Questions (TW LC and MC mentionned)

[sammysam]

OK. So. Bit of a back story...my SO and I got pregnant on cycle 4 of TTC back in 2013 and had our now 4 year old DD. I turned 35 one month after I delivered. We started TFAS when I was 37. We conceived again on cycle 8 of TFAS last July (at 38) which ended in a loss which we knew about at 10 weeks but which ended in a massive hemorrhage at 13 weeks. Pathology from the D&C was clear and the loss was due to chromosomal issues. We are now entering cycle 7AL of TFAS. I had initially said that we would try for 10 cycles and if it didn't happen then we would be happy with the family we have...but seeing how much SO wants another and having my DD asking for a sibling has got me thinking that maybe we should be seeking help at this point.

We are already 6 months in to TFAS AL so I could go see someone now...can anyone tell me what the process is? I'm not even really sure of the questions to ask here. I'm in Canada so I assume I make an appointment with my GP and try to get a referral (which I don't think should be an issue). What happens after this? What types of testing etc are manditory if we decide to move forward? Do we go immediately to something like IUI or are there other things we could try before this?

Or do we just keep trying as we are for a few more months? I am already 39 and SO is almost 51.

What do you think I need to know moving forward?

I am a total newb to this. Any suggestions, comments, insight would be appreciated.

[Bluebird]

I don't know the process in Canada, but for me in the US, we've done a lot of testing before moving to IUI. Some of that I did through my OBGyn, some with the RE. I had an HSG to check my tubes, a baseline ultrasound, and a bunch of blood tests to check for about a million things. MH had a semen analysis and bloodwork to screen for infections diseases, which is a requirement prior to IUI or IVF at our RE's office.

We tried a cycle with progesterone supplementation first because I have short LPs while we were going through the other testing, but now we are on to IUI. In our case, it is unexplained secondary IF. We will try IUI for 3 cycles and then if that doesn't work, we will consider IVF.

[obscureference]

I don’t know what they do in Canada, but I assume there would be some sort of testing. With my RE, I did a vaginal ultrasound to check follicles, before and after O blood work, an HSG, and MH did a semen analysis. After all the testing, I went in to talk to the doctor and make a plan. We are trying just meds and timed intercourse. I don’t know if we will move on to IUI, and I am 99% sure we will not do IVF.

The big thing is time commitment, for me anyway. Getting in for all of the appointments can be a bit overwhelming, and I’m basically doing the bare minimum! My best advice is to get the ball rolling now. The testing takes time. IF takes a lot of time in general. Start the process now and keep trying on your own. Also, you could just do the testing and then decide not to do any treatments. It’s really all up to you!

[sammysam]

Bluebird Thank you. My LP looks like it's starting to revert back to where it was before our loss and was only 9 days this cycle...so I'll bring that up with my doctor. How painful were the different tests? I've heard they can be quite painful and invasive. I think that's the part that is making me pause.

obscureference Yeah. That makes sense. I've made an appointment with my GP for next week to at least start the conversation. I'm glad to hear that it is mostly blood work and ultrasounds. If that is the case here then I feel more comfortable moving forward. But I am afraid of doong the HSG. I think a medicated cycle and timed intercourse sounds like something I could handle.

ETA How did you both find the HSG? Can you give me an idea what it entails?

[Bluebird]

sammysam, all the testing was NBD, mostly just a few vials of blood and the ol' dildo cam. I was pretty nervous about the HSG, but it was only mildly uncomfortable and over very quickly. I also have short LPs and they have me using progesterone suppositories after O to try and lengthen that. (My usual is 8 days.) They also have me taking a few supplements in addition to my prenatal.

[obscureference]

The HSG was no big deal for me. They had me take an ibuprofen beforehand and I literally didn’t feel a thing. I was a little crampy afterward but not even as bad as my usual period cramps. Well I mean I felt the speculum of course, but the catheter for the dye I didn’t feel at all and I didn’t feel the dye going in, either. For me it was less uncomfortable than a pap. The worst part was shimmying half naked under the X-ray screen to get my feet in the stirrups while my doc and nurse watched lol!

[sally]

Hi sammysam I'm also in Canada, but it seems like for the most part the tests are the same as in the US and what PPs have said is pretty much what we did. I didn't do a HSG, though, I did a SHG and I think that's standard practice in my province. It was no big deal, but I did take ibuprofen ahead of time. We did bloodwork, including day 3 and day 21 blood work to check hormones, a SA for DH and maybe that was it?

You will need a referral from your Family doctor but if you're over 35 and trying for more than 6 months it shouldn't be a problem. It can take a while to get in depending on where you are.

Good luck!

[charliefox]

Hey sammysam, I'm glad you decided to intro over here <3 So many hugs!

As you know, I'm also dealing with secondary IF, here's how it went down:

-Initial consult: RE took our medical history (there was a long questionnaire we had to fill out beforehand), and did a quick trans-vaginal ultrasound to get an idea of what was going on physically (plus I knew I had just O'd because of my charts so my RE was able to check and saw that I had which was kind of cool). I also brought along all my charts from the previous year.

-Blood work: since I knew where I was in my cycle we did blood work at about 7dpo so she could also check my progesterone at the time because I was having shorter LPs (along with checking the basic fertility related stuff: amh, thyroid etc)

-SA: then H did a semen analysis which we were able to collect at home and I dropped off (so he didn't have to miss work).

-HSG: another important one, to make sure your tubes are open. No use TTC if the sperm and egg can't meet! I really freaked out before this one and it was no big deal. They insert some contrast dye into your uterus/tubes to make sure all is clear, it's super quick and I've heard stories that some people really cramp up but remember it will be over quickly.

Once you have all those results they will determine what's next. Maybe it's more blood work, maybe it's some meds for you or YH, maybe it's other treatments. You won't necessarily move directly to IUI or IVF if they can find something else to fix/try.

Not sure how it works in Canada, but in the US is can take a while (sometimes months) to get in to see an RE so I'd get the referral and try to make that first appointment asap. It can always be cancelled or rescheduled if you're not ready but it's nice to know it's there.

[orangehibiscus]

sammysam Ditto what everyone else said. I’m in the US, but I called my RE and made an appt. I didn’t need a referral. I had a bunch of labs and an US. H did a SA.

I’ve had 2 HSGs. The catheter they put into the uterus isn’t comfortable. Putting it in made me crampy, and it was a bit painful. The dye going through didn’t hurt at all. I had cramping afterwards, like period cramps, for 12-24 hours.

[sammysam]

Thanks everyone. I'm feeling better about the potential process now. It sounds at least manageable and I'm glad no one found the HSG to be too horrible. sally what's the difference between a SHG and an HSG? I'm in Ontario...but my guess is it would be the same everywhere in Canada maybe. I'm also glad there are options we can try before IUI. I think that would be a good place to start.

I'll talk to my GP on Wednesday and get her take on things. She is a registered OB as well as being my GP so she might have some insight for me as well.

[sammysam]

charliefox thank you for taking the time to give a run down of the actual process. I can see why it takes so long...but you're right. Best to get the ball rolling now rather than just waiting around. We'll keep trying in the meantime until we get an appointment or we figure out for sure our next step.

[sammysam]

For those of you who have done medicated cycles, what sort of side effects did the drugs have, if any?

[orangehibiscus]

Mar 29, 2018 20:48:21 GMT -6 sammysam said:

For those of you who have done medicated cycles, what sort of side effects did the drugs have, if any?

Femara gives me headaches. Once I had 3 follicles from Follistim, and I felt a bit bloated. Pregnyl trigger shot made my arm sore from the injection. That’s it for me!

[sammysam]

Mar 29, 2018 21:07:25 GMT -6 orangehibiscus said:

Mar 29, 2018 20:48:21 GMT -6 sammysam said:

For those of you who have done medicated cycles, what sort of side effects did the drugs have, if any?

Femara gives me headaches. Once I had 3 follicles from Follistim, and I felt a bit bloated. Pregnyl trigger shot made my arm sore from the injection. That’s it for me!

That is encouraging. My body tends to react badly to most meds for some reason but if the side effects aren't too bad to start with maybe it won't end up being too crazy.

[obscureference]

Femara gives me mild headaches the last few days. So far that’s all I’ve noticed.

[orangehibiscus]

I forgot to clarify sammysam. obscureference’s post reminded me I should clarify! My headaches are mild too. Annoying more than painful. I take some ibuprofen for them, but it doesn’t really help. Headaches are gone the day after I take my last Femara. I’m definitely still able to work with the headaches, and I have a high stress job.

[sammysam]

Thanks obscureference and orangehibiscus . For the potential outcome I can definitely deal with mild headaches. I used to have seasonal migraines so at least I'm no stranger to dealing with annoying and uncomfortable headaches while working.

[Bluebird]

Mar 29, 2018 20:48:21 GMT -6 sammysam said:

For those of you who have done medicated cycles, what sort of side effects did the drugs have, if any?

I had zero side effects with the Femara. However, my body did not like the CoQ10 supplement. Luckily that one is not so critical!

[sammysam]

Bluebird What type of reaction did you have to it?

[Bluebird]

Mar 30, 2018 12:22:49 GMT -6 sammysam said:

Bluebird What type of reaction did you have to it?

It gave me horrendous heartburn and also insomnia. I tried a different brand and take it in the daytime now with food and am much better.

[sammysam]

Bluebird I'm glad you were able to find something that worked better for you!

[thechickencoop]

I'll jump in here too with my 2 cents.

I'm in the US as well, so no clue about your referral process BUT do make sure that you're working with a specialist and not just your OB/midwife. Their job is to keep you pregnant. You need an RE to actually get you there. A lot of OBs will rx Clomid or other fertility meds without testing which 1. Is a shot in the dark if you don't know what the issue is, and 2. Can seriously fuck up your fertility moving forward.

Basic testing is a lot of bloodwork, vaginal ultrasounds, HSG. I had a uterine biopsy too because we had 3 early losses in the 2 years that we were TFAS. I'm the biggest of babies when it comes to medical stuff and all of it was NBD, so really don't let the testing stop you from moving forward.

If it's all clear and you're diagnosed unexplained, then they'll probably do TI or IUI. I did three low dose IUIs and didn't notice any side effects from the Clomid or trigger shot. One brand of progesterone suppository made me feel like shit but once I switched, then it was fine.

Good luck!!

[sammysam]

thechickencoop Thanks so much for your input! I'm glad the testing wasn't a big deal and I'm glad you told me that about OBs. I'll make sure she gives me a referral for sure...I was considering just seeing what she suggested so I'm happy you added that in there!

[sally]

Mar 29, 2018 20:42:22 GMT -6 sammysam said:

Thanks everyone. I'm feeling better about the potential process now. It sounds at least manageable and I'm glad no one found the HSG to be too horrible. sally what's the difference between a SHG and an HSG? I'm in Ontario...but my guess is it would be the same everywhere in Canada maybe. I'm also glad there are options we can try before IUI. I think that would be a good place to start.

I'll talk to my GP on Wednesday and get her take on things. She is a registered OB as well as being my GP so she might have some insight for me as well.

I haven't done a HSG, so someone else will probably have more info, but from what I understand the HSG uses dye and is usually done in a hospital because they use an X-ray machine to track the dye through your tubes. A SHG uses saline, and they track bubbles created from the saline through your tubes using ultrasound. The SHG also helps to visualize your ute better than a regular ultrasound. I've read that for people that have had both the HSG is more painful, but I guess if your tubes are blocked either could be painful.

[sammysam]

Thanks sally . That makes sense. It's still the part I'm looking forward to the least if we end up moving forward with testing:/

[orangehibiscus]

sammysam, my RE gave me a Valium to take before each of my 2 HSGs. I don’t know if it helped much, but it sure didn’t hurt. You may want to ask if you could have 1 just to take before your HSG.

I also want to echo what thechickencoop said about making sure you see an RE and not an OB!