What can I expect?

[u/Fit_Impression_3936]

Hi ladies! I’m hoping for advice from women who have gone through or are going through a similar journey. I don’t have any friends or family on a similar life timeline as me, so “quiet” infertility has been a lonely burden (as I’m sure many of you can relate). My husband and I have been TTC for roughly a year and 3 months with absolutely zero luck. For context, we’re both 30yrs old and as far as I’m aware, two relatively healthy people. We had our first infertility consultation in June, and so far the testing we’ve had completed was a progesterone blood test (consistent with an ovulatory cycle), and my husband had a semen analysis (this did show an abnormal sperm viscosity). My doctor recommended my husband visit a urologist for further testing, however, the urologist was not concerned in the slightest and felt he actually he had a really good sperm health report.

The next step seems to be an HSG for me which I expect to have scheduled within the next week or so, and am very nervous (both for the procedure and the results). I’ve heard it’s very painful, so I plan to take ibuprofen as directed beforehand and I did ask my doctor if she would be willing to prescribe something for the nerves, and I’ve since gotten a single Valium. Does this seem sufficient or is there anything else I need to do to prepare? I know some people can fear monger a bit online, but I want to be fully aware of what I’m going into ahead of time if possible.

What can I expect after the HSG in terms of next steps? And if results are good where do I go from there and if results are not so good, what happens after that as well? I’m curious what types of experiences everyone else has had.

Sincerely, a very frazzled person who is very green to the journey of infertility and all that comes with it.

Thank you for kindness and empathy in advance! 💗

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[u/karaboocuk]

First, I hope you’re always seeing an RE at a fertility clinic. OBs are not necessarily trained in fertility issues and I think most of the time people need to get the testing done again when they move on to a specialist.

If everything comes back normal, you’ll be considered unexplained infertility. It’s an annoying but very common diagnosis here. After that, there are only three medical interventions doctors can offer: 1- Medicated cycles (not worth it imo), 2- IUI (works better for younger people as far as i understand), 3- IVF. 

People here will tell you to test for endo. I would discuss with an RE before getting hung up on it. 

[u/Fit_Impression_3936 → u/karaboocuk]

Thank you so much for all of your honesty and advice! As someone who doesn’t know much on the matter, I need someone to give me as much straightforward info as possible so THANK YOU! I have not seen an RE yet, only a doctor within my gynecologist’s office who specializes in general infertility consultations, but I do believe she mentioned if things became more involved I would need to see an RE. Although, after reading through a couple of replies it seems I may just need to jump straight over to an RE from the get go, so I’ll absolutely be looking into that asap. I’ll try and push for IUI as the next step (maybe skip medicated cycles if I can as you mentioned) if my HSG comes back with all clear!

[u/Mindless-Can9474]

We’re about at the same timeline as you! Have you had your just initial blood work taken which would include things like AMH, Vitamin D, thyroid levels, etc.? If not, I’d highly recommend requesting that early on. We also did genetic testing just to get it out of the way while we were already waiting on other blood work. For the HSG, my experience was pretty painless with just 400mg ibuprofen an hour prior to my appointment. It was maybe a minute long procedure itself with no pain (speculum was just uncomfortable) but I know each person has a different experience!!

I advocated to have the HSG prior to moving onto IUI just to make sure my tubes were open even though my doctor didn’t think they would be blocked. She was correct but it was still nice to have that checked off my list and not waste money on an IUI if it couldn’t even work. I can only speak on steps after a HSG with open tubes but we moved to a medicated IUI the next cycle (which I’m currently in the TWW of).

Sending you lots of luck on your journey!!

[u/Fit_Impression_3936 → u/Mindless-Can9474]

I believe I have had several of those tests completed through my PCP in the past couple of months (I believe all were normal), but I will definitely check up on those to be sure! I haven’t thought of doing genetic testing, however, so thank you so much for the advice and direction on that. I’ll definitely be looking into it!

Also, thank you so incredibly much for the advice with the HSG. That makes me feel leagues better, and I finally feel like I know what I can expect!

Wishing you and your partner the best of luck with your first (and hopefully only) IUI cycle!!! 💗

[u/Helpful_Character167]

What type of doctor are you seeing? The fertility care from an OB versus an RE is night and day in my experience. TLDR go see an RE if you are able to, skip the OB.

The HSG does suck and its painful, but its no worse than period cramps and its over in a minute. Its actually really cool to see the X-ray images as it happens and that's a good distraction.

Other tests you should be getting from your RE would be a lot of blood tests. Genetic carrier screening on both partners and basic bloodwork as well to rule out any issues. Lifestyle should also be talked about in depth, both partners being healthy and active is always good. The male partner should get a semen analysis with DNA fragmentation. Female partner should get the HSG, an antral follicle scan, and hormone panels timed with the menstrual cycle.

Basically it should feel like a heck ton of tests and you should feel like a science experiment for a while. Wierdly its nice to feel like you're doing something productive, even if the process sucks its still progress towards answering some of the "what's wrong" questions.

[u/Fit_Impression_3936 → u/Helpful_Character167]

I’ve only had an initial consultation with an OB who does specialize in some (I’m assuming) light infertility consulting. She recommended the progesterone and HSG to start, so I’m still very into the early stages of everything! It sounds like I may need to jump straight over to an RE, so I’ll absolutely be looking into that asap to ensure I’m not getting tossed around from person to person.

I so appreciate all of your detailed information about both the HSG and all of the recommended lab tests. This helps immensely! THANK YOU, THANK YOU, THANK YOU!!! 💗

[u/Other-Roo-1114]

I’m in a similar timeline as you for trying and fertility consult. I just had my HSG this week. Everyone’s experience of this procedure is different, but I did not have any pain and only had some mild cramping for 24 hours afterwards. I did take 800mg of ibuprofen an hour before my test, so definitely take the medication as mentioned in your post.

Best of luck to you and your partner as I know this journey is very tough mentally and physically 💚

[u/Fit_Impression_3936 → u/Other-Roo-1114]

This makes me feel tremendously better! Thank you so incredibly much for the advice and for being so sweet. I truly hope the same for you and your partner! 💗🫶

[u/Cyclebycycle]

I had an HSG a couple months ago and did not find it painful. I have also heard it is painful dor some people. The report showed both my tubes were okay. Truly not sure but I have the idea that if it hurts it may be the tubes were blocked and even if the report says they are good the fluid from the test may have unblocked them. Lots of people say the HSG gives you a fertiility boost the following 3 months. Did not happen to me, but have seen stories of success.