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Showing posts with label ovulation. Show all posts

How many weeks pregnant am I ?

Posted by nurul Saturday, March 26, 2011 0 comments

Many IVF patients get very confused about how the doctor calculates the age of their pregnancy
( = gestational age, in medical jargon). Logically, shouldn't it be from the day of the embryo transfer ? After all, it's only after the embryos are transferred that a woman can be considered to be pregnant !

However, doctors are not always logical, and we usually use the menstrual age when talking about the length of the pregnancy. This is because obstetricians usually see women who have got pregnant after having sex in their bedroom. Very few of them will know the exact date they ovulated , which is why we use the menstrual age in clinical practise. This does not change just because you have had an IVF pregnancy - the clinical rules remain the same !

This creates a lot of confusion in patient's minds - especially when they are trying to make sense of their ultrasound scan results or their HCG levels.

Remember that your OB is always talking about the menstrual age - not the age of the
embryo ! This is purely for clinical convenience and is a well-accepted universal convention.

So how do you convert the date of embryo transfer to menstrual age. This is very simple ! The key reproductive event you need to focus on is ovulation ! It makes much more sense to talk about the pregnancy in terms of DPO ( days post ovulation), rather than the menstrual age or the day of the embryo transfer. This is because we can use this landmark for all situations
( including IUI pregnancies; and for Day 3 embryo transfers and Day 5 embryo transfers as
well !)

Since every IVF patient knows the date they ovulated ( = the day of egg collection), it's easy to calculate your menstrual age. Just subtract 14 from your date of ovulation. This is your
" corrected LMP" ( last menstrual period) .

( Corrected) LMP = Date of egg collection minus 14

The reason we do this is simple - it's because text books assume the follicular phase is exactly 14 days ! Once you know your corrected LMP, it's then easy to use this as the anchor, based on which your OB can calculate your gestational age.

This means that the menstrual age will always be 14 days more than the actual age of the embryo.

Confused ? Let's look at an example.

Let's suppose your LMP was 5 Jan; and your egg collection was done on 24 Jan ( let's assume you took a long time to grow eggs); and your embryo transfer was done on 29 Jan ( Day 5 transfer). The HCG pregnancy test will be usually done about 14 days post ovulation ( DPO), which is 7 Feb. If it's positive - say 120 mIU/ml, the doctor will confirm you are pregnant ! This means that even though you are only 14 DPO ( and your embryo's age is only 14 days ) , he will calculate your corrected LMP as 10 Jan ( date of ovulation , 24 Jan, minus 14 days) - which means your clinical gestational age ( or menstrual age) will become 4 weeks ( 28 days) ! Once you understand this " 2 week gap" and the rationale behind it , you'll find it much easier to date your pregnancy !

Why follicular studies ( ovulation tracking ) can be a waste of time

Posted by nurul Monday, February 28, 2011 1 comments

Many gynecologists advise ovulation tracking as the first line of "treatment" for infertile couples.
This seems to be sensible advise. You just have to go for vaginal ultrasound scans which help you time precisely when you ovulate. You have sex at this time, and since eggs plus sperm = baby, you get pregnant in the first cycle itself ! How can this fail - especially if you are young and all your test results are normal ?

Actually, the tragedy is that patients have very unrealistic expectations from follicle tracking ! The success rate , even in a perfect cycle , is only about 10 % ! Remember that human reproduction is not very efficient, and just timing sex does not help ( unless you've never had sex at the right time earlier !)

Doctors often forget the downside of ordering follicular studies. It can be very stressful because you need to take time out of your office work duties to get ultrasound scans done . Even worse, it can play havoc with your sexual life. We all know that Men are from Mars and Women are from Venus - and this difference gets hugely exaggreated when you are battling with infertility, because you and your partner seem to be on completely different planets as regards having a baby . Most men would rather let nature take its own course - and having sex frequently in order to have a baby sounds like fun ! They just cannot understand why baby lust seems to have taken over their wife's life - and why you are obsessed with stuff like eggs and ovulation and fertile times !

Doctors can be very casual about advising scans and they underestimate the additional stress this puts on the marriage ! Husbands hate having to have sex on demand - they feel they have become reduced to becoming sperm donors who have to perform when ordered to do so. This takes all the fun out of sex, and adds to the marital disharmony when the wife refuses to have sex on any day other than the day of ovulation because she wants her husband to "store up" the good sperm ! This can often be the last straw which breaks the camel's back , because infertility already stresses the couple. Also, having to lie with your legs up in the air for the scans can be quite embarrassing and humiliating - and having a doctor insert an ultrasound probe into your vagina on a daily basis can be a major turnoff !

My advise is that one cycle of ovulation tracking is enough. This can be useful because it teaches you to correlate the scan findings with your body's signals , such as your cervical mucus and ovulation pain . Scanning also allows you to make better use of OPKs and the free online fertility calculator in future cycles, because you understand what's happening to your body, so you do not have to medicalise baby making sex in future cycles and track ovulation discreetly at home !

However, if your doctor advises repeated follicular studies, please get a second opinion ! Otherwise you ( and your husband) are likely to get fed up and frustrated before getting pregnant !

Testing for pregnancy after an embryo transfer in an IVF cycle

Posted by nurul Thursday, January 6, 2011 0 comments

While all IVF patients understand with their heads that not every IVF cycle results in success, in their heart of hearts, every patient expects to get pregnant every time they do IVF ! This is why the 2ww after the embryo transfer can be so nerve-wracking ! Am I pregnant or not ? Have the embryos implanted or not ? The suspense during the 2ww can be even worse than the pain of the IVF injections !

Most patients would love to have a test which will allow them to find out if they are pregnant immediately after the embryo transfer ! Have the embryos stuck or not ? Why can’t we do a pregnancy test and find out right now ? Even if I am not pregnant, at least it’s better to know than to be unsure.

To understand why patients ( and their doctors ) still have to suffer through a 2 week wait to find out the outcome of an IVF cycle, let’s look at the biological basis of pregnancy tests and how they work.

A pregnancy test measures the amount of beta hCG ( human chorionic gonadotropin) that is in your body. HCG is a hormone which is produced by the trophectoderm cells of the embryo. It is produced in detectable quantities only after the embryo implants. Since implantation occurs 3 - 8 days after the embryo transfer ( depending upon whether you have had a Day 3 transfer or a blastocyst transfer), this means that the HCG produced by your embryo will be first detectable in your bloodstream only after this time.

As your pregnancy progresses, the amount of hCG in your system will increase. At 10 days past ovulation ( DPO) , for example, the average woman has an hCG measurement of around 25 mIU. This amount doubles to 50 mIU at 12 days past ovulation, and then doubles again to 100 mIU at around two weeks past ovulation. Every woman’s body is different, and there’s a lot of variation in HCG levels from woman to woman !

Home pregnancy tests measure the level of HCG in urine. Different pregnancy tests have different levels of sensitivity which means if you use a home pregnancy test that is sensitive to 100 mIU, it will not tell you that you are pregnant if your level of hCG is only 75 mIU. These tests cannot measure a level lower than 25, so they do not become accurate until a few days after embryo implantation. A negative result before then is meaningless, since there would not be a high enough level of HCG to detect even if you were pregnant. If your test is negative, you should retest after 2 days. This is why taking a pregnancy test too early can lead to inaccurate results. I know it’s hard to wait those extra days and you may want to try much earlier. It’s fine to do this, but please don’t assume that a negative results means that you are not pregnant.
This is also why blood tests for HCG are much better than urine tests. Not only are they more reliable, accurate and sensitive, they also give the doctor a number which he can measure and monitor.

If blood tests are so sensitive, then why not do a blood test for HCG 1 week after the embryo transfer ? Unfortunately, doing a blood test for HCG so soon does not make any sense. This is because there will still be some HCG in your body as a result of the HCG trigger shot ( Choragon or Ovidrel) which the doctor gave you to trigger off ovulation 36 hours prior to egg collection. If you test too early, the test will always be positive, as this HCG will show up in the test and give rise to false hopes ! This is why the doctor needs to repeat the blood test for HCG after 48-72 hours. In a healthy pregnancy, the HCG levels will continue to rise. If they do not do so, this means this is not a viable pregnancy.

Finally, remember that you should do the test even if you bleed. Bleeding can sometimes occur during pregnancy as well – and just because you have had bleeding or spotting does not mean you are not pregnant !

Top Ten Tips for Facing Infertility

Posted by nurul Wednesday, December 29, 2010 0 comments

One of the most amusing books I have read on infertility is: A Few Good Eggs : Two Chicks Dish on Overcoming the Insanity of Infertility by Julie Vargo and Maureen Regan.

The book is targetted towards infertile women living in the US, and is written in the currently fashionable "chick-lit" style. It's amusingly written; and is a breath of fresh air , if you are the sort of person who finds a sense of humour helps you cope better with infertility.

The book has lots of Top-10 lists, and here's their list of Top Ten Tips for Facing Infertility.

# 10 Tips for Facing Infertility
1. Keep reminding yourself that you are not alone.
2. Realize that dealing with infertility is an all-consuming process.
3. Stay calm.
4. Remind yourself you are not a failure if a procedure doesn't work.
5. Have a sense of humor about this - even if it doesn't seem at all funny
right now.
6. Do your research. Then do some more.
7. Listen to your body and your inner self. If you really listen you will
learn those two are rarely wrong.
8. Don't rule anything out - from antibiotics to acupuncture and from
yoga headstands to standing on your head during sex.
9. Find the right doctor.
10.Don't get angry at your partner for not nurturing you - he is hurting
and confused, too.

Here are my comments about this list.

1. Keep reminding yourself that you are not alone.

One of the major problems with infertility is the social and emotional isolation it causes. It seems that everyone around you is having babies and you are the only one who cannot have them ! Moreover, there is little social support , and people can be thoughtless and unkind. However, remember that you are in this together with your partner - and you can love and support each other. Millions of other couples are also fighting the same battle - and you can support each other.

2. Realize that dealing with infertility is an all-consuming process.

Many infertile couples are amazed when they find how obsessed they become with tracking their fertility - and how their desire to have a baby seems to become the central focus of their life.

3. Stay calm.

This can be hard to do , especially at certain times : for example, when your period had just started; your friend has just told you she's pregnant again; the latest treatment which seemed to be going so well has failed; and it seems that your partner does not care or understand. Don't make a bad situation worse by losing your calm. If you can weather this, you will emerge a much stronger and better person !

4. Remind yourself you are not a failure if a procedure doesn't work.

The failure of a procedure does NOT mean you are a failure ! When the embryos transferred during an IVF cycle fail to implant, many women feel that their uterus is defective and has "rejected" the embryos. Remember that Nature is not efficient at making babies - and the odds are always going to be against you in each month, so you need to be patient. Have realistic expectations, and treat this as a war , not just a battle. Even if the procedure fails, you have peace of mind you tried your best - and failed procedures also provide the doctor with useful information which he can use to fine-tune your next treatment cycle, bringing you closer to your goal.

5. Have a sense of humor about this - even if it doesn't seem at all funny right now.

A sense of humour is often the only thing which help you keep your sanity ! Hang on to this - it will help you cope with whatever trials and tribulations you may have to deal with !

6. Do your research. Then do some more.

You can never know too much. While the endpoint is not to become an IVF specialist ( though you will find that you often know much more about infertility than your GP or family physician, many of whom are quite clueless about infertility), you need to become an expert on your problem, so you have peace of mind you did your best, and didn't leave any stone unturned.

7. Listen to your body and your inner self. If you really listen you will learn - those two are rarely wrong.

This is good advise, whether you are infertile or not ! However, be careful not to fall into the trap of listening only to your body - and not listening to your doctor ! Find the right balance between the inner wisdom of the body and the outer wisdom of medical science.

8. Don't rule anything out - from antibiotics to acupuncture and from yoga headstands to standing on your head during sex.

Keeping an open mind is a good idea - but it shouldn't be so open that everything in it falls out either ! It's fine to use yourself as a guinea pig, if that's what you want to do. Take an objective approach, and treat your experiences as a scientific experiment ( on yourself). Document all your results, so that you can learn from them.

9. Find the right doctor.

While everyone knows how important it is to find Dr Right, it can be extremely hard to do this in real life ! Often you are trapped by the healthcare system you find yourself in - or you don't know how to judge your doctor's competence and abilities.

10.Don't get angry at your partner for not nurturing you - he is hurting and confused, too.

Don't make a bad situation worse by using your partner as a punching bag. Being infertile is bad enough - but as long as you can love and support each other, you'll find it much easier to deal with. Love divides the misery, and any couple who can weather the crisis of infertility will find that their marriage is much more resilient than the ordinary marriage. It is true that all Men are from Mars , not just your husband ! The sooner you accept this, the easier it will be for both of you. From his point of view, his priority is to work so that he can earn the money you need to be able to afford infertility treatment ! Providing emotional support comes a distant second in his brain, so please be charitable !

Want to make sure you are on the right track ? Please send me your medical details by filling in the Free Second Opinion Form and I'll be happy to help !

Is BBT charting of any use for infertile couples

Posted by nurul Tuesday, September 28, 2010 0 comments

During the luteal phase of the cycle, the corpus luteum produces the hormone progestrone, which elevates the basal body temperature ( BBT) . When the basal body temperature has gone up for several days, one can assume that ovulation has occurred. However, it is important to remember that the BBT chart cannot predict ovulation - it cannot tell you when it is going to occur !

In the past, doctors felt the basal temperature chart was a useful tool. It allowed the patient to determine for herself if she is ovulating as well as the approximate date of ovulation, but only in retrospect. Basal body temperature charts are easy to obtain and the only equipment required is a special BBT thermometer.

General instructions for keeping a basal body temperature chart include the following :

The chart starts on the first day of menstrual flow. Enter the date here.
Each morning immediately after awakening, and before getting out of bed or doing anything else, the thermometer is placed under the tongue for at least two minutes. This must be done every morning, except during the period.
Accurately record the temperature reading on the graph by placing a dot in the proper location. Indicate days of intercourse with a cross.
Note any obvious reason for temperature variation such as colds, or fever on the graph above the reading for that day.

However, the major limitation of the BBT is that it does not tell you in advance when you are going to ovulate - therefore its utility in timing sex during the fertile period is small. Interpreting the BBT chart can be tricky for many patients - rarely do the charts look like those you see in textbooks!

Also, keeping a BBT chart can be very stressful - taking your temperature as the first thing you do when you get up in the morning is not much fun. What is worse is that you start to let the BBT chart dictate your sex life. This is why though the BBT chart used to be a useful method in the past, it's utility is limited today - and newer methods are available which are more accurate are available. We advise our patients never to chart their BBTs - we feel they are just a waste of time.

Want to find out what your fertile time is ? You can use our free online fertility calculator to determine when you ovulate !

What every infertile woman needs to know about missed periods

Posted by nurul Tuesday, September 21, 2010 0 comments

Missing a period can be very difficult for infertile women ! Every time you miss a period, you hope ( against hope) that maybe you are finally pregnant ! However , you are worried about getting your hopes up too high, because you are scared that they will come dashing down again – and you remember all the false alarms you have had in the past !

There are many reasons for missing a period, including stress ; side effects of medications you are taking; and a systemic illness. The first step, of course, is to rule out a pregnancy. You can do this by checking with a urine pregnancy test kit. The new ones are very reliable, and a negative test result usually means that you are not pregnant. If you are unsure, you can repeat the test in 2 days. A better option is to do a blood test to check your HCG level. This is much more reliable ( but it’s also much more expensive !) . A blood level of less than 10 mIU/ml confirms you are not pregnant.

If you miss three menstrual periods in a row, your doctor will make the diagnosis of “secondary amenorrhea “. This is just medical jargon for – “ has missed more than three menstrual periods”. It’s not really a diagnosis – just a description of your problem.

So what are the reasons for a missed period ? And what can you do about this ?

Let’s review some basic biology first. The reason women who ovulate get a natural menstrual period is because of a drop in the circulating blood levels of the reproductive hormones, estrogen and progesterone hormones. When these levels drop, the uterine lining loses its hormonal support, as a result of which it is shed as a menstrual period. This is called a estrogen primed progesterone withdrawal bleed.

A missed period means there is a problem with the normal balance between estrogen and progesterone in your body. This usually happens when you do not ovulate. This is called anovulation.

Most women ( for example, those with PCOD) have high estrogen levels, but because you have not ovulated, your progesterone levels remain low, as a result of which you do not get a withdrawal bleed.

In other cases, the corpus luteum forms a functional cyst. Because this continues to produce estrogen and progesterone, there is no progesterone withdrawal, and the lining remains thick and does not shed.

Others have low estrogen levels ( as a result of which your uterine lining remains thin and does not develop at all). This is commonly seen in lean athletic women who exercise a lot. The missed period in these women is called hypothalamic amenorrhea.

In order to come to the right diagnosis, the doctor may need to do a vaginal ultrasound scan .
This should check for the following.
a. Is there a cyst in the ovaries ? Are the ovaries small ? What’s their volume ? The antral follicle count ?
b. The endometrial thickness and texture.

Patients with PCOD will have a thick uterine lining, which suggests they have high estrogen levels. Women with hypothalamic amenorrhea have small ovaries with a thin lining; as do perimenopausal women who have reached the oopause and whose ovaries are failing. A functional cyst will be easily apparent on the scan.

It’s also possible to confirm this diagnosis by checking the blood levels of estrogen and progesterone.

After making a diagnosis, it’s easy to induce a period, based on the problem.

If the uterine lining ( endometrium) is thick, this means that the level of estrogen in the body is already high ; and it's easy to induce a period by taking 5 days of progestins, such as medroxyprogesterone acetate. There are many options available. These include:Tab Provera ( medroxyprogesterone acetate), 10 mg, twice a day. The period will usually start 3-7 days after taking the last tablet. This is called inducing a withdrawal bleed with progestins.

On the other hand, in women with low estrogen levels who have a thin uterine lining, we first need to build up the lining with estrogens and then induce a period with progesterone . We give the estrogen and progesterone hormones sequentially, thus mimicking a natural cycle. This is what a typical prescription would look like.

Estrogen tablets from Day 1 - Day 25. There are many options available. The least expensive is Tab Ethinyl estradiol ( Lynoral), 0.05 mg daily. Other choices include:
Tab Premarin, 1.25 mg daily; or
Tab Progynova ( estradiol valerate, 2 mg), 2 tab daily. You may feel some nausea and have some temporary fluid retention while taking the estrogen.

Progestin tablets, from Day 16 - Day 25. There are many options available. These include:Tab Provera ( medroxyprogesterone acetate), 10 mg, twice a day.

This regimen is called Hormone Replacement Therapy , and is available commercially in some countries in the form of a pack, called CycloProgynova.
The withdrawal period ( menstrual period) will start approximately 3-6 days after you take the last tablet, as the levels of the administered hormones decline in your body because they get excreted in the urine.

It’s also possible to achieve the same results with a 21 day course of birth control pills, since these contain both estrogen and progesterone. It's best to take the old-fashioned monophasic birth control pills, which contain a sufficient amount of estrogen and progestins ( combined together in one "active" tablet). A typical choice would be Ovral, which contains 50 ug of ethinyl estradiol and 500 ug of norgestrel ( a type of progestin). The withdrawal bleeding induced when you take birth control pills may be scanty as compared to a regular period. This is normal.

If the reason for the missed period is a functional cyst, you may have to wait till it resolves. It will usually do so on its own. If needed, the doctor can induce a period with mifegest ( RU-486), a very powerful antiprogestin.

LUF syndrome and infertility

Posted by nurul Friday, August 27, 2010 0 comments

In normal healthy fertile females, ovulation with rupture of the mature ovarian follicle and release of the eggs occurs within 38 hours of the surge in luteinizing hormone (LH). However, in a small percentage of women, the dominant follicle will undergo the luteinization process but will not rupture following the midcycle LH surge. This is called LUF (luteinized unruptured follicle syndrome). As a result of the increased progesterone secretion, the endometrium undergoes the secretory changes, but, obviously, without the release of the oocyte , pregnancy cannot occur. This means that the cycles are regular; and hormonal studies ( Day 21 progesterone level) , the basal body temperature curve, and the findings in an endometrial biopsy will all be consistent with ovulation.

This is obviously a difficult diagnosis to make; and can only be made by serial vaginal ultrasound scans to track ovulation. These scans show that the follicle matures; but the dominant follicle fails to rupture. The lack of follicle rupture and the lack of free peritoneal fluid around the time of ovulation are used to establish the diagnosis of LUF. This condition is also called “trapped egg syndrome”.

LUF is more commonly seen in women with endometriosis; and PCOD. Often the diagnosis is made only when patients are being monitored for follicle tracking with serial ultrasound scans. LUF is a “silent” problem; and because it does not cause any symptoms or signs, it’s very easy to miss the diagnosis as well ! Since LH is responsible for inducing follicular rupture, LUF can be treated by giving an injection of Human Chorionic Gonadotropin (hCG) in a dose of 10,000 IU intramuscularly, when the lead follicle reaches 18-20 mm in diameter. Ultrasound can be used to document ovulation. It takes about 36 to 40 hours for the oocyte to be released after the injection. Intercourse or insemination should be timed accordingly. If it still does not take place, the dose of the hCG injection can be increased. If ovulation still cannot be achieved even with an increased dose of 20000 IU , then IVF is the best solution.

In our clinic, we really do not bother to make a diagnosis of LUF ! This is because this diagnosis does not really change your treatment options . After all, if you are infertile, this means the eggs and sperm are not meeting. The next step logically is to then do an IUI – and since an HCG injection is routinely given during IUI treatment to induce ovulation, the IUI automatically helps to treat patients who have LUF !

Why infertile couples need to look for solutions - and not worry about problems !!

Posted by nurul Thursday, July 22, 2010 0 comments

Many infertile couples are very confused about how their treatment. Unfortunately, many gynecologists add to their confusion. Thus, if an infertile woman is found to have endometriosis, they will spend a lot of time, money and energy on "treating " the endometriosis with medicines. Similarly, the woman has irregular periods, they will concentrate on trying to "regularise the cycle" !

Why are these approaches flawed ?

The truth is that we really do not have any effective treatment for endometriosis. This is hardly surprising, when you consider that we do not even know what causes this enigmatic disease ! While we are very good at suppressing this medically ( with GnRH analogs), this suppression is only temporary. Even worse, while these medicines are very effective as suppressing the endometriosis , they also suppress normal fertility ( because they stop ovulation). This medical treatment just wastes time and money ; and patients get fed up and lose confidence in doctors and in themselves !

What about laparoscopic surgery for removing the endometriosis ? While this is effective in some selected cases ( those patients with open tubes, good ovarian reserve, and anatomic distortion because of adhesions), it's not helpful for the majority. In fact, in some women, unnecessary surgery actually reduces fertility as normal ovarian tissue is also removed along with the wall of the chocolate cyst, thus reducing their ovarian reserve.

Unfortunately, patients believe that once the doctor has made a diagnosis of endometriosis, this disease is the cause of their infertility; and that once this is "treated", their fertility will be restored, and they will be able to get pregnant in their own bedroom. However, this is also a flawed assumption ! Endometriosis is a very common finding, even in fertile women; the endometriosis found on the laparoscopy in an infertile woman may just be a red herring, and not the cause of the infertility. This is why "treating" it may not help at all !

Similarly, patients with irregular cycles are often very poorly managed. Many patients are unsure about the relationship between their irregular cycles and their fertility, and consider this as a chicken and egg problem. They naively believe that once the cycles are regularised, they will then get pregnant in their own bedroom ! After all, if the reason they are not getting pregnant is the fact that their periods are irregular, then surely fixing the irregularity problem will them to have a baby ! Many doctors also seem to subscribe to this belief, and will regularise the cycles by putting these infertile couples on birth control pills ! While this will regularise the cycle while they are taking the pills, this is hardly helping them to have a baby ! They obviously cannot get pregnant while taking the pill - and once they stop the pill, their cycles continue remaining irregular, because they are still not ovulating !

If you are infertile, how can you make sure your doctor is providing you with the most effective treatment ? The answer is surprisingly simple ! Remember, that the reason you are infertile ( no matter what your actual diagnosis is !) is the fact that your eggs and sperm are not being able to meet. The question you need to ask is - what is the doctor doing to increase the chances of the eggs and sperm meeting ?

Thus, if he is simply suppressing your endometriosis with drugs; or regularising your cycles with birth control pills, he is wasting your time and not doing a good job ! We need to look for solutions - not waste time in finding problems which maybe irrelevant . Fortunately, our technology for bypassing problems ( even without identifying them precisely ) is better than our technology for identifying problems !

Remember, the question should NOT be "Why am I not getting pregnant ? " Rather, it should be - What can I do in order to get pregnant ?" After all, no one cares about problems - we only care about results - about having a baby ! The quality of a doctor’s answers depend upon the quality of the patient’s questions !

Not sure if you are on the right track ? I'll be happy to provide a free second opinion ! Send me your medical details by filling in the second opinion form, and I'll be happy to help !

Missed periods and infertility - causes and treatment

Posted by nurul Thursday, April 1, 2010 0 comments

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One of the most frustrating things an infertile woman can experience is having a late period and a negative pregnancy test! If you are trying-to-conceive , every time you miss your period, your hopes that you are now finally pregnant go up. You do the pregnancy test with a lot of hope - and lots of prayers. You are scared to do it, because you do not want to get your hopes up, and you are worried that it maybe negative once again . You finally screw up your courage - even if the news is bad, it's best to know the truth, you tell yourself - and then do the test.

When it's negative, you are depressed, disappointed and disheartened. But then you start hoping against hope ! Maybe I didn't do the test properly ? Maybe I drank too much water and the HCG is not showing up in the urine ? Maybe I did the test too early ? Maybe I ovulated late this cycle ? Maybe this brand is not reliable ? Aren't these tests fallible ? Maybe the test kits have expired ? Should I test again ? Should I use another brand ?

What happens if the test is repeatedly negative ? A late period and recurring negative pregnancy test results can lead to a great deal of stress, worry, confusion, and conjecture on what might be happening.... If I'm not pregnant, then where is my period?!? Have I stopped ovulating all together ? What's happened to my eggs ? Is my body going crazy ?

One possibility is that you are in fact pregnant , but the urine test result comes back negative. This is called a "false negative pregnancy test"? First, read all the instructions again and make sure you are doing the test properly. If you are, then a false negative result can occur if the test kit you are using is of low sensitivity. This means that the test is capable of detecting pregnancy only when the level of hCG reaches a certain threshold, and the test is simply not sensitive enough to yield the positive result.The best option is to do a blood test for checking your HCG level. This is very reliable ! If this is less than 10 mIU/ml, this confirms you are definitely not pregnant.If the test is negative , this means the reason you missed your periods is because you did not ovulate. This is called anovulation. You can read more about this at www.drmalpani.com/anovulation.htm !

Many factors can cause a missed period because they disrupt your hormonal balance. These include increased stress, anxiety, travel, jet-lag, weight loss, exercise and sleeplessness. The doctor may need to do an ultrasound scan to find out why you have missed your period. This vaginal ultrasound scan should check for the following.

a. ovarian volume
b. antral follicle count
c. uterus morphology
d. endometrial thickness and texture.

Based on these results, your doctor may prescribe medications for you to induce a period.