Initial fertility tests - what have people done, or considering? (TTC)

[CC81]

I find the 'not knowing' part of TTC really stressful - in terms of my fertility - which I think has an impact on my general wellbeing (and thus probably natural fertility). Aaaagh, the irony!

I'm wondering how useful it would be to get a private consultation and pay for an AMH test, to check egg quality/quantity. Is anyone else looking into the same thing, or has done it recently?

I know hormone tests are available via GP - but the NHS is obviously under pressure and it's tough to book blood tests on the right days (i.e. CD3-5 for FSH etc. and CD21 for progesterone). Especially as my cycle went randomly wonky last month, so predicting dates is unreliable. I had the same tests last summer and they were normal, but the results may be different a year later and I don't want to waste precious time (I'm 38).

One of our local clinics offers a 'Fertility MOT' where you pay about £400 for a couple to have all the tests (including AMH) and a consultation.

Alternatively, if I get a GP referral, I can get an AMH test at the clinic for about £170 - but I'm not sure how the results would be interpreted (the clinic said they'd fax them to my GP, but the GP sounded unsure and said she'd need to check with a senior partner at the practice).

It's all a bit confusing and frustrating. We've been TTC for about 6-7 months and I've got worried in the last month because I had the random long cycle. I literally don't have a clue what to expect, this cycle - I've started temping, using OPKs, etc., to try to get some idea.

If things don't settle down, I think we'll end up doing the initial MOT thing. But if they DO get back to 'normal' - i.e. cycle length, signs of ovulation - I'll be more inclined to see how the NHS process goes.

@Tink2019 - Ah, yes, that makes sense! Thanks :)

Just an update: I managed to get an urgent appointment for my 'day 21' progesterone test (except it was actually day 26, as that's what I estimated to be 7 days after ovulation - I had an LH surge on days 17 and 18, so probably ovulated on day 18 or 19).

It's come back "normal" and "indicates ovulation", which is a huge relief. It's a box ticked, at least. The rest of the blood screen was also normal (they tested for tons of stuff).

So... I'm encouraged. But I still need to make a decision about the private 'fertility MOT' (which includes scans and all sorts, to check egg quality/quantity, potential physical barriers, etc. - I had a c-section in 2017).

We've been trying for about 6 months, but I feel like I've only been fully informed about how everything works in the last few weeks, to be honest - and it's been such a weird year (which I think has affected my cycles).

So... hmmm. Maybe I should wait until my period starts (assuming no BFP) and then take the plunge.

How is everyone else getting on?

Hi @CC81.
I just recently had a couples MOT which was helpful in terms of the semen analysis and anatomy scan, but the other indicators they test are AMH and AFC which, as a previous poster said, are really only relevant indicators of how you would respond to IVF.
There is no test for egg quality unfortunately, and the best predictor of this is age. The % of chromosomally normal eggs declines with age and reduces the chance of conception each month. I wish this stuff was taught in school!
I read 'It starts with the egg' on how to improve egg quality, and found it overwhelming but have started taking ubiquinol.

@sweetpea2000 - Thanks for the message. How were your results?

Unfortunately, after my good 'day 21' results, I had my 'day 3' hormone tests at my GP practice and my FSH was higher than ideal, at 15.9 - which indicates a low ovarian reserve. It should ideally be below 10. But it's good that it's lower than 20. Apparently people DO get pregnant with similar levels. But there's a lower probability - especially at my age (38).

We'll continue trying naturally - but we're going to pursue private treatment and see where that leads. I've been reading about natural/mild IVF (instead of conventional IVF), which seems to be focused on quality over quantity and is aimed at those with a low reserve. But we need to do a lot more research.

I've booked initial private tests for September (AMH, AFC, etc.) and started taking ubiquinol about a month ago, so hopefully that should help.

Also planning to look into acupuncture, to help my stress/anxiety/sleep (and thus improve my general wellbeing)!

@CC81. My results were quite good - just over 30 for AMH and AFC.

I will also request the hormone tests from my GP next. Like AMH and AFC, I'm not sure how much FSH indicates the likelihood of conceiving naturally. Does a low ovarian reserve matter so much for natural conception, when you only need one egg, rather then IVF where you want to maximise the number of eggs?

I thought egg quality is the main issue at older ages, and there is no measure of that, it's just a case of taking longer to try until you get a good egg. Am I right?

The frustration at older ages is that we don't have as long to wait to try, before seeking assisted treatment, as the likelihood of the treatment working is reducing all the while. It's so hard to know how long to keep trying for, or when to get help.

Have you selected a clinic yet?

I'd be interested to hear how you get on with the acupuncture too - I've been really struggling with sleep and stress levels, and know this doesn't help!

@sweetpea2000 - That's a really good way of looking at it (thank you). Yes, I think you are right.

I've seen lots of people say similar things - and I've also read the same about scientific studies - but sometimes it takes a while for the penny to fully drop! I think you've hit the nail on the head with the way you've described it (or at least, I hope you have).

If trying to conceive naturally and ovulating monthly, then the key is for timings, conditions and a good-quality egg to all work in harmony.

But for IVF, from my limited knowledge, it's all about quantity (to raise the chances) - so the overall reserve carries more importance.

From that point of view, I wonder if IVF can actually cause problems too, as surely it depletes the reserve more quickly, not to mention all the stress! But I can understand the desire to move quickly and get some sort of answer (we may opt for that).

We'll be having our 'MOT' tests at Manchester Fertility, as it's our nearest and only £395 for a couple. We'll be asking tons of questions.

Congrats on your results - they sound really encouraging so far :)

@CC81 From what I understand (and perhaps someone more knowledgable will come on to correct me!) I don't think IVF will deplete the reserve. IVF stimulation will still only generate tens of eggs. And I think at an older age the risk is not literally running out, we still have thousands left, but it's just that fewer of them are chromosomally normal, plus there is a higher risk of annovulatory cycles. So there is a lower likelihood of successful conception.

I think the risk with IVF is that we miss out on valuable 'trying time' for natural conception whilst the process is taking place. Sometimes the likelihood of conception is just as high naturally as with IVF, we just need more months to 'roll the dice' IYSWIM. I'm not sure how long a cycle takes and how long it takes for you cycle to reset afterwards.

I'm sure they'll talk you through it all and have stats. I found Manchester Fertility really helpful for our assessment (Dr Munjeera) and if we aren't successful by the end of the year we'll be going back.

@sweetpea2000 - Good to know you're going to the same place! Thanks for that.

There are so many things to weigh up. I guess now that I've booked the appointment(s), in the meantime the best thing I can do is focus on improving my wellbeing - and hope that I keep ovulating!

Good luck for your next cycles :)

Hey, I’m in a similar boat to you all, I’m 38 and after several miscarriages was referred to a fertility specialist where I had bloods done on cd2 and my day 21.

I had texts from my surgery to say results were ‘normal’ but wasn’t until today I could actually view the figures for myself.

I have no clue what the numbers mean and although they call them normal, I don’t know if that means they’re any good for ttc.

I have 3 children already and because I now seem to struggle to remain pregnant I figure it’s clearly to do with my age etc.

These are my results if anyone is a bit more clues up than I am.

Day 2 - serum prolactin - 144miu/L
- serum testosterone 0.7nmol/L
- serum TSH - 0.9miu/L
- serum LH - 2iu/L
- serum FSH - 5iu/L

Day 21 - serum progesterone - 67nmol/L

@Moominmiss - Yes, those results are really good - definitely encouraging from a fertility point of view (from what I've learned recently).

Hopefully you'll get to the bottom of whatever is going wrong - but at least you know it doesn't appear to be your hormones (or egg reserve).

It's rather a lottery, isn't it?

I'm finding it difficult to believe that my situation is SO different to just a couple of years ago. I wonder if maybe I was just super-lucky to conceive our first child immediately (it's the one and only time I've ever been pregnant).

@CC81 really? Thank you. I was just confusing myself even more trying to google what normal levels are.

My main worry was that I might be perimenopausal due to my age.

As you say it really just seems to be a lottery. My thinking is that so far it’s likely been my ‘old’ eggs and the fact they just aren’t as good quality anymore.

My 3 children were conceived really easily but I had my last 6 years ago which is a long time in fertility terms.

After my first miscarriage in January I put it down to bad luck, but then after another 2 losses I started to wonder what’s going on.

I’ve been taking ubiquinol now for nearly 3 months so I’m hoping that might do something to help with egg quality.

It’s really positive though that you conceived with no issues only a couple of years ago! 🤞🏻 It will just be a matter of time before you’re pregnant again!

@sweetpea2000 - Do you mind me asking how long the waiting times seem to be at Manchester Fertility?

@Moominmiss - Well it was actually three years ago now, but still feels very recent!

The thing is, for all I know, I may have already had a low egg reserve back then - but the right egg was released at the right time. It's impossible to know!

So sorry about your losses - it must have been such a difficult time.

@CC81 it was two weeks for the appointment and one week following that for the consultation, so pretty quick.

@sweetpea2000 - Oh sorry, I meant to start IVF treatment (once you decide). Did they give you any idea?

@CC81 oh right... they didn't say. They just said to come back if we hadn't conceived naturally in 4-6 months. I actually liked that they didn't pressure us to sign up sooner.

But I don't imagine it would be long. From what I've read on here, most clinics will put a protocol together quickly.

@sweetpea2000 - Cheers. Will keep fingers crossed. I've got tests on 2 September then the consultation on 22 September.

Hi ladies has anyone had an internal ultrasound scan? I will be having one this evening as we’ve been trying to conceive for a while now and still nothing. It did take 18months for my periods to return after coming off the pill. I’ve had bloods done by my gp which came back fine so I’ve now been referred to the hospital for test which start this evening

@Suki2020 you mean a pelvic ultrasound? Yep I had one as part of the fertility MOT to check the uterus and ovaries/ follicle count. It was very straightforward.

@sweetpea2000 yeah pelvic ultrasound. Did it take long? Did you find out there and then if there were any issues or did you have to wait to see your gynaecologist?

I have been ttc for 8 months now. I did get pregnant first try but unfortunately had an early miscarriage at 5 weeks. I have been using opks and tracking my temperature. I do get a positive opk and I do get a temperature shift but not in consistent with each other. I don't get a temp rise until 3-4 days after a positive opk. I was using 3 apps (I know over the top) but they all predicted different ovulation days as my slow temp rise is throwing them off. Also two apps are saying I have a short luteal pahse because of the day they predicted ovulation and 1 reckons I'm normal. I have not seen any other charts like mine and is really starting to get to me. I am waiting to see a gynecologist but God knows how long that's going to be. Anyone experienced something similar? xx

@Suki2020 It didn't take long and was painless. The sonographer talked me through what she was doing and looking at (uterus, ovaries, follicles) but she didn't tell me much. I was asking her if everything was okay and was paranoid from her reaction that there was something she wasn't telling me!

But when it came to the results everything was good. I received the results from a consultant about a week later.

I've just realised based on this thread that I think my doc has messed up the bloods as well. I've had 2 lots of bloods done (1 set but they said they needed repeating for some reason) both were day 21 ish.

The doc didn't give me the results but just said they were all normal (I asked but she wouldn't give them).
Partner is now waiting for his SA results (again they needed repeating).
I'm 41, he's 40, ttc our 1st, just hit the 12 month mark

@Sammyleigh28 - Have you had blood tests done by your GP? Day 3 for LH/FSH and day 21 for progesterone (among other things).

My day 21 results were fine, but my day 3 FSH was rubbish - so I'm now paying for private tests for AMH and AFC.

I've found BBT, OPKs and apps useful for monitoring when things happen, but they can also be misleading.

@claireb707 - Sounds like you still need to get your day 3 blood test done, for LH and FSH.

See my comment above - my FSH has been a red flag! So I'm onto the next stage of investigations.

Annoyingly, I was told last year (after similar tests) that "everything is normal" - but now I think they messed up the FSH test, which may mean I could have been warned a year ago. Nothing I can do about it, though (and it may have made no difference).

Just rang to check and FSH and LH weren't requested so would have to speak to doc again to get them requested and then get an appointment for them to be taken. Missed this month now as am cd11 so will have to wait.

Still waiting to hear about partners SA at the moment