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The Infertility Guidebook: Diagnosis

The Infertility Guidebook | One Hangry Mama

Your Infertility Diagnosis

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Your first step in the infertility treatment process will likely be a diagnosis. It usually goes something like this:

You’ve been trying to get pregnant for a while. Probably 6 months or so, since that’s what most OB/GYNs recommend before seeking help.

You’re probably starting to think hm, this TTC thing is taking longer than I thought it would… (or more realistically, WTF, why am I still not pregnant, I hate everyone and everything.)

Hopefully you’ve been tracking your cycles using an app, or a planner, or just a sheet of paper, for a few months. I recommend the Fertility Friend app – you just mark when your period starts, and if you’re using any ovulation predictor kits or temping, you can enter that info in as well, and it helps you predict when your “fertile days” of the month are.

Regardless, if you’ve been trying to conceive consistently for 6 months, it’s time to go see your OB/GYN.

If you've been trying to get pregnant for at least six months, it might be time to talk to your OB/GYN about infertility treatments.

Infertility Consult with your OB/GYN

If you’re lucky, you can tack this onto your annual well woman visit so insurance covers it, and save yourself some money. And when it comes to infertility, trust me – you’re going to want to save money.

When do you meet with your OB/GYN to talk about your issues getting pregnant, you’ll likely cover a few different things:

Detail your TTC methods: This will feel intrusive, but get over it. She’ll ask how often you’re having intercourse, and on which days of your cycle?

(This is where an app is really helpful. I just handed mine to the doctor and let her look through it to see what we’d been doing and when.)

Detail your cycles: How long are they? Are they regular? Heavy? Painful?

Run some blood work: If you’re afraid of needles, now would be a great time to buck up and throw that fear out the window.

Your OB/GYN will probably take some blood to look at your hormone levels:

  • CBC (Complete Blood Count)
  • Thyroid (TSH, T4)
  • FSH (Follicle Stimulating Hormone – the hormone that controls ovulation)
  • Testosterone

These tests can tell your doctor a WEALTH of knowledge about your fertility. Any one hormone in particular being high or low can indicate an issue or point them in the direction of a particular infertility treatment.

Perform a vaginal ultrasound: This sounds scary, but it’s not. You’ll get very, very well-acquainted with this machine the further you get into the process. 

This will usually have to be scheduled for a separate appointment with a sonogram tech. They’ll look at your ovaries, sometimes on a specific day of your cycle, to see if there are follicles growing.

They’ll also poke around at your uterus to see if your lining is thickening to accept a fertilized egg, and to generally make sure everything looks how it’s supposed to look.

Interpreting Your Infertility Diagnosis

From here, you’ll hopefully get some answers and next steps fairly quickly.

As for my infertility journey, my doctor found that my testosterone was very high (double the normal range), which can indicate PCOS.

So she started me on Metformin, which helps even out insulin levels, and in turn can regulate the rest of your hormones. For many PCOSers, this is all your body needs to get it together.

Ovulation Frustration

For a lot of women – PCOS or not – the problem surrounds ovulation.

Either you’re not growing the eggs big enough, or you’re growing the eggs, but not releasing them, or the timing is just out of whack. By the time your eggs release, your lining is already breaking down and isn’t right for implantation.

For that reason, Clomid is typically the first line of defense when you’re having trouble getting pregnant. (And lucky you, I’ve got a whole post dedicated to the Clomid treatment process!)

BUT, before most doctors will give you any medication, they’ll want to rule out male factor infertility.

That means you’ve gotta get your man to a clinic of his own to, uh… provide a sample.

He’s probably going to whine and groan about it, but remind him that A) you’re a team and he’s gotta to his part, and B) at the end of this you’re going to be growing his child inside your body until it explodes out of you, so he can shove it.

It usually takes about 3-5 days to get the results of the semen analysis, so typically this whole diagnostic process takes up the whole month. Which means you end up losing a cycle for TTC.

(Which blows.)

But keep on trying to get pregnant the old fashioned way while you work through all of this, knowing that help is on the way!

The Infertility Guidebook

  1. Diagnosis
  2. Clomid
  3. RE Consult
  4. Femara + Injectables
  5. IUI
  6. IVF
  7. FET
  8. …and Beyond

*This should go without saying, but this is the internet and therefore it doesn’t: I am not a doctor and you need to consult your doctor about any kind of medical treatment.

The Infertility Guidebook | One Hangry Mama


Sunday 20th of December 2020

Thanks for this guidebook. I've been through most of the early stages, just now going through femara and injectables. PCOS here with high AmH, high testosterone...I could be a male. I've tried spironolactone and BC pills (early days of PCOS) and body can't take any...the side effects are always overpowering. I've been on progesterone for inducing bleeding regularly. But this whole injections strategy is still new. I'm curious as to how you sustained all these while working? I work and also in grad's been hell and I'm getting to be over 30 soon. I don't mind a support group.


Friday 8th of January 2021

It wasn't easy to maintain all the shots while working, and I sometimes had to travel for work, which made it all the more difficult. Most of the daily injections are morning and evening, so I would just time them for before and after work. My clinic also always gave me a calendar with my exact med dates and timing printed on it, so I lived by that – I'd physically check off each dose on the calendar as I did them so I could keep up with it all and not forget something. Good luck to you!

Laura Holmgren

Tuesday 27th of February 2018

Hi There- This guidebook is saving my life right now. So. Many. Questions. Well- less since I have found you. I was wondering-- how long you were on Metformin? Thank you for writing this!


Tuesday 27th of February 2018

So glad you’re finding it helpful! I remember alllll the questions at the beginning of each stage — that’s the whole reason I made it! I was on metformin for about a year and a half total. I started it with my OB when I was first diagnosed with PCOS, then my RE upped my dose when I started with her, and I continued on it for a year of treatments, and then the first three months of my pregnancy.