Testing, testing, 1-2-3...

One thing I promised myself I would do with this blog, despite my preference for introversion and privacy, is share the steps of our fertility process. Not the sex, ya creeps, you gotta check my OnlyFans page for that. KIDDING! (And please don't look that up, Mom & Dad.) Anyway, something I've found lacking in my expert-level Googling is a clear, layman's description of this early part of the fertility process and what it all means. Yes, I've found plenty of medical webpages describing much of it, but even those leave a lot to the anxiety-riddled imagination. So for anyone who finds themselves in those first moments of realizing they may need medical intervention to make a bébé or for anyone who is trying to conceive and wondering what comes next if it doesn't happen, this post is for you. 

Of course, there's a disclaimer: I'm not a doctor or nurse, and these are my own experiences. You should obviously follow the advice of your physician, as your health background and needs may differ greatly from mine. Also! If you're someone who has also been through this process, I would encourage you to share your experiences in the comments as well, especially if they differ from mine.

So basically, if you're under 35, it's recommended that you try to conceive for a year before undergoing any sort of fertility evaluation. But if you're an octogenarian like me (aka over 35 years old), medical experts heavily recommend that you come in after six months of trying so that you aren't wasting any of your precious time (and healthy eggs) if something does in fact require medical intervention. It all seems very arbitrary, but what do I know. The great, panic-inducing irony here is that when you are over 35, it's also statistically likely that it may take upwards of a year or 18 months to get pregnant, but that six month marker makes you feel like if it hasn't happened by then, welp, you must be broken. This fear and diminishing hope is a tough pill to swallow and may make you want to put off calling the doctor and making that first appointment because you're afraid of what news it will bring, but honestly, you just gotta rip off the band-aid.

I honestly wasn't sure if I should call my OB/GYN or go straight to a fertility specialist/reproductive endocrinologist (RE). For you, this might depend on what your insurance tells you (more on that nightmare in another post). For me personally, I knew that my periods are pretty regular, the ovulation predictor kits I have been using for several months indicate that I should be ovulating every month, and I don't have a health history that includes PCOS or endometriosis diagnoses. I also just really wanted to talk to someone first that I felt comfortable with, and for that reason alone, I do recommend making an appointment with your OB/GYN first. My doctor is still fairly new to me, but she reads my anxiety well, never makes me feel rushed, and is always reassuring but straightforward. I called for a fertility evaluation appointment (I truly didn't even know what to call it until I spoke to the receptionist), and was seen within a week. 

Sidenote: The wonderfully kind receptionist also told me a story about a 58-year-old woman their practice successfully got pregnant with twins and said that she was sure they "had some magic tricks in that ol' doctor bag" for me. If we had been face-to-face and weren't in the middle of a pandemic, I could have hugged her right then and there. 

It was just me at the appointment (COVID protocols) and the doctor started off by asking questions about my cycle, use of ovulation predictors, my and my husband's sexual history (nothing detailed, just the basics like, have you been pregnant before). I will say that it did help a lot to come prepared with information about the length of my cycles and typical days of ovulation. I use the GLOW app to track my cycles, so I jotted down each month's numbers before I came to the appointment, simply because I didn't want to rely on the averages since my ovulation day isn't always consistent. Once we went over all of this information, my doctor told me there were two things she could do: run some preliminary tests or send me straight to an reproductive endocrinologist. She was comfortable with pursuing whatever option I felt most comfortable with (a wonderful trait in any doctor, but especially an OB/GYN). Since she had the ability to order and interpret the results of the same initial tests that a fertility specialist would pursue, I opted to continue the initial fertility evaluation with her. She proceeded to carefully explain each of the initial tests she would order and when I could expect to complete each of the steps. Fortunately because I called the day I got my period, and got an appointment around day five of my cycle, she predicted that we would be able to get all of the preliminary results within the next two cycles, which felt momentous. 

The first tests she recommended for me were completed that day since it was just blood work that could be completed onsite. In those first tests, she was really checking for three things: my FSH (follicle-stimulating hormone) and AMH (anti-Mullerian hormone) levels and my thyroid levels. I won't get into the nitty-gritty of FSH and AMH, but it basically tells the doctor how many eggs are left in your supply. Neither of these tests give them any indication about egg quality, which is also very important, especially at my age, but knowing about the quantity of your egg reserve can help your doctor decide how quickly to move and what your options might be later down the road for egg retrieval or freezing. The thyroid numbers can tell the doctor if your thyroid might be interfering with ovulation and general reproductive health. They took a couple vials of blood and sent me on my way. 

The moment was actually more poignant than that last sentence suggests. Going through the process of having my blood drawn that first time felt like positive turning point; it was either going to give us some answers and a way forward or assuage our fears that something was wrong. As I sat in the chair waiting to be called, I had a direct view into the little lab area and the phlebotomist's computer screen. It was the day of the Presidential inauguration, and just as I sat down, Vice-President Kamala Harris stepped forward to take her oath of office. The phlebotomist and a nurse, both women, were crying as they watched, and I couldn't help but break my "no crying in public" policy and cry too. It's no secret to those who are close to me that I have long wanted a daughter, and though I will be thrilled to bear any child, I have always felt destined to be a girl mom. It just felt like a really beautiful omen to begin this journey right as the first female Vice President was being sworn into office. Perhaps it's a sentimental stretch toward superstition, but when you've been trying to get knocked up for over seven months (and waiting many more years than that to begin motherhood), you tend to take your lucky charms where you can get them. Should I be fortunate enough to have a daughter, I look forward to telling her about this moment in history and how, as it happened, I dreamt only of her and the great things she would do.

Anyhow, we waited a few days for my results, and were pleased to hear that my egg reserve numbers and my thyroid levels are all within a very healthy range. The next step is to have my progesterone level tested, which has to happen on day 21 of your cycle. This test is meant to confirm that you have indeed ovulated (since the ovulation predictor kits only measure the hormone spike that ultimately encourages your body to release an egg, but doesn't guarantee it). Around the same time, my husband gets to "make his contribution" and undergo a semen analysis to make sure everything is moving as it should be and his own hormone levels are healthy. Should we find ourselves still un-pregnant next cycle, there's also a delightfully nicknamed "dye test" waiting for me, and I'll be sure to share my experiences with it should we cross that bridge.

So insurance covers nothing, having your day revolve around waiting for a call from the doctor's office sucks, and we don't really have any real answers yet, but I'm feeling much more content these days knowing a little more each day than we did the day before. Just keep swimming, I say to myself (and whisper to my husband's crotch).