FAQS

It’s rare but possible. If there are signs of a male bacterial infection, with infection-fighting white blood cells in the sperm (pyospermia) we would not use that specimen for an Intrauterine Insemination or IUI as we might spread infection to the uterus or tubes. Viral infections like Hepatitis B, Hepatitis C, and HIV can be transmitted by sperm, so sperm donors are tested for infectious diseases. Washing the sperm for IUI doesn’t completely remove all of a viral infection from the sample.

Yes, it’s still OK. There is a window where the egg could be fertilized, from around 3-5 days before ovulation until the day of ovulation (and maybe one day after ovulation). The day of ovulation might be the best day to do an Intrauterine Insemination (IUI) – if you choose one IUI per month we time it for the day of expected ovulation for two IUIs a month we choose the day before ovulation and the day of ovulation. If we are monitoring a treatment cycle with ultrasound and you have a decent-sized follicle and then get a positive LH surge I would do an IUI on the day of your surge. The egg has up to 24 hours after ovulation when fertilization could occur.

Your doctor will get to know you, review your medical history and your partner’s history, and usually do a quick physical exam for you at the first visit. Many fertility doctors don’t perform a pelvic examination on the first visit, but some do. We get much more information from a pelvic ultrasound scan. Some clinics do an ultrasound on the first visit, others will bring you in for an ultrasound at a later visit, usually in the first few days of your menstrual cycle.

Typically, your doctor will talk to you about why you may need In Vitro Fertilization (IVF) treatments, and she or he will often need to arrange testing to make sure that you’re a good candidate for IVF, even if IVF is the right treatment. If you have had any previous fertility testing or treatments it is very helpful to provide these records before the first visit so that your MD can review them – this may avoid duplicating tests that don’t need to be redone. You will usually be offered prenatal testing: checking your blood type, making sure you don’t need any vaccines before pregnancy, and offering optional genetic screening tests. Your doctor will explain the IVF process to you, either at the first visit or at your follow-up visits.

This is a general overview, but I hope it helps. Contact your fertility clinic if you have specific questions or concerns, of course.

Acupuncture may help fertility, but it is not supported by high-quality scientific evidence. One study performed in Seattle had lower pregnancy rates in the acupuncture group doing IVF compared to the no acupuncture group . It’s very hard to conduct properly-controlled trials: for a drug we might compare the pregnancy rate for women taking the drug compared with women taking a sugar pill or placebo or another drug. For acupuncture it’s hard to define a placebo (fake treatment) group – either putting the needles in the ‘wrong places’ or using needles that retract – you still get acupressure not acupuncture. We are OK with couples who wish to use acupuncture but we do not recommend Chinese herbal treatments as these may have hormonal effects or interact with fertility medications.

If your insurance doesn’t cover it (worth checking) look into Fertile Hope who offer discounted treatment and/or free medications.

Women who don’t ovulate don’t have regular periods. An Ovulation Predictor Kit is a good way of confirming that you are ovulating – get it from a pharmacy, don’t buy a monitor. Start testing every day from Day 10 in your cycle (Day 1 is the first day of your period). Test between 10 am and noon as the first morning urine is not as accurate. We recommend the Ovuquick brand (search online and get the 9-stick pack not the 6-pack). If you test for a couple of months and it’s not working see your OB or a see a fertility specialist (Reproductive Endocrinology and Infertility or REI) if you’re trying to conceive.

After fertility testing, we rarely see ‘unexplained infertility’. We used to think 15-20% of infertility was ‘unexplained’ (with regular cycles, open tubes, and good sperm) – with modern testing it’s under 1%. Ovarian reserve testing (ultrasound for ovarian volumes and antral follicle count, Antimullerian Hormone or AMH and the Clomid Challenge test) ‘explains’ a lot but there are other possible factors. See a board-certified Reproductive Endocrinology and Infertility or REI specialist for more detailed testing and to give you treatment choices: inseminations (IUI) combined with medications to increase the number of eggs IVF can be appropriate depending on your case.

A sensitive home pregnancy test should be positive 15 days after ovulation. If the result is unclear get a blood pregnancy test (quantitative beta hCG) through your OB/Gyn. How accurately you determined the day of ovulation may affect the results – ovulation predictor kits are most accurate if you have regular cycles. Basal body temperature (BBT), checking cervical mucus, and tracking symptoms of ovulation are less reliable.

On average it’s in the 40’s, and fertility for most women is very low at 45 and older with their own eggs. There are many individual factors however – we see women in their 20’s who can’t conceive naturally, and there are healthy pregnancies in 47 year olds, and everything in between. Using egg donation there may be no biological upper limit but risks are higher in the 50’s: women 55 and older should not try to conceive.

Roughly two weeks after conception, or about 15 days after a positive ovulation test. If your pregnancy hormone levels are high enough, home pregnancy tests may turn positive a few days before the date of your ‘missed period’. Blood pregnancy tests are more sensitive.

See a Reproductive Endocrinology and Infertility or REI MD, who will review your medical history and your partner’s history, examine you, and recommend appropriate fertility tests for both of you. These may include blood work to check your ovarian reserve (egg numbers and quality) and to check for hormonal problems, an ultrasound scan of your uterus and ovaries, a Hysterosalpingogram (HSG) to check your tubes, and a Semen Analysis for him.

Lifestyle changes that may help include aiming for a normal weight if you’re underweight or overweight, stopping smoking, avoiding heavy alcohol use, and avoiding illegal drugs as well as prescription narcotic pain medications. High caffeine intake may increase the risk of miscarriage, based on a single study – stick to one cup of brewed coffee a day and decaf for the rest (no espresso-based drinks). There are no well-proven herbs or supplements, but Coenzyme Q10 (CoQ10) 500 – 1000 mg a day, may help older women. Vitamin D levels should also be checked as there is some evidence that low levels can have a wide variety of effects on the body.

Her age is important. Other important factors are her previous pregnancy history, including miscarriages and ectopic pregnancies and whether or not she has regular periods. We will ask if she has any history of endometriosis ovarian surgery, Chlamydia or Pelvic Inflammatory Disease (PID) infections, smoking, or cancer therapy (rare). Previous fertility treatment(s) such as Clomid, Inseminations (IUI), or In Vitro Fertilization (IVF) are important to review too, and whether or not these treatments were successful.

First we do tests to find the cause(s) – including diminished ovarian reserve (low egg supply), hormonal issues, blocked tubes, polyps or fibroids inside the uterus, or sperm problems. Treatment depends on the results but may include fertility tablets like Clomid or letrozole with Intrauterine Inseminations (IUI) injectable medicines and IUI In Vitro Fertilization (IVF)” egg donation or embryo donation.

The Hysterosalpingogram (HSG) test is a diagnostic test, and is the best non-surgical way to check that the Fallopian tubes are open, and that they are normal-appearing. It’s also a good screening test that can pick up polyps or fibroids inside the uterus. Sometimes we see evidence of scarring around the tubes. It’s an important fertility test to do before treatment. Some women get pregnant after the HSG test, and it’s safe to try to conceive in the month you do the test, but it’s not really a fertility treatment by itself.

Regular periods are a sign of ovulating, as is getting pregnant! Some women have mid cycle cramping (mittelschmerz) and may notice more cervical mucus or a change in mucus consistency – ‘egg white’ like and stretchy. If you have regular cycles, an ovulation predictor kit (OPK) is a better test than checking mucus or basal body temperatures. OPK should go positive between Days 10 to 18 in most women with regular cycles. Start testing every day from Day 10 in your cycle (Day 1 is the first day of your period). Test between 10 am and noon as the first morning urine is not as accurate. We recommend the Ovuquick brand (search online and get the 9-stick pack not the 6-pack). If you test for a couple of months and it’s not working see a fertility specialist (Reproductive Endocrinology and Infertility or REI) if you’re trying to conceive.

Endometriomas are cysts from stage 3 or 4 endometriosis – most women with these have reduced fertility. If a cyst needs removal, such as a large dermoid cyst, the surgery may reduce ovarian reserve (lower egg numbers and quality). The most common ovarian cysts are follicular or corpus luteum cysts and don’t cause infertility, but frequent follicular cysts can be a sign of reduced ovarian reserve.

Options depend on whether or not pelvic pain is an issue, and if you’re trying to conceive now, want kids in the future, or are done with childbearing. Medical treatment options are available -Depo Lupron shots work best, and we can also use letrozole tablets or birth control pills. Surgical options consist of laparoscopy with excision or ablation of the endometriosis, versus definitive surgery for women who have completed their families – removal of both ovaries with or without hysterectomy. Fertility patients may need In Vitro Fertilization after Depo Lupron treatment or medications and IUI.

The most common factor is diminished ovarian reserve (low egg numbers and quality) which is more common as women get older, but infections like Chlamydia or Pelvic Inflammatory Disease (PID), endometriosis, smoking, or ovarian surgery can all cause diminished ovarian reserve in younger women, too. Ovulation problems like PCOS, tubal problems, and fibroids or polyps inside the uterus are common, as are sperm issues for the man. 40-50% of couples with infertility have a sperm issue, which may be the only problem or occur together with issues for the female partner.

If you are ovulating regularly you should have regular monthly periods. Basal Body Temperature (BBT) with a special thermometer works, but the temperature only rises after you ovulate. Ovulation Predictor Kits (OPK) are more useful when trying to conceive as they go positive 24 to 36 hours before you ovulate, so you know your most fertile days. Drugstore brands should work; we recommend Ovuquick – search online and get the 9-stick pack not 6. If you have very irregular periods don’t do BBT or an OPK, see a Reproductive Endocrinology and Infertility (REI) specialist for testing to find out why you’re irregular.

Low body weight may be associated with lower fertility, especially if you also have irregular periods or no cycles (amenorrhea). This means that you’re not ovulating (releasing an egg) every month. This can be due to low levels of hormones that control your cycles from the pituitary gland, known as hypogonadotropic hypogonadism, which is more common in women who are significantly underweight, or may be due to stress, eating disorders, or heavy exercise such as long-distance running.

If you’re young and not trying to conceive it’s not dangerous in the short term. Very irregular periods, especially less than four periods a year, over a long period of time (many years) can increase the risk of a type of uterine cancer (endometrial cancer). If you have acne or unwanted hair growth you should get tested for Polycystic Ovarian Syndrome (PCOS) which can cause an increased risk of diabetes. Birth control pills regulate your periods if you’re not trying to conceive, but it’s good to have a diagnosis before going on the pills. Whether or not you’re trying to conceive, you can see a Reproductive Endocrinology and Infertility (REI) MD for testing, and for treatment if needed

There are many possible causes: Pregnancy or not ovulating (releasing an egg) can make your period late by weeks or months. Common causes of not ovulating include polycystic ovarian syndrome (PCOS), underactive thyroid, excess prolactin hormone, aging of the ovary (diminished ovarian reserve), or low hormone levels (hypogonadism) from heavy exercise, eating disorders, or stress. You can see an Ob/Gyn for tests, including a blood pregnancy test; see a Reproductive Endocrinology and Infertility (REI) MD if you’re trying to conceive.

Enlarged ovaries (high ovarian volumes) are most commonly caused by ovarian cysts, but if the ovaries are enlarged without large cysts it can be a sign of Polycystic Ovarian Syndrome or PCOS, a hormonal condition that affects about 1 in 10 women. An ultrasound scan of your ovaries will look for ovarian cysts, and is part of the diagnostic tests that we do to look for PCOS, as well as blood testing.

No, in couples trying to conceive there is a sperm issue about 40-50% of the time, ranging from mild to severe sperm problems. Semen analysis is an important part of infertility testing. Sometimes the sperm issue is the only problem we find when we test both partners, often there are male and female factors together. Even if the man’s sperm is ‘normal’ it helps a lot if the male partner is supportive!

Women’s fertility starts to decrease from the mid 20’s, and decreases fastest in he 40’s. Smoking, Sexually Transmitted Infections like Chlamydia, endometriosis, ovarian surgery, chemo- or radiotherapy for cancer can all reduce egg numbers and egg quality (ovarian reserve). Chlamydia, Pelvic Inflammatory Disease (PID), endometriosis or surgery can block one or both fallopian tubes. Being overweight or underweight may lower fertility. Infertility in men can be increased by testosterone or anabolic steroid use, being overweight, and heavy use of alcohol, marijuana, or narcotics.

Irregular cycles or no periods, especially in a woman who was regular before, is a common sign. However there are many other causes of irregular cycles that we need to exclude, including Polycystic Ovarian Syndrome or PCOS. Hot flashes, vaginal dryness, or mood changes may occur, particularly if the woman’s periods are stopped. Some women with primary ovarian insufficiency still have regular periods but see a MD for difficulty getting pregnant.

The best time to take an ovulation test is with the second morning urine – roughly between 10 am and noon. The ovulation predictor test looks for a hormone called LH or luteinizing hormone in your urine. LH hormone surges 24 to 36 hours before you ovulate. If the surge occurs first thing in the morning, it can take 4 hours for the hormone to be detected, so your first morning urine may miss it. Below we look to answer some of the most frequently asked questions about when to take ovulation tests.

How many days after your period should you take an ovulation test?

Day one is the first day of your period. If you have 28 day cycles, test between days 10 to 18. If your cycles are longer but regular, like 32 days, start 32 minus 28 or 4 days later – days 14 to 22.

See a Fertility specialist (Reproductive Endocrinology and Infertility or REI MD) if you’re not pregnant after up to a year of trying and you’re 34 years old or under, or not pregnant after six months of trying if you’re 35-39. See a REI soon if you have irregular cycles, or if you’re 40 or older. Even with a fertility specialist, conceiving can take time, so please do not wait too long to seek help.

When to Take an Ovulation Test: Morning or Night?

Morning is generally the best time of day to take an ovulation test, although you can take it at any time. For best results we recommend testing on the second morning urine, which for most people is between 10am and 12am.

Why Take an Ovulation Test with the Second Urine of the Day, Not First?

The hormone that ovulation tests look for to signal ovulation is luteinizing hormone (LH). This hormone can take 4 hours to come out in your urine, which is why it might be missed on the first urine of the day.

When to Take an Ovulation Test After Period?

For women with 28 day menstrual cycles, the best time to take an ovulation test is 10 to 18 days after your period. If your cycles are longer but regular, like 32 days, start 32 minus 28 or 4 days later – days 14 to 22. If your cycle is different or irregular we recommend speaking to a fertility specialist about the best time to take an ovulation test.

Should I Drink a Lot of Fluid Before Taking an Ovulation Test?

We don’t recommend drinking too much fluid in the 4 hours before you take your ovulation test. This helps ensure that your urine and luteinizing hormone levels are concentrated.

Can you get Pregnant Even if Ovulation Test is Negative?

It’s not likely. If the ovulation test was administered correctly and the luteinizing hormone peak has yet to occur, there is little to no chance of getting pregnant. However, there’s an extremely low chance of a false negative result with the kit to consider – but again, those are rare.

For any help with Ovulation Tests or other fertility questions – Contact Overlake Reproductive Health on (425) 646-4700

Bacterial vaginosis (BV) is not a sexually transmitted disease and does not affect your fallopian tubes. It is an overgrowth of ‘bad’ bacteria in the vagina, with less of the ‘good’ ones.

BV may increase a woman’s chance of getting other STDs like chlamydia and gonorrhea. So get treated for BV by your OB/Gyn, but it’s not usually a factor in how easy (or not) it is to get pregnant.

If you’re under 35 you can try for up to a year before seeing a Fertility specialist (Reproductive Endocrinology / Infertility or REI MD). If 35-39 try for six months, if 40 or over get checked out right away. If you are irregular the next few months see a REI soon too.

Tylenol (or generic acetaminophen) – regular or extra strength is the safest painkiller in pregnancy. Avoid combinations of Tylenol with other painkillers like Excedrin. We avoid NSAIDs like ibuprofen (Motrin, Advil) Aleve and full strength aspirin (325 mg) in pregnancy. Baby aspirin (81 mg) can be given to pregnant women but it’s too low a dose for pain.

Local anesthetics (without epinephrine), Extra Strength Tylenol and additional pain medications are sometimes used but you should review these medicines with your OB/Gyn before taking them, such as if you are scheduled for dental work.

Having your tubes tied does not affect your periods so there may be other reasons for missed period after tubal ligation.

There is a small chance of getting pregnant after a tubal ligation (about 7 women out of 1000 who have their tubes tied will get pregnant in the first 10 years after surgery). So you need to see your Ob/Gyn for a blood pregnancy test to be 100% sure – if you are pregnant, it might be a tubal (ectopic) pregnancy which can be dangerous.

If you’re not pregnant your OB can find out why you are not regular, such as a hormone-producing ovarian cyst. If you continue to be irregular you will need more testing to find out why, but not if it’s a one-off”” episode and you go back to being regular every month.

A fertility specialist (Reproductive Endocrinologist) has more training and can better assess your individual situation. It is important to know more details such as: how low is your ovarian reserve (egg supply), what is your age, are there any tube or sperm problems? They can then come up with a treatment plan that’s right for you. Some women with low ovarian reserve need tablets or shots to release more eggs, some need In Vitro Fertilization (IVF) with their own eggs, and some need IVF with donor eggs.

Yes, most people can be tested for infertility. Limiting factors are age, with a minimum age of 18; many clinics also have a maximum age. We recommend infertility testing after up to a year of trying to conceive in couples where the female partner is under 35, after 6 months if 35-39. In 40 + year olds it makes sense to test right away. Some couples don’t get tested if their insurance doesn’t cover infertility tests; however, many insurance plans do cover diagnostic testing.

Fibroids are tumors that each grow from a single cell, but are usually non-cancerous. We don’t know exactly what causes them but there may be genetic and environmental factors – race and maybe diet play a part. Up to 50% of African-American women have them, up to 25% of other ethnicities. Not all fibroids need treatment – only if they are causing symptoms like heavy or painful periods or pelvic pressure symptoms including pushing on the bladder causing frequent urination, or if they are affecting fertility.

Treatment should be individualized, not ‘one-size-fits-all’. Other than hysterectomy these are the options:

1. 1. Myomectomy – surgical removal of fibroids. This can be done through the hysteroscope (a small telescope that goes through the cervix) for fibroids that are totally or partly inside the cavity of the uterus. Open myomectomy goes through a bikini-line or vertical incision in the abdomen and can remove large fibroids or fibroids deep inside the muscle of the uterus. Laparoscopic myomectomy uses a telescope through the belly button, and small incisions, to remove fibroids on the outside of the uterus. These procedures are most appropriate for women who want to have children in the future, but can be done if a woman just wants to keep her uterus. With the open myomectomy, we can do an ultrasound scan during the surgery to find smaller fibroids that could be missed and cause problems in the future. It is safe to get pegnant after a myomectomy but you may need a C/Section for delivery, depending on where the fibroid or fibroids were located.
2. 2. Uterine artery embolization / uterine fibroid embolization (UAE / UFE) – an interventional radiologist can insert material into the blood vessels ‘feeding’ a fibroid to reduce its blood supply. This can shrink a fibroid but may not make it disappear altogether. This procedure is non-surgical but has complications, including post-procedure pain, infection or blood clots. It is not appropriate for women who want to have kids in the future – it may not be safe to get pregnant, and the procedure can reduce the blood supply to the ovaries, which get part of their blood flow from the uterus, causing diminished ovarian reserve (low egg supply).
3. 3. MRI-guided focused ultrasound (MRgFUS) – this non-surgical procedure uses Magnetic Resonance Imaging (MRI) to direct a powerful ultrasound beam to damage fibroids and cause them to shrink. This can be performed by a specially trained Ob/Gyn or an interventional radiologist. Again, it may shrink a fibroid but may not make it disappear altogether. It is also not an appropriate choice for a woman who wants to have children in the future.

We don’t have good medications to shrink fibroids other than Depo-Lupron shots (a monthly or 3-monthly injection given in a Dr’s office) which may be used short-term – their best use is to shrink and soften fibroids before hysteroscopic surgery. They are not a long-term treatment for fibroids due to side-effects. This may change in the future as a new class of medicines comes out (oral GnRH antagonists).

If you are interested in future fertility I recommend seeing a Reproductive Endocrinologist, and even if you are not interested in childbearing or done with having kids we can see you as a Gynecology patient for the heavy periods and offer you a more detailed evaluation. There are interventional radiologists who offer the UAE / UFE procedure.There may be one physician offering MRgFUS in the Seattle area in the near future.

Before pregnancy, there are no proven natural ways to shrink a uterine fibroid. Resveratrol, a plant estrogen-like compound found in red wine, can kill fibroid cells in the lab, but there are no clinical studies showing that it works to shrink fibroids in women. It is not advisable to take resveratrol supplements (or red wine) when you’re pregnant – studies in rats exposed to resveratrol in their mothers’ milk showed long-term effects on the offspring including changes in the brains of male offspring.

During pregnancy, your body is producing large amounts of estrogen hormones, which causes many (but not all) fibroids to grow. Different fibroids can grow at different speeds, and some fibroids don’t grow or even shrink during pregnancy. Sometimes a fibroid can outgrow its blood supply which can cause pain. It’s rare for a fibroid to get in the way of a normal delivery, unless the fibroid is very large, and is positioned low in the pelvis.

Most subserosal fibroids don’t need to be treated with surgery unless they are very large and/or cause symptoms, like an anterior (front side of the uterus) fibroid which pushes on the bladder causing frequent urination.

At least 2-3 times a week when not on your period. If you have regular cycles days 10 – 18 are the most fertile time and you can have sex every other night. You can also use an ovulation predictor test and have sex for the three days starting with a positive test.

Don’t douche after intercourse. Nearly all lubricants like KY jelly are harmful to sperm but are not a major factor for most couples, but if you usually use lubricant switch to pre-seed (see link below). I have no commercial interest in pre-seed.

If you have regular periods, you can try for up to a year if you are under 35, six months if 35 or over, before seeing a Fertility specialist (Reproductive Endocrinologist). If you are irregular, or if you are 40 or over, see a Reproductive Endocrinologist soon.

It could take up to 6 months to a year to conceive even for couples under 35 with no ‘fertility issues’.

Have intercourse at least 2-3 times a week when not on your period. If you have regular cycles days 10 – 18 are the most fertile time and you can have sex every other night. If you are regular, you can also use an ovulation predictor test and have sex for the three days starting with a positive test. If you have irregular cycles using the ovulation predictor kit is not a good idea, it is better to find out why you are irregular and fix any treatable cause. We recommend the OvuQuick brand (search online for ‘OvuQuick kit’ and be aware that it comes in 6-day and 9-day kit sizes) but most drugstore-brand tests are OK. Test between 10 am and noon as the hormone that the kit detects may peak at 3 or 4 am so when you first get up it may be too early in the day to test.

Don’t douche after intercourse. Nearly all lubricants like KY jelly are harmful to sperm but are not a major factor for most couples, but if you usually use lubricant switch to pre-seed. We am not affiliated with the makers of OvuQuick or pre-seed.

If you have regular periods, you can try for up to a year if you are under 35, six months if 35 or over, before seeing a Fertility specialist (Reproductive Endocrinologist). If you are irregular, or if you are 40 or over, see a Reproductive Endocrinologist soon.

I’m really sorry to hear of your loss. The form of Tay-Sachs that kids get is a terrible thing for parents and kids to have to go through.

Tay-Sachs is a single-gene disorder where both you and your partner have an abnormal gene for the disease and one normal gene. A child that gets one abnormal gene from each parent gets Tay-Sachs disease, a kid with one abnormal gene from one parent and a normal gene from the other is a Tay-Sachs carrier and will be normal, like you and your partner.

Unless anyone else in your family or your partner’s family had a kid with Tay-Sachs before (very rare) there is no way that most people would know this before you got pregnant with your first child. So it’s not your ‘fault’ that you had an affected child, but there are ways to do things differently in the next pregnancy.

Getting pregnant ‘the normal way’ there is a one out of four (25%) chance that your next child will also have Tay-Sachs. There are two choices – one is to go through In Vitro Fertilization with Preimplantation Genetic Diagnosis (IVF with PGD) where take eggs from your body after 8-10 days of fertility shots, fertilize them with your partner’s sperm, and test the embryos before putting embryos back inside your uterus – we want to pick embryos that are normal or Tay-Sachs carriers but NOT the ones with the disease.

The alternative is to get early testing when you are pregnant to see if the fetus has the disease – this is mostly for couples who would terminate the pregnancy if another child has the disease.

I recommend that you see both a genetic counselor, if you haven’t already, and a Fertility Specialist (Reproductive Endocrinologist / Infertility or REI MD) to talk about PGD, and not trying until you have seen both. A maternal-fetal medicine (MFM) MD can offer testing of the baby when you’re pregnant.

Rarely, some couples’ insurance will cover PGD testing if you have had a child with a genetic disorder and can get pregnant normally (so don’t have infertility) but want to avoid another affected child. Sometimes your MD needs to write a letter for you, and getting coverage can be a slow process.

If you go the PGD route, REI MD’s can work with different labs that do the actual genetic testing of embryos. I recommend a practice that works with Genesis Genetics, who are the most experienced lab in the USA for single-gene disorders. See the link below. I have no business interest in Genesis, but I know that you’re in good hands with Dr. Mark Hughes.

The diagnosis and treatment of endometriosis depends very much on whether or not you are trying to conceive as well. Some women with early-stage endometriosis have little or zero pelvic pain or fertility issues. We used to diagnose these women when they had a laparoscopy to tie their tubes (there are now less invasive ways to block the tubes in women who are done with childbearing).

The ‘gold standard’ for diagnosis is still to perform a diagnostic/operative laparoscopy, an outpatient surgery performed under anesthesia where a small incision below your belly button allows us to pass a surgical telescope into your abdomen and pelvis and look for endometriosis and often destroy or cut out endometriosis if we find it. More advanced endometriosis may show up on pelvic ultrasound (a sonogram which is best perfomed with a transvaginal probe), bur early-stage endometriosis will not show up on ultrasound. If you are trying to conceive, a hysterosalpingogram (HSG) does not ‘see’ endometriosis but looks for blocked tubes or scar tissue around the tubes, which can occur in women who have endometriosis, as well as for other reasons like past infections.

If you’re not trying to conceive and your main problem is pelvic pain, while it’s more satisfying to have a ‘proven’ diagnosis, it is acceptable to treat the pain with medications (Depo-Lupron shots) without performing a laparoscopy first.

If you are trying to conceive, having endometriosis may change the course of your treatment in subtle or obvious ways. Having endometriosis (and surgical endometriosis treatment) may cause diminished ovarian reserve (low egg supply), scarring around the tubes or pelvic adhesions (scar tissue), or both. Some women with endometriosis need in vitro fertilization (IVF) to deal with these issues, and Depo-Lupron shots before IVF may improve success rates.

Be careful what you wish for … twins are more high risk than a single baby, although most twins do fine with good OB and neonatal care, some twins have long-term problems, some are premature and some don’t even make it to viability and are born before 24 weeks. The risk of cerebral palsy, a serious birth defect, is 4 – 5 times higher in twins compared to a single baby. You have a higher chance of pregnancy complications including serous ones like preeclampsia or placental abruption, a higher risk of C/Section, and even a very slight increase in divorce rate.

I know the media and Anne Geddes and other baby photographers all love to show pictures of cute twins all dressed up … the kids with cerebral palsy are generally not shown on the front cover of a magazine.

Couples who need treatment for infertility, from simple treatments like Clomid to advanced treatments such as In Vitro Fertilization (IVF), often have an increased risk of twins if more than one egg is released with fertility medications, or if more than one embryo is replaced into a woman’s uterus after IVF.

If we’re treating couples for infertility who can’t get pregnant on their own twins may be an acceptable risk of the treatment. Many couples tell me they want twins – they have been trying for a baby for one or many years, and many couples want two babies total and would love to have twins and ‘be done’. We do our best to avoid triplets or more, though. In this case the risk of twins is justified by the benefit of treatment of their infertility.

If you don’t have any problems getting pregnant your natural chance of twins is about 1%. I don’t recommend going to an Ob/Gyn or Fertility MD just because you want twins (wanting twins for social reasons””) – if you end up with complications to you or the babies” would it be worthwhile compared with just having two more kids separately? I would not recommend “getting fixed” in your early 20’s until you are 100% sure that you’re done either we have great birth control options like the Mirena IUD which is about as effective as having your tubes tied but reversible if you have one more child and then want another one later.

Bacterial vaginosis (BV) is not a sexually transmitted disease and does not affect your fallopian tubes or cause infertility. There are no proven home remedies to treat BV once you have it. One very small study suggested that eating 150 ml of live yogurt containing Lactobacillus acidophilus every day helped a small number of women to get less BV infections compared with eating pasteurized yogurt, but this is prevention not treatment.

BV may increase a woman’s chance of getting other STDs like chlamydia and gonorrhea. So get treated for BV by your OB/Gyn, but it’s not usually a factor in how easy (or not) it is to get pregnant.

There is little evidence that specific foods cause infertility. There was one study (link below) published in the journal Human Reproduction that looked at diet and fertility in 18,000 women without a history of infertility who were trying to conceive or got pregnant in an 8 year period. Women with a high intake of low-fat dairy foods (skim or low-fat milk, yogurt, cottage cheese) were more likely to have infertility associated with problems with ovulation (egg release) than women who ate full-fat dairy. Women who don’t ovulate don’t have regular periods, so this finding may not apply to women with regular cycles. The lowest risk of infertility due to anovulation was in women with at least one serving a day of high-fat dairy – defined as whole milk, cream, ice cream, cream cheese or other non-cottage cheese. Yes, ice cream – this should be the most popular fertility study in years. Of all the high fat dairy choices, whole milk appeared to have the strongest effect in this study.

One study doesn’t ‘prove’ that there is a link or even tell us that low fat dairy is ‘bad for fertility’ – there could be some other thing that is really ‘good for fertility’ that the high-fat dairy eaters did or ate more compared with the low-fat dairy eaters (or something bad that the low-fat dairy eaters did or ate more). Having said that you’re welcome to run with it and try one serving a day of full-fat dairy, preferably whole milk, just pay attention to serving size and don’t increase your total calories by a large amount.

Extremes of body weight are associated with reduced fertility. Body Mass Index (BMI) is not a perfect measure of being overweight or not (it doesn’t work for someone who is ‘all muscle’) but a healthy range for fertility is about 18.5 to 25. The ability to get pregnant may fall more at a BMI of 35 and above, although many women can conceive even in this range. See the link below for a BMI calculator.

If you have regular periods, you can try to conceive for up to a year if you are under 35, or six months if 35 or over, before seeing a Fertility specialist (Reproductive Endocrinology and Infertility or REI). If you are irregular, or if you are 40 or over, see a REI physician soon.

Don’t smoke, or quit now if you do. Aim for a normal weight if you’re overweight through diet and exercising regularly (Body Mass Index or BMI 18.5 to 25). Use condoms to avoid STDs if you’re not in a stable relationship, and get tested if you are at risk.

Don’t wait too many years to start trying, and if you’re over 35 when you start trying see a Fertility specialist (Reproductive Endocrinology and Infertility or REI MD) if you’re not pregnant after 6 months of unprotected intercourse. See an REI when you’re ready to start if you don’t have a regular period every month, if you have had endometriosis or Pelvic Inflammatory Disease (PID), a previous ectopic pregnancy, or any surgery on your ovaries.

If you’re asking you’re already beginning to be concerned. In general, peak fertility for women is in the 18-30 age range, and fertility decreases in your 30’s and 40’s. All women are different – there is no age where everyone can get pregnant or no-one can get pregnant; having said that pregnancy is much less common at 45 years and older. On average, your fertility goes down every year from age 40 to 45.

I would start to be more seriously concerned as you get closer to the 38-40 age range, but if you have a fertility issue at 38 it would be better to find out sooner rather than later. There is a lot of individual variation in ovarian reserve or egg supply (the number and quality of eggs that a woman has left) at any age, so there are 35 year olds with good egg supply and 35 year olds with diminished ovarian reserve.

If you’re aware of your fertility but don’t want a baby yet it wouldn’t be unreasonable to do some basic tests to get an idea of how healthy your ovaries look at 35. These would be an ultrasound scan of your ovaries, looking at the size of each ovary and the number of egg-containing follicles on each side or Antral Follicle Count, and blood tests on Day 2 or 3 of your cycle for estradiol, Follicle Stimulating Hormone or FSH, and Antimullerian Hormone or AMH. Day 1 is the first day of your period. If you’re on hormonal birth control such as pills, NuvaRing, Mirena or Implanon we would skip the estradiol and FSH tests. A fertility clinic (Reproductive Endocrinology and Infertility or REI practice) can perform these tests and interpret the results.

If the results look good you can relax and wait a couple of years longer before trying. If there’s a problem with low ovarian reserve, options include freezing your eggs if you’re single or not in a long-term relationship, or freezing embryos for later use if you have a partner or wish to use donor sperm but aren’t ready to get pregnant now. You could also decide to pursue fertility treatment sooner based on the results.

In general, you only need endometriosis surgery if you –
1. Want to have kids and have a large endometrioma (endometriosis cyst within the ovary) or

2. Are completely done with wanting kids and wish to have definitive surgery – removal of both ovaries (with or without hysterectomy).

Surgery rarely ‘cures’ endometriosis unless the surgery is removal of both ovaries (with or without hysterectomy). Removing both ovaries takes away most of a woman’s production of estrogen hormone which stimulates endometriosis tissue and may cause it to grow.

Any other surgery (laparoscopy with laser treatment or cautery or excision of endometriosis, and/or removal of endometriosis cysts) may not remove all the endometriosis in your pelvis – even if your surgeon destroys or excises all visible spots of endometriosis on the surface of the uterus or behind the uterus, on or in the ovaries or on the pelvic side wall, there may be deeper areas of endometriosis not visible on laparoscopy which are missed. Endometriosis may also be hidden underneath areas of scarring.

Because of the above, some women get good pain relief after surgery to treat endometriosis, and some women don’t get good pain relief after surgery. Women with significant endometriosis (more than just a few spots on the surface of the uterus or ovaries) often do better with surgery to confirm the diagnosis and to treat visible disease, followed by Depo-Lupron injections to suppress any endometriosis that’s left behind, than with surgery alone. Surgery alone may provide short term relief of endometriosis pain (a few months up to a few years) before the disease and pain symptoms recur. Women who undergo multiple laparoscopies may get diminishing returns, with less and less pain relief with each successive laparoscopy.

Depo-Lupron can be used on its own without laparoscopy too – it also (but reversibly) takes away most of a woman’s production of estrogen hormone which stimulates endometriosis tissue. If you have pelvic pain symptoms suggesting endometriosis and your pain goes away with Depo-Lupron you are at least 80% likely to have endometriosis.

If you want to try to conceive and you have only small endometriomas, or early stage endometriosis without any endometriosis cysts visible on ultrasound, the surgery may do more harm than good by damaging some normal ovary tissue, which can reduce your ovarian reserve (the number of eggs left in your ovaries).

So the answer is complex but in summary – not everyone with endometriosis needs surgery – it is only definitely needed for big endometriosis cysts or women who are done childbearing. Unless you have both ovaries removed cure is unlikely, but you may get benefit in terms of reducing your pain for a period of time. Medical treatment with Depo-Lupron after surgery often gives better pain control than just surgery. Depo-Lupron can be used on its own without surgery, too.

Chlamydia infections may reduce your chances of having children, but they don’t always cause fertility problems. Chlamydia can lead to pelvic inflammatory disease which can cause damage to the fallopian tubes and even damage to the ovaries as well. This can increase the chances of difficulty getting pregnant, tubal pregnancy (ectopic pregnancy) or low egg supply (diminished ovarian reserve).

Get treated ASAP if you have Chlamydia at the moment, and see a Fertility MD (Reproductive Endocrinologist) if you are trying to conceive now or in the future.

About 85% of couples get pregnant after a year of trying. It could still happen ‘naturally’ (at two years it’s over 90%) but if you have been trying for more than one year or more (under 35 years of age), 6 months or more (36-40 years of age) or if you are over 40 years of age this is a good time to see a Fertility specialist (Reproductive Endocrinology/Infertility or REI) to find out why your partner is not getting pregnant and to help you to get to that first child.

REI physicians train in Ob/Gyn before specializing in fertility medicine. They can do tests to check the number of eggs left in the female partner’s ovaries (ovarian reserve) which can go down as women get older. She should also be checked for hormonal problems which can stop her from getting pregnant including thyroid problems or polycystic ovarian syndrome (PCOS), and the MD will check her uterus for fibroids or polyps and perform a hysterosalpingogram or HSG test to make sure that her fallopian tubes are both open and look normal.

It takes two to get pregnant of course, and the man has a sperm problem in 40-50% of couples trying to conceive, so you will need a semen analysis (sperm test). If there is a sperm issue, it may be the only reason that the female partner is not pregnant yet, or a contributing factor along with problems on the female side. Most REI docs like to see you both partners as a couple, but it is not mandatory that you come to the first visit.

After these tests there are specific treatments for improving fertility depending on the cause(s) we find, such as Clomid can help her ovulate (release an egg) or release more than one egg in a month. Clomid can be combined with Intrauterine Inseminations (IUI) where the sperm is washed and placed inside her uterus. Some couples may need more intensive treatment such as In Vitro Fertilization (IVF).

In short, see a specialist for testing and to come up with an individualized treatment plan to help your wife get pregnant. Lifestyle changes may help if needed as well – quit smoking, avoid heavy drinking and drug, and aim for a normal weight applies to both of you.

It is now possible for women interested in knowing their reproductive potential to obtain a detailed fertility assessment. Our new Fertility Snapshot program lets women know just how easily they will be able to get pregnant in the next couple of years without going through costly testing.