You’ve got questions; we’ve got answers. We’ve compiled a list of frequently asked questions in each category.
If your question isn’t listed, please don’t hesitate to reach out. We are happy to assist in helping you understand each and every part of your fertility journey.
DOES CYCLE LENGTH MATTER?
The length of your menstrual cycle is determined by the number of days from the first day of bleeding to the start of the next period. The length of your cycle—while not on any form of birth control—can be a key indicator of hormonal imbalances and whether ovulation is occurring in a regular manner. If ovulation does not occur, pregnancy is not possible.
Normal menstrual cycle
A normal menstrual cycle lasts from 21 to 35 days. If you have a normal menstrual cycle, regular ovulation should be occurring, and all hormones should be in balance, making natural conception possible.
Short menstrual cycle
A short menstrual cycle is anything shorter than 21 days. Shortened cycles can be an indication that the ovaries contain fewer eggs and that menopause may be approaching. As the number of eggs in the ovaries decrease, the brain releases more follicle-stimulating hormone (FSH) to stimulate the ovaries to develop a follicle. This results in earlier development of the follicle and earlier ovulation, creating shortened cycles. This can make conception more difficult.
Long or irregular menstrual cycle
A long menstrual cycle lasts more than 35 days. Longer cycles are an indicator that ovulation is not occurring or at least not occurring in a regular manner. This lack of ovulation is known as anovulation. There are many potential causes of anovulation, such as:
Irregularities with the thyroid gland
Elevations of the hormone prolactin that can disrupt the brain’s ability to communicate with the ovary
Polycystic ovary syndrome (PCOS)
These hormonal imbalances lead to problems with ovulation and fertility, but they may also increase the risk of miscarriage.
WHAT DOES IT MEAN IF MENSTRUAL BLEEDING LASTS MORE THAN 7 DAYS?
The normal length of bleeding for women is 2 to 7 days. Anything longer than 7 days is known as prolonged bleeding. Prolonged bleeding tells your physician that either ovulation is not occurring regularly or that there may be something disrupting the lining of the uterus. There also could be a problem forming blood clots. Prolonged bleeding can occur if the ovulation is not occurring regularly.
Additionally, prolonged bleeding can be caused by polyps, fibroids, or infection within the uterus or cervix. In these situations, if an embryo should enter the uterus, implantation can be compromised, resulting in lower pregnancy rates or an increased chance of miscarriage. Although rare, a problem with blood clotting can also cause prolonged bleeding, which would necessitate an evaluation from a specialist.
WHAT IF I NEVER MENSTRUATE?
If you never menstruate, ovulation is not occurring, and conception would be difficult without intervention. This can be common in women who are considered underweight by body mass index (BMI) standards. The body requires a certain level of body fat for menstrual cycles and reproduction to occur. Weight is not the only cause to consider, though. If a woman has never had menstrual bleeding, there may have been a problem with the normal development of the uterus or the vagina. If a woman had menstrual cycles previously, but then stopped, this could be due to a problem with the uterus itself, due to scar tissue inside the uterine cavity or premature menopause. If the uterus has not formed or if menopause has occurred, pregnancy is not possible.
CAN I STILL CONCEIVE IF MY MENSTRUAL CYCLE IS NOT NORMAL?
Yes, even if your menstrual cycle is abnormal, you may still conceive on your own. However, it may be a little more challenging, especially if you’re trying to determine your most fertile window based on your menstrual cycle. It’s important to realize that there are many situations in which ovulation does not occur, and thus, conception cannot occur naturally. There are also instances in which scar tissue in the uterine cavity or premature menopause can be factors limiting conception. Despite these factors though, there are a range of fertility treatment options that can help you conceive.
WHEN SHOULD I SEEK HELP?
If you suspect you are not ovulating and/or you’re experiencing abnormal periods, you should seek help from a fertility specialist when you are ready to conceive. Often, a regimen that involves clomiphene citrate (Clomid, Serophene) can help your body re-establish normal ovulation.
Even if you do have a normal menstrual cycle, though, you should seek help from a specialist if you have not conceived in the following timeframes:
If you are under the age of 35 and have been trying to conceive for more than 1 year
If you are 35 to 40 and have been trying to conceive for 6 months
If you are over 40 and have been trying to conceive for 3 months or less
Does taking birth control affect fertility?
In general, birth control pills do not affect fertility. Within 1 to 2 months of stopping pills, a woman’s menstrual cycle returns to what’s considered normal for her.
Birth control pills will “cover over ” a woman’s natural and possibly irregular cycle giving her a predictable monthly cycle. When she stops pills, her cycle returns to her normal and possibly irregular cycle and hence the pill gets the blame.
What should I expect if I’m coming off birth control and trying to conceive?
Within one to two cycles, all women who have a naturally strong ovulatory and regular cycle should be ovulating. You can use an ovulation predictor kit to help time intercourse with ovulation.
What are the chances of conception each month?
The rate of conception is highly dependent on the quality and quantity of the woman’s egg. According to the American Society for Reproductive Medicine, a woman’s best reproductive years are in her 20s. Fertility gradually declines in the 30s, particularly after age 35. Each month that she tries, a healthy, fertile 30-year-old woman has a 20 percent chance of getting pregnant. That means that for every 100 fertile 30-year-old women trying to get pregnant in one cycle, 20 will be successful and the other 80 will have to try again. By age 40, a woman’s chance is less than 5 percent per cycle, so fewer than five out of every 100 women are expected to be successful each month.
Why does egg quality decrease with age?
The concept of a woman’s egg quality has everything to do with the probability that an embryo will implant and is strongly related to the age of the woman’s egg and her ovarian reserve. We cannot determine egg quality by looking at an egg or measuring how receptive it will be to sperm, or even how well the embryo cells appear to be initially dividing.
We can test egg supply with ovarian reserve testing, but we do not currently have a test for egg quality; instead, the most reliable test for egg quality is female age.
Much of the problem with egg quality as women age has to do with an increased likelihood for chromosomal abnormalities to affect the eggs. Chromosomal abnormalities may affect the number of chromosomes, as in the case of Down syndrome or Turner syndrome, or the structure of chromosomes, which may show as chromosome translocation, duplication, or deletion. The bottom line, egg quality decreases and the rate of chromosomal abnormality increases as a woman ages.
While we weren’t using birth control for a few years, we’ve only been actively “trying” for 6 months with no success. Should we be concerned?
Often when couples aren’t on birth control they will avoid pregnancy by having the male partner withdraw prior to ejaculation. Withdrawing the penis before ejaculation is not an effective method of contraception. Something else is going on that you have not yet become pregnant.
Is there a best time to have intercourse?
The best time to have intercourse that will result in conception is during a woman’s luteinizing hormone (LH) surge. In an ideal 28 day cycle, this typically happens around day 14. The body releases the egg 24 hours after the peak of the LH surge. The egg only lives for 1 day after ovulation. If conception has not occurred, the egg dies and there will not be a pregnancy that month.
Ejaculated sperm can live in the reproductive track for 4 days, but optimal timing is with the LH surge so that sperm will be waiting in the Fallopian tube when the egg arrives. It is reasonable to try from days 12 to 16. Some people may choose to extend this from days 10 to 18. If there was only 1 day per month that a couple could engage in intercourse, then they should have sex at the time of the LH surge. Intercourse too early in the cycle or later in the month maybe important in a relationship, but it is recreational not procreative.
How do I know if I’m ovulating?
If you have regular and predicable cycle, then you are ovulating. Many women have an awareness of the changes in their body across their menstrual cycle. Some women note changes in the cervical mucus, others say they can actually feel the ovulation event. Once ovulation occurs and the egg is released, you may feel the effects of progesterone such as breast tenderness. However, if you don’t feel these things, you can certainly still be ovulating especially if you have a regular cycle.
Should I use an ovulation predictor kit?
One way to be sure ovulation is occurring is to use an ovulation predictor kit. There are many brands. Our patients have had good luck with the Clear Blue Easy kit, as it is very easy to interpret—a circle for negative, a smiley face for positive. Begin testing around day 12. It is good to have a couple of negative days, so that when you get a positive, you are sure it is positive.
Are there kits you don’t recommend?
We do not recommend the digital kit, which provides information on high fertility (by measuring estrogen, and then a flashing smiley face that measures LH). It is expensive and does not provide additional useful information.
How often should we have sex?
People should do what feels natural. Getting pregnant can be stressful. Sex should not be stressful. Often couples (read: men) have trouble performing on demand. Attempting conception after several months of negative results can put a strain on couples and impedes the romance in a relationship. Our physicians typically say that having sexual intercourse every other day during the week of ovulation (days 12 to 18) is reasonable. If every day feels right for you, then go for it. Some couples are concerned that daily sex will deplete the amount of sperm the male has available. This is a myth.
Is one position better to conceive?
No. They all work.
Do I need to lay with my legs up after intercourse?
This is not necessary. If it makes you feel more at ease, you can wait 5 to 10 minutes before getting up, although this is not necessary.
A lot of ejaculate spills out after withdrawal. Is this a problem?
No. More than enough sperm stay inside the vagina.
What is an infertility evaluation?
An infertility evaluation includes exams and tests to try to find the reason why you and your partner have not become pregnant. If a cause is found, treatment may be possible. In many cases, infertility can be successfully treated even if no cause is found.
When should I consider having an infertility evaluation?
You should consider having an infertility evaluation if any of the following apply to you:
- You have not become pregnant after 1 year of having regular sexual intercourse without the use of birth control.
- You are older than age 35 years and have not become pregnant after trying for 6 months without using birth control.
- You are older than age 40 years and have not become pregnant within 6 months of trying without using birth control.
- Your menstrual cycle is not regular.
- You or your partner have a known fertility problem.
What type of doctor does an infertility evaluation?
Your obstetrician–gynecologist (ob-gyn) usually will do the first assessment. You also may choose to see a specialist. Infertility specialists are ob-gyns with special training in evaluating and treating infertility in women and men. These specialists are called reproductive endocrinologists. Men also may be evaluated and treated by a urologist. Some urologists have special training in male infertility.
What causes infertility?
The most common cause of female infertility is lack of or irregular ovulation. The most common causes of male infertility are problems in the testes that affect how sperm are made or how they function.
Other factors in women include problems with the reproductive organs or hormones. Scarring or blockages of the
fallopian tubes may contribute to infertility. This may be the result of past sexually transmitted infections (STIs) or endometriosis. Problems with the thyroid gland or pituitary gland also may contribute to infertility. In men, blockage of the tubes that carry sperm from the testes may be a cause of infertility.
How does age affect fertility?
For healthy couples in their 20s or early 30s, the chance that a woman will become pregnant is about 25–30% in any single menstrual cycle. This percentage decreases rapidly after age 37 years. By age 40 years, a woman’s chance of getting pregnant drops to less than 10% per menstrual cycle. A man’s fertility also declines with age, but not as predictably.
Can lifestyle affect fertility?
In women, being underweight, being overweight, or exercising too much may be associated with infertility. In both men and women, drinking alcohol at moderate or heavy levels may be a factor in infertility. In men, smoking cigarettes and marijuana can reduce sperm count and movement.
What should I expect during my first visit for infertility?
The first visit with a fertility specialist usually involves a detailed medical history and a physical exam. You will be asked questions about your menstrual period, abnormal bleeding or discharge from the vagina, pelvic pain, and disorders that can affect reproduction such as thyroid disease. You and your partner will be asked about the following health issues:
Medications (both prescription and over-the-counter) and herbal remedies
Illnesses, including STIs and past surgery
Birth defects in your family
Past pregnancies and their outcomes
Use of tobacco, alcohol, and illegal drugs
You and your partner also will be asked questions about your sexual history:
- Methods of birth control
- How long you have been trying to become pregnant
- How often you have sex and whether you have difficulties
- If you use lubricants during sex
- Prior sexual relationships
What tests are done for infertility?
Tests for infertility include laboratory tests, imaging tests, and certain procedures. Imaging tests and procedures look at the reproductive organs and how they work. Laboratory tests often involve testing samples of blood or semen.
What does the basic testing for a woman include?
Laboratory tests may include blood work: a progesterone test, thyroid function tests, a prolactin level test, and tests of ovarian reserve. Imaging tests and procedures may include an ultrasound exam, hysterosalpingography, sonohysterography, hysteroscopy, and laparoscopy. You may not have all of these tests and procedures. Some are done based on results of previous tests and procedures. You also may track your basal body temperature (BBT) at home.
What is the purpose of tracking basal body temperature?
A woman’s temperature increases around the time of ovulation and stays elevated for the rest of her menstrual cycle. To track ovulation, you will need to take your temperature by mouth every morning before you get out of bed. You record your temperature on a chart for two or three menstrual cycles.
Charting monthly temperature changes can confirm ovulation but it cannot predict it. Some women also monitor their cervical mucus while charting BBT. Just before ovulation, a woman’s cervical mucus becomes thin, slippery, and stretchy. Cervical mucus monitoring is a natural way to help a woman identify her most fertile days.
What do results from a urine test determine?
A urine test determines when and if you ovulate by detecting an increase in the levels of luteinizing hormone (LH) in the urine. A surge in the level of LH triggers the release of an egg. If the test result is positive, it suggests that ovulation will occur in the next 24–48 hours. This gives you an idea of the best time to have sex to try to get pregnant.
How is a progesterone test done?
For a progesterone test, a sample of blood is taken about 1 week before you expect your menstrual period. The level of progesterone is measured. An increased level shows that you have ovulated.
Why would a thyroid function test be done?
Problems with the thyroid gland may cause infertility problems. If a thyroid problem is suspected, levels of hormones that control the thyroid gland are measured to see if it is working normally.
What is a prolactin level test?
This test measures the level of the hormone prolactin. A high prolactin level can disrupt ovulation.
What are tests of ovarian reserve?
The term ovarian reserve refers to a woman’s supply of eggs. Blood tests are used to check the remaining number of eggs.
- Why are imaging tests and procedures done?
Different imaging tests and procedures are used to look at the uterus, ovaries, and fallopian tubes to find problems. Some procedures also are used to treat certain problems if they are found. The procedures that you may have depend on your symptoms as well as the results of other tests. Common imaging tests for female infertility include the following:
- Ultrasound exam—This test can predict when ovulation will occur by viewing changes in the follicles.
- Sonohysterography—This special ultrasound exam looks for scarring or other problems inside the uterus.
- Hysterosalpingography—This X-ray procedure shows the inside of the uterus and whether the fallopian tubes are blocked.
- Hysteroscopy—The procedure uses a camera with a thin light source that is inserted through the cervix and into the uterus. This can show problems inside the uterus and help guide minor surgery.
- Laparoscopy—This procedure uses a camera with a thin light source that is inserted through the abdomen. This can show the fallopian tubes, ovaries, and the outside of the uterus.
What does the basic testing for a man include?
Testing for a man often involves a semen analysis. This analysis is done to assess the amount of sperm, the shape of the sperm, and the way that the sperm move. Blood tests for men measure levels of male reproductive hormones. Too much or too little of these hormones can cause problems with making sperm or with having sex. In some cases, an ultrasound exam of the scrotum may be done to look for problems in the testes.
How long does it take to complete an infertility evaluation?
An infertility evaluation can be finished within a few menstrual cycles in most cases. Some insurance companies may cover the cost of an infertility evaluation. It is a good idea to call your insurance company to find out before you start your evaluation.
When will my IVF cycle start?
IVF cycles start one time per month and you will need to discuss with the IVF Department when you would like to begin your stimulation. Please remember your workup must be completed before your IVF cycle start.
How do I begin my workup?
Call with the first day of your menstrual cycle so we can schedule blood work and ultrasound on cycle day 2 or 3. Call the front office staff at ext. 10 to begin your testing.
How do I get placed into an IVF Group?
You will need to be placed on some form of suppression (such as birth control pills) to help control our cycle and allow us to start your stimulation medications at the appropriate time. When you call with your menstrual cycle, to begin your workup, Dr. Russell will determine what suppression is best for you.
What can I expect to schedule as part of my workup?
There are certain things necessary to be completed as part of your IVF workup; your chart will be reviewed to see what you have done in the past, what additional testing is necessary, and what items need to be repeated that are more than one year old. This may include lab work at an outside facility. In-office procedures include office hysteroscopy, uterine sound, Pap, cultures, and a semen analysis. We strongly recommend that you complete your three day diet log. You will need to schedule a consents appointment with Dr. Russell. This should be scheduled no later than one week before your IVF cycle is to begin.
What if I am unable to complete my work?
If you are unable to complete your workup you IVF cycle will be delayed until the next group to allow you more time to complete.
Why is this workup important?
Dr. Russell will review all parts of the workup to create an individualized medication protocol for your upcoming IVF cycle.
What will happen once my workup is complete?
Dr. Russell will review your workup to create a medication protocol for your cycle. At this point you will be contacted to review your treatment plan and medications will be ordered for your upcoming cycle.
What type of medications will I use for my IVF cycle and how do they work?
Depending upon your infertility diagnosis, you may be asked to begin medications such as antibiotics and steroids prior to your stimulation. FSH (follicle stimulating hormone) is the injectable medication used during fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF). Injections of FSH (gonadotropins) are started early in the menstrual cycle to cause multiple eggs to grow to a mature size. Human chorionic gonadotropin (hCG) or leuprolide(GnRH), other injectable medications, is then used to trigger the release of the eggs when they are mature.
Do these injectable medications have any side effects?
Local or generalized reactions. In some women, the injection may cause a local skin irritation. It is extremely rare to have an actual allergy to these medications . Some women may experience breast tenderness, headaches, mood swings or a slightly bloated feeling from the gonadotropins.
How often will I need to be seen in your office during my IVF cycle?
You will need frequent monitoring with blood work and ultrasound as you progress through your cycle. Please refer to the IVF sample calendar as to when your projected visit may be.
When will my egg retrieval be?
An average stimulation may take approximately 7 to 10 days. When Dr. Russell feels your eggs are mature and appropriate for retrieval your procedure will be scheduled.
What can I expect after retrieval?
You may experience some bloating and mild discomfort such as cramping. You will recover in our facility for approximately 45 minutes and will be given discharge instructions from the IVF Department.
When will the transfer be?
Your embryo transfer will be 5 days after your retrieval unless it has been determined that a frozen transfer is necessary.
Fresh Embryo Transfer vs. Frozen Embryo Transfer
During your IVF cycle there are two possible treatment plans to expect after your egg retrieval, and they include:
- A fresh embryo transfer about five days after your retrieval; or
- It may become necessary to freeze your embryos and transfer them approximately 4 weeks later.
Why would it become necessary to freeze the embryos and transfer later?
During the IVF cycle your hormone levels will rise as numerous eggs grow; if the progesterone rises above a certain level, your uterine lining begins to prepare itself too soon for an embryo transfer. When this occurs, the uterine lining and the embryos are no longer in synchronization. We also know that when embryos are transferred into a uterus that is not in synchronization with embryo development a conception will not occur.
Before freezing the embryos and preparing the uterus for a frozen embryo transfer, we are able to schedule the transfer procedure when the lining is in perfect synchronization with the cryopreserved embryos. The success rate for frozen embryo transfer cycles are currently higher than those results we see in a fresh transfer.
When will I be told to expect a fresh transfer versus doing a frozen cycle?
In many cases we know a day or two before retrieval. You will be continuously updated on your treatment progress and plan.
How will I be prepared for a frozen embryo transfer?
You will meet with the IVF Coordinator after your retrieval. If a frozen cycle is necessary you will be given additional medication instructions. You will return to the office with your menses and can expect your embryo transfer procedure approximately 4 weeks later.
We realize there is a lot of planning that goes into the decision to do an IVF cycle. When it becomes necessary to do a frozen cycle you can expect embryo transfer approximately 4 weeks after retrieval. Visits to the office are very minimal (2-3) during a frozen cycle. We hope that by giving you this information you can make an informed decision regarding when to do your IVF cycle.
What can I expect after transfer?
You will be given transfer instructions to include bed rest for the remainder of the day. You may return to work the following day. You will also be given instructions on limitations and when to return for monitoring blood work.
If my cycle is successful what is my next step?
You will repeat the lab work again in two days. When we see that your HCG level is rising appropriately (usually doubles every two to three days) you will then be asked to schedule your first nutrition meeting. This meeting is to review your medications and discuss nutritional needs as you transition from an infertility patient to an obstetrical patient. Your obstetrical ultrasound is approximately one week later; you will be followed here until 12-13 weeks of pregnancy and then referred back to your OB/GYN for your continued care.
If my cycle is not successful what is my next step?
You will be instructed to stop all IVF medications and schedule a consult to discuss the cycle and the plan moving forward.
How much time will my IVF treatment cycle involve?
IVF procedures demand a considerable amount of time and emotional commitment. In order to help you adjust your outside responsibilities, we are providing the following information regarding the time commitment needed to do a cycle.
In order for us to provide you with the best care available, we ask that you make yourself available during your cycle.
What Testing is required?
The testing prior to your IVF cycle may involve several visits to the office depending upon how much testing has been previously completed. Workup includes: office hysteroscopy, cervical cultures, pap smear and outside labs for you and your partner, a semen analysis, an appointment with our counselor, and an appointment to review your recipient consent with Dr. Russell.
When will the donor eggs be inseminated with my partners sperm?
We will need a semen sample on the day that the eggs are retrieved from your donor or the day the eggs are thawed if using frozen eggs.
When will I have the embryo transfer?
The embryo transfer date will be determined after the donor cycle is completed. During the actual recipient cycle you will be seen for ultrasound and lab work approximately 2-3 times over a two a half week period of time leading up to your embryo transfer.
Please remember that all of these dates are approximations, but should assist you in planning your time around your cycle.
DIRM is truly a place where dreams, through science, become reality.