The Infertility Guidebook: Diagnosis

The Infertility Guidebook | One Hangry Mama

The Infertility Guidebook

Stage 1: Diagnosis

Cost: $0-50
Meds: N/A

So, you’ve been trying to get pregnant for a while. Probably 6 months or so, since that’s what most OB/GYNs recommend as the “normal” time it can take to get pregnant. You’re probably starting to think hm, this 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, it’s time to go see 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 – I’m all about saving money throughout this process.

Your OB/GYN will likely do the following:
  • Ask about your cycles: How long are they? Are they regular? Heavy? Painful?
  • Ask how you’ve been trying: This will feel intrusive, but get over it. How often are you having intercourse? Which days of the month? 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.
  • 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. They will 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
  • 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 look at your ovaries, sometimes on a specific day of your cycle, to see if there are follicles growing, and 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.

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

For me, my doctor found that my testosterone was very high (double the normal range), which can indicate PCOS. So she started me on Metformin, typically a diabetes medication, which also helps even out insulin levels, which in turn can regulate the rest of your hormones. For many PCOSers, this is all your body needs to get its shit together.

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 has started to break 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. Check out Stage 2: Clomid, for more info on that!

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 piss and moan about it, but remind him that 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, and you end up losing a cycle. Which blows. So keep trying 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


  1. 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!

    • 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.

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