Does anyone have a better idea than I do what my GP is on about?

[ArielNonBio]

Afternoon ladies.

I wonder if anyone has any advice. After 18 months actively TTC, last month I suddenly had a bit of a meltdown when I realised I was 37 next birthday and still wasn't pregnant and that there was likely to be an Issue. So off I trotted down to the GP - who I haven't had a whole heap to do with before as I am luckly to be in robust good health, touch wood. She advised me to come in on day 16 of my cycle for a smear (which was due), and "you might as well have some blood taken then as well". I asked what it would be tested for and she said general stuff - liver and kidney function, thyroid, diabetes, rubella immunity and anaemia. I asked about hormones and she said they would also test for progesterone.

Now I'm not an enormous expert, but I ventured that testing me a mere 2 days after ovulation would produce a low result and she said they would test it anyway. So the results came back, including the smear, and they were all normal, apart from, the receptionist said, the progesterone which was "very low for a day 21 test" (it was 3.4). I told her it wasn't a day 21 test because it had been taken two days after ovulation, and I asked about day 3 FSH testing. She said I would have to come back to chat with the doc (sorry this is long), and that she had never heard of such a test. Fair enough - she's not a doctor.

So I've just been back and the first thing she said was "How long before your period was the blood test?" Clearly she concerned about the low reading so I said I wasn't worried because it was only 2 days after ovulation, when I knew it should be taken 7 days after. She was adamant that no, it should be taken 7 days before your period starts. She also gave me some results for FSH and LH, again both of which sound ok (49 and 7.6) except of course they were taken on day 17 as well (day 16 was a Sunday so I had them the next day). We talked ourselves round in circles with me asking how did she know if it was a good FSH result if it wasn't taken on day 3, or thereabouts?

The upshot is that she has ordered me back for another progesterone test "seven days before your period" (which of course will be a bit of guesswork) and she discounts the day 3 thing altogether. Nor has the word "ovulation" passed her lips. I'm confident I am ovulating, but I want to know if I have aged eggs!!!

And MrA is going for a jizz test soon, bless him. He has to drive 30 miles with a pot of spermz to hand in at the hospital.

That's by the by. Does this GP sound as clueless as I think she is, or is it me? I have asked to be referred anyway, which she's said she'll do as soon as this blood test is done and the SA result is in, because the fact remains I am still not bloody pregnant not matter how much blood is syringed out of my arm!

Apologies for the length. Any thoughts?

[ArielNonBio]

Oh and my blood pressure was a bit high. This was taken just after she had said "You seem very concerned about figures and numbers. Relax and it will happen". I refrained from saying "My blood pressure is high because I am trying hard not to shout at you."

[LittleChiefRunnyCustard]

Well. In an average 28 day cycle the day 21 would be the same day as 7 days before a period. If your cycle is longer or shorter the variable part of the cycle is the time from start of period until ovulation. The time between ovulation and the next day is pretty stable at 14 days and the blood test should be taken in the middle of this period. So if you had longer cycle, say 34 days you would ovulate around day 20, a day 21 test would be too early but a day 27 (i.e. 34-7) would be at the right time.

How long is your cycle?

[Northey]

Hmm. Well, 7 days after ovulation should roughly equal 7 days before period anyway - even if your luteal phase is a bit longer or shorter than 14 days, either way of choosing the blood test date should catch the progesterone surge either on the way up or the way down. So that could be a bit of a non thing to get worked up over. How long was it before your period, in the end?

It's good that she's being thorough and giving you another one though.

I never had a CD3 test either, for what it's worth. My doctor was happy to read the CD21 result in isolation.

[ArielNonBio]

It's 27-29 days generally, so I'm just splitting hairs there really.


It's the whole "getting normal FSH results from a blood test 2 DPO" thing I don't get really. What would be the point of having to test them on day 3-5 usually?

As I said I'm not that worried about the progesterone at the moment.

[ArielNonBio]

Hi Northey, haven't had the period yet! Should be tomorrow or the next day I reckon

[LittleChiefRunnyCustard]

Oops, pressed return too soon. I imagine your GP is wanting a raised day 21 progesterone to confirm ovulation before going onto to further testing/referral (even though you are pretty sure you are ovulating). Day 3 testing is usually done further down the line in secondary care (in my area at any rate).

[ArielNonBio]

Thanks. SHe did say I seemed a little mental anxious. It's that I suddenly feel ancient.

Maybe it's not actually me anyway

[PopcornMouseInBoots]

Considering your age, you're eligible for a referral to fertility specialists after 6 months ttc - it might be worth suggesting she send you down this route if there's no joy with the blood tests or you don't have confidence in her?

[LittleChiefRunnyCustard]

You're not ancient.

There really is little point in worrying about the individual numbers - you can't change them after all. Just try and get through all the tests, get a referral and wait and see what the consultant says when they have all the information they need.

(In the meantime keep having plenty sex. Sods law you will get pregnant while you are waiting for your appointment.)

[ArielNonBio]

Well I haven't so far, Custard. But I can hope.....she said "Oh I can think of several ladies in the last year who didn't need their consultation after all."

Popcorn, yes she is going to refer me. That's what i thought - what use is there waiting for test results because you can't change them, and the fact remains that I have been TTC for yonks with no result and I am over 35.

[KatAndKit]

ariel you should ideally push your clueless GP to refer you to a specialist. She sounds utterly clueless. However, it makes sense for them to check out Mr A's jizz before they refer you.
I had the LH/FSH done and i was told it had to be day 3-5 (I wasn't offered a day 21 test at that point as I was patently ovulating enough to get a teflon baby).

The point of having them done on day 3-5 is all about the ratio between the two hormones I believe. Day 3 is the "baseline" of your cycle. The FSH test is supposed to be the one that measures ovarian reserve. LH needs to be checked early in your cycle as it will surge before ovulating. If you get a too-high result early on, it might be indicative of PCOS. At the time you had yours done, there is no way of knowing if that is a normal level for you or a surge due to ovulation. Whereas on day 3 you will not be ovulating.

However, you are unlikely to have PCOS given that you have a normal length cycle and are pretty sure you are ovulating.

As far as the day 21 test is concerned, you know it is supposed to be 7dpo, so have it done when you think 7dpo is and just tell them it's 7 days before you are expecting a period. By the sounds of it, it will only be a day or so difference anyway unless you ovulate late in your cycle.

Hoping that MrA's jizz passes muster!

[VivaLeBeaver]

Doing the blood tests is good as otherwise you'd be with the specialist who would say well we need to do these blood tests, go back and have them done on X day with your GP. So you'd have gone to the hopital for nothing.

However seeing as there is bound to be a wait of a at least a few weeks to see the Obs/Gynae Dr you'd have thoughth the GP would sort out the test and the referral now. Not sure but that would seem good to me?

[ArielNonBio]

So is the consensus that she is clueless then?

Kat does it sound weird that I am hoping in a way that his jizz doesn't pass muster? At least then we would know why I'm not up the duff after this long.

I wonder if I just phone the surgery and ask for day 3 bloods for FSH and LH without having been told to by the doc? Last time I wanted to query something so I phoned and asked if I would be able to speak to her at a convenient time, and I was told no.

She already appears to think I am neurotic simply because I asked questions

[Northey]

It's very important not to care what she thinks of you. That's the first step to slinking off home with your unpregnant tail between your legs.

Even if she is clueless, she is referring you, which is what you want. It might be quicker to focus on getting that appointment sooner, than going back and forth with GP, maybe?

[ArielNonBio]

I'm fucked off with it all already to be honest

Maybe someone can just give me a baby?

[bugsylugs]

Op do not give up. Appointment ASAP as there are always delays and if you need any treatment and it is available on NHS best get into system as there are age criteria. test done before consultation would be good but they can run side by side. GPs like to have all the facts though, also need tsh. We do day 3 tests here may change next month due to cost of tests. Reason for saying 7 days before period is most people know their cycle length monitors do not tell you the day you ovulate but the 24-36hrs range and not many people do chart

[MagnumIcecreamAddict]

You may find this document useful. It is the standard all uk gps should be adhering to.
Good luck.

[ArielNonBio]

Thank you bugsy and magnum. I am currently working my way through the doc. I'm interested to see that there is no mention of day 3 for the FSH and LH test

[MagnumIcecreamAddict]

That doc is the patient version. If you look on the website it has the doc version too, but bit more technical - most long term TTCers will manage it no prob!!

[eurochick]

She does sound pretty useless, but from what I have seen on here, many GPs are.

As others have said standard first round blood tests are days 2-5 (to check LH/FSH levels and my GP threw in a general blood screen with this one to check iron levels, thyroid function, etc) and 7dpo to check progesterone levels to see if you are ovulating. My GP also sent Mr euro for a jizz test. Then he referred us on. For us, the second round of tests was a fanny cam for me, rubella immunity test, HSG and a second jizz test for him. After that we got a "helpful" diagnosis of unexplained infertility (in other words "Hmm, this is a bit complicated, we can't be arsed to investigate further") and a referral for IVF. That took a bit over 6 months from seeing the GP to getting the IVF referral letter.

G'luck.

[beangrower]

That sounds pretty crap to me. I've had similarly useless responses from my GP(s) and even a mention that its 'probably down to my eggs'. Turned out that DP has a low sperm count (poor motility too) - they even botched up giving us the results for that! (We are in a slightly diff boat as we are TTC 2. And I am a bit ancient.)

Try not to worry about your age if at all possible; though I understand your imperative. I had DS at 38 and know lots of people having babies at that age and older (though for many it was 2/3 child). Even know one or two who started their families in their 40s and have more than 1DC.

And if you have the cash you can go for a private fertility MOT at £300 - saves on all the GP-chivvying and you get results in two weeks plus 2 dildo scans and loads of different blood tests.

Btw - what will you do if you have got a low sperm count? We are trying acupuncture for him - I was already going - and I finally got him to drop the nightly glasses of wine (which is how I got him to go for the SA in the first place by promising to stop nagging him if everything was fine - which it isn't. Boo.)

Good luck and I hope you get to the bottom of the cause of this long TTC.

[ArielNonBio]

Cheers Euro, and g'luck to you as well. I gather you're about to start? Is that right?

[AttilaTheMeerkat]

"And MrA is going for a jizz test soon, bless him. He has to drive 30 miles with a pot of spermz to hand in at the hospital".

Your GP is bloody useless and should have referred you on by now instead of messing around in ignorance. Both of you need to be properly tested and in tandem as well.

The above scenario is not ideal at all; such tests too also need to be repeated as one semen analysis is not fully indicative of there not being any male factor problems. Also the semen needs to be tested, a 30 mile car journey make render the sample useless for testing.

[ArielNonBio]

We don't have the money at the moment :(

Haven't thought that far ahead to be honest. He's very fit and healthy, doesn't smoke, drinks a very modest amount, and is basically a clean living vegetarian. His only vice is sweets!

I think we're probably going to be told we're "unexplained" like euro.

[ArielNonBio]

Can't alter geography, Attila, much as I'd like to. They don't deal with fertility this far west, so the sperm has to go up to Truro within two hours. We had a little kit and a book of instructions through the post. He went to the doc's in Feb and the appt came through for the 22nd March, which is when he has to hand the pot over.

I know it's not ideal, but that's the far south west for you.