Fertility Workups [UK]

So I thought I’d write a bit about the process of getting fertility testing here in the UK, in case it helps others. It also helps me to get it all out.

NB:  This information is based on my own personal experience in Scotland. Your experience may vary, and I’m by no means an expert.

 

WHEN

Basically, the recommended time to be trying (if you’re under the age of 35) before they’ll start testing is now 18 months. Most couples conceive within a year, with almost all conceiving within 18-24 months.

However. If you have any other obvious issues going on (erratic periods, painful periods, no periods, very long cycles, etc) they will test you from 12 months. If you are over 35, they will test from 12 months if everything seems as it should, or 6 months if you have any of the aforementioned issues going on.

 

HOW TO GET THE BALL ROLLING

First port of call is your GP.  You’ll need a basic idea of your cycle history, notes of any issues you’ve noticed, any vitamins you’re taking, etc.  They will ask about your sex life, so don’t be shy.  Some GPs aren’t as knowledgeable on your options, but they’ll know how the referral process works at least.

 

THE REFERRAL

Your GP will then organise to refer you to your local Fertility clinic or centre. NHS centres are hospital-based (well the ones I’ve come across) and will send back a letter to you and your Dr explaining how the process works and what tests they need run by your GP.  My GP knew what they’d ask for so prepared me for it ahead of the letter, but your letter will most likely ask for the below:

  • A chlamydia swab test (self-swab, you do this at home and drop it in)
  • A blood test early in your cycle (between CD1-CD5) measuring levels of LH, FSH, E2, Prolactin, Testosterone, TFTs (I’ll explain what these are shortly).
  • A blood test around CD21 to test your hormone levels to see if you are ovulating
  • A Rubella test (immunity, rather than whether you actually have it!)

If your partner is also at the same GP they will get him sorted at the same time to get an SA – sperm analysis.  If it’s not at the same GP, his name will be noted on your referral and he will have to go to his own GP and give your name/mention the referral to get the ball rolling on his side.  Note: SAs are done “at least” a month apart, so that will hold things up – nothing will happen until both are done. Get your man on it ASAP.

After all of these tests have been completed, then you will go on the waiting list.

 

THE TESTS

LH –  Luteinising hormone:  Early in your cycle this hormone stimulates your ovaries to produce E2 and then surges before ovulation to get your body to release the egg.

FSH – Follicle-stimulating hormone:  Like LH, this is released by the pituitary gland to stimulate follicles to release an egg for ovulation. It is the main hormone involved in producing mature eggs in the ovaries. This test will help to assess your ovarian reserve.

E2 – Estradiol:  Estradiol is a form of the hormone estrogen. The ovaries, breasts, and adrenal glands make estradiol. During pregnancy, the placenta also makes estradiol. This test can indicate how well your ovaries are working/if there’s any cyst issues. Low levels of it can indicate PCOS.

Prolactin:  This is another hormone released by the pituitary gland. This test ultimate helps to rule out problems with the pituitary gland or hypothalamus. Increased levels of this can mess with ovulation.

Testosterone:  Too much going on can indicate PCOS. Too little means you’re not likely to get ovulation going.

TFTs:  This is a thyroid function test.  Your thyroid can play a big part in how your body regulates everything, and needs to be at an optimal level to get pregnant. If your thyroid is over or under-performing, conceiving can be difficult.

 

THE WAITING LIST

In Edinburgh right now the standard wait is 12 weeks. This means from GP to Clinic, you’re looking at 14-18 weeks before you’ll see anyone.  The tests need to be done (including the spaced-out SAs for your dude) and then the clinic needs an available appointment that you can both attend.  So don’t think it’ll be quick and that you’ll get assistance immediately, you need to just keep trying, unfortunately.

 

WHAT HAPPENS THEN

Well, I don’t personally know but I know the possibilities – they could want to scan my ovaries, they could take more blood, they could organise an HSG (dye/scan of your tubes), they could end up doing an op to see what’s going on in there.  I’ll do another post/update this one once we’ve had the appointment.

 

YOUR OPTIONS

There are many! From IUI to IVF. And I plan to go over them at some stage in future, after our appointments.

 

AND OF COURSE

You may not need any of this. My hope is that we will fall naturally before any of this shizzle happens. At the moment I appear to have one issue which I will cover in the next post.

 

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Coming up next: My results and where we stand.

On Timing

We were going to stop by now.

We had a plan and that plan was to stop by March because otherwise we’d have a baby at a very inconvenient time.

But then the baby didn’t happen.

 

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We’ve now been referred to the Reproductive Clinic. I’m in two minds about this. To me, it says that I am broken and my brain says, “That’s right, they’ll tell you you can’t have children” and that to me is one of the worst possible outcomes for my life in general. I can cope with not getting a good job, not having a nice house, having a small amount of good friends over being very popular, being a bit chubby, being not that attractive… but not being able to be a mother is not happening, people.

Yes, I know there are options and I can be a mother to a child that is not biologically mine, but that’s very hard for me to grasp right now. I really want a child that’s from us.  And if the option is gone, then of course I want a child that really needs a home. But I’d have to have some time to grieve not being able to carry my own.

 

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The other part of my mind on all this is like, “You’re fine. You just need to try longer. The tests will come back fine. Or they’ll put you on a drug and then a few months later you’ll be knocked up” and that gives me enthusiasm about a way forward.

However.

We’re not seeing anyone til August. That’s the waiting time. It’s a nightmare but also a blessing. We have more chances to try on our own and I really really want to succeed that way.

I really hate the uncertainty but at the same time, maybe we just require a bit more patience.

I hope you’re doing okay today.  Keep hopeful.

For the Almost Mothers

Happy Mother’s Day, almost mothers.

To the mother who lost her baby, but still feels and knows she is someone’s mother.

To the mother who has been trying a long time and feels the pain of this day.

To the mother who had to give her children another home, for them and for her.

To the mother who is waiting for that call to take in a child that needs a home.

To the mother who fosters temporarily and wonders if they see her as she sees them: family.

To the mother who hopes and dreams and waits.

To the mother whose children are grown and gone.

To the mother who takes in and raises her grandchildren.

To all the almost mothers.

Things People Need to Stop Saying

“Just relax!”

Yeah. I think if babies were made simply by relaxing, we’d all be pregnant by now. We’re all trying massages and acupuncture and meditation and long baths and treating ourselves. Trying to conceive is not relaxing. The stress of it makes us stressed and then we’re stressed because we’re stressed and that means we’ll have trouble and that’s stressful and…

 

“Read this book!”

This can actually sometimes be helpful, especially if someone is new to the process, but don’t assume immediately that we aren’t researching how to make this happen. Believe me, we’re all extremely obsessed with knowledge. Google any word and ‘ttc’ and you’ll find forums and question boards of women talking about things. We’re all talking about things.

 

“Book a holiday!”

If we book a holiday once a month we’re going to go broke. Thanks but yeah, nope.

 

“Don’t worry about it, my cousin just stopped trying and it happened!”

Yeah okay. I have cycles between 33-47 days long, so if I stop “worrying about it”, I’ll miss my opportunity altogether. If we ‘stop trying’ I’ll spend months wondering how I could have improved my chances that particular cycle. Believe me, we need to track. And all these anecdotes? Thanks but no thanks.

 

“Have you tried tracking your cycle?”

Er. No shit.

 

“It’ll happen!”

Like. No. I know you have the best of intentions but at cycle 10 I can’t hear this shit anymore. Maybe it won’t happen. I have to live with that in my head most of the time, so the glossing over it is really frustrating.

 

“Just adopt!”

This one drives me crazy. Have you any idea how hard it is to adopt? How expensive it is to adopt? Just stop.

 

“Why haven’t you guys had kids yet? Aren’t you going to have kids?”

Maybe we’ve been trying a long time and this is a really personal and insensitive question? (It’s also kinda hard to answer!)

 

“You’re getting a bit old, I hope it happens soon!”

Well thanks! I wasn’t worrying about this already at all!

 

“Are you putting your legs in the air?”

Studies show- no wait. What the hell? This is a weird question.

 

“Maybe you just need to pray more about it. God provides in his own time.”

Yeah, God has heard from me about this, thanks. I think I’ll leave it up to us.

 

I hope some of you can relate to these, and maybe a few of you will realise that some of this is unhelpful? I know people have the best of intentions but if one more person tells me to “just relax”…

Let Go

One of the hardest things for me is just to let go.  I struggle with trying to let things happen, always wanting to be in control. And fertility is not something I have control over.

 

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I keep trying to tell myself that when we finally do get this baby, this baby will be ridiculously cherished. I can’t let myself forget these days of longing; of wishing more than anything else that I could just grow and nurture new life inside me.

 

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It’s hard keeping a secret yet wanting to talk about it to everyone. It’s hard when people around you are getting pregnant and you had no idea they even were working on it. Maybe they were trying a long time,  maybe they weren’t trying at all. Regardless, it’s always a sting mixed with immense excitement and joy and goodwill for them. It’s hard. And it’s hard when so many don’t understand how tough it can be for some people to get pregnant – they seem to start trying and fall easily and enjoy the relative ease of it all.

 

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After 9 cycles there’s no ease. There’s counting and logging and thinking and hoping. And you try to keep “relaxing” (though this really means diddly squat if you ask me), you book the relaxing weekends away people tell you to, you try not to think about it and plan time away from charting and logging and counting and none of it makes the difference. Babies aren’t inevitable like all the accidental pregnancies make them out to be. There’s a window, there’s a time, there’s a routine, and without it, it won’t happen.

 

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I’ve found solace in the online communities where venting is key and talk is open and no one tells you it’s too personal or too much information or that you’re obsessing unnecessarily. We’re all in this together. And it does help me to let go. I only hope I didn’t have to live this much longer.

 

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Some pieces I’ve found helpful lately:

Parenting before children by Play, Unpenned – I feel like a mother without being a mother. It’s cruel and unsettling.

A guide to being nice at Christmas (or the gift of not being a jerk) by Emily Writes – the paragraph about the “maybe pregnant Mum” meant everything to me before Christmas. Luckily no questions were asked, but I did feel like I was sure to be pregnant by Christmas and when it came, it was a bit of a tough one, but this post made me feel like someone got it.

 

Read anything special lately? I might try and link to others more. There are some wonderful pieces out there.

Feeling like a failure

It’s hard not to feel like a failure.

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It’s hard not to compare yourself to everyone around you – everyone who seems to be falling pregnant without much effort or quarrel.

 

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It’s hard not to feel like you’re not a real woman; you’re not a woman who can perform something that seems to come so easily to others. The parts that can bring life to the world just aren’t playing ball.

 

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It’s hard to feel like you are already a mother, but the world isn’t matching up. You know in your heart you are made for this but for some reason, everything disagrees.

It’s hard not to be brought down by failure month after month, even when you know the odds, know the score, know how much luck comes into it.

It’s hard not being able to control it as much as you wish you could.

 

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It’s just hard.  But you’re not a failure.  Your body is taking its time, your timing is being perfected, your place in the world is still right.

 

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And when you have hope, you can carry on. There is always hope, there is always a light at the end – and if you have faith, maybe God (or the universe) will provide.

Don’t give up.

 

 

Excellent Web Resources

Here are some online tools I’ve found super helpful!

ctpCountdown to Pregnancy: This site not only has an account function where you can track your cycle, it also has calculators to work out ovulation and due dates (including important dates throughout the entire pregnancy, not just the end date!), and forum boards/feedback areas for your home pregnancy tests. Well worth checking out! I love that I can compare symptoms from current cycles with my previous one, so I know that yes, I am just being crazy. I do use a bunch of apps on my phone to track everything, but it’s really nice having another web resource as well.

twwTwo Week Wait:  This site is helpful for those who are obsessed with others’ stories. I love the bfp by dpo area where you can read posts from folks detailing what symptoms came up for them each day.  The majority of felt ‘symptoms’ each month are due to progesterone, not pregnancy, but it helps to read what others experienced – and post your own, if successful! (I journal mine for comparison too).

ffFertility Friend:  I’d be surprised if you’re TTC and not using FF.  It’s not the prettiest or most intuitive site/app, but it really does seem to be very accurate and it is always comparing your symptoms/cycle to others in the database. It has a “cycles like mine” feature, a cycle dates planner, and much more.  I check it daily, even if it’s not the TWW.

redditForums:  Everyone needs someone to talk to, right?  I’ve found throughout this whole process that there are very few people willing to speak openly out in the real world about what they’re going through.  Online discussion forums have been a bit of a godsend to me.  I find Reddit forums particularly helpful. Well worth signing up and making a “multireddit” to track all of them at once.

Any other good web resources you use?

 

Coping with disappointment

 

Something I try to repeat to myself every month: the odds. The odds are shit. The odds are against you.

Even with perfectly-timed shenanigans, most couples have a 20-30% chance of conceiving every month.  It can take 6 months for the healthiest folks with the best plans or even 12 months just because.

It’s kinda all I’ve got.

But the hard part about it is not knowing if there’s anything actually wrong. And of course you assume everything is wrong. They don’t run tests until you’ve been trying for over 12 months, or 6 if you’re over 35.  We’re under, so it’s just a waiting and hoping game.

 

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Disappointment comes in many forms for me. It’s so hard to plan your life not knowing whether or not you’ll need to factor in a baby.  I have budgets and travel plans and ideas, and I’ve put a baby into all of those. Because optimism, right? But at the same time, it’s really, really hard.  I want this more than anything in the world – it’s all I really want. And being a planner, it is so frustrating that I don’t really have that much control over it.

If it’s something that I’m/we’re not able to do, I honestly don’t know what I’ll do with myself.  I think I will grieve that for a long time.  I know there are other options, but I want nothing more than to be pregnant.  I want to feel and experience that.  I want my kids to carry on traits of my family and to be like my husband, and that’s becoming more important to me during this process – imagining him as a Dad or having wee ones whose eyes or smile or laugh remind me of him is one of the best things I can imagine, ever.

But I can’t give up yet. We’re coming up on cycle 7, and it’s far from over.  It can just be so disappointing.  Each month is a new little heartbreak.

Holding onto hope for me and you this month.

Highs and Lows

Temping drives me bananas.

 

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If this is not something you are doing/have experienced – let me paint a picture.  Each morning you awake, blink open your pretty eyes, grab for the side table where your thermometer awaits, and jam it in your mouth.  You make a mental note/physical note/app note of the temp, and then either get up for the day or go back to sleep.  This is your basal body temperature – the base temperature your body operates at before your organs “start up” for the day.

The trouble with temping as a method of tracking ovulation is that it shows you that you’ve ovulated after you have. It’s a way of confirming it, not predicting it.  If you’re lucky, you’ll get a clear dip which will make you think, “Ooh, okay! It’s time!” but sometimes your temps are all in a similar place, and then you’ll get a big leap to indicate that it’s been and gone.

And this month, my temps are trolling me.

Well everything has been a little bit, since the maca issue. So I’ve taken this month with a grain of salt, really.  It’s annoying not knowing where you’re at, and sometimes you’re kinda just wishing for your new cycle to start so that you have a clear idea.

It’s the not knowing that kills you.

 

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But the temps are at least on the up.  So I’ll keep watching them, day by day, and see if they slowly start to drop. Then I know I’m “out”, as folks on the fertility boards say.  If estrogen takes over again, then progesterone drops and your temp drops. And you can prepare to give it another go next time.

I always have bold plans for “next time”. One of these times it’ll stick.

Getting It All Out

Just a short post but I wanted to recommend something I’ve found really helpful.

 

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Journalling.

Oh yes, most of us had them, didn’t we? Journals as teens. Angst bleeding into the pages from our very dark and sad souls.  I do not want to read mine. They are probably so, so awful (and I imagine full of overdramatic lies).

When I was 16 I started a livejournal and found an amazing community around it. I also had a private livejournal, and wow. That was just amazing for my brain.

So now, at 31, I’ve found great solace in private journalling again. And I now use Penzu. (This is not a sponsored post in any way, by the way – pfft, you think I can get sponsorship?).  Penzu is free with upgradeable features, and I did end up going for that because I like having multiple journals and pretty cover art (I’m a magpie, okay?).  Journals default as private but you can also share your journal with anyone you wish.

So yes. Go get emosh. Let those feelings out. It helps, I promise.