Initial fertility tests - where do I start?

[PuffPants]

We have been trying for about 6 months for DC2. We already have a 2 yr old DS and so DH thinks I am jumping the gun but I am concerned that I am over 35 and don't want to delay of we might have trouble this time. I am thinking of having some initial fertility tests done, ie. sperm count, ovulation check for me.

My question is this: can I just make an appointment at a private clinic or do I have to be referred by my GP? I want to do it ASAP rather than wait more months only to be told I should have got the ball rolling sooner. Hopefully it will just be for reassurance but if there is a problem is rather know now.

Have just called my GP surgery but can't get an appointment for 2 weeks!

No it's not too soon.

In theory your GP should send you for initial blood tests and sperm analysis after 6 months since you are over 35.

Some are reluctant but it's NHS guidance so they should do it. If you get a reluctant GP, try another one! You shouldn't need to go private.

You don't need to be referred to a specialist or clinic for the blood tests/sperm analysis, the GP just gives you the appropriate forms and tells you and DH where to go to get it done.

The usual initial tests that your GP will do are:

1. "day 3" blood tests, done on day 3 of your cycle (i.e. 3rd day of proper period)

2. "day 21" blood tests. These should be done 14 days before you expect your next period, or 7 days after you ovulate (if you know that date).

This will be day 21 of your cycle IF you have a regular 28 day cycle (hence the name "day 21" tests) but if you have a different cycle it will not be day 21. Be careful - many GPs tell you to get it done on day 21 even if you have a non-28 day cycle, they are wrong. It should be done 14 days before your next period or 7 days post ovulation.

3. thyroid function check

4. chlamydia check

5. Sperm analysis for DH

The day 3 and day 21 tests check the levels of various hormones related to fertility. In particular, the day 21 tests check the level of progesterone which (assuming you have had the tests on the right day) will show whether you ovulated that month or not.

see this page.

I agree that you shouldn't need to go private. NICE guidelines are that you should be investigated after 6 months if over 35.

I agree with everything minipie said, save that the "day 21" test should be 7 days after ov if you know when that is, or 7 days (not 14 - I think that is a mistake) before you expect your next period. My GP also did a general blood screen along with my day 3 tests.

If you prefer to go private, a lot of fertility clinics accept self-referrals. Look on the website or call up the one you are thinkking of going to.

Doh yes I meant 7 days after ov or 7 days before expected period - not 14 days!! Thanks euro

Thanks for the info - I have made an apt with the GP in a week and a half. I will ring every day to see if there are any cancellations.

Just one more thing (seeing as you are all so knowledgeable) can the day 3 and day 21 tests be from different cycles or does it have to be the same one? ie. could you test day 21 of this current cycle and then day 3 after that? Just thinking about speeding things up. Day 3 for me is tomorrow so a bit late although maybe I can get in somewhere for day 21 this month.

I'm also going to get some ovulations sticks again this month. With my last pregnancy they showed a very clear surge but when i tried them last month I didn't really notice much. When I lined them all up after 7 days you could tell that one was darker than the rest but not much - could this indicate an ovulation problem? Or is any surge a surge?

Thanks

They don't have to be done in the same cycle.

I'e heard on here that some people never seem to manage to catch their surge. What sticks are you using? (I don't think some get as dark as they claim, again by what people post on here.) When are you testing? My IUI clinic had me doing 2 day (first thing in the morning and then again in the afternoon) to make sure I caught it in order to time the IUI.

I had the same question puff but never got it answered. I am pretty sure they can be from different cycles, as they are measuring different things rather than comparing one against the other iyswim.

hard to say on the ovulation sticks - i'd say if it's not much darker then it's probably not a surge. Are you getting a second line for lots of the month? Do you have regular cycles?

Yes, pretty regular cycles, around 28 days usually though this month was 29 and last month was actually 25.

I think I was a bit half-hearted about the ov.sticks last month, didn't actually do all 7. Maybe I need to start a bit earlier in the month. I was waiting for the EWCM which wasn't very apparent either this month come to think of it. That's a bit of a worry really as last time we were ttc I remember it being very obvious. Hmmmm, hope my eggs aren't giving up on me!

DH always used to joke that my fertility would "drop off a cliff" at 35 (as an incentive to get cracking I mean) - he must have read it in the Daily Mail... seems they might be onto something.

Hi PuffPants

I think issues can crop up after childbirth that might not have been there for the first pregnancy which might also be worth investigating if all else comes back OK. I had IVF 3 yrs ago and got pg first go with my DD who is now 2. We have been back to try for a sibling without any success so far...

It turns out (through further investigations) that I have a slight immune issue - not enough for it to cause me any symptoms, but enough for my body to be making too many natural killer cells (NK cells) - which can lower your chances of pregnancy. I got these tests done on the NHS, but they aren't really good prescribing treatment for the issues, but luckily I am with a good fertility clinic.

If your initial tests are OK, it might be worth considering these as well as thyroid (as someone else has already mentioned I think) and also your vitamin D levels. Unfortunately regular cycles don't necessarily mean you are ovulating either...which I only recently found out.

Good luck with it all, but do try and get as much done on the NHS as possible if you can as fertility treatment aint cheap!!