Should I be pushing for more investigations?

[WildForTheNight]

Hi all,

We've been TTC for 2 years this month and have been under fertility since September 2021. At our last follow up in March 2022 we were referred for IVF which will start in March 2023.

All my investigations have been normal- AMH 11.3 (I'm 32), follicle count of 8 (I thought this was low but apparently it's within normal range?), day 21 progesterone 46 and 68. My FSH was normal and nothing obviously wrong on scan. DP's semen analysis shows poor morphology (4% and 1%) but the doctor said there was a normal amount of progressively motile sperm so he's classing the samples as normal. With all that, we've been put under the 'unexplained fertility' umbrella. When I've queried investigations before going for IVF, the doctor says that a HSG isn't needed because my chlamydia antibodies are negative and a laparoscopy isn't needed because nothing was seen on scan.

Should I be pushing for more investigations? It just feels like we've been left to it with no advice on what else we can do. We're both already caffeine free, taking supplements, we don't smoke, rarely drink, normal BMIs. He's wearing loose boxers and avoiding hot baths. I've tried grapefruit juice, OPKs, Pre-Seed, using a menstrual cup after sex, BBTs, carrying on as if we're not TTC aaaaand NOTHING! No reason to take a pregnancy test in the whole 2 years.

Any advice would be very gratefully received, I think I'm starting to go a bit mad!

Hi @WildForTheNight - firstly I'm sorry you're going through this. Unexplained is a very frustrating diagnosis.

Your AMH at my clinic would be deemed low for your age. Mine is very similar and this is what they've told me. However, if you are ovulating each month that doesn't matter for natural conception. This only makes a difference when doing IVF.

1% morphology is low. If count is really high, lots believe this counteracts the low morphology but in this instance I think it's fair to say it could well be affecting things. Has your OH seen a urologist? There could be a reason for the low morphology. Other tests can be done to check for this and it might be worth getting a DNA fragmentation test. Is your OH also taking supplements?

If you've been trying 2 years, why is IVF only being offered in March 23? That seems a long time away! I had a HSG on the NHS as a tick in the box before I start IVF - my tubes were clear. I would push for a HSG personally. This can also be done privately.

That is my take on it anyway xx

Hi @FlyOnTheWall89 , thank you so much for your reply.

That's really interesting about the AMH level, I'm finding lots of conflicting advice about it online. I've left a message with the clinic this morning so hopefully when they ring back I'll be able to query it with them as well as asking about a HSG.

I thought the same about the morphology and raised it with the doctor at the appointment but he really didn't seem bothered by it at all. He isn't under a urologist- is this something that would be accessed by a GP referral? Or would you think private would be better? What does a DNA fragmentation test do? He is on supplements, we've tried Wellman, Pregnacare and Proceive so far. He hasn't had any samples since starting the supplements so I don't know if there's been any difference but I'm not pregnant so...😂

Oh, we live in Wales and the clinic is in England. The policy is 1 year waiting list from referral but 2 goes on the NHS. There was a bit of a cock up with the referral- my OH was referred in September after his SA results but because I'm the one who will be undergoing treatment and I wasn't referred until March (because they didn't tell us it needed to be under my name!!) the referral timeline didn't start until then.

Thanks again so much for your thoughts and best of luck to whatever journey you're on.