Hi Bee,  I'm so sorry for your trouble.  Infertility is difficult for all and can be excruciatingly painful  some.  You're in my thoughts and prayers. 

 

Each insurance policy is different and the guidelines within each state are different, but many PPO insurance plans do cover testing (not necessarily treatment) for infertility.  I suggest you take advantage of it after 6 months of consistent "trying" with no pregnancy. Seek out a "Reproductive Endocrinologist" in your area. They're the fertility doctors.  

And if you haven't already, start charting your cycle. I could never figure out the temperature tracking thing (I run cold to begin with) so I used the ovulation tests to identify when I was ovulating each cycle.  This data will come in handy when you bring stats to your RE.  The more information they have to work with, the better they'll be able to figure out what's going on.  

 

The standard infertility workup usually goes from least to most invasive.  Similar to this: 

(1) For Him: Semen analysis (40% of infertility cases are caused by his side of the deal)

(2) For Her: Bloodwork - baseline levels of FSH (follicle stimulating hormone) and LH (lutenizing hormone) - best taken during the first week of your cycle. 

(3) Use internal sonogram to check out the thickness of the endometrium during an LH surge, which happens right before ovulation (another reason why it's important to get familiar with your ovulation cycle).  A day or so after ovulation, they'll go back and check to ensure that the follicle released an egg. 

(4) Post-coital test  to test cervical mucus and see if his little guys can survive in your cervical mucus.  I know..

(5) HSG or HYSTEROSALPINOGRAM.  In this test, they push dye through your fallopian tubes to ensure there is a clear passage.  This test is the most invasive of the lot, so Doctors, acting in the best interest of their patients, will usually offer it last.  From what I have read in this forum, however, it is the most commonly FAILED test among J Pouchers. Fallopian tubes are delicate and can be damaged in the surgery(ies).  If both Fallopian tubes are damaged or blocked, IVF is often still a viable (if expensive) option. 

 

When you meet your RE, I suggest you tell them your history and you may want to request to do the HSG a earlier in the process.  This is your decision to make with your partner and doctor.  

 

Reproductive Endocrinologists are at the cutting edge of an ever advancing field, but there are still many "unexplained infertility" cases out there.  These are some of the many instances of infertility that have yet to be explained by medical science, and as a patient, that can be difficult to wrap your head around. I know I felt particularly let down upon learning that my doctors don't have all the answers

 

It was a difficult journey for me.  We began a regimin of IUI after we failed the post coital test.  I fell pregnant on my second IUI (we did most of them without hormones) but lost the pregnancy early.  We then knew that an IUI could be a viable solution to achieve pregnancy, so we pursued 4 more IUIs without hormones with no success.  For the 6th IUI, we escalated to IUI plus Clomid and the HSG injection to time ovulation.  TWINS!

 

Easy pregnancy.  Blessed Babies.  Happy toddlers after 3 years of IF.  

Everybody loves their kids to the fullest extent that their hearts will allow.  And I'm fully aware that I am rationalizing my situation, but it helps me when I believe that infertility made me a better mother and made my motherhood sweeter.  My patience is never ending, my commitment to my family is iron clad.  Plus - I'm a selfish gal, but it's very difficult to be selfish when your most fervent prayers and wishes have been answered.  

 

I feel for you through this tough time and hope for the best!!!

Hi Bee,

 

I'm sorry to hear you are having trouble getting pregnant and, unfortunately, I am in the same boat right now.  I am 29, had j-pouch surgery 5 years ago and have been trying to get pregnant for the last year.  This last month, I had all the blood work for hormone testing, a pelvic ultrasound, and HSG (my husband completed the semen analysis).  Blood work, ultrasound, and semen analysis were all completely normal, but the HSG did show an occlusion in my right Fallopian tube (completely blocked from scar tissue) and the left tube was inconclusive.  The fertility specialist is recommending I have laproscopic surgery to remove the right tube, get a better look at the left tube, and potentially remove the left as well if it is too damaged.  I don't know the technical explanation, but she basically said that the blocked tube is creating a "toxicity" back flow issue that is killing anything that tries to grow (even in the other tube).  She said that IVF would be 50% less likely to work if we keep the right tube intact, IUI and natural pregnancies would be even less likely to work.

 

Honestly, I wish we had had the testing done sooner and saved ourselves a year of heartache and disappointment.  I always knew this could be an issue following the j-pouch, but the doctors encouraged me to just try naturally for a while and see how it goes.  Knowing that there was no possible way for me to naturally conceive months ago would have been nice , so I would encourage you to push to have testing done now if you feel really ready to have a baby.  Please keep me posted, I have found it so difficult to get good info on infertility and j-pouchers so I would love to know how your situation unfolds.  I never knew surgery was even on the table as a possibility.  I hope it is a smooth and easy journey for you!

 

Anne

Thank you kdub and Anne for the information!  That is really really helpful!

 

I went to my GP two days ago to ask for some preliminary investigations and a referral to OB/REI specialist.  She said that normally she doesn't do these things unless someone has been trying for a year.  She didn't want to count the time we spent trying before I started using the OPK, so in her mind I only have failed for 4 months.  I told her that since I am at high risk for tubal adhesions, I thought I should get investigations sooner - I know some people have an HSG right at the start of trying to conceive.  We settled on a compromise that I would come back in 3 months if still no success.  Does this seem reasonable?  Hearing you, Anne, say that you wish you had dealt with all this sooner makes me want to just know now.  I don't want to be pushy, unreasonable, or waste health care resources, but if I end up being investigated in several months and something is found, I will feel very guilty for not advocating to get these tests earlier.  (Not getting any younger here!!!)   Anne, I also had no idea that surgery was even a possibility!  I can't even imagine. Thanks for your thoughts and support.    

Hi Bee -

I am totally biased on this one since it's turning out that I have issues.  I know it's totally possible for j-pouchers to get pregnant naturally, but the VAST majority have issues (at least from what I see on blogs/online communities).  It's frustrating to me that doctors don't seem to want to admit that fact.  In the scheme of things, 3 months is not very long and sounds totally reasonable to me, but I understand you wanting to get things going now and I tend to agree with you.  If you do decide to stick with this timeline, keep in mind that the diagnostic testing is all done based on your cycle.  The blood tests I had were on Day 3 and 21 and the HSG (I did pelvic ultrasound same day) has to be done sometime in the Day 5 - Day 10 range (but when you aren't spotting at all).  Just something to keep in mind so you don't lose another month because of where you are in your cycle when you make your next appointment. Also, you might want to look into your insurance coverage now, as kdub mentioned, some plans cover diagnostic treatments and others don't.  My plan doesn't so everything was out of pocket.  I only bring this up because if you have to pay totally out of pocket anyways, it probably gives you a little more leverage to push to get tested sooner.  Again, I'm clearly biased because of my current situation so take everything I'm saying with a grain of salt .  Keep me posted!

Bee, I think it is fair to argue that a) since you are over 30 b) are high risk for infertility and c) have no other children it is completely reasonable to begin RE work up at 6 months of trying...honestly, I don't understand the push back from your GP in your case.

Good luck

One year of no conception is the appropriate time table for women of average risk of infertility. However pelvic surgery like the the j-pouch increases the risk approximately three-fold. Being over 30 is another factor. Because of this, six months of trying to conceive is the appropriate time table. Otherwise you are just wasting time you do not have.

 

http://www.ncbi.nlm.nih.gov/pubmed/16772310

 

Jan

I feel lucky. It took about 8 months for me to naturally get pregnant with my daughter. A year after my C section, I had a huge mucoid ovarian cyst on my left ovary. It was removed by the local fertility specialist, "the baby maker," because I sort of fell into his lap as a patient.

After he removed the cyst in an open surgery, he came out to talk to my family. He pointed to my daughter and said, "That's Rachel's biological child?  She shouldn't be able to have kids... That child is an act of divine intervention."  Apparently EVERYTHING gyne in me was tied up in scar tissue and/or adhered to my bowels. He told me later I was a good IVF candidate, as I'd carried a child successfully, but he said I'd never get pregnant again naturally.

He was correct. But my hubby and I, though respectful of people's choices to use IVF, knew it wasn't a route we wanted to travel.

I'm very blessed and lucky to have my one and only super lovely daughter.  Good luck to you!

Hi again all!

Thank you for the continued discussion on this threat - the information and support is really helpful!  To update you, I found another MD to refer me to the RE specialist so now I am just waiting to get an appointment date/time.  Meanwhile, another cycle has passed with no success.  Knowing that now I have a referral and a plan makes me feel much better.

I had fertility issues post pouch removal.  Massachusetts has full coverage for IVF - but you have to do 6 rounds iui first.  I got that waived because of the risk of high order multiples.  One fresh cycle we transferred two embryos and got one beautiful boy who is now almost ten.  We did a frozen cycle that I miscarried early.  Second fresh cycle we transferred one hatching embryo at day 6 and she is now 7 :-). :-)