“Infertility breaks us down, but if we allow it, also reveals our true selves by allowing light into the dark parts. We become whole when we accept ourselves fully, the good with the bad, the highs and the lows, not just our shiny exteriors” – @infertileafcommunity
You never really know what to expect when you begin your investigative journey under the care of a gynae or fertility clinic. When I last saw my gynae, he asked me to have a Day 3 blood test which is basically a blood test on the 3￼ day of your period. At the time I didn’t even ask what it was for – but I have now learnt from Vanessa Haye, to ALWAYS ASK questions so you know exactly what is going on. Just a quick one on Vanessa… she is a fellow #brownskingirl I found on Instagram at the time that I started un_fertility and she was the only black/African I found visibly talking about infertility and her IVF experience. Her story has been featured on Sky, BBC & Metro. You can follow her story on her IG page. THANK YOU Vanessa for paving the way for people like me, and for accepting my call and giving me a fertility pep talk.
So the day 3 blood test (she says after much research online) is to test 3 important fertility hormones. The day 3 fertility test is normally the first test that is performed in any investigation into female infertility. It is performed 3 days after the start of your period (but it can also be taken on day 2, 4 or 5) during the follicular stage of the menstrual cycle. The aim of the test is to check that hormone levels can support the maturation and release of a healthy egg from the ovary. Follicle-stimulating hormone (FSH) is released from the pituitary gland to stimulate the ovary to start maturing an egg. Luteinising hormone (LH) is required for the final maturation and release of the egg from a follicle, while oestradiol both stimulates the growth of the follicle and prepares the uterine lining for a pregnancy. – ©Medichecks.com Ltd 2019. I had not heard from my gynae for a while so I decided to book myself with the GP as an impromptu visit because I could not see my test results online and I was hoping the GP would be able to tell me ‘everything looked ok’. I wasn’t worried, and I just went in there thinking, at the very least he is going to book me in with the gynae again, which is what I wanted. This is where all the things Vanessa said to me made ALL the sense. My gynae had written to my GP explaining things so far; based on my hormone levels (the 3 I mentioned before), my GP said to me in these exact words, “we cannot guarantee that you are ovulating every cycle based on your hormone levels. There is a certain threshold which we can be sure that you are ovulating but with yours we cannot be sure and if you are not ovulating every cycle this could explain the irregularity of your cycle.” So obviously I then asked him, so can I get a period without an ovulation and he point blank said “YES. It is called anovulation.” Before I explain what that is, am I the only person completely mind blown by this? Not so much the fact but the MISINFORMATION we hold onto as truth. I mean being exposed to the #tryingtoconceive community now, I had seen some people talk about period without ovulation but I thought it was a very specific condition that causes that and I paid no mind to it, but it happens to all of us at some point in our lives. When it occurs as a one-off it is not an issue but if it is chronic, it can obviously affect fertility.
So anoluvation or an anovulatory cycle is a menstrual cycle with no ovulation. This means an egg cell wasn’t released by the ovaries which normally happens at the end of the first stage in the menstrual cycle, known as the follicular phase. Ovulation is necessary for conception, as pregnancy happens when sperm fertilizes an egg cell – so you can’t get pregnant when no egg cell is released. Anovulatory cycles are pretty common and most women will experience them throughout their fertile lifetimes. – NaturalCycles Nordic AB ©. In a normal menstrual cycle, estradiol (the main estrogen hormone) increases steadily during the first half of the cycle. Estradiol helps to build up the uterine lining. Increasing estrogen levels help to trigger ovulation, which is the release of an egg from a follicle in the ovaries. After ovulation, the spent follicle transforms into something called a corpus luteum, which secretes the hormone progesterone. Progesterone levels are high during the second half of the cycle. This is important because one of the primary purposes of progesterone is to provide structure for the uterine lining built up earlier in the cycle. If the egg is not fertilized, then the corpus luteum shrinks and stops secreting progesterone. Without progesterone maintaining the uterine lining, it can no longer be maintained within the uterus, so it sheds in the process you will recognize as your period. If you did not ovulate, no corpus luteum is formed, and no progesterone is secreted. So, while the first half of your cycle was spent building up the uterine lining, there isn’t a hormone signal for maintaining it without ovulation. The uterine lining still has to be shed, and you can still experience bleeding that looks similar to your period. – © Ava Science Inc.
I don’t really know how to explain how it made me feel being told that the very thing I needed my body to be doing and that I assumed my body was doing, is probably not happening! I had/have so many conflicted feelings about it. The first thing that came to my head was “ok it’s me, not him (hubby), that’s good”, my husband is OKAY with everything and even the eventuality of him having a/the contributing factor, he is at peace with any scenario and does not need my cushioning but in MY mind, I feel that it would be better if our cause of infertility was with me. Maybe because there would be more treatment options on my end but also because I think I would start over worrying about him internalising our infertility, which by the way he hasn’t given me any reason to think that. But I care about him and I don’t want him to overthink any of this, I am happy to do that for the both of us. Crazy right – he is probably thinking the same about me! (We haven’t got his results yet). The second thing that came to my mind was, TWO AND A HALF YEARS and no ovulation! OK yes, that is a bit dramatic, because I’m sure I have ovulated, albeit sporadically, in that time but it just felt and sometimes still feels like time WASTED. Again, I started thinking about why I didn’t seek any help sooner. This is greatest takeway to anyone else out there dealing with infertility; as soon as you reach that one year mark of trying naturally, seek medical help. It might be a simple process or it might not be but I do think it would be better and that I would feel better if I was hearing this after only a year of trying. Another thing I felt was, how did my body not communicate this with me? How is this something one would only find out like this? My periods have always been irregular, does that mean all this time I wasn’t ovulating, where were the signs, I felt a bit let down by my body and even worse felt like I wasn’t in tune enough with my body. Because a few times people have said to me, “oh can’t you tell when you’re ovulating?” and the truth is I CANNOT. There are no symptoms that have been consistent enough for me to say yes that’s ovulation and if I am not ovulating that would make sense. I can tell when I’m about to go on my period, literally the day before or the day of but I cannot tell when I am ovulating. For people who might be confused, this is not the same thing i.e. does not happen at the same time. Your period usually comes 10-16 days after ovulation. Now that I think about it, we do need to be more sensitive with our words, I am happy for you if your body is like clockwork and communicates with you but that isn’t everyone’s experience and when I am already battling with the lack of synergy between myself and my body, it does not help when you are made to feel that ‘as a woman’ you should just know these things.
The flipside to all these feelings I felt was the sense of empowerment, from the KNOWING. I talk a lot about knowing and knowledge when it comes to fertility (and in general) and the information given to me by the GP motivated me. I remember coming out of the surgery and calling my mum and giving her this drill-down of everything I had learnt in the 20mins I spent with my GP. My GP explained that “if this is the only issue, we can give you medication that will induce ovulation, it a very simple solution.” So although the news was quite a blow if you really think about, in another light if that is the only issue that would be the best outcome from all this because potentially, as my GP asserted, all I would need is for an egg to be released and the hormones at the right levels. Obviously, in reality, it is not that basic and I am fully aware of that but coming from 2.5 years of trying unsuccessfully to a potential treatment option of taking some medication to make my body do what it needs to, it would be a huge step in the right direction. However, because of all my symptoms, even though my hormone levels do not necessarily reflect this, both the GP and my gynae suspect that I might have polycystic ovarian syndrome (PCOS).
The 3 main features of PCOS are:
- irregular periods – which means your ovaries do not regularly release eggs (ovulation)
- excess androgen – high levels of “male hormones” in your body, which may cause physical signs such as excess facial or body hair
- polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs (but despite the name, you do not actually have cysts if you have PCOS)
If you have at least 2 of these features, you may be diagnosed with PCOS. – NHS.
I hadn’t even considered the possibility that I might have PCOS and my GP even commented on the MISINFORMATION out there that makes people think that only excessively hairly women, or women with high testosterone levels, or women with acne have PCOS. Again, this is not true as some women have ‘milder’ forms of PCOS and as clearly stipulated in the features above, you only need to have 2 to be diagnosed with it. Already I have one of these features so I will be having a transvaginal scan to rule PCOS out. A transvaginal ultrasound is an internal examination which involves the insertion of the transducer into the vagina to produce incredibly detailed images of the organs in the pelvic region. Only after this will I know for sure whether I have PCOS or not. Fortunately the trying to conceive tool that I am using at the moment called Ovusense is suitable for women with PCOS if it turns out that I do have it. In fact it might be Ovusense’s biggest selling point because other trying-to-conceive tools are not always suitable for women with PCOS. (Next week I will do a detailed post on the trying to conceive tools I have tried and the ones I haven’t tried).
So this is where we are so far. I will be having more bloods done and this is by no means the full picture but it is reassuring to know that things are moving towards fertility/assistance. And interestingly we have relaxed a bit more in terms of timing the fertile window and scheduling the ‘trying’ (those who know, know!). For me, I’m not going to lie, it is partly because I kind of think, well I might not be ovulating anyway but also and perhaps more importantly, because I believe that the more we know and discover through science, the better help we can get and this is just the beginning. I still chart my temperature with Ovusense everyday because the picture from those stats is equally important in this process (and for my own my knowing/learning of my body). And look, I am fully aware that it is not all rosy from here (any altering of the natural functioning of the human body isn’t) but the thought of having a better chance at pregnancy fills me with renewed hope.