Trying to Conceive: Answering the Infertility Questions
If you're trying to conceive and it doesn't happen easily or quickly, you will have questions. We hear questions over and over again. Often they are the same questions, so the board certified reproductive endocrinologists and the clinical medical team at RMACT have taken some of those questions and answered them so that you can find reliable answers when you most need them.
Very often it does take up to a year to become pregnant. If you are under 35, with no known medical reason for not becoming pregnant, then that's a reasonable amount of time to try. If you are over 35, then six months is what is recommended before seeking help from a fertility specialist.
Meanwhile, here are a few typical questions if you are hoping and trying to become pregnant. We hope that your path to fertility is short and uncomplicated. LR
At what time of the month is a woman fertile?
The most fertile time of a woman’s cycle is just before or the of day ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time.
Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32-day period would likely ovulate around day 18 (32-14=18), while a woman with a 28-day cycle would ovulate around day 14 (28-14=14).
We recommend every other day intercourse around the day of ovulation. That would mean days 12, 14 and 16 for women with 28 days cycles. It is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 13 or 14. For women with irregular cycles you can extend the period of every other day sexual relations.
Alternatively, women with irregular cycles may want to use an ovulation predictor kit, which can be purchased over the counter at most local pharmacies. This involves testing your urine around the time of ovulation using a detector stick, which gives you a visual reading.
Additionally, there are electronic monitors which detect ovulation by tracking two hormones (estrogen and luteinizing hormone) starting with urine testing on day one of your menstrual cycle. The methods that utilize urine predictor sticks or urine ovulation detector machines are usually highly sensitive, accurate, and reliable.
How can a woman tell if she ovulates?
The simple, inexpensive way of finding out the approximate time of your ovulation is to take your basal temperature (that is, your body temperature at rest) every morning and record it on a chart. You can buy a Basal Body Thermometer at your local drug store. Save all your charts so you can review them with your doctor. Three or four months of charting should be adequate. If your temperature goes up after the middle of your menstrual month you likely do ovulate. In general you ovulate about two days prior to the temperature rise.
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Very suddenly it’s gotten cold. Wet. Chilly. In the midst of the heat and humidity of deep summer, we are having a reminder that autumn will be here, perhaps sooner than we thought. The changes of the seasons mark other changes as well. Often the changes of seasons signal endings and beginnings.
The end of long, lazy, summer days. The end of vacation time, more casual clothes, easy out door activities. The end at least, for this summer. Most of us realize and have become accustomed to the cycle of the seasons. Summer will be here once again, we will have it to look forward to. Just as on the hottest, most humid day of the summer, I at least, was longing for the chill and crispness of December.
Autumn is a wonderful time for beginnings just as summer is a lovely time to slow down, take it easy in the heat. The crispness of the air in September makes us feel more fully alert, awake and aware. September has always made me feel more determined. Spring cleaning, I get, definitely, but I also feel geared up in September. Maybe it’s that foundation that’s built into us with the waxing and waning of the school year.
If you’ve been taking a break from infertility treatment, you may be switching gears and getting ready to cycle again, in sympathy with the world’s changes. You may be thinking about what the next step is in trying to conceive. You may have gathered the energy from more restful, peaceful days to move ahead again with doctors appointments.
Or you may have realized that you have been trying to conceive for a year and it hasn’t happened. The cycle that you were hoping and expecting didn’t happen. Infertility is a disruption in the natural life cycle of human beings. With this next season, we can move on.
The seasons are changing; the earth is getting ready for a rest from all the abundance she’s been producing all summer. The earth’s explosion of summer abundance is our rest time; warm, slow days. Now it’s her time to rest, our time for action.
Gather in your resources, your energy and your support and let those things create the buoyancy needed to move through the autumn with confidence. May your fall days be full of cool weather and a firm resolution.
Straight from our FAQ's (frequently asked questions)
At what time of the month is a woman fertile?
The most fertile time of the month is just before or the day ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time. Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32 day period would likely ovulate around day 18 (32-14=18), while a woman with a 28 day cycle would ovulate around day 14 (28-14=14). We recommend every other day intercourse around the day of ovulation. That would mean days 12, 14 and 16 for women with 28 days cycles.
It is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 13 or 14. For women with irregular cycles you can extend the period of every other day sexual relations.
Alternatively, women with irregular cycles may want to use an ovulation predictor kit, which can be purchased over the counter at most local pharmacies. This involves testing your urine around the time of ovulation using a detector stick which give you a visual reading. Additionally, there are electronic monitors which detect ovulation by tracking two hormones (estrogen and luteinizing hormone) starting with urine testing on day one of your menstrual cycle. The methods that utilize urine predictor sticks or urine ovulation detector machines are usually highly sensitive, accurate, and reliable.
Some literature recommends following your basal body temperature. One important fact to note is that if a woman is using a basal body temperature chart, that the temperature will rise after ovulation, and therefore after the most fertile period. The couple should therefore not wait until the temperature has risen to start to have intercourse, as they will have missed the most fertile time. Therefore this is useful in the first few months of trying to confirm ovulation and time it before the temperature rises.
Recently, one of my children was sick. My wife and I sat at the doctor's, in the reception area, waiting for 40 minutes. The front desk receptionist never acknowledged us while we were waiting. I wondered to myself, "is this normal?" Our experience with the physician was rushed and felt strange after all that sitting and waiting. I couldn't help but think about what our fertility patients experience and how much faith they put into our hands; from scheduling their first appointment, to being greeted when they come in for their appointments; to sitting in the reception area, to the medical assistants, board certified doctors, nurses, patient coordinators, and finance staff meeting with them.
Making the decision to see a Reproductive Endocrinologist is a great first step when you need help conceiving. Once you call our office, our staff is set into motion. I know patients are scared, nervous, and ambivalent about coming here. We want you to know that we welcome you with open arms. We have a system that works for your benefit, and an organized knowledgeable practice designed to put you at ease. After many years of taking care of patients at RMACT, we have realized that a team approach to your care works best. One of the biggest compliments we receive is that patients feel really cared for by our practice.
So, to set your mind at ease.... here's what you can expect. RMACT has a team approach. Your team will include your doctor, nurse, patient coordinator and a member of our financial team. Having this type of team approach assures you that when you need answers, you will be helped by someone who knows your medical history, current situation and you personally. You will not need to repeat your information over and over again to new clinicians.
Your initial visit will include an hour consultation with your doctor. During this hour, you and your physician will review your reproductive history and formulate a plan. This time is all about you. All your questions will be reviewed. If you have questions that can not be answered at that time, we will make sure that you receive the answers from us in a timely fashion.
After meeting with your physician, you will meet with your nurse. Each patient has their own designated nurse. Our nurses are all specialists in reproductive care. They will review the plan that you and your physician made during your consultation. RMACT nurses are physician extenders. Through your reproductive journey, they will be in touch with you and will help you follow through with your treatment plan. You can call them at any time just to talk or to review any tests you have completed. It is comforting to have a person who you know is speaking with the doctor regularly and trained to be able to answer your questions.
Along with your nurse, one of our patient coordinators will meet with you. They will help you schedule tests and will act as a liaison between you and your physician. Our coordinators are awesome. Call them anytime.
Many of you will end up doing stimulation cycles with us. These cycles utilize medications. You will be coming into the office in the mornings. All four of our physicians perform ultrasounds and monitor these cycles. Since we are computerized, your primary physician will always know how you are doing no matter which office you go to or which office he/she is in at the time. Your records are electronic, so we can check them and minimize any possibility of mistakes or misunderstandings.
The results of your morning ultrasound and blood work will be reviewed at noon by the physician on call and our nurses as a group. Your nurse will call and review the instructions for that night with you. Any instructions given by the nurse have been thoroughly reviewed and approved by our doctors.
The member of our financial staff that works with you will make sure that you are aware of your insurance coverage, co-pays, forms that need to be filled out, and other responsibilities. They will work closely with you to ensure that you receive all the coverage you are entitled to and help you organize those things that can feel overwhelming.
Finally, we have many supportive services. Please check under patient resources for Acupuncture, Support Groups, Yoga, Nutritional information and more coming. In fact, we are having our first Nutrition Seminar this coming weekend in Norwalk at 10:00 am.
I want you to have a great experience with us. An organized office will put you at ease and make you comfortable. We feel that the best pregnancy rates result from attention to detail and we continually evaluate how best to ensure our patients are cared for with the very highest standards.
I know that in our front desk we have a sign that says, "If you are waiting more than 20 minutes, please let us know".
We mean it. Please let us know how else we can support you.
Spencer S. Richlin, MD, Surgical Director of Reproductive Medicine Associates of Connecticut (RMACT)