what do I have to expect

[huggerwocky]

When I have finally overcome myself and made an appointment with my GYN to find out why, after 16+ months, I haven't gotten pregnant?

I hate the unknown...

[jeniferm]

If you've done any charting of your cycles, take your charts with you. If not, it wouldn't hurt to read about it and start now so that you have more information before you go. A good resource is Toni Weschler's book "Taking Charge of Your Fertility", but there are others.

Be prepared with info about your cycle history. Your doc will likely want to run some blood tests. Some of them can be run anytime, others need to be done on certain days of your cycle. Some docs are more expert in this area than others, so you need to know what's what. It's not uncommon for gyns to run the tests on the wrong days and then diagnose a problem that isn't really there, just because they ran the tests wrong. www.fertilityplus.org is a good resource to understand the various tests that may be run, when they should be done, and what the reasonable results are.

Your doc should also give you a script for a semen analysis for your DH. Half of all fertility problems involve male-factor, so don't let him tell you he's embarrassed to do it, or doesn't feel manly doing it, etc. It's critical that this be done, even if other tests show a problem with your fertility. 15-20% of fertility problems result from a combination of male and female factors.

Your doc may also want to do tests for sexually transmitted diseases. Many can impair fertility.

Finally, depending on where you are in your cycle, your doc may want to do a trans-vaginal ultrasound, where they put a small ultrasound wand inside of you to look at your uterine lining and ovaries. If you are early- to mid-cycle, they'll be looking to see whether you're developing egg follicles properly. If you are post-ovulation, they may want to check the thickness of your uterine lining.

I've found it's definitely important to understand all of this so that if the doc is not as expert as you'd like, you don't add more stress to things with their ineptness. Read all you can - there are lots of good websites and books available (check your library). In addition to the website I posted above, check out www.inciid.org and www.resolve.org (they both have info, and probably a wealth of other links). Some docs will not even want to do testing, just throw you on some clomid because it does help a lot of women and is cheap. But if the problem is male factor, or if it's female but not related to ovulation, this won't help. And without monitoring, you won't know if the clomid is helping anyway, so you may end up wasting more time.

Another test that may be run, particularly if you have any reason to think there may be issues, is a hysterosalpingogram (HSG), where they inject dye into your uterus through the cervix and take x-rays of it to see the shape of the uterus and determine whether the fallopian tubes are unblocked (the dye will spill out the ends if they are). This is often run later after other results come back if there's no reason to suspect a problem, because it is expensive, a bit painful, and involves the risk of x-ray (however small).

Best of luck and hang in there - it's a stressful time, but you'll feel better knowing you're doing all that you can.

[djsmommy]

About the HSG test, if your doctor tells you it doesn't hurt they are lying! My ob told me oh its not painful at all, and it was horrible. This was of course coming from a man!

[huggerwocky]

Originally Posted by djsmommy

About the HSG test, if your doctor tells you it doesn't hurt they are lying! My ob told me oh its not painful at all, and it was horrible. This was of course coming from a man!

uhhh...it does sound horrible! I hope I can skip that.I've been charting for 6 months now and I do seem to ovulate. *sigh*

Thanks for all the great info....I do find it scary and still have to tell myself that it needs to be done.

[alicia622]

Originally Posted by djsmommy

About the HSG test, if your doctor tells you it doesn't hurt they are lying! My ob told me oh its not painful at all, and it was horrible. This was of course coming from a man!

I think the HSG is different for different people. I had one and experienced no pain to speak of- a tiny bit of cramping. I had a colposcopy with biopsy once and THAT was horrendous! Of course that wasn't for IF issues.

To OP- definately check out the links PP shared. Great information. The TCOYF book is a must have as well. When is your appointment? Is your GYN well-versed in fertility issues? If not, you might want to find someone who is to get the best treatment. Insurance can be a PITA with IF issues so check your coverage before you get started!

[jeniferm]

I don't think the HSG is horrible for most people, but it can be somewhat painful. It will definitely be necessary if you need to go to injectible fertility drugs either with intercourse or IUI (insemination). It's expensive to do those treatments, but they can't work if your tubes are blocked. If you're doing clomid they probably won't have you do the HSG right away, and if you're doing IVF it may not be necessary. But when you get to that point, I think you'll find that having to suffer through it (the pain, no matter how intense, should only last seconds) is worth it if it brings you one step closer to that baby.

Hugs!

[huggerwocky]

Originally Posted by alicia622

I think the HSG is different for different people. I had one and experienced no pain to speak of- a tiny bit of cramping. I had a colposcopy with biopsy once and THAT was horrendous! Of course that wasn't for IF issues.

To OP- definately check out the links PP shared. Great information. The TCOYF book is a must have as well. When is your appointment? Is your GYN well-versed in fertility issues? If not, you might want to find someone who is to get the best treatment. Insurance can be a PITA with IF issues so check your coverage before you get started!

How do I check my coverage?Last time I sent an email about soemthing I never got an answer...

[jeniferm]

You should have a book from when you first got the insurance outlining all that it covers. If not, you can usually get it from the HR department of your employer if they provide the insurance. Calling the insurance company may give you better results than emailing, but they are not always knowledgeable about what is covered, so you may have to be very patient in explaining things to them. The benefits info from your company is probably your best bet.

[alicia622]

Originally Posted by huggerwocky

How do I check my coverage?Last time I sent an email about soemthing I never got an answer...

You should be able to get the details of your coverage from HR or directly from the company. I'd avoid emailing and just call them directly. My policy specifically stated very limited coverage (just diagnosing IF and surgical corrections) but a coworker told me she knew of someone within the company who was using the insurances fertility program. This allowed for six tries of IUI's as well as monitoring through ultrasounds and bloodwork and non-injectable meds. COOL! So, I called the insurance company and they said there was no such program. I called another time because we were gearing up to begin all this out of pocket and the man I spoke to said, Oh, let me connect you with the infertility program! My point being- if you don't like the answer one rep tells you- call again and ask someone else! You don't always know what they will say- this man helped us save probably 10,000 dollars by connecting me with the program. Good Luck!!!!!