April is National Infertility Awareness Month. Here are the top ten things to know about fertility.

  • Timing – Many women do not know when they are ovulating or how to predict when they are ovulating.  They also do not understand that the cycle starts on the first day of menstrual bleeding. The first thing to keep in mind is the frequency of your cycles.  You calculate this from the first day of menstrual bleeding to the next cycle’s first day of bleeding.  Most women will have a cycle frequency between 21 and 35 days.  Subtract 14 from this number and this tells you on what day of the cycle you are ovulating.  For example, if you have a 28 day cycle you ovulate on day 14; if you have a 30 day cycle, you’ll ovulate on day 16; if you have a 32 day cycle, you’ll ovulate on day 18.  Remember again to count your first day of bleeding as day one to predict which day of the week to have intercourse.  It is best to have intercourse one or two days before ovulation and one or two days after.
  • Age – Unfortunately there is a biological clock.  As women approach 40 their fertility will decline.  The younger you are the more likely you are to be fertile.  The older you are the more likely you are to have issues with infertility.
  • Anovulation– A woman must have a monthly menstrual cycle to show that she is ovulating.  You must ovulate in order to have a baby.  If your cycles are either less than every 3 weeks or greater than every 35 days you may not be ovulating.
  • Male Factor – The male partner in the equation must have adequate sperm in order to conceive.  The adequacy of the sperm is based on 3 factors: the amount of sperm, the motility of the sperm and the morphology or structure of the sperm.  This can be determined by a semen analysis.
  • Tubal Factor-The fallopian tubes must be open in order for the sperm and egg to unite and for fertilization to occur.  Tubal scarring can occur from having undiagnosed pelvic infections with Chlamydia or from having adhesions or scarring from prior surgery or endometriosis.  A special X-ray called a Hysterosalpingogram can be performed to see if the fallopian tubes are open.
  • Waiting enough time– As hard as we try to prevent pregnancy when we do not want it, when we are ready to conceive we think it should happen instantaneously but the truth is the process takes time.  The average couple will have a 20 percent chance per month to conceive.  We do not consider a couple infertile until they have had unprotected intercourse for more than one year.  It is usually recommended to seek medical attention after one year of unprotected intercourse if you are under 35 years of age, or after 6 months if you are over 35 years of age.
  • Structural issues– Problems with tumors in the uterus or ovaries can prevent pregnancy.  For example, tumors in the ovaries can prevent ovulation from occurring, or fibroids in the cavity of the uterus can effect implantation.  If you have pelvic pain or abnormal menstrual cycles see your gynecologist for a pelvic ultrasound to insure that everything is normal.
  • Same sex couples now have the opportunity to have children – Male couples can use a surrogate mother with a donor egg and one partner’s sperm.  Female couples can use donor sperm either via insemination or in vitro fertilization.
  • Medical problems– If you have undiagnosed diabetes this can increase the risk of miscarriage and birth defects.  Make sure that you are not a diabetic before you conceive and if you have diabetes, make sure that your blood sugars are in very tight control at least three months before conception.
  • Weight problems – Make sure that you are at your ideal body weight.  Calculate your body mass index to see where you fall.  If you are either underweight or overweight you can experience problems with ovulation and conception.