Let’s talk about invasive tests for women

Photo by National Cancer Institute on Unsplash

It is a universally acknowledged truth that any woman going for fertility treatments need to get used to having a lot of people poking around their business. But what should you really expect when you go to your doctor ready to start the IUI or IVF process?

I found that I was given a lot of flowery or vague explanation about what the next steps would be when I really just wanted to get a better sense of what was actually going to happen. Not having that, I found I was surprised by some tests and horrified by others when everything would have been so much easier had I known what was coming ahead of time. 

So good news! My misfortune doesn’t have to be yours. Avoid my missteps and let’s talk about the tests you’re going to run into and how to prepare for them.  

 The pap smear 

Ok, this one isn’t really fertility related but it’s the best place to start because it will give you a frame of reference for the others. A Pap smear or Pap test is the most common way to find abnormal cells in your cervix that could lead to cervical cancer. In Ontario, its recommended women get a Pap smear every 3 years and your family doctor or gynecologist should be able to give you one. I actually had mine done at the fertility clinic when my 3 years came due since we were in Covid times. So if you need one, don’t be afraid to ask any of your doctors. They all know the drill. 

The process for a Pap smear is pretty straight forward. You’ll be asked to undress from the waist down and cover yourself with a sheet. Then it’s up into the stirrups while you stare at the ceiling and think of what to watch on Netflix. An instrument called a speculum will be inserted into your vagina so that the doctor or nurse can see the cervix. A swab is then passed through the speculum to take a sample of cells from the cervix. That’s sent off to a lab and results can take anywhere from 1 to 3 weeks. The whole process takes about 10 minutes tops.  

Tip: If the speculum hurts when it’s inserted or falls out of you, you can ask for a smaller size. It’s not the one size fits all situation. Typically, they’ll have both regular and small on hand if you want to request a change.  

Pain level: Puh-lease, you’ve got this girl. 1/5  

The trans-abdominal ultrasound 

Better get used to ultrasounds now, you’re going to have a lot of them. The easiest by far is the abdominal ultrasound. Your doctor might ask you to do it with an empty or full bladder, which would mean you’d need to drink a litre of water before your appointment (or 4 cups).  You’ll be asked to lie on the exam table and adjust your clothes so your whole stomach and abdomen are exposed. Next is a little cold gel on the belly and then all you have to do is relax while the sonographer slides the transducer (ultrasound wand) over you. The abdominal ultrasound is looking for cysts and the general condition of your ovaries and uterus to make sure there’s nothing wrong that could impact fertility. Ultrasounds are usually 5 to 10 minutes. 

Tip: If you’re doing a full bladder ultrasound, DON’T drink more than the recommended amount or you will be in some discomfort when they press down on your abdomen.

Pain level: What’s less than zero? 0/5   

The trans-vaginal ultrasound 

Alright, now we’re upping our game. During your cycle, you’ll also need higher resolution images than you can get from a trans-abdominal ultrasound alone. So you know what that means. Inside it goes.

Like with a Pap smear, you’ll be asked to undress from the waist down and cover yourself with a sheet. Lying back on the edge of the exam table with your feet in the stirrups, take a few deep breaths. The sonographer will use a small, thin transducer designed to fit inside you. Think medical sex toy. A lubricated sheath much like a long condom will encase it to keep things hygienic and it will be inserted a few inches into your vagina. The sonographer will turn it slightly in different directions to capture different angles of your ovaries, endometrial lining, and uterus. It feels a little uncomfortable but as you’ll be doing this pretty often, you get used to it. The process takes about 5 to 10 minutes. 

Pain level: There’s a lot of things I’d rather be doing, let’s just say that. 2/5    

The sonohysterogram  

I’ll see you in hell, sonohysterogram. Now to be fair, my experience with the sono might have been skewed. I had to do mine twice across two different fertility clinics and one was by far worse than the other.  

Sonohysterograms are a special kind of ultrasound that lets you see inside the uterus to make sure nothing is wrong with the structure. Again, you’ll be on your back with your feet in the stirrups and your doctor will insert a speculum much like with a Pap smear. Then they’ll insert a catheter into your cervix to inject saline into your uterus. Once the liquid is in, they’ll use a trans-vaginal ultrasound wand to examine the flow of the fluid from the uterus into the Fallopian tubes. They may also use the Doppler setting of the ultrasound to look at blood flow and identify blockages. The goal of this test is to make sure your tubes are open and the structure of your uterus is healthy. 

Now here’s where my experience gets varied. When I was at the west end clinic, I experienced my first sono. All was well and good until they injected the saline and things got real painful real fast. At one point my vision was getting spotty and I told the doctor she had two minutes before I was going to pass out so she needed to hurry. She unhelpfully told me she couldn’t work any faster. A nurse came over to put a cool cloth on my head and did her best to keep me conscious while the doctor worked. I’d never had such a painful experience before and bleed for about two days afterwards, which I later learned is not normal.  

When I changed clinics later to a very popular downtown clinic, my new doctor insisted on another sono because the results from the first one had been inconclusive. At first, I refused because of how awful the original one was but she insisted. She eventually convinced me with the promise of meds beforehand to make things easier. I don’t know if it was the meds or if my second clinic was simply light years better than my first for this procedure, but the second time I did it, it hurt far less and it took half the time. My tests were clear and I was good to move forward.  

Moral of the story? When in doubt, talk to your doctor about pain and ask for medication if you need it. Trust me, no one needs to be a hero when medical instruments are being pushed into places they don’t normally go.

The first time - Pain level: Mother have mercy. 5/5 

The second time - Pain level: Glad I don’t need a third try but definitely doable. 2.5/5