Seeing GP next week for fertility issues, what do I ask?

[TigerseyeMum]

Righty. After trying to get an appointment since November I finally have an appointment with a female GP.

What do I need to ask about wrt fertility issues?

This is me: 39, ttc for 2 years no luck. Severe endometriosis, consultant suggested another lap might help if necessary. Hypothyroid, allegedly in the normal range now. Went on pill briefly for 3 months Last summer which unfortunately reset the clock on ttc so GP (male) refused to refer me to endo consultant Until I'd tried again for at least 6 months (grr). Not sure I want another op anyway.

What do I need to ask re: blood tests, treatment...I think with my GP practise you have to ask otherwise they don't offer, especially as I am over the age of 37.

Please help me sound wise and knowledgable and not be fobbed off again by an uninterested GP

I would bypass the GP doing any tests given your previous medical history and ask immediately for a referral back to a cons gynaecologist at your nearest city based hospital.

The thyroid problem needs to be rechecked as well as the endometriosis as this can recur.

Re the gynae I would try and see a cons gynae who also has an interest in endometriosis and has up to date knowledge; you do not want to be seeing a standard issue gynae here.

www.endo.org.uk is a good website.

If GP is unhelpful see another GP within the practice or change GP practice. No point in talking to someone who is unhelpful and or cannot be communicative.

Last time I got referred though to the endo specialist it took about 12 months to get an appointment, I'll be almost 41 by then :(

I wondered if the gp could run any useful tests in the meantime?

I agree with Attila and would asked to be referred to a gynae. When I was referred for fertility problems the hospital spent the first 2 appointments basically redoing all the tests the GP had had done.
You need to be insistent with them- you are 39 so you know you don't have time to sit around. I think you need to make sure your Gp knows how much you want this and how upset you were that you were put back another 6 months. My GP really wasn't interested in referring me after 2 years of infertility until I basically made it clear how upset I was. I felt weird as I'm not overly demonstrative but honestly if you don't you will keep getting fobbed off.

Have you had blood tests / pelvic scan done? Agree with atila ask for a referral to fertility clinic, gynae as GPs are very much clueless about ttc issues.

We had our first appointment with GP and they referred us for initial blood tests DH and me both to check Vitamin levels (iron, vitamin d etc), TSH, kidney funtion (not sure how that relates to my ovaries!) prolactin and testosterone check for DH.

Within our first appointment we also got referred to the fertility clinic and got an appointment for DH's SA. Also GP scheduled us in for pelvic scan to check for PCOS. I have cysts on my ovaries, but I ovulate every month with regular periods so fertility clinic have diagnosed me with mild PCO.

Fertility Clinic asked for further blood tests, more useful ones like, LH / FSH on cycle day 3 and I had a recent 21 day Progesterone blood test done. These confirm if you have hormonal imbalance and confirm ovulation etc.

GP didn't spot I had hypothyroid as they class 3.3 as normal, however fertility consultant has informed us it needs to be under 2.5 to sustain pregnancy. So have been prescribed 50mg of levothyroxine.

I've had most of those blood levels tested, not had a pelvic scan but having had several laps the consultant said my tubes had all been clear so no blockages etc. of course that might have changed so a new lap was suggested 2 years ago by him when I started ttc.

I get ovulation pain and regular cycles but do get a lot of ovarian cysts because of endo. I have had a few massive ones that needed operating on but nothing that bad for years.

My DH has not been checked and I've not had bloods done to test hormones.

The male gps just said 'you're running out of time, you'd better get on with it' (helpful) then said their cut off age for treatment is 37. I think that's why they don't want to refer but as I have stage 4 endo I reckon I can get a referral on that basis alone.

So, I will get all my test results written down and maybe ask for a referral and go armed with all the results do far and see what they say.

Hi Tigerseye

I can only re-iterate what others have said before me. I am TTC my first and I am 43 (so you are a spring chicken in comparison ). I went to my GP after TTC six months because of my age and was worried I was going to be fobbed but I needed have worried my GP was fabulous! So I have had the FSH at day 3 (this checks that your hormone levels are enough to prepare the egg ), prolactin, thyroid, glucose levels, kidney and liver function, and I am just waiting for my day 21 progesterone results (to check that a) I am ovulating and b) if I am I have enough to support implantation and sustain a pregnancy). DP has been referred to get a sperm analysis done. So far my results have been really good for such an old gal and well within the normal range but I still know that my egg quality might be rubbish.

I am not entitled to assisted conception under the NHS due to my age and my DP has children from a previous relationship but my GP is happy to support me up to the point where I need to be referred to a fertility consultant and explore what assistance we might need. I am well aware that we will have to pay for that but she did talk me through that I was entitled to be referred to fertility clinic appointment under the NICE guidelines so you should read these before you go and gen up on what you are actually entitled to: guidance.nice.org.uk/CG11.

I also think it would help if you are really clear what you want from your GP, so if you say this is a summary of my journey so far, these are my issues and I would like you to refer me to a consultant gynae/fertility clinic given my age, length of TTC and medical history. Then say nothing and let them do the work .

I really wish you the very best of luck. Fingers crossed it goes well.

Thanks all for the comprehensive advice. I shall have a read through over the weekend and get myself prepared.

Is it just me or does everyone think of a Full Service History being done when you get your FSH?! I better go learn the lingo...

Just to report back: sensible lady GP has referred me to the fertility clinic plus is running tests on blood count, day 21 and sperm tests.

Thank goodness someone has some common sense.

Thanks for all your advice ladies :)