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Whether you’ve just got a hunch, you’ve been trying for 3 months, or 6 months, or 12 months … it can be daunting considering the idea that you may have problems with fertility, and even more daunting trying to figure out how to approach it.
I’ve put together this post to provide people with a structured starting point. It’s purely based on my personal experience and perspective, and by no means should it be considered professional medical advice. You should always find a doctor that you trust and who you feel truly listens to you to guide you through any health concerns. The first thing you should do is consider which Doctor you are going to approach. Do you have a regular GP that you already have a relationship with? This is a great starting point (especially if they bulk bill). All of the tests that I’ve listed below can be ordered by a GP.
If you don’t have a GP you already have a great relationship with, it might be worthwhile going straight to a fertility specialist. There are several clinics that offer bulk billed fertility programs, where initial consultations involve no out of pocket as long as you attend in person.
Once you have chosen your doctor, I would suggest requesting the investigations outlined below. While I, too, had all of these investigations completed as a part of my fertility work up, it took me over 12 months of TTC to have them all requested by a GP. If I had have known, I would have advocated for myself earlier and gone in armed with this list from the get go.
For females:
Full blood work up, including:
FBE
Iron (including ferritin)
B12
Day 3 Hormones (FSH, LH, Prolactin, Oestrogen)
Day 21 (7 days post ovulation) Progesterone
CRP
ANA
Thyroid Panel (TSH, T3, T4, Thyroid Antibodies)
Vit D
Homocysteine
Diabetes work up
STD Screener (including HIV)
Karyotype test (for genetic abnormalities)
I would also recommend getting your AMH checked. It’s not bulk billed like most blood tests - it costs $80 or there abouts - but it gives you insight into your ovarian reserve. Keep in mind that while your AMH may be low, it doesn’t mean you can’t fall pregnant. But it may predict how well you respond to certain treatments (ovulation induction, super ovulation, IVF).
Pelvic Ultrasound
‘Hycosy’ Ultrasound (to see if your Fallopian tubes are open)
For males:
Full blood work up, including:
Iron (including ferritin)
CRP
ANA
Thyroid Pan (TSH, T3, T4, Thyroid Antibodies)
Vit D
Homocysteine
Diabetes work up
STD Screener (including HIV)
Karyotype test (for genetic abnormalities)
Semen Analysis
When it comes to interpreting results, I urge you to be mindful that ‘normal’ does not necessarily mean ‘optimal’. So, once you’ve received all of these results back I highly recommend requesting a copy of them so you can always consult with others in your support team (e.g., naturopath, dietitian, etc.). In my experience I was told by several GPs everything looked ‘normal’, but when consulting with my acupuncturist (who also has a Masters in Reproductive Medicine) she identified several areas that I could improve on to support my fertility.
The second thing I would do is start tracking your cycle, in every which way you can. The more information you have to share with your fertility specialist, the better. A few tools you might consider using to track:
Basal body temperature
Cervical mucus
*My favourite app for the two above is ‘Fertility Friend’
Ovulation Predictor Kits
Then, I would recommend starting a supplement protocol. Sometimes a simple prenatal vitamin doesn’t quite cut it, and you need some help in other areas. I strongly recommend reading the book ‘It Starts With The Egg’ as a foundation for your supplement regime.
Once you have all of these things prepared, THEN I would pay the big bucks to see a private fertility specialist.
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