Not Getting Pregnant – When to ask for help

Most couples conceive with in 6 months – 1 year from trying, however, this can feel like an eternity. If you have been trying to conceive for a while, and are thinking you may need advice, support and help, the following steps are what I recommend to my clients.

After 3 months of trying to conceive:

Try to keep track of the length of your menstrual cycles. Charting Basal Body Temps (BBTs) for several months, as well using home Ovulation Predictor Kits and recording the results.

It also a good time to optimize your health and fertility with supportive care, such as acupuncture, Chinese Medicine, naturopathy, and chiropractics.

At 6 months, visit your family doctor and request the following blood tests:


  • FSH (on day 3 of your cycle)
  • LH
  • Estradiol ( on day 3 of your cycle)
  • Progesterone ( on day 21 or 7 days post ovulation)
  • Prolactin
  • Thyroid Stimulating Hormone (TSH), Free T3, Free Thyroxine (T4)
  • Total Testosterone, Free Testosterone
  • Anti-Mullerian Hormone (AMH) ( There is a cost to this test)

After 6 months, ask for a referral  from your family doctor to a fertility centre to further investigate your fertility issues.

ULTRASOUND EXAM(S): On the day of LH surge are used to assess the thickness of the endometrium (lining of the uterus), monitor follicle development and assess the condition of the uterus and ovaries. If the lining is thin, it indicates a hormonal problem. Fibroid tumors can often be detected via ultrasound, as well as abnormalities of the shape of the uterus and ovarian cysts. In some cases, endometriosis can also be detected. Many doctors order a second ultrasound two or three days after the first. This second ultrasound confirms that the follicle actually did release and can rule out lutenized unruptured follicle (LUF) syndrome—a situation in which eggs ripen but do not release from the follicle.

HYSTEROSALPINOGRAM (HSG): This test is used to examine a woman’s uterus and fallopian tubes. It is essentially an x-ray procedure in which a radio-opaque dye is injected through the cervix into the uterus and fallopian tubes. This “dye” appears white on the x-ray, and allows the radiologist and your doctor to see if there are any abnormalities, such as an unusually shaped uterus, tumors, scar tissue or blockages in the fallopian tubes. If you are trying to get pregnant in the same cycle as an HSG, make sure to schedule the test PRIOR to ovulation so that there is no danger of “flushing out” a released egg or developing embryo.

HYSTEROSCOPY: If a uterine abnormality is suspected after the HSG, your doctor may opt for this procedure, performed with a thin telescope mounted with a fiber optic light, called a hysteroscope. The hysteroscope is inserted through the cervix into the uterus and enables the doctor to see any uterine abnormalities or growths. “Photos” are taken for future reference. This procedure is usually performed in the early half of a woman’s cycle so that the build-up of the endometrium does not obscure the doctor’s view. However, if the doctor is planning to do an endometrial biopsy at the same time, it is done near the end of the cycle.

LAPAROSCOPY: A narrow fiber optic telescope is inserted through a woman’s abdomen to look at the uterus, fallopian tubes, and ovaries and to discern endometriosis or pelvic adhesions, and is the best diagnostic tool for evaluating the ovaries. This test us usually done two or three days before menstruation is expected, and only after an HCG beta blood test ensures the woman is not pregnant.

ENDOMETRIAL BIOPSY:This procedure involves a scraping a small amount of tissue from the endometrium shortly before menstruation is due— between 11 and 13 days from LH surge. It should ONLY be performed after an HCG blood test shows the woman is not pregnant. This test is used to determine if a woman has a luteal phase defect, a hormonal imbalance which prevents a woman from sustaining a pregnancy because not enough progesterone is produced.

SEMEN ANALYSIS: You’ll be asked to provide a semen sample, usually by masturbating and ejaculating into a specimen jar. Your doctor will examine your sperm under a microscope for count, shape, appearance, and movement

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