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Infertility Frequently Asked Questions

FAQ with Tips for Getting Pregnant

What is infertility?
Is infertility a "women's problem?"
How long should we try before we see a doctor?
What is a Fertility Specialist?
At what time of the month is a woman fertile?
How can a woman tell if she ovulates?
Are there any other ways to detect ovulation?
How often should we have intercourse?
What tests should our doctor perform?
What about smoking and drinking alcohol and caffeine?
Are hot tubs really bad for a man?
What else can we do?

IVF Frequently Asked Questions

Is it normal to bleed after stopping the birth control pill?
When will the bleeding stop?
Is it normal to have a reddened warm area "hot spot" on my belly after injection?
Is burning normal with injections?
What do I do if I don't have my meds?
What do I do if I do not remember how to mix my medications?
Can I bleed after giving myself the injections?
Can I go to work the day of VOR?
Can I take Endometrin the morning of transfer?
What is fever, when do I call?
Is it safe to take Endometrin/Prometrium and Estrace when pregnant even when the label says not too?

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 that 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 6 months of times intercourse. However, if you have a known reason to have a problem getting pregnant such as: a history of pelvic inflammatory disease, painful periods, miscarriage, irregular 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, a Reproductive Endocrinologist must complete highly specialized training in all aspects of female endocrinology and infertility. A physician can become Board Certified in Reproductive Endocrinology by completing the required training and passing a series of nationally certified exams.

Below are the educational and training requirements that an Ob/Gyn and Reproductive Endocrinologist must complete.

Obstetrics and Gynecology (Ob/Gyn)

• four years of medical school
• four year residency program in Ob/Gyn
Reproductive Endocrinologist

• four years of medical school
• four year residency program in Ob/Gyn
• Three year fellowship in Reproductive Endocrinology and Infertility
To Become Board Certified in Ob/Gyn, the doctor must:

• graduate from college & medical school
• complete 4-year residency in Ob/Gyn pass written exam in ob/gyn
• complete 2-years of practice
• pass oral exam in Ob/Gyn
To Become Board Certified in Endocrinology, the doctor must:

• complete all requirements for Ob/Gyn board certification (see above)
• attend 3-year fellowship in reproductive endocrinology
• pass written exam in reproductive endocrinology
• complete 2-years of practice
• pass a 3-hour oral exam in reproductive endocrinology

Currently in the Unites States, there are only about 1000 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 2-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 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.

How can a woman tell if she ovulates?
The simple, inexpensive way of finding out the approximate time when you ovulate 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 2 days prior to the temperature rise.

Are there any other ways to detect ovulation?
Yes. You can buy an ovulation predictor urine test at your local drug store. The kit will instruct you to test your urine around your potential ovulation time. In addition there is a electronic monitor which also involves testing your urine.

Also, your body may signal when you are about to ovulate; many women feel twinges in their lower abdomen (your ovaries are on the right and left sides of your lower abdomen). Other women notice clear, stretchy vaginal discharge just at their fertile time. Your doctor can also request an ultrasound or appropriate blood tests to determine ovulation.

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 tests should our 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 which 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 and the AFA has over 60 fact sheets on different topics related to infertility, and support groups in many areas.
• Also visit the ASRM, SART, ACOG, and CDC web sites for more information.

IVF Frequently Asked Questions

Is it normal to bleed after stopping the birth control pill?
Yes the bleeding is a result of the body responding to the lack of hormone support that the pill provided. This bleeding can range from spotting to a full flow period. This bleeding is normal and expected. Please continue with your medication protocol as planned.

When will the bleeding stop?
Usually the bleeding will stop in 3-5 days. You may bleed for the first few days while on the injections, but remain on your medications per your protocol.

Is it normal to have a reddened warm area "hot spot" on my belly after injection?
Yes, this happens in about 10% of people who take these medications. It is the body’s response to the proteins in the medications. Sometimes applying ice to the injection site 10 minutes prior to administering the injection can help. If the area of redness increases in size and/or itches or feels hot to the touch, contact your nurse during normal business hours and we will discuss ways to increase your comfort with the injections.

Is burning normal with injections?
Burning is normal after the injections. It is often helpful to rotate the site of the injections. Also, assuring that the alcohol used to clean the area has dried before administering the injection can help with this.

What do I do if I don't have my meds?
The medications used for an IVF cycle are highly specialized and often not available at local pharmacies (CVS, Walgreens…etc). It is extremely important that you check your inventory of medications prior to starting your IVF cycle to assure that you have the correct dosage of medications. If you are unsure of this, please contact your nurse during normal business hours to review.

• Many Mail order pharmacies can ship your medications the next day. If you run out of medications, your prescription can be called into one of these pharmacies.
• If your insurance does not participate with this pharmacy, you may have to pay for the medication out of pocket and submit to your insurance to be reimbursed.
• If you don’t have medications for the same day, you may have to skip that day’s meds and receive your medications the following day. This could negatively affect your cycle, so keeping track of your inventory is very important.
• Also please note that you have refills on most of your medications. You can call your pharmacy to receive these refills once you realize you are running low.
• It is extremely important that you stay on top of your medications before, during, and after your cycle.

What do I do if I do not remember how to mix my medications?
Please review your medication mixing and administration a few days prior to the first evening dose. If you are confused, you may call your nurse during normal business hours to review. If after business hours, there are many online resources available. www.freedommedteach.com is one of them. You were probably also given a written instruction sheet at the time of your med teach class or at the time your protocol sheet was mailed to you.

Can I bleed after giving myself the injections?
It is normal to have some bleeding and bruising at the injection site. Your body has many superficial blood vessels that can be punctured at the time of the injection. This will not necessarily damage them, but can result in a bruise. Continue to rotate the injections sites to allow for healing.

Can I go to work the day of VOR?
You may not go to work the day of the retrieval since you have had anesthesia that day. Since the retrievals mostly occur in the morning, you should plan on taking that entire day off of work. Many people feel fine to go to work the following day and doing this will not adversely affect your chances of getting pregnant.

Can I take Endometrin the morning of transfer?
It is recommended to take your morning (and afternoon, if applicable) dose of Endometrin on the day of the transfer. Endometrin is a form of progesterone, which has been found to relax the uterus. Since you can eat and drink normally that day, you may also take your morning dose of oral medications that day as well.

What is fever, when do I call?
You should contact the office if your temperate is >100.3, since a lower temperature may be a sign of dehydration. Some amount of dehydration is normal after the retrieval and will resolve once you are able to eat and drink later that day. If your fever is accompanied by chills, abdominal pains, and/or bleeding, then please call the office.

Is it safe to take Endometrin/Prometrium and Estrace when pregnant even when the label says not too?
These are natural forms of the hormones progesterone and estrogen, which are essential for maintaining a healthy pregnancy. These hormones are safe. Women should only take hormones in pregnancy if they are prescribed and monitored by their physician. We will monitor you very closely to assure that your estrogen and progesterone levels are similar to those of healthy pregnant women. There is no data that suggests taking these hormones after an IVF cycle will cause harm to you or your pregnancy. Not taking these hormones may put your pregnancy at risk.

Contact us for with your questions about infertility.