What to do at first fertility appt.? HSG? Bloodwork?

[Anonymous]

Going to see my OB next week for some initial testing due to TTC #2 now for 5 mos (I'm 36) without any luck. I know I should see an RE, but he suggested I come in at 5 mos for a check-up and bloodwork, and then he'd refer me to an RE. So I plan to see an RE as soon as I can but my question is about what I should be asking/making sure the OB tests.

Do they do an HSG right away? I have endometriosis, so it's possible that's one of my issues. Should I push for an HSG? Will the OB do full blood work? Anyone been through this and can give me tips about other things they should be looking at right away?

I got pregnant very quickly with #1 so am totally new to all this. I don't want to waste a lot of unnecessary time. TIA!

[Anonymous]

Hi - I had the exact same thing happen. Got PG with #1 on my first try at 32, now have been TTC #2 at 35 for nearly a year. I did testing with my OB and then she referred me to an RE immediately. She did two things - blood work to look at key hormones like estrogen, FSH, LH, Progesterone, etc. Then she did a sonogram to look at my ovaries and make sure she didn't see any cysts, abnormalities, etc.

Some advice to save yourself time:
- since you're having blood drawn anyway, ask if they can do AMH as well since mine didn't do it and then I had to go back again later on

- try to go on CD3 of your cycle if you can, if not, you will likely go back again on that day depending on what the tests uncover

- regardless of the results, push to see an RE (especially since you have endo) because the reality is that OBs just don't know much about infertility and I wasted time that I could have been seeing an RE who was actually able to prescribe treatment. My numbers came back borderline with my OB, so she said to keep trying. Fast forward a few months when I finally saw an RE and the tests revealed my FSH was much higher and AMH was practically non-existant.

Your OB will not do an HSG - and in fact my RE hasn't recommended one since I had a child already so he presumes my tubes are open. But, that could be different with endo.

- regardless of your results

[Anonymous]

OP here - thanks so much PP! I really appreciate all the advice. If you don't mind sharing - what is your RE recommending about the FSH and AMH?

[Anonymous]

This is the PP. My FSH has ranged between 9-15 but AMH is 0.18 (only had that tested once so far). It's the AMH which was most concerning, which seems to imply I don't have many eggs left.

I have been seeing the RE for 2.5 months now and the first month he had me try just a trigger shot with timed intercourse since I was ovulating. BFN that month. This past month he had me try Femara with the trigger which was also BFN, so I am trying that one more time this month. If it doesn't work, the RE says we should move to IVF so we don't waste more time and eggs. He doesn't think IUI is worth it. However, the worst part of having low AMH is that it will be much harder to stimulate me for an egg retrieval because I won't produce as many eggs.

If you know any REs you like or maybe a friend can recommend you may want to call for an appointment now - it took me a month to get an appt with my doctor at Shady Grove because they only see new patients at certain times and get pretty booked up (often in the middle of the day - blah).

All said, I have a couple friends who had similar issues to me and both ended up getting pregnant naturally after failed fertility treatments - but it took like 1-2 years. So keep trying regardless. I am holding out hope.

Did you have endometriosis when you had your first?

[Anonymous]

OP here. Thanks for the follow-up info, PP. Good tip about calling ahead. I don't know many people who've had RE's in this area (at least that have told me), but I assume I'll be trying SG or Dominion since they seem to be the go-to places.

I don't know if I had endo before my first pregnancy. It's possible but was never diagnosed if so. It was diagnosed after my pregnancy due to pain, excessive bleeding, and GI symptoms. I had a laparoscopy last fall during which they found "deep infiltrating endo" in my intestines and on several organs. They burned a lot of it off but didn't get it all. At that time, my tubes looked okay, but I suppose it could've grown since then. Or perhaps I have a whole different issue in addition!

Good luck to you! I hope it works out. I also have several friends who ended up conceiving naturally after many unsuccessful fertility treatments so you do never know!

[Anonymous]

I would say get the AMH from your OB, plus a pap, and then leave the rest to the RE. They will repeat a lot of things done at the OB's office anyway. Honestly, it strikes me as ridiculous that your OB is suggesting you start there when you have a history of endo. I'm not at all worried that you won't be able to get pregnant -- you will. But the OB can't help you with that.