Seven Ways to Know If You Are Ovulating

     Disclaimer: We do not endorse any one method or brand. We will attempt to remain as impartial as possible and give you the many ways mamas to be can make sure they are ovulating.

  1. Symptoms: Straight-up symptoms such as breast tenderness, bloating, and one-sided abdominal cramping mid-cycle (a.k.a. Mittelschmerz) are some of the simplest ways to predict if ovulation is occurring. That feeling that you get before you get your period but after you ovulate is due to the progesterone! If you feel this, you are likely ovulating and making progesterone.
  2. Regular Menses: If your period is more on time than planes landing at O’Hare, you are almost for sure ovulating. The cadence and regularity of the menstrual cycle is set by ovulation—the signals sent from the brain to the ovaries ultimately make their way to the uterus. In response to these signals, the lining of the uterus is shed in a predictable pattern. By association, you can see that, if the ovaries are doing their job and ovulating, then your periods will be regular.
  3. Basal Body Temperature (BBT) Charting: Your temperature charting looks like a convicted felon’s polygraph test. If there are pretty predictable highs and lows, you are likely ovulating. Progesterone is a “hot” hormone. Therefore, after you ovulate, your temperature will rise. It will remain elevated as long as progesterone is on board. If pregnancy is not achieved, the corpus luteum will break down, and with it, a drop in progesterone and your temperature!
  4. Cervical mucus changes: Although most of us have not paid any attention to what our cervix is producing before we cared about progesterone and pregnancy, cervical mucus changes are a pretty good way to predict ovulation. The cervical mucus changes throughout the cycle ultimately become a more hospitable and welcoming place for sperm (after ovulation, it goes back to being uninviting once again). The changes are not only evident to the sperm but also evident to you (if you track it from the beginning to the middle to the end of your cycle), if you pay close attention.
  5. Ovulation Prediction Kits (OPK): It’s hard to walk into a drugstore without seeing an OPK. They seem to hang out next to the pregnancy tests—and as you can imagine, this can be sort of frustrating. Their popularity comes from their ability to predict ovulation and help couples time intercourse. By measuring the LH level in the urine (LH is the hormone that leads to ovulation), you can pretty reliably predict when or if you are going to ovulate. Although a small percentage of women (about 7%) will get a false positive—the test says you’re ovulating but you’re not—for most women, it is a pretty reliable way to predict ovulation.
  6. Ultrasound measurements: Serial ultrasounds done from pre- to post-ovulation are another way to confirm ovulation. The presence of a large follicle followed by the absence and then the presence of a corpus luteum lets you know ovulation has occurred.
  7. Progesterone level: The queen of ovulation confirmation is checking a serum (blood) progesterone level. Anything greater than 3 ng/mL (nanograms per milliliter for the science buffs!) in the mid-luteal phase is a positive. Note the boldfaced mid-luteal; timing is important when checking your progesterone. Day 21 is not day 21 for all of us! Make sure to mention how long your cycles are to your doctor before getting your blood drawn. And although we all obsess over what the level is and how high is too high and how low is too low, all we are looking for is a positive result to confirm ovulation.

 

So you see, there are really plenty of ways to know if your body is producing progesterone. Some are costlier than others, some are more labor intensive than others, and some are more accurate than others. But whatever you choose to check the ovulation box, it’s important that you do something to cross it off the list.

     Confirming ovulation is an essential part of any fertility work-up. It may seem basic, but without an egg, there can be no embryo! Good news is that, when women have ovulatory issues, they usually have a ton of healthy eggs just hanging out waiting to be released, and we have lots of ways to persuade those eggs to come out! We just have to see why they are being so shy and what we can do to coax them out of their shell!

A Piece of the Pie: What Causes Infertility?

Finding out that you have infertility is no piece of cake. It can knock you, shock you, and rock you in a way nothing else can. Why me? What did I do? How did this happen? The questions are endless. And while we may not be able to give you individual answers (at least not right now!), we can tell you what is most likely (in percentages and rates) to be hampering your efforts.

Infertility and its various causes (e.g., low ovarian reserve, ovulatory dysfunction, tubal damage, uterine issues, sperm abnormalities) are often depicted in the medical literature and medical textbooks as a pie chart. And a pie chart for all of you who have been away from math and statistics for some time is a circular statistical graph that is divided into slices. Each slice represents a different piece of the overall pie (a.k.a. the problem you are analyzing). Therefore, the bigger the piece, the bigger its contribution to the issue at hand.

Whether you prefer apple, blueberry, or peach, close your eyes, and picture a pie. Now substitute infertility for whatever fruit you are envisioning, and let’s cut it up.

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~ 35% of infertility is “female related.”

~ 25% of infertility is “male related.”

~ 10% of infertility is unexplained.

~30% of infertility is due to both female and male issues (a.k.a. combined).

Keep in mind that percentages are like pieces of pie; cutting is not an exact science. Depending on the study or the reporting agency, numbers can be slightly higher or lower.

Now it’s pretty rare that you go to a party and there is only one dessert (or pie) option. How can you leave the blueberry crumble behind when walking away with that peach cobbler! The same goes for infertility pie graphs—there is usually one that represents the percentages for all causes of infertility, one that represents the percentages for all female causes of infertility and one that represents the percentages for all male causes of infertility. Take a bite out of these numbers.

 

For causes of female infertility, the numbers are as follows:

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~ 40% of female infertility is due to ovulatory disorder (includes ovulatory dysfunction and diminished ovarian reserve/failure).

~ 30% of female infertility is due to tubal/peritoneal disease.

~ 15% of female infertility is due to endometriosis.

~ 10% of female infertility is unexplained.

~ 5% of female infertility is due to uterine disease/cervical disease.

 

For causes of male infertility, the numbers are as follows:

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~ 35% of male infertility is unexplained.

~ 15% of male infertility is due to varicocele (s).

~ 10% of male infertility is due to hypogonadism (low testosterone).

~ 10% of male infertility is due to urogenital infection.

~ 8% of male infertility is due to an undescended testis.

~ 5% of male infertility is due to sexual dysfunction.

~ 15% of male infertility is due to other causes (immune and systemic diseases).

However, just as there is variability in pie size (give or take a few slivers!) for the percentages of overall infertility diagnosis, the same can be said for female and male causes of infertility. Cutting is most certainly not an exact science!
Additionally, just as no two pies are baked exactly the same, geography matters big time in the pie percentages—it can seriously flavor how big each slice is. For example, in large metropolitan cities where women delay childbirth, you are going to see a much bigger percentage of women experiencing ovarian dysfunction rather than tubal disease. So while percentages and pie slices are helpful, take it with a grain of sugar.

Your Fertility Dentist

We as fertility specialists have always likened ourselves to the dentist. (No, your eyes are not deceiving you; we did say “dentist”!) This is not because we know anything about teeth or work even remotely around the same part of the body, but because seeing a fertility specialist like the dentist is usually something most people dread, delay, and don’t really want to do. Who likes going to the dentist? (Sorry to all of you dentists out there. It’s not personal; we just have very bad teeth!) What will they say, what does it mean, and what will it cost? The anxiety of “could be” can paralyze you and keep you from simply making, let alone keeping, an appointment until you are way past due. But just like that hot/cold sensation you have ignored, unprotected intercourse without a pregnancy for months, maybe even years, means something is not right. Cue the fertility specialist.

Whether the pain will wind up being a simple cavity, a root canal, or an extraction, you won’t know until you come in. But unlike those yearly “time for a cleaning” reminders your dentist sends, you won’t hear from us unless you come here to see us. The onus is on you. And knowing when to call it quits with the natural way can be confusing. To alleviate some of that anxiety you feel when putting us in your Google calendar, let us prepare you for what to expect when you finally sit in the chair.

First and most importantly, by admitting that there might be something wrong and making and keeping the appointment, you have already made some serious progress. You should stop, take a deep breath, and pat yourself (and your partner on the back) just for walking through those doors. It takes a lot of courage. In many ways, the first meeting may be like pulling teeth: talking about sex, timing, frequency, pelvic pain, periods, bleeding, and erections can be hard (to say the least).

And in order to have a good idea about what may be causing the fertility problems, we need to hear it all. Although we won’t fill your mouth with cotton and wax and then ask you questions (why do dentists do that?), the conversation can be somewhat difficult. Couples often feel shame, anxiety, and embarrassment when dealing with infertility. But you need to let these emotions go (admittedly easier said than done!). They will only hinder your ability to find out what’s going on and to treat it.

One of the most crucial parts of this first meeting is to make sure you feel comfortable with the doctor you have chosen. If it feels off, then you should probably go elsewhere. This relationship can be a long and winding road. Make sure you are comfortable with those driving the car. After we chat, we will usually start the checking process. In most fertility clinics, the doctor will do an ultrasound to look at your ovaries and your uterus. They are checking for things like antral follicle count, ovarian cysts, uterine fibroids, endometrial polyps, and what we like to call “other intruders.” The “other” category consists of abnormal things (fallopian tube dilation, pelvic fluid, masses) that shouldn’t be there. While many of these abnormalities are common and nothing to go crazy over, they can impact your fertility. Identifying them early in the game can limit the amount of time we are playing this problem out.

Following the ultrasound and physical exam, we will recommend a slew of blood tests (close your eyes, needle-phobes!). These will allow us to have a better understanding of things like ovarian reserve (how many eggs are remaining in the ovaries), ovulation, and thyroid function. Think FSH, Estradiol, AMH, TSH, prolactin, and progesterone.  In our attack plan, these are like pieces of intelligence that shed light on where the enemy is hiding. They are essential to completing the full fertility evaluation. Rome was not built in a day. Similarly, the fertility work-up can take about one month to complete. Many of the tests (blood and other) must be done on a specific day of the menstrual cycle. Your time and our time may not be fully in sync when we first meet, and as a result, it can add a few weeks to the evaluation process.

In addition to talking and checking blood levels, we are also going to want to check your fallopian tubes and uterine cavity (test: hysterosalpingogram) as well as your partner’s sperm (test: semen analysis). While in certain circumstances, the diagnosis is clear after our first discussion (e.g., female age, no periods, or no male partner), completing the whole fertility work-up up front is really the most efficient, most effective way to go about it. Just because you don’t get regular periods does not also mean that your fallopian tubes can’t be blocked. It’s better to know all the demons you are dealing with before deciding on a treatment option. While your doctor should be in touch as the “deets” come back, you should plan to sit down for a debrief once the work up is complete.

Unlike dentists, there is not much we can do on a daily basis to prevent future fertility problems. There is no fertility equivalent to flossing, brushing, and whitening—daily maintenance will likely not change what happens in the future. While healthy living, eating, and exercise is good for all parts of the body, they may not protect your reproductive organs. However, knowing that things can decay and need attention is half the battle. If pregnancy has not happened after six to twelve months of trying (depending on age and other medical factors), it’s time to schedule that cleaning. And if you have certain risk factors for infertility (endometriosis, family history of early menopause, irregular periods), you should go even sooner. While we may find nothing other than 32 pearly whites (or the equivalent in the fertility world), it’s important to have an evaluation, at the very least. Early attention can prevent cavities from becoming root canals! Let us take a look and see what’s going on.

Is My Grande Getting in the Way of Getting Pregnant?

Caffeine is key; ask any woman what moves her from bed to car/subway, office to a workout, and shower to dinner, and most will say coffee. Hot, iced, sugared, and frothed, it can motivate even the most sluggish of us to complete and power through our daily tasks. And more than the much-needed jolt that joe gives, it’s the warmth of the cup, the smell of the beans, and the smile from your corner barista that makes the morning routine one of our favorite parts of the day.

Questions about caffeine from bleary-eyed women who have been incorrectly instructed to quit flood our desks on a daily basis. But start brewing your beans, because we are here to say caffeine is not the culprit. While a cup a day may not keep the doctor away, it will likely keep you sane, keep you awake, and keep you functioning!

While caffeine has been deemed the devil in many pop culture forums for women struggling with fertility, there is only modest medical data to support this notion. Again, that age-old adage, “Anything in moderation,” is the key. Moderate caffeine consumption, defined by the American Society of Reproductive Medicine (the Holy Grail of most fertility doctors) as one to two cups a day (or the equivalent of about 100 to 200 mg per day), does not appear to increase a woman’s risk of infertility or poor pregnancy outcomeNow, to put this in perspective, when the street vendor on the corner serves you a medium cup, this is about 100 mg. Starbucks is a whole different story. Because we, too, are crazy caffeine addicts, this is one myth that we have already decoded. So here’s the skinny on Starbucks (and all other spots to fuel up!):

Espresso shots (think Americano, cappuccino, latte) have about 75 mg of caffeine. So if you go for a tall cappuccino, you will be having one shot, a.k.a. 75 mg of caffeine (totally acceptable). Even if you bump it up to a grande (two shots), you are still within the acceptable range (150 mg). Now, this may come as a surprise (it did to us), but the brewed coffee carries a much heavier caffeine load. A tall hot coffee has approximately 260 mg of caffeine! Size that up to a venti hot coffee, and we are talking 410 mg of caffeine. If you are more of an iced kind of a girl, size seems to matter less. A tall iced coffee will run you about 120 mg, while the venti has 235. So here, double the size does not double your caffeine load.

Although the medical data are limited, women who consumed high levels of caffeine (defined as greater than 500 mg a day or five cups/day) appeared to have a higher risk of infertility. There is also a concern that the babies exposed to these higher levels of caffeine will be delivered earlier and will be on the smaller side. This is not true when you stay under the two cups per day level (unless those two cups are venti coffees!).

How you get your caffeine is something to consider. While coffee and tea have not been clearly linked to infertility or miscarriage, sodas (both diet and regular) are not our faves! Yes, although we too break and grab a diet soda every now and again, the other chemicals fizzling in that carbonated beverage may not be what you need to quench your reproductive system with. But the long and “breve” of it is that caffeine is not the enemy and probably not the cause of your fertility struggles. While you may want to rethink that extra shot, your morning cup can continue to be consumed when you’re trying to conceive. (Try saying that seven times fast. It definitely can’t be done without caffeine!)

To Drink or Not to Drink…Is the Bubbly Blocking Your Ability to Conceive?

Alcohol has been lauded and lambasted when it comes to health issues. The tide can turn so fast on spirits that it’s difficult to know whether that glass of red wine is going to make you live forever or take a few years off your life. However, while the medical benefits of daily consumption are still murky, what’s on the minds of many reproductive-age women is: does a glass a day really keep the baby away? The answer is, unless you have a really heavy hand, probably not.

While alcohol in excess is a no-no for a pregnant woman, there is not much out there on what it does (if anything) to one’s fertility. It has not been shown to decrease egg quantity or quality. Additionally, it has no impact on a woman’s ability to ovulate, the function of her fallopian tubes, or your partner’s sperm. In moderation, it has not clearly been linked to infertility or miscarriage. In fact, some studies have shown that women who drank wine conceived at a faster rate than those that didn’t!

But this is where who’s pouring is important. Moderate alcohol use is defined as less than two drinks a day. In most studies, one drink is equal to 10 grams of ethanol. But (as many of us have found out the hard way) not all drinks are created equal, and therefore, who’s mixing your cocktails matters.

Here’s a cheat sheet…In the United States, a standard drink (12-ounce beer, 5-ounce glass of wine, 1.5 ounces of distilled spirits) has about 14 grams of pure alcohol. Bottom line, before you go bottoms up, be aware of what you are imbibing.

Too much of anything is not a good thing. And while a big night out once in a while is not the end of the world (let’s face it, this is probably the cause of many unintended pregnancies!), limiting alcohol consumption is a good idea. Although you certainly don’t need to put away those wine glasses when trying to conceive, be smart about how much and how frequently you imbibe (and don’t forget, there is no safe amount of alcohol consumption in pregnancy). But if the bubbly is what keeps you  bubbly, that’s ok; it’s not blocking you from having a baby. This fertility journey can be long and rocky; a few drinks along the way will most certainly not derail you.

Five Ways You Know You Have PCOS (Polycystic Ovary Syndrome)

  1. You get your period as often as the White Sox win the World Series (meaning about once a century).
    Irregular menstrual cycles (medically termed oligo-menorrhea) are a hallmark of PCOS. In fact, they are usually the main reason women with PCOS come to visit their GYN in the first place. Why, you may ask, are the cycles so off? The reason is, simply, wiring…in women with PCOS, the signals being sent from the brain to the ovaries are off. Without clear instructions from their boss, the ovaries are sort of lost. They don’t know how or when to produce an egg, and they certainly can’t figure out how or when to release one. Irregular or complete lack of ovulation (medically termed oligo– or anovulation) leads to wacky and infrequent menstrual cycles.
  2. You see your waxing lady more than your best friend.
    Elevated androgen levels (think male hormones) are very common in women with PCOS. Elevated androgens = elevated hair content (and not on top of your head!). More hair in not the most fun of places (lip, chin, sideburns, chest, and stomach, to name a few) means more visits to either the threading, waxing, or laser place. Unfortunately, most of these treatments are temporary, and unless you can lower the androgen levels in the blood, you will find yourself lying on that table forever.
  3. You have sampled every over-the-counter and prescription skin care product out there, and you still find yourself lathering cover-up on pimples.
    Fun fact: androgens not only cause abnormal hair growth, but they also cause acne. Oh, what a joy! The same culprit that caused you to fight facial hair is also public enemy no. 1 when it comes to pimples.
  4. You look at a sugary snack and gain five pounds.
    PCOS not only involves crossed signals from the brain to the ovary but also with insulin resistance and glucose metabolism. With insulin resistance comes high glucose and straight-up sugar intolerance. Problems with glucose metabolism leads to diabetes and obesity—not a sweet situation!
  5. You have taken so many ovulation prediction kits without ever once seeing a positive that you should own stock in the company.
    If you have PCOS, ovulation predictions kits are not your friend. They are pretty poor in interpreting the message your ovaries are sending out and will likely do nothing more than drive you crazy—and into poverty. They simply don’t work. And why they don’t is not because the tests don’t work but because the ovaries are not working and not ovulating. So do yourself a favor, and don’t waste your hard-earned cash on these kits!

Will the Eggs I Freeze Make a Baby?

Of all the questions we wish we had the answer to, “Doctor, will these eggs make a baby one day?” is at the very top of that list. But despite our white coats, our medical degrees, and our fancy instruments, we don’t know it all. We actually aren’t even close to knowing it all, especially when it comes to egg quality. Currently, we have really no way of looking at an egg, even under a microscope on high-power magnification, and knowing its potential.

Will it make an embryo that will be ready for transfer (ET), or will it barely survive the subsequent thaw? Will it result in a baby, or will it barely make it past the fertilization stage? Unfortunately, we still have no good way of predicting this. Therefore, while we can give you percentages based on your age, your fertility history, your family history, and your ovarian reserve, we can’t give you definites.

If you choose to egg freeze, you should be aware of this. You should be comfortable with the notion of possibilities, potentials, and perhaps—because in reality, this is all that any fertility MD can really give you.

Before a woman chooses to egg freeze, she will most likely meet with a fertility specialist to talk about the procedure, both in generalities and in particulars. What the overall process is like, what to expect on a day-to-day basis, and what the recovery period is like: these are the “generals.” As a result, you will get a lot of general answers.

Following this, your doctor will probably personalize the generals and add the specifics based on you, your medical/GYN history, your family history, and your ovarian reserve. Based on all of these factors, we can give you a projected response to the medications (a.k.a. how many eggs will you get). And this is the important stuff, the info you really need to know. Speaking in broad terms is nice, but it isn’t super helpful. You want to know how you will feel, how you will react to the medicine, and how this will determine your chances of having a baby in the future. Make sure you get this. Even if it’s speculative, it’s better than simplifications.

So if we can’t answer your burning fertility questions, what does egg freezing teach you? Is it even worth doing? (You could do a lot of good online shopping with that money!) So here’s what it for sure teaches you:

  • You have eggs.
  • How you will respond to fertility medications.
  • Your ovarian reserve (we measure hormones like FSH and AMH to get an idea on how to dose the hormones).
  • You are a tough cookie to take shots every day for several days—and you are a proactive, no-nonsense woman in the know for even asking these questions about your fertility future.

But with all the good it does, what it won’t tell you is if those eggs that you made will make a baby or the answer to your huge question: am I fertile? Fertility is one’s ability to conceive. And unless you are out there trying, we can’t really tell if you are fertile or infertile. Even women who respond poorly to fertility medications, make only a few eggs, and have abnormal ovarian reserve testing (low AMH or high FSH) can be fertile. We’ve seen it many times!

Don’t let the number of eggs you make in an egg-freezing cycle make or break your baby-making future. It could mean very little.

So while your eggs are a potential insurance policy, they are not your guarantee. Don’t look at eggs like babies because they are not; they are only just the beginning. We promise we aren’t Nelly Negatives or Debbie Downers. There are no bigger fans of egg freezing and reproductive choice then us at Truly, MD. We believe women should have options when it comes to their bodies, particularly their gametes (a fancy word for eggs).

But we are also big fans of honesty, transparency, and truth. You should know the truth about what egg freezing can tell you and what it can’t. It can’t give you complete clarity about your reproductive future, but it can give you choice. It can’t give you answers, but it can give you options. It can’t give you a slam dunk, but it can give you a shot. And even one shot can be the winning point.

Forever Young? Egg Freezing

How many of you can remember playing superheroes when you were a kid? Running around with your friends zapping, ka-powing, and bamming the bad guys was a fairly typical afternoon in the life of a child. Whether you were Wonder Woman or Super Girl, you probably kicked butt (and was pretty good at concocting the most awesome of superpowers).

Fast-forward nearly 30 years. Although you probably don’t play superheroes anymore (although we wouldn’t judge if you did!), if given the chance to have a superpower, we bet you could come up with a pretty long list. As fertility specialists and women who know how hard it can be to fit in careers and baby making, our greatest superpower would be to stop the inevitable biological clock: the decline in egg quality and quantity that happens as you age.

From the moment you make your debut into this world, it’s a downhill process. And for years, there was nothing anyone could do about it. Your ovaries didn’t really care what you ate, where you lived, and if you exercised—they were like a typical teenager (headstrong and independent). They just kept on going in a downhill fashion. And while they still don’t care, we have found a way to instill some discipline into them.

Cue egg freezing. While egg freezing has been around for nearly 30 years, it didn’t become mainstream until about five years ago. Around this time, it gained serious popularity and notoriety. With research, data, and the American Society of Reproductive Medicine (ASRM) removing the experimental label from egg freezing, more and more women signed up for the procedure. Nowadays, the press and social media are all over egg freezing. And taking it one step further, some companies now even cover the cost of egg freezing (e.g., Facebook, Apple)—its become pretty prevalent.

Why, you may ask, are women electively shooting themselves up with hormones, waking up at the crack of dawn for vaginal ultrasounds, and having a needle put in their vagina? All good questions…and here’s why. Because egg freezing may save your fertility and your chance of having a genetic child. The eggs you store today may make you a mother in the future when egg quality and egg quantity have taken a serious downturn. Nothing, with the exception of egg freezing, can halt the decline of ovarian reserve that occurs over time.

Although pregnancy, polycystic ovarian syndrome (PCOS), thyroid disease, too much exercise, eating disorders, and the pill may show your periods the red light, they will do nothing in terms of stopping the loss of eggs. The only thing that can show this process the yellow light is egg freezing.

If you want to freeze your eggs, don’t let fear about how long it will take you and what the process will do to your body and mind hold you back. All in all, egg freezing is a pretty quick and painless process (we need no more than about two weeks of your life before we can get those eggs into the freezer). Yes, you will need to give yourself shots. Yes, you will need to cut back on your exercise. Yes, you will have some transient weight gain, and yes, you will need to set your alarm an hour or so earlier than usual. Overall, though, it’s pretty tolerable.

Most women start the injectable fertility medications on day two or three of their period. The shots are administered twice a day for usually about 10 days; their primary job is supposed to help your body produce multiple follicles (a.k.a. eggs). Think of the shots as the gas fueling the development of the eggs present in your ovaries at the start of the menstrual cycle. They get them all going. But we can only put in as much gas as the tank will allow; if your starting antral follicle count (a.k.a. AFC) is 10, more medication will not make more eggs.  Your baseline, or AFC, is a measurement of your underlying reserve. Simply stated, those with more will have more eggs retrieved; those with less will have less retrieved. Here, there is no funny math.

However, while a car needs fuel to get going, we don’t want to overfill the tank. The same goes for the ovaries and the dose of fertility hormones. Too high of a dose can be dangerous and can result in overstimulation. Too low of dose will keep you idling in the parking lot. For this reason, your doctor will probably want to see you every other day for ultrasound exams or blood checks to make sure that your ovaries are running but not racing.

Once the follicles reach a certain size (usually about 17–19 mm), and the estrogen level is at a specific peak (we like to see about 150–200 pg/mL of estrogen/follicle), you will likely be instructed to take your “trigger” shot. This shot is either human chorionic gonadotropin (hCG ) (brand names: Novarel or Ovidrel) or Lupron (or a combo of both). It will prepare the follicles/eggs for the final stages of development needed to achieve maturity (remember only mature eggs can be fertilized in the future). The eggs will be extracted (a.k.a. retrieved) vaginally. That means a needle will puncture the vaginal wall, enter the ovary/follicle, and out comes the egg within the follicular fluid. The whole procedure takes no more than 20–30 minutes, although to you it will feel like seconds (this is the part you will be sleeping for). When you open your eyes, most will be relaxing in the recovery room snacking on graham crackers and apple juice. On occasion, the pain can be severe, but this is definitely not the norm!

Unlike most things that sit in your freezer, your eggs never really go bad. They can remain frozen until you are ready to defrost them; there is no expiration date. And while their Ice Age can be long, it’s important to remember that at some point you may no longer want to be pregnant. While women can carry pregnancies well into their forties and even fifties, the complications do increase as women age. This doesn’t mean that you have to freeze and thaw ASAP, but it does mean you need to make a personal timeline about when they will be used.

Although the sperm thing may seem like a problem, don’t let this part stand in your way.  Your eggs can be fertilized with partnered sperm or donor sperm—it’s totally up to you. In either case, the eggs will be thawed and inseminated in a process called ICSI (intracytoplasmic sperm injection). The resulting embryos will be grown in the laboratory, and the best embryo (s) will be selected for transfer about five days later. Any remaining high quality embryos can be frozen for future use.

Although egg freezing is good, it’s most certainly not perfect and is in no way a guarantee. It is not even a really good insurance policy. The success rates after egg freezing are never better than about 50–55% (and this is in women less than 35 years old). In the over-40 age group, it’s really no greater than about 15%. We say this not to bum you out but to bring reality to the situation. Egg freezing is expensive and a commitment. So before you drop some serious dough and time, you should know what you are doing and how much it can do for you. Egg freezing is a big decision—your doctor should go through it in detail before you sign on the dotted line.

While we may still lose to villains, we are getting stronger and stronger each day. Not only are more women choosing to freeze their eggs, but even more importantly, more women are also becoming aware of what will happen to their fertility, particularly their eggs, over time. Beating the “bad guys” is way more about brain power than muscle power—if you know what you are fighting, you will be able to devise a pretty awesome plan to beat them. Freezing your eggs may not be one of your weapons, but knowing about the process and the process of egg loss will ensure that you are not a victim of a surprise attack.

How Long Is Too Long? When Is It Time to Come in for a Fertility Evaluation?

As native New Yorkers, we don’t like waiting more than two minutes for our coffee, more than three minutes for a cab, and more than four minutes for the subway. We are as impatient as the next gal trying to get to and from work, home, and our workout class. Despite the unexpected (ugh, why did I have to get stuck behind the garbage truck? I’ll never make it!), we pretty much know how much time to allot to almost all of our daily tasks: one minute to make your coffee, 10 minutes to walk to the subway, 15 minutes to walk to the gym, and 20 minutes to walk the dog.

But while we have these routines down to the minute, what we often don’t know is when to seek medical advice for our bodies. Am I overreacting; will it just go away? Am I a hypochondriac? Maybe that pain is normal. And if something is really wrong, can it be fixed? The fear of the unknown, of what might be wrong, and what might need to be done to fix it can frighten even the strongest individuals.

For most of us, it’s hard to imagine that we won’t just pull the goalie (aka stop using contraception), have unprotected sex, and two weeks later see pregnant on the stick. The months of not pregnant, despite valid efforts, can become emotionally and physically exhausting. However, it’s confusing to know when it’s time to call the natural way quits and seek medical advice. Your mom will tell you “Relax, and it will happen.” Your friends will tell you, “It happened for me the first try!” and the Internet will tell you almost everything and anything. Whom do you believe?! A credible and comforting source in this process can be extremely hard to come by. Let us at Truly, MD, do our best to be your voice of reason.

Traditionally, infertility was defined as one year of unprotected intercourse. It didn’t matter if you were 24, 34, or 44 when trying to get pregnant—your OB/GYN generally did not refer you for further evaluation until you hit that one-year mark. Thankfully, this is no longer the case. Our current guidelines factor in the age of the female partner for when it’s time to call a time out from trying on your own. So get out your calendars, and start counting because here’s the latest advice: For women who are equal to or less than 35 years old, you can continue to follow the traditional recommendation and wait a year before seeking evaluation/treatment. Women who are older than 35 should, by the new guidelines, get the ball rolling after six months of trying. And lastly, women who are older than 40 should seek immediate evaluation/treatment. Come right to your fertility specialist.

And remember, while these recommendations are in place to guide the general population, there are certain situations where we would want to see a 32-year-old after trying for three months and a 35-year-old after trying for one. It’s super important that you share your medical, gynecologic, and family history with your OB/GYN. If your mom had menopause young, you might have it even younger! There are certain red flags, like this, that will prompt a referral to a fertility doctor before any alarm has even gone off.

So why are we lighting the fire under you? It’s not to scare you, rush you, or make a nerve-wracking situation even worse—we promise. It’s because, in this case, we sort of know how the story might end if you wait too long. We have shaken that Magic 8 ball (Will my mom let me stay out past curfew? Decidedly not!), and we know that female age is one of the most important factors when trying to conceive. Every month that passes, from the moment we are born, we are losing eggs. The rate or the slope (Algebra 101: y = mx + b!) of this line of loss is fairly gradual until we hit about 32. It picks up, or gets steeper, at about 37 and then nosedives at 40.

You’re not just losing quantity but also quality. The older the egg, the more likely it is to make an abnormal embryo (medically defined as an aneuploid embryo). And while abnormal or aneuploid embryos may get you pregnant, in most cases, they lead to a miscarriage.

There is a classic study that was done in France (They gave us more than just good wine and French Fries) that is mentioned frequently in the world of fertility medicine. Pourquoi?(That’s why, for all of you non-French speakers) The answer is because the women in the study all had partners with no sperm (medical term = azoospermia) and needed donor sperm insemination to get pregnant. Therefore, who got pregnant and who didn’t became all about female age (All donors were young, so male age went out the window, and the inseminations were timed so the appropriate time of intercourse became no big deal).

And voila, the results are as follows: As women aged, the pregnancy rates decreased significantly. The pregnancy rate after 12 insemination cycles was 74% for women less than 31 years old, 62% for women aged 31 to 35 years, and 54% for women older than 35. Bottom line: female age REALLY matters. The story ends pretty much the same way when we look at IVF success rates; pregnancy rates decline significantly as the age of the female partner rises. Translation…tick, tock, tick, tock…please make that clock stop!

While we can’t refuel your egg supply (when the gauge reads empty, you are truly on empty), we can help bring you in for gas before you hit that point. Unfortunately, we will all run out at some point. It’s part of being female. And while some cars lose gas faster than others, if you are aware of what makes them run low and seek evaluation and treatment earlier, your journey will be smoother, and you will reach your destination faster.