The first thing to do is find a doctor. Depending on your insurance, and what it covers, you should seek assistance from a Reproductive Endocrinologist instead of an OB/GYN. An RE is a fertility specialist and will be able to do all the needed testing and treatment to assist you in your goal of achieving pregnancy.
If you are not sure what your insurance will cover, if anything beyond a yearly check-up, either call the company or very carefully read over your insurance paperwork. Your insurance may cover none, some, or all of your treatments up to a certain cap.
When you call to set up your first appointment, keep your cycle in mind. Most RE’s will want to see you on the third day of your cycle. The reason for this is so they can start doing some testing right away. The tests that might/should be ordered on your first visit include baseline tests for Follicle Stimulating Hormone and Lutenizing Hormone. Your medical history and your husband’s will also be needed on your first visit.
If you have been seeing an OB/GYN on a regular basis, you should have your medical records transferred to your new doctor before your first appointment, (if the doctor will accept them) or bring them with you. If you have not already done so, start keeping track of how long each cycle is (day 1 is the first day of bleeding), any cramps or pain that you experience at anytime during your cycle, the results of Ovulation Predictor Kits if used (always a good idea to do for a few months prior to your visit), and your Basal Body Temperature chart if used (also a very good idea to do for a few months prior to your visit). If you do not currently use, or have never used an OPK, start using them now.
The results of the tests will let your doctor know if you are producing the hormones needed to ovulate each month. Also start charting your BBT if you are not doing so already. This monthly chart will inform your doctor if you are ovulating, and if you have a long enough Luteal Phase for implantation to take place and thrive. If you have never heard of charting before, or do not know how to chart your fertility, I strongly recommend the book ‘Taking Charge Of Your Fertility’ by Toni Weschler.
This book will teach you how to chart your temps as well as other fertility signs that will assist your doctor in determining if you have a problem and what the problem might be. This will help to reduce the tests that will need to be done and therefore reduce the total cost of infertility testing. You can get the book at this blog’s book resources at a discounted price. This book may also assist you in achieving pregnancy with out the assistance of a doctor by letting you know when your most fertile time is each cycle and therefore when to have intercourse.
Now depending on what your doctor learns from your medical history and any fertility information that you bring with you mentioned above, many different procedures could come next. If your doctor determines that you are not ovulating, he/she should run blood tests to find out why. These can include the testing of hormone levels at different times during your cycle, thyroid function, diabetes, and STD’s. Before or while most of these tests are done, your doctor will want to do a Semen Analysis. The reason that this test is usually done first is because it costs less and is not as invasive as other procedures that are done for women to determine infertility factors.
Once the basic testing has been done your doctor may need to do further and more invasive procedures to determine your infertility reason. One of the most often done procedures is Hysterosalpingogram (HSG). In this procedure the doctor inserts an X-ray able dye into your uterus and it flows through to (and ideally out of) your fallopian tubes. This is done to determine if a tubal blockage, an unusually shaped uterus, tumors, or scar tissue could be causing the infertility problem. This procedure needs to be done during the first part of your cycle so that it will not affect a possible pregnancy. Most women that have this procedure done complain of minor cramping, but a few have reported more severe pain (usually those that do have a blockage). If you are concerned about the possibility of pain, your doctor should allow you to take some pain medication about 30 to 45 minutes before the procedure is done. Many women report increased fertility after an HSG has been done.
If an abnormality is found or suspected after an HSG is done, your doctor may need to do a Hysteroscopy. During this procedure a hysteroscope (a thin telescope with a fiber optic light) is inserted through the cervix into the uterus. This allows the doctor to see any uterine abnormalities that may be causing infertility. This procedure is usually done at the beginning of a cycle so that the uterine lining will not obscure the doctor’s view. If this procedure is going to be done in conjunction with an endometrial biopsy, it is performed at the end of the cycle after an hCG blood test has been performed to confirm that a pregnancy has not started.
An endometrial biopsy is done at the end of a cycle (usually 11 to 13 days after ovulation) to determine if the woman has ovulated or not. If ovulation has occurred, the lining will be soft, spongy, and secretary. If ovulation has not occurred then the lining will be hard and proliferative. During this procedure a small amount of tissue is scraped off the endometrium. This will cause pain, but only for a very short time. An endometrial biopsy is no longer performed on a regular basis. However, the test is harmless and can provide additional information about a woman’s cycle.
Artificial Insemination Information
Artificial Insemination is usually performed in the following circumstances sperm with low motility, hostile cervical mucus, or presence of sperm antibodies. IUI or intrauterine insemination usually has a 5% to 20% chance of success depending on the reason for infertility. During an IUI procedure the following steps are taken a thorough medical evaluation of both the male and female is done for suspected causes of infertility, usage of fertility drugs (if needed) is started. The woman is monitored by ultrasound and blood testing to confirm ovulation (in response to drugs), or usage of OPK at home to monitor ovulation.
The day ovulation has occurred the couple will usually drive to the fertility clinic to have the actual procedure done. The male partner will provide a fresh sperm sample either at the clinic (or from home in some cases) or donor sperm must be available. During an IUI the semen sample is washed so only the best quality sperm is left. This washed sperm sample is then inserted directly into the woman’s uterus.
Insemination does not have to be done by putting the washed sperm into the woman’s uterus. Artificial Insemination can also be done by placing the sperm sample in the woman’s vagina at the cervical opening. This procedure should be done the day before ovulation as opposed to the day ovulation occurred as with IUI. An hCG blood test is sometimes performed 14 to 16 days after the procedure to determine success.
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