FertilityAnswers
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Frequently Asked Questions about Infertility

How long should I wait for an accurate result from a home pregnancy test?

The first day of my last period was on the 28th. I had unprotected sex on the third. I took a pregnancy test on the 11th. The result was negative. How long should I wait for an accurate result?
If your periods are normally every 28 days, then you will ovulate on Day 14. With that in mind, you would ovulate on the 10th. Again, if your periods occur every 28 days, your next period would be on the 25th. The home pregnancy test will detect pregnancy on or about the time for your next period. I would wait and see if your period starts on time. If it does, then obviously you are not pregnant. If it doesn’t, then repeat the pregnancy test. There is a nice article on the site about home pregnancy test that you should read.

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Should I stop taking the pill after a certain period of time? I have been on birth control pills for one year. First I started on orthocyclin and now I am on orthotrycyclin.

This a very common question asked by many women who are currently taking oral contraceptives. Women who use oral contraceptives have no reduction in their fertility once they stop taking the pill. There are a number of myths or misconceptions about the use of oral contraceptives. For example, you do not have to stop the pill or switch pills after a certain period of time. In fact, there is no reason to stop the pill until you are ready to have children. Furthermore, there is some evidence that using oral contraceptives actually helps to preserve a woman’s future fertility. For example, women taking oral contraceptives have a reduced incidence of endometriosis and have a reduced incidence of ovarian cyst formation. Unless you experience side-effects with the pill or you are ready to become pregnant, you should continue your oral contraceptives without fear of them reducing your future fertility.

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I have been trying to get pregnant for about two years. My doctor told me he thought I had endometriosis. How would I know?

Endometriosis is a condition in which tissue that normally lines the inside of the uterus (the endometrium) spreads and implants in areas outside of the uterus. Often the site of the implantation is somewhere in the abdominal cavity. In patients with endometriosis, these implants of endometrium grow on a cyclic basis just as the normal endometrium does. When the normal endometrium sheds during your menstrual cycle causing your period, so do these endometrial implants. They can cause a small amount of bleeding within your abdominal cavity which results in pain.

Symptoms of endometriosis are often described as menstrual cramping and pain that begins before the onset of menstrual bleeding, and continues through the menstrual cycle. The severity of endometriosis often does not correlate with the degree of pain experienced with endometriosis. Often women with a small amount of endometriosis will have significant cyclic pain, and often women with a large amount of endometriosis will have minimal pain. Endometriosis is often seen in women who previously had pain-free menstrual cycles, and have gradually noticed a worsening in their pain.
TThe definitive diagnosis of endometriosis can only be made through surgery where the endometriotic lesions can be seen and sometimes biopsied to make the diagnosis.

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Is it possible for a woman diagnosed with Polycystic Ovarian Syndrome to become pregnant? If so, is there a general timeline from the beginning of treatment to conception?

Polycystic Ovarian Syndrome (PCOS) is a condition associated with anovulation and was first described in 1935 by Drs. Stein and Leventhal. Thus, the condition is also known as Stein Leventhal Syndrome. As originally described, the condition was associated with decreased menstrual flow, hirsutism, and obesity. However, we now know that the condition is much more complex than originally described. The cause or the event that precipitates the problem is unknown. Because you are not ovulating on a regular basis, you are less likely to conceive. As a result, many women with Polycystic Ovarian Syndrome require medication in order to precipitate ovulation. In general, if you have no other problems that would contribute to infertility, the majority of women are pregnant within three to five cycles. As they say, 'individual results may vary' since everyone is a bit different. With this said, you should feel encouraged. Most women with Polycystic Ovarian Syndrome can have a very successful and healthy pregnancy.

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Is there any way to tell when you are ovulating?

Normal menstrual cycles follow a pattern: ovulation (the release of the egg), either fertilization and pregnancy or shedding of the endometrial lining. Normal menstruation involves communication between the pituitary gland, ovaries, and endometrium (the lining of the uterus).
Several measures can be used to determine if you are ovulating. One general method is based on the regularity of your menstrual cycles. If you have monthly menstrual cycles at regular intervals, with associated breast tenderness and abdominal cramping, you most likely are ovulating. Most women ovulate approximately 14 days before their menses begins.

One way you and your physician can predict ovulation is by measuring your basal body temperature. By taking your temperature each morning immediately upon waking, you will notice the distinct increase in basal body temperature after ovulation. Ovulation is thought to occur approximately 1 day prior to the first temperature elevation.

Your physician may measure serum progesterone levels approximately 7 days after suspected ovulation to determine ovulation. If this value is greater than 10 ng/ml you most probably are ovulating. If this value is less than 5 ng/ml you probably are not ovulating.

An additional test is home urinary LH testing. LH (luteinizing hormone) is a hormone produced by the pituitary gland. Immediately prior to ovulation there is a large surge in this hormone. Urine testing involves placing a small indicator in your urine that measures LH. When your urine dipstick turns positive you can expect ovulation in approximately 36 hours.

Finally, your physician may suggest a test known as endometrial biopsy. This test is performed approximately 2 to 3 days prior to your menses and involves removing a portion of your endometrium and sending it for pathologic evaluation.

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What are your chances of conceiving after a miscarriage? Are you fertile after a miscarriage?

Miscarriages are also known as spontaneous abortions in the medical literature. These losses are fairly common. It has been estimated that around 50% of pregnancies result in miscarriage. Many women do not realize that they are pregnant and assume that they are having a delayed period. Of women who know they are pregnant, approximately 20% will have a miscarriage.

Women who have more than one miscarriage consecutively are known as having recurrent abortions. If you have one prior liveborn infant, the risk of recurrent abortion is 20% to 25 % after one miscarriage, 25% after two miscarriages, and 30% after 3 miscarriages. If you have not had a liveborn infant, your risk of miscarriage after 3 prior pregnancy losses is approximately 40%. Infertility, or the inability to become pregnant, is usually not an issue after miscarriage.

IIt is currently debatable at what point testing for reproductive problems should be performed after miscarriage. If you are in your 30s and have a history of infertility, your physician may recommend evaluation after 2 miscarriages. All women should be evaluated after 3 consecutive miscarriages.

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What causes low sperm count?  My husband's doctor said that his sperm count is on the low side because the pH of the fluid is on the high side (8.3). What could cause this and how can it be fixed?  My husband doesn't use drugs, he smokes cigarettes and is an occasional drinker (maybe 3 or 4 beers a month). He's very healthy and fit.

When looking at the causes of infertility, 40% of the time the cause is the male (known as male factor infertility). Therefore, performing a semen analysis during the workup of infertility is commonplace. Low sperm counts are also known as oligospermia. The pH of semen is often measured, but is not usually of much help when evaluating unexplained male factor infertility.

The most common cause of low sperm count is the presence of a varicocele. A varicocele is an abnormal dilation of the veins within the spermatic cord. Treatment for this disorder is surgical, although the sperm counts do not always improve after treatment. Approximately 40% to 50% of the time there is no explanation for low sperm counts.

If an abnormal sperm count is noted on semen analysis, it is important to repeat this test at least one or two more times. Sperm counts may vary significantly from specimen to specimen. Additionally, a period of abstaining from ejaculation for up to 3 days may be necessary before obtaining the sample.
OOther causes of low sperm counts include testicular injury, prior testicular surgery, prior mumps, exposure to excessive heat, exposure to radiation, heavy marijuana or alcohol use, certain medications, use of anabolic steroids, certain anatomic abnormalities, certain endocrine abnormalities, etc. Your physician will obtain a detailed history and run multiple tests in an attempt to determine the cause of the low sperm count. Depending on the results of the testing, treatments may be recommended.

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What is the best time in a woman's cycle to get pregnant?

Most women ovulate approximately 14 days prior to the onset of their menstrual cycle. Therefore, if you have regular 28-day periods, you should be ovulating on approximately Day 14. The best chance of pregnancy is 3 to 4 days before ovulation and approximately 2 days after ovulation. Therefore, intercourse during this time frame would have the highest likelihood of being successful. There are ways to test for ovulation such as measuring your basal body temperature or testing your urine for a luteinizing hormone (LH) surge. This may help a woman determine the time of ovulation if her cycle is irregular.

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