I am 28 and have been married for two years. We have been trying to get pregnant for the past year and have not been successful yet, so I would like for us both to consult with an OB/GYN. What are the initial tests the doctor is likely to perform? Is a Pap smear required? I have never had one, and a close friend of mine says she passed out during this test, so I am scared about going to the doctor for a consultation.

S.

The first step will be a complete history and physical exam, including a Pap smear and possibly screening for various sexually transmitted diseases. It is very helpful to have your husband present for that initial consultation. Your husband will be asked to provide a sperm sample for analysis; male factors account for about 40 percent of cases of infertility. If his semen analysis is normal, what is done next depends on the information garnered during that initial history and physical.

You may be asked to do basal body temperature charting or ovulation predictor tests to determine if you are ovulating each month. If you have been having irregular cycles, your doctor may order blood tests to check your thyroid and pituitary gland status. If you have a history of sexually transmitted disease (for example, chlamydia) or pelvic inflammatory disease (PID), or if you have used an IUD, then you may get an X-ray test called a hysterosalpingogram (HSG) to determine if your tubes are blocked. If you have pelvic pain or very painful periods, a laparoscopy may be recommended to look for endometriosis or pelvic scar tissue.

What is done to investigate infertility, and the order in which it is done, depends on one's individual circumstances. Consultation with a qualified OB-GYN is essential. As for your fear of the Pap smear, while the whole process may not be the most pleasant activity on Earth, it is not usually painful -- and it could save your life. Let the doctor know it is your first exam; she will explain the process to you beforehand and try to make it as comfortable for you as possible.