Fertility Program FAQs for Trying to Conceive
Dr. Mark Leondires, Medical Director of our fertility program at Reproductive Medicine Associates of Connecticut (RMACT), uses the term "subfertile". Not only is a lot more user-friendly than "infertile", it turns out to be a whole lot more accurate. Infertile would truly mean not to bother trying, it's not going to work. Subfertile means that there are may be a problem in becoming pregnant but there are also ways to overcome those problems.
Otherwise, no one would ever get pregnant in fertility treatment and, luckily, that is not the case.
It may be that you are trying on your own at home. If so, please read below to make sure that you are optimizing your chances of conceiving.
After all, timing isn't everything. But with fertility, infertility and especially subfertility, it's an awful lot.
These questions and answers and many more are questions that we are asked over and over again at RMACT and that have been answered either by our board certified reproductive endocrinologists or other specialized clinical staff. There are other questions in our FAQ section, which focuses on Infertility Answers and Pregnancy FAQs. And if there's a question that you have that is not there, please ask me. I'll find out the answer for you ~Lisa Rosenthal
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 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.
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.
How often should you have intercourse?
It is a good idea to have intercourse every other day around the time you ovulate. Remember, every woman is different, and may not ovulate exactly on “Day 14.” And, just because you ovulated on “Day 14″ this month, doesn’t mean you will next month. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available. To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.
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Khloe Kardashian and Infertility
Khloe Kardashian doesn't have infertility.
She's been trying to conceive for three-and-a-half years and hasn't become pregnant. (Definition of infertility is inability to conceive after properly timed sexual intercourse in the time period of one year.)
She is saying that her hormones and timing have been off and that's why it hasn't happened.
Did you ever hear the expression, "If it walks like a duck, quacks like a duck, it's probably a duck"?
Photo: Yusuf C. Flickr Creative Commons
Consider adding these, "If it walks like a duck, quacks like a duck, eats like a duck, smells like a duck, swims like a duck, sleeps like a duck, maybe, just maybe it's a duck".
I truly do not mean to be flippant. We all come to things in our own time. More than that, none of us likes to be labeled. And certainly not by someone else.
So Khloe Kardashian doesn't consider herself infertile.
And she's certainly not asking my advice or opinion on if she is or isn't infertile.
Luckily, regardless of what she says or doesn't say in the media, she can get help if she needs it. She can see a board-certified reproductive endocrinologist and figure out if there is a problem and then formulate a course of treatment if it's indicated.
She can decide that she does not have infertility and go through fertility treatment and get pregnant and have a baby.
Then will she be right? That she didn't have infertility and all she needed was a little help?
Maybe this is a great model to follow.
Subfertility: Definitions and Labels
I know that Dr. Mark Leondires, Medical Director for RMACT (Reproductive Medicine Associates of CT) talks a lot about subfertility, rather than infertility. And that so much of subfertility is something that can be overcome. Hence why so many women who are labeled infertile end up conceiving, typically with fertility treatment.
And maybe that's really the case, that we are subfertile, rather than infertile. Because after all if we were infertile, we wouldn't get pregnant and have children.
Are we then cured of infertility because we've had children?
What if we want to have a second child and need fertility treatment, even IVF, do we become infertile again? And are we then not infertile if we become pregnant again?
I'm starting to think Khloe has the right idea. Go with she's not infertile. That she's fertile and all she or any of us need, is help in bringing it out. I like that a lot. The term infertility implies a state of being that cannot be changed. And yet, so often, with the right help from a good fertility program, it does change. We become pregnant and leave infertility behind us. At least until next time we decide to have a baby.
How about this?
I like it. It's almost as if your fertility is hiding, just waiting to be asked nicely to come out. Whether it's medications that you need, or IUI's (intrauterine inseminations) or IVF (in vitro fertilization) or more, your fertility is there, laying wait until the right combination is offered to allow it to blossom.
So, yes, maybe fertility challenged.
Whatever you want to call it, a fertility consultation and treatment is a great idea if you haven't gotten pregnant in over a year if you are thirty-five or under. Fertility treatment is a great idea if you are thirty-five and over and have tried to conceive for six months.
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Why Does it Matter that Betty White is Childfree at 90?
Betty White is going to celebrate turning ninety years old later this year. She was married three times. She is a remarkable woman who is still a working star; who is a household name; who is so on the ball, that she makes women half her age seem rather insipid and tired. She's beautiful, smart, funny, talented and has great timing.
If you google her, guess what comes up in the first three paragraphs on almost any print interview, description or video? Wait for it. It's coming. Yes, you got it. Why didn't Betty White have any children? The woman is about to be ninety years old. And she's still being asked why she didn't have children. I guess that answers the question of will people ever stop asking the question. The answer is no.
It's been at least forty years since she could have conceivably (sorry, couldn't resist) had a child. And still she's being asked why? Why? Why would anyone still care? She's done astonishing things in the last forty years, the last ninety years. Why would anyone still care whether she had children and why she didn't? It's part of her life and history, so it makes sense that it's a question that's asked. I guess. I just wonder.
Is it Only Socially Acceptable to Not Have Children When One's Infertile or Their Fertility Treatment Fails?
Is it ever ok to decide not to have children? Do you have to have been infertile and have fertility treatment not work out? And then try adoption and have that not work out? Do you just have to run out of money? Or stamina? Is it ever OK not to have children for a simpler reason? That reason being that one simply doesn't want to. Someone who does not want to have children makes the choice not to. Not backed into that choice but choosing not to. For whatever the reasons are. Maybe the reasons are personal and not shared with the public. Or that someone did want to have children and it didn't work out.
I wonder what makes it such a fascinating subject. And why we all feel entitled to an explanation. I wonder when we all came to feel that such a personal decision was one that we could inquire about in the first six minutes of knowing someone. When is someone old enough to not be asked about why they didn't have children? Don't ask Betty White. Because clearly ninety isn't old enough. Thanks K, for talking with me about this at Fertile Yoga the other night. We're all entititled to privacy, children or no children.
This photo, “Betty White David Shankbone 2010 NYC" is copyright (c) 2010 david_shankbone and made available under a Attribution-Noncommercial-Share Alike 2.0 license
For some of us, seeing a pregnant woman is devastating. For some of us, when we are dealing with our own infertility and know that woman has struggled, as we are or have, the visual of her rounded belly is encouraging. How do we support you, ourselves, when we live in a world where, it seems, everyone is pregnant?
I say, play it by ear. There will be times when going to a friends' baby shower will feel absolutely fine, no big deal. There may be other times where it will feel next to impossible. Why not treat each event or invitation individually and decide based on how you are feeling in that moment?
This may count as my true confession blog. The story of the baby shower I should not have gone to. I was an angry infertile woman. Very angry. Very infertile (six and half years in treatment!) I was angry at every single pregnant woman that I saw, infertility treatment or not, I really didn't care. Not throughout all of the years of treatment, luckily, but the first few, definitely, very, absolutely angry.
There was an invitation that I should never have accepted. You know the kind. Where you talk yourself into believing that it will be fine, knowing full well that it won't be. Knowing full well, because the anxious knot right below your stomach keeps reminding you.
My cousin's baby shower, right smack in the middle of an IVF cycle. In the middle of injections and blood draws and ultrasounds and anticipation and excitement and worry and wonder. How could it get worse? Don't you hate when you ask yourself that and find out the answer is that it could get worse, much worse. Worse could be that every single one of the other women attending the shower were pregnant. Every single one. The baby shower was just for our generation, so no Grandparents, and the other 11 women who were there were pregnant. A few of them with their first child, but most with their second or third.
Want to hear the worst thing? My confession that will make every one of you feel better and less guilty about whatever the worst thing is that you have done as an angry infertile woman? With twelve pregnant women at this shower, I stayed in the bathroom and cried for two hours straight. Uh huh. That doesn't sound so terrible does it? Except we were having this baby shower in a cute, little, one bedroom apartment in Manhattan. Guess how many bathrooms there were? Did I mention that there were twelve pregnant women there? That I stayed in the bathroom for over two hours?
I hope that you are at least smiling. Because, to my credit, as angry as I was, I didn't stay in the bathroom for two hours crying to make the twelve pregnant women uncomfortable. I stayed there because that was the best that I could do. And to my utter relief, that was a bottom for me. When I finally dried my tears and let those pregnant women fight each other about who was first in the bathroom, I felt better.
I cry perhaps twice or three times a year. That cry in the bathroom was one where truly there was release and comfort. Never again did I feel quite that level of despair and anguish. I was even able to see the humor in the situation.
Good morning. It's 5:30 am and I sit here writing to you. Hopefully none of you are as intimately connected as I used to be to the BBT. I'm even hoping that I am dating myself and that none of you even knows what that is. Chances are, if you are trying to conceive, you at least know what it is.
Basal Body Temperature. That's what BBT stands for. It seems so innocent, yet it's my recollection of wanting to throw those thermometers across the room, that stays with me. Spending the last few minutes looking on our glossary and further on the internet, I realize that the BBT is very much alive and well. Interesting to me is my vivid memories of how much I despised that particular test. Interesting because it's not painful, (no shots), it not inconvenient, (first thing in the morning before getting out of bed), it's doesn't raise/lower/alter any hormone levels, it's quick, it's inexpensive.
So why did I dislike that particular test so much? And what made me think of it now?
Because for me, 5:30 AM is first thing in the morning. Maybe and hopefully, for most of you that is true. (We won't talk about my crazy sister who is already done with her morning work out by this time in the morning. She also goes to sleep by 8:15 most nights.) That explains my distaste for the basal body test, thermometer and charting in a nutshell.
Waking up each morning, every single morning and having my failure to conceive (that's right, that's how it felt, that's how it feels sometimes, doesn't it? Especially first thing in the morning?) be the first thing I had to think about was demoralizing. Depressing. Just plain awful. Sorry, sugar coating it would also be rewriting history. I hated it.
Dr. Ben Sandler gave me permission to throw it away. He was very kind. He looked at the stack of graph paper in which I had meticulously charted my temperature for months and was very kind. I remember him asking me if it felt at all stressful to take my temperature every morning. I almost, but did NOT, burst into tears. I knew this was the right doctor for me.
And I knew also, that this innocuous, not painful, not expensive, not particularly invasive, not hormone altering test was not the right approach for me. We moved onto ovulation predictors, which were a relief after the daily grind of months of temperature taking.
The first morning I did not take my temperature felt like a vacation. I stretched, touched my toes, and didn't worry about moving around and skewing the chart. It felt luxurious, decadent, lovely and powerful not to have to focus that intently on my infertility first thing in the morning. Even better was when it left my consciousness completely as taking my temperature ceased to even enter my mind first thing in the morning.
Powerful. I loved that.
My moral of the story? Because if you have been reading my blog, you know that I kind of like to be able to learn something from everything. My moral of this story is that if you are on a break right now from treatment; see how you can support not being infertile first thing in the morning. A metaphor of course. But really, who needs to be reminded of being fertility challenged the first moment of every single day?
Do something different. Change up your routine. Do some of the stuff we keep telling you not to do. Have a drink, eat some chocolate, work out like crazy, stay up way too late, drink some caffeine.
Take a break from infertility. Notice those moments when you did not feel infertile. Just felt like you.
Savasana is final relaxation pose in a yoga
practice. A deeply quiet place where all the outer layers of who you are peel away. What you do for a living, how you spend your time, what you own, how much you weigh, even whether you are a parent; all melt away to reveal to you the essence of who you are.
You are not infertile. I am not infertile. I am Lisa. Some of you have been making your name known to me; none of you are "infertile". You each have your own name, and you are each a unique person. We are not our diagnoses. That's what a friend said to me today, as a response to yesterday's blog, "we are not our diagnoses". What a good reminder, thank you.
We will live in this space of trying to conceive for a time period. Sometimes it feels like it will last forever. Oh, like waiting those two weeks for the results after a cycle. Or getting blood drawn and knowing the phone call is coming with a "yes, you are" or "no, I'm sorry, you're not". Or yet another month of getting your period when you are so hoping not to.
It actually will not last forever. Life is not designed that way. One way or another, you will have resolution around becoming pregnant and having a baby. There are many different ways that resolution is reached. It may not be the way you expect or want. Already, it's been pretty tough, hasn't it? I love our practice, our doctors, nurses, clinicians. Still, not what you envisioned when you pictured creating a child. No matter where you are in treatment, it will have a time limit on it. And you will be in a different place. You will still be that essential you, separate than your diagnosis.
So spend some time with a spectacular person this holiday season. Yourself. Find a way to inhale deeply, coming into yourself. The season can be so busy, so full of things that must be done and need our attention. In yoga, we refer to that as our exhale. The inhale is necessary to replenish, refresh and renew. Similar to what the earth is doing. Bringing energy inward so that it can burst forth in the spring; the earths exhale.
You are worth it.Inhale.