Hellobee

A few months after my chemical pregnancy, I went for my yearly physical. My primary care physician asked if we were planning to have any more children and I gave her a brief overview of our story so far – three years of trying to conceive and two miscarriages before we had my son, ten months of trying to conceive and one early miscarriage since he was born. She immediately recommended a referral to an infertility specialist.

I was actually a little surprised. Of course I knew that having a baby was extremely difficult for us, but at the same time, I had managed to get pregnant without intervention four times already. And while it took a really long time, we still did it. So could I really say we were struggling with infertility? Either way, it was a huge relief to feel like we were doing something proactive about our struggles to have a second baby, and it also seemed like a good way to possibly get some answers about our repeated miscarriages.

A few weeks later, my husband and I went for our first appointment with our reproductive endocrinologist. I had absolutely no idea what to expect. At that first appointment, we met with our doctor (who ironically happened to be pregnant) in her office and gave her a rundown of our history. She talked to us about the general factors related to infertility – problems with ovulation, problems with the uterus, problems with the fallopian tubes, problems with the guy, and advanced age. And then if all of that stuff is ok, there is also unexplained infertility which basically just means there is a problem, but nobody knows what it is.

I was a little surprised that our doctor focused so much on the reasons it was so difficult for us to get pregnant and very little on the reasons we were struggling to stay pregnant. One of my biggest fears was getting pregnant again only to experience further loss. But the doctor explained that she wanted to address difficulties conceiving first because the two may be closely related. Also, we had already had basic testing done for the most common causes of miscarriages.

The first step was to do a detailed history and determine which factors might be a problem in our case. Once we knew more about the possible causes, we would know better how to proceed. One thing the doctor stressed was that we needed to explore every possibility. Even if we found one thing that was a probable cause of our problems conceiving and carrying a baby, that didn’t mean there weren’t other causes as well.

So we went down the list. This list includes all of the potential barriers to fertility our doctor discussed with us. I am sure it is probably not an exhaustive list, but it does seem to pretty thoroughly cover the scope of potential problems. This list does not cover potential reasons for our recurrent miscarriages.

Ovulation issues

The basic issue here is whether you are ovulating at all as well as whether you are ovulating at the right time. There are several possible factors including PCOS, being overweight and thyroid issues as well as other possible hormonal factors. In our specific case, I don’t have PCOS, my weight was normal, and I had just had my thyroid checked. So ovulation was still a potential problem but not for any of those reasons.

Uterine issues

Any physical issue with  the uterus can be a problem for both getting and staying pregnant. This could be caused by fibroids, polyps, an infection or scarring. At first I thought I was safe here since my uterus had effectively carried one baby to term, but my doctor pointed out that it was possible that scarring from the c section I had with my son was now causing a problem.

Tubal issues

Any blockage in the fallopian tubes is a definite deterrent to pregnancy. Again, I didn’t think this was terribly likely given my history – one successful pregnancy and two miscarriages where ultrasounds confirmed the pregnancy had been in the uterus.  But it was always possible only one tube was fully functioning.

Male factor issues

This is basically any problem originating with the father. Since all the guy does is supply the sperm, there are a lot less potential problems. Primarily that there are not enough sperm, that they don’t swim well, or that they are not high quality.

Advanced age

As we all know, fertility decreases with age, particularly over age 35.  This wasn’t an issue in my case.

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We left that first visit with lots of information and another appointment to discuss how we wanted to proceed. At the end of that first appointment, I felt pretty torn. I felt relieved to be taking some real action to figure out what the problem was and do something about it. But I also still had a lot of fears that we were addressing the wrong problems and I was going to end up in the same place I had been before – fighting to achieve a pregnancy that was only going to end in loss.