Currently Viewing Posts in Clinical

Getting Pregnant after 30, 35 or even 40

December 5, 2022

Uncover all the information you need about getting pregnant at a late age

The relevance of age

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. Getting pregnant after 40 the decline in fertility is attributed to depletion of ovarian oocyte (eggs) reserve and is determined by genetic, environmental, and lifestyle factors.(2).

how to get pregnant after 40
How likely is to get pregnant at certain age

What makes it hard to get pregnant after 35 or 40?

Although your changes of getting pregnant after 35 or 40 are decreasing, there are 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 and mostly trying to get pregnant after 40.

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 fertility specialist can help to conceive after 35 or 40?

Most of the factors other than extreme reproductive age are usually treatable. When you start you journey to get pregnant after 40, 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 and getting pregnant after 40.  Lifestyle modification and diet changes (such as following the Mediterranean diet) can also positively impact your chances to get pregnant after 40. Controlling your stress and regular moderate exercise also confer benefits (3,4).

The journey

Getting pregnant after 40 years old, especially in the face of infertility challenges, is a complex and emotional journey that many individuals and couples find themselves navigating. The desire for parenthood does not diminish with age, and the longing to conceive and welcome a child into one’s life remains strong. While fertility may decline with age, it’s essential to acknowledge that getting pregnant after 40 is not impossible, and there are various avenues to explore on this remarkable path.

In the midst of infertility concerns, it is crucial to seek expert guidance and remain informed about the available options. Fertility treatments, such as in vitro fertilization (IVF) and the use of donor eggs, have proven to be successful for many individuals in their 40s, offering renewed hope and possibilities. Additionally, maintaining a healthy lifestyle, including a balanced diet, regular exercise, and stress management, can positively impact fertility, no matter one’s age.

Moreover, the importance of emotional support cannot be overstated. The emotional toll of facing infertility and the challenges of getting pregnant after 40 can be overwhelming. Finding a support network, whether through friends, family, or support groups, is crucial in navigating the ups and downs of this journey.

Conclusion

In conclusion, while getting pregnant after 40 may present unique challenges, it is a goal within reach for many. Infertility should not be a deterrent, but rather a call to explore the many available options and seek professional advice. With perseverance, emotional support, and the right approach, individuals can overcome obstacles and realize their dreams of parenthood even at an age when conventional wisdom might suggest otherwise.

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

how to get pregnant after 40

Understanding Your Menstrual Cycle

November 14, 2022
Menstrual Cycle

Learn everything you need to know about your menstrual cycle

Understanding Your Menstrual Cycle

Understand your 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:  Ovarian (follicular) cycle, Endometrial lining cycle, and Cervical mucus development cycle.  It is important to understand that these cycles are taking place in tandem, and in relationship to each other.  That means that what happens in one of these cycles will affect the developments in the other ones.  

What is a Normal Cycle Length?

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.

3 main time frames of the cycle:

menstrual cycle
menstrual cycle
menstrual cycle
menstrual cycle
menstrual 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 receptors for the embryo become activated and stand ready.

The connection between different menstrual cycles

menstrual cycle

menstrual cycle

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 ejaculation 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 menstrual cycle is 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.  

How Estradiol helps my menstrual cycle?

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 it impacts the regular growth and development of the follicles. 

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 a part 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.  

What about Ovidrel?

Ovidrel, also known as chorionic gonadotropin (r-hCG), is a recombinant form of human chorionic gonadotropin hormone. It is created using recombinant DNA technology, which allows for the production of a biologically identical hormone to the one produced naturally by the human body.

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

The next menstrual cycle 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 mostly likely will be 2 days late.

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. Take a home pregnancy test, and if it is negative stop taking the Progesterone. 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.

Can Geritol directly regulate my menstrual cycle?

No, Geritol cannot directly regulate your menstrual cycle. However, by contributing to overall health, it could indirectly influence your cycle.

menstrual cycle

Unraveling the Mystery: A Deep Dive into PCOS Diagnosis

November 9, 2021

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects many women of reproductive age. It is characterized by hormonal imbalances and symptoms such as irregular periods, excessive hair growth, and acne. Diagnosing PCOS can be complex, as its symptoms can vary widely among individuals. In this article, we will explore the various methods used to diagnose PCOS and the importance of a comprehensive medical history in determining the condition.

Understanding the Symptoms of PCOS

PCOS presents with a range of symptoms that can differ from person to person. Some of the most common signs of PCOS include irregular menstrual cycles, excess hair growth (hirsutism), acne, and weight gain. Additionally, women with PCOS may experience difficulty getting pregnant due to irregular ovulation or absence of ovulation altogether. Identifying these symptoms is the first step in diagnosing PCOS.

It is important to note that PCOS is a complex endocrine disorder that not only affects reproductive health but also has metabolic implications. Women with PCOS are at an increased risk of developing type 2 diabetes, high blood pressure, and high cholesterol levels. These metabolic disturbances are often linked to insulin resistance, a common feature of PCOS. Therefore, managing PCOS goes beyond addressing the visible symptoms and requires a holistic approach that includes lifestyle modifications, such as a balanced diet and regular exercise, to reduce the risk of long-term health complications.

Furthermore, the psychological impact of PCOS should not be overlooked. Many women with PCOS experience emotional challenges such as anxiety, depression, and poor self-esteem due to the visible symptoms of the condition. Seeking support from healthcare professionals, mental health providers, and support groups can play a crucial role in managing the emotional well-being of individuals with PCOS. By addressing the physical, metabolic, and emotional aspects of PCOS, individuals can work towards improving their overall quality of life and well-being.

The Role of Hormonal Imbalances in PCOS Diagnosis

Hormonal imbalances play a crucial role in PCOS and can help healthcare providers in making a diagnosis. The two primary hormones affected in PCOS are insulin and androgens. Insulin resistance, which is common in PCOS, leads to higher insulin levels in the blood. Androgens, such as testosterone, can also be elevated in women with PCOS.

Furthermore, another hormone that is often impacted in PCOS is luteinizing hormone (LH). In women with PCOS, there is an imbalance in the ratio of LH to follicle-stimulating hormone (FSH), with LH levels being higher. This hormonal imbalance can contribute to the characteristic symptoms of PCOS, such as irregular menstrual cycles and ovarian cysts.

It is important to note that hormonal imbalances in PCOS can vary from one individual to another. Some women may have elevated levels of all three hormones – insulin, androgens, and LH, while others may only have abnormalities in one or two of these hormones. Understanding the specific hormonal profile of each patient is essential for accurate diagnosis and personalized treatment of PCOS.

Key Tests and Procedures for Diagnosing PCOS

To diagnose PCOS, healthcare providers may conduct various tests and procedures. These include:

  1. Blood tests: Measuring hormone levels, including testosterone, estrogen, prolactin, and thyroid hormones.
  2. Pelvic ultrasound: Assessing the ovaries for the presence of multiple cysts. However, it’s worth noting that not all women with PCOS have visible cysts on ultrasound.
  3. Physical examination: Evaluating symptoms such as excessive hair growth and acne.

Furthermore, in some cases, healthcare providers may also recommend additional tests to rule out other conditions that may present with similar symptoms to PCOS. These tests may include:

  • Glucose tolerance test: This test helps assess how your body processes sugar and can help identify insulin resistance, which is common in women with PCOS.
  • Lipid profile: Checking your cholesterol levels can provide insights into your risk of heart disease, as women with PCOS are at a higher risk of developing cardiovascular issues.

It’s important to note that the diagnosis of PCOS is not solely based on one test result but rather a combination of clinical symptoms, physical examination findings, and test results. Healthcare providers take a comprehensive approach to ensure an accurate diagnosis and appropriate management plan tailored to each individual’s unique needs.

In addition to gathering information about menstrual cycles and symptoms, healthcare providers may also inquire about lifestyle factors such as diet, exercise habits, and stress levels. These factors can play a significant role in the development and management of PCOS. For example, a high-sugar diet and sedentary lifestyle can exacerbate symptoms of insulin resistance, a common feature of PCOS.Furthermore, a detailed medical history can provide valuable insights into the potential underlying causes of PCOS. For instance, a history of irregular menstrual cycles or hormonal imbalances may indicate disruptions in the endocrine system, which can contribute to the development of PCOS. By understanding the patient’s medical background comprehensively, healthcare providers can tailor treatment plans to address the specific needs and concerns of individuals with PCOS.

Differentiating PCOS from Other Conditions

PCOS shares similarities with other conditions such as thyroid disorders and adrenal gland abnormalities. To differentiate PCOS from these conditions, additional tests, such as thyroid function tests and adrenal hormone testing, may be necessary. This is why a comprehensive approach is essential in diagnosing PCOS accurately.

Thyroid disorders, including hypothyroidism and hyperthyroidism, can present with symptoms that overlap with those of PCOS, such as irregular menstrual cycles and weight gain. However, thyroid function tests can help in ruling out or confirming the presence of thyroid abnormalities. Similarly, adrenal gland abnormalities, such as Cushing’s syndrome or adrenal hyperplasia, can manifest with symptoms like hirsutism and acne, which are also common in PCOS. Adrenal hormone testing, including cortisol levels and adrenal imaging studies, can aid in differentiating between PCOS and adrenal disorders.

Moreover, it is crucial to consider the impact of lifestyle factors, such as diet and exercise, in the diagnosis of PCOS. Women with PCOS often have insulin resistance, which can be exacerbated by poor dietary choices and sedentary habits. Therefore, assessing insulin levels and recommending lifestyle modifications, including a balanced diet and regular physical activity, are integral components of managing PCOS effectively. By addressing these multifaceted aspects, healthcare providers can offer personalized treatment plans tailored to the individual needs of patients with PCOS.

The Impact of Lifestyle Factors on Diagnosis

Lifestyle factors, such as diet and exercise, can significantly impact the symptoms of Polycystic Ovary Syndrome (PCOS). PCOS is a common hormonal disorder that affects reproductive-age women, characterized by irregular periods, high levels of male hormones (androgens), and cysts in the ovaries. Research has shown that lifestyle modifications play a crucial role in the management of PCOS symptoms.

Weight gain and insulin resistance are closely linked to PCOS. Excess weight can exacerbate hormonal imbalances and insulin resistance, leading to increased production of androgens. This can further disrupt ovulation and contribute to the development of cysts in the ovaries. By adopting a balanced diet and engaging in regular physical activity, individuals with PCOS can improve insulin sensitivity, regulate hormone levels, and potentially restore ovulation.

Interpreting Lab Results: What They Mean for PCOS

After conducting various tests and procedures, healthcare providers will interpret the lab results to reach a PCOS diagnosis. Elevated levels of androgens, such as testosterone, along with irregular menstrual cycles and visible cysts on ultrasound, are strong indicators of PCOS. However, it’s important to remember that the diagnosis of PCOS is made based on a combination of symptoms, physical examination findings, and lab results.

Diagnosing PCOS can be complex, but with a thorough investigation of symptoms, hormone levels, and medical history, healthcare providers can accurately identify this common condition. If you suspect you may have PCOS, it is essential to consult with a healthcare professional who can guide you through the diagnostic process and provide proper treatment options.

When interpreting lab results for PCOS, healthcare providers pay close attention to the levels of other hormones besides androgens, such as insulin and thyroid hormones. Imbalances in these hormones can also contribute to the symptoms of PCOS, including weight gain, irregular periods, and difficulty conceiving. Understanding the interplay of these different hormones is crucial in developing a comprehensive treatment plan tailored to each individual’s needs.

Furthermore, in addition to blood tests and ultrasounds, healthcare providers may recommend additional imaging studies or specialized tests to rule out other conditions that can mimic PCOS symptoms. These may include adrenal or ovarian tumors, thyroid disorders, or rare genetic conditions. By conducting a thorough and systematic evaluation, healthcare professionals can ensure an accurate diagnosis and provide appropriate management strategies for individuals with PCOS.

​​Financing Your Fertility Journey: Options, Insights, and Solutions

December 9, 2020

Introduction

Infertility affects millions of people worldwide, and for those looking to grow their families, the financial burden can be overwhelming. The process of fertility treatments is often expensive, however there are options to help alleviate the cost. In this article, we’ll explore the costs associated with fertility treatments, insurance coverage, financial assistance programs, alternative financing options, and saving strategies to help you navigate the financial aspects of your fertility journey.

The Cost of Fertility Treatments

Factors Affecting the Cost

The cost of fertility treatments can vary significantly depending on several factors, including the type of treatment, the clinic’s location, and the individual’s specific needs. It’s essential to research and compare prices at different clinics to get an accurate idea of the costs involved.

Types of Fertility Treatments

Fertility treatments range from relatively inexpensive options, like fertility medications and intrauterine insemination (IUI), to more advanced procedures like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). The costs for these treatments can range from a few hundred dollars to tens of thousands of dollars.

Insurance Coverage for Fertility Treatments

Understanding Your Policy

Insurance coverage for fertility treatments varies widely depending on your provider and plan. Some insurance policies cover diagnostic testing and basic treatments, while others may provide more comprehensive coverage for advanced procedures like IVF. It’s crucial to review your policy and discuss coverage with your insurance provider.

Tips for Navigating Insurance

Navigating insurance coverage for fertility treatments can be challenging. Be persistent and advocate for yourself – don’t hesitate to ask questions or seek clarification. Keep detailed records of your communications with your insurance provider, as well as any medical documentation related to your fertility journey.

Financial Assistance Programs

Grants and Scholarships

There are various grants and scholarships available to help cover the costs of fertility treatments. Some organizations offer financial aid based on factors like income, location, and specific fertility challenges. Research and apply for grants and scholarships to increase your chances of receiving assistance.

Clinical Trials

Participating in a clinical trial may provide access to fertility treatments at a reduced cost or even for free. Moreover, clinical trials are carefully regulated and can offer cutting-edge treatments, but there may be risks involved. Discuss the possibility of participating in a clinical trial with your fertility specialist to determine if it’s a suitable option for you.

Alternative Financing Options

Personal Loans

Personal loans are another option to help finance fertility treatments. While taking on debt may not be ideal, personal loans typically offer lower interest rates than credit cards and may provide the necessary funds to cover treatment costs. Shop around for the best rates and terms to minimize the financial impact.

Crowdfunding

Crowdfunding platforms like GoFundMe and Kickstarter allow you to raise money from friends, family, and even strangers to help finance your fertility journey. Create a compelling campaign, share your story, and leverage your social networks to help spread the word and generate support.

Saving Strategies for Fertility Treatments

Flexible Spending Accounts

A flexible spending account (FSA) is a pre-tax savings account that allows you to set aside money for qualified medical expenses, including fertility treatments. FSAs can help reduce your overall tax burden and provide a dedicated savings account for your fertility journey.

Budgeting and Lifestyle Changes

Making lifestyle changes and adopting a strict budget can help you save for fertility treatments. Identify areas where you can cut expenses, like dining out or subscription services, and put the savings towards your fertility fund. Consider taking on additional work or selling items to generate extra income.

Conclusion

Financing your fertility journey can be a daunting task, but understanding your options and being proactive in seeking assistance can make the process more manageable. Explore insurance coverage, financial assistance programs, alternative financing options, and saving strategies to help alleviate the financial burden and focus on what matters most – growing your family.

FAQs

Do all insurance policies cover fertility treatments?

  1. No, insurance coverage for fertility treatments varies widely depending on the provider and plan. Review your policy and discuss coverage with your insurance provider.

Are there any grants or scholarships available for fertility treatments?

  1. Yes, various organizations offer grants and scholarships to help cover the costs of fertility treatments. Research and apply for these opportunities to increase your chances of receiving assistance.

Is participating in a clinical trial a good option for financing fertility treatments?

  1. Participating in a clinical trial may provide access to fertility treatments at a reduced cost or for free, but there may be risks involved. Discuss this option with your fertility specialist to determine if it’s suitable for you.

What are some alternative financing options for fertility treatments?

  1. Personal loans and crowdfunding campaigns are alternative financing options that can help cover the costs of fertility treatments.

How can I save for fertility treatments?

  1. Consider using flexible spending accounts, adopting a strict budget, making lifestyle changes, and seeking additional income sources to save for fertility treatments.