So you decide to get help...

Otherwise known as "what to expect when you still aren't expecting..."

It obviously is going to be different for everyone, but there is a general pattern. If you like your gyno, I'd suggest talking with them first. If not, you can go to resolve.org to find a trained reproductive endocrinologist (RE) in your area. Make an appointment for a consultation with either the RE or gyno. I would suggest you bring any charts and journals you've used to keep track of your menstrual cycles. If you haven't done that, yet, start. Just keep track of any symptoms like cramping, fatigue, etc, as well as when you are on your period. If you have a smart phone, there are several free apps that make it really easy. Just search "women's health" and you should get several options. I used one on my smart phone and logged all my basal body temperatures, symptoms, and cycles into it. It was handy because my doctors asked a lot of questions about my menstrual history.

There really isn't anything to be scared of at the first appointment. The first time I met with both my gyno and my RE, I even got to keep all my clothes on. (Hey, it's the little things!) You should expect a ton of questions on your personal history and your family history. So if you don't know if your mother or grandmother had any difficulty conceiving, it's time to start asking questions. Oh, joy! Most women I've talked to seem to enjoy telling their war stories of birthing babies, so give 'em a chance. It probably won't be that bad. Plus your gonna want your families' support so you might as well 'fess up now...but the choice is completely yours! Oh, and don't forget your partner's side. Remember he's just as likely to have a problem as you are!

If you go to an RE the first time that you've never met, they may want to go ahead and do a pelvic. It's gonna be the same old routine from your yearly. Awkward, maybe, but not scary. Where they go from here is going to depend on what your history tells them, and where you are in your current menstrual cycle. They can only do certain tests on specific days of your cycle. I find that to be one of the biggest frustrations (aside from not conceiving, of course). Fertility tests and treatments are a hurry up and wait kind of game.

In the meantime, your wonderful life-mate needs to have a semen analysis. Depending on how far you live from the clinic will determine if your significant other can do his thing at home. At my clinic, you have to be able to provide the sample within an hour. If not, he's going to have to suck it up and do it in the "gentleman's lounge" at your clinic. Hold this thought...

If you go to your gyno, he or she is probably going to focus on you (the female). My gyno, for instance, will do up to intrauterine inseminations (IUIs) in addition to most fertility tests. I was geared up and ready to go through all this mess with him, until I thought, 'what if we're all set up and ready to get the IUI done only to be told BJ's (my husband) sperm is no good?' I would have been inconsolable. Take-home lesson, if you choose to stay with your gyno for the duration, go ahead and be proactive about setting up an appointment for your partner-in-crime to have a semen analysis done. Because infertility coverage by health insurance sucks in the US, you're definitely going to want to know if his swimmers can swim before you start shelling out some major dough.

Ok, so you've had your consult with your gyno/RE, now the real fun (I'm using that term very loosely) begins. It seems more oft than not, an exploratory laparoscopy to check your internal girly parts is ordered. I've met few women that have done the fertility treatment thing without going under the knife. That is how I started. Surgery is always a bummer, but the good thing about it is they can get several tests out of the way while you're completely out of it. Tests that otherwise would be done in the office with you completely conscious, and I have heard, would not exactly be fun...

Either during your laparoscopic surgery, or *gulp* in the office, your gyno/RE is going to want to know if your uterus is shaped normally. This is done with a hysteroscope, a small camera threaded through your cervix. Saline is used to blow your uterus up like a balloon so all the parts can be seen. A normal uterus is shaped like a triangle pointing down. Occasionally there can be one of a number of deformities that can make conception, but more likely carrying a pregnancy to term almost impossible. The good news is that several of them can be overcome with corrective surgery or assisted reproductive technology (ART), such as IUIs and in-vitro fertilization (IVF). Typically the laparocopy is done early in your menstrual cycle just after your period.

Another important thing for the doctor to check is your fallopian tubes. These tubes are responsible for guiding the egg from your ovary to the uterus while providing a place for fertilization to occur. A test called a hysterosalpingogram (HSG, play hangman with that word, kids) is done under x-ray with either your doctor or a radiologist. It is also done early in your cycle before you ovulate. A radioactive dye is squirted into your uterus via a catheter while a live x-ray of your lower abdomen is being taken. They will be looking for the dye to spill out of your fallopian tubes. If there is a blockage, the dye will be stuck behind it. The bonus of this test, is that if you do have a blockage, the dye itself is sometimes able to break through the blockage and open the tube. (I hear it is rather unpleasant.) So the test becomes the treatment. A similar test called a chromotubation can be done during the laparoscopy while you're under anesthesia. They just use a blue dye that isn't radioactive and look for immediate spillage on the camera in your belly. The positive thing about the tube checks is that they increase your odds of conceiving greatly over the next 6 months, with or without a blockage. It opens everything up and makes it easier for your eggs to pass through.

There will be a number of blood tests along the way. Some at the beginning of your cycle and some later to look at hormone levels. These test can tell them if you have good eggs left, are producing enough estrogen, and if you ovulate. Expect to be going to the doctor's office quite frequently from here on out. Once or twice a week is completely normal.

Ultrasounds are another exciting test to look forward to. Typically they are done internally to get a better view of your ovaries. This enables them to look for any cysts or other abnormalities in your anatomy. It's only uncomfortable if you are still having modesty issues at this point. If you are, bless your heart...But get over it! All these medical types do all day is look at naked lady parts...I really doubt that your undercarriage is all that special. Try not to get yourself all worked up...you have plenty of things to be worried about besides embarrassment. Besides, I hear that childbirth is not that modest of a process, either...

Another test that may or may not be performed depending on your doctor's beliefs, is an endometrial biopsy. It needs to done toward the end of your cycle because the point is to check the stage of your endometrium, or uterine lining. Unfortunately, this is an office procedure. While you are completely conscious, a sadist (otherwise known as your doctor) will basically jam a catheter through your cervix and pinch off pieces of your lining. The good news is this test is out of vogue as a diagnostic means. The bad news is that they have found that the healing process due to the trauma of the biopsy increases the chances that an embryo (your baby when it's still a microscopic mass of cells) will implant. If you have to do IVF, look out!

Well, I think that is pretty much all of the typical pre-fertility treatment diagnostics. It usually takes about a month or two to get everything done. Just remember that all of these tests allow your doctors to make the best possible decisions for you and get you knocked up that much sooner. As daunting as it may seem, it's gonna be so worth it when your little one finally arrives.

Peace, love and spawning,
MK