1) When is a Woman’s most fertile time?
• A woman’s most fertile time is during ovulation. Ovulation typically occurs within day 11 through day 21 of a woman’s cycle.
• Counting from the first day of a woman’s last period, day 1 is the first day a woman starts bleeding, and the 11th day is most likely the earliest day a woman will ovulate. The 21st day is most likely the last. A woman’s period comes between the 28th and 32nd day of the cycle. This pattern may differ slightly with each woman depending on a variety of factors.
2) How common is Infertility?
• 25% of infertile couples have more than one cause of infertility.
• The current increase in infertility might be the result of more women choosing to delay starting a family until later in life, when their reproductive health can be affected.
• The increase of some STD’s such as Chlamydia can result in conditions such as blocked tubes, preventing pregnancy from occurring.
3) Is Infertility a medical problem related to the woman only?
• Infertility is a medical condition that is found in both men and women, and men and women are affected almost equally.
• With men, declining sperm counts, testicular abnormalities, and decreased reach of climax are common causes of infertility. Shop Products to Help Increase Sperm Count
• With women, the most common causes are tubal blockage, endometriosis, PCOS, and advanced maternal age which affects egg quality/quantity. Shop Products to Help Female Reproductive Health
4) Can you find out earlier if you have fertility issues?
You always have the option of asking your health care provider to conduct a complete examination to determine if either partner has possible fertility issues. You can also choose to do at-home fertility testing, available for both men and women.
5) What about fertility treatments?
• Fertility treatments can increase the likelihood of getting pregnant.
• Treatments can include lifestyle changes, vitamins and supplements, surgery, medication, or assisted reproduction. Shop Fertility Supplements Now
• There are several treatments under assisted reproduction such as in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT). All these procedures involve harvesting a number of eggs in the hope of fertilizing at least one egg, and then insert the fertilized egg(s) into the uterus.
6) What is the In Vitro Fertilization (IVF) Cost?
The average cost of an IVF cycle in the United States is $12,400. Like other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment, and the cycle may need to be repeated to be successful. While IVF and other assisted reproductive technologies are not inexpensive, they account for only three hundredths of one percent (0.03%) of U.S. health care costs.
7) What if my eggs don’t fertilize?
Most eggs will fertilize when they are placed in a culture dish with several thousand normal sperm. This process is called “in vitro fertilization” or “IVF.” When there are not enough normal functioning sperm for IVF, fertilization will usually occur after a single live sperm is injected into each egg, termed “intracytoplasmic sperm injection” or “ICSI.” On rare occasions, fertilization does not occur even with ICSI, presumably because of a problem inherent to either eggs or sperm. In these cases, the use of donor sperm or donor eggs will usually result in fertilization. Your fertility specialist and IVF laboratory personnel will help you determine which approach is most likely to result in egg fertilization.
8) What if I don’t respond to the drugs for ovarian stimulation?
A response to ovarian stimulation depends on a number of different factors, the most important include available eggs, appropriate hormone levels, proper administration of any medications and lifestyle/environmental factors.
In order to respond to ovarian stimulation, a woman must have eggs available to respond; this is sometimes referred to as ovarian reserve. If a woman has diminished ovarian reserve (identified by a high blood levels of follicle stimulation hormone (FSH), low blood levels of anti Müllerian hormone (AMH) or a low antral follicle count on ultrasound), she may not have as robust (or any) response to stimulation. For these patients, an alternate stimulation protocol may be tried or donated eggs may be used (from a woman known or unknown to the patient).
It is possible that a woman does have the necessary eggs but lacks the appropriate pituitary hormones to respond. In this case, using a different medication- one which may contain both FSH and luteinizing hormone (LH) may allow for an optimal response.
Lifestyle factors can also affect a woman’s response to stimulation. Optimizing weight, diet and stress and cessation of use of tobacco, alcohol and recreational substances can also improve a response to ovarian stimulation.
Speak to your physician regarding improving your particular response to ovarian stimulation.
9) What happens during my initial consultation?
The specifics of what occurs during the initial consultation vary from patient to patient, as each patient or couple present with a unique set of problems and questions. However, in general our physicians take a very careful and thorough history of the presenting problem or problems. The initial visit often also includes an in-depth physical examination and ultrasound. Additional testing is generally required after the initial visit which may include blood work, a semen analysis, and a hysterosalpingogram (a test that assesses whether a woman’s Fallopian tubes are open patency and her uterus has a normal cavity).
10) What is being analyzed in a semen analysis?
The semen analysis is a very important test as it is the best way to evaluate sperm function. Normal sperm function is essential to allow natural fertilization of the egg. The semen analysis evaluates four main parameters: 1) volume - normally 2 ml or greater, 2) concentration - normally 20 million/ml or greater, 3) motility or movement - normally 50% or greater, and 4) morphology or shape - 15% or greater in normal shape, as a normal test. Sometimes a semen analysis may have abnormalities, but fertility treatments can help treat the vast majority of these. Your physician will inform you of your results and how best to approach the next step in treatment.
11) In general, what are the fertility treatments available to me?
This is a very broad question which often requires a very complicated and in-depth discussion, especially when individualizing treatment for a patient or couple. However, in general, the treatment options include observation, lifestyle management including nutritional adjustment and exercise, intra-uterine insemination, surgery (such as hysteroscopy or laparoscopy), ovulation stimulation with oral or injectable medications, in vitro fertilization (IVF), intra-cytoplasmic sperm injection (ICSI), use of donor gametes (oocytes and sperm), and gestational surrogacy.
12) Does the UCLA Fertility and Reproductive Health Center only deal with fertility problems?
No. There are many other patient problems that are evaluated for and treated here, including state-of-the-art and cutting-edge management of endometriosis, uterine abnormalities (such as fibroids, polyps, scar tissue and malformations) and problems causing menstrual and metabolic abnormalities (such as polycystic ovary syndrome (PCOS).
13) Can I exercise during my fertility treatment cycle?
Because the ovaries may be enlarged with maturing oocytes as a result of the gonadotropin stimulation, the ovaries are at an increased risk of twisting and hence cutting off their own blood supply that can result in a surgical emergency. We recommend avoiding exercise starting within 3-4 days of starting fertility medications.
14) Why do I need a scan on day 3 of my period while I am still bleeding?
Transvaginal ultrasound is a very important tool for the reproductive endocrinologist in assessing ovarian reserve and in evaluating the uterus. Day 2 or 3 of the menstrual cycle is the best time to evaluate the ovarian reserve by counting the number of resting antral follicles in each ovary (a method to assess egg quantity), and the endometrial lining thickness that should be ideally no more than 3-5 mm. If the lining is thicker, it may suggest an intracavitary lesion such as a polyp and thus require further evaluation.
15) Are there physical restrictions after an intrauterine insemination (IUI)? What should I expect on the day of the IUI? Can I go back to work? Do I have to take any medications after IUI?
On the day of IUI, the semen sample is prepared for insemination. If the semen is a fresh sample (rather than frozen), the preparation takes 30-60 minutes. The insemination involves taking the washed/prepared sperm and placing it gently into the uterine cavity using a soft flexible catheter. We then have our patient stay lying down for 10 minutes before leaving. Generally, there are no restrictions after IUI and you may go back to work. Sometimes we prescribe oral or vaginal progesterone to be starting 2-3 days after the procedure.
16) What to expect on the day of embryo transfer? What are the restrictions after the transfer?
Embryo transfer is typically performed 3 or 5 days (occasionally 6 days) after egg retrieval. We strictly adhere to the ASRM guidelines where typically 1 or 2 embryos, rarely more, are transferred into the uterine cavity. However, every patient will have individualized treatment plan to maximize conception while minimizing multiple pregnancies. You should not experience any pain with this procedure. It is performed under abdominal ultrasound guidance and the patient is required to have a full bladder for proper positioning of the uterus. After the embryo transfer, we recommend minimal physical activity for 48 hours, typically resting and avoiding physical strain. It does not have to be strict bed rest.
17) What are the symptoms of OHSS? What can I do to prevent it? How is it treated?
OHSS is an abbreviation for ovarian hyperstimulation syndrome. Thankfully, this potentially serious side-effect of gonadotropin injections during fertility treatment is now rare due to careful choice of medication dose and close monitoring. OHSS typically occurs after HCG administration (thus after ovulation or egg retrieval) and symptoms most commonly include abdominal bloating and pressure. Women at highest risk are young with a large number of follicles (eggs). The best prevention is to use the lowest effective gonadotropin dose with careful ultrasound and hormone monitoring. Treatment usually involves rest and hydration, but may involve frequent visits to the doctor’ s office and blood tests. Rarely, accumulation of fluid, which causes abdominal bloating and occasionally shortness of breath, may need to be removed or hospitalization required in rare instances.
18) What are you looking for during the pregnancy ultrasound?
At 5 weeks gestation, we expect to see a gestational sac with a yolk sac. At 6 weeks gestation, we expect in addition to the gestational and yolk sacs, a fetus measuring 3-5 mm with a heart beat of at least 90-100 beats/minute. At 7 weeks gestation, we expect the fetus to roughly double in size and the heart beat to increase to at least 120-130 beats/minute. At 8 weeks gestation, we expect the fetus to roughly double again in size and the heart beat to reach at least 150 beats/minute.
19) What should I do if I start spotting while pregnant?
Please call the office immediately to discuss the most appropriate plan and when to come in for further evaluation. Do not go to the emergency room unless specifically told to do so by your doctor as vaginal spotting during early pregnancy rarely indicates an emergency.
20) Can I travel during the fertility treatment or while I am pregnant?
Generally, the answer to is “yes”, but ask your doctor about specific travel restrictions that may apply depending on the length and location of your travel.