Testing, 1, 2, 3: Preliminary Tests Before IVF

One of the first things your RE will do is to run a few preliminary tests to help determine what may be preventing you from getting pregnant or staying pregnant. I'm hoping that by this point you had your OB/GYN run the baseline hormone tests (FSH, E2, P4, LH), but if not, then your RE will definitely do so.

Next, she/he will do an ultrasound and check if there are any visible cysts, polyps or anything out of the ordinary. If your RE discovers cysts on your ovaries, you are most likely suffering from Polycystic Ovarian Syndrome (PCOS), which can result in anovulation and is a common cause of infertility.

You will be asked to make an appointment for a hysterosalpingogram (HSG) where your RE will inject a contrast dye that will flow through your fallopian tubes to provide a clear picture of your tubes and uterus. An HSG is done 2 to 5 days after your period has ended but prior to ovulation. This is an uncomfortable procedure (you will not be put under) and some might say, a bit painful. Come prepared with a sanitary pad, some Tylenol and ideally take the rest of the afternoon off. Don't skip this test; it allows your RE to see if your tubes are open and to rule out uterine abnormalities like polyps, adhesions or fibroids.

As I'd stated in my last entry, it's important that you write down your conception journey and provide your records from your OB/GYN. Certain causes of infertility are not easily detectable from a simple ultrasound or blood tests; that's where your personal history comes in. Endometriosis (Endo) is one of them. It usually presents itself in the form of very painful periods, frequent miscarriages and heavy periods, and sometimes, nothing at all. Endo cannot be completely diagnosed and/or treated without a laparoscopy, which isn't part of the preliminary tests that your RE will order. But if you have experienced some of its symptoms, your RE may want to do a laparoscopy to confirm Endo and clean it out.

Another test that not all REs will do is an endocrine test to look at your thyroid function. Thyroiditis is a common problem and can lead to several other issues such as excessive weight gain or weight loss, and of course can affect your ovarian function (anovulation being one of its results). So if your RE doesn't run this test, then make an appointment with an endocrinologist ASAP. It's a simple blood test that can be done at any time of your cycle and the results will be available within a couple of days.

Last, but not least, your partner must get a semen analysis. The test can be done on the same day as your first consultation with your RE or he can come back on another day. But my advice would be to have him provide a sample on the same day as your consult -- he's already there, he can't run away. Get him tested. For that, make sure that he hasn't ejaculated in at least 48 hours but no more than 72 hours. If you read my first entry, you know why.

I will discuss many of the above possible outcomes and test in greater detail in my upcoming posts. Until then, remember that these tests (could) hold the key to unlock your infertility. Being able to finally determine the cause(s) of what's been preventing you from having your baby will empower you.

Are you doing it right? Conception 101

You’re probably thinking, “Come on, are you seriously going to tell me how to have sex?!” Well, not exactly, but before we discuss anything else about infertility, I want to make sure you’re timing things correctly. Many couples think they’re having trouble conceiving when all they really need is to know a little more about the basics of timing sex and ovulation.

Most women’s cycles are 28-30 days. This period is broken up into two phases:

• The follicular phase is from Day 1 (Spotting doesn’t count. We’re talking enough fluids to dirty a pad) of your period to ovulation.
• The luteal phase is from ovulation to your next period.

Once the egg is released from your fallopian tube, it will only stick around for a maximum of 24 hours. So what we want is to have intercourse a few days prior to ovulation (and on the day of ovulation), since sperm can live up to 5 days (if it’s in the right medium – more on that later).

There are several ways to figure out how long your cycles are in total and how long your follicular and luteal phases last respectively. One way is to chart your waking temperature (you need to do this for 3 months to have a clear grasp of your cycles). The second is check your cervix and the cervical fluids (it’s the “medium” I mentioned above. You’re looking for an raw egg-white like consistency). Lastly, you can purchase an ovulation detector kit from a drugstore (just follow the instructions on the box).

So assuming that your cycles are 28 days, then starting on Day 10 you want to have sex every other day. Unlike what some people think, in this case it’s not quantity (i.e., having intercourse every day) but quality (i.e., healthy sperm) that counts. Having sex everyday will actually diminish the quantity and quality of the sperm. Your egg is not going to stick around for tired sperm, so give your partner a rest.

After ovulation, your luteal phase should be around 14 days. If it seems that your cycles are very short, it may be that your body is not producing enough progesterone (P4). If that’s the case, you’ve got your first red flag. Luckily for you, it can be easily rectified by some progesterone supplements.

You want to take your first pregnancy test (HPT)on the day or one day after your period is due. I know the latest HPTs claim that they can detect a pregnancy up to 5 days before your period, but your body could be producing lower levels of pregnancy hormones (Hcg) that the test might not be able to detect that early on. More on the nightmare of pregnancy tests later.

So there you have it: Conception 101. If you want me to elaborate on any specifics above, just let me know. If you have time, I would highly recommend that you get this book:Taking Charge of Your Fertility, 10th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health