Within a couple weeks of my consult, I had started checking off the 'to do' list pretty quickly. The list was 2 x A4 pages long of everything I needed to do before they could even submit my status to my insurance company. I have attached a copy of the list below if you are just starting out, you could get ahead of the game!
To name a few tests to start off:
Mammogram
STD tests - full panel
CMV status
Varicella (chicken pox) status
Genetics Universal Panel
HSG
Turns out I was not immune to Varicella, which I knew I wouldn't be because I never had the pox as a kid. The doctor said I would need to get vaccinated or sign a waiver form if I wanted to be treated. This is because if you get pox as a adult and especially while pregnant, it can be deadly.
The issue with the varicella vaccine, is that it requires TWO injections a month apart, then I'd have to wait another month after that before I could try any start fertility treatment. Just great, now I have to wait 3 months to start trying, if I am even eligible at all that is.
If I have learned anything from this infertility journey, it is patience.
HSG (Hysterosalpingography)
This test is an X-ray test to outline the internal shape of the uterus and show whether the fallopian tubes are blocked. A thin tube is threaded through the the lady bits & cervix then injected with a contrast dye into the uterus. A series of X-rays, or follows the dye, which appears white on X-ray, as it moves into the uterus and then into the tubes. If the tube is open, the dye gradually fills it. The dye spills into the pelvic cavity, where the body reabsorbs it. If blocked... well, it is not a good sign.
I had heard that this procedure can be quite painful, so I went in expecting the worst. Turns out it was not bad at all. It was all over in 5 minutes. You have to wear a pad afterwards in case any dye came out or any spotting which may occur, don't stain those good undies ladies!
The uncomfortable part for me came about 2 hours later when I started cramping, it wasn't horrible, but it was enough to warrant some pain killers and a hot water bottle on my tummy. After a few hours, the pain was gone and I was back to normal.
** If your fallopian tubes are blocked, I've heard this is when the HSG tests can be quite painful.
A simple blood test for Universal Genetic Panel will identify genetic disorders you may be a carrier for (don't worry... you may never get that disorder if you have the gene).
Knowing this before hand will minimize the risk of having a child with a serious birth defect, if both parents have the same one.
In my case, turns out I had one genetic disorder, but nothing serious. But I needed to choose a donor that does not have the same defect.
Cycle Day 2/3 Ultrasound and blood work
If you are squeamish or grossed out, perhaps stop reading here. Something I never expected, was to have an internal (vaginal) ultrasound.... while on your period! When my doctor first told me that, I was like "are you sure, that sounds messy and humiliating". She laughed and assured me it was normal.
My first ever visit to the fertility clinic after multiple zoom calls, emails, phone calls etc came around pretty quickly. I will be honest and say, that I expected a warm and fuzzy feeling, a friendly and nurturing space, but that couldn't be further from the truth. Don't get me wrong, the space was very clean, top of the range equipment, loads of nurses and a great clinic but if you ever go in expecting a baby shower, you will get a surprise lol. It is just a doctors office.
First they take my blood, they are testing your hormone levels, which include:
E2 (Estradiol)
FSH (Follicular Stimulating Hormone)
LH (Luteinizing Hormone)
Immediately after, I was put in a room, told to strip down from waist down, and get on the table with my feet in the stirrups with the sheet draped over me (at least I could hold on to some dignity). Then it dawned on me and i started to panic. I don't use tampons.... I use use Diva Cups (way more convenient & much better for the environment & your bank account). But I had to remove it for the test. I quickly relaxed as there was a sink in corner of the room where I could pour it out. Phew... that would have been a disaster! A bloody one! note to self... next time wear a tampon or go to the bathroom first before coming into the exam room. I don't know about anyone else, but the older I get, the worse my periods have gotten. Day 1-2 is like a murder scene (TMI?).
The nurse came in, explained that I was getting a Baseline Ultrasound. It is a transvaginal probe to examine your ovaries and uterus. They inspect your uterus for fibroids, polyps, cysts or masses or irregularities of the uterine lining. Most importantly, they look at your ovaries to measure their volume and count the antral follicles, to determine your egg reserve. The older you get the less follicles you will have each cycle.
My first scan I had 13 follicles on the left and 15 on the right. VERY good numbers for someone my age (40). They were very impressed by my 'beautiful ovaries & uterus with the perfect lining'. Well done little eggs, well done, I said to myself as they poked my lady bits. But I still had to wait for the actual results from the doctor since it is the nurses doing the tests, not yet time to get excited.
This scan shows an ovary with quite a lot of follicles (photo from google). I called my ovaries Choc Chips Cookies. The more choc chips you can see in a scan, the higher the AFC is, which means you are still producing a decent amount of eggs each cycle.
My best friend still to this day will ask me how many choc chips to I have in my latest scans!! You have to make it a little fun right, to help you forget that have a probe inside you while you are bleeding. Go on, I dare you to say this to your physician next time!
FUN FACT: A female baby is born with all the eggs that she will ever have. It is estimated to be around two million, but by the time a girl reaches puberty, this number has decreased to about 400,000 eggs stored in the ovaires. I was 40 years old when I learned that!
Ovulation testing
The next & last step was to ensure that I actually ovulate. I had to start monitoring my LH levels (Luteinizing Hormone) and notify the doctor once I got a surge (a rise of LH triggers ovulation). So as soon as my period finished, I started peeing on a stick a couple times a day in hopes to see a darker line appear.
I highly recommend Premom Easy @ Home) tests kits and downloading the app!! The best thing about Premom, is that you can take a photo of the stick, and upload directly to the app & it tells you when you peak.
HOT TIP: when you are in your ovulation week, test 2-3 times a day. The peak can come and go very quickly, you don't want to miss it. Also, it is better to hold your bladder for a few hours before testing. The more watered down the pee, the harder to get accurate results. Most women see the surge mid afternoon to early evening.
I peaked on day 14 as you can see in the photo above. 5 days later, I was back in the clinic for another Baseline Ultrasound (thank goodness this one was much cleaner) a blood test to measure progesterone levels. All to confirm I was in the luteal phase and confirm that my body did actually ovulate.
BBT basal body temperature
The below chart shows the LH testing (the orange line), but also my body temperature. You can use your BBT to help learn your cycle. For example, right before ovulation my temperature drops. After ovulation my temperature spike for a few days, then 2 days before my period, my temp drops back down to normal and stays that way until the next ovulation cycle.
BBT testing can be tricky though. You have to take your temp as soon as you open your eyes, before getting out of bed and doing anything to get the most accurate results.
Charting and recording your test results can help you:
Figure out when you tend to ovulate every month
If you have a partner and trying naturally, you can plan your sexy baby dancing time (sex)
Detect possible fertility problems, including problems with ovulation or your luteal phase (that's the time between ovulation and your expected period)
Stay tuned for the next blog to find out my results and what the next steps will be!
