Let’s Not Make a Stressful Situation Worse

Our lives are filled with stress. Busting at the seams, boiling over the top, big-time stress. Will I get there on time? How can I pay the bills? And what can I do to improve my health? It never seems to end. From the moment we open our eyes to the second our heads hit the pillow, we have found hundreds of things to stress over. We even stress over the weather!

How we deal with that stress and remain positive and productive can be difficult. Succumbing to the anxiety and negative emotions can be tempting; in many ways, it is easier than powering through, becoming stronger, and seeing the positive. Difficulty conceiving can rock the core of even the toughest individuals. Getting a negative result month after month can bring anyone to her knees. And the more negatives you get, the more stressful the situation becomes…stress on top of stress on top of stress. It would drive anyone crazy. Finding ways to relieve this stress, quell your anxiety, and cope with the situation at hand is key.

It seems pretty clear that stress plays some role in infertility. How big or how small is hard to define, as it is difficult to study the impact of stress on infertility. But there is definitive evidence that stress levels influence the outcome of fertility treatment and contribute to a patient’s decision to remain in treatment. Trying to get pregnant can be stressful; when something that you thought would just happen doesn’t, it can be incredibly difficult to deal with. And as you get deeper into the world of infertility, from Clomid to IVF to egg donation, studies show that the level of stress rises.

In a large study, more than 50% of women reported that infertility was the most upsetting experience of their lives. It was likened to a cancer diagnosis. After a failed cycle, most women reported feelings of depression, anxiety, anger, and isolation. Bottom line, it sucks. And it often sucks so bad, patients quit. They stop the race and pull off to the side of the road before hitting the finish line.

While it has always been assumed that the brake was a financial or medical reason, data shows that it is actually the emotional stress of the situation. In countries where IVF and fertility treatment are paid for by the government, patients still veer off the road (and not for a pit stop, but for a total stop) before using up all of their free cycles.

What is even more of a bummer is that, for most women, the longer you stay in the game, the better your chances are of scoring; the chance of success (having a baby) increases over time (more treatment cycles). This is not the place to quit while you are ahead. Rather, don’t quit until you have succeeded. The exception is when your doctor has deemed it medically unadvisable, given a poor prognosis.

One of the most common questions we are asked is “Is my stress causing my infertility?” The answer is flat out, without a doubt, no. Your stress, your eating habits, and your activity level are not causing your infertility (extreme situations aside!). You are not the culprit. You did not cause this. You did not make this happen, so stop blaming yourself. Don’t forget about self-compassion. You have compassion for your partner, your friends, and your co-workers, but not enough compassion for yourself. You beat yourself up for every failure, every loss, every bad event; doing this won’t change the situation.

Developing the skills to accept the situation, to stop fighting the outcome, and to move forward can often be the difference between success and failure. How this is accomplished can be different for different people. While we all have the image of the therapist on a couch, there are many different forms of counseling and types of psychological interventions. Use whatever works for you because if it works in not getting you worked up, it will likely have a positive effect on your treatment outcome and even improve your chance of pregnancy.

Do what relaxes you. Whether that be running, reading, or riding, if it relaxes you, it is good for you. Don’t sit around stressing about your stress…if you stress about stress, then you will just have more stress! We all find our inner peace and meditate in different ways. Not all of us do this on a couch. For some, it’s out on the track; for others, it’s in a house of worship. For many of us, it’s toasting with good friends. But what makes you Zen is what makes you stronger, calmer, and more skilled to cope with what lies ahead.

The road may be long and filled with lots of ups and downs. Developing the tools to navigate this unpaved path will not only allow you to stay on the road but also may make for a more positive outcome. Finding the right tools can be challenging, but the options are limitless. Explore meditation, yoga, exercise, acupuncture, support groups, cognitive behavioral therapy, and in some cases medications. Something is bound to fit.

Unfortunately, there will always be things to worry about, from the banal (Will I make the next train?) to the critical (Will my loved one survive this deadly disease?). Some will turn out good, and some will turn out bad. Learning to accept the unknown and recognizing that you have done all that you can will help alleviate a great deal of stress. Remember, you can’t live life in reverse. If you knew what was going to happen tomorrow, you would probably live your life differently today.

We are certainly not here to echo the words of your friends and family who say “If you just relax, it will happen,” because in all honesty, it might not. And your stress is likely not the reason you haven’t gotten pregnant. But it will make the situation worse and possibly have a negative impact on your fertility treatment. Take a deep breath, let it out, and do it again. You can get through this, and you will get through this. Turn your stress into something positive, and kick infertility’s behind!

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:


~ 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!

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.