Sunday, October 25, 2009

Ovulation and Trying to Get Pregnant

Ovulation and Trying to Get Pregnant

When trying to get pregnant, a couple ideally should have frequent intercourse (hopefully increasing the chances of exposing the egg to active sperm) just before and around the time that the egg is released from the ovary (ovulation). Trying to get pregnant, rather than simply finding out that you are pregnant “by accident,” can seem unnatural for some couples and this can add stress to a relationship. Initially, keeping things as natural as possible may be beneficial, since stress is rarely helpful.

Ovulation generally occurs about 14 days (2 weeks) prior to the onset of the next menstrual flow. If the menstrual cycle intervals are normally 28-30 days, then ovulation usually will occur around cycle day 14-16. If the menstrual cycle intervals are every 60 days (2 months), then ovulation usually will occur around cycle day 46. If the menstrual cycle intervals are very irregular, then detecting when ovulation is occurring using tests like ovulation predictor kits, serial blood work, or serial ultrasound exams can be helpful.

If ovulation is rare or extremely irregular, then fertility medication may be helpful in inducing or enhancing ovulation. An infertility doctor should be considered when fertility medications are being selected and administered.

Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC is board certified in Reproductive Endocrinology and Infertility and he has extensive experience with ovulation problems and menstrual irregularities. Dr. Daiter would be happy to help. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250. Please visit us on the web at http://www.drericdaitermd.com http://infertilitytutorials.com and http://www.ericdaiter.com

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Friday, October 23, 2009

Ovulation and The Menstrual Cycle

Ovulation and the Menstrual Cycle

The onset of menstrual flow (menses) generally marks the beginning of the female reproductive cycle, during which an egg is matured and the uterine lining (endometrium) develops, to allow for embryo implantation and the development of a normal pregnancy. If no pregnancy occurs, then the endometrial lining is shed (the menstrual flow begins) and the cycle begins once again. Normally, menstrual cycle intervals are about every 28-30 days. Many fertile women have somewhat longer or shorter menstrual cycle intervals, suggesting that the egg quality at full maturity is somewhat independent of the time taken for the egg to develop fully.

The initial part of the menstrual cycle is often thought of as the “egg development” phase, and since the eggs develop within ovarian cysts called follicles this is usually referred to as the “follicular phase.” Ovulation normally occurs once a mature egg is developed. The final part of the menstrual cycle is the “luteal phase” marked by elevated progesterone production. The progesterone appears to modify the endometrium within the uterine cavity to allow for a 4-5 day “window of uterine receptivity” for embryo implantation, and if no pregnancy develops then the entire lining is shed about 14 days after ovulation. If a pregnancy does develop, then progesterone production normally remains elevated throughout the course of the pregnancy.

There are some problems with ovulation that can reduce fertility. Hormone imbalances involving thyroid hormone or prolactin can interfere with ovulation. If the egg is released from a follicle that has a smaller diameter than usual, then a relative progesterone deficiency may develop during the luteal phase of the cycle (luteal phase defect). Also, genetic or inherent problems with the egg can impact fertility.

At The NJ Center for Fertility and Reproductive Medicine, LLC, Dr. Daiter is experienced in identifying and treating ovulation dysfunctions that can result in reduced fertility. For an appointment to discuss your ovulation or fertility concerns with Dr. Daiter, please call the office at 908 226 0250. Visit us on the web at http://www.drericdaitermd.com http://www.ericdaiter.com or http://www.infertilitytutorials.com

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Thursday, October 22, 2009

Ovulation Detection

Ovulation Detection

Normally, a reproductive age woman will have regular menstrual cycle intervals every 28-30 x 4-5 days. Prior to the onset of the menstrual flow, premenstrual symptoms are common (including breast tenderness, headaches, abdominal bloating, and mood swings), which generally reflect the cycle’s normal changes in reproductive hormones. A history of regular menstrual cycle intervals with premenstrual symptoms is fairly strong clinical evidence that ovulation is occurring monthly.

Ovulation normally occurs about 14 days (2 weeks) prior to the onset of the next menstrual flow. In women with very regular menstrual cycle intervals, counting back 14 days from the expected next menstrual flow provides a rough estimate of the date of ovulation.

Ovulation tests include ovulation predictor kits that use test strips that are dipped in urine daily, which cause a chemical reaction that changes the color of the patient’s test result when LH is present. When a mature egg has been developed within the ovary, the body signals the ovary to get the egg ready for fertilization and to release the egg (ovulate) with a surge in the hormone LH. When the patient’s concentration of LH is great enough to suggest the LH surge (trigger to ovulate) then the patient’s test line on the test strip is often equal or darker than the test strip’s reference line. Since the egg normally will ovulate about 36 hours (one and a half days) after the onset of the LH surge, once the test strip is initially positive for the LH surge then ovulation can be expected within a day or so. These test strips are usually accurate for women, but sometimes they don’t seem to be reliable for (work effectively for) a particular woman.

Ultrasound examinations of the ovaries can determine the size of follicles (ovarian cysts that contain an egg) and serial ultrasound exams during the follicular phase of the menstrual cycle (egg development phase) can usually determine with high accuracy when a mature egg has developed. Once the egg is mature, ovulation can be triggered by administering the hormone hCG (human chorionic gonadotropin), which acts exactly like the LH surge to trigger ovulation. In this way, the timing of ovulation can generally be predicted accurately within a few hours.

Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has extensive experience with ovulation problems and ovulation detection. He would be happy to help you. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250. Visit us on the web at http://www.drericdaitermd.com http://www.infertilitytutorials.com or http://www.ericdaiter.com

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Tuesday, October 20, 2009

Ovulation and Infertility

Ovulation and Infertility

Successful human reproduction normally requires the coordination of several different events, including ovulation (release of a mature fertilization capable egg from the woman’s ovary), sperm production and release (ejaculation of mature motile sperm within seminal fluid), fertilization of the egg in the fallopian tube (sperm moves through the uterine cervix and uterine cavity into the tubes), and implantation of the developing pre-implantation embryo inside the uterine cavity.

Normally, a reproductive age woman will produce one mature egg per month, which is released from the ovary during ovulation. The eggs mature in ovarian cysts called follicles and during the “follicular phase” (egg developing phase) of the menstrual cycle the hormone FSH (follicle stimulating hormone) has a primary role in stimulating the maturation of eggs. Once the egg is developed, then the hormone LH surges to trigger the release of the egg at ovulation. After ovulation, there is an increase in the ovarian production of the hormone progesterone, which modifies and enhances the endometrial lining in preparation for embryo implantation.

Many abnormalities of the menstrual cycle and ovulation can occur and any of these problems will generally reduce fertility or cause infertility. A Reproductive Endocrinologist can suggest a diagnostic evaluation and infertility treatments based on the findings of the diagnostic tests.

Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has extensive experience with all types of ovulation problems and menstrual irregularities. Dr. Daiter would be happy to help you to determine the cause of an ovulation problem and suggest treatment options. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250. Please visit us on the web at http://www.drericdaitermd.com http://infertilitytutorials.com and http://www.ericdaiter.com

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Sunday, June 1, 2008

IUI Process Explained

As couples exhaust their non-medical resources and steps toward conception prove futile, they often contact their trusted physician or other fertility expert for advice in what ways to proceed. For many, intrauterine insemination, or IUI, appears as a viable option and is one of the lesser-invasive procedures offered.

A first step in the IUI process involves tests that help provide a better prediction of what day a woman’s egg is released. Ultrasounds can be used to monitor egg development within the ovarian follicles. Urine tests are used to identify and measure the luteinizing hormone levels that rise significantly in the hours preceding ovulation. These urine ovulation predictor tests may be administered at home and can be read by the couple trying to conceive. After ovulation predictor kit analysis provides the best choice of days for the treatment, preparations will be made for that day. This involves readying the sperm to be used for insemination. This sperm will be examined and shown to be fertile through testing. It is also necessary to wash the sperm to remove any chemicals that might cause unwanted reactions within the woman’s uterus. Often, antibiotics and protein supplements are added to the semen to enhance its viability and the seminal fluid is removed so that concentrated sperm is all that will be used for the procedure. This process of sperm washing is often very helpful in situations where the male partner possesses a low sperm count or the sperm is experiencing difficulty surviving its trip to the womb. The IUI process is often used successfully in cases where the female does not posses a partner that will be supplying the sperm, but might be using instead sperm chosen from a bank of sperm donors. Once the sperm has been readied, on the designated day, the process will begin. If there exists a problem with a woman’s ovulation, a doctor might feel the need to prescribe fertility drugs in order to amp up ovulation to release more eggs prior to the designated day. The sperm is inserted in the woman’s uterus by way of a catheter. By placing the sperm nearer the eggs, the sperm is given a better chance to fertilize the egg and stimulate a successful implantation and pregnancy.

Intrauterine insemination is often one of the first medical steps women choose because of its relative inexpensiveness as compared to in-vitro fertilization. IUI is less invasive, but is also proven less effective, with a success rate below 25%, where IVF has a success rate nearing 60%. It is best to contact a physician or fertility clinic in order to arrive at the best course of action.

About the Author: Eric Daiter has been sponsored by The NJ Center for Fertility and Reproductive Medicine, LLC, a leading provider of ovulation testing. For more information, please visit http://www.drericdaitermd.com/or http://www.ericdaiter.com/

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Saturday, May 31, 2008

Using Fertility Awareness Methods to Focus Conceptive Efforts

As couples embark upon the second stage of family planning, conception, after many years of practicing contraception, they may soon find that becoming pregnant might just be more difficult than they had previous believed. Just think: all of the right conditions must be in place for sperm to live to reach an egg, for an egg to be fertilized, and for that egg to succeed within a woman’s body. Many reproductively minded women find it helpful to become more aware of their bodies’ cycles in order to both better know themselves and increase their chances of conceiving. There are three signs that women can monitor successfully and thus feel empowered that they are actively involved in their successful conception. Please note that “self tests” for determining when ovulation is occurring are not always accurate or reliable. If you seem to be having problems with these tests, you can consult with your physician about more reliable tests that are available.

The first step in using Fertility Awareness Methods (FAM) to promote pregnancy involves the female’s Basal Body Temperature (BBT). A woman should take her body temperature in the same place (orally or vaginally) and at the same time each day, before daily activity begins, in order to be most accurate and most beneficial. Basal Body Temperature charts are readily available for free download on the Internet; each daily body temperature should be recorded on one of these charts with dots and connected with straight lines. When the full monthly cycle has been charted, the six temperatures occurring before the midcycle rise should be highlighted and the highest of these six duly noted. Another line, called the coverline will need be drawn above this highest temperature demarcating the time when ovulation most likely occurred. This charting should continue regularly in conjunction with the next two observations until conception is achieved successfully.

The next step a woman can take is making sure to observe the consistency of the cervical fluid. Beginning with the last day of bleeding from menstruation, it is helpful to check cervical fluid; always using clean hands, the vaginal lips should be separated and the fluid within swiped with fingers. It is helpful to check this at each restroom visit. Careful attention to the integrity and consistency of the fluid should be observed and charted. By putting finger and thumb together with fluid, pull fingers apart and check to see if it is sticky and tacky, or if it immediately pulls apart. Note when it is sticky and slippery, similar to egg white consistency – this is indicative of fertile days. Pay special attention as well to any sensations felt vaginally and note them. The wettest and stickiest day of the fluid checks should be noted as the day of optimum fertility and indicative that ovulation has occurred.

Perhaps the most difficult observation is the last one, and it involves checking the position of the cervix. Best observed during the fertile (wet and sticky) time preceding ovulation, in the squatted position, a woman should use their middle finger and note the condition of their cervix. Is it especially wet, high, soft, or open? A dot can be used on the chart to denote a closed and firm cervix, a small circle to show a partially open cervix, and a larger circle to show a high and open, soft cervix. Any other symbols can be used as well, just keep straight what each one means. When the cervix is soft, open, and high, a woman is at her most fertile and receptive of the male’s sperm. Take note of this, and compare with the results from the other two observations.

By combining and cross-referencing the data found with each observation method, a woman will successfully increase her chances of conceiving as well as becoming more aware of the changes within her body. Learning to listen to the body and being aware of each of its stages are ways to become actively involved in conception. Seeking advice from a doctor is always beneficial as well, so never hesitate in asking questions.

About the Author: Eric Daiter has been sponsored by The NJ Center for Fertility and Reproductive Medicine, LLC, a leading provider of ovulation testing. For more information, please visit http://www.infertilitytutorials.com/ http://www.drericdaitermd.com or http://www.ericdaiter.com/

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Thursday, May 15, 2008

Ovulation Pain (Mittelschmerz)

The decision to (try and) conceive is one made excitedly by couples each day. One of the first steps to scientifically better chances of this happening is for the woman to determine approximately at what time each month she ovulates. This does change slightly from month to month, but with Basal Temperature Charting, an approximation can be made and is very helpful for many women. While basal charting can be tedious and time-consuming, some women find that charting their time of ovulation is indeed no problem whatsoever. 20% of all women do have this easier time of pinpointing ovulation, but for a not so desirable reason. Nearly a quarter of women experience pain with ovulation called mittelschmerz, in German, meaning middle pain. This pain happens in the middle of a woman’s cycle, at ovulation, and this is where it gets its name.

This middle pain experienced by some women is not always felt in the middle (of their abdomen) but usually on the side, depending on which side the ovary releasing the egg that month resides.
The degree of pain is different from woman to woman, with some experiencing nausea due to intense pain, while others might experience merely a dull pain resembling indigestion. The length of this pain varies as well and, for some, is accompanied by bloody discharge. Scientists are not sure why some women experience this pain and others do not, but speculate that the blood released along with the egg during ovulation might in some way aggravate the lining of affected women’s abdominal cavities. Treating this pain, which should not last more than 24 hours, is relatively easy. Most women find that warm baths, warm compresses to the abdomen, and over-the-counter pain medicines such as ibuprofen work well enough to relieve the pressure and pain. Women for which mittelschmerz causes extreme pain that truly disrupts their daily living may find it necessary to take some sort of prescribed birth control pill to stop ovulation all-together. With no ovulation, no pain is experienced, but women trying to conceive, obviously, should not take this route.

Because this 20% of women experience this true indicator of when they ovulate, they do, in a sense have an advantage when deciding to conceive. Their charting might not need to involve a thermometer whatsoever, but merely a dot showing when, each month, this middle pain begins and ends. Having sexual intercourse in the days preceding this monthly pain would be advantageous and chances of conceiving, provided normal fertility exists in male and female partner, are quite good.

About the Author: Eric Daiter has been sponsored by The NJ Center for Fertility and Reproductive Medicine, LLC, a leading provider of ovulation testing. For more information, please visit www.infertilitytutorials.com.

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Tuesday, March 4, 2008

Egg Donation Part 2 - Egg Retrieval Procedure

Once you have been pre-screened and qualified to be an egg donor for in vitro fertilization the egg donation center that you are working with will teach you how to self-administer the medications used during the process. Be forewarned that you will be injecting yourself with these medications. Two types of medication often used for controlled ovarian hyperstimulation include Follicle Stimulating Hormone (FSH) and Lupron. FSH stimulates the production of eggs while Lupron prevents the ovaries from releasing the eggs before the retrieval process takes place. Some possible side effects of these drugs include fatigue, moodiness, headache, ovarian cysts, and in some rare cases hyper stimulation syndrome of the ovaries. An indication of hyper stimulation syndrome is enlarged painful ovaries and would be detectable on an ultrasound.

Timing is everything when it comes to the administration of these medications. Lupron is typically begun 5-6 days before the start of your period. When your period starts you will need to have a baseline vaginal ultrasound prior to starting the FSH. This will help to detect the presence of any cysts on the ovaries. Ovarian cysts are not uncommon and usually resolve on their own but large or complex cysts may require treatment. If the ultrasound is clear you will begin taking the FSH approximately 2-3 days after the start of your period. Your blood will be drawn at regularly to monitor the level of estradiol, the hormone secreted by developing eggs, in your system. Another vaginal ultrasound will be performed to determine the size and number of eggs in your ovaries when your estradiol level is at the appropriate level. A single injection of Human Chorionic Gonadotropins (hCG) will be administered when the eggs are ready for retrieval. HCG is a naturally occurring hormone that helps with the last stage of development of the eggs. About 36 hours after the hCG injection the eggs are ready for removal.

Since you will be sedated when your eggs are removed you will be asked not to eat or drink anything after midnight the day before the procedure. When you arrive for the procedure you will change into a gown and an IV will be started for the administration of medications and fluids. Then you will be given medication to ensure you are adequately sedated and comfortable during the egg removal. Once you are sedated, a thin needle is inserted through the vagina into the ovaries and the eggs are aspirated into the syringe.

After the procedure you may experience some pelvic discomfort, small amounts of vaginal bleeding or blood in your urine. These side effects usually clear within a day or two. You will be able to return home a few hours after you wake up. You will need to have someone drive you home since you will still be feeling the effects of the medication used to sedate you. You will be given a prescription for pain management as well as an antibiotic to decrease your chances of infection. After the eggs are removed your part is done. The eggs will then be used for the infertility treatment called in vitro fertilization.


About the Author: Eric Daiter has been sponsored by The NJ Center for Fertility and Reproductive Medicine, LLC, a leading provider of infertility treatment, to explain in vitro fertilization in plain language. To review this information, please visit www.infertilitytutorials.com.

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Monday, March 3, 2008

Egg Donation Part 1 – Qualifications for Donors

Many women are unable to have genetic children because of fertility problems related to egg production. As result of cancer, congenital absence of eggs, or early onset menopause these women no longer produce eggs that can successfully be fertilized. These women are usually candidates for an infertility treatment called in vitro fertilization with a third party egg donor. If you have considered becoming an egg donor but are unsure of the requirements to qualify as one here’s what you need to know.

In order to qualify to be an egg donor you need to be a female between the ages of 21 and 36 and who has given birth before. You need to be healthy and devoid of genetic disorders. Stable mental health is also a qualifier as a history of depression is contraindicated with some of the medications used in the process. Lactation can reduce the effects of the fertility drugs used which might result in lower egg production. If you are considering becoming a donor you will need to stop breastfeeding a few months before egg donation will be possible. If you have met these pre qualifiers here is what you can do next.

Contact an egg donation center and set up an assessment appointment. At this appointment they will obtain your medical history, give you a physical examination, and conduct a psychosocial evaluation. They will be trying to determine the health of the eggs to be donated, as well as the psychological impact on you, the donor, of giving up your eggs. They will also draw blood to test for infections. During your physical exam they will obtain cervical cultures to rule out sexually transmitted diseases. If your blood tests and cultures are negative for any infectious agents or STD’s they will check for normal levels of follicle stimulating hormone (FSH) in your blood. FSH in women stimulates the production of eggs. The normal level for FSH in a menstruating woman is between 5mlU/mL – 20mlU/mL. Having a normal level of FSH in your blood stream is required to be an egg donor. If you’ve met all of these qualifications the egg donation center will invite you to an informative counselling session about the ethical, legal, and financial side of donating your eggs. Some egg donation centers offer financial compensation for the donation of your eggs. At the end of this session, if you are still ready and willing to donate your eggs you will move on to the next phase in the process of egg donation.

Make a list of any questions or concerns you might have and don’t be afraid to ask. If you qualify as a donor then be sure to educate yourself about the procedure of egg removal and what your involvement will be in the process. Donating your eggs can bring about the hopes and dreams of yourself and others.


About the Author: Eric Daiter has been sponsored by The NJ Center for Fertility and Reproductive Medicine, LLC, a leading provider of infertility treatment, to explain in vitro fertilization in plain language. To review this information, please visit www.infertilitytutorials.com.

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Monday, December 31, 2007

Female Infertility Factors

If you have had difficulty conceiving for more than twelve months, or six months if you are over 35 years of age, you may be wondering if you are infertile. Researchers estimate that one in six couples face fertility challenges as a result of male or female health complications. There are multitudes of factors that can affect your chances of conception. Here we will briefly outline three major causes of infertility in women: endometriosis, fallopian tube damage or blockage, and ovulation disorders.

Endometriosis occurs when uterine tissue shed during a woman’s “period” implants outside of the uterus. The implanted tissue responds to the hormonal cycle and continues to grow, shed, and bleed in sync with the lining of the uterus each month. This can lead to inflammation and eventually scarring which adversely affects functions of the ovaries, uterus, and fallopian tubes. Pelvic pain and infertility are common in women with endometriosis. Upon examination, more than 40% of infertile women of reproductive age are found to have endometriosis. Laparoscopic surgery to remove abnormal tissue is a commonly used treatment option for this condition.

Fallopian tube damage usually results from inflammation of the fallopian tube. This blocks the passage of the egg through the fallopian tubes on its way to fertilization and implantation in the uterus. Chlamydia, a sexually transmitted disease, is the most frequent cause. Tubal inflammation can cause pain and fever, or it may go unnoticed. Tubal damage is the major risk factor for ectopic pregnancy. Here a fertilized egg implants in the fallopian tubes. One episode of tubal infection may cause fertility difficulties. The risk of ectopic pregnancy increases with each occurrence of tubal infection.

Some cases of female infertility are caused by ovulation disorders. Disruption in the part of the brain that regulates ovulation can cause low levels of luteinizing hormone and follicle-stimulating hormone. Even slight irregularities in the hormone system can affect ovulation. Specific causes of hypothalamic-pituitary disorders include injury, tumors, excessive exercise and starvation. Ovulation-stimulating drugs, follicle-stimulating hormones, human chorionic gonadotrophin (HCG), and in vitro fertilization are possible treatments for this condition.

If you are one of the many couples experiencing problems with conception talk to your general practitioner. Most of these problems can be resolved with medical treatment or lifestyle adjustments. Your doctor will be able to diagnose any conditions present and give you treatment options, or refer you to a specialist.


About the Author:

Eric Daiter has been sponsored by The NJ Center for Reproductive Medicine, a leading provider of infertility treatment, to write information about endometriosis symptoms. For more information, please visit www.infertilitytutorials.com

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