Today we’ll be reviewing General Lab Testing and talking about Transvaginal Ultrasounds. But first I want to share a reminder about my general “rule” for when to see someone for fertility support, and here are those guidelines again in case you’re just joining the conversation.
How long should you be trying before you get more tests? When should you seek out more support? Get support when the time is right. When is the right timing? We’ll refer to this guide when we go over the different tests in this ongoing email thread about testing procedures.
If you’re under 30 years old and you’ve been trying for 12 months
If you’re between 30 & 35 years old and have been trying for 9 months
If you’re over 35 years old and have been trying for 6 months
If you don’t think you’re ovulating
If you were on birth control and haven’t gotten a regular cycle back in 6 months
If you have had more than ONE pregnancy loss in a row. I know the standard is three losses, but I believe that two losses in a row necessitate further inquiry into your health
And here are the caveats:
If you have painful, heavy cycles and/or have a family history of endometriosis or fibroids, get support immediately. Sometimes the journey to diagnosis and treatment for that particular challenge can take years. I want you to have a leg up on this process so you don’t have to waste precious time.
If you intuitively think there is something “off” or “wrong”, honor your inner guide and wisdom, and start looking a little deeper sooner.
PEP TALK ABOUT FERTILITY TESTING:
Please remember that you may always request that a provider perform or order you one of these tests. They may give you some pushback, and you do have the right to ask for tests if you have reason to believe you may need them. You can always use this as a guide to help you advocate for yourself.
And here is something really important that I tell all of my clients about beginning testing and work with a Reproductive Endocrinologist and/or Fertility Clinic:
Before you enter into that territory, make sure you have an idea about what you’re willing to do, when (again there’s the whole timing thing ;). You have to remember that clinics’ whole purpose is to do what they’re trained in: procedures and medication.
In my clinical experience, I see that fertility clinic’s usually immediately recommend starting some kind of fertility treatment, whether it’s a medicated cycle or IUI or IVF. So, it’s important for you to be empowered -before- you go in there and know exactly what your current boundaries are:
What testing are you open to doing (that’s where this series of emails comes into play- some women really don’t want more invasive procedures done right away)?
Do you want to start fertility treatment right now or do you JUST want to do some testing?
If you’re open to fertility procedures at this time, what are they? What are you not willing to do?
How long do you want to wait to start fertility treatments if not now?
Do you want to do something else first before working with an RE (holistic coaching, nutrition, mind-body support, detoxification)?
Of course, these are beginning intentions because after you get more intel about your personal health from testing, you may decide to change your mind. BUT, it’s good to have a plan before you go in or you can start things before you actually WANT to.
Fertility clinics have a knack for creating alot of urgency, whether necessary or UNnecessary. My clients have gone through with procedures they weren’t quite ready for because they weren’t prepared with their boundaries first–and I want you to be supported.
Another thing I recommend is to educate yourself! There are things you have alot of control over, actually–and there are tons of natural ways to change them without going through expensive fertility treatments—so find out what you have the power to change and do your research before subscribing to the narrative that the fertility clinics are giving you.
Remember: they ONLY know about THEIR medicine because that’s what they learned. They learned how to use medication and procedures to make changes.
They didn’t actually learn about using high quality supplementation or nutrition (it’s true–my Doctor friend had ONE class in nutrition during her education), so don’t expect them to know anything about other options outside of their scope.
They are going to consult you about THEIR tools. That does NOT mean that there aren’t other ones out there :)
THIS WEEK’S TESTS!
General Lab Work Up: We touched on this a few weeks ago.
What: Your labs should include specific blood and hormone levels.
Who: You should have someone who can interpret them based on -optimal- ranges, not “normal” ones- and this is usually the territory of a holistic health practitioner or coach.
When To Get It Done: Now :) At any point in your journey (6 months before starting TTC to Now), I recommend getting this done.
Why: We need to see how your health is and if there are any pieces that aren’t being addressed by your primary care physician and/or Reproductive Endocrinologist (and as I’ve mentioned before Thyroid is a big one that causes challenges even at values BELOW sub-clinical levels. Surprisingly I see clinically that RE’s often ignore this because they rely on fertility medication- and this is a problematic approach).
***If you remember, I included a Lab Values Tool Sheet link in that email- feel free to hit reply to this if you’d like a copy and you missed that link!***
Transvaginal Ultrasound
What: A transvaginal ultrasound is a relatively quick, painless imaging procedure that provides a more detailed view of your pelvic organs than a traditional abdominal ultrasound provides. Your provider may order this imaging procedure to explore what’s causing your symptoms or to diagnose a condition. It’s a common, useful diagnostic tool but it has its limitations.
A transvaginal ultrasound uses sound waves to record your pelvic cavity and organs and project these images onto a screen. A wand-like instrument called a transducer is inserted into your vagina, where it releases sound waves that bounce off the various structures inside your pelvis. The sound waves travel back to the transducer, where they’re converted into electrical signals. These signals project a real-time visual image of your pelvic organs onto a screen that the technician performing the procedure can view. The ultrasound captures still images of the visuals on screen, too, so that your provider can examine them later. The image produced during an ultrasound is called a “sonogram.”
It can take 15-60 minutes to perform, and is usually done while you’re in stirrups (like in typical pelvic exams). The technician uses warm lubricant and a condom on the transducer and you may have to move in different positions so they can get different angled pictures of your anatomy.
Who: Usually this is performed at a reproductive endocrinologist’s practice or in a fertility clinic. Ob/Gyn’s may do this, but typically they reserve this procedure for pregnant women vs. women who are focusing on fertility care.
Oftentimes, bigger Ob/Gyn practices who are part of a bigger hospital system will either order a test with the imaging department of that institution or refer you out to a specialist (RE) for deeper inquiry into your health and so you begin your care and procedures with them instead. Ob/Gyn practices often just do bloodwork for fertility and refer out for any further care.
When you do receive the test, it is often either your provider, a trained specialist called a sonographer, or ultrasound technician who performs the procedure.
When To Get It Done: FYI these are my personal clinical recommendations and they may differ than that of your provider. I tend to be more proactive in my approach.
If you’re under 30 years old and you’ve been trying to conceive for 9 months
If you’re between 30 & 35 years old and have been trying to conceive for 6 months
If you’re over 35 years old and have been trying to conceive for 3-6 months
If you have profuse bleeding and/or pain during any point of your cycle - and whether that’s typical for you or not
If you have signs of a pelvic infection
If you have a family history of fibroids
If you have any signs of an ectopic pregnancy or miscarriage
If there’s a possibility that you have an STI or have had a more serious one in the past
If you were on birth control and haven’t gotten a regular cycle back in 6 months
If you have had more than ONE pregnancy loss in a row. I know the standard is three losses, but I believe that two losses in a row necessitate further inquiry into your health
Why: This is a first step to seeing the physiology and anatomy of your reproductive organs. This can help diagnose different issues that could be the cause of fertility challenges, and of course we want to know what’s happening if it’s a physiological issue or anomaly.
What it tests for:
Signs of a pelvic infection
Signs of cancer
Signs of ectopic pregnancy or miscarriage
Potential causes of fertility issues
I hope today’s entry gives you some clarity, ease and also things to think more about as you embark on your health inquiry.