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Your Preconception Checkup

Preconception

The best prenatal care begins long before egg and sperm meet up — and it starts with your preconception checkup. Before you get busy trying to make a baby, get busy making a few doctor and dentist appointments.

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You may not be pregnant yet, but the best way to care for your future pregnancy is to get a thorough top-to-bottom preconception checkup. A full-body tune-up now will make it easier to tackle health issues before baby’s on board and will help ensure your pregnancy is a safe and healthy one.

How should I prepare for my preconception checkup?

It doesn’t take much to prepare for your preconception checkup (other than actually making the appointment with your gynecologist), but there are a number of questions you’ll be asked during your appointment, so here’s a checklist of the information you’ll need to gather before you head to the doctor’s office:

  • The type of birth control you are on. Your doctor will let you know when to stop your birth control and how long you should ideally wait, if at all, before you can start trying for that baby of yours.
  • Your menstrual cycles. You’ll be asked about the date of your last period and the length of your cycles. This will help guide a discussion about your fertility and the best time each month to try to conceive.
  • Your diet and lifestyle habits. Be prepared to be asked about what you eat and whether you drink or smoke. You and your doctor will discuss ways to boost your fertility through possible diet and lifestyle changes if needed.
  • A list of the medications you currently take. Whether it’s over-the-counter or prescription, you and your doctor will discuss all the drugs (as well as vitamins and herbal supplements) you take. Depending on the medication (some are safe during pregnancy, others may not be), a change may be in the cards.
  • Any chronic conditions or medical problems you have. Any medical problems that should be treated before conception or will need to be monitored during pregnancy are important to talk about now, so have your medical history, including your mental health history, at the ready. The good news is that with the right care and precautions, most chronic conditions are perfectly compatible with getting pregnant and having a healthy pregnancy.
  • Your family history. When you’re starting a family, your family tree matters — which is why your doctor will want to check it out. Dig as deeply as you can, and write down everything you unearth, so you’ll be ready to answer the family history questions you’ll get from your practitioner. For instance, your doctor will want to know if there’s a history of breast cancer (and, depending on that answer, may recommend you get a baseline mammogram before you conceive). Your doctor will also ask about you and your partner’s family history of medical conditions (such as type 2 diabetes) and pregnancy conditions (such as preeclampsia) that might affect your pregnancy. And since multiples can run in families, be sure to share any twin trends on both your sides of the tree.

What tests and screenings will I get at my preconception appointment?

Your preconception checkup will include a lot of pre-pregnancy-specific tests and screenings, plus many of the standard screenings you’re used to from your regular annual visit. Here’s what you can expect:

  • A Pap test
  • A pelvic, breast and abdominal exam
  • Blood pressure reading
  • A weight check
  • Screening for any gynecological conditions that might interfere with fertility or pregnancy, such as irregular periods, polycystic ovarian syndrome (PCOS), uterine fibroids, cysts, benign tumors, endometriosis or pelvic inflammatory disease (PID)
  • A urine test to screen for urinary tract infection and kidney disease
  • A blood test to check hemoglobin count (to test for anemia), vitamin D levels (to make sure you’re not deficient), Rh factor (to see if you are positive or negative), rubella titer, (to check for immunity to rubella), varicella titer (to check for immunity to chicken pox), tuberculosis (if you’re at high risk for Tb), hepatitis B titers (if you’re in a high-risk category, such as being a health care worker), cytomegalovirus titers (to determine if you’re immune to CMV), toxoplasmosis titers (if you have a cat, regularly eat raw or rare meat, or garden without gloves), thyroid function and sexually transmitted diseases  
  • A mental health screening for depression, anxiety disorder or any other mental health issue, including eating disorders, can interfere with conception and increase your risk of mood disorders during pregnancy and postpartum

What fertility tests might my doctor do?

If you’re under 35 and have no known fertility issues, there aren’t any additional tests in store for you at the first preconception checkup. But some doctors will be more proactive with hopeful moms-to-be over 35, testing their blood for certain fertility markers that could give a heads up on any potential difficulties in the fertility department.

These tests might include a blood test to check progesterone levels (testing around day 21 of your cycle can confirm that you’re ovulating), FSH and estradiol (testing for these two hormones on day 3 of your cycle can help indicate how many eggs you have in reserve in your ovaries) and AMH (testing for the anti-mullerian hormone also measures ovarian reserve). If your doctor suspects you might have PCOS, testing for other hormones such as testosterone and DHEA-S may be ordered.

What vaccines do I need to get before I get pregnant?

Even if you received a full set of vaccines as a child, it doesn’t mean you’re off the immunization hook now. Some vaccines require boosters to keep immunities going strong, and you want to make sure your immunity is top-notch before you get a baby on board. 

The blood tests you’re getting at your preconception checkup will clue your doctor in to whether or not you have all the antibodies needed to keep you and your baby-to-be healthy during pregnancy. But it’s not just about pregnancy. Since infants aren’t fully immunized against some diseases until at least 6 months, your good health and antibodies will be vital in protecting your newborn baby’s health.

Keep in mind that once you conceive, some vaccines will be off the table, so if your antibody levels are low or you have some immunization holes that need filling in, now — before your TTC campaign begins — is the time to roll up your sleeve. Here are some vaccines that might be on your preconception agenda:

  • Measles, mumps, rubella (MMR). If you’ve never been immunized against this trio of serious childhood diseases, or if testing shows your immunity wore off, you’ll need the MMR vaccine. Wait one month from the time you get the vaccine until you start trying to conceive.
  • Chicken pox (varicella). If you’ve never had chicken pox or weren’t vaccinated against it, it’s recommended that you get the varicella vaccine pre-pregnancy, and that you wait at least one month before you start trying to conceive.
  • Hepatitis B. If you’re at high risk for hepatitis B, it’s recommended that you get vaccinated against hepB. The hep B shots come in a series of three, and if you don’t finish up the series before you conceive, it’s safe to continue it during pregnancy.
  • HPV (human papillomavirus). Are you younger than 26? If yes, you should be vaccinated against HPV with the full series of three shots before trying to conceive. If you become pregnant before completing the full series, you’ll have to resume the shots postpartum.
  • COVID-19. If you haven’t gotten it yet (or you’re missing out on a booster), there’s no time like the present to gain protection. The COVID vaccine is safe and recommended for everyone 6 months and up, including women who are trying to conceive, pregnant or breastfeeding. 

During pregnancy you’ll need to roll up your sleeves for two more shots: the flu shot and the Tetanus-diphtheria pertussis (Tdap) vaccine (which should be given ideally around 27 weeks to 36 weeks of pregnancy).

Other appointments to make before getting pregnant

Smile — you’re about to make a baby! And while you’re smiling, make an appointment with your dentist. 

Though you probably wouldn’t normally associate your pearly whites with baby making, you’ll definitely want to schedule a dental checkup and teeth cleaning before you start trying. That’s because gum disease is associated with pregnancy complications such as preterm labor, preeclampsia and gestational diabetes. 

Gum disease also tends to get worse during pregnancy, so getting your mouth in shape now is a smart idea — especially since treating gum disease before pregnancy can help reduce the risk of those complications.

If you need any work done — x-rays, fillings, crowns or gum surgery, for instance — schedule it soon so you won’t have to deal with it during pregnancy. Make sure you give yourself enough time to get it all finished up before you begin trying to get pregnant.Remember, even if you’ve never had a sick day, seeing your doctor(s) and dentist for thorough preconception checkups before you start trying to get pregnant will help ensure that all baby-making systems are go and that you’re setting yourself up for a healthy pregnancy and a healthy baby.

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I’m not producing much cervical fluid. Could this signal a fertility problem?

cervical fluid

It might indicate a fertility problem but not necessarily a serious one.

First, you need to find out if you’re ovulating. The easiest, most practical way to do that is to take your temperature with a digital thermometer every morning and look for the sustained rise that indicates ovulation. Your temperature should remain high for about 12 to 16 days, until your period.

Cervical fluid. If you find that you’re not ovulating, you might want to consider making some lifestyle changes, as well as consulting a fertility specialist.

Achieving a healthy weight may be all you need to boost your chances of conception. If you’re very thin, for example, you may not have enough estrogen to ovulate. (Ovulation requires a minimum of about 18 percent body fat.) Obesity can create too much estrogen, which can also prevent ovulation by disrupting the hormonal feedback system that tells the egg follicles to mature.

Cervical fluid

Having intercourse on demand when you’re trying to get pregnant can be stressful, and that in itself can cause vaginal dryness. If your problem is lack of arousal fluid, rather than cervical fluid, you might want to try a product called Pre-Seed. This lubricant won’t take the place of fertile-quality cervical fluid, but it can make sex more comfortable without killing sperm the way other lubricants can.

Women taking the fertility drug Clomid to stimulate ovulation may experience a paradoxical side effect. The drug encourages egg development in the ovaries but can dry up the cervical fluid needed to transport the sperm through the cervix.

Intrauterine insemination (IUI), also called artificial insemination, bypasses this roadblock by inserting the sperm through the cervix into the uterus. It’s a simple, low-tech procedure that’s done in a doctor’s office. Don’t try and do it with a turkey baster at home, though! The sperm needs to be delicately inserted beyond your cervix into your uterus, something you can’t do yourself.

No matter what’s causing your dryness, drink lots of water and avoid antihistamines and cough and cold medicines that dry up mucous membranes to increase your body’s ability to produce wet cervical fluid.

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Irregular periods: What causes them, and how to get yours back on track

Irregular periods. The average menstrual cycle is 28 days long, although a regular cycle is anywhere from 21 to 38 days. Sometimes, your cycle may be shorter or longer than usual. An occasional irregular period isn’t usually a cause for concern. But consistently irregular periods may be caused by certain health issues like thyroid problems or polycystic ovary syndrome (PCOS). If you do have irregular periods, your provider can help you figure out what’s going on.

Irregular periods

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Having an irregular period means that the length of time between the first day of your period and the first day of the next changes from cycle to cycle. It might come a few days earlier than expected or a few days late. A period that rarely arrives on schedule can throw you for a loop, especially if you’re trying to get pregnant.

Most of the time the menstrual cycle follows a pretty set schedule. Every month at roughly the same time, the ovaries release an egg. That’s called ovulation. If that egg isn’t fertilized, your hormones signal your body to shed the tissues lining your uterus and you get your period. You bleed for around five days, and then the whole cycle starts over again.

It’s like clockwork. Well, not always.

The average menstrual cycle is 28 days long, but it can range from 21 to 38 days. Some women have more unpredictable cycles that change in length from month to month. Not only does having an irregular period make it hard to know when it’s time to pick up a new box of tampons or pads, but it can make it more difficult to know when you could get pregnant.

If you’re wondering, “Why is my period irregular?” there are a few possible reasons.

What causes an irregular period?

Abnormal periods are the norm during the teen years when your body is still establishing its menstrual rhythm. It’s also common in your 40s and 50s as you inch closer to menopause.

If you’re not in either one of these age ranges here are some other reasons you may have irregular periods:

  • Stress. You may notice that your periods get out of whack whenever you’re under a lot of stress. That’s because the stress hormone, cortisol, affects the release of estrogen and progesterone, which control your menstrual cycle.
  • Birth control pills. Taking the “Pill” will make your menstrual cycle more regular while you’re on it. Once you go off birth control you can expect a little irregularity for a few months as your cycle gradually eases back into its previous rhythm.
  • Weight loss or gain. Quick or dramatic weight swings – up or down – can throw off your menstrual cycles. Irregular or missed periods are one sign of eating disorders like anorexia nervosa or bulimia. Hormonal changes that go along with weight gain or loss may be behind these menstrual changes.
  • Problems with your ovaries. Polycystic ovary syndrome (PCOS) causes your ovaries to make too much of male hormones called androgens. This prevents your eggs from maturing, which leads to irregular periods. About 1 in 10 women with irregular periods have PCOS. In premature ovarian failure (POF) (also called primary ovarian insufficiency, or POI), your ovaries stop working before age 40 – years before you would typically start menopause. You ovulate less and less often over a few months or years before your periods stop altogether.
  • Pelvic inflammatory disease (PID). Painful or irregular periods can be a sign of PID, a bacterial infection of the reproductive organs.
  • Hormone disorders. Irregular periods could be a sign that your hormones are out of balance. An overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid gland and excess prolactin (hyperprolactinemia) can throw off your menstrual cycle.
  • Endometriosis. When tissue that forms the lining of your uterus (endometrium) forms outside of the uterus, such as in the ovaries or fallopian tubes, you may have longer periods or shorter intervals between periods.

How to calculate ovulation with irregular periods

Using an ovulation calculator to figure out your most fertile days can help you predict when you’ll have the best odds of conceiving. But what if you have irregular periods and you ovulate at different times in each cycle? An ovulation calculator that works for irregular periods doesn’t really exist.

Instead, you may need to rely on other fertility tracking methods. One technique to try is measuring your basal body temperature (BBT). Your body temperature will rise slightly when you ovulate, giving you a window into the best time to have sex.

Or you can buy ovulation test strips. Using a bit of your urine or saliva, these strips can alert you to when ovulation is imminent.

Signs of pregnancy when you have irregular periods

A missed period is one of the most common ways that women know they’re pregnant. Once you conceive, your body releases hormones that basically shut down ovulation. But what if your period comes sporadically? One missed period can bring excitement – or panic – when you’re not actually pregnant.

Watch for these other signs of pregnancy when you have irregular periods:

  • Extreme tiredness
  • Morning sickness (or nausea and vomiting at any time of the day)
  • A frequent need to urinate
  • Swollen and sore breasts
  • Light spotting
  • Bloating
  • Moodiness
  • Cramping

Keep in mind that many of these symptoms happen for other reasons. You might feel extra tired if you haven’t been sleeping well or you have an infection, for example. The only way to know for sure is to take a pregnancy test.

What to do about irregular periods

Your periods might snap back into a normal rhythm eventually if the cause was something temporary, like work-related stress. In other cases, the way to treat irregular periods depends on their cause.

Taking hormonal forms of birth control like combination birth control pills or progestin-only pills can help to regulate your cycle, if you’re not planning a pregnancy. These are also treatments for PCOS.

Treating whatever other problem that caused your menstrual cycle to become irregular can also do the trick. For example, if you have an eating disorder, you may need counseling and nutritional therapy. For PID, antibiotics help you get rid of bacteria that caused the infection.

If you’re having irregular cycles, talk with your provider. It’s a good idea to track your cycle using an app or calendar so they can get a good idea of exactly what’s going on when you meet. They’ll suggest treatment options for any underlying health issues, which will in turn help regulate your cycles

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Why is my period late?

period late

Period late! A missed period is an early sign of pregnancy, but if your period is late and you’re not pregnant, you may wonder what’s going on. Stress, breastfeeding, certain medications, menopause, and some medical conditions can affect the hormones that regulate your menstrual cycle and cause a missed or late period. An occasional missed period isn’t usually cause for concern, but if you miss your period for 3 months in a row, have periods that are more than 35 days apart, or suddenly have irregular periods, talk with your healthcare provider.

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Reasons for a missed or period late

There are many reasons why you might have a missed or late period, but they all have to do with hormones. Anything that affects your body’s production of the hormones that influence your cycle can result in a menstrual cycle that’s out of whack. These hormones include progesterone and estrogen (made by the ovaries) and follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (made by the pituitary gland).

Common causes for a missed or late period include:

Pregnancy. A missed period is often the first sign of pregnancy. Your body will start producing human chorionic gonadotropic (hCG), yet another hormone, as soon as the fertilized egg implants itself in the lining of your uterus. A pregnancy test can pick up hCG in your urine when you’ve missed a period (and sometimes before). If you’re unsure of the results (or want confirmation), your healthcare provider can do a blood test.

Stress. Big and little stressors – from a switched schedule (day shift to night shift) or travel that disrupts your circadian rhythms, to an illness or major life event – can result in changes in hormone levels. These changes can cause you to ovulate off schedule or to not ovulate at all.

Breastfeeding. When you breastfeed, your body produces prolactin, which suppresses ovulation. In fact, some moms use exclusive breastfeeding as birth control, though it’s risky. Keep in mind that you can get pregnant before you have a period. Your first ovulation comes two weeks before your first period!

Medications. Certain birth control medications can affect your menstrual cycle.  Birth control pills keep your body from ovulating. (You may still have some bleeding, but bleeding when on birth control pills isn’t a true menstrual period linked with ovulation. It’s a result of the withdrawal from the hormones as you take the placebo pills.)

And if you’re on extended birth control pills, you’ll only get your period every 3 months, because they’re designed to cause withdrawal bleeding every 91 days. Other hormonal birth control, like the Depo-Provera shot (which suppresses ovulation) and hormone-containing IUDs, (which thin the uterine lining) can stop or delay your periods, too.

Other medications can also affect your cycle or cause it to stop. These include some types of psychiatric medications and cancer chemotherapy.

Being extremely underweight. Extreme weight loss, low calorie intake, excessive exercise, and/or being very underweight can inhibit the production of estrogen and slow the release of gonadotropin-releasing hormone (GnRH), which affects the timing of your period. A BMI of 18.5 or less can result in irregular menstrual cycles and may stop ovulation completely.

Your body stops ovulation and your periods because it thinks that you’re starving at this low weight and understands that this isn’t a great time to get pregnant. Keep in mind, though, that your cycle can restart at any time, so you still need to protect against pregnancy if you don’t want to conceive. In this case, changes in your menstrual cycle are a warning sign for your overall health. Seeing a physician to prevent long-term damage to your body is crucial.

Obesity. Being very overweight can cause your body to produce too much estrogen, leading to a loss of ovulation and menstrual periods. Like being extremely underweight, this is a warning sign for your overall health and should be addressed by your healthcare provider.

Menopause. The time when your body is transitioning to menopause is called perimenopause, and your period may come and go – or lengthen and shorten. That’s because the levels of estrogen in your body are rising and falling during this transition. Perimenopause can happen as early as mid-30s, though it’s more common in your 40s. The average age of menopause (defined as one year without a period) is 51, plus or minus 5 years. Irregular cycles can start a few years before your last period. If you enter menopause significantly early, it’s called primary ovarian insufficiency (early menopause). There are long-term health implications for early menopause, so talk with your healthcare prover about interventions.

Medical conditions. Health issues that cause hormonal imbalances can affect your menstrual cycle. These include:

  • Polycystic ovarian syndrome (PCOS) is a common cause of irregular periods. We don’t fully understand the condition yet, but it’s a communication problem between the brain, ovaries, and uterus that is probably caused by both genetic and environmental factors. PCOS is associated with diabetes and insulin resistance, excessive body hair, and/or acne.
  • Thyroid problems can cause irregular periods, or they can cause your period to stop. Hypothyroidism happens when the thyroid gland doesn’t produce enough thyroid hormone. And hyperthyroidism is when your thyroid is overactive and produces too much thyroid hormone.
  • Pituitary tumors can secrete excessive prolactin and cause missed periods.
  • Chronic diseases, such as uncontrolled celiac disease and diabetes, can affect menstruation (though this is rare).

Medical terms for a missed period

Amenorrhea is the medical name for not having a period. Here are the terms that a healthcare provider might use to define your missed periods:

  • Primary amenorrhea means a girl or woman has not had any period by age 15.
  • Secondary amenorrhea means that menstrual periods are absent for more than 3 to 6 months (3 months in someone who was previously having regular periods and 6 months in someone who was having irregular periods).  
  • Oligomenorrhea means having infrequent periods (fewer than 6 to 8 periods per year).

What to do if your period is late

If you just missed it – say your period is 3 days late or 5 days late – take a pregnancy test.

If you’re not pregnant and your period is late, keep in mind that missing a period or having a late period occasionally isn’t usually something to worry about. But not having a period for an extended time or infrequently can be a sign of a health problem. And these can lead to other problems, such as cardiovascular disease, diabetes, infertility, and osteoporosis.

See your healthcare provider if you:

  • Don’t get a period for three months or more in a row
  • Have fewer than 9 menstrual cycles each year
  • Had regular periods but now have irregular periods
  • Have a period that lasts more than 10 days
  • Have periods that are more than 35 days apart. A typical cycle is 28 days, but some women have a normal range of 21 to 35 days.

If you missed your period because you’re pregnant, call your healthcare provider to make a prenatal appointment. In the meantime, use our due date calculator to find out when your baby may arrive.

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How do ovulation test strips work?

ovulation

Ovulation test strips can increase your chances of getting pregnant by letting you know when you’re about to ovulate. But there are two different types of tests, saliva-based and urine-based, which work differently and have different levels of accuracy. Which one you choose depends on what type of ovulation test results you want to get (and your budget!).

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What is an ovulation test kit?

An ovulation test strip, (or ovulation predictor kit, OPK) can help you identify the most fertile days during your monthly cycle – that is, the day or two leading up to ovulation when sex (or insemination) is most likely to lead to pregnancy. It can be a quick and easy way to predict when you’re about to ovulate.

Of course, you don’t have to schedule sex in order to get pregnant. Having sex every few days during the middle two weeks of your cycle will usually do the job. However, you may want to try to pinpoint your most fertile days if:

  • You and your partner have hectic schedules or already have children, and it’s not feasible for you to have sex that often.
  • You’re trying to get pregnant through insemination.
  • You’ve had difficulty conceiving after a few months of trying, and think you might have irregular cycles that make it hard to find your fertile window.

How ovulation tests work

There are two kinds of ovulation prediction kits:

Urine-based OPKs

These test your urine for an increase in luteinizing hormone (LH). This usually happens within a day and a half before ovulation. There’s always a small amount of LH present in your blood and urine, but the level will go up by about two to five times in the days before ovulation. A test stick usually shows a positive result about 24 to 36 hours before your egg is released, so plan to have sex (or be inseminated) during that window if you want to maximize your chances of getting pregnant.

Salivary ferning kits

Salivary ferning kits help you tell when ovulation is imminent by showing changes in your saliva. As your estrogen levels rise in the days before ovulation, the salt content of your saliva increases. If you put a drop of saliva on a glass slide, the salt may dry and crystallize into a fern-like pattern that you may be able to see with a pocket-size portable microscope. The ferning pattern should indicate that you’ll ovulate in the next few days (though you may continue to see a ferning pattern up to two days after ovulation).

What does a positive ovulation test mean?

A positive result means that you’re likely to ovulate in the next 24 to 36 hours, so if you’re trying to conceive, try to have sex more frequently in the next several days (or schedule your insemination ASAP, if that’s the approach you’re taking).

A positive test result isn’t a guarantee, though, and all test kits have different parameters for displaying a positive result, so you should definitely make sure you’ve read the instructions for your individual kit and know how to interpret the results.

How accurate are ovulation test kits?

Urine-based LH tests are more accurate than salivary ferning kits, but they’re not foolproof. Follow the instructions on your kit carefully for the most accurate results. Make sure you use the test at the time of day recommended, and read the results within the timing window specified.

Also, keep in mind that because LH can surge with or without the release of an egg, the tests can’t tell you for sure whether you’ve ovulated.

Most importantly, don’t use these kits to try to avoid pregnancy, since you won’t know exactly when you’ve ovulated or when your fertile window has closed for that cycle.

Salivary ferning tests are less accurate than urine tests. Ferning may happen as early as six days before you ovulate as well as at other times in your menstrual cycle, particularly if you’re taking the fertility drug Clomid (clomiphene).

It may also be hard to recognize whether ferning has happened on the test slide. If you have poor eyesight, salivary ferning kits may not be the best method for you.

Taking Clomid or drugs containing human chorionic gonadotropin (hCG) or LH can affect results for both salivary ferning and urine-based tests. Ask your provider whether you need to stop taking certain drugs before using these tests.

Finally, OPKs are not likely to be accurate for women who are nearing menopause or have polycystic ovary syndrome.

How to use ovulation kits

First and foremost, you should always read and follow the instructions that come with the kit you select. But whatever kind of kit you’re using, you’ll need to figure out which day of your cycle to start testing. Some kits suggest that you count back 18 days from the day you expect your next period. So if you have a 28-day cycle, start testing on day 10 (the 10th day after your period starts), and continue until you get a positive result.

As far as how to use the kit and how to read your test results, the steps will differ based on whether you’re using a urine-based or salivary ferning OPK.

Using a urine-based OPK

Urine-based OPKs supply five to 20 days’ worth of test sticks. Once a day, you hold a test stick in your urine stream or dip the end of the stick into urine you’ve collected in a cup. The colored bands or symbols that appear on the test stick indicate whether the LH surge is occurring.

Try to collect your urine at about the same time every day, but follow the instructions on your particular kit for best results.

Don’t drink a lot of liquid during the two hours before testing. Too much liquid dilutes your urine, which could make it more difficult to detect the surge.

Read the results within 10 minutes. A positive result won’t disappear, but some negative results may later display a faint second color band that would be misleading.

Using a salivary ferning OPK

Use a finger or lick the slide to put a little bit of your saliva on a slide. Do this first thing in the morning, before you’ve had anything to eat or drink. Make sure the sample is free of air bubbles.

Wait for the saliva to dry and then use the microscope to see whether there is any ferning. Compare your slide with examples in the instructions to tell how to identify ferning.

Where to get ovulation test kits

You can buy kits online as well as over-the-counter at most drugstores and supermarkets (they’re usually near the pregnancy tests).

The more challenging thing about getting a hold of ovulation test kits is affording them. Urine-based OPKs cost between $20 and $50 and contain between five and 20 test sticks. Most brands offer the same level of reliability, so pick the one that offers you the most test sticks for the least amount of money.

Once you detect your surge, you can stop testing for that cycle and save any unused test sticks for the following month (unless you conceive, of course).

Salivary ferning OPKs can be a better value. After the initial outlay of about $30 for the microscope, you should be able to test again and again. If it takes you a long time to conceive, you may have to replace the kit with a new one after about two years, depending on the brand.

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8 Ovulation Symptoms to Detect Your Most Fertile Days

Ovulation Symptoms

Ovulation Symptoms and Signs can include increased basal body temperature, mild cramps and more. Here’s what to expect — and how to use this information to increase your chances of getting pregnant.

IN THIS ARTICLE

Recognizing the signs of ovulation is key when pregnancy is the goal. During each monthly cycle, healthy couples who aren’t using birth control typically have around a 25 to 30 percent chance of getting pregnant, though it can vary widely depending on the circumstances. That’s partly because you can only conceive around the time of ovulation — a small window each month (between 12 and 24 hours) when the egg is viable.

Doesn’t sound like much of an opening? Consider, then, that sperm can live for three to six days, meaning that even if you have sex a few days before ovulation, some sperm may still be around to greet the egg when it emerges. And remember: It only takes one sperm to make a baby.

Of course, having sex the day you ovulate would be ideal, since after that the window tends to close until the next cycle. So what ovulation symptoms should you look for to time it just right? Here are the signs of ovulation to pay close attention to when you’re trying to conceive. 

What is ovulation?

Ovulation is the release of a mature egg from one of the ovaries, which happens every month. A woman is most fertile around the time of ovulation.

Common signs of ovulation

Here are the ovulation symptoms to watch for. Note: Some women may experience all of these symptoms, while others may experience few, if any. 

  • Changes in body temperature. During ovulation, your basal body temperature (BBT) rises slightly. You’re most fertile in the two days before your BBT increases. Charting your BBT using a special thermometer for a few months may help you better pinpoint your most fertile days.
  • Changes in cervical mucus. Cervical mucus becomes clearer and thinner with a slippery consistency similar to that of egg whites. You might notice the change in consistency in your undies.
  • Ovulation pain. You may feel a slight twinge of pain or mild cramps in your lower abdomen (this is called mittelschmerz).
  • A libido boost. Your sex drive may increase right around the time your body’s about to ovulate.
  • Changes in cervical positioning. Just before ovulation, your cervix may soften, open up and move up higher.
  • Light spotting. You may notice some light spotting.
  • Vulva changes. Your labia, or the outer part of your genitalia, may swell.
  • Breast tenderness. Fluctuating hormones bring on achy breasts and sore nipples for some women.

When does ovulation occur?

Ovulation usually occurs halfway through your menstrual cycle, or around day 14 of the average 28-day cycle counting from the first day of one period to the first day of the next.

But as with everything pregnancy-related, there’s a wide range of normal here since cycles can last anywhere from 23 to 35 days, and even your own cycle and time of ovulation may vary slightly from month to month.

How long does ovulation last?

An egg can be fertilized for between 12 and 24 hours after ovulation. The specific length of time that it takes for the egg to be released by the ovary and picked up by the fallopian tube is variable but occurs 12 to 24 hours after a surge of the hormone LH as described below.

How to track ovulation

There are a number of ways to predict when you might start ovulating. Here’s how to prepare for ovulation and pinpoint the timing:

Chart your menstrual cycle

Keep a menstrual cycle calendar for a few months so you can get an idea of what’s normal for you — or use tools that can help you calculate ovulation. If your periods are irregular, you’ll need to be even more alert for other ovulation symptoms.

Listen to your body

Can you feel ovulation happening? If you’re like 20 percent of women, your body will send you a memo when it’s ovulating, in the form of a twinge of pain or a series of cramps in your lower abdominal area (usually localized to one side — the side you’re ovulating from). 

Called mittelschmerz — German for “middle pain” — this monthly reminder of fertility is thought to be the result of the maturation or release of an egg from an ovary. Pay close attention, and you may be more likely to get the message.

Track your basal body temperature

Your basal body temperature, or BBT, that is. Taken with a special thermometer, basal body temperature is the baseline reading you get first thing in the morning, after at least three to five hours of sleep and before you get out of bed, talk or even sit up. 

Your BBT changes throughout your cycle as fluctuations in hormone levels occur. During the first half of your cycle before ovulation, estrogen dominates.

During the second half after ovulation, there’s a surge in progesterone, which increases your body temperature as it gets your uterus ready for a fertilized, implantable egg. That means your temperature will be lower in the first half of the month than it is in the second half.

Confused? Here’s the bottom line: Your basal body temperature will reach its lowest point at ovulation and then rise immediately about a half a degree as soon as ovulation occurs. Keep in mind that charting your BBT for just one month will not enable you to predict the day you ovulate but rather give you evidence of ovulation after it’s happened. Tracking it over a few months, however, will help you see a pattern in your cycles, enabling you to predict when your fertile days are — and when to hop into bed accordingly.

Many women do find this approach a bit frustrating and it is important to know that studies have shown that the timing of ovulation does vary among women after the dip in temperature. Ovulation predictor kits are more precise.

Get to know your cervix

Ovulation isn’t an entirely hidden process, and there are some definite physical signs of ovulation. As your body senses the hormone shifts that indicate an egg is about to be released from the ovary, it begins prepping for incoming sperm to give the egg its best chance of being fertilized.

One detectable sign of ovulation is the position of the cervix itself. During the beginning of a cycle, your cervix — that neck-like passage between your vagina and uterus that has to stretch during birth to accommodate your baby’s head — is low, firm and closed. But as ovulation approaches, it pulls back up, softens a bit and opens just a little, to let the sperm through on their way to their target. 

Some women can easily feel these changes, while others have a tougher time. Check your cervix daily, using one or two fingers, and keep a record of your observations.

Pay attention to discharge

The other cervical ovulation symptom you can watch for is a change in mucus. Cervical mucus, which you’ll notice as discharge, carries the sperm to the egg deep inside you. 

After your period ends, you’ll have a dry spell, literally; you shouldn’t expect much, if any, cervical mucus. As the cycle proceeds, you’ll notice an increase in the amount of mucus, with an often white or cloudy appearance — and if you try to stretch it between your fingers, it’ll break apart.

As you get closer to ovulation, this mucus becomes even more copious, but now it’s thinner, clearer and has a slippery consistency similar to that of an egg white. If you try to stretch it between your fingers, you’ll be able to pull it into a string a few inches long before it breaks (how’s that for fun in the bathroom?). This egg white cervical mucus is yet another sign of impending ovulation.

After you ovulate, you may either become dry again or develop a thicker discharge. Put together with cervical position and BBT on a single chart, cervical mucus can be an extremely useful (if slightly messy) tool in pinpointing the day you’re most likely to ovulate — in plenty of time for you to do something about it. 

Some women do not produce much cervical mucus, particularly those who have had surgery on the cervix for abnormal PAP smears (such as a LEEP procedure).

Buy an ovulation predictor kit

Don’t want to mess around with mucus? You don’t have to. Many women use ovulation predictor kits, which identify the date of ovulation 12 to 24 hours in advance by looking at levels of luteinizing hormone, or LH, the last of the hormones to hit its peak before ovulation. 

All you have to do is pee on a stick and wait for the indicator to tell you whether you’re about to ovulate. These kits are more accurate than the use of apps which predict when you should be ovulating, but not necessarily when you are ovulating.

A less precise and rarely used approach is a saliva test, which measures estrogen levels in your saliva as ovulation nears. When you’re ovulating, a look at your saliva under the test’s eyepiece will reveal a microscopic pattern that resembles the leaves of a fern plant or frost on a window pane. Not all women get a good “fern,” but this test, which is reusable, can be cheaper than the kits.

There are also devices that detect the numerous salts (chloride, sodium, potassium) in a woman’s sweat, which change during different times of the month. Called the chloride ion surge, this shift happens even before the estrogen and the LH surge, so these tests give a woman a four-day warning of when she may be ovulating, versus the 12-to-24-hour notice that standard ovulation predictors provide. 

The saliva and chloride ion surge tests have not been well studied and tend to be used much less frequently.

Just remember: Patience and persistence are key when you’re trying to get pregnant, and there are no guarantees that you’ll definitely conceive even if you are ovulating. 

But it can’t hurt to keep an eye out for these common ovulation symptoms, then plan a candlelit dinner, draw a warm bubble bath or go on a romantic weekend getaway — whatever it takes to put you and your partner in the baby-making mood.

Good luck — and have fun trying!

Frequently Asked Questions

What are the signs of ovulation?

Increase in sex drive, light spotting, and mild cramping are just a few signs you may be ovulating.

How do I know I’m ovulating?

There are a number of ways to determine when you’re ovulating:

  • Chart your menstrual cycle
  • Pay attention to any twinges of pain or lower abdominal cramps (called mittelschmerz)
  • Track your basal body temperature
  • Buy an ovulation predictor kit
  • Pay attention to your cervical mucus

How many days during ovulation can you get pregnant?

You can only conceive around the time of ovulation — a small window each month (between 12 and 24 hours) when the egg is viable.

How long do you ovulate for?

An egg can be fertilized for between 12 and 24 hours after ovulation. Ovulation usually occurs halfway through your menstrual cycle, or around day 14 of the average 28-day cycle counting from the first day of one period to the first day of the next.

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Is it possible to get pregnant while breastfeeding?

pregnant while breastfeeding

Pregnant while breastfeeding. Can you get pregnant while nursing? The short answer is yes, you can. But isn’t breastfeeding a form of birth control? Well, it’s true that breastfeeding can keep you from ovulating — but only if you nurse your baby exclusively (no formula) and follow a few other rules carefully. Even then, it’s not a good idea to rely on breastfeeding to prevent pregnancy.   

IN THIS ARTICLE

Can you get pregnant while you’re breastfeeding?

Yes, you can. So if you don’t want to have another baby just yet, your best bet is to use a reliable form of birth control as soon as you start having sex again after giving birth.

That said, it’s also true that you may not get your period and fertility back for several months (or even longer) after giving birth, especially if you’re exclusively breastfeeding your baby it depends on your hormones.

Can I get pregnant if I’m breastfeeding and haven’t gotten my period yet pregnant while breastfeeding?

Yes! You could start ovulating again at any time without knowing it. That means it’s possible to get pregnant before your period returns.

How? You’re fertile around the time you ovulate, and that happens before you get your period – typically about two weeks earlier. So don’t wait until you have a period to find a reliable birth control method.

Breastfeeding as birth control

Breast milk production delays the return of menstruation. Some women rely on this as a contraceptive technique. It’s called the lactational amenorrhea method (LAM).

But in order to use this method properly, you have to meet certain criteria:

  • Your baby must be younger than 6 months old.
  • You have to breastfeed at least every four hours during the day and every six hours at night.
  • When using LAM, you can’t supplement breastfeeding with formula. (Pumping instead of nursing and feeding your baby solids also make LAM less effective.)

LAM is reported to be 98 percent effective when you meet these conditions exactly. But the rate of effectiveness drops as your baby gets older and your situation changes – like when your baby starts solids or nurses less as she starts sleeping through the night, for example.

Few women in the United States rely solely on LAM to prevent pregnancy, partly because there are so many other easy contraceptive methods available. Also, few women in this country nurse their babies around-the-clock for six months.

If you want to use breastfeeding for natural family planning, talk with your healthcare provider or a lactation consultant about LAM – ideally before your baby is born.

Can breastfeeding interfere with my pregnancy if I do get pregnant?

It’s generally considered safe to continue breastfeeding during pregnancy.

However, you may have some cramping when you nurse because it causes your body to produce small amounts of oxytocin (the hormone that causes contractions). In rare cases, it may be enough to cause preterm labor, so let your ob or midwife know if you think you’re having contractions.

Primarily, though, the important thing is to make sure you get enough calories to support both the baby in your belly and the one you’re nursing.

Also, consider waiting until your baby is at least a year old before you start trying to get pregnant again. Research suggests waiting one to two years after giving birth to conceive another child reduces the risk of pregnancy complications and other health problems.

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Basal body temperature and ovulation

Basal body temperature

Your basal body temperature (BBT) is your lowest body temperature in a 24-hour period, and it increases slightly right after you ovulate. Using a special thermometer, you can track your basal body temperature over time to estimate when you’ll ovulate and figure out your most fertile days.

IN THIS ARTICLE

What is basal body temperature?

Your basal body temperature (BBT) is your lowest body temperature in a 24-hour period. It’s the temperature of your body when you’re at rest. Typically, BBT increases slightly right after you ovulate.

If you’re trying to get pregnant, you can track your basal body temperature to estimate when you’ll ovulate and determine the best days to have sex (or be inseminated). For greater accuracy, you can combine tracking your BBT with monitoring changes in your cervical mucus.

Keep in mind that your most fertile period is in the two to three days before the increase in BBT. So when you detect a temperature change, your optimal window for getting pregnant will likely have already passed. Nevertheless, if you have regular menstrual cycles and chart your BBT over time, this method may help you predict when you’ll be most fertile.

Charting your BBT can also help your healthcare provider pinpoint the cause of any fertility problems.

How do I take my basal body temperature? Can I use a regular thermometer?

To get an accurate reading, you need to use a basal thermometer, which is sensitive enough to measure minute changes in body temperature. You can buy glass or digital BBT thermometers in your pharmacy or online. Although some digital ones give readings to a hundredth of a degree, all you really need is one that will give a reading to one-tenth of a degree (thermometers that only give readings to two-tenths of a degree are not accurate enough).

To get your BBT, take your temperature when you first wake up in the morning – before you eat, drink, have sex, or even sit up in bed or put a foot on the floor. Try to take a reading at about the same time each morning, and record it on a BBT chart. If you don’t take your temperature immediately after waking up, your BBT chart will not be accurate.

What is the normal basal body temperature?

Before ovulation, your BBT may range from about 97.2 to 97.7 degrees Fahrenheit. But the day after you ovulate, you should see an uptick of 0.5 to 1.0 degree in your BBT, which should last until your next period.

You may notice your temperature occasionally spiking on other days, but if it doesn’t stay up, you probably haven’t ovulated yet.

Be aware that, in addition to ovulation, the following can also affect your BBT:

  • Pregnancy: If you become pregnant, your basal body temperature will stay elevated throughout your pregnancy.
  • Fever: Having a fever (if you get sick with the flu or another illness) will raise your overall body temperature, so your BBT won’t be reliable.
  • Medications: Some medications, such as antibiotics or blood pressure medicines, can cause a rise in BBT.
  • Disease: Thyroid disorders can cause your body’s temperature to increase.
  • Exertion or heat: Exercise and hot weather can push your temperature up.

What is cervical mucus?

Cervical mucus is vaginal discharge produced by the cervix. Over the course of your menstrual cycle, the amount, color, and texture of your cervical mucus changes due to fluctuating hormone levels.

Checking your cervical mucus and keeping track of these changes can help you tell when you’re most fertile. Here’s what to watch for:

  • Once your period stops, you may not have any discharge for a few days.
  • Then you may notice a few days of cloudy, sticky discharge.
  • In the few days leading up to ovulation, the amount of discharge increases and becomes thin, slippery, and stretchy (like egg whites). This consistency makes it easier for the sperm to travel through the cervix to the egg. These are your most fertile days.
  • Just after ovulation, the amount of mucus decreases and becomes thicker.
  • Then you may be dry for several days before your next period.

A good time to check your cervical mucus is when you go to the bathroom first thing in the morning, but you can check it any time of day. Sometimes you may be able to see cervical mucus on the toilet paper after you wipe. Other times you may need to insert a clean finger into your vagina (toward your cervix) to get enough mucus to examine.

Keep in mind that taking certain medications, having sex, using a lubricant, or douching can change the appearance of cervical mucus.

Ovulation charts: Tools for tracking your BBT and cervical mucus

This blank chart gives you a handy way to track your basal body temperature. You can also use it to track your cervical mucus. After charting your BBT for a few months, you’ll be able to see whether there’s a pattern to your cycle. If there is, you may be able to estimate when you’ll next ovulate.

Print out some copies of our blank chart, buy a basal thermometer, and you’re ready to start charting.

And if you want to see what a chart looks like when it’s completed, take a look at our filled-in sample chart.

When you look at the sample chart, remember that every woman’s cycle is different, and your personal chart may not look like the example or even be the same month to month.

How to chart your basal body temperature and cervical mucus

Ready to begin charting? Here’s how to do it:

  1. On the first day you get your period, fill in the date and day of the week under cycle day 1. Continue noting the dates of your cycle until the first day of your next period.
  2. Each morning when you wake up – before you drink, eat, have sex, or even sit up in bed – take your temperature with a basal thermometer. Put a dot next to the temperature that matches your thermometer reading for that day. (You can also note the time you took your temperature. Try to take it at about the same time each morning.) Connect the dots to see how your basal temperature fluctuates from day to day.
  3. You can also check your cervical mucus each day if you wish. Record the type of discharge you find each day, according to the key at the bottom of the chart: P = period, D = dry, S = sticky, E = egg-white-like
  4. Toward the end of your cycle, watch for a day when your BBT rose 0.5 to 1 degree F and stayed high. That day is usually the day you ovulated. It should correspond with the last day you noticed egg-white-like cervical mucus. The days when you notice egg-white-like mucus are your most fertile.
  5. Track these symptoms for a few months to see if you notice an uptick in BBT and egg-white-like mucus at the same time each cycle. That will allow you to plan which days to have sex if you want to get pregnant.
  6. For the best chance of conceiving, have sex at least every other day during your most fertile period.

What if charting doesn’t work for me?

If the idea of charting sounds stressful, or if you just can’t make it work, there are other ways to estimate when you’ll ovulate. For example, you can try using an ovulation predictor kit, which measures your hormone levels and indicates when you’re about to ovulate.

And if you have the flexibility to take a more low-key approach, you can just have sex about every other day during the middle two weeks of your cycle.

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How the Artificial Insemination Process Works

Artificial Insemination

Artificial Insemination. Overcoming fertility challenges doesn’t always mean complicated surgeries or high-tech procedures. In some cases, a couple needs just a little extra help to make the miracle of conception happen.

IN THIS ARTICLE

Back when you first started trying to conceive, you probably knew that conception wouldn’t happen overnight. But you were pretty confident it would happen — and that it would happen in the privacy of your own bedroom.

Fast forward to now, following test after test — and perhaps even a few rounds of fertility medication — and it may be time to try something new.

Enter artificial insemination (AI) or intrauterine insemination (IUI) — one of the oldest and simplest assisted reproduction techniques, and still one of the most successful ones.

What is artificial insemination (AI)?

Artificial insemination, or AI, is a fertility treatment that places your partner’s (or a donor’s) sperm inside your reproductive tract when you’re ovulating to help promote conception.

AI aims to give sperm a better chance of reaching Destination Egg by bypassing the initial hurdles they would encounter in the vagina and cervix — sort of a running (or swimming) head start. 

What is intrauterine insemination (IUI)?

Intrauterine insemination, or IUI, is a type of AI in which sperm are placed directly into the uterus close to the fallopian tubes, where fertilization takes place.

The goal: to get those sperm as close as possible to their target — your waiting egg — so they can be at the right place at the right time.

Skipping the trip through the vagina and the cervix cuts down on the swimming sperm have to do, making it more likely that they’ll reach the egg on time.

What’s the difference between IUI and IVF?

In IUI, the sperm are inserted directly into your body (specifically, the uterus) in the hopes of fertilizing an egg. During in vitro fertilization (IVF), an egg is fertilized with sperm in a laboratory, then transferred back into the uterus.

Whereas an IUI procedure takes only a few minutes, an IVF cycle can take a month or more to complete.

With IVF, you’ll likely need to get hormone shots to stimulate your ovaries and will get a human chorionic gonadotropin (hCG) injection or another drug to help your eggs mature.

The eggs will then be retrieved using an ultrasound-guided needle, and fertilized with your partner or donor’s sperm. After three to five days, the embryos can be transferred into the uterus.

Women may want to try IVF if they have severe blockages in the fallopian tubes, poor egg quality or endometriosis.

Who’s a candidate for artificial insemination or IUI?

Couples experiencing otherwise unexplained fertility issues, where it’s clear nature could use a nudge, are good candidates for IUI.

Couples with mild male factor fertility problems are also good candidates. This assisted reproductive technique can also help when the cervical environment or cervical mucus is hostile to sperm, making it hard for them to swim.

Same-sex couples may also turn to artificial insemination for help starting their family (either themselves or with a surrogate), as can single women who want to become moms on their own with a sperm donor.

IUI isn’t recommended for women who have significant fallopian tube blockages or conditions, a history of pelvic infections or severe endometriosis. 

Does your guy have a very low sperm count, or significant problems with sperm motility or morphology (the percentage of sperm that appear to be of normal shape and size)? Fertility specialists will usually not recommend IUI in those situations, since it’s less likely to be successful.

How is IUI done?

IUI is done in the doctor’s office, during a visit timed to correspond to when you’re ovulating.

Ovulation may be induced with Clomid or another ovulation induction medication, though for women who don’t need the extra help, the procedure can be timed to correspond with your natural window, in what’s called a natural-cycle IUI.

Here’s what to expect during the procedure: 

  • First you’ll lie on the exam table with your feet in stirrups — the same position as for a pelvic exam.
  • The doctor will take a concentrated sperm sample from your partner or donor and inject it into your uterus through a thin, flexible catheter placed into the vagina and through the cervix. Because the procedure is done when you’re ovulating, your cervix will already be slightly open, making the insertion of the catheter and injection of the healthy sperm easier.
  • Once the insemination is complete, you’ll be asked to lie on your back for a brief period, and then you’ll be able to return to regular activity.

The whole IUI procedure takes only a couple of minutes, and there isn’t much discomfort — or, about as much as you’d have during a Pap test. There’s also no need to worry if you experience light spotting for a day or two after your IUI — that’s normal for some women.

A few notes about the sperm used in IUI: This sperm isn’t “fresh” — it’s been washed in preparation for the procedure, optimizing the sperm to maximize the odds of fertilization.

Because sperm is inserted directly into the uterus during IUI, it bypasses the cervical mucus. The washing process accomplishes what the cervical mucus would normally do, separating sperm from the semen, separating nonmotile sperm from motile sperm and purifying the sperm by removing potentially toxic substances and fluid.

For at least 48 hours before the procedure, sex and ejaculation will be off the table for your partner or donor. He’ll provide his sperm sample, either in the clinic’s collection room or at home, on the same day as your IUI, making sure that the sperm sample is handed over within an hour or so of the IUI.

If you’re using donor sperm or your partner’s previously frozen sperm, it will be thawed immediately before the IUI procedure. The insemination then takes place as soon as the sperm washing is complete.

Right now, IUI is the gold standard of artificial insemination — and the go-to AI procedure. 

Can you do artificial insemination at home?

At-home insemination is attractive to some trying-to-conceive couples who’d like to skip the fertility doctor (and the resulting bills) if possible. For heterosexual couples, at-home AI offers no fertility edge over regular sex. But single women or same-sex women couples may want to try at-home AI before turning the insemination process over to a doctor.

There are a few at-home options: There’s the “turkey baster method” — in which you inject freshly ejaculated semen into the vagina (close to the cervix) using a needleless syringe. Or you can fill a cervical cap, diaphragm, or a period collection cup with semen and insert it over your cervix, leaving it in place for two to three hours.

There are also at-home AI kits. As with IUI, timing is everything with at-home AI: You’ll need to inject the sperm as close to ovulation time as possible. And just as with any artificial insemination technique, an at-home AI won’t be effective if you have ovulation problems or if your partner has a very low sperm count or poor-quality sperm.

There are some potential risks with at-home AI: tissue damage, uterine perforation and even infection if the insertion is too deep or done improperly.

Be aware, too, of potential legal risk if you’re using donor sperm for an at-home AI, since the legal protections afforded by medically supervised donor sperm used for IUI in a fertility clinic — things like the automatic termination of the donor’s parental rights — don’t always cover women who artificially inseminate at home. The laws vary from state to state, so do check your state’s statutes before you do it yourself.

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In Vitro Fertilization (IVF)

In Vitro Fertilization

In Vitro Fertilization. If you’ve been struggling to conceive and treatments like fertility medication or IUI haven’t been successful, there could be another option: IVF. Here’s what you need to know about in vitro fertilization.

IN THIS ARTICLE

While many couples are able to conceive within a few months of trying, others have more difficulty getting pregnant and struggle with infertility. Luckily there are many options for hopeful parents when it comes to fertility treatments — from medications like Clomid (clomiphene) or Femara (letrozole) to intrauterine insemination (IUI) or surgery.

But some couples need a different kind of help — either because those types of fertility treatments are off the table (such as for same-sex couples) or because they’re not successful. That’s where in vitro fertilization, or IVF, comes in. Here’s a primer on the basics to help you determine if this assisted reproductive technology can help you get closer to having a baby.

What is in vitro fertilization (IVF)?

During in vitro fertilization, eggs are fertilized by sperm outside of the body in a laboratory. Then one (or more) of those fertilized eggs is transferred into the uterus with the hope it will implant and result in a pregnancy — and a baby nine months later.

The first IVF baby was born in 1978, and since then, an estimated 8 million have followed worldwide (born via in vitro fertilization and other reproductive technologies). Today, practitioners perform more than 270,000 IVF cycles annually in the United States, resulting in over 74,000 babies born each year.

How does IVF work?

There are a number of fertility treatments that your doctor may suggest before turning to IVF. But for women who have severe blockages in the fallopian tubes, ovulation disorders, diminished ovarian reserve, poor egg quality, or endometriosis, IVF could be the best option for conceiving a baby.

Ditto for men who have insurmountable sperm deficiencies, some same-sex couples, couples using donor eggs, or those who might need to screen embryos when there are concerns about genetic problems.

What is the IVF process and how long does it take?

A lot is involved in an IVF cycle. Luckily, you’ll have a whole team of doctors and nurses to help you along in the process. One cycle of IVF generally takes about two weeks, though you might need more than one and the whole thing generally lasts four to six weeks from start to finish. Here’s what you can expect:

  • Ovulation suppression. Not all hopeful moms-to-be will start with this step — ask your fertility specialist if your cycle will begin with ovarian suppression. If the answer is yes, you’ll be placed on birth control pills (oh, the irony!) or possibly leuprolide (Lupron) to suppress your natural hormones so that your IVF cycle can be optimally timed.
  • Hormone shots. The vast majority of IVF cycles include hormone injections — usually with follicle-stimulating hormone (FSH), luteinizing hormone (LH) or both, though the precise cocktail used will be unique to you — that stimulate the ovaries. (It’s also possible to do in vitro fertilization without ovarian stimulation in what’s called “natural cycle IVF” or “unstimulated IVF,” but those methods are uncommon.) During this ovary stimulation phase, you’ll receive blood tests to monitor your hormone levels plus ultrasounds to see how many egg follicles are growing and how well they’re developing. The ultrasounds will also monitor how well your uterine lining is thickening.
  • Trigger shot. When your follicles are just about ready for egg retrieval (in about eight to 14 days), you’ll inject human chorionic gonadotropin (hCG) or another drug such as Lupron (leuprolide) to help the eggs mature and trigger ovulation.
  • Egg retrieval. Your eggs will be ready for retrieval approximately 36 hours after the trigger hCG shot. The doctor will retrieve the eggs transvaginally with an ultrasound-guided needle that reaches your ovaries and aspirates the fluid and egg from each follicle. Most doctors try to retrieve 10 to 15 eggs per cycle, though the number could be as low as two or three or higher than 15. Egg retrieval typically takes 20 to 30 minutes and is done under IV sedation, so you won’t feel any discomfort. Because you’ll be groggy after the procedure, you’ll need someone else to drive you home. Once you’re back, plan on taking the rest of the day off, resting and relaxing. Be sure to avoid high-impact activities and even sex until after your pregnancy test.
  • Sperm retrieval. On the same day of egg retrieval, the clinic will prepare donor sperm or your partner’s previously frozen sperm, or your partner may produce a sperm sample that day.  
  • Fertilization. It’s time for fertilization! Your eggs will either be fertilized using an intracytoplasmic sperm injection (ICSI), when a single sperm is injected into an egg, or standard insemination, in which the retrieved eggs are placed in a petri dish with 50,000 to 100,000 sperm in the hopes that the magic of fertilization will happen. The culture dishes are left in a special incubator and checked 12 to 24 hours later to see if fertilization took place. Although there are many factors, by some estimates about 50 percent of mature eggs become fertilized using standard insemination and 60 to 70 percent are fertilized via ICSI. 
  • Checking on the embryos. An embryologist will monitor each developing embryo over the next three to five days, looking for healthy growth and development. By day three after fertilization (cleavage stage), the goal is to have a six- to eight-cell embryo, and by day five, there should be a healthy blastocyst. About 30 to 50 percent of IVF embryos make it to the blastocyst stage. Any extra embryos that aren’t going to be transferred can be frozen for future use.
  • Testing the embryos. If preimplantation genetic diagnosis (PGT) is planned, the embryos are biopsied (a few cells are safely removed from the embryo and genetically tested).
  • Progesterone boost. Soon after fertilization (usually either on the day of the egg retrieval or the day of the embryo transfer), your doctor may start you on supplemental progesterone via injection, vaginal suppository or vaginal gel. This hormone will optimize your uterine lining in anticipation of the embryo transfer and implantation. The medication is usually continued at least until a positive pregnancy test result and often through weeks 8 to 10 of pregnancy.
  • Embryo transfer. Usually three or five days after egg retrieval and fertilization (or if you’re using frozen embryos, whenever your uterine lining is ready for implantation), the embryo or embryos are transferred into your uterus. The number of eggs transferred will depend on your age — it’s recommended that women under 35 have only one or two embryos transferred, for example. Using ultrasound guidance, your doctor will insert a thin, flexible catheter through your vagina and cervix into the uterus, and then gently depress the attached syringe containing the embryo(s), placing it in your uterus with the hope that it will implant and continue to grow just as it would with unassisted conception. Some fertility clinics coat the embryo in “embryo glue” before transfer to help it adhere to the uterine wall during implantation. You will be wide awake for the embryo transfer (no anesthesia necessary) and you’ll likely be able to watch the procedure on the ultrasound monitor if you’d like. Most doctors recommend that you take it easy for the first five days after the embryo transfer. That’s to minimize the chances of uterine contractions that might prevent the embryo from implanting. For the same reason, you’ll likely be advised against having sex.
  • The pregnancy test. About two weeks after the embryo transfer, you’ll have a blood test to confirm whether your IVF was successful. As eager as you’ll be to get an early heads-up, don’t be tempted to use a home pregnancy test before you get your blood test results — testing too soon can give you a false positive (if you had a shot of hCG) or a false negative (because it’s too soon for the pregnancy to generate its own hCG).

What is the IVF success rate?

The likelihood that a cycle of in vitro fertilization will result in pregnancy depends on a number of factors, including:

Your age

The younger you are the better your IVF success rate, especially if you’re under 35. That’s because as you age, it becomes less likely your ovaries will respond well to the hormone-stimulating drugs, which in turn means fewer eggs.

What’s more, when you get older, the quality of your eggs will generally diminish (though there are exceptions), which means they may have a harder time implanting in your uterus. Although it can be complicated to calculate, here’s the approximate odds of a live birth per treatment cycle based on age (assuming the use of the woman’s own eggs):

  • For women under age 35: 53.9 percent
  • For women ages 35 to 40: 26 to 40.2 percent
  • For women ages 41 and over: 3.9 to 12.6 percent

Your ovarian reserve

The better your ovarian reserve (the number of high-quality fertilizable eggs left in your ovaries), the higher the chances for IVF success.

Your fallopian tubes

The healthier your fallopian tubes, the higher your IVF success rates. Women with a fluid-filled blockage in one or both fallopian tubes (called a hydrosalpinx) have lower success rates, even though in vitro fertilization bypasses the fallopian tubes altogether. A simple procedure called salpingectomy before attempting IVF can bump up your odds for success.

Your lifestyle

The less healthy your lifestyle (say you smoke, or you’re obese or underweight), the lower your chances for IVF success.

Keep in mind that different fertility clinics have varying success rates. The Society for Assisted Reproductive Technology (SART) and the Centers for Disease Control and Prevention (CDC) track pregnancy and live birth rate by clinics and publish their findings online, so you can size up the success rate of your prospective clinic before signing up for your treatments.

What are the possible side effects of in vitro fertilization? Is it painful?

For couples unable to conceive, in vitro fertilization can deliver the happiest news of all: The baby of their dreams is finally a reality. And more good news: IVF is a safe and often successful procedure. That said, in vitro fertilization does pose a small chance of side effects and can be somewhat painful. Here’s what to look out for during your IVF cycle:

After hormone shots

Your fertility drug injections come with common side effects:

  • Breast tenderness
  • Mood swings
  • Headaches
  • Abdominal pain
  • Nausea
  • Bloating
  • Bruising (where the shots were administered)
  • Pronounced and unusual fatigue

In rare cases, women may develop mild forms of ovarian hyperstimulation syndrome (OHSS). OHSS can cause your ovaries to become swollen and painful. Symptoms include abdominal swelling, mild to moderate abdominal pain, nausea, vomiting and diarrhea. Call your doctor if you’re experiencing symptoms of OHSS.

After egg retrieval

It’s normal to experience cramping or bloating after egg retrieval, and any pain can be relieved with Tylenol.

After embryo transfer

You might notice some bloody or clear discharge after the transfer. That kind of spotting or discharge is totally normal and not a sign that the embryo(s) is lost. It’s usually just the result of the cervix being manipulated during the procedure. Also not unusual: mild cramping, bloating and even slightly sharp pains a few days post-transfer. Contact your doctor if you have questions about any pain you’re experiencing.

Late OHSS, which develops after a successful implantation (usually a week or more after egg retrieval), is much less common than the already uncommon early OHSS, but it usually is more severe. Symptoms of severe OHSS include the following and warrant a call to the doctor right away:

  • Rapid weight gain (two or more pounds a day)
  • Severe bloating and/or severe abdominal pain
  • Decreased urination
  • Ovarian tenderness
  • Severe nausea, vomiting and diarrhea
  • Shortness of breath
  • Low blood pressure

And though in vitro fertilization is generally safe for both moms and babies, it may present some other risks too:

Risks for babies

The greatest risks to baby’s health come from the possibility that there will be two or more babies. Multiples come with multiple risks, including prematurity and risks that stem from being born too early. Even singleton IVF babies face some increased risks, including premature delivery and low birth weight.

Risks for parents

For moms, an IVF pregnancy includes an increased risk of gestational diabetes, hypertension, preeclampsia, placental abruption, placenta previa, and C-section.

The IVF process can also be physically and emotionally trying for you and your partner, if you have one, especially with such high levels of hormones coursing through your body. If you are experiencing anxiety or depression, talk to your doctor so you can get the help you need.

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