4. Bloodwork

So here I was, things were moving in the right direction. All I had to do was contact a clinic and get things going, right?

Well, let me start at the beginning:

I had really my mind set that I was going to use a clinic abroad.  My research had informed this choice in terms of how advanced and specialist some other countries were in fertility treatment.  Also, to be perfectly honest, the cost was far more reasonable.  Due to the expertise and economics (even with travel) treatment abroad seemed the better decision all round.

I did really get into researching clinics in various countries.  I read reviews, made lists, made more lists – research, research, research. I knew everything about them. My shortlist brought me to a shortlist of two countries; Spain and Czech Republic.  I finally reached out to some clinics in Spain and set up an initial consultation at one.  (conducted remotely via Skype – remember that!?? - in a pre-covid era, long before Zoom, feels like a lifetime ago)

I’m going to do a whole post about this clinic later as I have so, so many things to say about it, and pretty much all of it is wonderful.

I researched so many clinics – I should have written a top-ten at the time; I could have written a “Fertility Abroad” guide book/travel directory!

The clinic asked for some updated blood tests and they also wanted an updated thyroid profile as I had previously been diagnosed with a hypothyroid condition.  The way these blood tests worked was that the clinic told me what bloods were required for the consultation and I made arrangements to have these taken locally.  The local clinic then sent the results to me with the option that they could send them directly to the clinic abroad or I could pass them on myself.

Below are the bloods I had taken and my basic understanding of what they relate to. I’ve also put in the hormone profile graph again as I find it a really good way of making sense of all the hormones working together –

·         Estrogen Hormones - Estradiol (oestradiol/E2) – is one of three main estrogens in the body (the other two are estriol and estrone) but Estradiol is the strongest, it matures and maintains the reproductive system.  It is a hormone produced in the ovaries and during the menstrual cycle, levels rise causing eggs to mature (and subsequently be released) and the uterine lining to simultaneously thicken. (There is a 4th Estrogen hormone which is produced during pregnancy too)

·         Progesterone – Progesterone is a hormone that supports menstruation and pregnancy.    It gets the endometrium (the inner lining of your uterus which sheds during menstruation) ready for potential pregnancy after ovulation occurs.  Progesterone is at low levels during the follicular phase of a menstrual cycle but rises after ovulation, peaking around day 21 in a 28 day cycle.  If a woman does not become pregnant, progesterone levels start to fall again and this then causes menstruation to occur.  If conception occurs, progesterone remains elevated and prepares the lining of the uterus to receive the fertilized egg.  Progesterone is important in supporting implantation and the early embryo.  It also helps to maintain the uterine lining throughout pregnancy.  Progesterone levels continue to rise during pregnancy and prevent your body from ovulating while pregnant.  

·         Follicle Stimulating Hormone (FSH) – this is another hormone which plays an important role in fertility and is responsible for the growth of follicles in the ovary.  It works along with the Luteinizing Hormone (see below).  It is produced by the pituitary gland and FSH blood tests are usually carried out on specific days of your cycle.  FSH is at its peak just before ovulation.    

·         Luteinizing Hormone (LH) – again this hormone is produced by the pituitary gland and plays an important role in ovarian function.   In the early part of the cycle, LH stimulates follicles in the ovary to produce Estradiol. Mid-cycle, the LH ‘surge’ occurs and this causes ovulation, i.e. the release of a mature egg from the ovary. This LH surge can be measured in ovulation tests to allow those seeking to conceive to identify their ‘fertile window’.  Ovulation usually occurs somewhere between 12-36 hours from the LH surge. (this is approximate and it can of course fall either side of that window).  In the second half of the cycle, LH stimulates the production of progesterone, to support the early stages of pregnancy, if fertilisation occurs.

·         Anti-Mullerian Hormone (AMH) – This is a test that can be carried out at any day of your cycle and is a marker for ovarian quality and ovarian reserve. Experts seem to be careful saying what is ‘normal range’ for this because the tests are not all the same and I think there can be discrepancies in readings.  A reasonable range is between 1 ng/mL – 3ng mL.  For context, my first AMH result was 0.7 in my 30’s and it only went downhill from there! That was pretty poor.  However, this test is not an indication of whether you can get pregnant, but rather was a snap-shot of ovarian reserve.  Spontaneous pregnancy is possible even for those with low AMH scores. 

·         Thyroid Profile – This related to my secondary hypothyroidism.  It was to ensure my thyroid levels had returned to normal.  The main thyroid tests being carried out were FT4 and TSH, however my clinic sought a more complete profile to get a clearer picture, given my history. From reading up on this, it does appear that some women who suffer recurrent miscarriage tend to have their thyroid levels reviewed as higher TSH can be linked to miscarriage.

·         Prolactin – Another pituitary gland hormone linked to breast milk production. Those with elevated prolactin levels may not ovulate or may not ovulate regularly.  Elevated Prolactin levels can also adversely affect Progesterone levels which in turn can affect the uterine lining, resulting in failed implantation.  If you have elevated Prolactin, there are adjustments that can be made which may lower the levels such as reducing refined sugar, reducing stress, reducing alcohol and eating fresh fruit and vegetables. Foods which apparently are thought to help naturally lower Prolactin include foods rich in vitamin B6 and zinc and you should avoid foods recommended to breastfeeding mothers which assist in lactation (such as fennel and fenugreek). In some cases, medication can be given to lower Prolactin levels.  Elevated Prolactin can be linked to conditions such as hypothyroidism and anorexia. 

·         Vitamin D – Some studies have shown that there may be a link between vitamin D deficiency and fertility issues.  From what I read online, the studies are not conclusive but there seems to be a general view that whilst vitamin D alone would not resolve ‘infertility’, but rather that adequate levels may have beneficial effects on fertility.

·         Blood Group

·         HIV/Hepatitis B/Hepatitis C/Smear Test/RPR (screening test for syphilis) – these are just the normal sexual health checks undertaken before any clinic treats you.

The costs of these varied depending on where I had them taken and I was able to request a “hormone profile” which was available as a bundle in one of the clinics which lowered the price. 

By far the most expensive test was the AMH test which came in at about £150 for just this one.  I was able to get a female hormone profile for about £145 which included LH, FSH, Prolactin and Oestradiol. The thyroid profile (Thyroid autoantibodies, Thyroid peroxidase, thyroxine, TSH, FT3 & FT4) came in about £135 and Vitamin D at £75.

These were the tests I needed because of my personal circumstances; they may not be the tests everyone needs. The doctors direct what tests are needed based the history and circumstances of each individual.

Weeks later I reported back to the clinic.  I had sent the results to my liaison contact by email and she set up a further remote consultation with the Consultant.  To my absolute surprise, he didn’t say that egg donation or embryo donation was my only option.  He thought IVF with donor sperm should not be ruled out.  He didn’t make any promises, and he certainly acknowledged that the results were far from ideal, but he said that I wasn’t out of the game yet. 

Great, right? Emmm, not really - I was very skeptical, but the Dr C really talked me through it.  He had dealt with thousands of women just like me.  He readily agreed that embryo or egg donation would also have to be a very real consideration if I didn’t want to try IVF or if it didn’t work.  His tone and manner eased my nerves, he had read my history, knew my bloods and was very frank, realistic and honest about my options.  He talked me through each option in detail and what that would involve in terms of drug, scans, travel to the clinic, and/or the necessity to have scans/blood tests conducted in my home country and sent to him.  

Once we had talked through the options and a number of proposed treatment plans, the liaison contact would send me a full itinerary and pricing plan for three options.  I received these within 48 hours. So now the ball was well and truly in my court, all I had to do was book my treatment and go…

Summary: Bloodwork really paints a picture.  Clinics will need it and it does help for you to also know what your body may be deficient in such as Prolactin or Vitamin D.