I everyone,

I don't know if I can help anyone with this message and by no way am I an big expert on this as I'm only finding out things now. But if I can help anyone make the decision to not waste time and move onto the IVF stage and actually have a baby then I'll be a happy person.

Sorry this is going to be rambling as I awoke at 4.30am this morning stressed out and it's just before 9am now and obviously I've not been back to sleep yet!

I started looking into tests for my fertility by chance 2 years ago now in the run up to my wedding -I'd had abdominal pains and went through some tests to check them out (it turns out it was just ovulation sort of pains).

As a result I was told that my FSH levels had fluctuated slightly out of the desired range. However I was told it was ok (by the Gynaecologist) as they had returned to normal again (It would seem that he was wrong - according to my present specialist, also please read the following link as it may be informative if you are in the same boat) -

http://www.infertilityspecialist.com/ovulation_toner.html

Anyway I had the HSG done and I was told that my tubes were clear etc and my husbands sperm count was normal. Anyway I got married and came off the pill and started checking I was ovulating and having sex at the right time etc - but nothing happened.

I moved house ( I live in the UK) and moved into London. To cut a long story short it took me months and months to see a new Gynaecologist and once I finally started to go through the red tape of going on our NHS waiting list for IVF I found I had to do my HSG again as it was now a year old and again the same with my husbands sperm count. Anyway they had trouble this time getting the dye to go along my left tube properly but after further discussion they decided it was ok. I had all my bloods done again and they decided that yes I should do IVF but really they didn't know why I hadn't got pregnant.

Luckily!!!! My husbands job is relocating us out of the country and I panicked and though sod it lets just pay and go private and fit it in before we have to leave. I was all excited by this clinic in London called 'Create' as they do 'natural' IVF - which means no drugs they will just collect your egg in a normal cycle - fertilise it with your partners sperm and put it back in the right place - which makes it much much cheaper as no expensive drugs are involved and you avoid the chance of hyperstimulation of your ovaries.

So I toddled off to this clinic all happy that I was going to have a baby in a 'sort' of natural way.

The lady I spoke to Geeta Nargund - http://www.stgeorgeshouseclinic.org.uk/geeta%20nargund.htm

spoke to me about my health problems and my surgery and was interested in my FSH spike. "Oh but it's ok it's gone back to normal" I said. But apparently that's not ok! Take a look at the first link to the infertility specialist website (further up the page) and you'll see that it's not. Also she was very very interested in the fact that I'd had steroids! I wasn't on steroids for that long as my colitis was so severe possibly 2-4 weeks but I was on a very high dose. It would seem that steroids can affect your fertility but no one told me this and the other two Gynaecologists didn't mention it either.

Anyway this is the important bit -

She asked me to have another blood test to check the FSH levels and also mentioned this new ultrasound scanner that they had that would measure the blood supply to my womb and ovaries etc, that sounded good to me and so that all looked fine. Then she had a look at the mobility of my ovaries by pushing up and down on my tummy (sounds old fashioned - but it worked) as she spotted that my left ovary wasn't moving about as freely as it should - which would correlate with the recent HSG problems. She said she thought there probably was an adhesion there. But the really good thing was that she measured the size and volume of my ovaries and the presence of antral follicles. My right ovary was much smaller in size and volume than my left and my left was smaller and of less volume than it should have been for my age.
She looked at the antral follicles and on my left ovary there was 1 normal size and 3 much smaller follicles and on my right (the one that doesn't have an adhesion) 1 small follicle and 3 tiny little follicles.

Her response to this was -
Ok I don't even need to see your FSH levels anymore. I know exactly why you've not got pregnant- you have very low ovarian reserve for your age and natural IVF wont be suitable for you we need to get you on a normal IVF cycle ASAP. Apparently she believed the main cause was the steroids that I was given and also that I had had Ulcerative Colitis (autoimmune diseases can be linked to low fertility apparently).

Anyway after 2 other Gynaecologists and 2 years of the same tests this lady diagnosed me in 4-5 mins with an ultrasound scanner. I mentioned this to my 2nd Gynaey's secretary and she poo poo'd Dr Nargunds diagnosis (not sure where a secretary gets off on giving medical advice, but anyway) which obviously upset me, but as a result I did a bit of googling and found these links which back up Dr Nargund's opinion on the significance of ovarian size/volume and antral follicle presence/size.

http://humrep.oxfordjournals.org/cgi/reprint/12/5/1028.pdf
http://www.infertilityspecialist.com/ovulation_toner.html

So I hope that this may help someone to get a quicker diagnosis of fertility problems. I don't know how common these test might be in the US as they don't appear to be mainstream over here - but hey fingers crossed.

Also natural cycle IVF or low dose IVF (they use a lower dose of the IVF drugs) may be a slightly cheaper option for those of you who may not be able to afford normal IVF prices.

Good luck everyone!
And I'll keep you posted.

Zenaxx