IVF: Getting Started, Testing, and Diagnosis

Building a family can look so different, for so many people.  For some it comes easy, for others it doesn’t.  And even for others, there are surprises along the way!

There have definitely already been some surprises, twists and turns along the way for us on our road to parenthood.  We had great plans to wait a year or so after getting married to start having kids.  We figured we would have four to six kids, evenly spaced out and still close together in age and we would all live happily ever after.

Except a year and a half after we were married came and we began trying to get pregnant… and another year and a half passed and we still had no baby on the way.  What we did have, though, was the most precious little stranger we had ever met who we were sharing our lives with and had no idea where it would lead.

Fostering became one of those twists and turns along our parenting journey, and with hearts full of joy at all the possible ways God could use us to serve children who would enter our home.

None the less, we had still experienced a lengthy infertility journey to this point, and had curious hearts about where fertility treatments might lead us as well.

What do you do when you suspect you might dealing with infertility after some time trying to conceive?  How long should you try to conceive before seeking medical advice?  And when you decide to explore your options, where do you even begin?

Infertility - Diagnostic Testing - Starting a Fertility Journey

When a couple begins building their family, or wishes to add to their current family, there are some common guidelines to follow when considering  if it is necessary to seek medical attention for possible infertility.

Chances are if you are in any stage of an infertility journey, you’ve seen this list before.

It is recommended that you seek infertility treatment guidance if you (or your partner):

  • Are under 35 and have been trying to get pregnant for over a year
  • Are over 35 and have been trying for 6 months
  • Are over 40 and have been trying for 3 months
  • Have general concerns about your fertility
  • Have irregular periods
  • Have menstrual cycles shorter than 20 days or longer than 38 days
  • Have had a miscarriage
  • Have endometriosis or PCOS, or suspect you have one of those conditions
  • Have heavy or painful menstrual periods
  • Have a history of steroid use
  • Have a change in sex drive
  • Have erectile dysfunction or difficulty ejaculating
  • Have low semen motility, count, or morphology
  • Have frequent urinary infections

When we first got started with infertility specialists, we were both under the age of 30 and had only been trying for six months to get pregnant.   Typically, doctors ask that you try for at least one year if you’re under the age of 35 before seeking fertility support because it’s normal for it to take that long for any healthy couple without infertility struggles to fall pregnant.

I mean, really… when you fully understand the biological circumstances it takes for a baby to be created and realize how incredibly precise individual health and timing must be for this to happen, it’s truly a miracle any of us are here today.  And, yet, these miracles happen for so many couples so easily every single day.

So why did we go to a specialist early?  Something just didn’t seem right to us.

And to be honest.  We were ready for kids.  Now.

We knew that by the time we sought advice from my OBGYN, and then got a referral and an appointment with a reproductive specialist, AND got through diagnostic testing, we would be around the one year mark before we would even be looking into treatment plans.

So, that’s just the route we took.

Infertility - Diagnostic Testing - Am I Infertile

So, how did we get started on our infertility journey?

I first made an appointment with my OBGYN.  I went in for my yearly well woman check and asked to discuss fertility treatment options.  I took this opportunity to discuss my speculation of endometriosis to see what she recommended as far as further testing and treatment options for getting pregnant.  My OBGYN didn’t have anything to say about the endometriosis, but promptly gave us a referral for a reproductive endocrinologist (RE), and a referral to a urologist for my husband to get checked out.

Infertility - Finding A Specialist - Choosing a Fertility TeamWe went our rounds with diagnostic testing through both specialists.  We chose to get a second opinion from another reproductive specialist we found through an internet search.  Long story short, we ended up sticking with this second RE for all of our fertility treatments, and are so thankful we did!  You can read about our experiences here.  Choosing the right fertility specialist is very important and can make a huge difference during your fertility journey!

Upon finding an AMAZING reproductive endocrinologist team, along with a new urologist this doc preferred to send his patients to, I also switched my OBGYN.   These three changes made a difference for us and how we felt about our infertility journey.   We finally felt like there was hope and we had a team of people who were ready to work with us through this process.

Though we did do some retesting with our new specialists, we were thankfully able to use the results from some previous diagnostic testing we had done with the first RE and come up with a game plan for treatment options.

So, what exactly did our initial diagnostic testing look like?  I’ll share with you!

Infertility - Diagnostic Testing - Testing for Him

For men, the first step is a semen analysis and blood work to check hormone levels and to check for STDs.  My husband went through three rounds of analysis to get a clear overview of what his numbers looked like.  From there, the urologist can choose to take a few different routes for treatment options.

We found out we were up against low sperm morphology and motility.  Though the sperm count was good, this basically meant the sperm had a hard time moving all the way to the top of the uterus to reach the egg in time, and the ones that could swim that far didn’t have a great chance at penetrating the egg wall because only 4% were of viable shape to successfully do so.

Couple this with trying to time ovulation for the best chances at the sperm meeting the egg at the right time you might say it’s no wonder we weren’t getting pregnant.

The first urologist my husband saw had prescribed Clomid.

Yep, for my husband.

The second urologist had actually agreed with this prescription method, only he opted for a lower dose.  At one point, my husband was taking 1/4 of a Clomid pill.  Isn’t that fun to manage daily? haha  But wouldn’t you know it?  The quarter of a pill dose worked better than the full pill dosage.

If no improvement had been made with these methods, the next step would have been to check vericocele veins which could be the cause of sperm issues.

Infertility - Preparing for Conception 5Thankfully, we saw some improvement with the Clomid, and we later saw enormously improved results in overall sperm health with some natural methods we chose.  Take a look at our post about Preparing For Conception to see what my husband used this during this time!  If I hadn’t found the power of these methods so late in our infertility journey (4 1/2 years in and a couple months away from doing IVF) and wasn’t in such a rush to get pregnant, I firmly believe about a year or so maintaining these natural methods would have allowed us to get pregnant naturally, and something we will look to do before trying to get pregnant again!

Now, let’s talk about what was on the lineup for women!  In our experience, women go through a greater amount of diagnostic testing.

Infertility - Diagnostic Testing - Testing for Her

I, too, had blood work done that checked for STDs and also looked at my hormone levels across the board.  I was shocked, and thankful, to see the amount of hormones the doc wanted to check.  They collected seven vials of blood from me!

The blood work and initial trans-vaginal ultrasound was performed on day 3 of my menstrual cycle, and was in addition to a consultation and lengthy questionnaire about my medical history, medications I take, lifestyle habits, previous surgeries, long-term conditions, and possible exposure to chemicals, toxins, or radiation.   Boy, how I wish I knew more about living a toxin-free lifestyle then!

The Questionnaire also asked about my sex life and history, pregnancy history, birth control use history, STDs, questions about periods and ovulation, and common questions about symptoms which may guide the doctor to look into certain infertility diagnosis.

In addition, I also had a hysterosalpingogram, or HSG, done.  Basically, this is an X-ray test done so the doctor can see if there are any fallopian tube blocks.  The doctor will have you lie down under the x-ray machine and fill your uterus with a dye filled liquid, like iodine,  which will show a color contrast on the x-ray.   The doctor will look around and examine your uterus and fallopian tubes.  This is an outpatient procedure that only takes 5-10 minutes.  If the -ray shows blocked tubes, you may be referred for a laparoscopy and further treatment.

Some warning about the HSG: you may experience cramping and feel ill, especially if you find you’re allergic to the dye.  This was a test I did with our first RE, who did a terrible job at explaining any side effects of the test.  You may want to ask if it’s okay to take an over the counter pain reliever before your procedure to help with the cramping you can experience afterward.  I had terrible cramps for a couple of hours after the procedure and wish I had taken something right before the appointment to stay ahead of the pain.

I also felt VERY nauseous from the procedure, which I assume was from the dye.  Though this is an outpatient procedure, and you should be able to drive home yourself, there is a chance it can make you feel nauseous or dizzy, so it’s always best to try to have someone go with you.  Since this office was just down the street from my work, I went during my lunch hour and I had driven myself.  After the procedure, I couldn’t even sit up all the way without immediately feeling lightheaded, dizzy, and nauseous.  I laid in the procedure room for about ten minutes before leaving and going out to my car, where I laid down for another 15 minutes before driving back to work.  About that time my cramping had kicked in fully and I was in pain from the pelvic cramps.  Not all women experience this, but be prepared for it.  You can take your typical nausea remedy go-to with you to the office, like crackers and ginger ale, or YL Therapeutic Grade Peppermint Oil.   Having something on hand may help you recover from any nausea much quicker.  Again, something I wish I had known before my appointment.

We were blessed to have a positive outcome from the HSG.  The doctor did not find any blockages or any reason to pursue a laparoscopy.

Infertility - Diagnostic Testing - Our Infertility Testing Diagnosis and What We Did About It

Though our first RE was the now third doctor I had spoken to about my suspicion of endometriosis, he was also the third doctor to assure me it wasn’t something I needed to worry about.  He did not find any fertility obstacles with me and did not order any more testing to be done.  He determined our infertility struggles to male-factor infertility and suggested we move forward with IVF, which was over $20,000 at his clinic.

These are the reasons we chose not to move forward with this reproductive endocrinologist or any treatments.  For one, we did NOT have that kind of money and didn’t want to go into debt at the time for any treatment.  Our insurance covers diagnostic testing for infertility, but does not cover treatment, and we don’t have any mandatory fertility treatment coverage in Arizona.  Deep down, we also did not trust the diagnosis of this specialist could not comfortably move forward with their office.

After this I started seeing my new OBGYN, and our new RE.  These were the best decisions of our journey!  Throughout this time was also when I found natural options to help support fertility.

With these new doctors on our fertility team, I brought up the possibility of me having endometriosis, AGAIN, based on my symptoms and my mother having had severe endometriosis and difficulty getting pregnant.

Both the new OBGYN and new RE suspect endometriosis could be playing a huge part in our infertility struggles.  As I mentioned earlier, this RE also referred hubby to a new urologist who he highly recommends and loves to work with.  This urologist prescribed hubby the lower dose of Clomid to raise sperm count, motility and morphology to give us the very best chances at achieving success through treatment.  He followed up very often to give us the very best outcome with fertility treatments, which was greatly appreciated.

My OBGYN was very open to doing a laparoscopy to check for endometriosis (no other OBGYN has wanted to do that for me or felt it was worth doing).  We chose to put off the laparoscopic procedure for the time being and follow our new reproductive endocrinologist’s recommendations.   This doc did a consultation, had us fill out questionnaires, did more blood work with both my husband and I, and also did diagnostic ultrasounds on me.

Based on our results, he asked if we wanted to try a couple rounds of IUI, which was an inexpensive treatment, or move forward with further diagnostic testing.  Impatience got the better of us, mostly me, and we chose to try IUIs.  You can read about our IUI experiences here.

In the end, we needed to move forward with IVF, and the first steps to that process were, again, a consultation, blood work and ultrasounds.  The doctor also performed an outpatient hysteroscopy procedure on me and found that our infertility struggles, indeed, may have been more due to issues with me and very little was because of my husband’s sperm – especially since we had seen improvement in this area.   Check out how my hysteroscopy procedure went HERE,  what the doc found, and find out why I would have done this SOONER!

Infertility - Finding A Specialist - Finding the Right Specialist 1

It is very important to find the right doctors when entering into a fertility journey.  While there may be multiple or limited clinic options in your area, I would recommend you still do a great amount of research on the doctors in your area to find a doctor you feel comfortable with.

After all,  this is an emotionally and physically trying time and you want to have someone who will be sensitive and attuned to your needs.  We did NOT like the first fertility clinic, or my original OBGYN, but fell in love with our current team of professionals and it has made the journey much more enjoyable, hopeful, and easier to get through.

We, luckily, found another office about 5 miles away from the other office that we fell in love with!  Our doctor was also amazing to work with throughout the entire process.  He was great at explaining procedures and answering all questions, even the silly ones we felt stupid for asking.  He made us feel like we were part of the process and had a say in our treatment plan.  He didn’t at all make us feel uncomfortable.

We were blessed to find a doctor and team of staff who had incredible bedside manner, actually cared about our feelings and our family journey, who used updated technology and techniques, and had access to a greater network of resources and experience.  This is SO important to have better chances at success, and a great fertility experience, if there is such a thing!

I’m curious and want to hear from you!  What was included in your infertility diagnostic workup?  Tell us below in the comments!

Visit Our Etsy Shop
Want a fun way to document your infertility journey?  Check out our Infertility Journey Milestone cards you can print and use as photo props on your blog or to share your journey with friends and family on social media, or you can even print these and journal on the back for a special keepsake of all the special moments in your journey!

Infertility - IVF Getting Started


3 thoughts on “IVF: Getting Started, Testing, and Diagnosis

Leave a Reply