Heartbroken month after month - Looking for guidance on next steps

[christianforever999]

Hello Reddit family,

My wife (30F) and I (31M) have been trying since last August 2022 with no success. All the tests have come back normal according to her OBGYN. Here are her test results and my SA results.

Her OBGYN says we're young, enjoy and not to worry too much. But it's getting exteremly difficult seeing my wife break down every month. Especially seeing friends and family members around us with kids and/or pregnant.

Her OBGYN started her on Letrozole 2.5 mg and last month her blood work came back with progesterone level of 34.6 on day 21.

We're not ready for IUI or IVF yet but what can we do? Are there additional tests that we can do to factor out any other possible cause? Does anything jump out from the test results below? I mean any guidance, advice would be appreciated.

varicella zoster IgG index = 2267

rubella antibodies, IgG index = 6.71

US, pelvis, transabdominal + transvaginal = normal

anti-mullerian hormone (amh) NG/mL = 1.77

TSH uIU/mL = 1.55

T4,free(direct) NG/dL = 1.13

progesterone NG/mL = 34.6

My SA results (as of April 2023):

Volume (ml) = 3.5

Liquefaction = Complete

Viscosity = Normal

Agglutination = None

Concentration (M/ml) = 55.6

Motility (%) = 65

Progressive Motility (%) = 65

Grade of Progression (1-4) = 3

Total Motile Sperm (M) = 126.3

Morphology(% Normal) = 8

White Blood Cell (WBC) = NA

Antisperm Antibodies IgG = NA

Antisperm Antibodies IgA = NA

*** Edit ***

Day 3 results came in:

FSH = 14.9

AMH = 1.77 (tested on 4/2023)

AFC = 8 (Day 3)

The doctor said the options are IUI or IVF. His point was that the FSH level is concerning and it's saying that the brain is concerned about egg reserve.

Wife (30F) is upset. She thinks she has DOR and wants to go with IVF. Any thoughts?

 

[youngrebornmommy]

@christianforever999 In my very non-medical opinion (but TTC for almost 2 years and currently working with a fertility clinic), her AMH is slightly on the lower end of normal for her age. I would recommend she also get her estrogen and FSH checked on day 3 of her cycle, as that can offer some indication of egg quality. That is a great progesterone value for day 21, indicating she did ovulate that cycle.

 

[youngrebornmommy]

Just to add, she can also ask her OB to order a HSG, which would show whether her tubes are blocked. That is typically the next step after baseline lab testing. You may want to try to get in with a fertility specialist for further testing if her OB is unwilling to do so.

 

[christianforever999]

@youngrebornmommy I think the OBGYN did mention about that procedure but said it will be painful and wanted to wait until other options are exhausted. Will see if wife is ready for this and discuss. This is good to know though. Thank you.

 

[pilgrimseeker]

@christianforever999 Just want to add, it can be anywhere from unpleasant to very painful depending on the person, their pain tolerance, if there is a blockage, etc., but there is no benefit of taking letrozole/ovulating if the tubes are blocked. She should consider doing it sooner rather than later.

 

[oladi]

@christianforever999 Personally, my HSG was painful but it was worth the peace of mind that my tubes weren’t blocked and we weren’t wasting time. If her tubes are blocked, you’re essentially delaying the inevitable.

 

[eudy93]

@christianforever999 I had my HSG a couple months ago; it was over in 5 mins and less painful than an intense Pap smear, 3/10 pain at MOST. There are plenty of other positive stories here for HSG experiences! While these tests might be painful, they are the best way to find out things about our bodies. I personally think that just waiting because there is a possibility of pain isn’t a good reason to exclude this from your diagnostics. HSGs can reveal if she has any blockages in her tubes or irregularities in her uterus, idk about uterus abnormalities but I know you can only see tubal blockages with a test like an HSG

 

[pasha0672]

@christianforever999 I was very worried about the test but it was not painful AT ALL with minimal Tylenol and a blocked tube (which is likely to increase pain). I think it’s worth pushing for that. But DEF get it done somewhere experiences with giving them (a fertility clinic) vs getting a script from the obgyn and going to a random radiology office that doesn’t do them a lot

 

[cam1987]

@christianforever999 Birth will be way worse

 

[katrina2017]

@christianforever999 My HSG was pain free. I was expecting the worst because my period cramps pre-TTC life were extreme. But I was totally fine...didn't even take anything for it. Everyone is different so it's not a guaranteed painful procedure.

 

[christianforever999]

@youngrebornmommy Thanks for the insight. We'll ask her OBGYN to see if we can check for estrogen and FSH.

 

[mybiblemessage]

@youngrebornmommy I thought age is more an indicator of egg quality than fsh? That’s what I keep reading. I have an Amh 0.7 with secondary infertility issues right now and just started seeing a fertility clinic. My fsh is also high at 14 so even if I’m 32 how is the fsh showing quality? Would love to know your input since you work in a clinic.

 

[youngrebornmommy]

@mybiblemessage Sorry that wasn’t clear, I’m working with a fertility clinic to try and conceive. Not for my job.

 

[anxiousinphx]

@christianforever999 I’m not a doctor so can’t interpret the results but just from my general experience of me and my friends trying to conceive is that it’s very common to take 6 months - 2 years. I’m 30 and been TTC since October 2022 and I’m pretty average in my group of friends. My friend are very open about their fertility journeys but I think a lot of people aren’t. I work in health care and my older female colleagues all very openly talk about their ivf experiences, miscarriages etc. Its such a normal part of conversation that it’s helped me feel better about it taking a while. Obviously I also have friends who conceived on the first few cycles but they’re quite rare.

Anyway, not hugely helpful but please know you’re not alone. Sometimes I get really stressed out about it but generally I try and focus on other things and hope one day it’ll just happen for us.

 

[braendz]

@christianforever999 Have either of you had vitamin D levels checked?

 

[christianforever999]

@braendz For me, it's usually on the low side. I'm taking 2000 IU per day.

2021 = 31.7 ng/mL

2022 = 26 ng/mL

For wife:

2023 = 26.0 ng/mL

2022 = 24.9 ng/mL

 

[braendz]

@christianforever999 I’m not a doctor but her levels seem pretty low based on what I’ve seen as recommended for TTC. I would do some research on vitamin D, and of course talk to your doctor about what they suggest!

 

[pasha0672]

@christianforever999 Even though though lab standards are lower a lot of doctors recommend higher (50ng/ml iirc) for optimal function

 

[squiddles]

@christianforever999 I'd say an HCG is necessary for a fertility work up, if the tubes are blocked, nothing you try will really work. I think it's important to do right away.

 

[herring2145]

@squiddles *HSG. Yes, it could be something like a blocked tube, weird uterus, or fibroids that’s preventing.