Reproductive Health Information - Fertility General
General Fertility Information
Infertility is a condition diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages. If the woman is over 35 years old, it is diagnosed after 6 months of unprotected, well-timed intercourse.
As per the ASRM (American Society of Reproductive Medicine), infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality. Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.
Accurately determining the time a woman ovulates is paramount when trying to conceive. The only other parameters that are equal in importance is being certain there is sperm present and that the fallopian tubes are open.
The following are ways to better pin-point when and if you have ovulated so that proper timing of sex can occur;
BBT (basal body temperature charting). Learning to properly take and chart your basal body temperature each morning for at least 3 menstrual cycles is a great thing to do if you have been trying to conceive without luck. In a perfect world there will be a slight dip in your temperature at the end of your follicular phase (bleed and maturing of the egg). This dip, if followed by a rise in temperature of at least 0.2 degrees celcius in the following couple days is an indicator of ovulation. The temperature should remain at higher temperatures for at least 10 days to support and maintain an early pregnancy.
‘Fertile’ pre-ovulation cervical fluid. This essential body fluid is something that a woman trying to conceive must understand. ‘Slippery, clear, raw egg-white, stretchy’. These are the common descriptions given to the vagnial secretions that must be present just before the release of the egg from the ovary (ovulation). There are 3 main characteristics to look for when identifying ‘fertile’ pre-ovulatory cervical fluid; 1. It is slippery so as to provide lubrication for sex. Some women report a ‘wet’ sensation. 2. It becomes more transparent (like raw egg-white) due to higher water content so as to aid in sperm motility (swimming). 3. It stretches when examined between the fingers. Does not appear ‘tacky’ like lotion. Click here to learn more about the importance of cervical fluid and fertility.
Ovulation Urine Strips (luteinizing hormone detection strips). Depending on the length of your menstrual cycle, starting to use these pee strips should occur when approx 1/3 of your cycle is complete (i.e. 30 day cycle, start using strips on day 10). Be sure to use the same urine each day to be sure to obtain accurate relative results (i.e. always use 1st or 2nd pee of the day). There are very expensive strips at your local drugstore and they often come with a fancy monitor. You don't need these. All you need is simple strips that show you a line when your ovulating hormones are at their peak (go to early pregnancy tests website to order). When the tests show the luteinizing hormone at its peak, this communicates to the woman that in the next 12-36 hours ovulation will occur.
'Twinges' or slight pain. This is often reported around ovulation. Theories of it being the follicle (aspect of the ovary which contains the egg) rupturing and releasing the egg are quite likely true.
Libido or sex drive. Yes, women are ready to make babies like no other time of their cycle during ovulation. If a woman is healthy and trying to conceive has not completely snuffed out all romance, this is a great indicator of when a woman is fertile.
Cervical position. When a woman is fertile her cervix (muscular opening between the vagina and the uterus), which when open allows the passage of sperm into the uterus and ultimately the fallopian tubes. it also retracts upwards away from the vaginal opening and softens to allow for deeper penetration during intercourse. Simply put, when a woman is fertile, sex is better for both partners.
Day 21 Progesterone blood work. A lab test that can tell to some certainty whether a woman ovulated. A woman gives blood approx 7 days after she thinks she has ovulated. Numbers within a certain range are tell tale.
Ultrasound. Sometimes a woman will get ultrasounds to determine if a follicle is in atrophy (shrinking). This is also a good indicator as to whether an egg has been released.
OK, now lets put some of this together very simply. Libido, cervical position, twinges, fertile cervical fluid, and ovulation pee strips should all be present at approximately the same time. This is when a woman is fertile. This is when intercourse should occur. If sperm is healthy, every day is great. If sperm is not optimal, allow a day between ejaculations. Once the BBT has risen, it is now too late. See 'When should we have sex?' for a more detailed description of punctual coitus.
How a Harvard-trained doctor began to appreciate traditional Chinese medicine - by Leana Wen, M.D.
As a child growing up in China, I was always aware of Traditional Chinese Medicine (TCM). TCM is what we refer to as Eastern medicine, in contrast to the Western medicine we know from U.S. hospitals. I never understood much about TCM, only that it somehow involves herbs and that many Chinese people used it. The more I progressed in my medical training in major U.S. academic centers, the more distanced I felt from TCM. Why should I learn about something that lacks evidence, when there’s so much to know about for which there is good research?
Last fall, I went to China on a research trip. While my study is primarily on its Western medical system, I was so fascinated by what I learned of Eastern medicine that I spent many free evenings observing TCM practitioners. There is so much I didn’t know. As a discipline, TCM is far too complex for me to understand in my short observation, but there are some very important “lessons from the East” that are applicable to our Western medical practice:
#1. Listen—really listen. The first TCM practitioner I shadowed explained to me that to practice TCM is to “listen with your whole body”. Pay attention and use every sense you have, he said. I watched this doctor as he diagnosed a woman with new-onset cervical cancer and severe anemia the moment she walked into his exam room, and within two minutes, without blood tests or CTs, sent her to be admitted to a (Western) medical service. I’ve seen expert clinicians make remarkable diagnoses, but this was something else!
“How could you know what you had and that she needed to be admitted?” I asked.
“I smelled the cervical cancer,” he said. “I looked and saw the anemia. I heard her speak and I knew she could not care for herself at home.” (I followed her records in the hospital; he was right on all accounts.)
#2. Focus on the diagnosis. I watched another TCM doctor patiently explain to a young woman with long-standing abdominal pain why painkillers were not the answer.
“Why should we treat you for something if we don’t know what it is?” he said. “Let’s find out the diagnosis first.” What an important lesson for us—to always begin the diagnosis.
#3. Treat the whole person. “A big difference between our two practices,” said one TCM doctor, “Is that Western medicine treats people as organs. Eastern medicine treats people as a whole.” Indeed, I watched her inquire about family, diet, and life stressors. She counseled on issues of family planning, food safety, and managing debt. She even helped patients who needed advice on caring for the their elderly parents and choosing schools for their child. This is truly “whole person” care!
#4. Health is not just about disease, but also about wellness. There is a term in Chinese that does not have its exact equivalent in English. The closest translation is probably “tune-up to remain in balance”, but it doesn’t do the term justice, because it refers to maintaining and promoting wellness. Many choose to see a TCM doctor not because they are ill, but because they want to be well. They believe TCM helps them keep in balance. It’s an important lesson for doctors and patients alike to address wellness and prevention.
#5. Medicine is a life-long practice. Western medicine revers the newest as the best; in contrast, patients revere old TCM doctors for their knowledge and experience. Practicing doctors do not rest on their laurels.
“This is a practice that has taken thousands of years to develop,” I was told. “That’s why you must keep learning throughout your life, and even then you will only learn just a small fraction.” Western medicine should be no different: not only are there new medical advances all the time, doctors need to continually improve their skills in the art of medicine.
#6. Evidence is in the eyes of the beholder. Evidence-based medicine was my mantra in Western medical training, so I was highly skeptical of the anecdotes I heard. But then I met so many patients who said that they were able to get relief from Eastern remedies while Western treatments failed them. Could there be a placebo effect? Sure. Is research important? Of course. But research is done on populations, and our treatment is of individuals. It has taken me a while to accept that I may not always be able to explain why—but that the care should be for the individual patient, not a population of patients.
“In a way, there is more evidence for our type of medicine than for yours,” a TCM teacher told me. “We have four thousand years of experience—that must count for something!”
There is so much I have not covered about TCM. Its practices vary regionally, and no doubt, there are more and less capable practitioners (as there are in Western medicine). More research into TCM methods will be important. However, regardless of whether we Western doctors want to prescribe TCM treatments, we should recognize there is much to learn from Eastern medicine, including what it means to be a physician to really care for our patients. Upon my return from China, I, for one, have a newfound appreciation for Eastern medical practice a renewed understanding of holistic medical care.
Yes. As a matter of fact, at the time of this writing I have a 45 year old woman in Vancouver that after 3 consecutive miscarriages, is pregnant naturally and about to give birth. For me, this has only happened a handful of times but it does happen, there is hope. Although, I have to say, the women that I have seen achieve advanced maternal age babies are women that took great care of themselves, followed recommendations for acupuncture and Chinese medicine treatment, exercised regularly, got enough sleep, and ate a diet conducive to optimized fertility. They also seem to maintain a young spirit and walk through their days with a deep faith that they are being taken care of and things will happen as it should.
I have also worked with women of ages up to 51 that have conceived with the aid of a donor egg. Strong commitment to prolonged treatment protocols and lifestyle choices seem to be key in these cases.
Bottom line to me is that conception with women of advanced maternal age boils down to overall health and well-being. A woman's state of fertility potential is not a separate entity from the rest of her body mind and spirit. In Chinese medicine, all 3 of these treasures must be nourished in order to optimize chances of long life and conception after age 40.
A great resource for these numbers:http://www.fertilityplus.org/faq/hormonelevels.html
*note: in Canada, the estrogen/estradiol values for cycle day 3 are <200.
A great resource for this: http://fertilityplus.org/faq/infertility.html#sect7