| Greetings,
The most common cause of fertility problems is
believed to be ovulatory disorders. So, along with a
semen analysis for the male partner, one of the first
steps in assessing your fertility level will be
determining if you are indeed ovulating.
Unfortunately, finding out if you're ovulating isn't as
simple as having a regular menstrual period. Some
ovulatory disorders result in infrequent or absent
periods, but not in every case.
How can you tell you're ovulating before even setting
foot in the doctor's office?
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Get To Know You
Learn more about your menstrual and ovulatory cycles
through the Internet and books. Most of us weren't
taught much beyond the old adage that an average
cycle is 28 days (and even that tidbit of widsom is not
very accurate...)
One of the most recommended books is Taking
Charge of Your Fertility, by Toni Weschler, MPH.
Another print resource is the workbook-style Honoring
Our Cycles, by Katie Singer. You may find some of the
information surprising and new. For example, there's
actually a broad range of "normal" for menstrual cycle
length. Counting the first day of your period as Cycle
Day 1 and the day before your next period starts as the
last day in that cycle, you could regularly have
anywhere from 21-day to 36-day cycles and still be in
the "normal" range.
For more good reading on topics related to fertility and
infertility, see the bottom of our website's
Education page.
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Home Testing
There are numerous methods and gadgets for
detecting the hormones that will indicate whether or
not your ovaries are functioning. Before you spend a
lot of money on some of the more expensive ovulation
tracking products, start with the simplest: charting your
basal body temperature (BBT). You can also add to
that practice the charting of fluctuations in amount and
consistency of your cervical mucus, and the changing
position of your cervix. Either of the books mentioned
above can give you helpful instructions in these cost-
free methods.
If you find that charting your body's fertility indicators is
inconvenient, or if you've tried it for a few cycles and
don't feel like you have a handle on your ovulation
cycle yet, try using the variety of ovulation prediction
kits (OPK) that are available without a prescription at
any pharmacy. There are several different brands, and
you're sure to find both positive and negative
comments on most of them at online bulletin boards.
The most important thing, however, in using OPK's is
to precisely follow the directions for the brand you've
purchased.
There are also personal microscope devices that
utilize your saliva to help determine if you're ovulating.
These work by helping you discern a phenomena
called "ferning" in which tiny salt crystals form a plant-
like pattern viewable in saliva samples during the time
of ovulation, due to hormone level changes.
Unfortunately, such devices have not proven as
effective in helping women detect ovulation, especially
if there are hormonal levels out of normal range.
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Now What?
If, after going through the above and you've either
detected irregular ovulation or you haven't conceived,
it's time to see a fertility specialist and talk about your
options.
There are certain women who are better off skipping
the at-home testing process altogether. Women with
known or suspected health conditions such as those
listed below, and women who are in their late 30's or
older can avoid wasting precious time and money by
coming straight in for clinical tests.
At our office, we'll explore some of the typical causes
of ovulation disorders such as:
- hypothalamus or thyroid dysfunction
- hyperprolactinemia
- polycystic ovarian syndrome
- luteal phase defect
- tumors of the pituitary or adrenal glands or ovaries
Less typical ovulation disorders are:
- Primary ovarian failure (POF)
- Resistant ovary syndrome
- Autoimmune oophoritis
We may use the following lab tests: * serum FSH *
serum LH * serum prolactin * serum testosterone *
free androgen index * thyroid stimulating hormone
(TSH) and in some cases:
- CAT scan or MRI scan of pituitary and
hypothalamus
- endometrial biopsy
- ovarian biopsy
- more specific antibody tests (antithyroid, adrenal,
islet-cell, gastric parietal cell)
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The Good News
Ovulatory disorders are often the most treatable forms
of infertility. Treatments may include:
- use of ovulation-inducing fertility medications
- use of other drugs more specific to the diagnosed
cause
- nutritional adjustment
- stress reduction
- surgery (in the case of tumors)
In Closing
One of the silver linings to the gray cloud of fertility
problems is that it leads many women (and men who
love them) to learn more about our reproductive and
endocrine systems. There's no way to know just how
many people start out believing that they have
infertility, only to find that they simply didn't have all the
right facts about getting pregnant. Our goal at Houston
Infertility Clinic is not to get you into treatment,
regardless of need. Our goal is to help you conceive
and have a successful pregnancy and healthy baby.
When that can be accomplished with just a little extra
knowledge on your part, we're happy to hear about it!
As always, our bilingual staff is available to answer
even your most basic questions about ovulation and
getting pregnant.
Sincerely,
Sonja B. Kristiansen, MD
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