$39 Menstrual Cycles and Fertility

Fertility means that a woman is capable of getting pregnant. Women are most fertile around the time of ovulation. The tricky part is determining when ovulation occurs. Unfortunately, ovulation can be determined only in retrospect.

When Does Ovulation Occur?

Ovulation generally occurs about two weeks before the first day of your period. This is considered the second half of your cycle and usually remains constant no matter how many days are in your cycle. For example, if your cycle is the same duration every month, then you can guess about the timing of ovulation based on the first day of your period, which is the first day of your cycle. The first half of your cycle is of variable duration. For example, if your cycle is 28 days long, then ovulation will occur around day 14. On the other hand, if your cycle is 21 days long, then ovulation would occur on about day seven.

The first day of your period is the first day of your cycle. If you have a 28-day cycle, your fertile days would be from 10 to 14 of your cycle, but if your cycle is 21 days, your fertile days would more likely be days 3 through 7. If your period lasts five days and you have a 28-day cycle, you would have 9 days from the end of your period until you ovulate, and you would have 4 days from the end of your period until you could get pregnant, which could be as soon as day 9.

The fertility window is those days when pregnancy could possibly result. Usually, good mucus will occur a few days before ovulation, so the window would include the day of ovulation plus up to five days before and possibly 12 to 24 hours after ovulation. This creates a window of five or six days when pregnancy could occur. During this window, sperm are slowly released by the mucus to travel through the uterine cavity, into the fallopian tubes and connect with a mature egg. Eggs can remain in your fallopian tubes for 12 to 24 hours. Becoming pregnant is most likely when live sperm are present in the fallopian tubes during ovulation

The best time to try to get pregnant is one of the four or five days before you ovulate when your cervical mucus is copious, clear, and stretchy. The sperm can live in this mucus for up to four or five days. The mucus at the time preceding ovulation serves a police function, allowing the sperm into your uterine cavity and fallopian tubes but keeping the semen in your vagina.

Fertility Varies With Age

Women are most fertile between the late teens and the late 20s. By age 30, fertility begins to decline and the decline occurs more rapidly by mid 30s. By age 45,  pregnancy is not likely. Getting pregnant is not position dependent. Old and out of date recommendations include lying on your back with your knees to your chest or knees and elbows on the bed. That being said, standing, and sitting positions are not recommended. It is recommended to lie in bed for 10 or 15 minutes after having intercourse.

Medication to increase fertility include clomiphene (Clomid) and letrozole. Other treatments for infertility include intrauterine insemination, (IUI), in vitro fertilization, (IVF), donor eggs, surrogacy, and egg freezing. The treatment cost depends on what kind of treatment you’re getting. If you’re looking at Clomid, the cost is relatively inexpensive, less than $100. If on the other hand, you’re looking at in vitro or donor eggs, you’re looking thousands of dollars which most likely will not be covered by your insurance. IVF can cost between $15,000 and $20,000. One intramuscular hormone cycle can cost $12,000 to $14,000 for medications alone.

You should look for a doctor who will talk with you and explain the plan, the next level, and the anticipated outcome, as well as the risks of treatment and treatment failure. And remember, just because the doctor presents as charismatic doesn’t necessarily mean that you’ll get good results. You might also want to interview several doctors to see which one you are most comfortable with. Integrity is hard to assess in one visit.

You do not want to find, after five cycles and spending $125,000 cash, that your eggs are no good. That news should come early on after the first visit. There’s no reason to continue with $100,000 worth of treatments if there is no hope of getting pregnant with your eggs. If your eggs won’t work, then you need donor eggs. A blighted ovum is one which is not complete and cannot support life. Blighted ova have a normal appearing gestational sac, but the sac lacks an embryo needed to sustain life. Your doctor can identify blighted ova with ultrasound. Likewise, if the sperm are no good, you need donor sperm, not $100,000 of useless hormone treatment.

Always remember that miscarriages are not your fault. If you have had miscarriages and are looking for a doctor to work with you in having a successful pregnancy, ask your friends for recommendations. You might want to interview several physicians before you make a decision about the doctor you are most comfortable to work with..