General

For many patients, time with their OB/GYN is limited to an annual appointment where the physician is only in the room for a matter of minutes. Bringing up the topic of infertility can be daunting when you are unsure of what questions to even ask, especially while you’re in the stirrups.

Since many OB/GYNs are not necessarily focused on infertility, it is crucial for you to be your own advocate and get them to listen up to your concerns and questions. Here is a guide to help you take control of your health and make the most of your time with your OB/GYN.

6 Tips for Talking to Your OB/GYN about Infertility

1. Know what topics you’d like to discuss.

For any topic that you wish to discuss with your OB/GYN, be sure to write down your questions and take notes on any concerns or health issues you may have that could affect getting pregnant. Being prepared for your appointment is important.

2. Know what you want when it comes to trying to conceive.

The first question that you should ask yourself is “how old do you want to be when you have your LAST baby?” Then work backward from there to decide when the best time to start trying to conceive your first baby. “There is no such thing as ‘actively trying’ to conceive.  That is because regular sexual activity without contraception has similar chances of pregnancy than timing intercourse by ovulation predictor kits or the like. Thus, if a woman under the age of 35 has been having unprotected intercourse for a year and has not become pregnant then it is time to see a fertility specialist. If a woman is over the age of 35, generally we recommend seeking help after 6 months,” states Dr. Ricardo A. Yazigi, of our Bel Air and Towson offices.

3. Ask the tough questions.

If you’d like to begin trying for your family, now is the time to ask your OB/GYN if there is anything in your medical history that could impact your chances of a successful pregnancy. Pelvic surgeries, irregular cycles, and painful or heavy periods could all be early warning signs to see a fertility specialist sooner.

4. Keep track of your menstrual cycles, which provides helpful information about your fertility potential.

Though female age is a the number one indictor of fertility health, women of any age should not wait to see a fertility specialist if they have irregular menstrual cycles as that could be a sign of polycystic ovary syndrome, or PCOS, among other conditions. The absence of a menstrual period on a regular basis is typically the number one indicator that a problem may be present. If a menstrual cycle is heavy and painful then this could be a sign of endometriosis. Your OB/GYN should be able to help you understand if your cycle is irregular and order the appropriate blood test and ultrasound to confirm.

5. Know that simple fertility testing can provide helpful answers as to why you are not conceiving.

Four simple tests will give you many answers to your fertility. Some OB/GYNs can perform these diagnostic tests; we recommend seeing a reproductive endocrinologist for testing.

An evaluation typically includes:

• A detailed medical history
• Ovarian reserve testing with blood test to check follicle-stimulating hormone (FSH), estradiol, and anti-Müllerian hormone (AMH) levels.
• A transvaginal ultrasound performed on the second, third, or fourth day of the menstrual cycle to count the number of follicles (egg sacs) in each ovary
• A hysterosalpingogram (HSG), a dye test to evaluate if the Fallopian tubes are open
• Semen analysis

Testing at Shady Grove Fertility, depending on the timing of the menstrual cycle, can be completed quickly, frequently in as little as a month. In addition to a faster turnaround time, patients often find that completing all of their testing at a fertility center is easier. In the majority of cases, all testing from blood work and ultrasounds to HSGs and the semen analysis can be completed in one of our 25 locations.

6. Know your options to preserve your fertility for the future.

If you’re not ready to begin a family in the near future, talk to your OB/GYN about preserving your fertility through egg freezing. Egg freezing represents a way to suspend your fertility in time, preventing the decrease in quality and quantity that inevitably comes with age. You will, of course, still continue to age. But the eggs that you freeze will stay suspended in time at the quality present at the time of the freeze. Your OB/GYN will be able to guide you on if this is the right decision for your family planning.

Your OBGYN is there for YOU. By being prepared for your next appointment you will be able to advocate for your own fertility health and get your physician to listen up.

If you have questions regarding infertility testing or would like to schedule a new patient appointment, please call our New Patient Center at 877-971-7755 or click to schedule an appointment.

At Shady Grove Fertility, we’re here to give you the caring support you deserve as you start or grow your family. As a leading fertility and IVF center of excellence, we offer patients individualized care, innovative financial options, over 30 accepted insurance plans, and pregnancy rates among the highest of all national centers. We offer patients the convenience of 19 full-service and 6 satellite locations across Maryland, Pennsylvania, Virginia, and Washington, D.C. More than 1,700 physicians choose Shady Grove Fertility to refer their patients, and more than 96 percent of our patients say they would recommend Shady Grove Fertility’s 39 physicians to a friend. With 10 Shady Grove Fertility babies born each day, your dream of starting or growing your family is within reach.

Constant chatter about superfoods, vitamins, nutrients, and things like chia seed and flax seed make it difficult for the average busy person to figure out what’s really healthy to incorporate into your daily diet and what’s just a trendy fad. The List set out to find what nutrition tips are truly myths and Meghan Sylvester, RDN, LDN, based in Rockville at Shady Grove Fertility’s recently opened Wellness Center, immediately named her top nutrition trend, Agave, telling the site that it’s really not, “a guilt-free sweetener.”

For the past couple of years, health food blogs have encouraged readers to substitute sugar and other artificial sweeteners for Agave, but Sylvester sets the record straight. “Agave nectar is a highly processed syrup that is 1.5 times sweeter and actually more calorically dense than regular table sugar. It is primarily made up of fructose (similar to high fructose corn syrup).”

Sylvester explains that humans can’t use the energy from fructose so it is stored in the liver. When too much fructose is consumed, “the liver cannot store anymore, it converts the excess fructose into fat, triglycerides, and very low-density lipoproteins (VLDL), which can lead to fatty liver, hyperlipidemia, and insulin resistance, all increasing the risk of heart disease and diabetes.”

Instead of sugar or Agave, Sylvester suggests substituting more natural sweeteners like, “raw honey, stevia, and pureed dates,” as healthier alternatives.

Learn more about How Sugar Impacts Your Fertility.

The Shady Grove Fertility Wellness Center, headquartered at our Rockville office, provides holistic support to patients including nutrition services, acupuncture treatment, and fertility-stimulating massage. As the practice’s nutritionist, Meghan Sylvester is available to work with patients in our Rockville,  K Street, Fair Oaks, VA offices. She is also available for phone consultations throughout our 4-state region.

If you have questions regarding infertility treatment or would like to schedule a new patient appointment, please call our New Patient Center at 877-971-7755 or click to schedule an appointment.

Your Menstrual Cycle May Reveal the Culprit to Your Trouble Conceiving

One in eight couples will experience infertility, defined as the inability to conceive after 6 months to a year of unprotected intercourse, depending on the female partner’s age. Many of the causes behind infertility are unknown until testing has been completed. However there is one sign that women can look for in regards to their fertility: the regularity of her menstrual cycle.

The menstrual cycle is directly related to ovulation (the release of an egg). But what if ovulation isn’t occurring, how do you know and what can be done to help? Understanding your menstrual cycle could offer important insights into your fertility.

Understanding Your Menstrual Cycle: It’s More than Just Your Period

The menstrual cycle is a series of changes a woman’s body goes through each month whereby the ovary releases an egg and the uterus prepares for pregnancy. The menstrual cycle includes two phases: the follicular phase and the luteal phase.

Phase One: The Follicular Phase

The first day of your menses—or period—is day 1 of your cycle and the start of the follicular phase. During the follicular phase, the hypothalamus and pituitary glands in the brain release a hormone known as follicle-stimulating hormone (FSH). FSH stimulates the development of a follicle, which is a tiny fluid-filled sac within the ovary containing a maturing egg. The follicle also secretes estrogen, which produces mid-cycle changes in the cervical mucus and stimulates the lining of the uterus to thicken. These changes help prepare the uterus to receive the embryo. The follicular phase starts on day 1 of your menstrual cycle, the first day of day of your period, and concludes with a mature egg ready for release around 13 days later.

Phase Two: The Luteal Phase

The start of the second phase, or luteal phase, begins with ovulation. There is a drastic surge in luteinizing hormone (LH), also released by the pituitary gland, causing the follicle to break open and release the mature egg into the Fallopian tube. During a woman’s reproductive years, a woman usually releases a single mature egg each month, in a process known as ovulation.

Cervical mucus is most receptive to sperm around this point in the cycle and a woman has the best chances of conceiving leading up to and during ovulation. When a couple has intercourse around the time of ovulation, sperm swim through the cervical mucus, into the uterus and along the Fallopian tube, where they meet the egg. The egg has the capacity to be fertilized for about 24 hours after it is released from the follicle.

Once ovulation occurs, the follicle that produced the egg becomes a functioning cyst called the corpus luteum. The corpus luteum produces progesterone, which prepares the lining of the uterus for implantation of the fertilized egg resulting in pregnancy.

If fertilization does not occur, the egg passes through the uterus, and the corpus luteum ceases to function on about 14 days after ovulation. The uterine lining then breaks down and is shed several days later as the next menstrual cycle begins.

What is considered a “normal” menstrual cycle?

There is such thing as a normal cycle. The menstrual cycle is essential for the maturation and ovulation of an egg in addition to the preparation of the uterus for implantation. A normal menstrual interval ranges from 21 to 35 days and indicates that a woman is likely ovulating regularly. The portion of the cycle where the uterine lining is shed, also known as the period, in a normal cycle lasts between 2 and 7 days. If there is very little bleeding during the period (less than 2 days or very scant amount) or the bleeding lasts for greater than 7 days then it may indicate an abnormality within the cavity such as polyps, fibroids, cancer, or an infection of the uterus, or irregular ovulation. Cycles of a normal length suggest regular ovulation and that all of the sex hormones are balanced to support natural conception.

What does it mean if the number of days in my menstrual cycle or between periods has increased all of a sudden?

If the cycle length is still in the normal range described above (between 21 to 35 days) then the change is likely normal variation. However, if the cycle extends beyond 35 days, the cycle might be considered irregular raising concerns as to whether or not ovulation is occurring since longer cycles are caused by a lack of regular ovulation.

During a normal cycle, it is the fall of progesterone that brings upon bleeding. If a follicle does not mature and ovulate, progesterone is never released and the lining of the uterus continues to build in response to estrogen. Eventually, the lining gets so thick that it becomes unstable and, like a tower of blocks, eventually falls and bleeding occurs. This bleeding can be unpredictable, and oftentimes very heavy and lasting a prolonged period of time.

How can I time my ovulation to get pregnant?

It is a common misconception that the luteal phase begins around day 14 of your cycle; in fact, it can more easily be determined by counting 14 days prior to the start of your cycle. The length of a normal cycle is anywhere between 21 and 35 days, so if you are counting from the start of the cycle you may be missing the time of ovulation by as much as a week. To calculate when ovulation is likely to occur determine how long your cycle lasts and subtract 14 days from the predicted end of the next cycle. Another option is to use an at-home urine-based ovulation predictor kit. These at-home fertility tests look for the surge of luteinizing hormone (LH) that occurs 1 to 2 days prior to ovulation. It’s important to note that the ovulation predictor kits are not 100% accurate. These can be useful for women who have regular cycles, however, if you’re having irregular cycles, your levels of luteinizing hormone (LH)—the hormone such tests attempt to detect—could be outside of the normal ranges, making this test potentially unreliable for you. Learn more about how to determine your fertile window.

If I am not ovulating, what might be the cause? 

There are many causes of anovulation, the medical term used to describe when ovaries do not release mature eggs on a regular basis. Irregularities with the thyroid gland or elevations of the hormone prolactin can disrupt the brain’s ability to communicate with the ovary and result in anovulation. In addition, polycystic ovary syndrome (PCOS), a syndrome caused by imbalanced sex hormones, can also cause failed ovulation. Not only do these hormonal imbalances lead to problems with ovulation and therefore fertility, but they may also increase the risk of miscarriage.

Can I still get pregnant if my menstrual cycle is not normal? 

Yes, even if your menstrual cycle is abnormal, you may still conceive on your own. However, it may be a little more challenging, especially if you’re trying to determine your most fertile window based on your menstrual cycle. However, it’s important to realize that there are many situations in which ovulation does not occur, and thus, conception cannot occur naturally. There are also instances in which scar tissue in the uterine cavity or premature menopause can be factors limiting conception. Despite these factors though, there are a range of fertility treatment options that can help almost everyone conceive.

When should I seek help? 

Irregular or no ovulation makes conception very difficult without intervention. If you do not have a normal monthly menses, no matter the amount how long you have been trying to conceive, you should be evaluated by a fertility specialist. Any woman under 35 years of age with normal cycles who has not become pregnant after 1 year of trying should see fertility specialist. If you are 35 or older with a normal menstrual cycle and have been trying for 6 months without success, you should seek an evaluation as well. Normal menstruation indicates that you are ovulating; however, there are other reasons why you may not be able to get pregnant, and these should also be evaluated.

Medical contribution by: Stephanie Beall, M.D., Ph.D., of Shady Grove Fertility’s Towson, MD and Columbia, MD offices and Kara Nguyen, M.D., MPH of Shady Grove Fertility’s Reading, PA office and Harrisburg, MD offices.

Editors Note: This post was originally published in July 2014 and has been updated for accuracy and comprehensiveness as of March 30, 2017. 

If you do not have a normal menstrual cycle and are having trouble conceiving, a fertility work-up may help determine if you are ovulating or if there are other factors. Shady Grove Fertility’s team of dedicated New Patient Liaisons is available to answer your questions and schedule a consultation with a physician. Call 877-971-7755 or click to schedule an appointment.

At Shady Grove Fertility, we’re here to give you the caring support you deserve as you start or grow your family. As a leading fertility and IVF center of excellence, we offer patients individualized care, innovative financial options, over 30 accepted insurance plans, and pregnancy rates among the highest of all national centers. We offer patients the convenience of 19 full-service and 6 satellite locations across Maryland, Pennsylvania, Virginia, and Washington, D.C. More than 1,700 physicians choose Shady Grove Fertility to refer their patients, and more than 96 percent of our patients say they would recommend Shady Grove Fertility’s 39 physicians to a friend. With 10 Shady Grove Fertility babies born each day, your dream of starting or growing your family is within reach. 

Being proactive about your reproductive health is a solid first step toward preparing for that family you’re looking forward to having one day. After all, 40 to 50 percent of infertility cases are attributed to male fertility issues.

Whether you’re looking to start a family next month or next year, you’ve likely put some thought into how you can promote healthy sperm development. If you’re actively trying, you might have even attempted some of the “tricks,” such as switching from briefs to boxers—an idea often touted in glossy magazines.

But do these strategies truly improve your fertility? We turned to Dr. Eric Levens of our Annandale, VA office to shed some important light and actionable steps that could help you increase your knowledge and potentially enhance your fertility.

Q: What are the primary causes of male infertility?

Dr. Levens: While there are many different causes of male infertility, each falls into one of three categories.

     1. Sperm production disorders

Your brain sends signals to your testicles, telling them to produce sperm. These signals are sent through hormones—primarily follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
In some cases, however, your testicles are unable to produce sperm, even though they’re receiving the signals from your brain.

In other cases, the signal isn’t strong enough. Though your testicles can produce the sperm, you may lack sufficient FSH or LH hormones to kick them into sperm production mode.
As specialists, the way we handle a sperm production disorder depends on what exactly the problem is. In some cases, we can use medicine to create the ideal hormonal balance. In others, we retrieve sperm from the testicle.

  2. Obstructive issues

Obstructive issues, which result in reduced sperm count and often lower seminal volume, occur when sperm is prevented from being ejaculated.

While there can be many causes, obstructive issues are often congenital (present at birth), such as the congenital absence of the vas deferens. Problems of this nature can also result from a failed vasectomy reversal.

Some men, particularly those with diabetes, experience outflow obstruction—also known as retrograde ejaculation. When men have this issue, their semen will flow into the bladder instead of out the urethra during ejaculation.

When a man has an obstruction issue, fertility specialists are commonly able to extract sperm cells from the epididymis. In the case of retrograde ejaculation, we can usually reduce urine acidity using medication, then extract sperm from the urine.

 3. Immune system dysfunction

In some cases, your immune system may be fighting against your fertility. Because sperm is naturally antigenic, your body can form antibodies against them. In some cases, a man’s body forms antibodies that attach to sperm, making it more difficult for sperm to move.
When a problem pertaining to your immune system is hindering conception, we are often able to “wash” the sperm, remove the antibodies, and proceed with more advanced reproductive care—like an IVF cycle.

Q: What’s a semen analysis, and when should I have one?

Dr. Levens: A semen analysis is a non-invasive, low-cost test in which we assess your sperm. In a semen analysis, we examine three main things:

• Count – How many sperm you have
• Motility – How well your sperm move
• Morphology – How your sperm are shaped

Because a semen analysis is such a simple test that yields a substantial amount of information, we suggest that couples have this test as part of their primary fertility work-up. In many cases, where patients initiated low-tech treatment such as timed intercourse with Clomid under the care of their OB/GYN or primary care physician—only to have an unsuccessful result—the answer was only revealed after a simple semen analysis. Had that couple started with an early semen analysis they could have saved precious time with other treatment strategies.

The bottom line, if you’ve been having unprotected sex for 1 year with a female partner under 35 or 6 months with a female partner over 35 and she hasn’t yet conceived, it is time to see a fertility specialist for testing of both the male and female.

If you have reason to suspect you may have an issue with your sperm—like if you’ve ever had testicular trauma, erectile dysfunction, or problems ejaculating—consider skipping the wait, regardless of your partner’s age or how long you’ve been trying, and get tested immediately.

When it comes to conception, knowledge is power. And a semen analysis can offer a quick, easy snapshot of your sperm health, providing knowledge that can be crucial to your starting a family.

Q: What can I do to promote healthy sperm development?

Dr. Levens: To have the maximum possible impact on sperm quality, you need to do more than simply eat the “right foods” or add a fertility supplement to your diet.

Whether you’re hoping to become a father soon or planning for future parenthood, here are a few actionable items to help you improve your sperm health.

     1. Maintain a healthy weight.

Carrying extra weight can increase testicle temperature and ultimately hinder sperm health. Not to mention, our body’s fat cells produce estrogen, which, when present in abundance, can decrease sperm production.

Since a direct correlation exists between obesity and having fertility issues, weight loss may help men improve sperm quality.

To maintain a weight within the ideal range, we encourage our patients to focus both on maintaining a healthy diet and engaging in moderate physical activity.

     2. Stop smoking.

Smoking increases oxidative stress on all body tissue, including sperm. Oxidative stress impacts both sperm motility and sperm morphology.

     3. Avoid excessive alcohol consumption.

Drinking excessive alcohol not only impacts your physical health—which can result in sperm issues—but it also commonly causes sexual dysfunction. This dysfunction may impact the frequency with which you are able, or choose, to have sex, therefore making conception harder.

     4. Avoid excessive heat.

Your testicles need to be at a lower temperature than the rest of your body—which is why they form outside of your body. Like smoking, excessive heat exposure puts oxidative stress on your sperm.
Further research is needed to know how much heat is truly damaging, however. Though we often hear it, there is no guarantee that switching from briefs to boxers will positively impact sperm count. At the same time, however, making the switch likely won’t hurt.

     5. Don’t take testosterone-containing medicines.

Some men who struggle to maintain a healthy libido often receive a testosterone (Low T) prescription from their general physicians as a remedy. While it may seem that increasing your testosterone level will help your sperm, many of the medicines used to do this actually suppress sperm function.

     6. Take a vitamin.

Maintaining an ideal vitamin and mineral balance is critical for sperm production. Some research indicates that zinc and folate supplements help promote sperm health.

Shady Grove Fertility is proud to recommend Luminary Vitamins and Theralogix to offer high-quality, evidence-based nutritional supplements patients can trust. 

Medical contribution by Eric D. Levens, M.D.

Eric D. Levens, M.D., FACOG, board certified in obstetrics and gynecology and subspecialty board certified in reproductive endocrinology and infertility. Dr. Levens is committed to improving the success of fertility care through active research and national advocacy. He sees SGF patients at the Fairfax, Virginia, office.