# Where to start?



## Atickle76 (Feb 8, 2016)

Another month, another period 😢 

I have been off the pill for 9 years, been trying on and off during that time. I had an ectopic in September 2014 and been actively trying since the beginning of 2015. 

I went to my GP in October and again in February, felt that she fobbed me off both times.

So my questions are, How do I get her to send me for tests?  And what are the tests?

Really haven't a clue about any of this, so any help or advice would be gratefully appreciated 

xxx


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## BethP (Feb 27, 2015)

Hi

I think some GPs will only refer you to a fertility clinic after two years of actively trying. That is the rule mine have, but think it also depends on your age so if you are above a certain age (I think 36) it may be a shorter wait. It can be incredibly frustrating, especially as we get a lovely little reminder each month that it isn't happening.

I think some fertility centres do take self referrals, so you don't necessarily have to wait for your GP to refer you. It may be worth giving your local one a call on the off chance.

If you are unlikely to qualify for any NHS funding, then going straight to the clinic of your choice may be best anyway.  Your GP should be able to advise you of this.

I think it's pretty unfair of your GP to just fob you off. There are basic blood and sperm tests that they can do for you, so I think you should have at least been offered these.

Is there anyway you can see a different GP? I have found some at the practice I go to are much nicer than others. 

Beth xx


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## Atickle76 (Feb 8, 2016)

Thanks Beth. 

How would I find a fertility clinic? How much do these sort of things cost? I'm 39, so maybe my GP would refer me?

She did say to me last time that there was no point to do blood tests as I had been pregnant before. The other half hasn't had any tests yet.


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## Hopefulshell (Mar 14, 2013)

Hi Atickle

At 39 your doctor shouldn't be fobbing you off. Under 35 I think the common rule doctors seem to follow is to try naturally for 2 years; over 35 one year. I went to see my GP when I was 35 and had been trying naturally just over a year. My GP took action very promptly.

Yes you've been pregnant before and hopefully could be again, but I think your GP is a bit remiss not offering to run some basic tests. Ovarian reserve reduces after 35 as I'm sure you know so it's important that they determine this as a starting point. Also, it's imperative for your partner to be checked out too as likewise his situation may have changed since you last conceived. I'd seek a second opinion from another GP and ask to have the basic fertility tests done. For you, it'll be hormone levels to see if you are ovulating and to get an idea of your ovarian reserve. The hormone levels (FSH and LH) are combined with something called AHM which is normally a private test. AMH can be taken any time whereas your FSH and LH are taken during menstruation. Hormone levels are often repeated to see if there is a pattern. I'm afraid I don't know much about tubal issues but having had an ectopic, it might be worth finding out from your GP if a scan can be carried out. Apologies, I have no experience of this so can't advise but just a thought? There are private labs/clinics that will run basic fertility tests but if your GP is willing to carry some out for you, this will save you money in the early stages. 
More in depth tests are referred to as Level 1s and details of these can be found in Agate's guide under 13.2:

http://www.fertilityfriends.co.uk/forum/index.php?topic=242395.msg3904727#msg3904727

These all provide valid information about your fertility status and will help inform your dr how to proceed. You probably don't need all of them at this early stage but as much info as you can gather will help you in the long run, and prevent your dr missing something important that could later affect tx.

Your partner will be asked to give a sperm sample (again, sometimes more than once) to assess the count, morphology and motility. These basic tests give you a sound starting point to know what you're up against. I don't know what your personal situation is with regards to funding but it may be worth asking your GP or local CCG (Clinical Commissioning Group - the funding body) what their funding criteria is. In addition, the HFEA provides information of all the fertility clinics along with waiting times for private and funded patients so might be worth looking at their site too - http://www.hfea.gov.uk/. If you have to fund your own tx, individual clinics usually post their fees on their websites (or just call them and they'll outline the different costs pertaining to your particular situation). As a ballpark, take a look at a few local ones and see what their offer is. Some clinics offer packages for eg. Or lots of ladies go abroad for tx which I understand is cheaper than the UK. Anyhow, I wouldn't worry too much about that at this stage as until you have your tests done you don't know what you may need.

For now, I'd make an appointment with a different GP and if possible go along with your partner to discuss your situation. Don't let them fob you off sweetie. If you've been actively trying for a year and have regular AF then you're quite within your rights to ask for help now you're 39.

Best of luck.

x 
/links


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## Atickle76 (Feb 8, 2016)

Thank you xxx


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## MFK (May 5, 2014)

All above answers are good. At your age I wouldn't waste time with GP investigations if you can afford to go to an IVF clinic. If you can't afford it then change GPs and tell them you've been trying for over two years. While AMH is measured a lot mine was super low and I got pregnant on my first trial with IVF and am now expecting naturally,starting 4 months after giving birth to the first one. 
Don't know where you live but in my mind ARGC in London is the best clinic in the UK if not Europe. Tough regime, very expensive (depending on your issue) but my feeling is if they can't help, no one can. Again at your age, I'd throw the kitchen sink at it and there's no reason it shouldn't work. Often it's also the sperm that's the issue and you need good biologists to determine whether it's good or not. Very few clinics have them which is why ARGC insists on testing sperm themselves rather than take results from a GP prescribed test.
Good luck whichever way you choose to go.


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