Fertility tests - what am I missing?

[JoCM]

I’m going into my 12th cycle ttc and feeling sad.
I’ve had day 3-5 bloods, transvaginal ultrasound, hycosy, AMH, thyroid, iron - and OH has had a SA.

Everything has been fine apart from progesterone has been a bit low on one of the day 21 tests. I had some cyclogest to try this cycle but on Mira my progesterone was much higher than it ever has been so I didn’t take it - but I don’t know if that was silly now..

I think we’ll be looking at IVF as i can’t think there’s anything else to try, though I’ll give the cyclogest an go, apart from maybe daye micro biome? Is there anything im missing? Not sure what else to do.

Ask gp to do
Prolactin
Crp
Vit d
B12

Also get celiac ruled out.

Have u had pcos recently ruled out ? - hertility health are very good - 150 gbp.

Have you had a hyfosy / tube flush ?

Do any of your immediate fam have auto immune stuff ?

Also - how old are u ?

Progesterone declines with age - from over 30
( our ivf consultant told us that )

Also worth asking gp to do blood clotting test -
( best to get it checked )

@worldwidetravel2017 thank you. I have had my prolactin checked which was normal. Haven’t had vit d/b 12 though I do take a prenatal plus vitamin d.
i have also had PCOS ruled out by androgens blood test plus ultrasound - also don’t have any other symptoms. I did have a hycosy and my tubes were clear - 2 cycles ago and was hoping might make a difference but sadly not.
no one in my family has auto immune problems - I hadn’t thought about blood clotting - would my GP do this and crp? I feel bad as I keep asking them for stuff.
sadly am 35 - started ttc at 34 and was hoping it would’ve happened my now. My AFc was good though at 26, and my AMH was ok I think, 16.

My advice would be to take 1000 iu vit d

( prenatals often have just small amount and many brits vit d deficiency )

Yes gp can do crp and blood clotting

Theres 4 types of pcos - and to have it - you only need 2 things off a very - very long list ..

Ask gbp to test shbg
( shbg often low in pcos patients)

Id advise you to do the HH testing if you havent - they are way more thorough than nhs re pcos

You also want your b12 at least 300 ish really
When mine was 200 ish - ivf consultant wasnt exstatic.
Even300 = lower end

Nhs bands 4 things are wide

Gp will mark some tests ok
Whereas ivf consultant would often re test or query some

Your progesterone will likely be low due to age ..

Have u discussed with gynae or fertility clinic etc

Do you have any living children?
Have you told nhs how long youve been ttc ?

What number was your feretin? You want it at least 80

Feretin needs to be gd to get preg and stay preg

And thats not nhs gp saying good - thats a consultant saying good..

Was progesterone over the 30 ?
How long are your cycles?
How regular are your cycles ?

@worldwidetravel2017 my cycles are 26-29 days, I’ve never missed one. My progesterone was 28 one cycle and 20 another which I know is low - though I have seen varying reports on what is normal - but also progesterone seems to fluctuate a lot so it’s hard to really tell…My luteal phase isn’t short, it’s 12-14 days. All my other hormones were fine.
I spoke to a consultant about it, which is how I got the cyclogest if I wanted to try it.
i live in Scotland so you don’t get fertility treatment on the NHs (unless there’s a known cause) until you have been trying for 2 years. Sadly don’t have any children.

They like progesterone to be over 30 to confirm ovulation .
Tnats what many clinics say.

Honestly - i know i sound like a broken record but i really feel like theres more going on..

For progesterone 7 days after ovulation - ' should ' be over 30

I knw i sound like a broken record

But i really recommend hertility health

They explain results

And those private results can go to your gp too if you want .

I'm a GP, prolactin is part of standard sub-fertility screen, none of the others are - you don't get to request tests on demand. Everyone should be on a vitamin D supplement anyway.

@JoCM next step is referral to a fertility clinic for assessment of tube patency then they'll talk about IVF or other treatment. Have you been referred?

Depending on peoples needs and history - some gp 's will do those tests
Ive had them done - as have many others

Theres a book called - it starts with an egg

Which recommends many

I corrected 3 deficiencies b4 we started ttc
Then conceived fast
Then early miscarriage -
Then other diagnoses and then ivf

But things like blood clotting = important to rule out

( im on blood thinners now)

Day 21 tests are actually supposed to be 7 days after ovulation, I ovulated on day 16, so my day 21 was actually day 23 for me

@bluecurtains14 thank you. I’ve had a hycosy and my tubes were clear. I have already the had other tests at a fertility clinic - ultrasound etc where I also got the hycosy - and they ruled out polyps, fibroids, everything else structurally looked normal/good. We have another consultation coming up next week where we’ll look at IVF. Just wondered if there was anything else I was missing….

ah I see - yes sounds like heading for IVF then, good luck.

Hi OP, I would suggest more investigations for your husband. Has he had DNA frag? I would recommend the extend, some time known as comet. We were unexplained infertility for years- all my husbands SA came back brilliant. A private consultation recommended this based on our ivf round and boom, that was the problem. I think we always assume it’s us and I had every test under the sun convinced it was me. Make sure to throughly investigate your partner too. Best of luck xxxx