Infertility Answers and Pregnancy FAQs
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 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 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 and the American Fertility Association (AFA) has over 60 fact sheets on different topics related to infertility, and support groups in many areas.
- Also visit American Society for Reproductive Medicine (ASRM) , Society For Assisted Reproductive Technology (SART), American Congress of Obstetricians and Gynecologists (ACOG) and Centers for Disease Control & Prevention (CDC) web sites for more information.
We wish you a happy and healthy pregnancy. Although this is an exciting time, it can also feel overwhelming. We have compiled this list of our patients’ most frequently asked questions in order to provide you additional information and guidance as you enter into the early weeks and months of your pregnancy. Of course, always feel free to call your nurse for guidance or any additional concerns.
Frequently Asked Questions in Early Pregnancy
1. Is it normal to have spotting?
Twenty five percent (25%) of women experience bleeding in the first trimester. Over 90% of women with first trimester bleeding have only spotting. Women with spotting only are not at increased risk for pregnancy loss. If you have any spotting or bleeding please call your nurse. She will probably ask you some additional questions and may ask you to come into the office for blood work and an ultrasound if needed. You may also be asked to limit your activities until the bleeding has resolved.
2. Is it normal to be “crampy”?
Mild cramps are normal. These are most commonly due to the uterus stretching and enlarging as the baby, and your belly, grows. Progesterone can also cause some mild cramping. If you have cramping with bleeding or pain that is worse than menstrual cramps please notify your nurse. We may ask you to come in for an exam or ultrasound.
3. Is it ok to exercise?
Continuing to exercise is very important in pregnancy, but high-impact activities should be avoided. Walking, swimming, and prenatal yoga are the best activities to engage in as you can continue them throughout your pregnancy. You should be able to have a conversation while exercising (this shows that your heart rate is not too high) and be sure to drink water frequently. Also, do not utilize hot tubs or saunas as excessive heat is not recommended in pregnancy. If you have not been regularly exercising prior to pregnancy please make sure to have a discussion with your physician before starting a new exercise program.
4. Is it ok to have intercourse?
In patients who have undergone fertility treatment we recommend abstaining until documentation of the fetal heart beat. This occurs between 6 and 7 weeks of gestation. Also you should abstain if you are having any vaginal bleeding. Your physician will let you know when you can resume regular activities, such as intercourse, if you have experienced bleeding. In general, if you are not having any problems, it is safe to have intercourse.
5. What medications am I allowed to take?
All the medications given to you as part of your fertility treatment at RMACT are safe in pregnancy. The website, www.safefetus.com is an excellent reference for questions about over-the-counter medications. You will just need to type in the name of the medication to find out if it is safe to take while pregnant. Any medication that is listed as category A or B is considered safe in pregnancy. For prescription medications please consult the prescribing physician.
6. Do I need to continue my hormone supplementation and for how long?
Your hormone supplementation will be continued until you are 8-10 weeks pregnant unless you have been otherwise instructed by your physician. At about 8-10 weeks we will discontinue your medications and check your hormone levels off of medication.
7. What foods should I avoid during pregnancy?
Avoid fish with high levels of mercury (shark, tilefish, swordfish and mackerel) and limit tuna to less than 12oz per week. Any raw meats or seafood should not be consumed. Avoid unpasteurized cheeses and soft cheeses especially those from Mexico as they have been associated with outbreaks of Listeria, a bacteria that can cause serious complications in pregnancy. Prepared lunch or deli-style meats and hot dogs should not be eaten unless they are heated to steaming hot, as they can carry listeria as well. Please limit artificial sweeteners, as the effects of them have not been adequately studied.
Making sure you are eating properly throughout your pregnancy is important. Please don’t hesitate to call your coordinator to schedule an appointment with our Nutritionist, Carolyn Gundell, if you have any questions about what you should or should not be eating. This visit is almost always covered by your insurer now that you are pregnant. Don’t hesitate to take advantage of this to set the stage for your dietary habits in pregnancy
8. Is it safe to color/highlight my hair?
Studies done have not shown that hair color or bleaching can cause birth defects. Most salons offer vegetable dyes that do not contain bleach, and some OB/GYN’s prefer that you use these in the first trimester. The March of Dimes has a comment on this.
9. Can I have caffeine?
Caffeine intake should be limited to less than 200mg/day this is the amount that is in 2 8oz cups of coffee. Remember that iced tea, chocolate, and sodas also have caffeine and should be limited. Some large sodas contain caffeine that is double the amount recommended per day.
10. Is it safe to travel?
Travel, including flying, is fine during pregnancy, just make sure you get up and walk every 2 hours to reduce risk of pregnancy complications associated with travel. Some patients feel reassured if they know the location of a medical facility in their destination city, just in case they need to be seen. If you are experiencing complications of pregnancy (such as bleeding or pain) your physician may recommend limiting travel. The second trimester is the safest time to travel, and if you are planning a trip, you should plan it then, if possible.
11. Can I get a massage?
Massages are great in pregnancy, and many spas are now offering prenatal massage. There are tables especially designed for pregnant women to make lying on your stomach more comfortable. In the second and third trimesters, you should not lie on your back for too long as the growing uterus can make breathing difficult and possibly compress important blood vessels which support the fetus.
12. Can I drink alcohol?
No alcohol should be consumed in pregnancy due to the risk of the baby developing Fetal Alcohol Syndrome. Even very small amounts are considered unsafe. There are some great recipes for alcohol-free cocktails!
13. Can I take the flu vaccine?
The flu vaccine (including H1N1) is highly recommended for women who are pregnant or trying to become pregnant.
14. What about nausea?
Some nausea is normal in pregnancy. Ginger is a natural anti-nausea agent which can be found in various crackers, cookies, candies and food. Some patients keep ginger cookies or candies with them at all times during early pregnancy to help with the nausea. Some patients have relief from acupressure or “Sea Band” wristbands. If you cannot keep down any foods or liquids please contact your nurse as there are medications we can safely prescribe during pregnancy.
15. Can I continue to have acupuncture once I am pregnant?
You can continue, or start, to have acupuncture once pregnant. Acupuncture, and acupressure, may relieve many of the pregnancy-associated symptoms that people experience, such as joint pain, sciatica, and maybe even nausea. Just be assured that your practitioner specializes in women’s health, as there are certain acupressure points that may cause uterine cramping. Ask your nurse or coordinator if you are interested in seeing one of the specialized acupuncturists at RMA CT.
16. When do I make an appointment with my OB/GYN?
We will continue to see you at RMA CT until you are 8 to 10 weeks gestation. At your last ultrasound appointment, your physician will encourage you to make an appointment with your OB. Most OB’s will want you to see you in their office between 10-13 weeks so that they can offer you first trimester testing. Please be sure to sign a record release form at the front desk so that we can send your blood results to your OB in a timely manner.
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.”