TTC and ready to start having fertility discussions with a doctor

[Anonymous]

We've been TTC #2 for several months now, I'm 35, and thinking it's time to start exploring getting some help with the process.

What happens first? What questions should I ask or will I be expected to answer? And if we do proceed, what are the treatments that my doctor will want me to try first?

TIA!

[Anonymous]

Have you been charting? The process of charting can help ID some problems. While not necessary it is helpful. Takine Charge of Your Fertility is a good book and will help guide you with charting and all the ins and outs of fertility. Usually the first thing they do is test you FSH and test your husband's sperm. When they test your FSH (day 3 tests), as part of the same blood draw they'll test you thryroid and some other hormones (it has been awhile so I cannot remember what all they tested). If all those tests come back normal, then they might send you in for an HSG to make sure your tubes are not blocked. After that, they tried me on Clomid, but I soon moved to IVF since they then diagnosed me with severe endometriosis (although my tubes were clear).

We did up through the Clomid with my regular OB-GYN, but after getting cysts on my ovaries while on Clomid, they referred me to an RE.

Now is a good time to review your insurance coverage. For example, it may be worthwhile to switch companies during your next open season (if you have choices) so you can go with a plan that has better infertility coverage. In our case we did all our testing and went up through the Clomid on our regular plan, but then switched to a plan provides some IUI and IVF coverage (my husband is a fed) when we realized that we were probably headed down that route.

Best of Luck!

[Anonymous]

Some insurance companies require that you TTC for at least a year prior to covering fertility treatment -- this is easily addressed by telling your OBGYN that you've been TTC for a year and that you are ready to become more proactive given your age. I struggled to get pregnant with #2 at 32, so my regular OBGYN did some basic bloodwork and sono. Had I not gotten pregnant, the first step would have been to have my husband's sperm tested (easy to do, and my regular OBGYN offered to do it through his lab (with me bringing in the sample) so as not to be too stressful for DH (note: my obgyn was pretty much convinced that the problem was with my husband's struggle to deal with stress).

My obgyn told me to use the OPK but not to tell my husband when I was actually ovulating -- again, to shield him from pressure to perform. Instead, I was supposed to stop all talk about babymaking and just try to initiate things leading up to, during and through the window period. Long story short, we got pregnant the first month of trying once I used the OPK and shielded DH from my angst (and a glass of wine didn't hurt either

But definitely tell your doc you want to be aggressive and he/she should present you with many options given your personal history. Good luck to you.

[Anonymous]

I'd check with your insurance company but the common standard is if you are trying for over a year and are under 35 then you get infertility treatment, if *6 months* and over 35- then you can go in.. our insurance covered my going to a specialist without needing a referral- I did need approval for IVF (showing trying for x months- and my re's provided that).. good luck!

[Anonymous]

Thanks everyone. I didn't even think about the insurance angle. We're on a PPO so I'm assuming he referral isn't a problem, but will have to read the fine print on our coverage. We have been trying on and off for a year--my husband had some unrelated health issues for a while and we moved, etc., but good enough.

I haven't been good about charting--really tried for a couple of months but got discouraged when I kept having to get up in the morning because of potty issues (my son's, not mine) and other random stuff. I do have TCOYF, and also have an ovulation monitor (from a friend, but got reset instructions) that I've used for a couple of months.

For PP with the stressed husband--how did you know this was the issue? We've definitely had a lot of stress with job changes, moving, buying a house, etc., but I don't know that it's much worse than when we conceived our first. But we are both 4 years older...

[Anonymous]

OP again--looks like we're ok on the insurance up to $10K, no mention of how long to try before seeking treatment. And I turned 35 last month (sigh).

[Anonymous]

Great news that you have infertility coverage.. but there is still insurance steps you need to take before doing infertility treatment (if and when you do it).. with mine I had to call an 800 number, provide paperwork, then get a code for each iui treatment (if i didn't give the code- the office would expect full payment at first visit).. there was nothing in my paperwork that said I had to do all this but - i did.. it was aetna.. so not some small insurance company (ppo too)..

as for going to an re- i also needed a code- that was strange since i can go to any specialist without needing a referral but for an re apparently i did.. i had no idea and went toa few and then had to go back and get codes etc..

i'd at least consult with an re- they can do more tests (including to your husband) than an ob can.. good luck..

[Anonymous]

OP -- if you are planning to contact a reproductive endocrinologist, i highly recommend Dr. Preston Sacks at Columbia Fertility Associates. I am currently pregnant with my 1st after seeing him, he is an incredibly thorough and understanding doctor and his nurses and staff are also very knowledgeable and always ready to help. Plus he has an in-house lab so you get bloodwork on the same day which is great when you're waiting on pins & needles for a test result!!

I'm now 11 weeks pregnant with my 1st thanks to him

[Anonymous]

16:46 again: just wanted to FYI as well, i never hit 10K although i had zillions of blood tests, ultrasounds & one round of clomid. now if you need IUI or IVF, that may be different.

[Anonymous]

OP again, thanks for the doc recommendation, but we're no longer in the DC area. I just can't give up DCUM!

[Anonymous]

TO OP RE: my stressed out husband

We can't be totally sure that he was the problem. We were nearly 4 years older too when we struggled to get pregnant again. DH was having health issues (gastro related) as well as work-related stress. I had basic tests done on me by my obgyn who also knew about my husband's gastro issues. He thought that my husband's stress level could have prompted the gastro issues and told me that stress can definitely take a toll on the quality (not quantity -- but quality) of sperm. He also told me that when a couple has trouble getting pregnant, it's the woman's problem 40% of the time -- the guy's problem 40% of the time -- and they just can't pinpoint a reason the rest of the time. Testing a guy's sperm is usually one of the first steps since it is so easy to do. We didn't have to go that route since we finally conceived the month before we agreed to go down the infertility treatment route. And again, I attribute the success to removing my husband from the stressful situation of charting and using the OPK and just making things fun and spontaneous. Doesn't hurt to try, right?