Mirena and Fertility Awareness
January 30, 2012 8:51 AM   Subscribe

This may be naive: is there any way to have my fertility tested while I have a Mirena inserted?

I am 32 years old, and my partner and I would definitely like to have children in the future. However, it will be about a year or two before I'm really ready if I pursue some not-very-child-friendly career opportunities, such as overseas development work. Lately though, I've been experiencing a pretty intense desire to become a mother, as well as vivid dreams about babies and children, all of which have upended my previously laissez faire approach to timing and priorities. I talked about this with my partner, and while we haven't yet changed our plans to work overseas for a while before settling down somewhere, we figured that it would be best if we were informed with some more specific-to-us odds before we make any big decisions one way or another. We have about 5 or 6 months before it's life-style decision time.

I've done a fair amount of research, but I might be doing it wrong because I can't find anything that tells me definitively whether my fertility can be accurately gauged while using hormonal BC, specifically a Mirena. For instance, can I use an ovulation kit or should I just wait until I speak with a doctor? Do I need to have my Mirena removed for more accuracy? I do plan to see one, but I want to be armed with some knowledge and maybe the right questions to ask and tests to request beforehand. I've never actually talked about fertility issues with a doctor, and I'm feeling a little at sea and overwhelmed by all the info out there.

Possibly relevant: I have had one pregnancy which I terminated, so I know that it's possible for me to become pregnant, but that was over a decade ago.

Thanks for any advice.
posted by swingbraid to Health & Fitness (11 answers total)
IANAD, but I don't think so. Typical fertility investigations involve checking your hormone levels and tracking your cycles -- none of this is useful to do while one is using hormonal BC.

Taking Charge of Your Fertility
gets recommended here a lot. It has HEAPS of information about how your body works...things I had somehow gotten to be 30 without knowing about.
posted by pantarei70 at 9:04 AM on January 30, 2012

Do you have any reason to believe you wouldn't be fertile? Doctors generally don't do ferility testing until after couples have had problems trying to conceive. On my pregnancy board, couples generally try 6-12 months before seeing fertility specialists. Also, testing just you doesn't give the whole picture - you could be perfectly fine and your partner could have zero sperm output.
posted by ThePinkSuperhero at 9:14 AM on January 30, 2012 [3 favorites]

Keep in mind that it may take a few months for your fertility to return to normal after removing the Mirena. I know this doesn't answer your question at all, but something to take into account with timing and general fertility issues.
posted by radioaction at 9:36 AM on January 30, 2012 [1 favorite]

Let me echo ThePinkSuperhero and suggest that your partner get tested. Male factor infertility is a big issue, and is many ways more straightforward to test for than female factor infertility. Much of fertility testing is sort of empirical. It isn't that they won't test you, but without the empirical knowledge that you have been trying but have not gotten pregnant, and with the evidence that you have previously gotten pregnant, the tests may well be pretty equivocal.
posted by OmieWise at 9:46 AM on January 30, 2012

I've read that you are supposed to stop taking the pill 3 months before fertility testing.

Re ThePinkSuperhero's question, "do you have any reason to believe you wouldn't be fertile?" I assume the OP's concern is the quality of her ovarian reserve. This isn't a crazy thing to worry about, if she's aiming to start trying to conceive ~35. It would give peace of mind to know that, as of now, it's ok. And it would change her planning to know that she is one of the unlucky ones whose egg numbers and quality start plummeting early.

*Other* fertility testing -- do his boys swim? Are her tubes clear? etc. are not really very age-related, and are more easily treatable. *Those* things, I agree, aren't very relevant right now, but I don't think that's what the OP is asking about.
posted by kestrel251 at 9:50 AM on January 30, 2012

P.S. I know that Mirena isn't the pill, but I assume the recommendation would be the same.
posted by kestrel251 at 9:51 AM on January 30, 2012

I've spent the last 6 months learning about my fertility, and my partner's, and based on my experience, I'd suggest you might misunderstand what's involved... Or what you'll learn.

Cycle monitoring means testing your blood hormone levels a half-dozen times, with concurrent ultrasounds, to see whether your body creating the right stuff at the right times. There are also a few tests on hubby. At the end of which, the doc will be able to give you some odds, (women in your situation conceive 60% of the time) and describe your current plumbing ... But nothing really concrete unless it's bad news.

This is definitely a situation in which there are no guarantees... Despite what you learned in health class, a whole lot of timing has to be right to actually conceive.
posted by Heart_on_Sleeve at 9:58 AM on January 30, 2012

Re tracking ovulation: you may or may not even be ovulating at all on Mirena. See here: http://www.mirena-us.com/what-it-does/how-mirena-works.jsp
posted by Betty's Table at 10:11 AM on January 30, 2012

I don't believe that there is any simple way to "test fertility"; it's not just a question of whether you are ovulating or not. There are lots of tests they can do, but doctors won't do them unless you've already had a problem conceiving.

If you wanted to go really high-tech and cover all your bases, you could freeze some eggs.
posted by yarly at 10:11 AM on January 30, 2012

There's really no way to "accurately gauge" your fertility even when you are not using hormonal birth control (apart from actually conceiving, that is). While there are a number of fertility-limiting conditions that a doctor would be able to identify, the absence of these conditions does not indicate that you are definitely fertile.

Yarly is right; you could freeze some eggs. The procedures involved are quite invasive, however. (Hormone injections, minor surgery to retrive the eggs).
posted by mr_roboto at 12:17 PM on January 30, 2012

Thanks, kestrel251! That's actually exactly what I'm concerned about (but I forgot the term 'ovarian reserve'). I'm going to talk about it with my doctor and figure out my next steps.

For those of you wondering why I'm asking about this before trying to conceive, my question stems from advice given here on askmefi about getting workups to expose possible problems beforehand, especially for women who aren't immediately ready to start trying (like myself). None of the answers in those examples or elsewhere really address the HBC factor, so I thought I'd give it a shot.
posted by swingbraid at 2:38 PM on January 30, 2012

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