# Trying to Conceive for the First Time



## GomTay (Aug 11, 2009)

I have posted this elsewhere but want as much advice as possible. 
I hope that their are people out there who can provide some insight.

My wife and I are trying to conceive for the first time. She stopped taking the pill in December and we started trying to conceive after we were married in February. I read a lot of advice on conception (books and internet) early on and we have been pretty good at monitoring and charting biomarkers and cervical mucous (though the latter has been difficult).

However, it has now been 80 days since the last period (typically my wife's period alternates each month between 30 and 37 days), the basal body temperature charts no longer show ovulation and the fertility monitor cannot be used as there has been no period. We have taken many pregnancy test over the past two months (including this morning) but none were positive. 

I am really concerned that we are continually waiting for changes (three months and counting) and that nothing is being done to address the problems. We are awaiting the results of her pelvic ultrasound and my semen analysis (just precautionary) but I feel this is unlikely to address why my wife's ovulation has undergone an apparent abrupt stop. We have always been vigilant with monitoring her biomarkers, which has provided great support to us as we feel in control, but now we feel lost.

I realise that conception takes time and I am not concerned about the fact that after four/five months no conception has occurred. I am however gravely concerned that for the past two/three months we have lost control: the monitors are of no use and no period has occurred. Our GP has not been particularly attentive and we are having a difficult time trying to understand what to do.

We are living in the London area and basically need some good advice. What would you recommend? There seem to be lots of clinics for contraception but not fertility. Where can we go for advice? 

My wife is nearly 36 and I am 30 but we would like to have a large family and it feels like time is slowly passing by with no progress made. Your advice would be gratefully appreciated.


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## prija (Apr 24, 2003)

Hi GomTay,
I would have thought you should be entitled to a referral to a gynaecologist with specific interest in fertility. Have you not asked your GP about this? I know that there is a time of 1 year or even 2 years that people should try to conceive without seeking medical advice, but as far as I know, that is for people who have no cause to believe they may have any issues. I am not saying you have fertility issues but you seem pretty certain that there has been a lack of ovulation and I believe this should be investigated. Let me know what you feel about this. I do have some ideas of other ways of assessing fertlity if you are not happy with this, but personally a gynaecology referral is what I would recommend.
Best of Luck!
Prija


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## GomTay (Aug 11, 2009)

Many thanks to everybody for reading, it provides plenty of support. Well here is my update:

I got frustrated waiting for an appointment with our GP so I got transcripts of my semen analysis and of my wife’s pelvic ultrasound and we went for a consult with a fertility specialist (The Bridge Centre, London). My semen analysis was normal but we were told my wife has Polycystic Ovary Syndrome (PCOS). It was pretty devastating but it appears to be unfortunately common and basic treatment options (TSI, IUI) are not so unreasonable.

We are thinking that we will try TSI (timed sexual intercourse – stimulated) for three cycles and see what happens. There was a lot of information thrown at us and we are still trying to find our way. However, it’s relieving to have identified a treatable problem and not to continue trying in vain. 

I believe the following is the procedure (please correct or advise where appropriate, I only have sketchy notes I took during the consult):

1.	Take one 10mg Provera tablet a day for 5 days – this initiates my wife’s period (she has been amenorrheic for nearly 3 months)
2.	From the second day of bleeding take one 50mg Clomifene tablet each day for five days – this induces ovulation and will be monitored by ultrasound to ensure ovulation and that there are a sensible number of ova released
3.	Regular (twice daily) urine monitoring will locate the expected release time of the ova – this will allow timed sexual intercourse

To ensure that there are no unforeseen delays my wife will undergo a HyCoSy (ultrasound) scan to ensure the patency of her fallopian tubes – this will occur after her induced period but before ovulation induction. She must also have a Chlamydia screen, and possibly a blood screen for hormone levels when ovulation is triggered.

Any advice would be appreciated.


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## prija (Apr 24, 2003)

Hello,
I am not familiar with protocols but you sound like you have a pretty good idea of what is to happen! I also think this is a good starting point for you and the very best of luck to you both!
If you have any further questions please do not hesitate to ask!
Best wishes!
Prija


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## GomTay (Aug 11, 2009)

Dear all,

Apologies for my tardy updates but life has been pretty hectic for the past couple of months.

Basically our treatment has progressed through 3 cycles (of roughly one month duration each) of ovulation induction with timed-sexual intercourse:

1st Cycle:
Started by taking Clomid for over a week but no effect of follicle growth (for any or all follicles) so rapidly changed to subcutaneous injections of Gonal_F (on same treatment cycle). Achieved mono-follicular growth.
No success

2nd Cycle:
Continued with Gonal_F combined with the usual regular ultrasound scans to check follicle growth. Developed excessively large cysts (~50mm). Delayed stimulation for a few days and observed reduction in follicle size. Restarted stimulation and achieved mono-follicular growth.
No Success

3rd Cycle:
Continued Gonal_F injections, achieved mono-follicular growth and took Ovitrelle injection to induce ovulation. 
Success. Pregnancy was achieved.

However, my wife experienced strong abdominal pains in the following weeks and we went to the hospital. Ultrasound raised concerns that there might be a heterotopic pregnancy (though they are uncommon), i.e., a small unknown feature was observed. Unfortunately, scan also showed the presence of large bi-lateral cysts (two ~50 mm cysts in each ovary). Cysts appeared clear on ultrasound so not likely blood-filled and, hence, not of serious concern. Blood tests showed that a viable embryo was formed. 

Pregnancy is now at 11 weeks and no notable symptoms of heterotopic pregnancy so fingers crossed all is well (would have expected severe symptoms to be manifest by week 9). Cysts on one side reduced greatly in size and slowly reducing on other ovary. Awaiting next scan to see if they have abated. My wife now has only mild abdominal pains, nothing nearly as severe as with the large cysts so hopefully all will be well.

Good luck to all and many thanks for all the support.


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## Guest (Jan 14, 2010)

congratulations x


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