Age and Fertility- Written by a specialist.

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Age and Fertility- Written by a specialist.

According to research over the last 40 years, a healthy 30 year old woman has about a 20% chance of getting pregnant each month. A healthy, ovulatory 40-year-old woman’s chance per month is 5% (1,6). The decline is slow and steady up until the age of about 35. After that the decline becomes steeper. These ranges and time frames have been established through multiple studies and have been consistent for the last 30+ years. The decline in fertility is attributed to depletion of ovarian oocyte (eggs) reserve and is determined by genetic, environmental, and lifestyle factors.(2).

Now, for the good news. Age at conception does have bearing on time to pregnancy in a healthy, ovulatory woman. In general, fecundity (a woman’s physiological ability to have a child) is reported as age ranges because it is difficult to correlate a specific age to a specific chance of success. There are also factors that can affect reproductive aging. These include other medical conditions that can have an effect such as endometriosis, fibroids, genetic conditions (errors in number of chromosomes), environmental influences, obesity, smoking, thyroid gland dysfunction, history of sexually transmitted diseases (STDs), and ovulatory dysfunction, to name a few (2,3).

PCOS stands for Polycystic Ovarian Syndrome, it is the most common form of ovulatory ovarian dysfunction.  The pathology of PCOS makes ovulation irregular and unpredictable, making the timing of intercourse for conception difficult. 

There could also be issues with male fertility such as erectile dysfunction and sperm quality issues. Male evaluation initially consists of a semen analysis and potentially other endocrine blood testing to evaluate any severe sperm abnormality.

HOW CAN ASSISTED REPRODUCTIVE TECHNOLOGY HELP?

Most of the factors other than extreme reproductive age are usually treatable. When you get started, the first step is a comprehensive evaluation of both you and your partner (if applicable). We test your ovarian reserve to gauge likelihood of adequate number of eggs produced per cycle, prolactin levels since the elevated levels can affect regularity of ovulation, and PCOS testing. If there are any positive findings, we can offer prescription medications or supplements beneficial for conception (5).

There are supplements that both partners can take that have been shown to be beneficial for conception.  Lifestyle modification and diet changes (such as following the Mediterranean diet) can also positively impact your chances.  Controlling your stress and regular moderate exercise also confer benefits (3,4).

Please click the link below for a consultation with an experienced Reproductive Endocrinologist. You can also follow us on Facebook or return to our website for updated information about your fertility journey.

References

1.   Menken J, Trussell J, Larsen U. Age and infertility.  Science. 1986;233:1389-1394.

2.   Utting, D., & Bewley, S. (2011). Family planning and age-related reproductive risk. The Obstetrician & Gynaecologist, 13(1), 35–41. https://doi.org/10.1576/TOAG.13.1.35.27639

3.   Collins GG, Rossi BV. The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility. Fertil Res Pract. 2015 Jul 25;1:11. doi: 10.1186/s40738-015-0003-4. PMID: 28620516; PMCID: PMC5424364.

4.   Dimitrios Karayiannis, Meropi D Kontogianni, Christina Mendorou, Minas Mastrominas, Nikos Yiannakouris. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Human Reproduction, 2018; DOI: 10.1093/humrep/dey003

5.   Unfer, V., Nestler, J. E., Kamenov, Z. A., Prapas, N., & Facchinetti, F. (2016). Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials. International journal of endocrinology, 2016, 1849162. https://doi.org/10.1155/2016/1849162

6. Sozou PD, Hartshorne GM (2012) Time to Pregnancy: A Computational Method for Using the Duration of Non-Conception for Predicting Conception. PLOS ONE 7(10): e46544. https://doi.org/10.1371/journal.pone.0046544

Menstrual Cycle- Written by a specialist.

Menstrual Cycle

By Fertility Cloud Head Nurse Svetlana Izrailevsky, BSN, RN.

What is a menstrual cycle?  In reality, a menstrual cycle consists of 3 broad categories of cycles:  hormones, ovarian (follicular) cycle, Endometrial lining cycle, and Cervical mucus development cycle.  It is important to understand that these cycles are taking place in tandem, in parallel and in relationship to each other.  That means that what happens in one of these cycles will affect the developments in the other ones.  

First, lets review the hormones involved in the menstrual cycle:

FSH–FSH helps control the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation.

LH– LH helps control the menstrual cycle. It also triggers the release of an egg from the ovary. This is known as ovulation. LH levels quickly rise just before ovulation.

Estradiol, also called E2, is the main estrogen in nonpregnant females of childbearing age. It’s mostly made in the ovaries and is important for uterine lining development.

Progesterone is a hormone that’s made mainly by the ovaries. Each month, progesterone prepares your uterus for pregnancy. During a normal menstrual cycle, an ovary releases an egg and your progesterone levels begin to rise. Progesterone makes the lining of your uterus grow thicker so that a fertilized egg can attach (implant) inside of the uterus and grow into a baby. If you don’t become pregnant, your progesterone levels will fall. The lining of your uterus will become thinner again. When your uterus starts to get rid of the extra blood and tissue, your menstrual period will begin.  If you become pregnant, progesterone levels will continue to rise to about 10 times higher than usual to support the pregnancy.

Now, lets us look at the 3 main time frames of the cycle:

These different cycles communicate via hormone messengers. For example, when the egg inside the follicle is mature, it sends a signal to the pituitary gland via the increased levels of Estradiol hormone. This stimulates the rise in LH hormone levels which finishes the maturation of the egg and allows it to break out of the follicle–ovulate. At the same time, Progesterone level rises to support the uterine lining and the uterine lining undergoes a transformation where the recetors for the embryo become activated and stand ready.

The diagram below illustrates how the different cycles are connected:



LET’S LOOK AT SOME COMMON QUESTIONS THAT COME UP:

  • What is the best time to get pregnant during my cycle? What should I be doing to maximize the potential for conceiving?

When we are speaking of a regular 28-30 day cycle, your fertility window is between cycle day 10-15.  We would recommend intercourse every other day starting on cycle day 10.  Once you note your LH surge by using ovulation predictor kits, you should have intercourse daily on the day of the LH peak/surge and the subsequent 2 days.  

Please remember that LH hormone stays elevated for a very short time, just about 24 hours so we do not recommend that you keep checking your LH after you see the peak.  

Male partners, if applicable, should do ejeculation every 2-3 days starting with your cycle day 1.  We would like to have the freshest sperm sample available for insemination.  Please do not hold off on regular ejeculation because that increases the number of dead and dying sperm in the sperm sample that will be produced for the insemination.

  • Wait!  What if my cycles are not regular?

For some patients, the cycles are regular and predictable, but long.  It is possible to have a regular ovulatory cycle with the overall length of 35 days, for example.  However, there are also women who have irregular ovulatory cycles due to ovarian dysfunction.  This dysfunction is usually related to improper hormone levels of Estradiol and FSH.

  • What does the follicle stimulating hormone (FSH) do again?

FSH–FSH helps control the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation.  

  • What about Estradiol?

Estradiol, also called E2, is the main estrogen in nonpregnant females of childbearing age. It’s mostly made in the ovaries and is important for uterine lining development.  As you can see in the diagram above, Estradiol rises slowly before ovulation and stays elevated for a period of about 7 days after the ovulation.  This is so that there is no ovarian follicular recruitment happening during the period of potential fertilization and implantation.   Elevated levels of Estradiol can interfere with production of FSH so if the Estradiol levels are high at the beginning of the cycle, the regular growth and development of the follicles can be impacted. 

Estradiol can be elevated as a result of conditions such as polycystic ovarian syndrome (PCOS) or presence of elevated levels of BPA in the system. Bisphenol A (BPA) is a chemical produced in large quantities for use primarily in the production of polycarbonate plastics. It is found in various products including shatterproof windows, eyewear, water bottles, and epoxy resins that coat some metal food cans, bottle tops, and water supply pipes. https://www.niehs.nih.gov/health/topics/agents/sya-bpa/index.cfm.  

  • I ovulated 2 days past normal ovulation days, does that mean my period will start two days later than expected?

The next menstrual period will start once the Progesterone and Estradiol levels fall, if there is no conception.  They typically occur 10-14 days after ovulation occurs.  If you ovulate 2 days later than you usually do, your menses might be delayed accordingly.

  • I have been taking Progesterone to support my uterine lining.  Will that impact my menses?

Yes!  If you are taking Progesterone, you are not likely to start menses even if you are not pregnant. You will be asked to do a home pregnancy test and stop  taking the Progesterone if the test is negative.  You can expect your menses 2-5 days after stopping the medication.  Some patients may begin spotting even before stopping Progesterone.  The spotting/bleeding you will get after the Progesterone may be a little heavier than your usual menses and the first day of bleeding will count as cycle day 1 for next treatment.

  • It was my first time taking Clomid, is it normal that I expect menses to be delayed even with negative HPT?

Clomid does not directly impact the length of menses.  However, it does help regulate the ovulatory process so your menstrual cycle will look different.  For some patients, cycles are a bit shorter and for others they are longer as Clomid works to increase production of FSH hormone.

  • What does LH hormone timing look like in the cycle?

LH rises slowly only a few days before ovulation and then has a sharp rise known as LH peak or surge, 24-36 hours before ovulation.  It only stays elevated for about 24 hours and then drops sharply.  It does not begin to rise again with the start of the menses, at least not right away.

How to get pregnant with Unexplained Infertility.

Our hearts melt when our patients text us: “We did it! I can’t believe it.” We want to share a story of one of our patients who underwent IVF and other procedures and lost her hope. However this story does have a happy end.


“Alice tried everything and her hope was lost…”

By Dr. Gary Levy

(Board-Certified Reproductive Endocrinologist, Chief Medical Officer of Fertility Cloud)


I would like to introduce to you the story of Alice (name changed for the purposes of this blog post).

Alice is a patient that came to us with the diagnosis of unexplained (undiagnosed) infertility. Alice had an evaluation that demonstrated normal ovarian reserve, her AMH was 3.58 ng/mL (the lab norm is from 1 to 7.6 ng/mL), her fallopian tubes were open as documented by a hysterosalpingogram test and her spouse’s sperm evaluation was completely normal. In addition, her male partner had two prior children from a previous relationship. Alice had been trying to conceive for over fourteen months prior to seeking care with us. She underwent a few cycles of letrozole and then underwent IVF and did not get pregnant with a frozen embryo transfer.

After seeing her through our, always accessible, telehealth platform, we realized that Alice likely suffers from LPD. We discussed additional testing for PDG monitoring and confirmed our suspicions.

We discussed her treatment options, and she underwent ovarian stimulation and progesterone support and got pregnant on her second treatment cycle. She was ecstatic, as her experience at FC allowed her to be successful and receive an answer to the question that has been unanswered for a long time providing much needed closure in a much more affordable manner.”

How do we diagnose PCOS?

PCOS is typically diagnosed via the Rotterdam Criteria which consists of four categories:

1️⃣Irregular menstrual cycles – typically defined as greater than 45 days apart or less than 10 per year
2️⃣Clinical or laboratory evidence of elevated male hormones (hyperandrogenism)
2️⃣Ultrasound findings consistent with polycystic ovaries and the absence of any other cause. The diagnosis is made when two of the three criteria are present. Also, keep in mind this syndrome is a spectrum and will have variable presentation and symptoms.

According to our polls 30% of women do not start treatment because it’s expensive.

We are so proud to say that me made it possible for everyone! Fertility treatment is not a luxurious purchase anymore. Most of our patients get pregnant within 6 months for under $2,500

You should plan to book an appointment ($150), go through a complete evaluation ($350) and then take a complete 6-month treatment ($289×6) until you get a positive pregnancy test. The total is expected to reach $2,234, and this is probably the maximum you can expect to pay at Fertility Cloud.

Everything is transparent.

And you can schedule an appointment and talk to a reproductive specialist today.

HSAs And FSAs Can Cover Fertility Treatment

Use your HSA or FSA to pay for your Fertility Cloud treatment.
Fertility treatment may be expensive. One way to get ahead of the financial burden is to make sure you’re taking full advantage of your Health Savings Account (HSA) or Flexible Spending Account (FSA).
HSAs and FSAs are handy accounts that you contribute to, tax-free, to save up for healthcare costs. Understanding how these accounts work can help you plan, save money, and make the best decisions you can for yourself and your family.

❓How do you qualify for an HSA?
You must have a high-deductible health plan. A high-deductible health plan for 2020 is any plan with a deductible of at least $1,400 for an individual or $2,800 for a family.
Not all plans with deductibles over these limits qualify for HSAs, so it’s important to check with the insurance company before you make any decisions.
Your high-deductible health plan must serve as your only medical insurance plan, and you must not qualify for Medicare, Medicaid, or be claimed as a dependent on someone else’s tax return.

❓How do you qualify for an FSA?
FSAs are available only as part of a benefits package from an employer, not if you’re on your own — but the medical expenses you can use them for are the same as with HSAs. There are no eligibility requirements for an FSA beyond being employed, but self-employed folks and freelancers don’t have the option to set up an FSA.
❓What can I use my HSA or FSA with Fertility Cloud?
In most cases these funds can be used to pay for:

  • Doctor consultation
  • Medical labs
  • Prescription drugs
    So you can pay for Fertility Cloud treatment 100% out of your FSA or HSA funds.

You should investigate the details of these with your insurance company
✅ Start your journey
Qualify for medical treatment with Fertility Cloud (we determine your ability to undergo treatment with us with four screening questions), then you have a good probability of conception within six months of treatment. Good Luck!
✅ Ask your questions
We want to hear from you, please send us your questions. Our mission is to provide timely and accurate answers on your fertility journey. It’s free and believe us – we truly will be happy to hear from you.