I've wanted to write this post for about six months, but I keep running out of time to sit down and write it!
After about a year of trying to conceive without success, most doctors will concede that it's possible that you may be facing infertility, but it's very difficult to get the doctor to recommend that you see a specialist. In our case, Brian was seeing his general practitioner and an endocrinologist and neither would come out and directly say that we should see a fertility specialist. I'm not sure why, but I assume it's because they don't want you to go off and see another doctor and never come back to their practice! Pretty ridiculous. We asked for recommendations and never received any help, so we took matters into our own hands and researched various clinics.
I highly recommend that if you think there's an issue that you go see a fertility specialist as soon as possible. There is quite a lot of diagnostic testing for infertility and many of the tests have to been done at certain points during the menstrual cycle, so it's possible that it could take several months from your initial appointment before any procedures are done for conception.
When you're watching all your friends and family members announce their pregnancies, that can be a very, very, very long time period to wait.
Some of the diagnostic testing is a little unnerving, so I thought I'd review the various diagnostic procedures that we experienced. Of course, every person and body is different, so what's painful for one person, may not even be an annoyance for another.
Men
Semen analysis: In our case, most of the semen analyses were conducted by Brian's endocrinologist while Brian was on testosterone medication in hopes of improving sperm counts. It takes about 6 weeks for the body to make sperm, so you can expect that if you are on testosterone medicine that you might have several analyses over several months. (Note, if you have low testosterone and are also trying to conceive, you must make sure your provider knows this because gels to increase testosterone will also kill sperm and destroy your counts.)
Pain factor: -3/10
Embarrassment factor: 400/10
Recovery time: Negligible
Women
Blood tests:
If you have infertility, I hope you have good veins because you're going to have your blood drawn a lot. I had my blood drawn at least 13 times from September 2012 to January 2013 (plus two more draws in February for my pregnancy tests). Your doctor will be checking your AMH, LH, progesterone, prolactin, and estradiol levels. If you decide to do IVF, you'll also have your blood drawn for infections disease testing (as required by the FDA). I had recently had my annual physical, so I also already had results for cholesterol, glucose, and other typical checks, which your doctor may also do if it's been a while.
Pain factor: 1/10 (for me); 4/10 (for Brian, who also had infectious disease testing)
Embarrassment factor: 0/10
Recovery time: Negligible
Diagnostic ultrasound:
You will also have a lot of ultrasounds throughout the entire process. The diagnostic ultrasound looks at the shape of your uterus, the location/size of your ovaries, and if you have any cysts in your ovaries and fibroids in your uterus. The parts of your body that they're looking at are very small, so the only ultrasound that works is a transvaginal ultrasound wand. (The good news is that you do not have to have a full bladder like you would with an abdominal ultrasound. The bad news is that the vaginal wand can be a bit uncomfortable at times.) These become less painful as time goes on, but they are definitely uncomfortable, especially if the doctor has to manipulate the location of the wand to get a better look at things.
Pain factor: 2-4/10
Embarrassment factor: 2/10 (but after the 3rd one probably 0/10)
Recovery time: Several hours to a day. You will likely have some internal soreness and possibly some spotting.
Hysterosalpingogram (HSG) test:
There is a lot of information about this test on the Internet and I was pretty terrified going in. The purpose of the test is to check to make sure your fallopian tubes are clear from any blockages. The test is done by a radiologist. A speculum is used and a tube is inserted into the tip of your uterus, just past your cervix, and a fluorescent dye is sent through the tube while the X-ray machine takes a series of pictures. My doctor recommended that I take Advil a few hours before the test.
Pain factor: 9/10 (Though during the test, it very much feels like 10/10; I almost yelled aloud and in the moment, I wasn't sure if I could take the pain. Fortunately, the worst part was very quick. The other bad thing is that because there was an x-ray involved, Brian was not allowed in the room with me. But I was very glad that he was there to drive me home.)
Embarrassment factor: 5/10 (I was not pleased with the radiology clinic we used and did not like the facility, nurse, or radiologist.)
Recovery time: A day or so. I was sore for several days. For the hours immediately following the test, there is also some leakage from the dye, so a good pad is necessary.
Saline ultrasound:
In my case, my HSG indicated a small "doughnut" shaped indention in my uterus, so the doctor suggested a saline ultrasound to look at it more closely. Saline is inserted into the uterus and the doctor looks around with a transvaginal ultrasound wand. This was slightly uncomfortable, but nothing like the HSG test.
Pain factor: 5/10
Embarrassment factor: 4/10
Recovery time: A day or so. Again, I experienced some internal tenderness and some slight spotting for a day or so afterward.
Endometrial biopsy:
Before our first IVF cycle, my doctor strongly suggested an endometrial biopsy to ensure the mass in my uterus was gone, so that it wouldn't affect any embryo transfers. This procedure, for lack of a better phrase, "vacuums" out your uterus so that any masses or tissues are forced out. A speculum is inserted and a vacuum aspirator is inserted into the uterus to force everything out. Any tissues removed are also sent to lab for abnormal cell growth. Again, my doctor told me to take Advil a few hours before the test.
Pain factor: 10/10
Embarrassment factory: 4/10
Recovery time: Quite a lot longer than expected. I was quite sore. My doctor told me that I could have spotting for a few days. In my case, it was more like a two weeks and it was very similar to medium-flow period.
So, that's pretty much it, but the good news is that if you do end up pregnant, then nothing (in at least the first 27 weeks) will be nearly as painful as the tests. Also, the pain from running a marathon is still worse. :-) So, if you've done that, you'll be golden.
Still TBD if labor and delivery + recovery is worse. ;-)
