The first step usually involves seeing an RE (reproductive endocrinologist). Some ob/gyns do know a bit about IF and can help you, but for the most part, the recommendation is that you go straight to an RE who specializes in getting women PG (as opposed to an OB who specializes in getting a woman to deliver a healthy baby). Some insurance companies require a referral from your ob/gyn while others will allow you to go straight to the RE.
Most women aren't sure what to expect on their first visit. The first visit usually entails a bit of discussion, so the doctor can learn about your history, what has been going on, take a look at your charts, etc. The doctor will want to order a SA (semen analysis) for your hubby and possibly some b/w (bloodwork) for you. Certain things can affect your fertility such as high prolactin, low thyroid levels, insulin resistance, etc. so those are just some of the things they'll be checking for. It's very important that this b/w be done on CD3, so if you are getting this done through your OB, make sure it is on the right day. Many women get the initial workup done at their OB, and then end up having to re-do it when they get to the RE because it wasn't done on the appropriate CD. Another value they'll check with your CD3 b/w is your FSH. Every lab has different "normals," but in general they like to see your FSH lower than 6. Anything higher than 6 indicates that your ovarian reserve is diminishing and that time is critical. Here's a quick run down of what values are considered normal vs. abnormal and what that might mean for you.
Most women aren't sure what to expect on their first visit. The first visit usually entails a bit of discussion, so the doctor can learn about your history, what has been going on, take a look at your charts, etc. The doctor will want to order a SA (semen analysis) for your hubby and possibly some b/w (bloodwork) for you. Certain things can affect your fertility such as high prolactin, low thyroid levels, insulin resistance, etc. so those are just some of the things they'll be checking for. It's very important that this b/w be done on CD3, so if you are getting this done through your OB, make sure it is on the right day. Many women get the initial workup done at their OB, and then end up having to re-do it when they get to the RE because it wasn't done on the appropriate CD. Another value they'll check with your CD3 b/w is your FSH. Every lab has different "normals," but in general they like to see your FSH lower than 6. Anything higher than 6 indicates that your ovarian reserve is diminishing and that time is critical. Here's a quick run down of what values are considered normal vs. abnormal and what that might mean for you.
The last thing your doctor may want to do is an transvaginal u/s to take a look at your uterus and ovaries. Women who deal with IF quickly become familiar with what we jokingly refer to as the "vag cam" or "dildo cam." It's not painful or anything, but it's certainly a bit uncomfortable and embarrassing the first time you have to have one inserted inside you. When I came home from the doctor's office after my first transvaginal u/s, I told my husband that I had entered a whole new chapter of womanhood. He chuckled. It's kind of like going to see the ob/gyn for the first time to get a pap smear. You don't really know what to expect; it doesn't really hurt; but boy is it awkward! This is also often done on CD3 and many women are concerned that they may still be bleeding a little bit from their period. Not to worry - you can use the bathroom right before the procedure so you can remove a tampon if needed and when you are in there they put a pad underneath you. It's a bit messy, but they are totally used to it.
Depending on your history, the doctor may also order an HSG (hysterosalpingogram) to check to see if your tubes are blocked. Some doctors do it on every patient as part of the IF workup, while others only do it if there an indication to do so. It's a fairly simple procedure where they inject some dye into your uterus, then they take a radiograph to make sure nothing is blocked. Most women report very little pain from it, just some mild cramping. If you take some ibuprofen beforehand, you should be ok afterwards.
That's more or less the basic, initial IF workup. If you're "lucky," after this you'll get some answers explaining why you haven't had any success getting PG. Of course no one dealing with IF is really lucky, but if you have a diagnosis, then your treatment plan can be optimized to give you the best chances of success. Those who are unlucky get labeled as "unexplained" and the doctors just have to hope that something they try will help. Often times, those that are considered unexplained actually have a diagnosis, but it isn't discovered until much more testing is done. When it comes to IF, often doctors won't work towards an actual diagnosis if it doesn't come easily from the initial workup. As long as they can successfully get you PG, they don't care what's wrong with you. The additional testing is usually only done if multiple cycles of IUI's and IVF are done without any successful outcome.
So that's it in a nutshell. What to expect when you're not expecting. Not really what any of us who wanted a child ever expected as our reality.
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