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Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse or if the woman has been unable to carry a pregnancy that results in a live birth.
Infertility is a medical problem. Approximately one-third of infertility cases are due to a female factor and one-third is due to a male factor. In the balance of cases, infertility results from problems in both partners, or the cause of the infertility cannot be explained.
The most fertile time of the month is just before or at ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time. Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32 day period would likely ovulate around day 18 (32-14=18), while a woman with a 28 day cycle would ovulate around day 14 (28-14=14).
Because the sperm live longer than the egg does, it is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 13 or 14. For women with irregular cycles, one way to decide on the potential fertile period is by taking the shortest cycle and subtracting 16, then taking the longest cycle and subtracting 12. This would give the fertile time and allow for even more fluctuation in cycle length than usual. For example, the fertile period for a woman whose cycles vary from 27 to 33 days should be sometime between day 11 (27-16=11) and 21 (33-12=21). Alternatively, women with irregular cycles may want to use an ovulation predictor kit, which can be purchased over the counter at drug stores. One important fact to note is that, if a woman is using a basal body temperature chart, that the temperature will rise after ovulation and therefore after the most fertile period. The couple should therefore not wait until the temperature has risen to start to have intercourse, as they will have missed the most fertile time.
The simple, inexpensive way of finding out the approximate time when you ovulate is to take your basal temperature (that is, your body temperature at rest) every morning and record it on a chart. You can buy a Basal Body Thermometer at your drug store. Save all your charts so you can review them with your doctor. Three or four months of charting should be adequate.
Yes. You can buy an ovulation predictor urine test at your drug store. Also, your body may signal when you are about to ovulate; many women feel twinges in their lower abdomen (your ovaries are on the right and left sides of your lower abdomen). Other women notice clear, stretchy vaginal discharge just at their fertile time. Your doctor can also request an ultrasound or appropriate blood tests to determine ovulation.
It is a good idea to have intercourse every other day around the time you ovulate. (Day 10, 12, 14, and 16.) Remember, every woman is different, and may not ovulate exactly on “Day 14.” And, just because you ovulated on “Day 14” this month, doesn’t mean you will next month. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available. To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.
We advise you not to be concerned unless you have been trying to conceive for at least one year. However, if you are over 30 years old, have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles or if your partner has a known low sperm count, you may want to seek help sooner. Many couples have a hard time admitting that there may be an infertility problem. After each menstrual period, they hope that “maybe it will work this cycle”. When these hopes are dashed month after month, a woman often consults her regular OB/GYN or a fertility specialist.
A fertility specialist, or Reproductive Endocrinologist, is a medical doctor who has been specially trained in the complex issues that can contribute to infertility. In addition to being trained as an OB/GYN, a Reproductive Endocrinologist must complete highly specialized training for all aspects of infertility.
Below are the school and training requirements that an OB/GYN and Reproductive Endocrinologist must complete.
OB/GYN
Reproductive Endocrinologist
To Become Board Certified in OB/GYN, the doctor must:
To Become Board Certified in Reproductive Endocrinology, the doctor must:
Currently in the U.S., there are just over 1,300 Board Certified Endocrinologists. Specifically for infertility related to males, Urologists with a sub-specialty in Andrology are the most qualified experts they have completed 2-year fellowships and passed exams to become Board Certified in Andrology.
We typically tell patients to plan to be at our office for an hour and a half. You will meet with a physician, nurse and financial counselor during your first appointment. The appointment will really depend on how many questions you and your partner (if applicable) may have.
The following tests are used to help diagnose a fertility issue:
When you call to schedule your semen analysis appointment we will provide instructions to abstain from sex for 2-7 days before the test. When you arrive for your appointment you will be taken to our lab where we have collection rooms for the males. In the collection room you will produce your specimen to be tested. For males who would like to produce the sample at home they will need to come to our office prior to their appointment to pick up a collection kit, which includes a sterile specimen cup. You still must make an appointment and get the sample to us by your scheduled time. The sample must get to us within an hour of producing it.
One of the biggest questions patients always want to know is, how much does treatment cost? This is always tricky because there are so many variables that can affect the cost of treatment. Do you have any insurance coverage? What is your deductible? How much will medication cost? Do you want to have any type of genetic testing done? These are all questions that can greatly affect the cost of treatment. The cost of treatment will always be discussed in detail at your initial consultation so that you have a clear understanding of how much treatment will cost.
Unfortunately, we do not accept payment plans but we will provide you with third party financing information during your initial consultation.
There is evidence linking reproductive impairment with exposure to alcohol, tobacco and caffeine. Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women and tobacco is an especially potent reproductive toxin. It is wise to be in the best physical shape possible while you attempt to conceive and, of course, to ensure a healthy pregnancy and baby.
Yes. High temperatures can kill sperm. That is why the scrotum is located outside the body — to act as a kind of “refrigerator” to keep the sperm cool. So, it is a good idea to avoid hot tubs, saunas, and steam rooms. Wear loose pants and underwear.
