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Path To Fertility Blogger Lisa Rosenthal  

Lisa Rosenthal has over twenty-five years of experience in the fertility field, including her current roles as Coordinator of Professional and Patient Communications for RMACT and teacher and founder of Fertile Yoga, a class designed to support, comfort and enhance men and women's sense of self. Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association, where she was Educational Coordinator, Conference Director and Assistant Executive Director

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Fertility Program FAQs - Am I Infertile? Should I Keep Trying to Conceive?

  
  
  

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?


ovarian cycle chart for fertility program FAQsThe 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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Frequently Asked Infertility Questions

  
  
  

Trying to Conceive: Answering the Infertility Questions

Infertility Questions when Trying to ConceiveIf 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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Ovulation and Trying to Conceive | Medical Monday

  
  
  

Understanding Ovulation and Trying to Conceive

ovulation cycle

For Medical Monday, let's revisit some basics: If you know when you ovulate, you are the minority. Most of us women don't have a clue until we are trying to conceive and it doesn't work. A lot of us don't even know that we need to ovulate or what ovulation is.

 

So, for the record, here's the definition of ovulation, according to WebMD:

 

Ovulation is the release of a mature egg from an ovary during the menstrual cycle.


Ovulation dates vary widely from woman to woman and from month to month. Many women need to use one or more methods to pinpoint their ovulation day. This can be done by checking for several days of stringy cervical mucus, charting basal body temperature changes, and checking luteinizing hormone changes with urine test kits.

Ovulation and Conception

We are often pleasantly surprised to find that adjusting our understanding of when we ovulate so that we have correctly timed sexual relations can allow us to conceive with no further interventions. 

 

If conception does not happen and you are not pregnant after one year of properly timed sexual intercourse (six months if you are over the age of 35), then it's time to investigate further. 

 

Still, do not assume that becoming pregnant will be a long, drawn out situation or that it will be inordinately expensive. Many of us become pregnant with very little medical intervention.

Financing Fertility Treatment

There are many options for financing fertility treatment--probably more than you think. Many of us have medical insurance that covers infertility and fertility treatment. There is also the Connecticut State Mandate, the New York State Mandate and financial plans, like the IVF Opportunity Plan and the IUI Opportunity Plan.

 

Plan on taking this one step at a time. 

 

First, make sure that you ovulating and when you are ovulating. Then, make sure you have having sexual intercourse during that window of opportunity.

 

Then, if conception is not happening, we'll take the next steps together. 

 

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You Get Your Period, You're Okay, Right? Maybe Not | Fertility Basics

  
  
  

Fertility Basics: How the Reproductive Cycle Works

Fertility Basics means understanding how your reproductive cycle works.

 

Sounds simple.

 

But how many of us really understand? 

 

And before you think I'm looking down my nose at you, forget it.

 

After all, how many of us know how our pulminary system works? Or really understand how our cardiac system works. We know which organ is responsible for each system, but do you really understand the intricacies of how each system works?

 

Getting Periods Doesn't Guarantee Ovulation

It was eye opening to me to realize that just because I was getting my periods didn't mean that I was ovulating.

 

Reproductive Cycle

 

Huh?

 

Wasn't that the whole point of menstruating, because I ovulated?

 

No.

 

Oh, really.

 

Okay, so my endometrial lining could build up even without my producting an egg, otherwise known as ovulating? Then that lining will shed anyway. And it will seem like a very heavy or light or anything in between period. Or it won't. Or it can produce endometriosis (endometrial lining tissue adhering places other than in the uterus). It gets very complicated. And it's intricately related to hormones being produced in the right amounts at the right times and in the right order, governed by the endocrine system. Another system that I don't necessarily understand that well.

 

Here is where I excuse myself. I did not go to medical or nursing school. I do not expect that I will know or understand the inner workings of the liver or kidney or spleen. I suppose if I found out that I was having a problem with one of those organs, I would educate myself. 

 

I would also still depend on finding a great doctor and hear what they had to tell me. 

 

Facing the Challenge of Fertility Problems

One challenge with fertility problems is that until you are trying to become pregnant, sometimes you have no idea that there is any problem at all. Especially if you are menstruating. Or you are on birth control and it regulates your period. Or if you are like most of the rest of us women out there and don't know what to look for.

 

It comes as a shock when you are healthy and fit and get your period every 28 days that you are having trouble conceiving. It doesn't make sense.

 

Until you look at all the details that have to fall into place. All the intricate details.

 

When I understood more about my reproductive system and my endocrine system, it never made sense again that anyone ever got pregnant. 

 

Which was kind of a cool realization. Because it really is a miracle to get pregnant.

 

With or without help from a fertility specialist.

 

It is a miracle. 

 

If you are under 35 and have been having properly timed intercourse for a year and have not gotten pregnant, get a referral to see a board-certified reproductive endocrinologist. If you are over 35 and have been trying for six months, it's time to make that appointment. Make an appointment sooner if you know that you have a problem or are not menstruating regularly.

 

Getting pregnant isn't always easy. Sometimes it's harder than any of us ever thought possible. Getting help shouldn't be.

 

Find yourself a fertility doctor. Get yourself help. Find your miracle. 

 

 

Ovulation and Infertility Treatment | Fertility Basics

  
  
  

Understanding Ovulation and Trying to Conceive

ovulation cycle

If you know when you ovulate, you are the minority. Most of us women don't have a clue until we are trying to conceive and it doesn't work. A lot of us don't even know that we need to ovulate or what ovulation is.

So, for the record, here's the definition of ovulation, according to WebMD:

 

Ovulation is the release of a mature egg from an ovary during the menstrual cycle.


Ovulation dates vary widely from woman to woman and from month to month. Many women need to use one or more methods to pinpoint their ovulation day. This can be done by checking for several days of stringy cervical mucus, charting basal body temperature changes, and checking luteinizing hormone changes with urine test kits.


Ovulation and Conception

We are often pleasantly surprised to find that adjusting our understanding of when we ovulate so that we have correctly timed sexual relations can allow us to conceive with no further interventions. 

 

If conception does not happen and you are not pregnant after one year of properly timed sexual intercourse (six months if you are over the age of 35), then it's time to investigate further. 

 

Still, do not assume that becoming pregnant will be a long, drawn out situation or that it will be inordinately expensive. Many of us become pregnant with very little medical intervention.

 

Financing Fertility Treatment

There are many options for financing fertility treatment--probably more than you think. Many of us have medical insurance that covers infertility and fertility treatment. There is also the Connecticut State Mandate, the New York State Mandate and financial plans, like the IVF Opportunity Plan and the IUI Opportunity Plan.

 

Plan on taking this one step at a time. 

 

First, make sure that you ovulating and when you are ovulating. Then, make sure you have having sexual intercourse during that window of opportunity.

 

Then, if conception is not happening, we'll take the next steps together. 

 

 

Five Simple Things to do If You Are Trying to Conceive

  
  
  

Tuesday text
If you have been trying to become pregnant and it’s not working, here are five simple things to think about

  1. Discontinue all forms of birth control. I know this is common sense, I know, but still. This includes condoms and many forms of lubricants that have spermicide. My husband of 26 years will still ask me to check the plug when something’s not working. At least 40% of the time, it’s unplugged. So don’t use any birth control methods.

  2. Keep track of when you are menstruating. Day one is the first day that you get your period. If you have started menstruating after 2 or 3 in the afternoon, count the next day as day one. I write the number 1 in my date book with a circle around it, makes it simple.

  3. Make sure that you are having sex at the time you are most likely to become pregnant, during ovulation. Usually that’s around day 12-18, depending on how frequent your menstrual cycle is.

  4. Have sexual intercourse every other day starting at least two days before you believe you will ovulate (using an ovulation kit will help you be more accurate). Ejaculation should be done inside the woman’s body. Again, I know this makes sense, but still, a reminder.

  5. Don’t use any methods of vaginal cleansing immediately after intercourse, particularly douching. No spermicide of any kind either.

For those of you who understand all of the above, keep in mind that there are those who do not. Not all of us do understand how things are supposed to work, so while these tips may be obvious beyond belief, they may not be for everyone. Assumptions that we understand our bodies and reproductive cycles are often wrong and the tips above are just a simple reminder.

Another simple reminder, if you are under 35 and have been trying to conceive for a year or over 35 and have been trying for six months, it’s time to consider seeing a board certified reproductive endocrinologist, also known as a fertility specialist.

 

You Are Most Fertile the Day Before Ovulation- When is That?

  
  
  

Wednesday test
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.

Infertility specialists answer most frequently asked questions

  
  
  

Fertility Specialists Answer Most Common Infertility Questions

Norwalk, CT (March 30, 2010) - The fertility doctors of Reproductive Medicine Associates of Connecticut (RMACT) - Fairfield county's largest fertility clinic - have compiled the most common questions they receive about fertility, as well as answers. 

"Infertility can be confusing, and people frequently ask questions because they want to know if they should seek help from a fertility specialist," says Dr. Mark Leondires, Medical Director.  "The questions and answers below are intended to give some basic knowledge.  Many couples put off seeing a fertility specialist when they are having trouble getting pregnant, but they are typically reassured after being diagnosed and starting a treatment plan."

What is infertility?

Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has been unable to carry a pregnancy that results in a live birth.

Is infertility a "women's problem"?

Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. In the balance of cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.

How long should we try before we see a doctor?

In general, if you are less than 35 years old and have been trying for more than one year you should schedule an appointment with a fertility specialist. If you are greater than 35 years old we would like to see you after at least six months of timed, unprotected intercourse. However, if you have a reason to suspect you may have a problem getting pregnant such as a history of pelvic inflammatory disease, painful periods, miscarriage, irregular menstrual cycles, or if your partner has a low sperm count, you should seek help sooner. Many couples have a hard time admitting that there may be an infertility problem, but be reassured there are often many things we can do to help.

What is a Fertility Specialist?

A fertility specialist, or Reproductive Endocrinologist, is a medical doctor who has been specially trained in the complex issues that can contribute to infertility. In addition to being trained as an Obstetrician/Gynecologist which requires a four-year residency a fertility specialist must complete an additional two to three year fellowship in reproductive endocrinology.  This fellowship training is highly specialized to focus on the diagnosis and treatment of infertility and  female endocrinology.. A physician can become Board Certified in Reproductive Endocrinology by successfully completing the fellowship as well as written and oral examinations. 

Currently in the Unites States, there are only about 1,000 Board Certified Reproductive Endocrinologists. Specifically for infertility related to males, Urologists with a sub-specialty in Andrology are the most qualified experts as they have often completed two-year fellowships and passed exams to become Board Certified in Andrology.

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 having sexual relations to every other day from day 11 to 18 ( 11-13-15-17).  In order to better understand what day you ovulate take your average menstrual cycle length (for example 32 days) and subtract 14 and that will give you that day you ovulate around (that would be about day 18).  Therefore you would have relations days 15-17&19 to cover all your bases.

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 we 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.

What fertility testing should our fertility doctor perform?

Your doctor will likely do the following:

  • Blood tests to check reproductive hormone levels in the woman; estradiol (E2), progesterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormone, prolactin, and possibly male hormone levels.
  • Complete semen analysis on the male partner
  • Hysterosalpingogram (HSG), an x-ray exam to evaluate if the woman's fallopian tubes are open
  • Ultrasound to confirm the normal appearance of your uterus and ovaries in the woman

What about smoking and drinking alcohol and caffeine?

There is evidence linking reproductive impairment with exposure to alcohol, tobacco, and caffeine.

Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women, and tobacco is an especially potent reproductive toxin that negatively effects female fertility by damaging eggs. In men there is a direct effect on sperm quantity, quality, and reproductive function. In general we ask that women consume less than 150 mg of caffeine per day which is equivalent to two small 8 oz cups per day. Remember sodas and tea also contain caffeine. In addition, it is wise to be in the best physical shape possible while you attempt to conceive and, of course, to ensure a healthy pregnancy and baby.

Are hot tubs really bad for a man?

Yes. High temperatures can damage sperm. That is why the scrotum is located outside the body - to act as a kind of "refrigerator" to keep the sperm cool. So, it is a good idea to avoid hot tubs, saunas, and steam rooms when men are trying to help in the pregnancy pathway.

What else can we do?

Learn as much as you can about infertility.

  • Get and read good, reliable information (not just from popular magazines) from your doctor, library, or trusted friends or family.
  • RESOLVE (http://www.resolve.org/) and the American Fertility Association (AFA - www.theafa.org) has over 60 fact sheets on different topics related to infertility, and support groups in many areas.
  • Also visit the ASRM (http://www.asrm.com/), SART (http://www.sart.org/), ACOG (www.acog.org) and CDC (http://www.cdc.gov/) web sites for more information.

 

About RMACT

Reproductive Medicine Associates of Connecticut (RMACT) specializes in the treatment of infertility.  With Connecticut fertility clinics and egg donation offices in Norwalk, Danbury and Greenwich, and affiliate New York fertility clinics serving Westchester, Putnam and Dutchess counties, our team of Board-Certified Reproductive Endocrinologists offer a wide range of infertility treatments from ovulation induction and intrauterine insemination (IUI) to the most advanced assisted reproductive technologies including in-vitro fertilization (IVF), egg donation and preimplantation genetic diagnosis (PGD). The RMACT team of fertility doctors includes Drs. Mark P. Leondires, Spencer S. Richlin, Joshua M. Hurwitz and Cynthia M. Murdock. All physicians are members of the American Society for Reproductive Medicine (ASRM), the Society for Assisted Reproductive Technology (SART) and the Fairfield County and Connecticut Medical Societies. RMACT's IVF laboratory is accredited by the College of American Pathologists (CAP), and CLIA; other accreditations include the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Institute for Ultrasound in Medicine (AIUM). RMACT offers individualized infertility treatment plans in a patient-focused and supportive environment. Support services, such as, infertility treatment financing, psychological counseling, acupuncture and yoga are also available. For more information visit, http://http://www.rmact.com/.

  

 

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