TTC but don't think I'm ovulating - any advice?

[2023ttc]

Hi everyone. Long-time lurker, first time posting. DH & I are in our early/mid 30s. Both childless. I came off contraception 18 months ago. My periods have been very irregular (first one 6 weeks later but each period later and later, most recent was over 4 months since the last). I don't think I'm ovulating - is there anything that can be done? Already had blood tests and ultrasound a year or so back for period issues.

Saw GP recently with a TTC hat on. They've said they'll do more bloods and referral to gynae is a couple of years who would then have to refer me to fertility specialists. I was told "dont worry you have time" and that privately would be "20 grand".

Is there nothing in the middle? Surely costs of fertility treatments vary based on what the treatment is. Doing some reading I think I need something to induce ovulation / regulate cycles, I think this is what Clomid does? I just felt a bit hopeless to be honest. Already a "normal" weight (a little chubby in some places, working on it but BMI <25), never smoked, normally casually drink but currently teetotal in hopes of TTC. Not sure I can/would like to sustain that for years. Any advice?

I assume you were on hormonal contraception? I came off the pill and I don't think I ovulated at all in the year after. I then had ivf (unrelated issue, male factor) and since having a baby, my cycles have been regular and my body is basically doing what it's supposed to! I honestly believe I'd been on the pill so long my body just got a bit stuck and needed a reset.

Of course there is something in the middle, your gp is being ridiculous. Ovulation induction can be done privately and will not cost 20 grand. Depending on your circumstances, ivf may not even cost that - I paid less than £5k for mine. Given your age, I wouldn't hang around and I think it would be wise to start contacting private gynaecologists ASAP. If you are in london/Surrey I can recommend one who I saw prior to my IVF.

@OdeToBarney Yes - COCP. Did your periods get further and further apart post coming off the pill? The worry is if it continues this way... how infrequent could it get/will they stop. Its obviously really hard to plan TTC when periods are over 4 months apart but also feels pointless if not ovulating.

Not in London unfortunately (about 4hrs away), how quickly do people generally get seen privately? Does that make you ineligible to also stay waiting your turn on NHS? Could I ask what you had exactly and how much did that affect your life (I work full time, can be odd shifts).

There are lots of options. I saw one company a few days ago doing a male and female reproductive health check for around £300 (included bloods and scans plus sperm analysi) after that you could then decide on options.

They are being ridiculous saying £20k I would imagine that would cover a few rounds of IVF which you may not even need x

Yes they did, I think I had 4 periods in a year before starting the IVF!

Privately you could be seen within a few days. It will be much, much, much longer on the NHS. I don't know how that affects your entitlement to NHS treatment, I think for fertility treatment it depends on your local trust's policy. Google the name of your local NHS Trust and IVF policy and you should get an idea. Honestly though, age is a massive factor in success of any kind of fertility treatment or general ability to get (and maintain) pregnant so if you have the means to go private, I would.

My original gynaecologist appointment was covered by my private health insurance as I went under the guise of absent periods rather than fertility treatment. I think if I had paid it would have probably been around £500 including the scan and blood tests. I then paid around £4,000 for one cycle of IVF with ICSI as we needed ICSI due to using frozen sperm. This cost included all medication, scans, egg collection, embro transfer, bloods (except initial rubella antibody and thyroid bloods which I think were an extra £60). It also included an early pregnancy scan. We have also paid in the region of £1000 for two years embryo storage as we were lucky enough to have two embryos to freeze in addition to the one that was put back and is now my 10 month old.

Ivf is intense. You will need to inject medication every day for between 7-14 days to stimulate your eggs to grow. That's fine, you can work during that time, however you will also need to attend your clinic every other day for scans and bloods. This is why I would always pick a clinic close to home if possible. I was fine after egg collection and could have worked the next day, although I actually took a week off. Likewise after the embryo transfer I was fine and carried on working. Ultimately its a couple of weeks of disruption with hopefully a good result at the end of it. But it can be emotionally tough, especially when things don't go well.

But in your case, I wouldn't be jumping to ivf. I would consider ovulation induction first of all. Speak to a gynae and see what they suggest.

I don't ovulate either although tests showed I was borderline. I had IVF for my first child which was £3500 then clomid for my second which induces ovulation. For some reason they were very reluctant to give me the clomid, without explanation. If you can see someone privately for that it's around £600 per month I think.

I am on round 2 of clomid, done privately. Initial consultation was £150, private prescription was £14.50 - that’s it!! I had already had a scan and blood test done on the NHS though

If you can afford private esp. for clomid that's a good option. In most NHS trusts private IVF does count as one of your 1-3 goes but that's way down the line if you have to go there.

Thanks everyone this is all useful info.
Yes it just felt a bit like - 'not conceived naturally? must need IVF it will cost 20 grand privately or several years in NHS and in the mean time we'll do fertility bloods'. I asked what exactly costs 20 grand (is it IVF theyre referring to and how have we come to that conclusion, what else can be done in the mean time etc).

I have already had a scan for irregular periods rather than fertility issues and theyre doing fertility bloods (but wouldnt do AMH). These bloods aren't being timed (i.e not day 21) just a random one off set of bloods. Can I ask which blood tests people ? (@Longbin , how do you know you were borderline? and did they say why they were reluctant to give clomid, what are the side effects?)

@Superstorefan123 oh wow thats so cheap! could I ask who you are with? and are they monitoring you on Clomid, if so in what way?

thanks @Un7breakable , would something like Clomid/ovulation induction count as "IVF" do you know? I would have thought 'in vitro fertilisation' is different and more of an assisted conception that clomid?

@2023ttc with Spire hospitals! Nope no monitoring - not sure if that is a good thing really as I am on quite a high dose but certainly cheaper!

@Superstorefan123 thank you. how do they know if its working if theres no monitoring? or if its too strong and overstimulating the ovaries? Did you choose to opt out of monitoring or was it not offered?

How do you actually get Clomid/ovulation induction treatment? I have googled private fertility treatment centers near me and they seem to everything but ovulation induction - IVF, ICSI, IUI, embryo freezing etc. What would Clomid/ovulation treatment come under?

@2023ttc monitoring wasn’t offered… I know I am ovulating as I track BBT which confirms ovulation :)

I had to make a general gynaecologist appointment. I didn’t go in with ovulation induction in mind but once I had explained my symptoms (lots of follicles on ovaries, irregular periods, trouble getting pregnant) I was subscribed.

@2023ttc hiya I’m having assisted conception through the nhs at the moment. I’m near Bristol and there are some private clinics that offer it as well. Have they said anything about why it might be you are having irregular cycles? Did the scans and tests show anything? I had an instant gp referral to fertility when we wanted to TTC because I don’t have many natural cycles and can go months (up to a year) between them but I will caveat that with I came off the pill years ago didn’t have periods for months and had investigations then and was diagnosed with pcos. But those referrals and investigations in 2017 took about 2 months from seeing gp to diagnosis. pcos itself isn’t a reason for a quick referral as plenty get naturally pregnant with the condition but lack of periods is which is why I got an immediate referral. First fertility appointment was a about a month later in feb 2022 about 3 months to have all of the scans and tests they wanted to plan the best course of treatment (bloods scans and HSG and 2 semen analyses for my husband) started letrozole last summer, didn’t respond, currently using injections for ovulation induction then will go to ivf if no success. Clomid or letrozole should be monitored though, I was closely monitored, due to the risk of multiples and to make sure you are actually responding to it. Happy to answer any questions you might have

Be a bit careful with GPs...I respect them hugely, but fertility is incredibly complicated. They're not specialists.

Anyway, ovulation drugs have been used for many decades so they are cheap and safe and usually tried before IVF if there is no sperm issue. Fertility doctors told me that sometimes Clomid can weaken the lining of the uterus, so they gave me letrozole instead, which is better for women with PCOS. Plus they prescribed progesterone suppositories for the first 12 weeks to support the uterine lining.

Rounding up, I paid probably £500 for scans, blood tests and semen analysis for me and my husband (they checked my AMH i.e. egg reserve, prolactin, testosterone and thyroid), then another couple of hundred £ for ovulation treatment. Roughly every time I had a scan it was £250, and private clinics will scan you at least once so you don't have too many eggs and risk octomum! I didn't go via NHS because honestly I can pay for it so I should.

I'm in London so probs more expensive.

PS sorry to be really pessimistic, but I would guess the reason the private fertility centres don't mention ovulation treatment is that make less money off of it! Plus it can be easily done on the NHS.

That is the downside of private, I did feel a bit like it was a money making machine taking advantage of desperate women (which I was). Maybe I'm just being cynical...

I have a general question regarding the long waiting times on the NHS - I had already been referred to gynaecology a few years ago for period related issues (at this point was not actively TTC) saw the specialist over a year ago and was told of waiting times on the NHS for gynae surgery etc.
I have recently seen GP regarding TTC (still have the period issues, probably getting worse and more infrequent) and have now been referred to gynae again from a fertility point of view. They know I am already under gynae but said we need to do fertility bloods and send another referral but because I'm just under 35, "have loads of time" and wont be seen for a few years.

How does the waiting time actually work - I am actually due to see the gynae consultant in a few months (as listed for diagnostic surgery but because of COVID was told routine surgery wait is years and years and that i would be seen annually while waiting). At this appointment, if I mention the TTC - would they be able to get me started on Clomid etc move forward with the fertility stuff or would it be a case of no you must wait in line as the fertility issue is relatively new? I think the consultant specialises in both areas. What causes the delay in NHS fertility, actually getting that initial appointment with gynae? To be honest the irregular/infrequent periods and fertility are probably linked.

@2023ttc they might, gynaecology and fertility tend to be separate lists even if some of the same staff. But usually before clomid or letrozole they would do a HSG or hycosy to make sure the tubes are okay, no point in that route if there is a tube problem. My referral was to general fertility not to gynae and it did move quickly but not every area will be the same

@2023ttc this sounds very similar to me.

As you've not been trying for a year yet you might fall upon some long wait times for things. However, if you have been referred to your consultant, that's great news. But before you go make sure you have asked your GP for your full fertility profile blood tests including AMH. You will also likely need an ultrasound scan so they can look at your womb and ovaries. These you should definitely get done before your consultant appointment as they might not prescribe without this info.

What I would do in the meantime is enquire whether you can see a consultant in a private capacity. That appointment is usually somewhere in the region of £200-£250, of course this might not be affordable but thought you might want to know it is an option. You will still need all the above tests and the ultrasound but it might get you on something like Clomid, which you can try whilst you wait for your regular NHS appointment.

Hope that helps!

@2023ttc sorry, you have been trying longer than a year, I misread!

I'm happy to share my experience, but firstly i would say that especially if you are considering going private, don't ask for Clomid. There is a newer, more effective drug with better side effects and it works in exactly the same way called Letrozole. So if you are going to pay, you are better off getting that. Also, in most private settings, it is called "ovulation induction" so that might be what you need to google. I had my treatment in the NHS, but many NHS hospitals also offer a private route (i think when i looked at our hospital it worked out to be around £1000-1500 including consultant appointments and scans) so that could also be worth investigating.

For DD1, I had a referral sent by my GP when i had only 2 periods a year. I then got an appointment for an initial internal scan and a series of bloods taken at different points in my cycle. Once the results were back, i had an appt with one of the doctors to agree a treatment plan. This meant being referred specifically to the fertility clinic (so separate to the Endocrinology dept that had initially seen me), which meant another wait (and for us coincided with then covid so actually end up being nearly 6 months when in normal times, i think it would have been a few weeks?). The fertility clinic repeated bloods, scans and then wrote a prescription for provera (progesterone to bring on a period) and letrozole. I then had monitoring scans every 2-3days to measure how the follicles were developing. The first cycle, i didn't ovulate, so the dosage was increased. Process repeated on second cycle when i did ovulate but did not fall pregnant so the third cycle i was able to go away and do unmonitored, which did result in DD1. So although the wait time in total was quite long, there was lots of backwards and forwards etc so didn't feel too bad.

We now want to conceive a sibling for DD1. I went to the GP in November, who referred me to our specialist women's clinic which is run once a week by a gynae consultant. They did an internal scan in January and confirmed (and i saw) that i still had horribly cysty ovaries so probs not ovulating. They referred me onto the fertility clinic (although different borough as we have moved since then). I looked online and it said something like 10months wait so we were about to go private, when a letter came through with an appointment for April.

So in both those cases, it seems like i've had to go from gynae / endo onto the specific fertility clinic? Anyway, 3 months wait is not too bad given how terrible everything seems to be at the moment (i'm also 37 now and so am keen not to hang about) so for now we are continuing with NHS and see where we get to in the summer.

@Alexis7890 Thanks. I dont think theres a reason to suspect tubal disease (no history of STIs/PID etc). I think the obvious problem for not conceiving is the lack of periods which surely needs to be sorted out first (if they also want to test for tubal issues thats fine too). I dont think its a case of unexplained fertility issues if you see what I mean (GP was telling me to DTD 2-3/week etc, all good and well but without ovulating/no periods for months obviously no amount of DTD will work). They werent able to refer to my fertility - was told general referral to gynae then they would triage it and also take into account age (<35), other health issues (none diagnosed) and other things like if already have children (not the case for us).

@tarrazu Annoyingly they wouldnt do AMH, was told they arent able to in primary care and wouldnt know how to interpret it. They can do baseline tests including hormones (FSH/LH/testosterone/prolactin). I specifically asked about AMH but was told no can do, maybe the fertility specialists can. I have already had an ultrasound scan in view of cause for period issues (but not since TTC). It was fine so they didnt think it needed to be done again. Does clomid need to be timed, so I'd have to wait months till a period?

@YorkshireTeaCup thanks for sharing. Isn't Letrozole a breast cancer drug? A quick google search shows its being used off licence for ovulation induction, did you have any side effects? Were you counselled etc? Did you try Clomid first as I think thats first line? (Probably has its own side effects too but would have thoughts as its been used longer possible more is known about it). Thank you, I have tried searching "ovulation induction treatment" too without much joy.

Did anyone ever find out why they werent ovulating? Or were you just told its "multifactorial" stress etc? I guess I'm wondering if theres anything I can do while waiting for appointments etc.

@2023ttc i have PCOS which is why i dont ovulate. I also take metformin which technically is a T2 diabetes drug (PCOS can affect insulin resistance due to the way it messes with your hormones) but can be used off label for PCOS to regulate periods. In some PCOS sufferers, this brings on ovulation but it wasnt enough for me.

I had zero side effects with letrozole. Yes letrozole is used off label which is why GPs can't prescribe it so it has to be done through the fertility clinic. The doctor who did my treatment is one of the UK's specialists in PCOS and ovulation induction apparently - she sang its praises and told me not to bother with clomid first. Theres a big study going on at the moment that is aiming to get better data on clomid vs letrozole but some of the previous studies show that letrozole doesn't thin the lining of the uterus as much as clomid, is less likely to result in higher risk multiple births and had a higher success rate (ie resulted in more births). There was a fertility counsellor available but i didn't feel the need to use them - i was happy to discuss pros and cons with the doctor then go for it.

@2023ttc it isn’t so much tubal disease but for any blockages or scarring etc that might be causing a problem. Clomid and letrozole both need to be timed and taken on day 2-5 of the cycle usually but they prescribe provera or norethisterone which starts a period for you. That’s frustrating they couldn’t go straight to fertility! Letrozole is a breast cancer drug but works for ovulation induction with fewer risks than clomid, my nhs trust don’t use clomid anymore only letrozole.

@2023ttc from my experience yes it was timed, I took it from day 2 to day 6 of my cycle, luckily it arrived just after my consultant appointment. Small wins!

Sorry you are going through this OP. Did they find anything on your previous bloods or Ultrasound? Has DH had a semen analysis yet?

Pre-covid, I worked 4 mths of each year abroad. Due to appalling lack of care or understanding from my UK GP, I had testing done abroad. Hycosy, STI screening, bloods, AMH, semen etc. Although no actual cause for sub-fertility was found, GP referred me to fertility services. I don't know if my overseas testing sped things up, but the fertility clinic only did 1 further blood test. If you can afford it, I'd at least have a private consult. Ask what testing they'd normally do, and costing, and take it from there.

Many NHS fertility clinics will also see private patients and offer testing. Look into those, and they might be cheaper than an exclusively private clinic. Yes, they will be IVF focused, but also do other gynae testing:
guysandstthomasprivatehealthcare.co.uk/wp-content/uploads/2018/11/ACU-Self-Funding-Price-List.pdf

I ovulate, but never got on with urine OPK's. I used a re-usable saliva one. Many people aren't aware they even exist! Mine was called 'Maybe Baby' but you can buy other brands online.

The GP telling you 'not to worry, you have time' sounds like the same, dismissive GP I saw! Told me to relax, and that I'd attended days too early to have a D21 blood test done- so wouldn't do one. When they finally did a D21 blood test- told the result was normal, and no follow up offered.

13yrs of TTC, unfortunately, we don't have any living children. Going back- I wish I'd changed GP's much sooner and found mumsnet back then- to know what tests were available and that my lack of treatment wasn't normal. Best of luck op.