Care · By concern

Infertility: the couple's assessment at the practice, before any treatment pathway, in Paris 16th

The months go by and pregnancy does not come. At the practice, 42 avenue Mozart, Dr Chaima Gatri, OB-GYN, holder of a university diploma in infertility management, sees couples who are having difficulty conceiving: a couple's consultation, an ultrasound during the consultation, an assessment of both partners, then treatment of the cause that is found — or, when assisted reproduction is needed, referral to the fertility (IVF) team of the Clinique de la Muette, file in hand. English-speaking practice.

Recognizing it

When to speak of infertility, when to consult

Infertility is defined as the absence of pregnancy after one year of regular intercourse without contraception. That timeframe is a guide: some situations call for an earlier consultation. The assessment always concerns the couple — the causes are shared between the two partners, and a proportion of them remain unexplained.

Consulting commits you only to understanding. The assessment tells you where you stand; what comes next is decided together.

Book an appointment — Dr GATRI

The consultation

A couple's consultation, together

The infertility consultation is a couple's consultation: Dr Gatri sees both partners, together. She goes over each partner's history — how long you have been trying, cycles, medical history, lifestyle —, then examines the patient and performs a pelvic ultrasound at the practice, during the consultation, on the Voluson Expert 22 system: uterus, ovaries and antral follicle count, which gives information on ovarian reserve, with the result explained immediately.

The work-up is then prescribed for both partners, and the second consultation brings the results together. This care is part of the practice's medical gynecology; Dr Mahdhi-Basli (team) also performs pelvic ultrasound.

Assessment

The assessment and the steps, one by one

  1. The woman's assessment — the examination and ultrasound of the first appointment; a hormonal blood test, prescribed at the beginning of the cycle, to assess ovulation and ovarian reserve; an imaging examination of the fallopian tubes, prescribed and performed in an imaging center; and, when the ultrasound shows an abnormality of the uterine cavity, a diagnostic hysteroscopy at the practice, without general anesthesia, looking for a polyp, a fibroid or adhesions.
  2. The man's assessment — a semen analysis, prescribed at the couple's consultation and performed in a laboratory: number, motility and shape of the sperm. Its result carries as much weight as the woman's work-up.
  3. Treating the cause that is found — an ovulation disorder is treated with simple ovulation induction, monitored at the practice with ovulation monitoring scans; a cause that calls for surgery — endometriosis (laparoscopy), a fibroid distorting the cavity (myomectomy, which preserves the possibility of pregnancy), a polyp or adhesions (operative hysteroscopy), an ovarian cyst — is operated on by Dr Gatri at the Clinique de la Muette, usually as day surgery (surgery, step by step).
  4. Referral for assisted reproduction — when assisted reproduction is needed, intrauterine insemination or in vitro fertilization, Dr Gatri refers the couple to the fertility team of the Clinique de la Muette, with the complete file: the assessment is done, and the pathway starts on established ground. The practice does not perform assisted reproduction itself.

When one of these procedures is offered, you are given the corresponding information sheet of the French College of Gynecologists and Obstetricians (CNGOF), translated into English: hysteroscopy information sheet, laparoscopy information sheet.

Frequently asked questions

Your questions, our answers

How long should we wait before consulting?

One year of regular intercourse without pregnancy; six months when the woman is over 35; without waiting in the case of irregular cycles or a history of endometriosis, pelvic surgery or infection. And as soon as the question is on your mind.

Do we need to come as a couple?

Yes: it is a couple's consultation, and the man's tests are prescribed at the same time. If one of you cannot get away, we start anyway, and that partner comes to the next consultation.

Which tests are done at the first consultation?

The couple's history, the gynecological (gynaecological) examination and the pelvic ultrasound with antral follicle count, at the practice, during the consultation. Dr Gatri then prescribes the hormonal blood test, the tubal imaging and the semen analysis; the second consultation brings the results together.

Does the practice perform IVF?

No. The practice carries out the couple's assessment and treats the causes that fall within consultation or surgery: simple ovulation induction with ultrasound monitoring, surgery at La Muette. For intrauterine insemination or IVF, Dr Gatri refers the couple to the fertility team of the Clinique de la Muette and sends them the complete file.

Do endometriosis or a fibroid prevent pregnancy?

Many women with these conditions become pregnant without help. When the lesion interferes with conception — endometriosis of the ovaries or tubes, a fibroid distorting the cavity — it is treated: laparoscopy for endometriosis, uterus-preserving myomectomy for the fibroid. Dedicated pages: endometriosis, uterine fibroids.

What if everything is normal?

This is the case for a proportion of couples: the infertility is then called unexplained. Dr Gatri discusses it with you — age, how long you have been trying, lifestyle — and proposes the next step: counseling and follow-up, then a further review, or referral to the fertility team of La Muette when age or duration warrant it.

Is it covered by health insurance?

Consultations, ultrasound scans and diagnostic hysteroscopy performed at the practice are covered by the French health insurance (Assurance maladie) under the usual sector 2 conditions; prescribed tests are billed by those who perform them. Fertility assessment and assisted reproduction come under specific coverage rules, explained at the consultation. The full picture is in “Fees and reimbursement”, further down.

How do I book?

On Doctolib, with Dr Gatri, choosing “Consultation de couple — infertilité”, or by telephone through the secretariat. Antral follicle count and ovulation monitoring scans have their own appointment types.

Fees

Fees and reimbursement

Consultations, ultrasound scans and diagnostic hysteroscopy performed at the practice are covered by the Assurance maladie under sector 2 (non-OPTAM) conditions; prescribed tests — blood tests, semen analysis, tubal imaging — are billed by the laboratories and imaging centers that perform them; assisted reproduction procedures come under the team of the Clinique de la Muette. Fees are listed in the fee schedule and displayed at the practice. The information framework of this site is described on the Patient information and ethics page.

Appointments

Book an appointment

Appointments can be booked online via Doctolib or by telephone through the secretariat.

Doctolib — Dr Chaima GATRI