Getting pregnant in your 30s and 40s At PFC, we use a number of means to evaluate fertility health. In the case of female infertility, one of the first things we look at is a patient’s age -- in particular, the age of her ovarian reserve or, put simply, her egg supply. An increasing number of women are choosing to have their first child in their mid-30s or later. The challenge for this age group is that with the body’s natural aging process, a woman’s eggs age as well; and this phenomenon is a significant cause of infertility and miscarriage. Getting pregnant after age 40 is a challenge for women that may have no other impediment to conception.
The decline in fertility potential or ‘ovarian reserve’ means that not only do the ovaries have fewer eggs to offer, but the eggs they have are of poorer quality, and thus have a harder time producing eggs that are capable of fertilizing and resulting in a healthy pregnancy. (For many years, researchers wondered whether the uterus was also affected by the aging process, but today it is clear that decline in fertility is mostly due to the results of the aging egg.)
The inability to produce healthy, viable eggs often results in lower pregnancy rates as well as higher rates of miscarriage in women over the age of 35. For women over 40, getting pregnant is only half the journey. As miscarriage rates over 40 are 50% and rise quickly with each advancing year.
Hormone testing to assess egg quality

Three simple blood tests can check hormone levels and reveal more information about egg quality. These tests may also help diagnose infertility in a younger woman, who ordinarily would not be experiencing diminished ovarian reserve or poor quality:

1. Basal FSH. FSH (follicle stimulating hormone) is the main hormone involved in producing mature eggs in the ovaries. If this test reveals excessive levels of FSH in the body, it is a signal that the brain is trying to boost poorly performing ovaries into action. (In other words, the ovaries may need extra help to make eggs.)
2. Estradiol. Estradiol is the most important form of estrogen found in the body, and is responsible for maintaining healthy eggs in a woman’s ovaries, as well as for facilitating a healthy pregnancy. If this test shows high levels of Estradiol, it indicates a problem with egg numbers and/or quality.


3. Anti-mullerian hormone (AMH). AMH is a blood test that directly measures ovarian reserve. It is produced directly by early stage ovarian follicles. High levels (over 1.0) are favorable, while low levels (less than 1.0) indicate decreased ovarian reserve. AMH may be the best measure of the menopausal transition and ovarian age. It may also be useful in predicting ovarian hyperstimulation syndrome, the effects of chemotherapy, and in determining the treatment of PCOS.
AMH seems a superior predictor of ovarian response compared to other markers, including age, and day 3 FSH and estradiol. It offers similar predictive value compared to AFC. AMH can be drawn at any time in the menstrual cycle, and is not affected by hormonal therapy, including oral contraceptives.
Ultrasound evaluation to assess egg quantity
Antral Follicle Count. One of the first tests that is typically performed at an initial patient visit at PFC is a trans-vaginal ultrasound. This ultrasound allows the physician to evaluate the uterus and uterine cavity, and ovaries. Especially if done just prior to ovulation, the ultrasound can be very informative in making sure there are no fibroids or endometrial polyps affecting the uterine lining. Very importantly, the physician can assess the number of small follicles in the ovaries. Ideally, about 10-20 total follicles should be visualized between the two ovaries. If the follicle count is much lower, this may be an indication of declining ovarian reserve.

treatment and understanding of infertility

Treatment of infertility depends aff Treatment of infertility depends on the cause, how long you've been infertile, your age and your partner’s age, and many personal preferences. Some causes of infertility can't be corrected. However, a woman can still become pregnant with assisted reproductive technology or other procedures to restore fertility.

Treatment for men Approaches that involve the male include treatment for:

General sexual problems. Addressing impotence or premature ejaculation can improve fertility. Treatment for these problems often is with medication or behavioral approaches.

Lack of sperm. If a lack of sperm is suspected as the cause of a man's infertility, surgery or hormones to correct the problem or use of assisted reproductive technology is sometimes possible. In some cases, sperm can be taken directly from the testicles or recovered from the bladder and injected into an egg in the laboratory setting.

Treatment for women Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. In general, they work like natural hormones — such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. Commonly used fertility drugs include:

Clomiphene citrate (Clomid, Serophene). This drug is taken orally and stimulates ovulation in women who have polycystic ovary syndrome (PCOS) or other ovulatory disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.

Human menopausal gonadotropin (Repronex, Menopur). This injected medication is for women who don't ovulate on their own due to the failure of the pituitary gland to stimulate ovulation. Unlike clomiphene, which stimulates the pituitary gland, human menopausal gonadotropin (hMG) and other gonadotropins directly stimulate the ovaries. This drug contains both FSH and LH.

Follicle-stimulating hormone (Bravelle). FSH works by stimulating maturation of egg follicles the ovaries.

Human chorionic gonadotropin (Ovidrel, Pregnyl). Used in combination with clomiphene, hMG and FSH, human chorionic gonadotropin (HCG) stimulates the follicle to release its egg (ovulate).
Gonadotropin-releasing hormone analogs. This treatment is for women with irregular ovulatory cycles or who ovulate prematurely —before the lead follicle is mature enough — during hMG treatment. Gonadotropin-releasing hormone (Gn-RH) analogs suppress pituitary gland activity, which alters hormone production so that a doctor can induce follicle growth with FSH.


Aromatase inhibitors. This class of medications, which includes letrozole (Femara) and anastrozole (Arimidex), is approved for treatment of advanced breast cancer. Doctors sometimes prescribe them for women who don't ovulate on their own and who haven't responded to treatment with clomiphene citrate. These drugs are not approved by the Food and Drug Administration for inducing ovulation, and their effect on early pregnancy isn't yet known.


Metformin (Glucophage). This oral drug is taken to boost ovulation. It's used when insulin resistance is a known or suspected cause of infertility. Insulin resistance may play a role in the development of PCOS.

Bromocriptine (Parlodel). This medication is for women whose ovulation cycles are irregular due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers. Bromocriptine inhibits prolactin production.

Surgery Depending on the cause, surgery may be a treatment option for infertility. Blockages or other problems in the fallopian tubes can often be surgically repaired. Laparoscopic techniques allow delicate operations on the fallopian tubes.


If you have endometriosis, your doctor may treat you with ovulation therapy, in which medication is used to stimulate or regulate ovulation, or in vitro fertilization, in which the egg and sperm are joined in the laboratory and transferred to the uterus.


Assisted reproductive technology (ART) Each year thousands of babies are born in the United States as a result of ART. An ART health team includes physicians, psychologists, embryologists, laboratory technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.


The most common forms of ART include:
In vitro fertilization (IVF). IVF involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory, and implanting the embryos in the uterus three to five days after fertilization.

Electric or vibratory stimulation to achieve ejaculation. Electric or vibratory stimulation brings about ejaculation to obtain semen. This procedure can be used in men with a spinal cord injury who can't otherwise achieve ejaculation.

Surgical sperm aspiration. This technique involves removing sperm from part of the male reproductive tract, such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if the ejaculatory duct is blocked.

Intracytoplasmic sperm injection (ICSI). This procedure consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure.


Assisted hatching. This technique attempts to assist the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).

ART works best when the woman has a healthy uterus, responds well to fertility drugs, and ovulates naturally or uses donor eggs. The man should have healthy sperm, or donor sperm should be available. The success rate of ART is lower after age 35.

Complications of treatment Certain complications exist with the treatment of infertility. These include:
Multiple pregnancy. The most common complication of ART is a multiple fetus pregnancy. Generally, the greater the number of fetuses, the higher the risk of premature labor. Babies born prematurely are at increased risk of health and developmental problems.
The number of quality embryos kept and matured to fetuses and birth ultimately is a decision made by the couple. If too many are conceived, the removal of one or more fetuses (multifetal pregnancy reduction) is possible to improve survival odds for the other fetuses.
Ovarian hyperstimulation syndrome (OHSS). If overstimulated, a woman's ovaries may enlarge and cause pain and bloating. Mild to moderate symptoms often resolve without treatment, but severe cases — marked by abdominal swelling and shortness of breath —require emergency treatment. Younger women and those who have polycystic ovary syndrome have a higher risk of developing OHSS than do other women.
Bleeding or infection. As with any invasive procedure, there is a risk of bleeding or infection with assisted reproductive technology.
Low birth weight. The greatest risk factor for low birth weight is a multiple fetus pregnancy. In single live births, there may be a greater chance of low birth weight associated with ART.

Birth defects. There is some concern about the possible relationship between ART and birth defects. More research is necessary to confirm this possible connection. Weigh this factor if you're considering whether to take advantage of this treatment. ART is the most successful fertility-enhancing therapy to date

male infertility reasons and treatment

MALE INFERTILITY OVERVIEW —

Infertility is defined as a couple's inability to become pregnant after one year of unprotected intercourse. In any given year, about 15 percent of couples in North America and Europe who are trying to conceive are infertile. The fertility of a couple depends upon several factors in both the male and female partner. Among all cases of infertility in developed countries, about 8 percent can be traced to male factors, 37 percent can be traced to female factors, 35 percent can be traced to factors in both the male and female partners, and 5 percent cannot be traced to obvious factors in either partner [1]. When infertility occurs, the male and female partners are evaluated to determine the cause and best treatment options. In the past, men with infertility had few options because there was limited information about uses and even less information about successful treatment. However, new tests have made it possible to determine the causes of male infertility and treatments, and assisted reproductive techniques (ART) offer hope to many couples. 30 to 40 percent of cases are due to problems in the testes (of which about 15 to 25 percent are due to genetic causes) 10 to 20 percent are due to a blockage uin the pathway that sperm use to exit the testes during ejaculation; this can be caused by prior infection (figure 2) 1 to 2 percent of cases are due to conditions of the pituitary gland or hypothalamus 40 to 50 percent of cases have no identifiable cause, even after an evaluation INFERTILITY EVALUATION — A separate article discusses the evaluation of infertility in men. The most important test for infertile men is a semen analysis (sperm evaluation). A normal result tells you that the male partner most likely does not have an infertility problem. (See "Patient information: Evaluation of the infertile couple (Beyond the Basics)".) INFERTILITY TREATMENT — The treatment of male infertility depends upon the underlying cause. Several months to years of treatment are usually necessary to achieve fertility. The treatment often involves both male and female partners. Blockage of the reproductive tract — Men who have a blockage in the ducts conveying the sperm from the testis until ejacuilation (so that sperm cannot get out) can undergo surgery to correct the blockage. If it is not successful, another option is assisted reproductive technologies using sperm retrieved from the testes. (See "Treatment of male infertility", section on 'Retrieval of sperm from the testis'.) Vasectomy (male sterilization) is a different type of blockage. Vasectomies can be reversed in up to 85 percent of cases; over 50 percent of couples can achieve pregnancy following vasectomy reversal. However, the more time that has passed since the vasectomy, the less likely vasectomy reversal is to restore fertility. Treatment of hypothalamic or pituitary deficiency — In a small percentage of cases (1 to 2 percent), male infertility is due to problems in the hypothalamus and pituitary gland (parts of the brain that regulate hormone production). In this case, treatment with human chorionic gonadotropin (hCG), recombinant human follicle stimulating hormone (rhFSH), lso called gonadotropin treatment, is often given. Gonadotropin treatment — Gonadotropin treatment is started with injections of hCG three times per week (or sometimes every other day) for up to six months. Blood tests are used to monitor blood testosterone levels and to adjust the dose if necessary. If sperm cells do not appear in semen after six months of treatment, recombinant human follicle stimulating hormone (rhFSH) is added; this is also given by injection. The success rate for this therapy is high as most men will eventually develop sperm in the ejaculate. In many cases, a total of one to two years of treatment is needed to achieve normal fertility. The cost of these treatments can be significant, especially if health insurance does not cover the costs of infertility treatment.



Varicocele — A varicocele is a dilation of a vein (like a varicose vein) in the scrotum. Many men with varicocele have a low sperm count or abnormal sperm morphology (shape). The reason a varicocele affects the sperm may be related to a higher than normal temperature in the testicles, poor oxygen supply, and poor blood flow in the testes. Varicocele can be treated surgically by cutting the veins connected to the varicocele. However, surgery does not always improve fertility and is not recommended for most men unless there is a large varicocele. A varicocele that has been present for a long time can cause irreversible damage that cannot be surgically treated. An alternative to varicocele repair is assisted reproductive techniques (ART), such as intracytoplasmic sperm injection (ICSI). With ICSI, only a small number of sperm are needed (see 'Intracytoplasmic sperm injection (ICSI)' below). Other — Treatment is not currently available for most types of male infertility. For example, there is no known treatment when the sperm-producing structures of the testes have been severely damaged or are abnormal. This happens in men with certain chromosomal abnormalities such as Klinefelter syndrome and small deletions in the Y (male specific) chromosome (see 'When infertility cannot be treated' below). ASSISTED REPRODUCTIVE TECHNIQUES — If the male partner's semen contains few sperm, no sperm, abnormal sperm, or sperm with poor motility, assisted reproductive techniques can often help. These techniques offer hope to som infertile couples who could not achieve pregnancy without them. However, the techniques are expensive, require a considerable commitment of time and energy, may pose certain health risks, and may have disappointingly low success rates. Couples should discuss the pros, cons, and success rates of these techniques with an infertility specialist. In vitro fertilization (IVF) —




VF is a commonly used technique for a variety of infertility problems, including female tubal blockages and unexplained infertility. IVF is usually recommended for men with infertility. (See 'Intracytoplasmic sperm injection (ICSI)' below.) IVF success rates depend upon a number of variables, including the age and health of the woman, health of the male sperm and female egg, and to some extent, the experience of the infertility center. Approximately 28 percent of IVF cycles result in pregnancy, and 82 percent of those pregnancies result in the birth of one or more children. (See "Patient information: In vitro fertilization (IVF) (Beyond the Basics)".) Intracytoplasmic sperm injection (ICSI) — ICSI is a procedure that is performed in conjunction with IVF. With ICSI, a single sperm from the male partner is injected directly into a woman's egg (oocyte) in the laboratory. (See "Intracytoplasmic sperm injection".) This technique can be useful in many cases of low sperm count. The pregnancy rate with ICSI is approximately 20 to 40 percent per cycle, although the technique is expensive. Testicular extraction of sperm (TESE) — If a man's semen completely lacks sperm in the ejaculate (azoospermia), sperm can sometimes be directly removed from the testes. This is done in a minor surgery or by using a needle to aspirate semen under local anesthesia. If sperm can be found < extracted from the testis, the sperm will be used for ICSI and the fertilization rate of the oocyte is not very different from IVF. Thus, men with no sperm in the ejaculate can have a potential of fathering a child using these techniques. Risks of ART — Most patients who undergo ART have no major complications. There are few to no risks for men, depending upon the procedure used to obtain sperm. Men who must undergo a procedure to retrieve sperm have a small risk of bleeding, damage to the testes, and infection. Risks of ART for women include infection and damage to blood vessels, reproductive, or surrounding organs. The ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication that can occur during the process of IVF. (See "Patient information: In vitro fertilization (IVF) (Beyond the Basics)".) There is some evidence that children of couples who become pregnant after IVF or ICSI have a slightly higher rate of chromosomal or congenital (birth) abnormalities and may have a higher rate of lower birth weight. This potential risk should be discussed with an infertility specialist. For now, couples can be reassured that these conditions are rare and the absolute risk of having a child with a congenital anomaly is low (the population baseline risk is 2 to 4 percent, which is potentially increased by about one-third with ART). WHEN INFERTILITY CANNOT BE TREATED — Some treatments for male infertility fail, and some cases of male infertility simply cannot be treated at this time. If this is this case, an infertility specialist can advise the couple of available alternatives. Each couple's choice is a very personal one. Men with irreversible infertility and testosterone deficiency may benefit from testosterone treatment. Although this treatment may not address a couple's goal of having a child, it can improve the male partner's sexual function and mood and help increase and maintain bone and muscle mass. (See "Patient information: Sexual problems in men (Beyond the Basics)".) Artificial insemination with donor sperm



some couples affected by irreversible male infertility consider artificial insemination of the female partner with donor sperm. Donor sperm may be obtained from a sperm bank, which screens men for infections, certain genetic problems, and provides a complete personal and family history. Most sperm banks keep the identity of their donors confidential; some banks give donors the option to be contacted by the children conceived with their sperm. The decision to use donor sperm, whether from a known or unknown donor, can be complicated and difficult for a couple. Counseling may be helpful to help both partners discuss their feelings and the potential implications of using donor sperm. The American Society for Reproductive Medicine recommends that parents discuss their child's genetic origins with the child. The optimal age for this discussion is not known, although most experts recommend that the child be told before he or she is an adolescent (before approximately age 13) [2]. The use of donor sperm has a high success rate; pregnancy rates are about 50 percent after six cycles of insemination. Insemination may be done without the use of infertility medications or monitoring in women who have no infertility. Women who have difficulty conceiving may require intrauterine insemination or in vitro fertilization. (See "Patient information: Infertility treatment with gonadotropins (Beyond the Basics)".) Adoption — Some couples affected by irreversible male infertility consider adopting a child. A healthcare provider or social worker can suggest resources for couples who decide to pursue this option. Approximately 2 to 4 percent of American families include an adopted child. Childlessness — Some couples affected by irreversible male infertility decide to remain childless. Couples who decide to remain childless often face questions from friends or family regarding their decision. These questions can be hurtful for couples who have struggled with infertility. Couples often benefit from counseling after they decide to stop infertility treatments; communicating openly is important to maintain a healthy relationship.

horomonal therepy for childless women

Chemical Pregnancy A chemical pregnancy happens when a fertilized egg does not attach itself to the uterine wall. This is also known as a very early miscarriage. According to ACOG, the American College of Obstetricians and Gynecologists, chemical pregnancies account for 50-75% of all miscarriages. Unlike miscarriages, which typically occur before the 20 th week of gestation, chemical pregnancies occur just after implantation. In cases where the woman is not expecting to become pregnant, she may not realize she was since menstruation bleeding usually occurs around the same time. If she is expecting and takes a test, it could lead to false positive pregnancy test results.
In the past, sensitive pregnancy tests were administered by doctors via blood tests. Nowadays, there are several over-the-counter products that are able to detect pregnancies almost a week before menstruation is due. This could be why so many women are realizing they are pregnant, only to learn the pregnancy resulted in a chemical pregnancy or early miscarriage. Research has shown up to 70% of all conceptions end in miscarriage. Health care providers do not clinically confirm a pregnancy until it is detected on an ultrasound. First ultrasounds are typically given between the 4 th and 6 th weeks of gestation.
Signs and Symptoms of a Chemical Pregnancy
In most cases, women have no symptoms of a chemical pregnancy. In actuality, most women do not know they were ever pregnant. Some women report mild abdominal cramping and mild spotting a week before their period is due, but there are usually no pregnancy symptoms such as fatigue or nausea, since the fertilized egg did not implant itself to the uterine wall. Vaginal bleeding will occur after a positive pregnancy test and blood tests may reveal low hCG levels that decrease instead of increase. Menstruation cycles are typically on time or a couple days late.
What Causes a Chemical Pregnancy?
Experts have no conclusive evidence stating what causes a chemical pregnancy. However, most experts believe it happens for the same reasons why other miscarriages happen- abnormal chromosomes in the developing embryo. Abnormal chromosomes can be the result of many factors such as poor quality of the sperm or egg, genetic abnormalities of the mother or father, or an abnormal cell division of the fetus. Experts believe half of all chemical pregnancies are due to some form of chromosomal abnormality. Additional potential causes may include the following:
Infections such as toxoplasmosis, chlamydia, genital herpes, or syphilis Systemic illnesses such as untreated thyroid disease Uterine abnormalities (congenital and acquired) Abnormal hormone levels Luteal phase defect Inadequate uterine lining
Treating and Preventing Chemical Pregnancies
Unfortunately, chemical pregnancies can not be prevented, nor is there a specific type of treatment method. Women who experience a chemical pregnancy are encouraged to follow-up with tests to ensure their hCG levels return to normal. There is no evidence suggesting chemical pregnancies will affect future pregnancies, as many women go on to have healthy pregnancies, labors and deliveries. For some couples, treatment may involve treating the emotional side of a chemical pregnancy, especially for those who are hopeful to conceive. Seeking counseling can help you cope with the pregnancy loss. Treatment for recurrent chemical pregnancies may include the following:
Progesterone cream Vitamin B6 (minimum 50mg per day) Baby aspirin Antibiotics may be prescribed if an infection is present Genetic counseling for those who experience several early miscarriages
If you are anxious to ‘try again,’ it is recommended that you wait at least one regular menstrual cycle. Talk with your doctor or midwife about an appropriate treatment plan for you.

polycystic ovary syndrom

If you have polycystic ovary syndrome (PCOS) and worry about your weight, you may be interested in learning some PCOS diet strategies.
Polycystic ovary syndrome (PCOS) is the most common reproductive hormone disease among premenopausal women. Women with PCOS often struggle with the following three symptoms:
1. Obesity and trouble losing weight 2. Excessive hair growth and skin problems (acne) 3. Infertility and/or irregular periods
If you have PCOS and are trying to lose weight, we offer you the following helpful PCOS diet tips. PCOS Diet Tip 1: Stop deprivation dieting. What does the word “diet” mean to you? The real definition of “diet” means nourishment or nutrition. This implies health and wellness—not starvation. Yet so many popular diets today are associated with pain and distress. On the contrary, healthy eating can and should be enjoyable.
Visit your local health food store for ideas on how to incorporate delicious natural foods like lentils, vegetables, and local, organic ingredients into your daily meals. Many health food stores offer delis and take-home fresh food items that can make your PCOS diet food preparations easier.
PCOS Diet Tip 2: Control your blood sugar. Weight gain with PCOS can be linked to abnormalities in insulin and glucose metabolism. Insulin’s main job is to control your blood sugar. But insulin also signals your body to store fat. High levels of insulin increase the production of androgens, which can worsen PCOS symptoms.
With insulin resistance (IR), your blood sugar levels rise in spite of high levels of insulin. Eventually type 2 diabetes may result. Yet positive changes in diet and exercise may postpone the development of diabetes. A PCOS diet reducing the amount of sugary carbs that you eat may offer the weight-loss benefits you seek.
To make these healthy PCOS diet changes, cut out white breads, pasta, potatoes, cereals, and some fruits and snack foods. Replace those items with healthy PCOS diet options like the following:
Nutrient dense, high-fiber carbs Foods high in protein (lean meats, legumes) Foods containing healthy fats (olive oil, nuts, fish)
Ask your doctor or a registered dietitian for a list of foods to try and a list of foods to avoid. And try to eat mini-meals throughout the day to keep your blood sugar levels even.
PCOS Diet TIP 3: Exercise daily. OK, we know that exercise is not a diet tip, but if you are looking to burn calories, you must exercise every day! Check in with your doctor first, and once you have the go-ahead, get moving. Exercise is a perfect accompaniment to a PCOS diet, especially for women with PCOS and insulin resistance or type 2 diabetes. Regular exercise is wonderful and necessary for all of us, and here are some reasons why.
Exercise:
Regulates blood glucose levels Offers a mood boost Increases endorphins (the body’s natural opioids) Gets us in top physical shape for pregnancy Increases weight loss
Also, being physically fit may help you carry a healthy baby to term and have an uncomplicated delivery.
PCOS Diet Tip 4: Evaluate your relationship with food. If you live to eat and want to be successful with a PCOS diet…you must rethink your relationship with food. Some women use food as a reward for an accomplishment or for emotional solace when they feel lonely or blue. Other women live for the next meal at their favorite restaurant or use food as a way to bring family and friends together.
To lose weight on a PCOS diet, reframe your thinking to eating to live, not living to eat. Choose foods that are filling and nutrient dense. Instead of party food, junk food, or comfort food that only adds more fat and pounds, eat food that will nourish your body. Having said that, it is perfectly fine to enjoy delicious, rich foods on occasion, but only in moderation! And certainly not every day. If you have an unhealthy relationship with food, like binge eating, purging, or starving yourself, help is available.
PCOS Diet TIP 5: Ask about metformin. Metformin (Glucophage) is a drug that was developed for type 2 diabetes and is often prescribed “off label” for obesity and PCOS. Metformin may help women seeking a PCOS diet by offering the following benefits:
Helping with weight loss Lowering blood pressure Improving cholesterol levels Decreasing levels of androgens Restoring normal periods Improving sensitivity to fertility drugs
Remember, no one is to blame for PCOS. It is in your hands to work with your doctor to find PCOS diet solutions and to learn how to live healthily with this common hormonal problem.

chemical pregancy understanding

Chemical Pregnancy A chemical pregnancy happens when a fertilized egg does not attach itself to the uterine wall. This is also known as a very early miscarriage. According to ACOG, the American College of Obstetricians and Gynecologists, chemical pregnancies account for 50-75% of all miscarriages. Unlike miscarriages, which typically occur before the 20 th week of gestation, chemical pregnancies occur just after implantation. In cases where the woman is not expecting to become pregnant, she may not realize she was since menstruation bleeding usually occurs around the same time. If she is expecting and takes a test, it could lead to false positive pregnancy test results. In the past, sensitive pregnancy tests were administered by doctors via blood tests. Nowadays, there are several over-the-counter products that are able to detect pregnancies almost a week before menstruation is due. This could be why so many women are realizing they are pregnant, only to learn the pregnancy resulted in a chemical pregnancy or early miscarriage. Research has shown up to 70% of all conceptions end in miscarriage. Health care providers do not clinically confirm a pregnancy until it is detected on an ultrasound. First ultrasounds are typically given between the 4 th and 6 th weeks of gestation. Signs and Symptoms of a Chemical Pregnancy In most cases, women have no symptoms of a chemical pregnancy. In actuality, most women do not know they were ever pregnant. Some women report mild abdominal cramping and mild spotting a week before their period is due, but there are usually no pregnancy symptoms such as fatigue or nausea, since the fertilized egg did not implant itself to the uterine wall. Vaginal bleeding will occur after a positive pregnancy test and blood tests may reveal low hCG levels that decrease instead of increase. Menstruation cycles are typically on time or a couple days late. What Causes a Chemical Pregnancy? Experts have no conclusive evidence stating what causes a chemical pregnancy. However, most experts believe it happens for the same reasons why other miscarriages happen- abnormal chromosomes in the developing embryo. Abnormal chromosomes can be the result of many factors such as poor quality of the sperm or egg, genetic abnormalities of the mother or father, or an abnormal cell division of the fetus. Experts believe half of all chemical pregnancies are due to some form of chromosomal abnormality. Additional potential causes may include the following: Infections such as toxoplasmosis, chlamydia, genital herpes, or syphilis Systemic illnesses such as untreated thyroid disease Uterine abnormalities (congenital and acquired) Abnormal hormone levels Luteal phase defect Inadequate uterine lining Treating and Preventing Chemical Pregnancies Unfortunately, chemical pregnancies can not be prevented, nor is there a specific type of treatment method. Women who experience a chemical pregnancy are encouraged to follow-up with tests to ensure their hCG levels return to normal. There is no evidence suggesting chemical pregnancies will affect future pregnancies, as many women go on to have healthy pregnancies, labors and deliveries. For some couples, treatment may involve treating the emotional side of a chemical pregnancy, especially for those who are hopeful to conceive. Seeking counseling can help you cope with the pregnancy loss. Treatment for recurrent chemical pregnancies may include the following: Progesterone cream Vitamin B6 (minimum 50mg per day) Baby aspirin Antibiotics may be prescribed if an infection is present Genetic counseling for those who experience several early miscarriages If you are anxious to ‘try again,’ it is recommended that you wait at least one regular menstrual cycle. Talk with your doctor or midwife about an appropriate treatment plan for you.

clomid is treatment for women who are not producing egg

CLOMID FOR OVULATION INDUCTION Clomid (Clomiphene Citrate) is a fertility drug used for the treatment of ovulation disorders. Clomid may be used to treat women with complete failure to ovulate or for the treatment of luteal phase defect. Clomid acts by causing the pituitary gland to produce a higher level of the hormones (FSH and LH) that control ovulation. Clomid is taken in pill form from the 5th through the 9th day of the menstrual cycle - day 1 is the first day of full menstrual flow. The dose of Clomid may vary from 1 to 4 tablets per day depending on individual patient response. The usual starting dose is 1 tablet per day. Clomid may be taken at any time of day and if more than 1 pill is prescribed, the total dose may be taken all at the same time. As Clomid treatment is started we will often see you for a “mid cycle scan.” At that appointment we will perform a sonogram to see how your ovaries are responding to the drug – how many eggs have developed. In a small percentage of patients, Clomid interferes with endometrial development (the uterine lining) or with cervical mucous development. We will check those things as well. Clomid may delay ovulation by 1-3 days – relative to your usual cycle. At mid cycle you may be given human chorionic gonadotropin (hCG). hCG is a hormone, given by injection, that mimics the pituitary gland message to the ovary to release the egg. It is helpful in timing intercourse or artificial insemination. It also has a beneficial effect on hormone production during the luteal phase (the second half of the ovarian cycle). Occasionally, women taking Clomid have side effects. Common side effects include: headache, abdominal fullness or bloating, hot flashes, blurred vision. These side effects are usually temporary and are mild. There are several case reports of persistent blurred vision after clomiphene treatment. Occasionally Clomid causes moodiness or even mild depression. Clomid is highly effective in stimulating ovulation. Approximately 80% of women who are treated with clomiphene will ovulate. Pregnancy rates vary depending on other factors - sperm count, etc. Many clomiphene pregnancies occur within 3 or 4 treatment cycles. There are two recognized risks of Clomid treatment: multiple pregnancy and ovarian cyst formation. Approximately 8% of Clomid conceptions are multiple -twins or more. This may occur even on the lowest dose of Clomid. Approximately 10% of women who are treated with clomiphene will develop an ovarian cyst. For this reason, a pelvic examination is performed at the end of each treatment cycle - around the time of your menstrual period. If an ovarian cyst is detected, clomiphene treatment is withheld during the following cycle. The ovarian cyst usually resolves without further treatment. Clomid has been in clinical use for over 30 years. There is a large amount of data that suggests that babies born as a product of clomiphene treatment have a normal risk of congenital anomalies - not higher and not lower. Clomid is widely used and is generally accepted as a safe drug in this regard. There have been a variety of serious illnesses reported in association with Clomiphene treatment. Their frequency is rare or extremely rare and in some cases a proven link to Clomiphene treatment as the cause is not clear. There have been at least two publications suggesting there may be a link between Clomid treatment and increased risk of ovarian tumors. The first publication was in 1993 and noted that women who took " fertility drugs” seemed to be at increased risk of developing ovarian cancer -particularly if they never conceived a pregnancy. A second study was published in 1994 with long-term follow-up of a large number of infertility patients. This study showed an increased risk of ovarian cancer in women using clomiphene citrate for treatment of ovulation. The increased risk was noted only in women using the drug for 12 or more treatment cycles (that is - 12 total cycles not necessarily consecutive). Since these initial publications, there have been several larger studies of this issue, which have concluded that there is not a link between Clomid (or any other fertility drug) and an increased risk of ovarian cancer. Making Clomid follow up appointments: a follow up to check for ovarian enlargement is performed either a week before the period is due (allowing for a blood test to check progesterone level) or at the end of the cycle. We call these appointments “ovary checks.” Your fertility specialist will tell you what to schedule. KEY POINTS ABOUT CLOMID IN SUMMARY: Cycle day 1 is the first day of full menstrual flow. Intercourse on the day of ovulation predictor kit change and/or the following day or every other day 10 thru 20. Pelvic exam/”ovary check” at the end of the cycle or one week after ovulation if a blood test for progesterone is planned.