Secondary infertility tests?

[Prinsessa]

Hi,

We have been ttc for 2 years. I am 36 next month and we have got a 4 year old boy already. I have already had the following tests: 21 day blood- ok + thyroid test -ok, husbands sperm test- ok, scan revealed a (1 cm) polyp - removed in April during hysteroscopy consultant said womb appeared ok. Got pregnant 4 months later but miscarried at 5 weeks (5 days ago!). I have been given an appointment with a fertility consultant on the nhs in a couple of months. I want to make sure that the correct tests are done now going forward. I assume that it is probably worth having a HSG, although I did manage to get pregnant- although I miscarried, so wondering if this will help in our diagnosis? What other tests should I push for when I see the consultant? I am just conscious that I am not getting any younger and am expecting there to be quite a wait on the nhs, so want to try and determine quickly which tests i should ensure I get scheduled in. Any advice? Thank you!

Hi

You need a day 2-5 LH, FSH and oestradiol, day 21 progesterone if you have a 28 day cycle (is this the one you had already?) If your cycle is not 28 days then you need to have your bloods done seven days before the expected onset of a period. You need an ultrasound to assess your antral follicle count. Consultant will probably want you to have an HSG, HyCoSy (similar to an HSG) or a repeat laparoscopy/hysteroscopy/dye - unlikely if this was only done in April though.

Although semen analyses are good indicators, the Consultant may want to do what is called a sperm separation test (also known as a swim up) to look at how many "really good" sperm there are.

Some NHS Trusts are able to offer AMH levels - a blood test to assess your egg quality. It is an excellent indicator, if you can't have it done on the NHS (some labs don't have the assay) then I would strongly recommend that you have it privately - cost approximately £100 depending on where you go.

One thing that I would warn of though, and this is going to sound very dramatic and negative, is that if you need assisted conception then this is an absolute minefield. As you have a child you unfortunately won't be eligible for IVF/ICSI/IUI on the NHS, but depending on where you live you may be able to have other treatment - for example, there might be something simple that they can do which would have a big effect, e.g. if your periods are irregular then you may be able to have clomiphene (please be very wary if they offer you metformin without a trial of clomiphene - can't tell you how without outing myself but please just trust me on this). However this may or may not work depending on why you have irregular periods. If you have regular periods then the evidence shows that taking clomiphene can reduce your chances of natural conception.

Hope this helps and good luck!

Sorry to hear your news. The list above is great. Just wanted to say they will not necessarily offer all those tests due to previous pregnancy and birth of child. As I have found each NHS area offers different treatment. And as the poster above says unless they find a medical cause of infertility they are unlikely to offer any treatment options ( again due to recent pregnancy etc) and if you need IUI or IVF you will have to pay. You need 3 miscarriages to have miscarriage tests but worth an ask ( sometimes a kind dr will do them after 2 miscarriages).

Hoop you're absolutely spot on: tests won't necessarily be offered, but to be blunt there are NHS units out there who will deliberately not offer even the most basic of tests, instead insisting that everything has to be private. Not necessarily the aim of a fertility service - especially as most CCGs are quite happy to fund full investigations as long as the female partner is under 40......

It is encouraging you have already had Tests and got a referral though

Hi both,

Thank you so much for your advice. This gives me an idea of what is available and what I should be pushing for in terms of test. I have a regular period (28-29 days) so perhaps clomiphene is not something I should be taking then? One of my friends mentioned she had been on it, so was wondering if it was something that I should consider. I actually had my polyp removed privately but felt that continuing going down that route for diagnosis would be pricey, particularly if I have to pay for assisted conception should we need to go down that route. Where I live I think that even if I didn't have a child already I would be considered too old for IVF here anyway, as think you need to be under 35. Having managed to get pregnant (perhaps due to the polyp removal) has given me some hope, although I am of course worried that if it happens again(took 2 years until it finally happened, so not too hopeful) I will miscarry. I am of course also wondering if having been pregnant recently - although miscarried at 5 weeks - will actually work against me and they will therfore offer less test. Feel that having to get pregnant again, perhaps only to miscarry, is a slightly pointless and dramatic thing to have to go through again, just to get more tests, but seems like you have to miscarry 3 times to ensure you qualify for those tests then. Having already had a full term pregnancy without complications 4 years ago, I feel something has definately changed since then, so I do need to find out what to try and sort it, if possible. I am very lucky, I know! I did have a emergency c cection, so always wondered if that may perhaps have effected things. I was of course younger too but my DS was not even planned, so my ability to conceive has definitely changed since. I do have private medical insurance, but appears fertility diagnosis is not covered, so you really would need the money to pay for it if you want to be fully investigated it seems. Knowing what is available in terms of tests and what you perhaps may need to end up paying for in your diagnosis is helpful though, like the AMH levels test that you mention. Being able to make an informed choice feels important with such an important and time pressing thing as ttc when you are over 35. Thank you, yet again!

Cuold you get any tests done under "gynae" problems instead?
It is hard - 38 here and struggling too!

That's a very good point Hoops - some Trusts will, some won't, but it's worth checking.

IIWY I'd do a bit of background research into the Trusts that you're able to be referred to - look at who the clinical lead is, where they trained, who they trained under etc. Some are better than others - I work in this field, been in two hospitals, first was wonderful and totally patient centred.

However, my own experience of fertility referral was I was referred to a certain consultant - but 3 times I saw a different junior person (each on their 6 month of rotation!) and did not see a consultant until appointment 4 - having had to complain about number 3 who ordered the wrong tests and the senior nurse had to step in. Sigh!!

But if you got private medical insurance then if your gp referred you for gynae issues you may at least get an internal investigation or scan on insurance?

I had my polyp removed on my insurance, as fell under gynaecological problems but don't think that I.e an HSG would fall under this as clearly a fertility diagnosis. I have been referred to a fertility specialist and I would really like to see him, as before I only saw a gynaecologist and I really feel that I now need expert advice in this area, although I am clearly worried I will not get the help I need. Good point though about looking into consultant, although not really sure how good I will be at judging if he is any good or not, but worth a google.

Hoop- agree it is hard! Harder than I would ever have thought. I wish you luck on your journey! It is such a shame that the quality of care can differ so much. Keeping my fingers crossed I get a good consultant.

It's much, much harder I think than anyone realises. Sometimes with ttc/pregnancy etc there is a tendency with friends/family/people in general to assume that everything is automatically everyone's business. Been married for 4 years, together for 13, and I've lost count of the number of times some well-meaning busy-body has asked why we don't have DC. It's a very personal thing, and sometimes I just want to say "back the fuck off". Then there is the emotional stress of trying, not knowing and investigations. It's a complete roller-coaster.

Please, both of you, be kind to yourselves and try, if you possibly can, to relax (I know it's like telling you not to breathe, it feels impossible). I wish you the very, very best - if there is anything you feel that you want to contact me about please feel free to PM me x