First Fertility Clinic Appointment Tomorrow

[dogmam]

Me and my partner have our first appointment with our fertility clinic tomorrow!

We went to the GP after a year of TTC and after 21 day bloods and partners SA, we were referred straight away to the fertility clinic. GP tests were in October/November so it's moved along quite quickly so far.

Feeling slightly nervous but also excited to hopefully get some help! My partners SA showed low motility and morphology so I assume that will be discussed..
What else should i expect from this first appointment? Is there anything I should be asking?

Thanks in advance! I'll update this after the appointment tomorrow as I know there are a few others on here who are in a similar position and might find it useful.

@Juno231 Yes, I have introduced my new starter to the team this morning, and will then have to give the bad news this afternoon. I'm sure there will be some raised eyebrows, but the logic behind the hire/redundancies is sound and the roles are very different.

I'll defo bring a pad don't want any embarrassing patches appear on my jeans in the post office queue

@Juno231 sounds legit. I had it twice and the cannula thingy went in easily apparently, maybe the liquid also rushed out easily lol

@kay00 best of luck, those are tough meetings to have!

@thislittlebird haha tbh I've wondered that too - I didn't feel the cervix dilation at all!

@Juno231 I felt the balloon a bit, like a cramping. But I was too busy being stressed and anxious to compute exactly what I was feeling.

So Mr Ramsay is on holiday in June 🙃🙃🙃. No idea when we’ll get our results since his secretary is also off it seems. Need to email in July. The results aren’t due until the end of June or first week of July but I was hoping to get an appointment booked in for the week after they were due. More waiting it is!

@thislittlebird urgh, thats annoying! I suspect my consultant will be on holiday during July as she hinted she might be away and so we should expect our follow up call in August! Hopefully she's not on holiday for the whole of July though!?

I wondered how long did it take your fellas to get their SA results back? Its been 2 x weeks now and I thought we'd get them by now?

@kay00 call about the results - technically they're ready the same day as the SA as it's done as soon as the sample comes in. Officially I think it takes max 2 weeks.

@thislittlebird gah that's typical! A bit like @dogmam and the clinic closing for cleaning lol...

Morning ladies. I'm just back from my HyCoSy. I'm going to type out my experience/findings quickly now, before I forget them , so here goes...

I was encouraged to empty my bladder before I went in, and the nurse made me comfortable before my consultant explained my previously high AMH result to me. She said it was unusually high and indicated that I had A LOT of eggs in there. She suspected at this stage that I have not actually been ovulating at all . My other results (Prolactin, FSH, LT, Testosterone etc) were normal, so she said they indicated that i didn't have PCOS.

The started with the ultrasound scan of my ovaries. And straight away she found my left ovary was enlarged and poly cystic (13 follicles), my right ovary was borderline (10 follicles). She re-confirmed that she thinks this + my high AMH levels + my wonky/long cycles means I have probably not been ovulating.

Then I needed another wee (full bladder was getting in the way). Speculum went in (uncomfortable, but none more so than a Smear). The catheter I didn't feel, but the expanding of the balloon was pretty painful, like sever period cramps. Once in though it got a little easier to manage and the consultant and nurse did lots to make me feel calm. She injected the foam and we all watched the shoot up my fallopian tubes. They are both open and no blockages to be seen.

As soon as it was over I went for my third wee which raised a few eyebrows lol. And the consultant came back in to chat. She said that I have PCOS and has given me some leaflets. She said she will happily prescribe me Metformin, and I need to think about whether its right for me. And she said in out follow up consultation she will offer me Clomid.

The other good news is that my OH's SA was all good. He has been sent the results (which we will look at together over lunch) but she said to be 'in broad terms, there is nothing to worry about there' - yey!

@Kay00 I was going to start in August so no follow up until August for us means September 🙃. We got our SA results weeks later, maybe three or more. There was a delay and post problem or something.

Glad it’s done, that’s a lot of wees! What was your AMH, Kay? I can’t remember.

“And straight away she found my left ovary was enlarged and poly cystic (13 follicles), my right ovary was borderline (10 follicles). She re-confirmed that she thinks this + my high AMH levels + my wonky/long cycles means I have probably not been ovulating.” >>> Yeah this is exactly the same numbers as me except I’ve been told I’m not PCO/S lmao. I expect I’m PCO and not S. Welcome to the probably not ovulating gang, I guess.

How long/regular are your periods?

@Juno231 exactly! Get back from holiday, I’m not getting any younger here.

13 follicles on the left, 10 on the right

@thislittlebird hehe, thanks for the meme and for welcoming me to the 'not ovulating gang'!

Its very odd that you have been told you don't have PCOS? Did they give you any diagnosis? My AMH was 64 pmol/L and my cycles have been all over the place (between 32 days and 47 days with a few annoulatory cycles in there too... although maybe they were all annovulatory??)

@Kay00 it’s not the must fun gang ever . Maybe AMH is the difference. You have the higher AMH. I have an AMH of 36 and normal ish cycles. From about 25-36, but mostly 29. I just reading this when you posted:
www.dralexpolyakov.com.au/blog/polycystic-ovaries-or-pcos-whats-the-difference/

They say you need 2/3 symptoms for PCOS. Guessing I’m only ticking one box, which is high-ish AFC.

No diagnosis, just suboptimal ovulation, that’s why I assume I’m PCO without the S. Lister doc mentioned official PCOS diagnosis is 20 follicles on each side when I raised it, so guessing they all vary slightly in opinion.

And honestly, even as I read this it’s confusing because, when is a follicle a cyst and when is it a follicle? Very confusing, I’m none the wiser. Maybe I’m not even PCO, no one has said much other than I could be borderline or just have a good reserve. 🤷‍♀️

@thislittlebird cyst is a misnomer, you don't actually have cysts with PCOS - it's just lots of follicles if that helps. Is there anything in the NICE guidelines on the diagnosis of PCOS? Certainly sounds like you and @kay00 are in similar situations but are getting very different care.

@thislittlebird My consultant seemed quite pleased that I had high egg reserves, even if I wasn't managing to pop them out... as there are many 'easy options' for encouraging ovulation.

I must have 2 x symptoms: The multiple follicles and the wonky/long cycles then I suppose. I do get some cycles that are a more 'normal', in fact the last two were 32 days long with supposed ovulation on day 18/19. I have been singing the praises of Concieve Plus Ovulation Support (which I started just before these two normal cycles) but maybe I still haven't been ovulating?

I need to think about whether to try Metformin, or whether I just jump straight in with the Clomid?

My OH suggested we freeze some eggs too (Which really made me laugh as he has previously said he only wanted 1 x child max, and he'd be happy if we had none... maybe he secretly wants a small tribe?!) but I think I'll give one of these treatments a go first and see how we get on, if no pregnancy in the next 6 months, maybe we can freeze and look at other options. I'm 36 in July by the way.

It also looks like I can take Metformin and Clomid together... I need to do some research!

@kay00 yes the metformin will be good regardless of TTC - but maybe ask for the slow release version as a lot of people really struggle tummy wise from the regular one and obviously you have a sensitive gut already.

The treatment or care seems the same roughly but different diagnosis because different results @Juno231 (discounting my weird nhs experience). I’ve had three consultants say I’m not PCOS (one said maybe borderline but was very unbothered about it all) so it’s not something I’m concerned by especially. I’ve read about the classifications over the last few months and the only way I fit it is follicle count (since they can’t confirm I don’t ovulate), so PCO or borderline PCOS maybe, as per the article I was reading. I think @dogmam is the same, has lots of follicles and nothing else? Unless I’m misremembering. Feels like there’s lots of people just floating in the maybe maybe not zone.

They can’t tell an empty follicle/cyst from one with eggs in so the term polycystic sucks because of this, and I know there’s campaigns to change it.

Yeah they’re always thrilled with the egg reserve lol. I’ve been offered Letrozole by the private clinic and I think @Kay00 is private too. I just don’t know whether I want to try Letrozole at this point, would rather go straight to ivf I think. And that’s if we can try it, sperm quality might be too poor. I would definitely try it if the nhs had offered it to me, or if I was 36. I’m 38 now and not keen on losing more time. You definitely have time to try the metformin and or clomid if you want to.

I’ve contemplated trying CP Ovulation Support but don’t want it to mess with my cycles ahead of ivf. Do you temp? Not sure if that would help you know if it’s helping.

@thislittlebird yes I temp, but looking at my cycles it looks as though I haven't had many cycles in the past year where my LP temps were much higher than my follicular phase... so maybe I wasn't ovulating in those cycles.

I have had my follow up appointment date come through... Tuesday 3rd August. I could finish this cycle and be mid-way through the next before I get offered Clomid, so I need to think about whether I should call up for my Metformin prescription now (she said she would do that if I asked). That would give me a month and a half on Met before starting Clomid (or will she suggest I take the Metformin for longer before I start Clomid)?

I'm a bit worried about the effect Metformin can have on your stomach (it seems to make a lot of women quite sick) and seems to work best on women who are insulin resistant.... which I assume I'm not (although I do seem to wee frequently, and I'm always freaking starving)!

@kay00 I'd perhaps push back and ask about whether they think you may have insulin resistance and explain you dont want to take metformin unnecessarily due to your gut problems? FWIW I think plenty of women have no such issues whilst on metformin - or you could start on a low dose and slow release one at that?

@Kay00 how much did your temps rise when it didn’t rise much? Is that a weird question? Mine didn’t rise a lot or was slow to.

I was thinking about this today, after reading about it all and I wondered how they test for insulin resistance. I’m not sure I’ve ever had such but I’d be interested to be tested after learning about my follicles. Is it just a regular diabetes test?

Like @Juno231 said, you might be fine on metformin. I was debating buying the ovulation support and seeing if it works, just not sure it will because everything seems very borderline with me.

I go round in circles thinking I may have PCO/S and may not, does my head in. Either way, I have only a few the symptoms (anxiety, high cholesterol, lots of follicles) and I don’t know what that says at all because these things aren’t exclusively PCOS things. The rest aren’t an issue for me. Except for infertility 🤪

Either way, no one has helped me get hold of clomid or Letrozole. Might ask the new GP when I speak to him.

Oh! I missed low sex drive. I wonder why that’s on there? Wonky hormones thing?

So low sex drive, high cholesterol, anxiety, follicles and infertility. Very slightly irregular periods (but not always). Maybe you can be a little bit PCOS 🤷‍♀️

@thislittlebird Hehe, not a strange question. I have attached an example cycle where my post ov temps are still quite low, and I assume ovulation didn't happen.

I assume insulin resistance is tested through a blood test? But could be a urine sample. I might ask the doctor to do one, not that I think I'm resistant, but my chances of being resistant are higher and I do urinate a lot. Like a lot a lot 😆 if I yest positive for insulin resistance then I might go on the metformin.

It might be worth giving the ovulation support tablets a go, if you are borderline then maybe they will push you over the edge and help you ovulate?

Also a chart from a more recent cycle when using the ovulation support... hopefully I ovulated! 🤞

@Kay00 yeah I’m thinking about it. I’m concerned they’ll drag my cycles out or something when they’re an ok length mostly. Maybe I’ll try one month and see what happens.

Here’s the last chart I did in January for comparison.

I’m going to ask the doctor to test me for insulin resistance too, since I’m asking for a ton of other tests anyway lol. I definitely don’t have the frequent urination thing you describe, is that a classic sign?

@kay00 pleased the SA come back with no issues and that the Hycosy is over with. I dont know much about Clomid or metformin but worth a shot. Was anything mentioned about IVF or I suppose that will be the next step although hopefully not needed.
Interesting about the PCOS diagnosis, that's right @thislittlebird my AFC was 32 but as I have regular periods and no other symptoms (excess body hair, acne, overweight) they dismissed, something about 'keeping it at bay' as I am 'lean', think she was referring to normal BMI perhaps. Having said that, at my consent appointment the doctor mentioned about being borderline but again didn't really elaborate or confirm and to be honest I never pushed it because I just feel like ICSI is the way forward for us anyway.

@thislittlebird have you thought about how you want to go forward with things in terms of your partners SA? I know you want to wait for the Dr Ramsey appointment in July but is it worth getting the ball rolling with IVF/ICSI whilst waiting?

I'm counting down the days to AF so I can ring the clinic to see if I can start this cycle.. hope there's space for me because I really don't want to wait another month when I feel like I'm in touching distance.