When do you wish you'd started tests?

[orangejumper]

I was wondering if any of you could share some of your hard-won wisdom with me? I've really appreciated everyone's advice as I've lurked on various forums.

When do you wish you would/could have started testing?

We've just finished our 12th cycle ttc (but only nine months - my cycles are between 20 and 27 days) so I know this is early days. We had a very very early miscarriage 3rd cycle ttc, nothing since. Due to my irregular/varying cycles I've already had the FSH/LH and progesterone tests and they were fine, but I'm turning 34 soon and (we are lucky that) we could afford more testing privately. So I am wondering if we should... Any thoughts or reflections on what you would have done with the benefit of hindsight gratefully received.

So sorry to hear you're in this situation. I don't want to be a downer, but it doesn't sound like such early days to me if it's been 12 cycles. I wish I'd got some more testing early on, but was falsely reassured by all that stuff the NHS says about it being normal for it to take a year or more. I don't think it is, to be honest - people I know who've had children without medical intervention have generally conceived in 6 months or less, regardless of age.

We started trying when I was 34. After 9 months and no pregnancy, we decided to start bbt charting in addition to ovulation tests, etc, and discovered we'd had our timings wrong - and also that I had a very short luteal phase and very late ovulation. Sorted our our timings, took all the supplements they recommend for a short luteal phase, but nothing changed, and still no pregnancy for another 9 months. We had some initial tests but my GP didn't give us the details, just said everything was fine. And then I finally got pregnant naturally, so I didn't think anything more of it.

But despite a completely textbook pregnancy, my daughter was stillborn at full term, and I found myself even older and back to trying again. That's when I had my first proper fertility investigations. We turned out to have a significant sperm issue the GP had brushed off as nothing (very poor morphology, borderline count, poor motility), hidden infections (contributing to poor sperm & possibly implantation problems), and - alas, as I left it so late to get any help - age-related egg quality deterioration. Still no baby and I'm 39.

All the tests and monitoring sounded so full-on to me when I was first ttc and I had this hope (bolstered by everyone I ever spoke to about it) that if I just relaxed (!!) it would happen. With the benefit of hindsight I now wish I'd got on it properly a bit sooner.

Tests I'd suggest - a semen analysis for your partner if you haven't already done one. AMH test to determine your ovarian reserve. Pelvic scan to check for cysts, fibroids, etc (you should be able to get this on the NHS). Also I'd suggest possibly having the hidden infection tests done through the Serum clinic in Athens (you can send a sample off for testing), as sometimes unexplained infertility can be due to an infection in the uterus, which can be cleared up relatively easily with a course of antibiotics. An infection can also cause a heightened immune response in the uterus that can prevent embryos from implanting.

Best of luck.

I second what Bip is saying get the best and most thorough testing done ASAP. I had the testing on NHS done but only after TTc naturally for 3 years, I was told unexplained infertility as everything looked ok and told DH sperm is ok. We then had 2 ivf cycles then stopped treatments after a miscarriage at 6 weeks. Been getting on with life for 2 years now as felt so exhausted and traumatised after but just restarted tests with Serum in Athens to try and get some answers. Will continue TTC naturally and see what happens. Choose a good and supportive clinic if you do IVF.

Thank you so much Bip and Motherchuck for taking the time to reply. So sorry to hear about everything you've both gone through.

We have already booked AMH, scan and semen in a fortnight but after another 'everything is fine' GP appointment was wondering if I was overreacting. I will definitely add those Athens tests to the list, I think they could be relevant to us.

Thank you again.

HyCoSy worth doing to check your tubes and also any uterine anomalies too x

Thanks banana, that sounds like good advice. I really appreciate the reply.

NHS will generally do a HSG which is the older style tubal patency test - squirting iodine dye through your tubes under xray. It just looks at your tubes and I'm told is pretty uncomfortable

HyCoSy is a combination of a saline ultrasound and a tubal patency test - involves squirting saline into your uterus, which enables much clearer visualisation of the uterine cavity on pelvic ultrasound (if undergoing fertility investigations or treatment you will become very well acquainted with dildocam, as transvaginal ultrasound is affectionately nicknamed)

Then they squirt some foam up the catheter which visualises whether your tubes are open or not

I've never had a HSG to compare, but I had minimal discomfort (for about 2 secs when I had a bit of cramping) with the HyCoSy. And it's a 2 for 1.

I DID get fertility investigations done very early on and am glad I did so. I actually got them done before we started TTC, as I had a suspicion something wasn't right 'down there', as I'd never really had proper periods when I wasn't on the pill. Read about these fertility MOT things online (ovarian reserve tests ie AMH and antral follicle count) and so decided that sounded like a good idea. Found out I had PCOS - but fantastic ovarian reserve. So no rush to start TTC, but we expected to need some kind of treatment right away when we did, because we expected I wouldn't ovulate . NHS isn't interested until you've been trying for months - even if you know you haven't been ovulating and so aren't even in the game. So I went to a private gynae before coming off the pill who said we could start clomid whenever we liked - DH just had to have a semen analysis done

Ironically it was because I'd had these tests and expected NOT to ovulate, that I charted and used OPKs from the word go. And when I ovulated 2 weeks after coming off the pill alarm bells immediately rang, because for me that wasn't supposed to happen

Went to see my gynae who did a pelvic ultrasound and we discovered my PCOS seemed to have vanished along with most of my eggs

Tests all indicated that despite my fantastic ovarian reserve at 28, at 33 I appeared to be in borderline premature ovarian failure. We rushed to IVF and got pregnant on our second cycle. Sadly I miscarried - NHS won't do any investigations until you've had 3 consecutive losses, as 1 miscarriage is deemed to be 'just bad luck'. We paid for investigations privately and discovered that the embryo was chromosomally normal - ie it wasn't 'just a bad egg', there was a problem with me

We decided to therefore do another cycle with genetic testing so we could ensure we only put back a chromosomally normal embryo - and if I miscarried again, we would know the problem was definitely with the soil and not the seed.

We had a very successful third cycle and have 6 genetically perfect embryos on ice. The challenge now is to try and get the uterine environment right to give me the best chance of sustaining a pregnancy. The learnings gained from all the tests we did will hopefully give us a better chance of success

It hasn't been cheap to have tests and treatment privately, but we've identified problems much earlier than we would otherwise have done. My main issue is to do with endometrial lining, which the NHS just isn't set up to diagnose or treat, as it doesn't neatly fit into a box

Very long winded waffle, but from my own personal experience I am v v v glad we were OTT in the speed and scale of investigations. I'm pretty complex (my consultant said he's been a fertility Dr since 1992 and I'm the most puzzling case he's ever had) so I'm not particularly representative. But can certainly advocate for not hanging around and being as proactive as possible, as far as you can

Good luck! X

Thanks banana, that is so incredibly helpful. Really sorry to hear about everything you've been through - really good luck for your current plan.

It's really kind of all of you to write such long and useful replies!

I asked for a referral after trying for 6 months both times. My cycles are anything from 4-12 weeks so clearly an issue. First time I fell pregnant while waiting on SA before referral would be sent.
Second time it took 11 months from referral to get clomid, lots of delays and weeks between appointments I'm sure the NHS deliberately space appointments out hoping that their services will not be needed. Both clomid & iui failed and I ended up going private IVF (now 3 months pregnant) I messed about with the NHS for 3 years, in hindsight I wish we'd gone private a year earlier after second failed IUI.

Yes the dildocam will become completely normal. And somebody mentioned HSG as sore it was no worse than a smear test to me.

My advice would be to get referred asap. You can still try while on waiting list. The hospital will know what tests they want.
NHS v Private depends on your area what help you will get and would you need to save to go private. I used my time on NHS to save so should I need IVF which I didn't think I would meant the cash was there when I went private.

Bip sorry to read that your daughter was stillborn, hugs.

Thanks MrEBear, very useful advice & good to hear your experience. The NHS won't do anything for me for a long time (until we're been trying two years or I've had more miscarriages) so private it is. Congratulations on your pregnancy!

When I first spoke to the doctor about tests, i was 33 and I wasn't expecting them to find anything wrong so once we got the results I was very glad that I had spoken to them rather than just waiting. I went to the doctor about 12 months after coming off contraception but after only 6 months of actually trying (we had to move in with my parents for a few months and were not trying at all then!) so I fudged the dates a bit and got the tests. Turned out DH had low sperm count and motility, I had fibroids and a cyst. It would've been difficult to become pregnant naturally. 2 years later and I'm pregnant after ICSI.

I think private tests are a great idea, also they are more thorough. Good luck

Thanks Blueroses, congratulations on the pregnancy!

Thanks Orangejumper!