Not true. Infertility is more or less equal with women as with men. However, it is a shade higher because age has more effect on female fertility than on male fertility, as a woman makes few, if any, new eggs in her lifetime, with a peak number of eggs at birth. The number and quality of eggs left (ovarian reserve or egg supply) declines in women in their 30’s and 40’s, and rarely in their 20’s. Men have less consistent effects of aging, as they make new sperm all the time, so some men in their 50’s or 60’s may have little or no sperm problems.

The most common factor is diminished ovarian reserve (low egg numbers and quality) which is more common as women get older. Some of the contributory causes are:

1. Ovulation disorders

This means that ovulation is non-existent or infrequent. Problems with hormonal regulation may have their origin in the hypothalamus or the pituitary gland or the ovary. Among these alterations we would have polycystic ovary syndrome, hypothalamic dysfunction, premature ovarian failure or excess of prolactin, for example.

2. Damage in the Fallopian tubes

Blocked Fallopian tubes can interrupt the passage of sperm to the egg, as well as the passage of the fertilized egg to the uterus. This blockage could come from STDs that have caused a pelvic inflammatory disease or an infection in the uterus. Other causes could be previous surgery on the abdomen or pelvis.

3. Endometriosis

In endometriosis, the endometrial tissue grows outside the uterus. This abnormal growth, and the surgical procedure to remove the tissue, can form scars capable of blocking the Fallopian tubes.

Endometriosis can also damage the ovary since the formation of endometriosis cysts (endometriomas) can decrease a woman’s ovarian reserve.

4. Uterine causes

The presence of large fibroids or fibroids that affect the uterine cavity as well as congenital malformations of the uterus could affect implantation and can cause difficulty in becoming pregnant or in the case of malformations, increase the risk of miscarriage of the woman.

5. Risk factors

There are factors that increase the chances of infertility, such as age, smoking, overweight, alcoholism or a sexual background in which unprotected sex has caused multiple STDs.

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.

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.

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.

No. However, many women with painful periods and pain with intercourse might harbor endometriosis, which is indeed associated with infertility. Therefore, an evaluation is warranted in these cases.

Birth control pills or the Nuva Ring have return to fertility within weeks of stopping them. Many women start birth control pills as teenagers, and stop them in their late-30’s when ready to conceive – fertility is the same as for non-Pill users, their age when starting trying to conceive may be a factor rather than the length of time on the pill. Depo-Provera shots can stop periods for 6-18 months after stopping – during this time fertility is low but there are no long-term bad effects.

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.

It is normal for most of the ejaculated sperm to come out of the vagina following coitus. For most of the couple, this does not decrease the chance of pregnancy. This is because, the sperm which represents only 2-3 drops of the ejaculate volume, immediately moves from the vagina and enters the cervical mucus where it can remain alive for 5-7 days. The cervical mucus acts as a reservoir for the sperm, from which the sperm moves through the upper reproductive tract to reach the egg in the fallopian tube and fertilize

There are ovulation tests that are able to detect this period through an increase of the luteinizing hormone (LH) in the woman’s urine.

In addition, there are certain physical signs that can help us find out which days are our most fertile: mainly, vaginal discharge and basal temperature (which usually increases by 0.3ºC to 0.5ºC in the two or three days after ovulation).

Now you know when the best time is to get pregnant! And if you have any questions, don’t hesitate, we at PSFC will be happy to help you!

Occasionally, stress control, diet changes, and physical exercise may be enough to restore ovulation. If there are hormonal changes, a treatment adapted to each situation will be received.

If the treatment fails to recover ovulation and a woman wants to become pregnant, there are other alternatives such as assisted reproduction. Currently there are different options that adapt to the needs of each person

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.

The process of ovulation is part of the menstrual cycle and starts 5 days after your period. From the fifth to the seventh day, the hormonal changes that make it easier for the egg to leave the body and travel to the fallopian tubes, begin.

At the end of this second week – that is, 14 days after the period starts – the egg can be fertilized. This is the key moment.

Therefore, and taking into account that sperm live around 48-72 hours, the optimal fertile range is between days 11 and 17 of the cycle.

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.

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.

It is generally due to a hormonal imbalance that may be caused, among other reasons,

• Polycystic ovarian syndrome (PCOS)
• Stress
• Hyperprolactinemia
• Thyroid problems
• Alimentary disorders
• Excessive exercise

Usually during the menstrual cycle occurs the ovulation. This consists in the release of a mature egg that can be fertilized by a sperm to form an embryo.

Anovulation is the absence of this ovulation, that means, along the menstrual cycle the ovaries do not release eggs and fertilization can’t occur. This causes female infertility problems.

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.

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.

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.

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 PSFC

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

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.

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.

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.

AMH is a protein hormone produced by cells inside the ovarian follicles. The level of AMH in the blood can help doctors estimate the number of follicles inside the ovaries (egg count). A typical AMH level for a fertile woman is 1.0–4.0 ng/ml.

There is scientific evidence that weight can significantly affect the time it takes for a healthy woman to become pregnant. Being overweight, obese or being excessively thin can negatively influence both the menstrual cycle, the normal development of the egg or the ability to get pregnant.

In men, it has been seen in some studies that seminal quality is altered in the presence of obesity, since sperm concentration and morphology is worse.

Therefore, the best thing to ensure a pregnancy with a high success rate, it is advisable to be within normal weight limits.

How do I know if my weight is within the right range for conceiving? What risks do I take?

Rather than focus on weight, we should look at the famous BMI (body mass index). Currently there are many online BMI calculators to calculate this value. According to the WHO recommendations, it is considered that:

• A BMI <18.5 indicates excessive thinness. Patients in this range are at risk of ovarian dysfunction and an increased risk of preterm pregnancy.
• A BMI between 18.5 – 25 is considered normal weight. Patients in this range have the ideal conditions to conceive safely.
• A BMI between 25 – 30 indicates that there is overweight
• and a BMI> 30 indicates obesity. Patients in this range have higher cycle cancellation rates, worse embryo implantation rates (due to less endometrial receptivity) and increased abortion rates. Also, it would be more likely to find gestational complications such as gestational diabetes.

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.

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

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.

During a woman’s reproductive cycle, each month a single follicle is selected out of a group of potential follicles, reaches maturity and ovulates a single egg. Many fertility treatments stimulate the ovarian process to retrieve more egg. Those women who respond well to fertility medications are described as having normal ovarian reserve. Those patients who have a poor response to fertility medications are described as having diminished ovarian reserve.

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.

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.

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.

Yes, egg count can be measured with two tests: an antral follicle count and an AMH
(anti-Müllerian hormone) test. These tests give an idea of not only your total egg count, but also of how many eggs you may be able to freeze during one cycle.

These tests are performed during our initial fertility assessment. Contact us to schedule Fertility Assessment.

Your egg count is the number of follicles, or potential eggs, remaining in your ovaries. Though born with 1–2 million egg follicles, a woman loses upwards of 1,000 eggs per month until menopause, with the rate of loss increasing after 35. Low egg count can lead to infertility, and can also affect how successful a woman is with egg freezing or in vitro fertilization treatments.

No, it’s not possible to measure the quality (or genetic normalcy) of an individual egg. But there’s a clear relationship between age and egg quality, so your age is a good proxy for how many normal eggs you may have.

An antral follicle count is performed by a doctor during an ultrasound. After visualizing the ovaries, the doctor can count the “activated” follicles in that cycle and use that number to estimate her total egg count.

One of the reasons linking fertility issues with fibroids is that they can even obstruct the fallopian tubes, preventing the fertilization of the egg. On the other hand, continued miscarriages can also be explained due to their presence.

Diagnosis is easy. Annual check-ups at the gynecologist, through a scan, can detect the fibroids presence and size.

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.

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.