waiting on gynae/fertility referral. what can I expect?

73trix

Ttc for last 6months on #2. Aged 42. Had #1 at 41. Conceived easily and naturally. After 3 cycles of ttc #2, had a chemical pg so still trying. Given my age and no pregnancy after 6months, am waiting to see a gynae for advice.

Not really sure what she can offer as I still ovulate myself each month, am bang on regular 29/30days with luteal phase of 11days. I temp and OPK so fairly certain of ov date. I do ov late (average CD18) but this was when I conceived my baby so wasn't an issue then.

Only dif I have noticed in past 2 months is no CM after ovulation as normal. Very dry. Also have noticed that my period seems to have changed to shorter and lighter but with spotting dragging on a few days more than normal. Used to have 4-5 days - heavy-medium-light. Now they seem to be day 1 very heavy, 2 days medium and then next to nothing yet I will spot for a week. I know I'm not young so this could be the start of hormonal changes. My AMH was 9.62 in Sept- told above average for my age and my bloods were within range when taken in July (just before my BFP). Can they change that soon? I would have thought my regular cycles and regular ovulation was a good indicator for my age so I'm not really sure what the gynae can suggest but anyone have any similar experiences? I hear about Clomid but I do ovulate myself and would worry about side effects - less CM, thinned lining.

Intothesea

Hello there. I think it's certainly a good sign that you managed unassisted pregnancy at 41! However, as you know, AMH can drop like a stone in a 6 month period once you move towards the late 30s. At 42, 6 months is more than enough time to wait to see a specialist -- it can only help you sooner rather than later anyway!

It sounds as though the number of your eggs is high enough to keep ovulation rates steady, so the issue now is probably egg quality. The spotting after your period has ended suggests that estrogen levels are not rising high or quick enough to shut off the flow, so a steady ovulation rate may be apparent (i.e. these could be anovulatory cycles). I say this as a non-doctor, though technically if there are no other types of issues causing it the only cause is hormonal imbalance.

A good specialist will point the direction to go in very quickly. They can't possibly waste any time in facilitating you. I hope this helps and the best of luck!

** And to specifically answer your question, you can expect a quick investigation into the cause of the spotting, or maybe hormone supplementation to observe any changes in cycle structure. As far as I know, nailing down anovulatory cycle type can be an arduous time-consuming process and there will probably be quick decisive ways around it all based on known probabilities and desired outcomes.

I.e. expect to have to recount a lot of details about your cycle. It would be good to have some kind of chemical proof of an LH spike or two in relation to start of period. There probably will be some investigation into other probable causes (i.e. mechanical = polyps, sperm count etc.), but not before ruling out the most obvious issue, the one driving the spotting, and the likely dearth of high-quality eggs.

73trix

thank you so much. i keep my FF app religiously so have lots of info. i do get 2-3days LH surge before ovulation and all signs point to ovulation but i do wonder about egg quality at this point and what the doc can offer. only one way to find out!

Intothesea

Ah, you have all the right moves and information together already -- a fact that will make the whole experience of going to a specialist a lot easier to deal with. Just to balance my picture above, there aren't many women standing at 40 having kids easily and naturally, and if your LH surges are only 2-3 days long and not longer, there is a very good chance that the cycles are ovulatory. Bar a little hormonal re-balancing, I'd say you might be recommended a small number of IUI cycles. But I suspect you already know this!

If the specialist you see is especially by-the-book, it might be straight to IVF, and as you know, the advantage there is being able to inspect embryos for quality, or potentially testing for genetic issues. Ok, best of luck! ** And once again I forget something: Since your pregnancies would be (hopefully) close together it is wise to look especially hard at your rest, stress, exercise and nutritional levels. A toddler is probably the best birth control format of them all after all!

contrary_mary

Self-refer to a consultant in a fertility clinic. There is no point wasting time with a gynae referral - they are limited in what they can offer you outside of the fertility clinic setting.

73trix

contrary_mary wrote: »

Self-refer to a consultant in a fertility clinic. There is no point wasting time with a gynae referral - they are limited in what they can offer you outside of the fertility clinic setting.

Could the gynae not check other issues like womb lining? I had a section on my baby too. Could there be any internal side effects there? Couldn't she prescribe fertility drugs and monitor same?

I'd have gone straight to a fertility clinic if I lived near one! The nearest one to me is a 2.5 hour drive!

contrary_mary

73trix wrote: »

Could the gynae not check other issues like womb lining? I had a section on my baby too. Could there be any internal side effects there? Couldn't she prescribe fertility drugs and monitor same?

I'd have gone straight to a fertility clinic if I lived near one! The nearest one to me is a 2.5 hour drive!

Sorry I didn't mean to panic you! Of course a gynae can do investigations and could prescribe clomid or other ovulation stimulators (but if you're ovulating yourself then I'm not sure what benefit these would be). I've heard of the odd gynae doing ovulation tracking but more who don't or who rely on blood tests as they don't have the facilities/capacity to do follicle scanning.

The gynae is a good starting point and hopefully you won't be waiting long for your appointment - fingers crossed it's just a matter of time for you anyway. If you wanted to in the meantime I'm sure your GP could arrange for AMH testing for you and SA for your partner - then you would have these results to hand for your consultation? The fact that you've had one successful pregnancy is great - fingers crossed for you!

73trix

contrary_mary wrote: »

Sorry I didn't mean to panic you! Of course a gynae can do investigations and could prescribe clomid or other ovulation stimulators (but if you're ovulating yourself then I'm not sure what benefit these would be). I've heard of the odd gynae doing ovulation tracking but more who don't or who rely on blood tests as they don't have the facilities/capacity to do follicle scanning.

The gynae is a good starting point and hopefully you won't be waiting long for your appointment - fingers crossed it's just a matter of time for you anyway. If you wanted to in the meantime I'm sure your GP could arrange for AMH testing for you and SA for your partner - then you would have these results to hand for your consultation? The fact that you've had one successful pregnancy is great - fingers crossed for you!

Thanks. My appt is this Thurs. I got the free AMH test done in September with SIMS so that's done. It's 9.62 - just above average for my age. Maybe she can't do much but I will try her first. She was my obstetrician as well. I really think it's am egg quality issue. Unless I have any issues since the section.