Are you are seeing an OBGYN who specialises in infertility, or a reproductive endocrinologist (RE), who only treats infertility?
What REs normally do is take a detailed health history, ask you about your periods (how regular are they, are they heavy/painful, do you have any bleeding between periods etc), ask if what contraception you have used, if you've ever used an OPK to see if you're ovulating, if there's any family history of infertility, if you've ever had any pelvic infections, how often you have sex .. just the usual stuff you would discuss with anyone.
Your dh will probably be asked for a sperm sample and I would expect the doctor to give you an ultrasound to look at your ovaries, and probably schedule some blood tests to measure your hormones if he or she suspects ovulatory disfunction. I knew I had a tubal problem but the PCOS was only diagnosed after my RE looked at my ovaries (PCOS ovaries typically have what's called a "string of pearls" appearance on ultrasound) and by my day 3 bloodtests.
The doctor may possibly suggest that you have an HSG (hysterosalpingogram) to make sure that your tubes are open and you don't have any uterine abnormalities.
If you've been charting bbts I would take your charts along in case the doctor wants to see them. I wouldn't worry about having to undergo unnecessary tests. There are lots of different reasons why people have difficulty conceiving and sometimes you have to have a lot of tests to work out what's going on. I know a lot of infertile women (in cyberspace) and it's the tests that were not done, which should have been, which upsets them.
Now you're probably really freaked out! Honestly it's not so bad. You're probably dreading it, but honestly it's a big relief to go and do something about it when you've been ttc for a while with no result.
If you're worried that you'll leave out important information, write down on a piece of paper everything that you think might be relevant and take it with you. I tend to talk a LOT at doctors' appointments and ask a lot of questions, (I do it at the vet's as well!) because I want to make sure I know what's going on and why. The way I see it, my dh and I are working together with the doctor to solve a problem, and it's very important that we understand what's going on so that we can have confidence in the treatment.
Good luck tomorrow - let us know how you get on!
From my experience....make sure dh is tested pronto - and not just a sperm count but a full work up that includes motility, morphology and a whole bunch of other medical words that I forget. Basically, you need to know how many sperm there are, what they're shaped like, how well they swim, how fast, etc, etc. The reason I say to get this done first is that it is the least invasive test and usually doesn't cost a whole bunch.
You will likely be asked to come back for blood tests on Day 1 of your cycle, probably day 3 and likely ultrasound test around the time of ovulation. They will be testing for blood for the various hormones that are necessary and will be using the ultrasound to determine if you are ovulating and when (although, if you're charting, you already know all that ).
They will need to determine if your tubes are open through the HSG that Nomadic described. This is a good test but be aware that it only shows if the dye (which is a liquid)can pass through your tubes, it is not the final word on your tubes being okay. I say this because although my HSG was normal, I had a laproscopy surgery done later and it turned out that my tubes were full of scar tissue and an egg would never had made it through (they fixed it ).
They may test your cervical fluid quality by getting you to come in shortly after you've had sex near ovulation to see if the sperm are making it through the cervical fluid.
There are lots of possibilites and it can be a very daunting and overwhelming process. Bring to the dr any charting you've done, your and dh's sexual and medical history, your menstrual history and write down any questions you have so that you remember them once you get there!
Do you have any thoughts on why you haven't conceived yet? Have you charted? Have you ever been pregnant or has dh ever gotten anyone pregnant?
Good luck and please post with the results of your visit. It's very scary to start the IF journey and you know we'll all be here to hold your hand
just browsing around & saw your post, do you remember when I used to live here on the TTC board?
I wanted to let you know that for me, us actually going in for investigation/treament of our fertility problems was the biggest step. Emotionally & physically it was a rollercoaster from one appt to the next. It was really an all consuming time for me- the biggest challenge was being this super-vulnerable person working with such an emotionally charged issue, and having to deal with so much "administrative" stuff, if that's the right word. I became a champ at juggling insurance, procedures, clinical diagnosis, and my own (& DH's) emotional responses.
What helped me was remembering:
1) Medical professionals are people who *work for me.* I'm the boss! What a concept! I could not deal with them at all as "authority figures." My REs & OBs & Gyns & all their nurses, office staff, etc are basically paid consultants who I go to for their expertise. They are not decision makers about my life. I am paying them to provide me with as much information in as much detail as I want- and it is my responsiblilty to understand & use the info.
2) these people are @ work- this is just a job for them. For me it's my *LIFE* and I can't expect them to have the same priorities I do- I may have to advocate very hard for myself here, and that's just the way it is.
3) TTC was a part of my life, my path, a part of my journey, if you will. I finally saw it as a mission- like climbing Mt Everest. I would feel beat down & discouraged, but I would tell myself that I was strong & resisilient & amazing. I would tell myself that life is abundant, that life will win out & I am a part of that life, & my challenge to TTC is just how life is- an amazing challenging stretching growing experience.
So, that said, I fully believe that without this message board, I never would have figured any of that out! I was already seeing fertility specialists when we got this new computer last year & I got on-line & wandered over here to MDC. It made a huge difference in everything I went thru & w/out it nothing would have been the same. The experience, strength, & hope here is amazing, and you were one of those who saw me thru it all. I know you are going to have an amazing experience- hold on tight!
The biggest step is getting yourself to go to the doc. And I had a hard time doing that too.
The postcoital yucks me out too! Be sure that you have it done at the right time for your cycle - the most important time is when you see the EWCM. That is the fluid that needs to be good. If you have it done when you don't have EWCM, you may get misleading results. (That tidbit of info came frm TCOYF)
Good luck and keep us posted - hopefully we will both be mommies soon!!
Adina mama to B 4/06 and E 8/13/12 (on her due date!)
wow, you got alot of results @ once, can be kind of overwhelming, huh? There are so many decisions to make & I remember how hard it was to be clinical & analytical. I am the type that had to review my info many times & have as much "hard data" as possible. I mean like my actual hormone levels, etc.
Can I ask a couple of questions? I assume but can't remember if you've been charting long term while TTC. If you have, are you seeing the biphasic indication of your ovulation? Is this what the Dr used to determine you ovulated or did they do an U/S?
#2) are you saying that they haven't ruled out tubal blockage? The 2 tests I had done to determine if my tubes were clear were very important to me to do *before* I started any meds. & was the order that my Dr recommended. Even though they were invasive (one more so than the other) they were quick (not painless) & didn't mess with my own hormonal system, which I was very leery of doing just experimentally. Knowing that there is no blockage seemed like a prereq to me. It is very hard emotionally going thru a cycle of TTC as you know, I wouldn't want to mess around for 3 more months & then find out that there was no way it could have worked bcz there is a tubal problem. The 1st test I had done was an Airsonhystogram~ invasive like a massive pap smear, but not a totally big deal, def not surgical. Killer cramps hurt like hell by the time I got home though!! Took 3 advil & slept the rest of the afternoon. That one showed 1 tube open, 1 tube ? Later with a different Dr I had a Hysterosalpingogram, which was more definitive & showed both tubes open. Just food for thought there. You would want to time this test for before ovulation so that it wouldn't interfere with any fertilized eggies already trying to implant.
About the "senile eggs" I do know that egg quality can be a problem for some women. Do you how the Dr came to that determination? I would be interested in knowing more. If estrogen levels are low during the preovulatory phase it can take too long for the eggs to ripen. Is your cycle consistent? Do you have good amts of EWCM? The clomid does rev up your estrogen production & gets things working more consistently for lots of women.
As far as all the meds, the clomid, trigger shot & all that is pretty standard procedure for alot of Drs. But if your hormone levels are normal I wonder what the Dr thinks they are going to improve?? My hormone levels were all pretty normal (our biggest problem was sluggish swimmers) but I did opt for the clomid when we did our insemination bcz it just helps the timing be perfect (with the help of U/S to see the follicles) I didn't do the ovulation shot though bcz I didn't seem to need it. Then my progesterone was great after we concieved & I didn't need to supplement that either.
well, my post is now as long or longer than yours!!! I just am really interested in how this goes for you- IF treatment can be so taxing emotionally. You should post here as long & as often as helps, I know I never would have made it thru my stuff without MDC!!
blessings for a special healthy easter eggie this month!
I had heard of "senile" eggs - though not in that exact term. The IVF guy we talked to for DH's sperm analysis said that would be a good reason to be on Clomid - because I had psycho long irregular cycles.
I am on my second round of Clomid. Not too bad - a little more hormonal mess that last cycle - but still not as bad as BCP. My body responds to it well and I get good follicles going.
I don't really have any advice. Just a BIG .
Adina mama to B 4/06 and E 8/13/12 (on her due date!)
I really think that it is a shame that the medical world seems so uninterested in the whole FAM that is where most of the valuable information is.
I think that it just pisses Doctor's off that a layperson can do something without a degree. It just baffels me:
My doctor discourged me from doing FAM but I was lent the book and I am taking charge of my Fertility damnit!!!
DG, I know exactly what you're talking about. I was actually quite appalled that my dr placed no value on my charts. They are just as factual of data as any of the #@%&* blood tests he ordered. Thanks to TCOYF/fam, I know I will never, ever get back on to bcp.
Mama to a boy EnviroKid 9 years old and a new little girl EnviroBaby !
I write about parenting, environment, cooking, and more.
I sincerely doubt I am going to graduate this month....don't think we bd'ed nearly enough. I was in tech for a show. I am patiently waiting for af to show up....and then I am taking a cycle off to lose some weight and relax about the whoe thing. Too much stress not being pregnant every month. Especially since one of my good friends is due TOMORROW! Nothing like being happy for someone but wanting to lock your self in a room and cry all day. BLECH!
Adina mama to B 4/06 and E 8/13/12 (on her due date!)
|Would an egg look like it had come out normally on u/s if the tube was blocked?|
An U/S of the ovaries shows the size of the follicles the eggs are developing in. The info you get from this is how many eggs are ripening & how large they are & if you have eggs on both ovaries or not. Depending on the timing it can even show the follicle rupturing. But it does not show the egg quality, or where the egg goes after the follicle ruptures.
Regarding egg quality, if it is taking a while for you to ovulate & your estrogen isn't building steadily from the beginning of your period, sometimes follicles will develop & never rupture. Are you familiar with how normally there will be several & then usually 1 will dominate & get larger then rupture? With low estrogen levels the follicles might grow, stagnate, & then even recede without ever rupturing. U/S might show a follicle 1 day & then none 2 days later, but that still might not be proof positive of ovulation. Did they tell you what size the follicles measured or how many there were? Normally you want at least 1 18-22 mm follie, and then there might be 2-3 smaller ones. It sounds like they were pretty thorough with the U/S. They get tedious though don't they?
With taking the clomid you are giving your body a chance to basically get with the program & see what it can do & with the U/S & trigger shot you will have a very good ability to time your baby-dancing, hurrah! It sounds like the Dr really feels you have a hormonal thing going on, not a blockage. Also with the clomid you have a better chance of ovulating from both sides, so if there is blockage on just 1 side that is cutting your odds, the clomid could compensate for that. Not to push the HSG, but alot of women get pregnant *after* they have it done, like it is actually theraputic & can help open the blockage if there is one.
I know how frustrating it is to have care providers completely discount the info you've collected by charting. I had a really nice female Nurse Practioner & even she couldn't get with it! She was a firm believer in the 14 day luteal phase, I would bring my chart in with my ovulation marked & she would count back 14 days from my LMP & mark my ovulation there no matter what other signs had indicated my ovulation! In fact that is one reason I took the clomid, just so I wouldn't have to fight her to get the U/S & insemination timing done to my cycle. The clomid basically controlled my cycle & it all worked out for the best. I still continued to chart & think that info was really important to *me* in assessing what the Drs & all were saying, even if they wouldn't look @ it. Personally, I think they are very regimented, "scientific" people & do not like taking a backseat to "nature's rhythym". It all works better for them & their office schedules, setting appts, etc if they can control your cycle. It makes it more predictable & they really like that.
Sorry this is so long again, but what you are going thru is so similar to my experience. I know it will all work out for you! Also, are you eating really well & taking your prenatals already? Give your body it's very best chance to make those high quality eggies! Vitamin C is real important to cell growth & division. Get a cool affirmation going to feed those ovaries everything they need~ they want to do their job & make that little baby happen!
many baby blessings, Maria
No, tubal blockage has not been ruled out. The dr asked if I knew of anything that might indicate it: I don't know what that would be. [/B]
If you're concerned about unnecessary tests/treatments, just take your time. don't agree with the dr as a matter of course when s/he says, "ok, i'm going to prescribe xyz and we're going to do this because such and such." It's too easy to refuse or accept just because that's the first response to emerge from your mouth. this is what I struggle with, anyway. As others have said here, *you* are paying *them* for a service, so be sure you're getting the service you want.
Best of luck! Sounds as though it's going quite well.