Initial Procedures

Like initial bloodwork, you'll probably have 1 or more of these procedures in your fertility work-up. If you begin fertility treatments, Transvaginal Ultrasounds will become your friend.

Initial Procedures:

Hysterosalpingogram (HSG):
This procedure essentially will tell you if you have any fallopin tube problems. People have differing opinions re: the degree of pain this causes but everyone agrees it is not pleasant. Luckily, the procedure its is 90% doctor prep, 10% test. This test is performed around Day 10 of your cycle (remember, you'll get Day 3 labs drawn as well, try to do this in the same cycle because again you'll need this before starting most fertility treatments).  The process includes: speculum inserted, catheter guided through your cervix into the uterus, small ballon inflated at end of catheter (this is the part that causes cramping, feels much like a knife poking around in your uterus), dye injected into both tubes, x-rays taken. The doctor or nurse practitioner (NP) can give you the resutls right away. After the test, the dye leaves a sticky residue and you will experience some cramping.

**TIP** Ask your doctor for a Tylenol 3 for pain before the test.- regular over-the-counter pain relievers won't cut it. Eat beforehand. Bring a pad. Take the rest of the day off from work.


Transvaginal Ultrasound:
Much like a regular ultrasound but these test means a small probe will be inserted into your vagina (painless) to take a look at your uterus, endometrium lining, and ovaries. Pictures and measurments will be taken. Eggs and their size can seen in your ovaries. Very good at diagnosing Polycystic Ovarian Syndrome (PCOS).

**TIP** Ask your tech for the ultrasound pictures. After a doctor reads and signs off on the report, many medical offices discard the pictures. You want the pictures for your personal medical record.

Initial Labs

There are tons of labs! Who knew that hormones took this many tests to examine? The sheer number many seem like you or your doctor are being overly dramatic but you are not. Part of the diagnosis work-up is to weed out things. Depending on your diagnosis and future fertility treatments, you'll never have some of these labs again, while others you will become quite familiar with.

**TIP**  Ask your doctor about all of these tests upfront. Some doctors may elect for you to have only a couple to begin with but, according to my doctor, it is beneficial to have all of these as part of a fertility work-up. Fertility treatments will likely only begin after you've had a complete work-up so you might as well. In addition, because some of these labs will need to be done on day 3 of your cycle, ask your doctor for medication to induce a period, especially if you don't get regular periods! If you don't get induced, you could be waiting for a period that never comes right?

Initial Labs:
Anti Mullerian Hormone (AMH)
Estradiol (E2)
Follicle Stimulating Hormone (FSH)
Human Chronic Gonadotropin
Luteinizing Hormone (LH)
Prolactin
Semen Analysis
Thyroid Stimulating Hormone (TSH)
Testosterone Free
Testosterone Total

Background and Diagnosis

Reading my first infertility message boards, I read them about as fast as a 1st grader- too many acronyms! DH, AF, TTC- what?! I understand, it is a pain in the ass to type out the same words/phrases 10 times but for the uninitiated or the reader who skims it makes little sense. I had to open a page of fertility acronyms to be able to read a paragraph- no fun. Oh, and men will NOT learn them so ladies, you'll be speaking in code. Thus, no acronyms unless they are clearly defined.

We got married in 2008. Before we got married we both discussed children and we both  didn't want any. Not because we didn't like kids, but we relished our freedom. We wanted to live abroad (still do) and honestly, infacy freaks me out- no sleep, all poop. Then sometime in early 2011, we started to see the benefits. We want to show the world to another human being. To make a long story short, we decided to try. I knew I was high-risk already because I was diagnosed with Irritable Bowel Disease (IBD) in 2010. Luckily I have had no surgeries to date but pregnancy puts enough strain on a healthy body without adding an autoimmune disease to the mix. I had already been off the Pill since my diagnosis (the Pill can add to autoimmune problems) so now we would discard our usual condoms- how hard could it be? Well, pretty hard it you aren't even ovulating.

My periods since getting off the Pill were few and far between. Every 6 weeks for awhile, then every 8 weeks. Strange. I wasn't getting tender breasts or cramps either like I did on the Pill. Strange. I wasn't as bitchy as I was on the Pill. Strange. This brings us to July 1, 2011. Saw an Ob-Gyn, explained my symptoms, had some bloodwork and a transvaginal ultrasound. Polycystic Ovarian Syndrome (PCOS) it is.

It is defined as "a condition in which there is an imbalance of a woman's female sex hormones." I also learned it is the leading cause of infertility among women in their reproductive years. Okay, glad I'm in good company.

This diagnosis made sense to me. First, my weird periods. Second, I have gained weight in recent years. I thought I was just getting older, so lower metabolism but actually the syndrome makes many women gain weight AND it is harder to lose weight. Wow, like we don't have enough problems. In any event, we began the infertility journey on that day.