research has shown preconception counseling prior to pregnancy can greatly reduce poor outcomes such as maternal and fetal sickness or death.
Prior to attempting to conceive, Dr. Butt may suggest a preconception counseling session, which will help prepare you for starting a family. This session will provide you with educational resources so that you can make the best possible decisions for your growing family.
For example, if you have a chronic medical condition such as diabetes, depression, or a thyroid disorder, it is important you work with Dr. Butt to make sure your condition is well-controlled prior to becoming pregnant. In addition, women who anticipate pregnancy should start taking a daily prenatal vitamin with folic acid so as to reduce the risk of neural tube defects.
Another example of a preconception step you may want to take is carrier screening for both partners. Carrier screening can tell you if you, your partner, or both partners are carriers of a certain gene, and what your likelihood would be of having a child with that same gene or a genetic condition.
If you know that you are a carrier for a specific condition, have a family history, or belong to an ethnicity that is predisposed for certain conditions, targeted carrier screening can be done. Targeted carrier screening looks at several specific genes, such as those that are more common in certain groups, like Tay-Sachs disease or sickle cell disease.
Generalized carrier screening panels are also called expanded carrier screening panels and can test for over 100 genetic conditions. These expanded panels typically test for conditions that are more common, such as Fragile X syndrome, cystic fibrosis, Huntington’s disease, and blood disorders.
Basic fertility evaluation
A fertility evaluation can help you determine your reproductive potential, or ability to become pregnant naturally. This is not synonymous with an infertility evaluation, which is done after a year of attempting to conceive unsuccessfully.
Dr. Butt may evaluate your fertility in several ways, as fertility itself is complex and multifactorial. She will take into account your age, menstrual cycle regularity, prior pregnancies and/or births, prior medical history including reproductive surgeries and STIs, and results of any blood tests or imaging studies done relating to your reproductive system.
Should you experience difficulty conceiving, Dr. Butt may order special tests to help determine the cause of your difficulty. AMH (anti-Mullerian hormone) blood tests have been shown to be both an indicator of fertility and a positive predictor of ovarian response in a controlled hyperstimulation cycle (also known as oocyte stimulation for IVF/in vitro fertilization). FSH (follicle stimulating hormone), LH (luteinizing hormone), and TSH (thyroid stimulating hormone) blood tests may also be helpful in evaluating your fertility.
In addition to these blood tests, there are certain imaging procedures that can be conducted, such as transvaginal ultrasound, hysteroscopy, or hysterosalpingogram (which is used to evaluate whether or not your fallopian tubes are blocked).
If, after your basic fertility evaluation, Dr. Butt feels you would be best treated by a specialty fertility physician, she may refer you out to one of her trusted colleagues to ensure you are in the best hands moving forward.
Genetic testing--also known as carrier screening—may be part of the preconception counseling Dr. Butt provides and can be extremely helpful in providing information relevant to both your own health as well as the health of your future pregnancies.
Genetic testing is recommended for those who have a family health history involving congenital anomalies, developmental disorders, or hereditary conditions. It may also be helpful for infertile couples or those who are able to become pregnant but have had recurrent pregnancy losses.
In the case of a hereditary or genetic condition, both parents can be carriers of a specific gene without actually expressing the disease itself. However, if each parent passes a copy of the gene on to the baby, the baby could display the disease in full. Two common hereditary conditions include Tay-Sachs disease (which is very common in the Ashkenazi Jewish population) and sickle cell disease (commonly seen in the black population).
Dr. Butt follows current ACOG guidelines regarding carrier screening, meaning all patients actively attempting pregnancy will be offered screening for cystic fibrosis, spinal muscular atrophy, and disorders of the blood such as thalassemias.
There are many avenues to growing or creating a family, and Dr. Butt will guide you each step of the way to ensure you have the best chance of achieving your fertility goals.
Fertility preservation is one of these avenues, and involves saving your eggs or sperm for future use, essentially freezing your reproductive potential in time. This option has been increasingly utilized for those who want to start a family later in life, are about to start cancer treatment, or who have a genetic condition that may prematurely affect their fertility. If you are a candidate for fertility preservation, Dr. Butt may refer you to a colleague who specializes in Reproductive Endocrinology & Infertility.
Dr. Butt also offers fertility options to same-sex couples. As an ally of the LGBTQ+ community, Dr. Butt offers inclusive care to all, and will work hard to ensure your needs are heard.
If your care falls outside Dr. Butt’s wide range of provided services, she will ensure that you are in good hands by referring you out to one of her trusted colleagues. These situations include more advanced fertility evaluations, high-risk pregnancies that require monitoring by a Maternal-Fetal-Medicine specialist, and certain surgical cases.