Updated: Oct 31, 2022
The logical first step when you realise it's taking longer than you hoped to get pregnant is to go and see your GP.
But depending on who your GP is, and what kind of relationship you have with them... this may or may not be a useful step....
If you go to a bulk billing clinic where you have approximately 7.5 minutes with your GP in a normal consultation, they're not going to be able to cover much in that time that is really going to help you on your quest.. but they may request some tests..
Some of the tests they may request are really important, some a very useful.. and some are, in my opinion, a bit of a waste of time....
Pre-pregnancy screening test
This one is SUPER important! This is a blood test that screens for diseases that are really important to know about BEFORE you get pregnant. Things like whether you're immune to Rubella (German Measles), Varicella (Chicken Pox), whether you have Hepatitis, HIV, Syphilis or Chlamydia what your blood group is.
If you're not immune to rubella for example, then you can have that vaccination before you get pregnant, which will make your pregnancy safer (you don't want to get a disease like rubella while you're pregnant!)
Pap Smear/Cervical Screening test and Breast Check
Again, these are Super Important and really good to have done PRIOR to getting pregnant. They wont make any difference to how quickly you might get pregnant, but they are important tests to have done before you get pregnant - if there are any issues, you can have those investigated before you are pregnant without any risk of complications during pregnancy.
Day 2 or 3 Hormone Profile
This is a blood test done on day 2 or 3 of your cycle. The test is looking for the levels of certain hormones that will give an indication of where you are up to in your reproductive lifetime. One of the hormones measured is FSH.
FSH is one of the hormones produced in your brain that tells your ovary to start growing follicles... the growing follicles then produce oestrogen which feeds back to the brain to tell it to stop producing so much FSH.
So if your FSH is elevated at this stage of your cycle - that is an indication that your body is having to work really hard to grow follicles.. more FSH = harder to 'kick start' the ovaries to produce eggs.
As you get older, and your ovarian reserve decreases, your FSH level at this part of your cycle increases.. so measuring FSH at this stage gives an indication of ovarian reserve.
This doesn't really tell you anything about 'fertility' per se. You could have a very low ovarian reserve, but still get pregnant next month, or a really high ovarian reserve and Never get pregnant due to some other issue - like blocked tubes for example.
What it does tell us, is how you are likely to respond to the drugs that you may need to take if you end up having a cycle of IVF - what kind of dose may be required to stimulate your ovaries to produce a number of eggs.
If your cycles are irregular, it can also give some indication as to why that might be. For example, if oestrogen is elevated at this stage of your cycle, that means that follicles have already started to grow... this is common in older women. If the follicles start to grow too early in the cycle, it means that the endometrium (the lining of the uterus) doesn't have enough time to grow before ovulation... which leads to a timing issue between egg growth and endometrium growth which can cause problems with implantation.
There is some suggestion that what your hormones are doing on day 2/3 of your cycle can indicate a number of things about how you may respond to fertility treatment, or what your outcomes might be.... but this information isn't that helpful and really only adds to the anxiety. It's not going to stop you trying to conceive, it's only going to make you more anxious about whether it will ever happen....
Day 21 progesterone
This is a test that is generally done on day 21 of your cycle and, in theory, tests the level of progesterone half way between ovulation and day 1 of the next cycle. The time from ovulation to day one of your next period is called the Luteal Phase.
A rise in progesterone during the luteal phase indicates that ovulation has occurred.
The Luteal Phase is (almost always) 14 days (if it is shorter than 12 days then this will make implantation tricky and is a topic for another blog post)
If you have a 28 day cycle, then ovulation will occur on around day 14, and day 21 will be exactly half way through the luteal phase, so testing progesterone on this day can confirm ovulation.
If, however, you have a 30 day cycle... ovulation will occur on day 16 and the halfway point of your luteal phase will land on day 23
If you have a 26 day cycle, ovulation will occur on day 12 and the halfway point of your luteal phase will land on day 19... so testing on day 21 wont be mid-luteal phase and will likely give you a weird kind of result that doesn't confirm ovulation. There is no harm to doing this test... but here are 2 reasons why I think this test is a waste of time
If you have a 28 day cycle (or anything between 25-33 days) - pin pointing that mid-luteal day is easy - day 21 is correct... but, I can also tell you without a test that you are almost certainly ovulating. It is the process of ovulation that causes you to have your next period 14 days later... there is no need to measure progesterone mid-luteal phase to check for ovulation.
If your cycle is longer than 33 days, then it's likely you are not ovulating, or ovulating only sporadically. Pinpointing that mid-luteal phase day to test is going to be very difficult... and may waste valuable time whilst you wait.
The best way to test for ovulation is to learn about the signs of ovulation and to keep a look out for them. (If you want some help with this - check out my Masterclass Why aren't we pregnant yet parts 1 and 2)
AMH stands for Anti-Mullerian Hormone - a hormone secreted by the cells surrounding the really tiny follicles in your ovaries that hold the tiny eggs that may one day grow up to be big follicles holding bigger eggs that may be ovulated and fertilised and become a baby.
I wrote a whole other blog piece about the AMH test (you can check it out here)
But basically - AMH testing gives an indication of what your ovarian reserve is, but tells you nothing about your ability to conceive. Measuring it is not going to help you get pregnant, but may indicate that you might need to seek help sooner.
This is another one that is SUPER IMPORTANT. There are obviously 2 essential ingredients for making a baby - eggs and sperm. If you don't have these 2 ingredients, it's not going to work.
It's really simple to do a semen analysis and a crucial early step if things are taking longer than expected. An ejaculate contains all sorts of things - only 5% is actually sperm. So it's important to have an andrologist assess the semen sample and determine how many sperm there are, how quickly they are moving and what kinds of shapes they are.
It's quite normal for only 5 % of the sperm in an ejaculate to be 'normally shaped'.. but if that number is lower (like just 1 or 2%) then that may make natural conception trickier.
In some cases we discover that there are very low numbers of sperm, or that the movement of the sperm is restricted - sometimes by antibodies. if there are not enough sperm, or they are not enough of them swimming in nice straight lines, that can make getting pregnant naturally trickier... it might happen eventually... it just may take longer. So this information is really important to have when deciding what steps you want to take next. (you can read another whole blog on Semen Analysis here).
If your Dr requests a Semen Analysis - make sure they request it from an ANDROLOGY lab, and not a pathology lab!
If you would like more help decoding Why you're not pregnant yet - head over to my masterclass: Why aren't we pregnant yet - you'll find it here