GynoFiles

PCOS causes infertility. It was always assumed that failure to ovulate was the main cause of not getting pregnant in women with PCOS, and it is clear that this is still a cause. Beyond not ovulating it was thought that the irregular shedding of the lining, would perhaps produce loss of a fertilized egg. But that was not established firmly. And fertility studies published in the Cochrane based review showed that miscarriages are more frequent. Traditional treatment of infertility in women with PCOS has centered on treating the lack of consistent ovulation. New studies discussed in the American Journal of Obstetrics and Gynecology in their October 2015 issue   have now shown that treatment of the lining of the uterus to make it healthy before trying for pregnancy is very important. The treatment would be fairly strait forward treatment with progesterone for several cycles before trying for pregnancy. And now the American College of Obstetriians and gynecologists has stated that for ...

Some women are able to be fertile until they are quite old, others are running out of usable eggs even though they are quite young. There are tests of the age of your ovaries, but then usually it's only fertility patients who get these tests; and while very interesting it doesn't typically change medical care to know whether you are still fertile unless you are seeking pregnancy. Those wondering how close to menopause you are, or even more interestingly, when to time having a baby. You might make a different decision if you know your ovaries are running out of eggs, rather than if you had plenty of eggs and could easily postpone while you work on that job change, that new marriage, or that bucket list. And that was one of the questions a recent Practice Committee of the American Society for Reproductive Medicine opinion tried to answer for you: how to use tests of ovarian aging . Generally speaking, the most eggs we will ever have is during the 4th or 5th month of fetal life! ...

1. Felt midcyle unilateral pain that corresponds to an egg being released 2. Had mittlesmertz, or the accompanying rupture of the follicular capsule that has bleeding at the time of the pain 3. Had temperature shift on your basal body temperature chart (BBT) 4. Temperature on BBT, when taken first thing in the morning, remained elevated relative to the early part of your cycle after it elevated 5.Your urine ovulation predictor test (OPK) test is positive 6. Follicle collapsed on ultrasound monitoring 7. Corpus Luteum appeared on ultrasound, this is the progesterone producing structure the follicle becomes after it ovulates 8. Mucus discharge from cervix increases, usually this occurs in the few hours around ovulation, for some women it may be a day, for others a few hours 9. Spinbarkite of mucus increases, this is a word that means stretchy, like egg white 10. You don't get a period and have a positive pregnancy test!

Nervous meaning "can I perform" can definitely impact conception. The alarms, bells, whistles, and sticks turning blue, signaling a woman's ovulation can be a fun game just so long. Then it gets to be a strain on the sexuality of many couples to the point that artificial insemination of partner's sperm may be necessary to just avoid the performance topic all together! We know that stress produces a variety of hormones that wreak havoc on our endocrine system. These stress hormones can produce derangement in the menstrual cycle, so affect ovulation, and derangement in our blood sugar and metabolism, affecting our weight, throw off our biological clock and affect sleep, so we always thought that there must be a link between cortisol levels and conception.In the late 1990s a research group in Australia looked at levels in epinephrine, norepinephrine and cortisol, and they really couldn't detect differences in those cycles that got pregnant, their study was published...

Some couples get prego fast, and others, well it stretches from weeks, to months...so it's time to be seen by your gyno and make sure you are not infertile. If you just came off the birth control pill they make recommend you be a bit more patient. PCOS and problems ovulation, STDs and tubal disease, poor sperm counts are just some of the commmon causes of infertility; and to start with you can do some basic home strategies to help yourself get pregnant. Home strategies would include taking prenatal vitamins, getting proper nutrition and rest, and check your temperature to see if you ovulate, and don't forget to have sex when you do ovulate.Charting your cycles, your bleeding, any PMS symptoms, your mucus, and temperature, as well as  the results of any ovulation predictor kits will help you from getting pg.  If you still are not pregnantm, it's time to talk to your gyno, and depending upon your medical history you need a few medical tests. At Womens's Health Practice ,...

A new study questions whether it is best Essentially gynos thought that it really was not likely for a woman without periods to get pregnant easily, because most likely she won't be ovulating, so it would be impossible to conceive. So traditional thinking has us kick starting ovulation by either bringing on a period, or bringing on a period followed by giving ovulation inducing medicine like clomid or follistim or similar medications. Many women who do not have regular period,s but still want a baby, liked this system, thinking that shedding off that lining with a period take fer is a way of getting a fresh start to one's cycle and therefore the best way to get pregnant. In a newly published large NIH/NICHD grant study that whole premise has been challenged. The study, headed up by Dr. Michael Diamond, looked at women with polycystic ovarian syndrome (PCOS). These women were given progesterone to make them bleed or just given the fertility medicine right away without waiting...

Infertility is defined as a couple trying to conceive for more than a year and not getting successfully pregnant. Your gyno is likely going to tell you that if you are over the age of 35 and have been trying for over 6 months then it is time to get talking to your gyno about beginning the testing. An initial interview will target your individual gynecologic and health history and direct some testing. The National Institute of Health has also come up with recommended infertility testing . Most testing will be focused on the female, but there is recommended testing for her partner. At the NIH infertility site you can find guidelines from many organizations, such as ACOG which over sees recommendations from all Board Certified Obstetricians and Gynecologists, and other organizations, such as the one that oversees recommendations on in vitro fertilization. The American Society of Reproductive Medicine (ASRM) Practice Committee in the August issue of Fertility and Sterility has issued t...

When fertility treatments fail patients and their gynos look for what new strategies can help their female patients and their partners to conceive. In the broad sense we explain fertility to our patients fairly simply: we have to ovulate, the egg has to meet up with the sperm, it has to implant. And the ovulation treatments aim to make this happen, and literally dozens of medications and perhaps hundreds of dosing and timing strategies have been tried. We say that these three 'simple' steps is all it takes, but of course there are many delicate steps in the ovulation process, and some women will just not respond to the treatments we give. Overall good nutrition is very important, and we now know that for men over the age of 35, as their sperm counts are dropping, the micronutrients of vitamins C and E as well as zinc will help them have less DNA damage to their sperm. One newer treatment that is fairly controversial for women is the use of Growth Hormone (GH) to improve ovu...

If you are not on the birth control pill you ovulate in almost every cycle, if you are in you mid to late 40s you ovulate significantly less frequently, but if you are having regular cycles, you are still ovulating. If you are on birth control pills ovulation is decreased, but not completely eliminated. For birth control pills with the 30 to 35 mcg of estrogen the ovulation rates have been reported to be about 2%, and for pills with only 15 to 20 mcg the ovulation rates are about 1.1%. It should be that higher estrogen doses produce less ovulation, and it could be the way these statistics are interpreted that produces these small differences. Since pregnancy is prevented in ways other than preventing ovulation, most all birth control pills have the same effectiveness. For women with special considerations: if you are obese, on medication, have trouble taking your pills on time, if you have had a prior contraceptive failure, or other problems with the birth control pill. A discussion...

Aging decreases the number of eggs in the ovaries that a woman can ovulate and therefore the odds of of conceiving also decreases as one age. The 24 million eggs that are present in the ovaries of a female fetus only result in about a million follicles at birth, and we only ovulate about 400 times. As the number of reserve eggs decreases the rate of regular ovulation goes down and in order to conceive a woman may require help in ovulating. Although previously it was thought that a single follicle awakes from a group of eggs that are stimulated in the weeks before ovulation, always thought to occur in a cycle before the cycle in which we ovulate, there is evidence now that the process takes more like 3 months. The cycle is mostly controlled by the brain hormone FSH (follicle stimulating hormone) from the pituitary gland. FSH stimulates follicles, which are sacs of cells that contain an egg, to develop during those important last two weeks when rapid growth in a follicle occurs.. And ...

Blood testing of hormones can be complex, it depends upon what you want to know before we can recommend some tests over other tests. Some women want to know if they have a hormone imbalance, have a reason for excessive hair loss, reasons for weight gain, or wondering if they are menopausal by checking to see if they still make estrogen or have high levels of  (FSH) Follicle Stimulating Hormone, but more commonly what women really want to know is: are you still ovulating? Ultrasound tests can show that the ovary is forming those small cysts that the egg forms within, but a blood test can check for ovulation as well. The ovary releases it’s egg and then will form another cyst that releases your progesterone. Progesterone stabilizes the lining of the uterus so that the menstrual lining won’t shed (the period is stopped when you are newly pregnant) and the newly fertilized egg can implant. The amount of progesterone made is important, and high levels are probably necessary for the...

A new study looking at conception rates depending upon when you have sex during the week around ovulation has been recently published. And so often when research like this comes out, I think by the title: "duh" did we need a scientific study to prove this? Like you are cleaner if you bathe more than people who never bathe, really? Did we need to prove that. So when I read the title, about conception probability based on the menstrual cycle, I thought, "duh" you get pregnant if you nail the ovulation date (only some pun intended). And we know that sperm live for about 48-72 hours and that eggs only live for about 24 hours, and it has been shown that having sex on the earlier side is probably better. But then there was another fascinating aspect to the new study reported in the September issue of Fertility and Sterility, and performed at the Sichuan Reproductive Health Institute, more sex was NO MORE likely to occur even if you have sex more frequently! Interesting....

It may not actually be the newest way to make your ovary make estrogen then produce a fertile egg from the sleeping follicle, but using an anti-estrogen is still one powerful way of achieving this end. The newest issue of Fertility and Sterility (Sept 2009) delves into the mystery of why the anti-estrogenic fertility treatments clomiphene citrate and letrozole work to improve ovulation. Clomiphene has been used since the 1970s so it's safety and track record are well known. But in using anti-estrogens the down side can be a dry cervix with poor mucus, a thin uninhabitable by a nascent placenta-to be uterine lining, or plain resistance in up to a fifth of the patients. So the use of competitor medications, especially for PCOS patients, has become increasingly popular. The use of the letrozole medication may be hampered by the fact that when used alone the ideal dose has not been determined. Another less known fact to consider when picking a medication to use for ovulation, Clomid ha...

World Health Organization organizes women who do not ovulate into class 1, 2 and 3. Class 1 : Due to poor function of the pituitary gland. Estrogen levels are low, and so are the levels of the pituitary hormone FSH. These women might be the runners, those suffering from stress. Class 2 : The second group is the most common, and includes the women with PCOS. Their pituitary hormones like FSH are normal, usually the estrogen levels are normal too. It is thought that the ovary may be resistant to the normal cycles of hormones from the controlling centers of the brain. Other factors make make the ovary resistant for instance insulin or male hormone levels may be abnormal. Class 3: High levels of pituitary hormones. These are women who usually have one of two types of problems. Either they have prematurely gone into menopause and their FSH is high. Or, they have other pituitary over production of hormones, such as high prolactin, which is a treatable condition. Like other medical condition...

Dr. Corner pondered this in the UK for us at the turn of the century, oh, I mean, the last turn. He studied menstrual cycles from 1910 to 1950, and concluded women have monthly periods (I'm paraphrasing here). But now, we have more accurate methods of science to put this question to the test. When do they begin, when do we ovulate, how long will the follicular or estrogen phase be, how long will the luteal (progesterone phase) be? First we ask a woman when her period starts (ok, I'm paraphrasing the "more scientific" part too, but they are using all sorts of fancy blood and urine tests once she raises her hand and says, ready to go). New conclusions from a Feb 2009 study published in Fertility and Sterility journal: normal cycles are not the 21 to 35 days that it says in my gyn text books, but 23 to 32 days. Although these researchers have only slightly tweaked average normal menstrual cycle length...used to be "every 28 days" now we can reliably say "e...