Frequently Asked TTC Questions from Fertility Consultations

November 12, 2020 | By: Monica Rincon, MSc., NFP Health Professional 
Did you know you can receive fertility consultations right within your Premom app to support you throughout your fertility journey?  Learn  from some of the most frequently asked consultation questions!

1. How do I know if my husband has a fertility problem?

One of the very first steps toward identifying the causes of male infertility begins with semen collection and analysis. The primary focus of this exam is to determine the quality and quantity of semen and sperm, in other words, how the spermatozoids move and how many of them there are. There are two ways to collect the specimen for semen analysis: by masturbation and collecting it into a cup or by using a seminal fluid collection kit, which enables the couple to take the sample during intercourse.

It's important to consider lifestyle factors that can affect male infertility, such as sexually transmitted diseases (STDs) and the use of recreational and illegal drugs like marijuana and cocaine. Other important factors that affect fertility  are smoking cigarettes and vaping with any products containing tetrahydrocannabinol (TCH), alcohol in excess, obesity and lack of exercise, fatigue, and stress. The use of endocrine-disrupting agents --  chemicals that mimic, block, or interfere with hormones in the body’s endocrine system -- may also play an important role in decreasing the quality of the sperm and can be found in some common, everyday products. Any activity that heats the scrotum for prolonged periods, such as driving for many hours or using hot tubs should be avoided.

Depending on the results from the spermogram, some men will need to see a urologist or male infertility specialist. You can use a Premom consultation option to determine the next steps for treatment. Options might include a complete physical exam, potential surgical procedures, testing of hormone levels, and general laboratory testing.

2. What are suggested additional steps after TTC for 12 months?

Clinically, infertility is defined as being unable to conceive within one year of engaging in random acts of intercourse. If you are trying for six months with focused intercourse and awareness of your fertile window -- or you are older than 35 years old -- and still, you are not getting pregnant, it is time to look at possible causes.  Because both female and male partners can contribute to the couple’s infertility, the medical history and physical examination of both are important. The primary focus for the male will be the quality and quantity of the semen and sperm. For the female this will be the quality of ovulation, female hormonal balance, her oocyte reserve, and the patency (openness) of the tubes and uterus. Some of these tests are described further in our blog on what to investigate next if still not pregnant after regular tracking

Ultrasounds of the pelvis and testes (female and male reproductive organs), as well as other specific procedures for better visualization provide a clear assessment of the anatomy of these organs and a more definitive diagnosis for female infertility.

Infertility treatment will be determined by the underlying cause or causes.  For example, a woman might receive hormonal treatment for an underlying hormonal cause. The major modes of treatment are hormonal, surgical, and in vitro fertilization (IVF) techniques.

3. When is the best time for intercourse to achieve pregnancy, based on LH testing?

The goal to achieve pregnancy is to accurately pinpoint your peak fertility time. We recommend that you target peak day, the day before, and the day after (ovulation day) for sexual activity.  However, your entire fertile window is the 5 days leading up to ovulation and ovulation day.  (Sometimes it can be helpful to have sex the day after ovulation as well to make sure you have covered the full window.)The best test to predict ovulation and the peak of fertility is through ovulation tests, urinary test of LH.  Check out our blog on best timing for intercourse.

4. When do I need to take progesterone?

The secretion of progesterone is absolutely required for the success of early human pregnancy. This secretion is very dependent on your ovaries (corpus luteum), once you have ovulated. Once the egg has been fertilized, the progesterone that you produced supports the continuation of this early stage of pregnancy. Progesterone supplementation is necessary when a lack of progesterone has been found as the main cause of an early miscarriage -- or if a short luteal phase (less than 9 days) is consistent in your menstrual cycles.  Learn more about the importance of progesterone in our blogs about chemical pregnancies and chart interpretation.

5. How can I confirm that I ovulated after I identified an LH surge?

 

1-2 days after predicted ovulation, your BBT (basal body temperature) should spike, confirming ovulation has occurred.  This is due to  the temperature rise caused by the release of progesterone from the ovary after ovulation Another way way to confirm ovulation precisely and accurately is by detecting three progesterone positive tests in a row using progesterone (PdG) urine tests.  In the first cycle, we recommend these tests be taken once in the preovulatory days and on 3DPO and 7DPO (days past ovulation) In future cycles, you can start testing 5 days after your predicted ovulation day.  To learn more, check out our blogs on BBT and chart interpretation.

You can also take a look at your luteal cycle length after your predicted ovulation. The menstrual cycle can be divided into two phases: follicular and luteal phase (see figure above). The follicular phase starts with menstruation and lasts right up to ovulation. The luteal phase starts right after ovulation occurs and ends just before the first day of the next menstruation. A healthy normal luteal phase is between 11-17 days (a different length of days depending on the woman).  If your period comes on the predicted cycle day, this is also a means to help you confirm ovulation. 

Want to learn more about how your cycle chart is looking?  Compare your fertility chart to typical ovulation charts here.

Need support for your own unique fertility journey?  Set up a consultation with Monica right from your fertility app!  Go to More --> Schedule Consultation to get started. 

Monica Rincon is a certified Marquette Method Natural Family Planning (NFP) Teacher / fertility awareness educator and a medical microbiologist.

Sources:

1. https://www.niehs.nih.gov/health/topics/agents/endocrine/index.cfm

2. Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HWG, Behre HM, et al. World Health Organization reference values for human semen characteristics*‡. Human Reproduction Update. 2009;16(3):231-45.

3. Ajayi AF, Akhigbe RE. The physiology of male reproduction: Impact of drugs and their abuse on male fertility. Andrologia. 2020;52(9).

4. Kahn LG, Philippat C, Nakayama SF, Slama R, Trasande L. Endocrine-disrupting chemicals: implications for human health. The Lancet Diabetes and Endocrinology. 2020;8(8):703-18.

5. Farsimadan M, Motamedifar M. Bacterial infection of the male reproductive system causing infertility. Journal of Reproductive Immunology. 2020;142:103183.

6. Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin. Fertility and Sterility. 2008;89(4):789-92.

8. Bouchard TP, Fehring RJ, Schneider M. Pilot evaluation of a new urine progesterone test to confirm ovulation in women using a fertility monitor. Frontiers in Public Health. 2019;7(JUL).

8. Vigil P, Lyon C, Flores B, Rioseco H, Serrano F. Ovulation, a sign of health. Linacre Quarterly. 2017;84(4):343-55.

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