WHAT TO EXPECT AT YOUR INFERTILITY CONSULTATION AND TESTING WITH THE OB/GYN

When I originally started this blog, I was going to focus on home decorating / house tips.  However, I quickly realized there would be times other topics would consume my life. Infertility is one of those topics that has completely taken over most aspects of my life.  Everything related to it is my top priority right now.  From doctor appointments to acupuncture appointments, starting a paleo diet to exercising more, and reading about infertility to dealing with my emotional roller coaster ride, this topic is all consuming.

While there is information online about this topic, I have struggled to find many personal accounts about this journey. I think part of the reason is because infertility is such a personal and private topic and unfortunately I think some people feel ashamed that they cannot easily conceive. I have felt very comfortable being open with everyone about my journey and thought it might be helpful to others if I share my journey in this blog.

I am 37 years old and began trying to get pregnant with my husband at the beginning of last year.  After unsuccessfully trying to conceive for 6 months (1 year if you are under 35), I decided to contact my gynecologist to set up a consultation meeting.

THE CONSULTATION MEETING

The consultation meeting with my gynecologist was simple.  She wanted to know how long we had been trying to conceive and then proceeded to ask questions about my cycle. How many days was my cycle? How many days in did I ovulate? Was I using ovulation prediction kits (OPKs) to identify when I was about to ovulate? Was I testing my basal body temperature in the morning so I could see if I was in fact ovulating? Luckily I had been tracking all of these details for my cycles in my Glow Cycle & Fertility Tracker App, so it was easy to answer all of her questions. By asking these questions she was able to verify that I was correctly tracking my cycle.

Since she felt confident that my infertility was not a result of incorrect timing of intercourse with my ovulation, she decided to run what she called a Fertility Workup on me and my husband.  The Fertility Workup consisted of a semen analysis for my husband and a series of tests on me (day 3 blood test, a Sonohyterogram (HSN) between days 7 and 12, and a day 21 Progesterone level blood test).

My gynecologist was incredibly encouraging and said these tests would help provide information into why I was unable to conceive.  The last thing she said to me as she was leaving the room was “Let’s get you pregnant!” which helped me feel more encouraged.

She was right that the tests would help uncover why I was not getting pregnant. While she was very positive, I do want to prepare you that it can be quite emotional when you learn why you are not conceiving.

THE SEMEN ANALYSIS

When I got home from my appointment I was a little nervous to tell my husband he had to complete a semen analysis.  I knew in general this would be an awkward experience for him and since he had been tentative to have a child, I was hesitant how he would feel about this.  But I must say he was great when I spoke with him about it and within a day or two he had his appointment scheduled at a Fertility Clinic.

My gynecologist gave me a sterile container in case he preferred to take care of it in the privacy of our home. However, after speaking with the Fertility Clinic, he decided it would be easier to just provide a sample at the office.  He learned that if he did the sample at home, he would need to keep the sample warm from when it was collected until it was delivered at the clinic. In addition, we were having construction done that day in the house so going straight to the clinic just made the most sense.

It turned out not to be a big deal and his results were good!

DAY 3 BLOOD TEST

I was given instructions to call the office of the OB/GYN on the first day of my period to schedule my day 3 labs which they try and do on day 2, 3 or 4 of your cycle.  I came in early in the morning on day 3 of my cycle and was taken into a room where they drew a vile of my blood. It was like any blood draw, and I was in and out within a matter of minutes. I was told that I would get the results from my test within a day or two.

The next day after work, I was on the phone with my mom when I received a call from the doctor’s office.  I tried to answer it but for some reason I had a problem switching the call from my mom to the doctor and I ended up missing the call.  My doctor left a message asking me to call her back to discuss my results.  Suddenly I was nervous, because normally the nurse calls with my results, not the doctor. I tried calling back but it was after the office was technically close so the phone system would not even let me return her call.  I began to panic and worry.  What was wrong?  What horrible news did the tests show?

My husband reminded me that it did not make sense to work myself up when I had no clue what my results were.  I tried to relax as much as I could the rest of the evening, but in all honestly my mind was spinning.

The next morning I called the doctor’s office as soon as it opened. I was told a nurse would call me back with my results later. Luckily my adorable nephew, who was born in February, came over because I was going to babysit him. As my brother and sister-in-law were getting ready to leave, I finally got a call from the nurse.  The nurse explained that she was not familiar with my results and would just read the doctors summary which said my FSH and Estradiol levels were borderline and my TSH and Prolactin levels were good.  She did not know my exact values and could not tell me much about what the term “borderline” meant. 

I was happy to learn my results but was incredibly frustrated that I did not understand what that meant to my infertility. So I turned to google.  As my nephew was over and I wanted to pay attention to him, I quickly looked up what the “borderline” meant and how that impacted me.

After some research I learned that “borderline” meant I was outside the normal or “good” range defined for FSH and Estradiol. How far outside I did not know. As I did more research, I learned that borderline values of FSH and Estradiol are often signs of a lower ovarian reserve which also meant I may not respond as well to fertility treatments. Not exactly great news to receive. I definitely was disappointed, but this also made some sense based on my age.

SONOHYSTEROGRAM (HSN)

The sonohysterogram was described by the doctor as an ultrasound where saline is inserted into the cervix in order to observe the uterus more clearly. She said if the saline quickly fills the fallopian tubes they would also know those were not blocked.

I showed up on a Friday morning.  When I arrived, they asked for a urine sample because they wanted to do a pregnancy test to ensure I was not already pregnant.  The technician then took me into the room for the test. She started the exam with a transvaginal ultrasound where she took multiple pictures and wrote down the findings. There was a monitor on the wall in front of me so I could see everything, but I did not know if the results were good or bad. I asked her some questions about what she was writing and she replied that the doctor would review the results with me so I started to worry that something fairly major was wrong.

When she left the room to get the doctor I began to cry, feeling frustrated that my body was not cooperating and my mind jumping to the most extreme conclusion that I would soon learn that I would never be able to have a child.  As the doctor would be coming in soon, I tried to collect myself quickly. 

The doctor came in and explained what she would be doing during the exam.  She began by inserting a speculum in order to have easy access to my cervix. She then used a swab to clean the cervix before inserting a a tube through it. Unfortunately my cervix decided it did not want to cooperate and she had to use an additional instrument to help get the tube in. She clipped me lightly with that tool and it stung, especially when the saline fluid began to flow through the tube and into the uterus and fallopian tubes.

I have read that many people find this test to be pretty painless, but in full disclosure, I thought it hurt a lot!  I thought the saline flowing through the uterus and fallopian tubes hurt a lot. Plus there was also an ultrasound being done at the same time. Luckily the test did not take very long and they saw saline going through each of my fallopian tubes so that was good because it meant they were not blocked.  As the doctor was finishing up and getting ready to leave the room, she told me to redress and then we would talk in a different room.

I was so nervous as I walked into the room. What if something was wrong?The doctor came into the room, sat down and said to my relief, that everything looked great. I cannot tell you how happy I was to hear that news. I used my time with her to also ask for the exact results from my day 3 labs. I was happy to learn that my borderline FSH and Estradiol levels were just outside of the the normal values. That made me feel better. However, she suggested that due to my age, that I schedule an appoinment with a Reproductive Endocrinologist.

I left that appointment feeling more optimistic about eventually being able to get pregnant (that would change once I had my appointment with the fertility doctor – but more on that later).

Luckily I had a friend who had also had this exam and she recommended that I work from home that day.  I was really glad that I listened to her because I had a lot of pretty intense cramping for the rest of the day. I decided if I ever had to have this exam completed again, I would take the day off from work.

PROGESTERONE DAY 21

This test was the easiest of them all.  I went in for my blood test in the morning before work.  Like the day 3 labs, I was seen quickly and had my blood drawn.  My results on this test were within the acceptable range and had confirmed that I ovulated that cycle.

The initial consultation and fertility workup were just the beginning of my long and emotional infertility journey, but at least I had a better understanding of why I was having trouble conceiving.