More than 7 million American couples struggle with fertility. You may need a fertility evaluation if you have been engaging in regular intercourse without conception. Couples ages 35 and under should undergo fertility evaluation if they have been having timed intercourse for one year and have still not become pregnant. If you are over 35 years old, it is recommended that you undergo fertility testing after only 6 months of timed intercourse. If you are over 40, it is best to undergo complete ovarian reserve testing and seek consultation with a reproductive endocrinologist that specializes in assisted reproductive technologies.
Fertility testing can be time-consuming, a little invasive and often expensive. Most insurances do not offer fertility benefits so be sure to discuss your coverage directly with your insurance carrier. Many of the tests are cycle timed so make sure to discuss exact timing with your healthcare provider. It may take 3 to 4 menstrual cycles to complete all your testing.
What Does it Mean to be Fertile?
The fertility window for a woman is the six-day period when pregnancy can occur from having a sexual intercourse encounter. This period is determined by the 24 hours during which an egg is released and dies and the sperm survival of 5 days. After a woman ovulates, releases her eggs, the eggs can only survive up to 24 hours, and during these hours the egg slowly deteriorates. As the eggs decline, the probability of conception decreases rapidly.
The optimal way for pregnancy to occur is for the sperm to be present in the fallopian tube before the egg is released. This means a woman’s most fertile day is the day before ovulation rather than the day ovulation occurs. When trying to determine a fertility window, six days is the maximum length for a woman regardless of her regularity in her cycle. The reason for the 6-day window is due to ovulation rarely occurs on the same day in each of your periods, so there are a couple of extra days listed as a precaution for those trying to avoid a pregnancy.
Sperm can only survive in a fertile cervical mucus. The six-day window of fertility is based on the sperm encountering the right environment in which it can survive. If the right environment does not exist in the vagina, fallopian tubes, and uterus, the sperm rapidly dies reducing the fertile window to just a few hours during ovulation day. With fertile cervical mucus, the sperm is able to travel from the cervix to the uterus and then on to the fallopian tube. When the sperm enters the fallopian tube, it will be able to live there up to five days waiting to fertilize an egg.
Follicular Phase of Fertility
The first phase of your cycle is known as the follicular phase. This time is when your period begins, and it ends when you ovulate. This phase is when your body prepares for ovulation, and your hormones increase to start the ovulation process.
In the second half of the follicular phase, your estrogen levels will increase to make your uterine lining create a thicker lining in preparation for the coming egg. These increased estrogen levels also create more cervical fluids to raise your PH level and improve the environment to help the sperm travel up to the fallopian tube.
It is difficult to determine the exact number of days your body is in the follicular phase as it differs from cycle to cycle and from woman to woman. When you experience irregular periods, your follicular phase will be different for each cycle. You can create a chart with All Women’s Care to track your cycles and determine how long your follicular phase is on average and if there is a variation.
Luteal Phase of Fertility
The luteal phase is the second phase of your cycle. This phase is after ovulation but before your period. Once you have gone through the luteal phase, your period will begin. During the luteal phase, you might experience PMS symptoms.
Once ovulation has occurred, your body produces progesterone from the remains of the follicle (corpus luteum) which released the egg. Corpus luteum creates the progesterone that is required to soften the lining of your uterus allowing the egg an easier time to attach itself if fertilized. If the egg is unfertilized, it does not attach, and your period begins.
When there is an increase of progesterone in your body, your temperature increases which are how women are able to confirm ovulation, if an egg is unfertilized, the corpus luteum stops creating progesterone, your temperature drops, and your period begins.
The luteal phase lasts approximately ten to sixteen days with an average length of fourteen days. This phase is usually consistent in every cycle and can be tracked when you create a chart of your cycle with All Women’s Care.
When your ovaries do not produce enough progesterone, is it called having a luteal phase defect (LPD). Luteal phase defect is when there is not enough progesterone, or the endometrium (lining of your uterus) does not respond to the hormone. If your endometrium does not grow enough, it will be difficult for a fertilized embryo to attach itself which makes it difficult to become pregnant. Symptoms of LPD include miscarriages, spotting in between periods, more frequent periods, and difficulty in getting pregnant.
Factors that can cause LPD
- Thyroid Problems
The thyroid gland influences almost all of your metabolic processes occurring in your body. Disorders of this gland can range from small to life-threatening, but most problems result in abnormal production of hormones. If your thyroid creates too many hormones, it is called hyperthyroidism, and if it creates insufficient hormones, it is called hypothyroidism.
- High BMI
BMI (body mass index) is based on your weight and height. The ideal weight for conception will depend on your height with a healthy BMI range between 18 and 25. If your BMI is over 25, you would be considered overweight and will increase your chances of LPD.
When a woman engages is what is considered excessive exercise or restricts her food consumption, it results in a lower body mass than what is safe or healthy. This action is called anorexia or amenorrhea. It has been researched and documented that amenorrhea can lead to infertility in women.
- Extreme Exercise
The effects of exercise and fertility are difficult to gauge. Moderate exercise is said to be beneficial to every woman and may even help some improve their fertility. Performing vigorous exercise; however, it can negatively impact fertility in women within their healthy weight. Vigorous exercise would include four or more hours of jogging, biking, swimming, aerobic exercises, racquetball, or other intense activities.
PCOS (polycystic ovary syndrome) is a hormonal disorder that causes your ovaries to become enlarged. This syndrome usually creates small cysts on the outer edges of your ovaries. Symptoms of PCOS include acne, obesity, excess hair growth, and menstrual irregularity.
Hyperprolactinemia is a condition where your pituitary gland creates more amounts of hormone prolactin than is considered normal. Prolactin is the hormone that stimulates milk production in women and circulates typically in your blood in small quantities if you are not pregnant. When you are pregnant or right after you’ve given birth, there is an increase in the amounts. Those who suffer from hyperprolactinemia offer do not ovulate or have irregular ovulation which causes fertility problems.
Endometriosis develops when endometrial tissue grows outside the uterine cavity. The tissue normally lines the uterus, but when it locates on the ovaries, fallopian tube, or abdominal cavity, it creates a condition known as endometriosis. The irritation and inflammation caused by endometriosis can affect fertility as it can prevent the egg from reaching its destination.
What Does it Mean to be Infertile?
When it is said a woman is infertile, it means she is not able to get pregnant after having tried for one year to conceive. If a woman is 35 years or older, the time frame for attempting pregnancy is six months, and if not successful, they are then considered infertile. You can also be considered infertile if you have gotten pregnant but are unable to stay pregnant.
In order to achieve a pregnancy, your body must go through a process:
- Your body must release an egg from one of your ovaries
- The egg then has to travel through your fallopian tube towards your womb (uterus)
- Sperm from a man has to join the egg along the way to fertilize it
- The fertilized egg has to attach itself to the inside of your uterus
If there is a problem along any of these steps, infertility can occur.
Infertility and Reproduction Problems
Reproductive problems or infertility include aging and disease. A male being infertile is as common as a woman being unable to conceive and can often be treated with infertility drugs along with some high-tech procedures.
Infertility is when you are not able to become pregnant after having unprotected sex for six months to a year, depending on how old you are. There are no symptoms to look for in this problem other than the fact that you are unable to get pregnant. Potential signs for women that can be related to infertility include abnormal periods or bleeding heavier or lighter than is typical for your cycle. You may notice irregular periods or the number of days between each period becoming more varied. If you suddenly stop having periods or have never had a period, it is a good indication of being infertile. Another sign of infertility can be painful periods where you experience pelvic or back pain with excessive cramping.
Female infertility can be related to hormone problems. If you have problems with your hormone levels, you may notice skin changes including having more acne. A change in your sex drive can be an indication of your hormones changing as well as excessive hair growth on your lips chest and chin. Other changes that can occur when hormone levels fluctuate include loss of hair or thinning of your hair as well as weight gain. If you notice any of these changes in your body, you should discuss them with your physician at All Women’s Care so further testing can be done to check your ability to get pregnant.
Male infertility is harder to detect through symptoms. It may not be detected in men until the woman they are engaged with attempts to become pregnant. Any symptoms they would experience would depend on the reason behind their infertility but could include a change in their hair growth, a change in their sexual drive, swelling or pain in their testicles, problems with ejaculating or having an erections, or firm, small testicles. If you have noticed any of these symptoms while having trouble getting a woman pregnant, you should discuss them with a professional at All Women’s Care where she is receiving treatments.
Same-sex couples have a different journey to parenthood than opposite-sex couples which can involve significant legal and medical challenges to navigate. In a same-sex couple relationship, it must be decided between the couple who will carry the baby; however, your doctor may require both of you to undergo a full gynecologic and medical evaluation. The evaluation will detect if either partner suffers medical complications that could make pregnancy difficult or dangerous.
Some Common Fertility Testing Includes
A complete well-woman exam, including a pelvic and pap exam, STD screening, blood tests, and urine tests. If you have risk factors for diabetes or cardiovascular disease, these screening test should also be performed prior to trying to conceive. Hormone testing is collected at specific times in the menstrual cycle to evaluate ovulation and ovarian reserve. If you are over 35, talk with your provider about an anti-Mullerian hormone blood test to further evaluate your fertility reserve.
Pelvic ultrasounds to evaluate follicle count and development, and determine ovulation.
A hysterosalpingogram, which is an X-ray of the uterus and fallopian tubes, is an imaging test that evaluates tubal function and intra-uterine architecture.
A post-luteal phase endometrial biopsy to evaluate hormonal insufficiencies that can cause irregular cycles, repeated miscarriages, or irregular uterine bleeding.
Many couples find that they are struggling with combined infertility meaning both a male and female cause. Your partner should undergo a complete semen analysis to evaluate his fertility potential as well.
When Should You Consult Your Doctor Regarding Fertility?
If you have been attempting to get pregnant without success for a year and you are under the age of 35, you should talk to your doctor. If you are over the age of 35, you should speak with your doctor after trying to get pregnant without success after six months. Your doctor can perform urine, imaging and blood tests to try and determine why you have not become pregnant after this time period. For a man, they can perform a sperm analysis and check the overall health of the sperm as well as perform a sperm count.
Before your first visit to the doctor concerning infertility issues, you should make a list of information that will help determine your cause:
- Provide an estimate or the actual number of times you have unprotected sex, and how long it has been since you started trying to conceive. Having the date of the last time you tried to get pregnant will assist with your evaluation.
- If you have had any surgeries or treatments recently or in the past, you should list the dates. If you’ve had any treatments regarding your reproductive tract, these are especially important to record.
- Write down if you smoke and how much each day, along with how much and often you consume alcohol or use of any illegal drugs.
- Make note if there are any genetic disorder or chronic illnesses in your family such as thyroid disease or diabetes.
- Make a list of all medications you take including minerals, supplements, prescriptions or any other form of medicine that is not a prescription.
- Note if there have been any changes or symptoms in your body that you’ve noticed.
- Note the date of any radiation or chemotherapy treatments if they apply.
- List if you have had any STDs (sexually transmitted diseases) even if treated and no longer a current health issue.
Early diagnosis of infertility can improve your odds of getting pregnant, so it is vital to listen to your body and report any symptoms to your doctor.
Solutions for Infertility
Men are tested for infertility by having a physical exam and a sperm analysis, and women begin testing with an exam of her pelvis along with a physical and medical review. The doctor will want to ensure the woman is ovulating regularly and that your ovaries are releasing eggs. A blood test is performed to measure hormone levels, and they may examine your uterus and ovaries with an ultrasound. Other tests can include reviewing your fallopian tubes and uterus through a specific X-ray test.
The highest causes of infertility are from an ovulation problem, sperm health or count, or blockage in the fallopian tubes. There is less than a fifteen percent chance of the reason for infertility is unknown. There are both prescriptions and medical procedures to follow through with once the cause has been determined.
For men who have been diagnosed as infertile they can be treated with:
- Antibiotics to treat any detected infections in their reproductive organs.
- If it is determined that their hormones are either too high or low, they can receive hormone treatments.
- Surgery can repair a varicocele or blockage in the vas deferens (the tube that carries the sperm).
- They can receive counseling or medications to treat ejaculation or erection problems.
For women who have been diagnosed as infertile, treatments can include:
- Surgery to remove any tissue found blocking their fallopian tubes. Endometriosis is a common problem where tissue blocks this tube preventing pregnancy.
- Hormones or fertility drugs can also stimulate a woman to ovulate or restore hormone levels.
There are also innovated technology available today to help with both infertile men and women who are unable to be treated for their infertility. ART (assisted reproductive technology) is now available in several different types:
- Gamete Intrafallopian Transfer (GIFT) or Zygote Intrafallopian Transfer (ZIFT) are procedures to collect an egg and sperm and place them in a fallopian tube. The GIFT procedure involves removing a woman’s eggs and mixing them with sperm. Immediately after the two have been placed together, they are placed into the woman’s fallopian tube. With the use of a laparoscope, the egg is retrieved from the woman’s ovary, a man’s sperm is collected, and the two are mixed in a catheter. The catheter is then used to insert the mixture into the woman’s fallopian tube.
The Zygote Intrafallopian Transfer is similar to in vitro fertilization and embryo transfer except with ZIFT the fertilized embryo is placed into the fallopian tube instead of the uterus. This procedure has seen more success than GIFT as your doctor has a higher chance of making sure the egg is fertilized before being placed in the fallopian tube. With a ZIFT procedure, the woman is stimulated into producing multiple eggs. The eggs are then collected with an aspiration and then fertilized in a laboratory and then within 24 hours are transferred into the woman’s fallopian tube with the use of a catheter.
- Intrauterine Insemination (IUI)
The IUI is a fertility treatment involving placing sperm inside a woman’s uterus to help fertilization. This procedure is intended to increase the number of sperm inside the fallopian tubes and therefore increasing the chances of pregnancy. This procedure gives the sperm a head start, but they will still have to fertilize the egg on their own.
- In Vitro Fertilization (IVF)
With an in-vitro fertilization process, the egg is extracted from the woman, a sperm sample is collected from the man, and the two are mixed together in a laboratory dish. The mixture is then placed into the woman’s uterus. When a woman begins to prepare for an IVF, she is prescribed fertility medication to stimulate egg production. The eggs are retrieved through a minor surgical procedure and then mixed with a man’s sperm sample. The process to place the mixture into the woman’s uterus is called insemination.
Tips for a Faster Conception
- Start a prenatal vitamin (multivitamin for men), stick to a healthy diet, get 8 hours of sleep, exercise and eliminate any bad lifestyle habits like smoking, excessive alcohol, contraindicated medications, etc.
- Keep a menstrual calendar or try a fertility app to help you track your cycles
- Use an over the counter ovulation prediction kit to narrow down your fertile days
- Consider acupuncture
- Get a regular yearly physical exam with your primary care provider to screen for any health conditions that could negatively affect your fertility potential
Treatment of Basic Infertility
If your fertility workup determines that you have a normal ovarian reserve and no tubal disease, we can offer you basic ovulation induction with or without intrauterine insemination.
Basic fertility treatment includes ovulation induction with clomiphene citrate (Clomid) and injections with follicle stimulating hormones. Treatment cycles are timed and require multiple office visits, ultrasounds and lab testing to evaluate cycle progress. Intrauterine insemination is accomplished by taking your partner's semen, washing and separating the components, and then placing the sperm into the uterine cavity through the cervix with a soft, tiny catheter tube.
Insemination requires infectious disease testing of all partners and is only done in our office with previously intimate couples.
If you are concerned about your fertility reserve and would like to discuss testing and treatment options, please call to schedule a fertility consultation.
Fertility Services for Same-Sex Couple and Single Women
AWC has always been dedicated to offering affordable fertility services to lesbian couples and single women seeking conception with donor sperm. The most difficult part of the process might be picking your donor as now more than ever there are many choices in selecting a cryobank donor.
Cryobank donors are pre-screened for all infectious diseases and many genetic syndromes. It is best to purchase intrauterine insemination prepared specimens for your cycle.
If you are planning to use a known donor, there are many more California Department of Health Services regulations that will need to be followed and all known donors are required to have infectious disease screening prior to sperm donation. You should also consult an attorney regarding any paternity issues.
When undergoing donor insemination, it may take up to 10 cycles to conceive. Conception rates per cycle can be as low as 30%. If you have had more than 6 timed cycles without conception, your provider may recommend further fertility evaluation.
Keeping a fertility calendar is especially important as timing is everything with insemination and it's really important to narrow down your exact fertile window to give the best chances of conception.
Be sure to start your prenatal vitamins at least 90 days prior to starting your fertility journey!
Same-Sex Couple Solutions
Female same-sex couples have several different solutions to successfully becoming pregnant including intrauterine insemination or in-vitro fertilization. They can also do a co-maternity which is where one partner donates her eggs for the other partner to carry. Females can use anonymous sperm donors or ones that they know. Benefits and challenges exist with either method. When using a donor they know, there are legal and psychiatric clearances required along with a six-month quarantine of the sperm. The quarantine is to protect against any infectious diseases.
Male same-sex couples have two options when deciding to begin a family. They can use a gestational carrier which involves choosing a woman for her eggs and uterus and then using the sperm from one of the partners. There are legal aspects to consider for this method which has made it less popular. There is also the use of a surrogate carrier which involves one woman to serve as the egg donor and a second woman to carry the baby. There are fewer legal complications in this method.
When looking at the carrier chosen, the doctors at All Women’s Care will look into her obstetric history and evaluate her uterus. The ideal gestational carrier would be a woman who has not had a previous cesarean delivery and does not have toxic habits such as smoking. A woman who follows a healthy lifestyle is the best choice.
Find a Fertility Clinic Near Me
When you and your partner or spouse begin planning a family but experience trouble conceiving, call All Women’s Care at 213-250-9461. We serve the Los Angeles area, helping couples whether same-sex or opposite-sex find solutions to becoming pregnant. Start your family today with a call to our clinic and set up an appointment to find the best solution that will work for you.