[Disclaimer: I am not a doctor or medical practitioner. Any medical information is strictly my opinion based on research and personal experience, and not to be taken as advice. Always seek the advice of a licensed physician for your medical needs. Read my full disclaimer here.]
[Disclosure: This post may contain affiliate links. You can read my full disclosure here.]
Typically the one-year mark is when doctors recommend you begin to start trying to figure out what the “problem” is if you’re still not pregnant. (Or if you’re a little stubborn like me, and you think “next month will be the month,” you wait even longer.) If you’re 35 or older, they say wait just 6 months.
(Side note: If you haven’t been TTC for more than a year, check out this post first: What to do when you’re not getting pregnant right away.)
Although I don’t believe there is any one timeline or sequence that is “normal,” (it likely depends on your doctor, what clinic you go to, etc.), I thought I would share my experience and some tips I learned along the way. So, after I called my doctor when we had been TTC without success for over a year, here’s what happened:
1. Routine bloodwork from my regular OB
*Actually, my OB referred me immediately to a fertility center when I told him we had been TTC for over a year. I was hesitant to go there at first, so I asked if he would at least perform the routine bloodwork. I have to imagine most OBs would do that first.
My doctor ordered these blood tests: lipid panel, TSH reflex, testosterone, DHEA-sulfate, prolactin, and a complete blood count. (I’ve found that many people who struggle to get pregnant have a thyroid issue or other hormonal imbalance, which are a few things these blood tests check.)
Because all of my levels came back in the normal range, he sent me on my way to the fertility center.
2. Ovulation check (progesterone) + Clomid from another “regular” OB
I was still hesitant to go to the fertility center. So, at my physical with my primary care doctor, she suggested another regular OB she knew who routinely performed more testing for infertility patients.
At my first appointment with him, he questioned whether or not I was ovulating. I’ve read that the vast majority of women who struggle with infertility have problems with ovulation. He actually said he often has to send women away and instruct them to do ovulation tests first before he will do any more investigation.
See also: How do you know when you ovulate?
I informed him I’d already been doing ovulation strips (which confirmed ovulation) for several months. He was mostly satisfied with that, but also ordered a progesterone blood test on day 21 of my cycle to confirm ovulation and adequate progesterone to support a pregnancy. (Low progesterone seems to be a common cause of infertility and/or early miscarriages as well.) The test results that came back later were normal.
He also instructed me to start taking the fertility drug Clomid. This seems to be the first suggestion from most OBs, and it is prescribed quite often. The “issue” Clomid is supposed to fix is ovulation, so I was a little confused by his recommendation, and I decided not to take it. Instead, I asked him what other testing could be done first.
See also: Should you take Clomid? + Can Clomid make me have twins?
3. HSG test + husband’s sperm test
So, at this same first appointment, he ordered a semen analysis for my husband (everything ended up normal there), and an HSG test for me, which I regretted having later due to the cost that I had been unaware of (insurance covered nothing). Everything also came out normal there, too.
See also: How to survive an HSG test + How I unknowingly spent 2 grand on fertility testing
After I got the unexpected $2,000 bill for the HSG test (and read the book Taking Charge of Your Fertility, which told me some of his suggestions were a bit suspect), I was a little fed up with this doctor. I finally conceded that I would just go to the fertility center.
4. Fertility center
I saw a third doctor at the fertility center. She ordered a few more blood tests: another prolactin blood test (initially my level was on the high side of normal), another thyroid blood test, and an AMH test. Everything came back mostly normal again — my prolactin was slightly elevated still, and she prescribed me a drug called cabergoline to lower it. (Side note: It did lower it in the end, but I stopped taking it eventually because it wasn’t working and my functional doctor later recommended something else.)
See also: Do AMH levels really matter? + Does FertiliTea really work?
She confirmed that Clomid alone would be rather pointless to take for someone like me (for others with ovulation issues it would be great). Instead she ordered us to begin a Clomid + IUI treatment schedule on my next cycle. She said she wouldn’t do more than 2-3 cycles of this before moving on to IVF.
Another Option
This is where my timeline/procedures probably deviate from most people’s.
Although I completely respect other people’s decisions regarding treatment plans, I was not ready to do IUI or IVF. This was largely due to the fact that there was nothing wrong (besides that slightly elevated prolactin), and the fact that my doctor came across a little pushy (“I wouldn’t wait any longer if I were you.”). I felt the need to either determine what was wrong…or simply wait to see if I would fall pregnant naturally. (By no means do I think it would’ve been “wrong” to do IUI or IVF at this point…that’s just not what I was ready for.)
See also: Unexplained infertility: The Do’s and Don’ts
(Also: To be totally candid here, I think I was immediately turned off to the Fertility Center before I even went. When I first called them, the recording I listened to included: “Press 5 if you have leftover frozen embryos and want to know your options.” Yikes, I know that’s a real concern for IVF patients…but I was a little thrown off and taken aback that this was a number to press.)
See also: 3 things you need to know before your first fertility specialist appointment (+ 5 questions to ask)
5. Functional Doctor
Again, I don’t think this is the majority of people’s paths…and I’ve already written on this topic extensively. Check out:
5 Reasons to see a Functional Doctor for Infertility
2 Advanced Infertility Testing Options (to determine a root cause)
4 Possible Causes of Unexplained Infertility
So instead of rehashing what you can read above (if you’re interested in functional medicine), I instead wanted to offer you some of my takeaways if you’re just starting this whole process:
Takeaways + what I’ve learned from all this:
1. Don’t be afraid to get a second opinion or go see multiple doctors. Although my regular OB wasn’t willing to do a lot of infertility testing, there were others that were. At the same time, specialists may be more familiar with and knowledgeable about procedures and appropriate testing. I questioned many of the “regular” OB’s suggestions, and my doctor at the fertility center disagreed with him. Weigh all of your options. Don’t do anything rash.
2. There are a lot of different paths you can take with infertility. Make your own decisions (along with your husband, of course). The things that your doctor recommends are suggestions. Advocate for yourself and find a doctor you’re comfortable with.
3. Do your research — both medical-wise and from people’s personal experiences. Read blogs or join support groups (online or in-person) or talk to people who have gone through this. Realize that everyone’s experience is different, but other people may have suggestions to offer you.
Want more encouragement during your struggle with infertility? Join the Contentment + Chaos community!
(+ get my FREE six-week Infertility Bible Study ebook!)
