What is Infertility?
Infertility is the inability to conceive, or to carry a pregnancy to term. For women under 35, infertility is diagnosed after a year of unprotected intercourse. For women 35 years of age or older, this time length is shortened to 6 months. My practice prefers the opportunity to be proactive in light of the natural decline in pregnancy rates with the aging egg. Couples or individuals who have known fertility issues, such as anovulation/irregular periods, PCOS, male factor, endometriosis, should seek a fertility consultation at the time that they are planning to start a family.
My doctor says I am not ovulating regularly. How could I get my period if I do not ovulate?
Most patients who have regular cycles (26-35 days) are ovulating every month. In order to have a regular cycle, the hormones that grow and then shed the lining of the uterus are synchronized to a mid-cycle ovulation event.
For patients who have long and/or irregular cycles (30-90 days), the body is making the hormones to grow a uterine lining. If ovulation does not occur the lining sheds spontaneously. This process results in long and irregular cycles, but does not indicate that ovulation occurred.
I am concerned that I may have poor egg quality. How can I determine my egg quality?
The most important determining factor of egg quality is AGE. As women age, so do their eggs. The consequences of this aging process are lower pregnancy rates and higher miscarriage rates. Poor response to injectable fertility medications, failure of prior fertility treatment, prior surgery to the ovaries and shortening menstrual cycles can be other signs of egg quality issues.
Blood tests including FSH and Estradiol (on the 2nd or 3rd day of the menstrual cycle) and the Clomid Challenge Test (CCCT) can indicate if egg quality issues are present. Sometimes we do not have confirmation of an egg quality issue until we do an IVF cycle and see how the eggs behave and embryos develop (abnormal fertilization, poor embryo development).
I have been diagnosed with Decreased Ovarian Reserve, what does it mean?
Decreased or diminished ovarian reserve (DOR) has very significant implications for fertility treatment. It does not, however, say you cannot successfully conceive. The patient's age is of some importance, as women <38 with DOR are more likely to be successful than those who are older. However, age-for-age, patients with DOR have lower pregnancy rates and higher miscarriage rates. If all conventional treatment options have been exhausted, usually the most successful option for pregnancy is to pursue egg donation. Pregnancy rates using a donor egg are very high.
How do I interpret my FSH/E2 results?
Both of these hormone tests should be performed on the 2nd or 3rd day of the menstrual cycle (first day of FLOW is cycle day 1). Every laboratory has to determine its own FSH cutoff. However, using the more sensitive chemiluminescent assays, most clinics use an FSH level around ³ 10 IU/ml as indicating diminished ovarian reserve (diminished egg quality). The Estradiol should be less than 70 pg/ml. If the Estradiol is higher, this can also predict for diminished ovarian reserve.
It has been recommended I do a CCCT, what does it mean?
For some patients, we may recommend a CCCT for assessment of egg quality. This test is a more sensitive test than the day 3 FSH/Estradiol test. For patients who respond poorly to fertility medications, have unexplained infertility, have symptoms of decreased fertility (shortened cycles), have had ovarian surgery or are older than 37 years old we may recommend a CCCT.
The CCCT involves doing a blood test for the hormones FSH and Estradiol on cycle day 2 or 3. Then, 100 mg of Clomiphene Citrate is taken from cycle day 5-9, and the FSH blood test is repeated on cycle day 10.