Is there such a thing as a normal menstrual cycle?

Dr. Beall - Menstrual CycleMedical Contribution by Stephanie Beall, M.D., Ph.D.

One in eight couples will experience infertility, defined as the inability to conceive after six months to a year of trying depending on the female partners age. Many of the causes behind infertility leave no clues until testing has been completed, except for one: the regularity of a woman’s menstrual cycle.

The menstrual cycle is directly related to ovulation (the release of an egg). But what if ovulation isn’t occurring, how do you know and what can be done to help? Understanding your menstrual cycle could open a window offering important insight into the factors central to conception.

Understanding Your Menstrual Cycle: It’s more than just your period.

The menstrual cycle is a series of changes a woman’s body goes through each month whereby the ovary releases an egg and the uterus prepares for pregnancy. The menstrual cycle includes two phases: the follicular phase and the luteal phase.

Phase One: The Follicular Phase

During the follicular phase, the hypothalamus and pituitary glands in the brain release a hormone known as follicle stimulating hormone (FSH). FSH stimulates the development of a follicle, which is a tiny fluid-filled sac within the ovary containing a maturing egg. The follicle also secretes estrogen, which produces mid-cycle changes in the cervical mucus and stimulates the lining of the uterus to thicken. These changes help prepare the uterus to receive the embryo. The follicular phase starts on day one of your menstrual cycle, the first day of day of your period, and concludes around 13 days later.

Phase Two: The Luteal Phase

The start if the second phase, or luteal phase, begins with ovualtion. There is a drastic surge in luteinizing hormone (LH), also released by the pituitary gland, causing the follicle to break open and release the mature egg into the Fallopian tube. During her reproductive years, a woman usually releases a single mature egg each month, in a process known as ovulation.

Cervical mucus is most receptive to sperm around this point in the cycle and a woman has the best chances of conceiving leading up to and during ovulation. When a couple has intercourse around the time of ovulation, sperm swim through the cervical mucus, into the uterus and along the Fallopian tube, where they meet the egg. The egg has the capacity to be fertilized for about 24 hours after it is released from the follicle.

Once ovulation occurs, the follicle that produced the egg becomes a functioning cyst called the corpus luteum. The corpus luteum produces progesterone, which prepares the lining of the uterus for implantation of the fertilized egg resulting in pregnancy.

If fertilization does not occur, the egg passes through the uterus, and the corpus luteum ceases to function on about 14 days after ovulation. The uterine lining then breaks down and is shed several days later as the next menstrual cycle begins.

FAQs
Is there such a thing as a normal menstrual cycle?

There is such a thing as a normal cycle. The menstrual cycle is essential for the maturation and ovulation of an egg in addition to the preparation of the uterus for implantation.  A normal menstrual interval ranges from 21 to 35 days and indicates that a woman is likely ovulating regularly. The portion of the cycle where the uterine lining is shed, also known as the period, in a normal cycle lasts between 2 and 7 days.  If there is very little bleeding during the period (less than 2 days or very scant amount) or the bleeding lasts for greater than 7 days then it may indicate an abnormality within the cavity of the uterus or irregular ovulation.

What does it mean if the number of days in the menstrual cycle or between periods has increased?

If the cycle length is still in the normal range described above (between 21 to 35 days) then the change is likely normal variation. However, if the cycle extends beyond 35 days, the cycle might be considered irregular raising concerns as to whether or not ovulation is occurring since longer cycles are caused by a lack of regular ovulation.

During a normal cycle, it is the fall of progesterone that brings upon bleeding. If a follicle does not mature and ovulate, progesterone is never released and the lining of the uterus continues to build in response to estrogen. Eventually, the lining gets so thick that it becomes unstable and like a tower of blocks, eventually falls and bleeding occurs. This bleeding can be unpredictable, and oftentimes very heavy and lasting a prolonged period of time.

How can I time my ovulation?

It is a common misconception that the luteal phase begins around day 14 of your cycle; in fact, it can more easily be determined by counting 14 days prior to the start of your cycle. The length of a normal cycle is anywhere between 21 and 35 days, so if you are counting from the start of the cycle you may be missing the time of ovulation by as much as a week. To calculate when ovulation is likely to occur determine how long your cycle lasts and subtract 14 days from the predicted end of the next cycle. Another option is to use an at home urine based ovulation predictor kits. These tests look for the surge of luteinizing hormone (LH) which occurs a day to two days prior to ovulation.

If I am not ovulating, what might be the cause?

There are many causes of anovulation, the medical term used to describe when ovaries do not release mature eggs on a regular basis. Irregularities with the thyroid gland or elevations of the hormone prolactin can disrupt the brain’s ability to communicate with the ovary and result in anovulation. In addition, polycystic ovary syndrome (PCOS), a syndrome caused by imbalanced sex hormones, can also cause failed ovulation. Not only do these hormonal imbalances lead to problems with ovulation and therefore fertility, but they may also increase the risk of miscarriage.

What should I do if I don’t think I am ovulating?

Irregular or no ovulation makes conception very difficult without intervention. If you do not have a normal monthly menses, no matter the amount of time you have been trying to conceive, you should be evaluated by your OB/GYN or a fertility specialist. The first step will be a basic work-up including blood work at the start of the cycle. The results can help your physician better understand what may be causing your irregular cycle and what options are available to help you and your partner conceive.

If you are having trouble conceiving, a fertility work-up may help determine if you are ovulating or if there are other factors. Shady Grove Fertility’s team of dedicated New Patient Liaisons are available to answer your questions and schedule a consultation with a physician. Call 877-971-7755 or click to schedule an appointment.

 

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Katie Couric Show: Male Factor Infertility

Katie Couric - Shady Grove Fertility

“One in eight American couples will experience infertility. And did you know that in over 40 percent of all cases the problem is actually with the man.”

Dave & Sarah: Trying to Conceive with Male Factor Infertility

Childhood sweethearts, Dave and Sarah, knew they wanted to build a family of their own. After eleven months of trying to conceive, Sarah spoke with her gynecologist who suggested starting with a semen analysis for Dave to rule out any male factor infertility issues.

When the test results came back showing that Dave had very few sperm and the quality of the sperm came back inconclusive. “I just felt like there was something wrong with me – I felt like a failure,” says Dave. The next step was to see a urologist for more testing. After several semen analysis, which in a normal sample would have several million, Dave’s samples came back with just 12 sperm.

Click here to schedule a Semen Analysis>

Treating Male Factor Infertility

As a couple they ruled out the use of donor sperm to conceive, so sought out the experts at Shady Grove Fertility, where they learned about in vitro fertilization with intracytoplasmic sperm injection – otherwise known as IVF with ICSI.

Reproductive Endocrinologist - Dr. Sasson

Dr. Isaac Sasson
Chesterbrook, PA

IVF with ICSI, you need just one viable sperm which will be injected into the egg to create an embryo. Reproductive Endocrinologist, Isaac E. Sasson, M.D., Ph.D of Shady Grove Fertility’s Chesterbrook, PA office explains, “The embryologist is able to find just a very few sperm, so when we would get eggs from Sarah and we get ten eggs from Sarah, I just need ten sperm from Dave.”

Dr. Sasson goes on to explain that the embryologist will then select individual sperm from Dave’s sample and inject it directly into each of Sarah’s eggs.

Watch Dave & Sarah share their male factor infertility story on the Katie Couric Show.

If you suspect male factor infertility or have been having trouble conceiving for six months to a year, it may be time to speak with a reproductive endocrinologist. Shady Grove Fertility’s team of dedicated New Patient Liaisons are available to answer your questions and schedule a consultation with a physician. Call 877-971-7755 or click to schedule an appointment.

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Affording Egg Freezing: Assure 30, New Financial Program

Increased interest in egg freezing at Shady Grove Fertility has led to many changes regarding the patient experience and increasing access to care. These changes include an improved patient protocol beginning with scheduling an appointment, ovarian reserve testing and physician consultation, and most recently, both new and improved financial programs, Assure 20 and Assure 30, have made affording egg freezing possible for more women.

Benefits of Egg Freezing

EF Graph Age and Fertility v2As some may already know, fertility potential is mostly dependent on the quality and quantity of eggs
(a woman’s ovarian reserve), which is largely impacted by a woman’s age. Therefore, as a woman ages, her fertility potential steadily declines. Through egg freezing, women essentially extend their biological clock, and the ability to attempt pregnancy in the future, when the timing is right to have a child.

By undergoing treatment, women are able to return in the future to utilize the eggs, and have the same chance of success as they would have had at the age the eggs were frozen. For example, if a woman were to freeze eggs at the age of 34, and then return to use them at the age of 40, her chances of success would be based on the age of a 34 year old.

Number of Eggs to Freeze Based on Age

Human reproduction is quite inefficient – many are surprised to learn the chance of conception each month is only around 20%. As a result, the average couple takes 5 to 6 months to conceive naturally. At the beginning of each cycle, several follicles containing an egg are present with only one developing, maturing, and being released through ovulation. The remaining eggs die off and are no longer available for conception. Since not every egg will result in a pregnancy, we recommend women 37 or younger, with excellent ovarian function, to freeze between 15-20 mature eggs. For women over 38, or women at any age with diminished ovarian function, it is recommended to freeze between 25-30 eggs.

Upon returning to attempt pregnancy, several eggs at a time are thawed and inseminated with sperm in order to develop a high quality embryo with a strong pregnancy potential. By starting with a group of either 15-20 or 25-30 mature eggs, depending on the age and ovarian status of the patient at the time of freezing, multiple chances of conception are possible.

Affording Egg Freezing: Continued Growth Leads to New Financial Program

Beginning in 2011, Shady Grove Fertility has experienced a 50% increase year over year in the number of women interested in freezing their eggs. With this increase, the difficulties associated with egg freezing and what prevented some women from freezing their eggs was evaluated and for many, there was a financial barrier to access care. According to Joseph Doyle, MD, “due to the increased patient interest in egg freezing, and a desire to better serve our patients, we developed a new financial program to make affording egg freezing more accessible.”

In November of 2013, we developed Assure Fertility, the first financial program developed for women freezing their eggs. While Assure Fertility proved to be popular and well received by our patients, it did not fully serve the needs of the women seeking egg freezing treatment. As a result, we have introduced an additional financial program, called Assure 30, and modified the original program, now called Assure 20. We also modified the eligibility criteria, which will allow more women to qualify for either financial program; Assure 20 or Assure 30.

With the improved Assure 20 financial option, women are still able to freeze their eggs for a flat fee of $12,500, for up to 4 cycles or 20 mature eggs, whichever comes first. Assure 30, our newest financial program, allows women with favorable ovarian reserve, to freeze up to 30 mature eggs or 5 cycles, for 1 flat fee of $18,000. Women may now choose the program that works best for them. Details regarding refunds for both options are listed below. In addition to having several financial programs, the option to finance is available, as well with monthly rates varying depending on financial program, credit history, and length of the loan. Egg Freezing Financial Options

*Patients paying out-of-pocket will pay $250 to SGF for testing and consultation and $75 to Reprosource for Ovarian Reserve Testing.
**Medication cost will vary from $2,800-$5,000 based on ovarian function and insurance benefits.
***All egg freezing cycles must be complete by the age of 41.

Next Steps Toward Preserving Your Fertility

  1. Questions or ready to schedule an Egg Freezing consultation? Fill out this form or call 877-411-9292.
  2. Talk to someone who has frozen her eggs by e-mailing askmelanie@shadygrovefertility.com
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