The first year Brad and I started trying to conceive was the hardest. You’d think that infertility gets harder over time, but not for me. That first year was brutal, primarily because I knew something was wrong. I felt it in my gut. Sure my periods came like clockwork, but something still felt misaligned. And yet everyone was telling me I was fine. Brad was telling me. My primary care physician was telling me. Even the specialty OBGYN I saw after a year of trying to conceive told me I was fine (after zero medical testing, might I add).
A year and a half after we started trying, we went to a reproductive endocrinologist at an official fertility clinic. After one goddamn ultrasound, the RE diagnosed me as having endometriosis (with cysts on my ovaries). I KNEW something had been wrong, and yet for 16 months, all I was hearing was “You’re fine. Stop being dramatic!” My rambling, long-winded point is that a lot of infertility can just be “felt,” especially in the early months. Maybe you’re not getting positive readings on your OPKs or you have long-ass cycles…but your body is usually talking to you. And it’s your job to listen up.
So if you’ve been having unprotected sex with your partner for a few months, and you’re starting to get that “oh God, something might be wrong” feeling, here’s a step by step list of what to do next:
- Don’t panic. I know, I know. I just spent two paragraphs telling you that sometimes you just “know” something is wrong. But also…sometimes conceiving just takes time. I’ve had plenty of friends get pregnant naturally after 9 or 10 months of trying. Give your body a chance…but if you’re getting that “Oh God” feeling around 6 months, then it doesn’t hurt to start making those doctor’s appointments. Hell, you can always cancel them if you’re not ready after all or you get some surprising good news!
- Get smart. Read up, little grasshoppers. Unfortunately, middle school health class leaves out a crapton of information around fertility and now’s the time to get more technical. While you don’t need a master’s degree in biology, some foundational information is incredibly helpful when reading your test results and understanding your options. Don’t feel intimidated if you’re not a science nerd…Lord knows I’m not. I benefitted greatly from Taking Charge of Your Infertility by Toni Weschler. I wish schools taught from this book; it’s informative, clear and conversational. Also…when I say “get smart,” I mean read BOOKS, not Google. There is so much garbage information online…
- Make an appointment. Make an appointment with your OBGYN first; usually they can run some preliminary tests. If you’re not satisfied there, you can “graduate” to a fertility clinic. But fertility clinics are expensive and not always covered by insurance, so it can be more economically effective to see an OBGYN first. Some clinics offer more advanced fertility services (basically everything shy of IVF) while others might just write you a prescription of Clomid and call it a day. Even though making appointments is scary, it’s scarier to not know what is going on with your body.
- Be your own health care advocate. I’ve heard so many horrible stories from friends who were pressured or shamed out of getting tests they really wanted because their doctors or providers told them, “you don’t really need that right now.” If you believe something isn’t right with your body, then you need to insist. Push them. Speak up. They work for you, and only you know your body. And if your doctor refuses or gives you a hard time? Maybe consider finding a new doctor.
- Get the right tests. Of course this isn’t the same for everyone and you certainly won’t get all of these on the same day, but here’s a list of a few tests your doctor might consider running and which hormone levels they’ll want to check:
- A day 3 hormone test – This simple blood test needs to be done on day 3 of your cycle. Usually a variety of hormone levels are tested like your FSH (Follicle-Stimulating Hormone), your AMH (Anti-Müllerian Hormone which indicates the size of your ovarian reserve), your LH (Lutenizing Hormone) and your E2 (Estrogen).
- A TSH blood test – This blood test measures your Thyroid Stimulating Hormone, which can also affect your fertility.
A semen analysis – This is arguably one of the easiest tests to have done, and can be quite telling considering 1/3 of infertility causes are considered male factor. In this test, they’ll measure volume, sperm count, motility and morphology (their shape).
- Evaluation of your uterus either via ultrasound or hysteroscopy
- Evaluation of your ovaries/follicles via ultrasound
- An HSG test – This stands for hysterosalpingogram (woof!) and it looks at the inside of the fallopian tubes.