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A little over two years ago, the only “lady” tests I was familiar with were the annual pap smear & HPV panel at my annual GYN appointment. Oh, what I would give to go back to those sweet days of ignorant bliss!
Since then, I have gone from a naïve, unstudied, shy-in-a-gown thirty-year-old to an open, well-educated infertility veteran with an unofficial master’s degree in reproductive health and the female body.
So far, I have been through 3 IVF cycles. Along the way, I have undergone so many tests and taken so many medications that thinking about it makes my head spin.
Whether you’re at the beginning of your journey or wading through the thick of it, I thought I would do you a solid and let you in on the many tests I have had done and why to prevent your own head from spinning exorcist style.
*Please note that I am not a medical professional, and you should always consult with your Reproductive Endocrinologist first and foremost with any questions regarding diagnostic tests or results. This was just my experience, and everyone’s journey is different.
So, let’s start at the beginning of my story.
About eight months into trying to conceive, my husband and I found out he had a balanced translocation and that IVF was going to be our path to parenthood. Talk about the shock of a lifetime! No honeymoon stage baby-making for us!
We met with a Reproductive Endocrinologist and were off to the races. Right off the bat, our RE told us it was the standard operating procedure to run these four tests before starting IVF:
Std Screening
As my doctor explained, this was to make sure there wasn’t an underlying infection that needed to be treated or that could impact results. It was a simple blood test of just a couple of tubes.
My report: Good news—my husband and I were clear here!
Genetic Carrier Screening
This was a basic screening to see if my husband and I were carriers of any genetic conditions that could impact or challenge the IVF process.
My report: My husband and I did not have any challenges here other than his translocation. I did find out I was a recessive carrier of Usher’s syndrome, though. WHO KNEW?!
Anti-Mullerian Hormone (AMH)
From what I have learned, this blood test is one of the most accurate assessments of a woman's ovarian reserve. As a guide, a healthy AMH level for a fertile woman is between 1.0 – 4.0. This used to be the end-all-be-all, and in my experience doctors don’t seem to be relying as heavily on this test anymore.
My report: I have had readings from 0.8 – 2.6 within a period of 12 months, so my advice would be to take this number with a grain of salt.
Thyroid Panel
Thyroid function is crucial for achieving and maintaining a pregnancy, so doctors usually want to test thyroid levels prior to starting fertility treatments in case intervention is needed. Treatment for this is pretty straightforward if a problem is found, so don’t worry!
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My report: I tend to have high readings, which actually means my thyroid function is slightly low. I am on a Synthroid medication to stabilize my levels.
Whew! That is a lot just to start treatment, right?!
Some doctors also like to perform other tests and procedures before or in between IVF cycles. These are done either for diagnostic reasons or to resolve issues that might have come up during the course of treatment. These are some of the tests I have taken since starting IVF:
Saline Sonogram
With a saline sonogram, doctors are looking at the shape and position of the uterus and for anything out of the ordinary. This is a simple test that can be done inside a doctor’s office. It involves sticking a catheter up lady land, past the cervix, and into the uterus where a saline solution is shot up into the reproductive parts so a doctor can get a good look at the anatomy on an ultrasound machine. The pain level is minimal.
My report: I had this done prior to my second frozen embryo transfer and mine was normal and all clear!
Hysterosalpingogram (HSG)
I like to think of this as a slightly more intense version of the saline sonogram. An HSG test involves the same steps of inserting a catheter into the hoo-ha, but instead of shooting saline through the lady parts, a dye is shot through them. The dye is an agent that allows a physician or tech to take an x-ray of the reproductive system. The main function of this test is to see the shape of the uterus and to determine whether or not your Fallopian tubes are blocked. This test is usually done at an imaging center and not an RE’s office. My advice would be to take some extra strength Tylenol beforehand, just in case.
My report: I had this done after my second round of IVF and all was clear! Pro-tip: push for this test before starting fertility treatment.
Hysteroscopy
After my second transfer resulted in a miscarriage, I had a Hysteroscopy to make sure there wasn’t any scar tissue from my miscarriage that could hinder the implantation of another embryo and also to get a better look at my anatomy to make sure we weren’t dealing with any other underlying issues.
During a Hysteroscopy, a camera is inserted into the reproductive system vaginally to investigate problems or symptoms such as heavy periods, unusual vaginal bleeding, pelvic pain, repeated miscarriages, or difficulty getting pregnant. This procedure can diagnose conditions such as cysts, fibroids, polyps or any scar tissue that may remain in the uterus from previous miscarriage(s) or cysts. Anesthesia is necessary for this procedure, and recovery is just a few days.
My report: All clear!
RPL Panel
RPL stands for “Repeat Pregnancy Loss Panel,” and it looks for several different blood clotting disorders. Upon receiving a positive result, some women are put on blood-thinning medication prior to an embryo transfer to help with implantation and reduce the risk of miscarriage. This is a blood test that requires a lot of tubes of blood. My advice would be to eat a snack and drink water before you go.
My report after my first failed transfer: All normal!
Laparoscopy
A Laparoscopy procedure allows a doctor to see inside the body by making a handful of small incisions and inserting cameras into them. For fertility purposes, it allows the doctor to see everything: the ovaries, the fallopian tubes, the uterus, etc. A Laparoscopy can be used to remove scar tissue, a fibroid, or endometrial deposits that are causing pain. This procedure is very common for those who suffer from Endometriosis or suspect they may have it. Anesthesia is required, and the recovery is 3-7 days.
My advice would be to push for this if you are experiencing unexplained infertility. I have talked to so many women that say this test was their saving grace that finally gave them the answers they were looking for.
My report: Some scar tissue in my abdomen was removed, but all of my reproductive organs looked great!
Endometrial Receptivity Analysis (ERA)
The ERA test is for women who are undergoing IVF and want to narrow in as much as possible on their body’s ideal implantation window. The results determine an ideal transfer day and time. This test can be done under anesthesia or not – it depends on the doctor. A small biopsy is taken from the uterus and sent off to a lab. The lab is able to tell whether or not, on that specific day, there are the ideal amount of progesterone receptors in the uterus. The results will determine whether the uterus is pre-receptive, post-receptive, or receptive that day.
My report: I was 24 hours pre-receptive the day of my ERA test, meaning I needed 24 more hours of progesterone for ideal implantation. I had this done at the same time as my Hysteroscopy, which was a blessing because I was knocked out. I have heard from others that it is very painful otherwise. Pro tip: Ask to couple this procedure with one where you’ll be under or be prepared with pain meds.
Okay, now let’s say an IVF cycle results in an embryo. YAY!
Now there are more decisions about whether or not to run tests on that little guy or gal. For us, we didn’t have a choice. Because of my husband’s translocation, we have to have our embryos genetically tested. If we were to transfer an embryo that had his translocation, we would risk having a miscarriage, a high-risk pregnancy, or a child that may not live. It’s very scary stuff.
Some people may have no known genetic factors but simply don’t want to risk transferring an abnormal embryo, which is completely understandable. Either way, there are three kinds of testing when it comes to embryos:
PGT-A
This test is an analysis of embryo cells to determine if there is the normal amount of chromosomes. An unequal division of either sperm or egg cells can result in an embryo having too few or too many chromosomes.
PGT-M
This test analyzes for specific gene mutations that one (or both) of the parents is known to carry like cystic fibrosis or sickle cell anemia.
PGT-SR
This test analyzes embryos of patients known to have a chromosomal structural rearrangement, such as an inversion or translocation. This is the testing we have to do.
Now how exactly does the lab do this? The first step is an embryo biopsy, and the second step is analysis of the biopsy by a laboratory to conduct genetic testing on DNA. The biopsy is done at the blastocyst stage of development (days 5, 6 or 7), and the results usually take about two weeks. The wait is the most excruciating part. It truly is a mind fuck.
Our results have been so wild and varied. Round one, we sent 17 embryos off and 4 came back genetically normal. Our second round we sent off 2 for testing and both had the translocation. The third round we sent off 2 for testing and one had the translocation and one was completely abnormal.
Needless to say, all of this testing is expensive as well as physically and emotionally exhausting. I try to celebrate the small victories and acknowledge and move on from the disappointing results. At the end of the day, I’m just thankful this science exists, because if it didn’t, where would we be?
If you are reading this, I am sorry that you too are struggling to start your family. I feel your pain immensely. Never forget: Just because fertility is hard doesn’t mean it can’t be fabulous.
Blair Nelson is an infertility warrior who began her journey in 2018 after she and her husband found out they were facing a challenging genetic factor when they began trying to start their family. It was at that point they were told IVF was their only option. After their second transfer from their first round of treatment, Blair suffered a heartbreaking miscarriage that redefined her life. Ever since then, she has made it her mission to bring a voice to the topic of infertility. Her Instagram account, Fab Fertility, has grown into a brand and podcast., and she is also the Co-Founder of Fertility Rally, a membership community for women going through infertility. Blair is currently pregnant with her rainbow baby girl after her fourth IVF cycle.