New here + would love advice

[chocolatepie]

(I posted on GBCN a few years ago under a different name but wanted to have something less recognizable going forward)

I'm very new to TTC and am trying to wrap my head around all the different treatments, methods, and acronyms - it's very overwhelming. We just started TTC 6 months ago; I turned 40 last month and I'm downright panicked about time running out. 

I'm seeing a fertility specialist in the morning and I'm excited and terrified. I have great insurance; once an infertility diagnosis is given, it covers unlimited IVF at 100%. 

What tests should we anticipate being done in the beginning? What was done before you were given an infertility diagnosis?

What questions or things did you discuss (or wish you discussed) on your first visit? 

How quickly can the ball get rolling if insurance and finances are in order? 

Thanks for any advice you can send my way  

[seeyalater52]

Welcome and sorry you find yourself here. It’s a great and supportive group though!

For insurance purposes typically they will consider you infertile after a year of trying (if younger than 35) or 6 months of trying (if older than 35) with “regular unprotected intercourse.” Especially if you’ve done any tracking of ovulation. The specialist may ask some questions to get at whether you’ve been consistently missing the fertile window but technically you should meet criteria for infertility coverage right now assuming they use that common definition.

The type of infertility you have may be discovered during some preliminary testing. There’s a label of tests known collectively as “CD3 bloodwork” (typically done on days 2-4 of your cycle) that will look at stupid hormone levels. Mine included I think AMH, FSH, prolactin, and thyroid. Some practices will also want to test progesterone at 7dpo to see if you have a strong ovulation. And your H will need a sperm analysis. You may also be checked with an SHG or HSG to see if your tubes are clear and your uterus free of abnormalities related to shape, polyps etc.

If at the end of this an issue with your hormone levels or uterus or tubes is detected, or the sperm analysis shows issues, you might have a reason identitified for the infertility. Otherwise you will probably just be in the sad “unexplained” category, like me.

I’d expect the specialist to walk you through their next steps during the initial appointment. What do they typically recommend? Depending on how tests come back what would be needed for IUI to be an option? Or is there a scenario where you’d go straight to IVF? They will likely also walk you through any specific rules or limitations your plan has on treatments (for example some require a certain number of IUIs before authorizing IVF.)

It all seems overwhelming but it’s less scary once you get going!

[seeyalater52]

Forgot to comment on timing: usually testing takes at a minimum one cycle. You have to wait at least until you get a CD3 for most of the bloodwork. Sometimes HSGs can take a bit to schedule depending on your clinic.

If your insurer requires a pre-authorization for fertility interventions, as most do, you will need to have some tests and other information in your file in order for them to approve you for treatment. Pre-authorization can take 2-4 weeks to clear so that can sometimes delay things a little.

You may be able to start an ovulation inductor like clomid or letrozole and timed intercourse while you are waiting for approval for IUI/IVF.

[pooh8402]

Sorry you find yourself here, but this is a great group of women! And your insurance coverage sounds amazing!

Yea, what she said. Testing delays things, but usually no more than a month. I came into my first RE appointment with a SA already done (post-vasectomy reversal) and a year's worth of charts from Fertility Friend. With DH's SA results and my charts, my RE was able to come up with a tentative diagnosis of PCOS for me and moderate male factor infertility for him. The follow up ultrasound and bloodwork just confirmed her diagnosis. DH had bloodwork too, to check hormone levels.

You'll both likely be tested for communicable diseases as well, like hepatitis, HIV, various STIs, etc. And you may have genetic carrier screening (I did).

So how quickly did things happen? I saw the RE in December 2013, at 3dpo. She did an ultrasound (confirmed PCOS and that I was 3dpo) and some bloodwork immediately. I did CD3 bloodwork beginning of January 2014. I got my period again that month, and then we did meds and an IUI in February. So about 2 months from initial appointment to actual treatment.

This was without insurance. I was OOP back then. Insurance covered diagnosis, but not treatment at the time.

[barney96]

You'll also want an ovarian reserves test (done usually while on your period) due to your age. I'm 39 so that's not a knock. That will be the best indicator of how long you have or if you're already out of eggs.

[cherryvalance]

Sorry you find yourself here, but it is an excellent resource! Everyone is welcoming and knowledgeable.


What tests should we anticipate being done in the beginning? What was done before you were given an infertility diagnosis?
My RE did a pelvic exam and bloodwork or my H and I. H also did a semen analysis and I had a HSG to check my uterus and tubes.

What questions or things did you discuss (or wish you discussed) on your first visit?
Our RE was great, actually. He told us what to expect, what they'd be looking for, how IUI and IVF work.

How quickly can the ball get rolling if insurance and finances are in order?

I don't know if our timeline was typical, because Christmas got in the way, but we first went in November of 2015. I needed some polyps removed, which was done the following January. We did three IUIs back to back, finally starting our first IVF cycle in May. I also have coverage and my insurance moved very quickly with approving everything. My prescription benefits were a PITA, though.

[icedcoffee]

Welcome! Sorry you're here. I hope your stay is short.

Everyone seems to have covered most things. I'll add that they can get things started pretty quickly. Our longest delay for our first cycle was getting my H in to meet with a urologist after his sperm analysis came back terribly. Otherwise they can typically get you cycling in 1-2 months. Good luck! Let us know how it goes today.

[chocolatepie]

Thank you all for the info! My consult went really well and I think the doctor and staff are a good fit for us. Everyone was friendly, prompt, and explained things clearly.

He arranged for us to do bloodwork (did mine today), semen analysis (he's going next week), and an HSG. Unfortunately day 9 is tomorrow and they are booked solid so I have to wait until next month to do that He told me that the bloodwork and semen would come back around the time I do the HSG so this time next month, we will have a clear picture of next steps.

Thanks for the welcome!

[icedcoffee]

I'm glad it went well and they are moving in a quick manner. I hope you guys have a plan in place soon!