Fertility Testing - Beginners Level

When I started talking to my ob-gyn about infertility, he suggested this initial battery of tests:

1. Ovulation tests/fertility monitors (are you popping out eggs?)
2. Semen analysis (are there enough viable sperm to fertilize said eggs?)
3. Hysterosalpingogram (HSG, are there any blockages or hinderances in your uterus/tubes?)
4. Progesterone level (can you support the fertilization/implantation?)
5. Post-coital mucus test (can the sperm get to where they need to go?)

Spoiler alert: everything came back normal :).

I already talked about the fertility tests in the last post, so I just wanted to share my/our experiences with the rest of these tests. I am by no means an expert on this part of the process, so I would love to hear about other's experiences with these procedures and other tests that you may have gone through. I'd like to get an idea of what to expect at my fertility specialist appointment.

Ok, so first up was the semen analysis. We ended up doing this test last even though it is (seemingly) the easiest of the tests to perform. The test was ordered for Travis from my ob-gyn. He sent in a request  form to a lab office and Travis just had to call ahead to schedule a time for the analysis. They require you to set up a time because the "sample" is very time sensitive i.e. it can't be sitting around on someone's desk for a couple of hours until they get to it.

I thought everything about the preparation for this test was hilarious, which looking back was not very sensitive. I especially liked the step by step medical instructions given to us on how to "collect a sample". I wish I still had them to share, but I can't do the ridiculousness of the instructions justice from memory. I'm pretty sure any male over the age of 13 could have written them.

On the morning of the test, Travis was to collect his sample and drive to the lab. I did feel bad for him because it honestly is an embarrassing experience, even if nobody else sees you. I'm sure he is thrilled that I am sharing all of this with you! I wasn't at home while he did it, but I do know that it wasn't as easy as it would seem to collect the sample.  I suppose thinking about fertility troubles and lab analyses are not common topics to get you in the mood. Once collected, he had to take the sample to the lab, with the collection cup in between his legs, within half an hour. Travis has never paid more attention to traffic laws than on that trip, because try explaining that to the police officer that pulls you over.

The analysis came back to my ob-gyn a few days later. The major numbers to take away are:
1. Total sperm count
2. Motility (how many are moving correctly)
3. Morphology (how many are viable)

His total sperm count was 149 million, which according to my ob-gyn is ALOT. That number just blew my mind! I don't remember all of the other numbers, but we were told that 4% of the sperm were viable and moving correctly, aka had the ability to fertilize with an egg. Per my numbers, this leaves approximately 6 million sperm. My understanding is that you want the number to be over 5% viable and/or >5 million viable sperm. My ob-gyn told me that although his % was low, it did not surprise him due to the very high number of sperm. So, the obvious conclusion: my eggs are turning around and hopping back into the ovary once they catch sight of 143 million funky looking spermies catapulting their way! Wouldn't you turn and run if 143 million of anything came chasing you?

After the semen analysis, the men are done. Pretty cut and dry. Of course, us women, we have so many more things that can go wrong with our body. The first test I did was the HSG, which is as painful as it is to spell. I have a very good friend, Shauna, who had gone through this test when she was having fertility issues. I asked her about it ahead of time and that little liar told me it was not so bad! Afterwards I called her out and she told me that she didn't want me to be nervous going in to it, hence the lie!

My goal for this section is not to scare people that are going to have this test. I am going to try to recreate the feeling as best I can remember, because half of the issues with this test came from panic of not knowing what to expect. I took 800mg of ibuprofen about an hour before the procedure. If you have a prescription for xanax or equivalent and a driver, I would sincerely recommend popping one of those suckers (just clear with your doc first!). I had Travis come with me because I was nervous; you can have one person in the room with you during the procedure, they stand or sit up by your head. Travis was so sweet and helpful during the procedure and I feel like going through this procedure together made us feel like more of a team. I would recommend having your significant other come with you (even more than the xanax), it really is a bonding experience.

The test in a nutshell is: dye is injected in to your vagina and travels through the cervix, uterus, fallopian tubes and ovaries. An x-ray is taken, giving a complete image of all your reproductive organs. The pain from the procedure comes from the dye which causes cramping. I would liken the cramping pain to someone starting a small fire inside your body. It felt like a burning, not at all like typical menstrual cramping. Here is why I started to panic:

1. I did not know how long the pain would last. If I could have had a timeline of how the pain would go, I guarantee I would not remember it hurting so bad. Time, when one is in pain, of course seems longer than it really is, but I would estimate the whole procedure took about 5 minutes and probably about 3 of those minutes were burning (cramping) pain. The pain goes away VERY quickly once the procedure is complete.

2. They show the image up on a screen as the dye is injected. I knew fallopian tubes were thin but I didn't realize they were literally the diameter of a thread. I honestly remember looking at the screen and thinking that I had NO fallopian tubes. I could not see the "lines" connecting my uterus and ovaries and there was dye leaking out of the organ area (this is typical). I was so upset thinking that I had no tubes that it intensified the pain I was feeling. Looking back, it probably would have been better to not look at the picture until the procedure was over. The doctor informed me that I had "perfect anatomy", so all that worry was for nothing!

When I started to panic, I began having shallow breathing. Short breaths lead to less oxygen getting through the body, which then leads to more intensified pain. Having Travis there was so helpful, but the VIP was the nurse. She was able to relax me by placing her cool hand on my forehead and starting to count out my breaths (i.e. breathe in, now release for 3, 2, 1, repeat). The measured breaths are such a good idea for anyone going through this procedure, it keeps you breathing normal and takes your mind off of the procedure.

Since I divulged embarrassing info about Trav's procedure, I feel it is only fair to share a little embarrassing info about mine. Once the procedure is over, there will be a lot of leftover "discharge" (dye, lubricant, light bleeding). PLEASE do yourself a favor and bring your own pad from home. They handed me one that literally looked like a small pillow. I walked in to the bathroom a lady and walked out with a makeshift penis. And it made noise every time I walked; imagine the sound a baby's diaper makes when they are toddling around. It was the insult after the injury, so to speak.

The final test that I have done thus far is a progesterone level. This is a simple blood test performed optimally 1 week after ovulation. I plan on having this test again this month because I had been using the old fertility sticks and had a hard time that month interpreting what day I was ovulating. I would also like to see what effect Clomid has had on my level. The goal is to be >10 (not sure exactly what the unit of measure is) and I was at a 10.5. I may have waited too long to take the test due to the uncertainty which would explain why it was close to the minimum. I read that the goal after Clomid is between 18-20, so fingers crossed I will be close to those numbers next time!

I did list another test that my ob-gyn discussed with me but I opted out. It is the post-coital mucus test. Essentially, you have sex, go to the docs office, they take a sample of your mucus and determine whether it is thin enough for the sperm to swim through it. I had discussed my reservations about this process in my last blog, but there is another reason that I decided not to worry about this. The treatment for thick mucus is available OTC: Robitussin or Mucinex. These are classified as expectorants and are mainly used to break up mucus in your chest during a cold/infection. Apparently, they have the same effect everywhere. I started to take Mucinex once daily, even though I do not know if this is a problem for me; I figured it can't really hurt regardless. I start taking Mucinex the day my period ends and continue through my last "high fertility" day on my fertility monitor (usually about day 18), so about 10 days total per month.

I definitely feel like more testing would be a good idea for us, what with my borderline progesterone and Travis's crazy sperm count numbers. While I'm not looking forward to the cost of round two, hopefully it will provide some answers, or at least a little more insight.