Just getting started - what tests to ask for?

[Anonymous]

I'm just getting started with a general OB/GYN. What tests should I ask for? I've heard that celiac disease and hypothyroidism can both affect fertility. Are there any other tests I should ask for?

Also, what are the typical first steps? I've heard that doctors pretty quickly go to clearing the fallopian tubes. Is this a common early step? Thanks for any advice. I'm nervous but excited to be starting on this path.

[Anonymous]

Have you been ttc on your own for a period of time and are just now seeking assistance? If so, then I would highly recommend seeing a Reproductive Endocrinologist and not an OB/GYN. REs are specifically trained and focused on getting you pregnant, while OBs are focused on keeping you pregnant and delivering your baby. REs have specific tests that they perform at certain times of your cycle and are in the best position to tailor treatment based on the results - including both low-tech and high-tech options depending on your situation. If you need advanced/high-tech treatment for some reason, an OB cannot provide it. Good luck!

[Anonymous]

If you have celiac disease and hypothyroidism, and you've been trying for awhile with no success, then I would definitely make sure you see someone who has a good knowledge in the impact of autoimmune diseases on fertility. Not all REs are focused on this.

I also would search both these diseases on ivfconnections.com to see what other women's experiences were so that you have some more specific knowledge about what should be looked at.

[Anonymous]

If you are just starting TTC and going for a preconception visit with your OB, that's different from seeking help if you have been trying for a while without success. To echo the PPs, if you are specifically seeking fertility help because you've been unable to get pregnant, I would not waste my time with an OB.
You talked about "clearing the fallopian tubes," which makes me think you have been trying for a while b/c that is not a standard pre-conception procedure that an OB would order if you just walked in and said you'd like to try to get pregnant. You're referring to an HSG, which checks both the uterus and tubes for any obstructions or abnormalities and is part of the preliminary workup you would do with an RE before starting treatment. You also mentioned celiac & hypothyroidism - if you have these conditions, I would look for an RE that is well-equipped for dealing with those issues as well.

[Anonymous]

I don't think PP was saying she had celiac or thyroid problems, but rather these were things she thought she should be tested for on the initial visit.

REs have a standard panel of testing they run as part of an initial workup and the testing identifies the most common issues related to infertility, though certainly not all of them. You can easily get carried away with every test under the sun for the sake of testing, but additional testing is usually only done when there are signs that further investigation is needed.

REs routinely run thyroid testing as part of the initial workup. There is some disagreement on what the best TSH range is for ttc, but I have heard it should be below 2 for optimal ttc. An endocrinologist who has infertility experience is the best resource IF a thyroid problem is identified by an RE or your RE says TSH is ok above 2.

As to celiac, it is not routinely tested for and certainly not by an RE or OB. Many people investigate the celiac angle after discovering they have immune issues as part of the ttc process. Immune testing is widely debated in the RE community and many, if not most, REs will only do immune testing after 3 m/cs.

So much of ttc is out of our control. Even with a perfect cycle, sometimes it just doesn't happen. I would look for clues to potential problems as you move along in the process, but would not go beyond the basics to start with, as odds show it is unlikely you will need them and you could spend a lot of time and money on unnecessary tests.

[Anonymous]

I'm the OP. We've been trying for about 3 years with no luck and I'm entering my mid-30s so I don't have a lot of time to spare. I think with my insurance I have to start with a GYN. When I originally made an appt. I saw a nurse practitioner who referred me to a GYN, so this is a second step on what looks like might be a long journey. I'll ask right away about seeing a specialist. I don't know if I have hypothyroidism or celiac, those are just a couple of things that others have told me may be getting in the way of conceiving. A family friend is an endocronologist, perhaps I'll contact him to seek his advice. Thanks for all of your input.

[Anonymous]

Get your FSH tested and get a referral to an RE--we loved Dr. Sacks at Columbia.

[Anonymous]

OP, if you must go through an OB first for insurance reasons, ask if your OB will order the standard tests that an RE would start with. Those are: (1) day 3 bloodwork and ultrasound - this will check your hormone levels, including TSH (thyroid), and your estrogen & FSH, which are important for evaluating your ovarian reserve, and the ultrasound will check your antral follicle count, also a component of ovarian reserve; (2) an HSG test to see if your tubes are clear and/or if there are any uterine abnormalities, and (3) a semen analysis for your husband. These test are fairly simple (tho the HSG which can be a little uncomfortable) and most REs won't do any treatment without running them first. I think something like 40% of infertility is male factor, so if it's a sperm issue, that would be important information to have in determining your next steps - so before you put yourself through a whole lot of invasive procedures, you should definitely have an s/a done on your husband. Finally, you might also want to start charting basal body temperature as this can help you determine if/when you're ovulating.

[Anonymous]

OP again. Thank you everyone for the specific and helpful advice. I truly am just getting started on this path and the research I've done overwhelms me a little bit. My GYN appointment is in a couple of weeks so now I'll know what to mention/request.

A related question -- I've read that many times the HSG is effective in helping to conceive as the dye/procedure clears any blockages in the tubes. Has anyone had an experience with this working or know someone for whom this has worked? Thanks again.

[Anonymous]

HSG is supposed to provide some additional benefit for 3 months following the procedure. I personally have not had that benefit, but do know someone who got pregnant the same month in which she had the procedure and another friend who got pregnant shortly thereafter. It does happen and REs will even tell you that you might get lucky right after having one. Good luck!

[Anonymous]

I was two months away from my 40th birthday when I conceived after an HSG.