The road to IVF - the doctors get involved

I'm about to start my first cycle and just reflecting on the journey that I took to get to this point.

After 4 months of trying to get pregnant without success, I made an appointment to see my GP. I was worried he would not be very impressed about my seeking help after such a short time but he was fine. He explained how the investigations into fertility work. First stop is a blood test to see if I was ovulating.

The blood test was done at Day 22 of my cycle and detects the level of progesterone. If ovulation has occurred, the follicle from which the egg was released forms the corpus luteum, which starts to secrete progesterone and sustains the endometrium until implantation occurs and the embryo produces its own progesterone. A few days after the blood test, my GP confirmed that I was ovulating. This was really good news and made me feel much more relaxed about my chances of falling pregnant. I had one friend of my age who had taken Clomid because she wasn't ovulating, and this clearly wasn't a problem for me.

After 5 months of trying, the next step was for my husband to have a sperm test. More good news - everything was fine. He had a good sperm count and the motility and morphology of the sperm were fine.

At 6 months, it was definitely time to get some specialist help. My GP gave me a referral to Sydney IVF and I then had to choose a specialist gynaecologist. Not knowing where to start and with no-one to ask, I chose the only doctor I had heard of.

At our first appointment, the doctor explained again the age-related issues that we were having and recommended we consider IVF. I was a bit shocked to be considering it so soon and had expected that she would recommend Clomid, or at least interuterine insemination. She explained that these were the low tech options and as I was ovulating and the sperm seemed fine, she didn't feel that there was any reason to try these options. As it happens, a paper recently published in the British Medical Journal showed that in couples with unexplained infertility who had been trying to conceive for 2 years, IUI and Clomid were no better than expectant management - ie. doing nothing.

We talked about IVF and decided there was no reason why we should wait and it seemed like the right option for us. It has taken a while to get used to this idea. It is a bit scary to be at what I consider to be the last resort so soon. What if it doesn't work? Where does that leave us?

The next step was to have a day 3 blood test to check out my hormone levels, and an ultrasound to my ovaries, and my uterus for polyps or fibroids, both of which can interfere with fertility. My doctor said she would be happy to see 5 developing follicles.

The ultrasound was intravaginal and very straightforward. It was great to be able to see what was happening on the screen in front, although to be honest, if the sonographer hadn't told me what was happening, I wouldn't have had a clue what I was looking at. I had more good luck - my ovaries had 21 developing follicles, 11 on one side and 12 on the other. This was fantastic news since follicle numbers do influence the chance of IVF success. My blood test also showed normal hormone levels although my doctor forgot to ask for FSH levels but with the good result on the ultrasound, it didn't really matter. The story with my uterus was a little more complicated (more on this in the next post).