Frequently Asked Infertility Questions

• General reproductive endocrinology and infertilitiy questions
• Testing
• Pregnancy

What are the causes of Infertility?

• Tubal absence or tubal disease
• Endometriosis
• Ovarian dysfunction:
  • anovulation
  • PCOS
  • Reduced ovarian reserve
• Male factor infertility
• Unexplained infertility

How can I tell if I am ovulating?

Measuring Basal Body Temperature (BBT): This is a way to measure ovulation AFTER it has occurred. Normal temperature is stated to be 98.6 degrees Fahrenheit. A woman's temperature is lower during the first part of the menstrual cycle than it is during the last two weeks of the same cycle. The shift from lower to higher temperature occurs at the time of ovulation. The occurrence of ovulation is inferred when there is a rise of 0.4 to 0.6 degree or more between 24 hour readings. This measurement requires a special thermometer and must be done before you are up and active. It can be unreliable in detecting ovulation.

Ovulation Predictor Kits: OPK's detect a hormonal change that occurs a day or two before ovulation. They detect a spike in the luteinizing hormone (LH) that occurs in the middle of a woman's cycle. This surge can last for just hours or for as long as two days. This spike triggers the ovary to release a mature egg. Ovulation occurs 36-40 hours from the onset of the LH surge. Again, this test can be unreliable.

Day 21 progesterone level: If a patient has regular cycles, a progesterone level drawn on day 21 of her cycle can be a reliable way to document if she has ovulated and is often used as a measure of corpus luteum hormonal production.

How can I tell how many eggs I have left?

• Clomid Challenge Test (CCT):
  See below for how this test is done.
• Ovarian volume:
  This is measured using ultrasound.
• Number of antral follicles:
  These "resting follicles" can be counted by ultrasound.

  All of these tests give the physician and patient only a rough idea about the number of eggs left in the ovaries. These are far from perfect tests at this time. Some women with abnormal test are unable to get pregnancy due to reduced ovarian reserve and some women with abnormal tests can get pregnant with or without treatment.

Does smoking affect fertility?

Cigarette smoking is harmful to a woman's ovaries. Smokers enter menopause sooner. Studies have shown that smokers going through IVF have significantly lower estrogen levels, fewer follicles, fewer eggs retrieved, and fewer embryos per cycle than non-smokers. Smoking also increases your risk of miscarriage once pregnancy is achieved. Effects of smoking appear to be cumulative over the years and can cause irreversible harm to the ovaries. All smokers wanting to come through our program are encouraged to quit prior to their cycle.

Can eggs be frozen?

Fertilized eggs (embryos) freeze very well.

While unfertilized eggs have been frozen (experimentally), the success of this appears quite limited.

Testing

Will you repeat the testing that my local physician has already performed?

In general, no. We may request additional testing and may repeat tests in which the results are unclear. However, we make an effort to utilize the work-up already performed.

What is a clomid challenge test (CCT)?

A clomid challenge test (CCT) is one way of measuring ovarian reserve. It is done by having blood drawn for an FSH level on Day 3 of your cycle (day 1 is the first day of your period). You then take Clomiphene Citrate 100 mg (two 50 mg tablets) on days 5 through 9 of your cycle. A repeat FSH level is drawn on Day 10.

What are normal results for a CCT?

• Day 3 FSH level should be less than 12.
• Day 10 FSH level should be less than 12.
• Day 3 FSH level plus the Day 10 FSH level should be less than 25.

What does it mean if my test is not normal?

An abnormal CCT is associated with an increased risk of cycle cancellation and poor ovarian stimulation during IVF cycles. Pregnancy rates are lower in women with an abnormal Clomid challenge tests but some women are still able to conceive.

Pregnancy

I am newly pregnant and spotting. Should I be worried? What should I do?

It can be fairly common to spot when newly pregnant. It could mean absolutely nothing, or it could mean that you are at an increased risk to miscarry. We know that you will be worried. If you have any type of spotting or bleeding, we want you to call us. Most likely, you will receive an early ultrasound to see what is happening. Unless the bleeding is very heavy and associated with cramping, you may wait until regular offices hours to contact us.

What medications are safe to take during pregnancy?

Everything you take into your body passes from your blood to your baby's blood. Therefore it is best to avoid all over-the-counter medicines especially in the first ten weeks of pregnancy. The first eight weeks are when your baby's heart, lung and brain systems are being formed.

Before taking over-the-counter medicines, try other ways to relieve your symptoms.

For cold and cough symptoms it is recommended you rest, drink extra fluids, and use a cool mist vaporizer -- 18 inches from your face.

Occasionally it may be necessary for your doctor to prescribe medicines during pregnancy. Please take medicine exactly as prescribed. If you are unable to tolerate the medicine, call the clinic.

Medicines that are considered to be safe during pregnancy for common symptoms:

For cold symptoms

Clor-Trimeton - -antihistamine (If you have high blood pressure only take this)

Sudafed -- decongestant

Actifed -- antihistamine and decongestant

Cough Symptoms

Robitussin or Robitussin DM

Constipation

Docusate (Colace) 100 mg twice a day

Metamucil -- 1-2 teaspoons with 8 oz juice or water

Milk of Magnesia -- 1-2 Tablespoons every evening

We prefer these medications over the use on mineral oil.

Minor headache or body ache

Tylenol or any acetominophen preparations: 2 tablets or 650 mg every 4 hours

We prefer Tylenol to any aspirin or ibuprofen products, such as Advil or Motrin.

If headache persists more than 24 hours, call your physician.

Heartburn

Amphogel

Gelusil

Maalox

We prefer these medications over the use of baking soda or Pepto Bismol.

Fever or chills

Take your temperature if you feel unusually hot or cold. If your temperature is above 100.5 call your physician. If your temperature is above normal but less than 100.5, take Tylenol every 4 hours. If your fever lasts longer than 48 hours, call the clinic.

 How long does it take to get an appoint in the Reproductive Endocrinology Clinic?

It takes approximately 4 weeks to get a new appointment in the Reproductive Endocrinology Clinic.

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