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Tuesday, January 12, 2010

First Trimester Of Pregnancy

Week 3

Fetal Development: Sperm meets egg within the fallopian tube and the miracle of life begins. Although several sperm may penetrate the egg's outer layer, only one sperm will enter the ovum and fertilize it. In the middle of the ovum, the chromosomes of mother and father splash about and bits of information from both begin to form the chromosomes of your baby. At the moment of conception, your baby's gender is determined thanks to the sex chromosomes in the father's sperm. If you don't like the gender of your baby, blame dad.

Multiples: If two eggs are released from the ovary (or one egg from each ovary) and are fertilized by two separate sperm, fraternal twins (dizygotic) have been conceived. Fraternal twins can be the same sex or boy/girl, and will look as much alike or as different as any siblings. If one egg is fertilized and later divides in two, identical twins will develop (or divides into three, identical triplets will develop, etc).

Identical multiples have the same chromosomal makeup so will be the same gender, and have the same hair and eye color, blood type, etc. Only one-third of all twins are identical (monozygotic).

In the case of triplets or quadruplets, etc., any combination is possible. Three (or four or more) eggs can be fertilized creating fraternal triplets, etc. One fertilized egg can split into identical twins with another fertilized egg making it a triplet pregnancy (two identical babies and one fraternal). Or one egg can split into three creating identical triplets, etc.


Maternal Changes:

Around the 14th day from the start of your last menstrual cycle, one of the ripened eggs is released from your ovary and is drawn into your fallopian tube where conception occurs.
You may experience some spotting or bleeding at the time the blastocyst implants into your uterus. Don't be alarmed ~ it's normal, but not all women will experience this. Most women are unaware of the exact moment of conception.


Multiples: Same as for singletons except times two (or three or four . . .)


Ideas for Dad: You may still be making regular deposits in the conception effort. Enjoy because your life is about to change dramatically!


Inspirational Thoughts: That most sensitive, most delicate of instruments: the mind of a little child. ~Henry Handel Richardson

First Trimester Of Pregnancy

Week 2

Fetal Development: Nothing yet!

Maternal Changes:

Your uterus has shed its lining through your period and is now preparing a lush new bed of blood-rich tissue designed to house a growing fetus. Your eggs are ripening in one of the ovaries and preparing to release one.

Multiples:

Same as for singletons except that in the case of fraternal twins, your ovaries will release two eggs (or 3 in the case of fraternal triplets, etc.)


Ideas for Dad:
Okay Dad, on day 14, if Mom has a regular 28-day cycle, (counting from the first day of Mom's last period) which should be the end of this week, you know what to do! Enjoy, but remember, your involvement is needed throughout the pregnancy, not just for conception.


Inspirational Thoughts:
A baby is Mom and Pop art. ~Patricia Warner

The Pregnancy Planner

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Here's your pregnancy planner!


TIPS:
  • For the average couple, having sex once per day provides the best chance of getting pregnant.
  • To optimize your chances of getting pregnant, after your partner ejaculates, remain on your on your back with your hips elevated for 20-30 minutes.
  • The woman-on-top position isn't great for pregnancy, since ejaculate may flow out.

FACTS:

  • Most women have a 15 to 25 percent chance of getting pregnant during their cycle.
    Nearly 50 percent of couples conceive during the first 3 months.
  • About 75 percent of couples conceive during the first 6 months.
  • Up to 90 percent of couples conceive during the first year.
  • On the average, there are 280 days from the first day of your last period to your due date.



Fertility Awareness

Understanding your monthly fertility pattern (days in the month when you are fertile, days when you are infertile, and days when fertility is unlikely, but possible) can help you plan a pregnancy, or avoid pregnancy. But if you already understand your menstrual cycle and fertility pattern, and are having problems getting pregnant, there is help and support available. In 2000, one in 10 U.S. women of reproductive age had a problem with fertility. If you have a problem with fertility, learn all you can about you and your partner's health, and your options for treatments.


Fertility Awareness


The Menstrual Cycle


  • Being aware of your menstrual cycle and the changes in your body that happen during this time can be key to helping you plan a pregnancy, or avoid pregnancy. During the menstrual cycle (a total average of 28 days), there are two parts: before ovulation and after ovulation.

  • Day 1 starts with the first day of your period.

  • Usually by Day 7, a woman's eggs start to prepare to be fertilized by sperm.

  • Between Day 7 and 11, the lining of the uterus (womb) starts to thicken, waiting for a fertilized egg to implant there.

  • Around Day 14 (in a 28-day cycle), hormones cause the egg that is most ripe to be released, a process called ovulation. The egg travels down the fallopian tube towards the uterus. If a sperm unites with the egg here, the egg will attach to the lining of the uterus, and pregnancy occurs.

  • If the egg is not fertilized, it will break apart.

  • Around Day 25 when hormone levels drop, it will be shed from the body with the lining of the uterus as a menstrual period.


The first part of the menstrual cycle is different in every woman, and even can be different from month-to-month in the same woman, varying from 13 to 20 days long. This is the most important part of the cycle to learn about, since this is when ovulation and pregnancy can occur. After ovulation, every woman (unless she has a health problem that affects her periods) will have a period within 14 to 16 days.

Charting Your Fertility Pattern

If you are aware of when you are most fertile, this will help you plan or prevent a pregnancy. There are three ways that you can keep track of this time each month:

Basal body temperature method - This involves taking your basal body temperature (your body's temperature when you're at rest) every morning before you get out of bed, and recording it on a chart. You will begin to know your own fertility pattern, and you can see the changes from month to month. During the menstrual cycle, your body temperature remains at a somewhat steady, lower level, and begins to slightly rise with ovulation. The rise can be a sudden jump or a gradual climb over a few days. The rise in temperature can't predict exactly when the egg is released, but your temperature rises between .4 to .8 degrees Fahrenheit on the day of ovulation. You are most fertile, and most likely to get pregnant during the two to three days just before your temperature hits the highest point (ovulation), and for about 12 to 24 hours after ovulation. A man's sperm can live for up to three days in your body and is able to fertilize an egg during that time. So, if you have unprotected sex several days before ovulation, there is a chance of becoming pregnant then. Once your temperature spikes and stays at a higher level for about three days, you can be sure that ovulation has occurred. Your temperature will remain at the higher level until your period starts. Basal body temperature differs slightly from woman to woman, but anywhere from 96 to 98 degrees orally is normal before ovulation, and anywhere from 97 to 99 degrees orally after ovulation. So, any changes that you chart are very small and are in 1/10 degree. You can buy an oral basal body temperature thermometer or an easy-to-read thermometer, which has the degrees marked in these small fractions, at a drug store. If you can't find it easily, ask the pharmacist to help you.


Calendar method - This involves keeping a written record of each menstrual cycle on a regular calendar. The first day of your period is Day 1, which you can circle on the calendar. Continue doing this for eight to 12 months so you know how many days are in your cycle. The length of your cycle can vary from month to month, so write down the total number of days it lasts each time in a list. To find out the first day when you are most fertile, check your list and find the cycle with the fewest days. Then subtract 18 from that number. Take this new number and count ahead that many days on the calendar. Draw an X through this date. The X marks the first day you're likely to be fertile. To find out the last day when you are fertile, subtract 11 days from your longest cycle and draw an X through this date. This method always should be used with other fertility awareness methods, especially if your cycles are not always the same lengths.

Cervical mucus method (also known as the ovulation method) - This involves being aware of the changes in your cervical mucus throughout the month. The hormones that control the menstrual cycle also cause changes in the kind and how much mucus you have just before and during ovulation. Right after your period, you usually have a few days when there is no mucus present or "dry days." As the egg starts to mature, mucus increases in the vagina, appears at the vaginal opening, and is usually white or yellow and cloudy and sticky. The greatest amount of mucus appears just before ovulation, during the "wet days," when it becomes clear and slippery, like raw egg whites. Sometimes it can be stretched apart. This is when you are most fertile. About four days after the wet days begin, the mucus changes again. There is now much less and it becomes sticky and cloudy. You might have a few more dry days before your period returns. You can describe changes in your mucus on a calendar. Label the days, "Sticky," "Dry," or "Wet." You are most fertile at the first sign of wetness after your period, but maybe also a day or two before wetness begins. This method is less reliable for women whose mucus pattern is changed because of breastfeeding, use of oral contraceptives or feminine hygiene products, having aginitis, sexually transmitted diseases (STDs), or surgery on the cervix.


To most accurately track your fertility, it is best to use a combination of all three methods, which is called the symptothermal method.

Infertility

It is not uncommon to have trouble becoming pregnant or experience infertility. Infertility is defined as not being able to become pregnant, despite trying for one year, in women under 35, or after six months in women 35 and over. Pregnancy is the result of a chain of events. As described in the Fertility Awareness section, a woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus. A man's sperm must join with (fertilize) the egg along the way. The fertilized egg must then become attached to the inside of the uterus. While this may seem simple, in fact many things can happen to prevent pregnancy.

Reasons for Infertility

Age

There are many different reasons why a couple might have infertility. One is age-related. Women today are often delaying having children until later in life, when they are in their 30s and 40s. A couple of things add to this trend. Birth control is easy to obtain and use, more women are in the work force, women are marrying at an older age, the divorce rate remains high, and married couples are delaying pregnancy until they are more financially secure. But the older you are, the harder it is to become pregnant. Women generally have some decrease in fertility starting in their early 30s. And while many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35.

As a woman ages, there are normal changes that occur in her ovaries and eggs. All women are born with over a million eggs in their ovaries (all the eggs that they will ever have), but only have about 300,000 left by puberty. Then of these, only about 300 eggs will be ovulated during the reproductive years. Even though menstrual cycles continue to be regular in a woman's 30s and 40s, the eggs that ovulate each month are of poorer quality than those from the 20s. It is harder to get pregnant when the eggs are poorer in quality. Ovarian reserve is the number and quality of eggs in your ovaries and how well the ovarian follicles respond to hormones in your body. As you approach menopause, your ovaries don't respond as well to your hormones, and in time they may not release an egg each month. A reduced ovarian reserve is natural as a woman ages, but young women might have reduced ovarian reserve due to smoking, a prior surgery on their ovaries, or a family history of early menopause. Also, as a woman and her eggs age, if she becomes pregnant, there is a greater chance of having genetic problems, such as having a baby with Down syndrome. Embryos formed from eggs in older women also are less likely to fully develop, a main reason for miscarriage (early pregnancy loss).

Health Problems

Couples also can have fertility problems because of health problems, in either the woman or the man. Common problems with a woman's reproductive organs, like uterine fibroids, endometriosis, and pelvic inflammatory disease can worsen with age and also affect fertility. These conditions might cause the fallopian tubes to be blocked, so the egg can't travel through the tubes into the uterus. Certain lifestyle choices also can have a negative effect on a woman's fertility, such as smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder. Some people also have diseases or conditions that affect their hormone levels, which can cause infertility in women and impotence and infertility in men. Polycystic ovarian syndrome (PCOS) is one such hormonal condition that affects many women, and is the most common cause of anovulation, or when a woman rarely or never ovulates. Another hormonal condition that is a common cause of infertility is when a woman has a luteal phase defect (LPD). A luteal phase is the time in the menstrual cycle between ovulation and the start of the next menstrual period. LPD is a failure of the uterine lining to be fully prepared for a fertilized egg to implant there. This happens either because a woman's body is not producing enough progesterone, or the uterine lining isn't responding to progesterone levels at some point in the menstrual cycle. Since pregnancy depends on a fertilized egg implanting in the uterine lining, LPD can interfere with a woman getting pregnant and with carrying a pregnancy successfully.

Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm, and have a slightly higher risk of sperm gene defects. They also might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility. Men also can have other health problems that affect their sexual and reproductive function. These can include sexually transmitted diseases (STDs), diabetes, surgery on the prostate gland, or a severe testicle injury or problem. If you or your partner has a problem with sexual function or libido, don't delay seeing your health care provider for help.

Treating Infertility

You should talk to your health care provider about your fertility if you:


  • are under 35 and, after a year of frequent sex without birth control, you are having problems getting pregnant, or

  • are 35 or over and, after six months of frequent sex without birth control, you are having problems getting pregnant, or

  • believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant).

  • Your health care provider can refer you to a fertility specialist, a doctor who focuses in treating infertility. This doctor can recommend treatments such as drugs, surgery, or assisted reproductive technology. Don't delay seeing your health care provider because age also affects the success rates of these treatments.

Tests


The first step to treat infertility is to see a health care provider for a fertility evaluation. He or she will test both the woman and the man, to find out where the problem is. Testing on the man focuses on the number and health of his sperm. The lab will look at a sample of his sperm under a microscope to check sperm number, shape, and movement. Blood tests also can be done to check hormone levels. More tests might be needed to look for infection, or problems with hormones. These tests can include:



  • an x-ray (to look at his reproductive organs)

  • a mucus penetrance test (to see if sperm can swim through mucus)

  • a hamster-egg penetrance assay (to see if sperm can go through hamster egg cells, somewhat showing their power to fertilize human eggs)


Testing for the woman first looks at whether she is ovulating each month. This can be done by having her chart changes in her morning body temperature, by using an FDA-approved home ovulation test kit (which she can buy at a drug store), or by looking at her cervical mucus, which changes throughout her menstrual cycle. Ovulation also can be checked in her health care provider's office with an ultrasound test of the ovaries, or simple blood tests that check hormone levels, like the follicle-stimulating hormone (FSH) test. FSH is produced by the pituitary gland. In women, it helps control the menstrual cycle and the production of eggs by the ovaries. The amount of FSH varies throughout the menstrual cycle and is highest just before an egg is released. The amounts of FSH and other hormones (luteinizing hormone, estrogen, and progesterone) are measured in both a man and a woman to determine why the couple cannot achieve pregnancy. If the woman is ovulating, more testing will need to be done. These tests can include:



  • an hysterosalpingogram (an x-ray to check if the fallopian tubes are open and to show the shape of the uterus)

  • a laparoscopy (an exam of the tubes and other female organs for disease)

  • an endometrial biopsy (an exam of a small shred of the uterine lining to see if monthly changes in it are normal)

  • Other tests can be done to show whether the sperm and mucus are interacting in the right way, or if the man or woman is forming antibodies that are attacking the sperm and stopping them from getting to the egg.

Drugs and Surgery

Different treatments for infertility are recommended depending on what the problem is. About 90 percent of cases are treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems. It is important to talk with your health care provider about the drug to be used. You should understand the drug's benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women. If needed, surgery can be done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.

Assisted Reproductive Technology (ART)

Assisted reproductive technology (ART) uses special methods to help infertile couples, and involves handling both the woman's eggs and the man's sperm. Success rates vary and depend on many factors. But ART has made it possible for many couples to have children that otherwise would not have been conceived. ART can be expensive and time-consuming. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Also, some states have laws for infertility insurance coverage. Some of these include Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Rhode Island, Texas, and West Virginia.

In vitro fertilization (IVF) is a type of ART that is often used when a woman's fallopian tubes are blocked or when a man has low sperm counts. A drug is used to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed and placed in a culture dish with the man's sperm for fertilization. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman's uterus, thus bypassing the fallopian tubes. Gamete intrafallopian transfer (GIFT) is similar to IVF, but used when the woman has at least one normal fallopian tube. Three to five eggs are placed in the fallopian tube, along with the man's sperm, for fertilization inside the woman's body. Zygote intrafallopian transfer (ZIFT), also called tubal embryo transfer, combines IVF and GIFT. The eggs retrieved from the woman's ovaries are fertilized in the lab and placed in the fallopian tubes rather than the uterus.

ART sometimes involves the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby. And if a woman does not have any eggs, or her eggs are not of a good enough quality to produce a pregnancy, she and her partner might want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner, but the surrogate will give the baby to the couple at birth.

A gestational carrier might be an option for women who do not have a uterus, from having had a hysterectomy, but still have their ovaries, or for women who shouldn't become pregnant because of a serious health problem. In this case, the woman's eggs are fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. In this case, the carrier will not be related to the baby, and will give the baby to the parents at birth.

Counseling and Support Groups

If you've been having problems getting pregnant, you know how frustrating it can feel. Not being able to get pregnant can be one of the most stressful experiences a couple has. Both counseling and support groups can help you and your partner talk about your feelings, and to help you meet other couples like you in the same situation. You will learn that anger, grief, blame, guilt, and depression are all normal. Couples do survive infertility, and can become closer and stronger in the process. Ask your health care provider for the names of counselors or therapists with an interest in fertility.

Pregnancy Channel

alpha-fetoprotein screening (AFP) ~ This blood test measures the levels of a substance called alpha-fetoprotein in the mother's blood. Abnormal levels can indicate a brain or spinal cord defect, the presence of twins, a miscalculated due date, or an increased risk of Down syndrome.

alveoli cells ~ tiny glands in the breast that produce milk.

amniocentesis ~ If necessary, this test is performed between 15 and 20 weeks of pregnancy and can indicate chromosomal abnormalities such as Down syndrome, or genetic disorders such as Tay Sachs disease, sickle cell disease, cystic fibrosis, and others. It also can detect the baby's sex and risk of spina bifida (a condition in which the brain or spine do not develop properly).

amniotic fluid ~ clear, slightly yellowish liquid that surrounds the unborn baby (fetus) during pregnancy. It is contained in the amniotic sac.

anemia ~ when the amount of red blood cells or hemoglobin (the substance in the blood that carries oxygen to organs) becomes reduced, causing fatigue that can be severe.

anovulation ~ absence of ovulation.

antibodies ~ proteins made by certain white blood cells in response to a foreign substance (antigen). Antibodies neutralize or destroy antigens.

areola ~ the dark-colored skin on the breast that surrounds the nipple.

assisted reproductive technology ~ technology that involves procedures that handle a woman's eggs and a man's sperm to help infertile couples conceive a child.

bilirubin ~ when the hemoglobin in a person's blood breaks down, causing a yellowing of the skin and whites of the eyes. It is a temporary condition in newborn infants.

birth center ~ A special place for women to give birth. They have all the required equipment for birthing, but are specially designed for a woman, her partner, and family. Birth centers may be free standing (separate from a hospital) or located within a hospital.

breast shell ~ a round plastic shell that fits around the breast. It is used to correct inverted or flat nipples. Also referred to as breast shield or milk cup.

candida ~ a fungus, called Candida albicans, that causes yeast infections like thrush in the mouth and throat, and in intestines and other parts of the body.

cervix ~ the lower, narrow part of the uterus (womb). The cervix forms a canal that opens into the vagina, which leads to the outside of the body.

cesarean (C-section) ~ procedure where the baby is delivered through an abdominal incision.

chorionic villus sampling (CVS) ~ If necessary this test is performed between 10 and 12 weeks of pregnancy and can indicate the same chromosomal abnormalities and genetic disorders as amniocentesis can. It also can detect the baby's sex and risk of spina bifida.

colostrum ~ thick, yellowish fluid secreted from breast during pregnancy, and the first few days after childbirth before the onset of mature breast milk. Also called "first milk," it provides nutrients and protection against infectious diseases.

condom ~ a barrier method of birth control. There are both male and female condoms. The male condom is a sheath placed over an erect penis before sex that prevents pregnancy by blocking the passage of sperm. A female condom also is a sheath, but is inserted into the vagina to block the passage of sperm.

connective tissue ~ a type of body tissue that supports other tissues and binds them together. Connective tissue provides support in the breast.

constipation ~ infrequent or hard stools or difficulty passing stools.

cystic fibrosis (CF) ~ one of the most common serious genetic (inherited) diseases. One out of every 400 couples is at risk for having children with CF. CF causes the body to make abnormal secretions leading to mucous build-up. CF mucous build-up can impair organs such as the pancreas, the intestine and the lungs.

dehydration ~ excessive loss of body water that the body needs to carry on normal functions at an optimal level. Signs include increasing thirst, dry mouth, weakness or lightheadedness (particularly if worse on standing), and a darkening of the urine or a decrease in urination.

depression ~ term used to describe an emotional state involving sadness, lack of energy and low self-esteem.

diabetes ~ a disease in which blood glucose (blood sugar) levels are above normal. Type 2 diabetes, also known as adult-onset or noninsulin-dependent diabetes mellitus (NIDDM), is the most common form of diabetes.

diaphragm ~ birth control device made of a thin flexible disk, usually made of rubber, that is designed to cover the cervix to prevent the entry of sperm during sexual intercourse.

diarrhea ~ passing frequent and loose stools that can be watery. Acute diarrhea goes away in a few weeks. Diarrhea becomes chronic when it lasts longer than 4 weeks.

down syndrome ~ a genetic disease that is caused by an extra copy of chromosome 21.

ductules ~ small milk ducts in the breast leading to the mammary or lactiferous ducts.

eating disorder ~ eating disorders, such as anorexia nervosa, bulimia nervosa, and binge-eating disorder, involve serious problems with eating. This could include an extreme decrease of food or severe overeating, as well as feelings of distress and concern about body shape or weight.

ectopic pregnancy ~ a pregnancy that is not in the uterus. It happens when a fertilized egg settles and grows in a place other than the inner lining of the uterus. Most happen in the fallopian tube, but can happen in the ovary, cervix, or abdominal cavity.

embryo ~ a period during pregnancy where the baby has rapid growth, and the main external features begin to take form.

endometrial cancer ~ cancer that develops from the endometrium, or the inner lining of the uterus (womb).

endometriosis ~ a condition in which tissue that normally lines the uterus grows in other areas of the body, usually inside the abdominal cavity, but acts as if it were inside the uterus. Blood shed monthly from the misplaced tissue has no place to go, and tissues surrounding the area of endometriosis may become inflamed or swollen. This can produce scar tissue. Symptoms include painful menstrual cramps that can be felt in the abdomen or lower back, or pain during or after sexual activity, irregular bleeding, and infertility.

engorgement ~ condition in which breasts become overly full of milk. Engorged breasts may feel swollen, hard, and painful. Engorgement can lead to blocked milk ducts.

epidural ~ During labor a woman may be offered an epidural, where a needle is inserted into the epidural space at the end of the spine, to numb the lower body and reduce pain. This allows a woman to have more energy and strength for the end stage of labor, when it is time to push the baby out of the birth canal.

episiotomy ~ This is a procedure where an incision is made in the perineum (area between the vagina and the anus) to make the vaginal opening larger in order to prevent the area from tearing during delivery.

erectile dysfunction ~ inability to achieve and keep a penile erection.
estrogen ~ a group of female hormones that are responsible for the development of breasts and other secondary sex characteristics in women. Estrogen is produced by the ovaries and other body tissues. Estrogen, along with progesterone, is important in preparing a woman's body for pregnancy.

fallopian tubes ~ part of the female reproductive system, these tubes carry eggs from the ovaries to the uterus (or womb).

Family and Medical Leave Act (FMLA) ~ a federal regulation that allows eligible employees to take up to 12 work weeks of unpaid leave during any 12 month period for the serious health condition of the employee, parent, spouse or child, or for pregnancy or care of a newborn child, or for adoption or foster care of a child.

fatty tissue ~ connective tissue that contains stored fat. Also referred to as adipose tissue. Fatty tissue in the breast protects the breast from injury.

flat nipple ~ a nipple that cannot be compressed outward, does not protrude or become erect when stimulated or cold.

follicle ~ each month, an egg develops inside the ovary in a fluid filled pocket called a follicle. This follicle releases the egg into the fallopian tube.

follicle-stimulating hormone (FSH) ~ a hormone produced by the pituitary gland. In women, it helps control the menstrual cycle and the production of eggs by the ovaries.

galactosemia ~ a condition where the body is not able to process galactose (a sugar), which makes up half of the sugar (called lactose) found in milk. When galactose levels become high, body organs and the central nervous system can be damaged. In newborns, the condition is found when first breastfeeding and can cause jaundice and other problems.

glandular tissue ~ body tissue that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. In the breast, glandular tissue is involved in the production of milk.

hepatitis B ~a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. You get hepatitis B by direct contact with the blood or body fluids of an infected person; for instance, you can become infected by having sex or sharing needles with an infected person. A baby can get hepatitis B from an infected mother during childbirth.

hepatitis C ~ a liver disease, caused by a virus, that makes the liver swells and stops it from working correctly.

high blood pressure ~also known as hypertension. A cardiovascular disease which means the blood vessels become tight and constricted, forcing your heart to pump harder to move blood through your body. These changes cause the blood to press on the vessel walls with greater force, which can damage blood vessels and organs, including the heart, kidneys, eyes, and brain. Blood pressure is considered high if it is greater than 140 over 90 mm Hg (millimeters of mercury).

HIV/AIDS infection ~HIV is the virus that causes AIDS, or Acquired Immunodeficiency Syndrome. HIV infection can produce no symptoms for many years. When certain symptoms develop, a person has AIDS. AIDS is a syndrome, or group of diseases, that can be fatal. HIV/AIDS infection is life-long, there is no cure.

hormone ~substance produced by one tissue and conveyed by the bloodstream to another to effect a function of the body, such as growth or metabolism.

hypertension ~see high blood pressure.

hysterectomy ~surgery to remove the uterus.

immune system ~a complex system in the body that recognizes and responds to potentially harmful substances, like infections, in order to protect the body.

infertility ~A condition in which a couple has problems conceiving, or getting pregnant, after one year of regular sexual intercourse without using any birth control methods. Infertility can be caused by a problem with the man or the woman, or both.

inflammation ~used to describe an area on the body that is swollen, red, hot, and in pain.

insulin ~one of many hormones that helps the body turn the food we eat into energy and helps store energy to be used later. People with diabetes mellitus, a condition in which the body does not make enough insulin, might need to inject themselves with insulin to help their bodies and cells work properly.

interstitial cystitis ~a long-lasting condition also known as painful bladder syndrome or frequency-urgency-dysuria syndrome. The wall of the bladder becomes inflamed or irritated, which affects the amount of urine the bladder can hold and causes scarring, stiffening, and bleeding in the bladder.

intrauterine device ~a small device that is placed inside a woman's uterus by a health care provider, which prevents pregnancy by changing the environment of the uterus (or womb).

intravenous analgesic ~ An analgesic is a drug that relieves pain. During labor, a woman can be given pain-relieving drugs intravenously (through a tube inserted into her vein).

inverted nipple ~ a nipple that retracts, rather than protrudes when the areola is compressed.

jaundice ~ a yellowing of the skin and the whites of the eyes, caused by too much bilirubin in the blood. While not a disease, jaundice can signal a liver or gallbladder problem. Newborns can develop jaundice, which is only temporary and goes away.

lactation ~ breastfeeding, or the secretion of breast milk.

lactiferous sinuses ~ enlarged portion of the mammary or milk duct where breast milk pools during breastfeeding. The sinuses are behind the areola and connect to the nipple.

lactose ~ a sugar found in milk and milk products like cheese, cream, and butter.

lamaze ~ a philosophy of giving birth developed by Dr. Ferdinand Lamaze. The goal of Lamaze classes is to increase women's confidence in their ability to give birth. Lamaze classes teach women simple coping strategies for labor, including focused breathing. But Lamaze also teaches that breathing techniques are just one of the many things that help women in labor. Movement, positioning, labor support, massage, relaxation, hydrotherapy and the use of heat and cold are some others.

lead ~ a metal that can make infants and young children sick.

let-down reflex, or milk-ejection reflex ~ A conditioned reflex ejecting milk from the alveoli through the ducts to the sinuses of the breast and the nipple.

libido ~ sexual drive.

local analgesic ~ An analgesic is a drug that relieves pain. Pain-relieving drugs can be given to a woman during labor and delivery locally through a needle inserted into a muscle (intra-muscular) or under the skin (subcutaneous).

luteal phase defect ~ problems with the uterine lining that can affect a woman's ability to get pregnant and have a successful pregnancy.

luteinizing hormone ~ a hormone that triggers ovulation and stimulates the corpus luteum (empty follicle) to make progesterone.

lymph ~ the almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. Lymph tissue in the breast helps remove waste.

mammary ducts ~ ducts in the breast that carry milk to the lactiferous sinuses and the nipple.

mastitis ~ a condition that occurs mostly in breastfeeding women, causing a hard spot on the breast that can be sore or uncomfortable. It is caused by infection from bacteria that enters the breast through a break or crack in the skin on the nipple or by a plugged milk duct.

menopause ~ the transition in a woman's life when production of the hormone estrogen in her body falls permanently to very low levels, the ovaries stop producing eggs, and menstrual periods stop for good.

menstruating ~ The blood flow from the uterus that happens about every 4 weeks in a woman.

milk ducts ~ see mammary ducts.

milk sinuses ~ see lactiferous sinuses.

milk-ejection reflex ~ see let-down reflex.

miscarriage ~ an unplanned loss of a pregnancy. Also called a spontaneous abortion.

montgomery glands ~ also called Montgomery's glands or areolar glands. These small glands enlarge during pregnancy and breastfeeding and look somewhat like pimples on the areola. They secrete oils that lubricate the nipple.

mumps ~ a sudden illness caused by the virus paramyxovirus. It is spread by direct contact as well as by airborne droplets and saliva. Since 1967 the mumps vaccine (MMR, or measles, mumps and rubella) has helped cases decline in the United States. Symptoms include inflamed salivary glands (causing a child to have full cheeks like a chipmunk), inflamed tissues of the central nervous system (brain and spine), and an inflamed pancreas. Mumps in a child who has gone through adolescence tends to affect the ovary and the testes, which can lead to infertility.

nerve(s) ~ cells in the human body that are the building blocks of the nervous system (the system that records and transmits information chemically and electrically within a person). Nerve cells, or neurons, are made up of a nerve cell body and various extensions from the cell body that receive and transmit impulses from and to other nerves and muscles. Nerve tissue in the breast makes breasts sensitive to touch, allowing the baby's sucking to stimulate the let-down or milk-ejection reflex and milk production.

nipple ~ the protruding part of the breast that extends and becomes firmer upon stimulation. In breastfeeding, milk travels from the milk sinuses through the nipple to the baby.

nipple shield ~ an artificial latex or silicone nipple used over the mother's nipple during nursing.

nurse-midwife ~ A nurse who has undergone special training and has received certification on birthing (labor and delivery). Nurse-midwifes can perform most of the same tasks as physicians and have emergency physician backup when they deliver a baby.

ovarian reserve ~ health of the ovaries and eggs. It is an important factor in female fertility and decreases with age.

ovaries ~ part of a woman's reproductive system, the ovaries produce her eggs. Each month, through the process called ovulation, the ovaries release eggs into the fallopian tubes, where they travel to the uterus, or womb. If an egg is fertilized by a man's sperm, a woman becomes pregnant and the egg grows and develops inside the uterus. If the egg is not fertilize, the egg and the lining of the uterus is shed during a woman's monthly menstrual period.

ovulation ~ the release of a single egg from a follicle that developed in the ovary. It usually occurs regularly, around day 14 of a 28-day menstrual cycle.

ovulation method ~ a method used by couples trying to get pregnant, in which they have intercourse just before or after ovulation.

oxytocin ~ a hormone that increases during pregnancy and acts on the breast to help produce the milk-ejection reflex. Oxytocin also causes uterine contractions.

pelvic inflammatory disease (PID) ~ an infection of the female reproductive organs that are above the cervix, such as the fallopian tubes and ovaries. It is the most common and serious problem caused by sexually transmitted diseases (STDs). PID can cause ectopic pregnancies, infertility, chronic pelvic pain, and other serious problems. Symptoms include fever, foul-smelling vaginal discharge, extreme pain, and vaginal bleeding.

phototherapy ~ treatment with light. Prescription phototherapy exposes the baby's skin to special fluorescent lights. In mild cases of jaundice, exposing the baby's skin to sunlight (taking care to avoid sunburn) is sometimes recommended.

pituitary gland ~ a small gland in the head that makes hormones that control other glands and many body functions including growth.

plugged (milk) duct ~ when the small milk ducts in the breast become blocked, or plugged. This is often caused by mastitis.

postpartum depression (PPD) ~ a serious condition that requires treatment from a health care provider. With this condition, feelings of the baby blues (feeling sad, anxious, afraid, or confused after having a baby) do not go away or get worse.

post-traumatic stress disorder ~ A psychological condition that can happen when a person sees or experiences something traumatic, such as rape, murder, torture, or wartime combat. A person can have many symptoms including flashbacks (re-living the event), nightmares, fatigue, anxiety, and forgetfulness. A person can also withdraw from family and friends.

preeclampsia ~ Also known as Toxemia, it is a condition that can occur in a woman in the second half of her pregnancy that can cause serious problems for both her and the baby. It causes high blood pressure, protein in the urine, blood changes and other problems.

prematurely ~ before the expected time.

primary lactase deficiency ~ when a person is born with the inability to digest lactose, a sugar found in milk and milk products. Lactose can't be digested because there is not enough of an enzyme, called lactase, in the body. Consuming milk and dairy products causes diarrhea, bloating, gas, and discomfort. This deficiency can also develop over time, as the amount of lactase in the body decreases with age.

progesterone ~ a female hormone produced by the ovaries. Progesterone, along with estrogen, prepares the uterus (womb) for a possible pregnancy each month and supports the fertilized egg if conception occurs. Progesterone also helps prepare the breasts for milk production and breastfeeding.

progestin ~ a hormone that works by causing changes in the uterus. When taken with the hormone estrogen, progestin works to prevent thickening of the lining of the uterus. This is helpful for women who are in menopause and are taking estrogen for their symptoms. Progestins also are prescribed to regulate the menstrual cycle, treat unusual stopping of the menstrual periods, help a pregnancy occur or maintain a pregnancy, or treat unusual or heavy bleeding of the uterus. They also can be used to prevent pregnancy, help treat cancer of the breast, kidney, or uterus, and help treat loss of appetite and severe weight or muscle loss.

prolactin ~ a hormone that increases during pregnancy and breastfeeding. It stimulates the human breast to produce milk. Prolactin also helps inhibit ovulation.

prostate gland ~ a gland in a man's reproductive system. It makes and stores seminal fluid. This fluid is released to form part of semen.

puberty ~ time when the body is changing from the body of a child to the body of an adult. This process begins earlier in girls than in boys, usually between ages 8 and 13, and lasts 2 to 4 years.

pudenal block ~ This procedure anesthetizes, or numbs, the area around the vulva to reduce pain during labor and delivery.

rooting ~ a reflex that newborn babies have, along with the reflexes for sucking and swallowing. Rooting means turning the head to search for the nipple and milk.

rubella ~ also called German measles. Rubella virus causes rash, mild fever, and arthritis. If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born with serious birth defects.

semen ~ the fluid (which contains sperm) a male releases from his penis when he becomes sexually aroused or has an orgasm.

sexually transmitted diseases (STDs) ~ diseases that are spread by sexual activity.

sickle cell anemia ~ a blood disorder passed down from parents to children. It involves problems in the red blood cells. Normal red blood cells are round and smooth and move through blood vessels easily. Sickle cells are hard and have a curved edge. These cells cannot squeeze through small blood vessels. They block the organs from getting blood. Your body destroys sickle red cells quickly, but it can't make new red blood cells fast enough-- a condition called anemia.

spermicides ~ chemical jellies, foams, creams, or suppositories, inserted into the vagina prior to intercourse that kill sperm.

sudden infant death syndrome (SIDS) ~ the diagnosis given for the sudden death of an infant under one year of age that remains unexplained after a complete investigation. Because most cases of SIDS occur when a baby is sleeping in a crib, SIDS is also commonly known as crib death. Most SIDS deaths occur when a baby is between 1 and 4 months of age.

symptothermal method ~ a method of pregnancy planning or birth control that combines certain aspects of the calendar, the basal body temperature, and the cervical mucus methods. It takes into account all these factors as well as other symptoms a woman might have, such as slight cramping and breast tenderness.

synthetic ~ made in a lab and not from a natural source.

Tay-Sachs disease ~ a fatal genetic disorder in which harmful quantities of a fatty substance called ganglioside GM2 build up in the nerve cells in the brain and damage the cells. In children, this begins in the fetus early in pregnancy. By the time a child with Tay-Sachs is three or four years old, the nervous system is so badly affected that death usually results by age five.

testicle (testis) ~ the male sex gland. There are a pair of testes behind the penis in a pouch of skin called the scrotum. The testes make and store sperm, and make the male hormone testosterone.

thalassemia ~ a group of blood diseases, that are inherited, which affect a person's hemoglobin and cause anemia. Hemoglobin is a protein in red blood cells that carries oxygen and nutrients to cells in the body.

thrush ~ a yeast infection, caused by the fungus Candida albicans, of the mouth and throat. It's hallmark is white patches in the mouth. It can also occur in the gastrointestinal tract and vagina, and causes some types of diaper rash in infants.

thyroid ~ The thyroid is a small gland in the neck that makes and stores hormones that help regulate heart rate, blood pressure, body temperature, and the rate at which food is converted into energy.

toxemia ~ see preeclampsia.

toxoplasmosis ~ an infection caused by the parasite named Toxoplasma gondii that can invade tissues and damage the brain, especially in a fetus and in a newborn baby. Symptoms include fever, fatigue, headache, swollen lymph glands, and muscle aches and pains. Can be contracted by touching the hands to the mouth after gardening, cleaning a cat's litter box, or anything that came into contact with cat feces; or by eating raw or partly cooked meat, or touching the hands to the mouth after touching raw or undercooked meat.

trimester ~ A typical pregnancy is 9 months long. Pregnancy is divided into three time periods, or trimesters, that are each about three months in duration - the first, second, and third trimesters.

triple screen ~ blood test that indicates if there's an increased risk of a birth defect, or a condition like Down Syndrome, in the fetus. This test can also show twins.

ultrasound ~ a painless, harmless test that uses sound waves to produce images of the organs and structures of the body on a screen. Also called sonography.

umbilical cord ~ connected to the placenta and provides the transfer of nutrients and waste between the woman and the fetus.

urinalysis ~ a test that looks at urine to find out its content. Can be used to detect some types of diseases.

urinary tract infection ~ an infection anywhere in the urinary tract, or organs that collect and store urine and release it from your body (the kidneys, ureters, bladder, and urethra). An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the urethra (opening to the urinary tract) and begin to multiply.

uterine contractions ~ During the birthing process, a woman's uterus tightens, or contracts. Contractions can be strong and regular (meaning that they can happen every 5 minutes, every 3 minutes, and so on) during labor until the baby is delivered. Women can have contractions before labor starts; these are not regular and do not progress, or increase in intensity or duration.

uterine fibroids ~ common, benign (noncancerous) tumors that grow in the muscle of the uterus, or womb. Fibroids often cause no symptoms and need no treatment, and they usually shrink after menopause. But sometimes fibroids cause heavy bleeding or pain, and require treatment.

uterus ~ a woman's womb, or the hollow, pear-shaped organ located in a woman's lower abdomen between the bladder and the rectum.

vagina ~ The muscular canal that extends from the cervix to the outside of the body. Its walls are lined with mucus membranes and tiny glands that make vaginal secretions.

vulva ~ opening to the vagina.

Body Temperature Charting

Congratulations! You've made the decision to start trying to conceive. If you're like me, the thought can be daunting. After all, most of us have spent months or years avoiding conception. When my husband and I started planning the beginning of our family, I wanted to make the process as quick and efficient as possible. I did some research and decided that I would begin to chart my basal body temperature (BBT) in order to maximize my chances of becoming pregnant. After 19 completed cycles I'm a firm believer in this technique.

I am not a medical professional, just someone who has accumulated some experience through trial and error. Before you begin, I would encourage you to read a book by a health educator in order to gain some in-depth knowledge about BBT charting. My personal favorite is Taking Charge of Your Fertility by Toni Weschler. I strongly recommend this book; it's a fascinating read that covers the how's and why's of charting in a fun, easy to read format. With that disclaimer, I'm going to attempt to cover the basics.

How Does Charting Work?

During your monthly menstrual cycle, two hormones share star billing. During the first half of your cycle (called the follicular phase) estrogen is the star. Estrogen helps your ovaries produce an egg that is released during ovulation. During the second half of your cycle (the luteal phase), progesterone takes over. The progesterone will dominate until it falls in anticipation of your menstrual period.

With that background, it's easy to explain the theory behind charting. Estrogen is a "cool" hormone. Progesterone is "warm". Prior to ovulation, when estrogen is dominant, your body temperature is marginally cooler than after ovulation, when progesterone is in charge. Given these facts, an increase in basal body temperature indicates that you have ovulated.

How do I get started?

One nice thing about BBT charting is that it requires little monetary investment. The only equipment you will absolutely need is a reliable thermometer. I prefer to use a digital basal thermometer, but any thermometer will do. Make sure that the thermometer you are using will measure to the .10 degree, as the temperature changes at issue in charting can be quite small. I bought a basal thermometer at WalMart for under $10.00. I prefer it because it beeps when it is ready to go, it lights up, and it stores temperatures so that they don't have to be recorded right away.

You will also need a graph that displays a range of temperatures along the days of your cycle. Most digital basal thermometers come with a sample graph that can be enlarged and duplicated on any copy machine. There is also a thorough sample chart in the back of Taking Charge of Your Fertility. The type of chart you use is a matter of personal preference. All that matters is that you have one place to record your daily temperature, so that you can spot the fluctuating temperature patters that occur during your cycle.

Some people prefer to do their charting on-line. There are two Web sites that provide this service. At http://www.fertilityfriend.com/you can download free software that allows you to post your daily temperatures. The software also gives hints about your cycle. Or, you can go to http://www.tcoyf.com/.

I have my thermometer, what do I do now?

Great, you're ready to get started! BBT charting measures basal temperature. Basal temperature is your temperature when you very first awaken in the morning. That means that you take your temperature before you stand up, go to the bathroom, take a sip of water, brush your teeth, talk on the phone, or kiss your spouse. In my routine, the alarm goes off and I stick the thermometer in my mouth. It's that simple.

To be accurate, the temperature must be taken at the same time every day. During the week, I get up at 5:30. I take my temperature at that time. That means that I must also take my temperature at 5:30 on the weekends. Fortunately, I don't have to fully awaken; I just let the thermometer do its thing and then I go back to sleep.

The easiest way to begin charting is to start at CD1, the first day of your cycle. Cycle Day One is the first day that you see true red menstrual flow. You simply take your temperature and record it on your chart. Typically, pre-ovulatory temperatures range from 97.0 to 97.6, although there is a wide range of "normal" temperatures. One day, you will notice that your temperature is higher than it has been on previous days. The general rule is that you have ovulated when your temperature rises .2 degrees higher than any temperature from the previous 6 days, and it stays elevated for at least 3 consecutive days. In general, post-ovulatory temperatures range from 97.7 upward.

So, will charting tell me when I'm going to ovulate?

Unfortunately, using a BBT chart will only tell you when you have ovulated. It doesn't predict ovulation. Occasionally, you may experience a temperature dip on the day of ovulation. This is caused by an estrogen surge right at ovulation. Unfortunately, this does not always occur. In order to predict ovulation, it is necessary to track your cervical mucous.

When your period is over, you may notice that your cervical mucous is sticky or chalky. As you get closer to ovulation the fluid will get thinner. Eventually, the mucous turns to the consistency of egg whites. This is egg white cervical mucous, and it is highly fertile. As a general rule, you and your partner should be intimate every day that you see egg white cervical fluid. Once your temperature increases after ovulation you will notice that your cervical fluid gets thicker or dries up all together.

Some women are able to check for cervical mucous externally. Some women don't have enough fluid to feel externally and need to do an internal check. This is most easily accomplished while sitting on the toilet. Just make sure you have clean hands, and use your index or middle finger to reach up towards your cervix. I realize that this seems odd, but it's the best way to gauge your fertility at any given time of the month. The analysis of cervical mucous, in combination with using a BBT chart, is a great way to pinpoint your fertile times. The rule to remember is this: You should have intercourse every day that you see fertile cervical mucous, and continue until you see a temperature rise. Following this rule will guarantee that you are intimate on the days that promise the best chance of conceiving.

What are other benefits of charting?

If you and your partner have normal fertility, you should achieve success within 4 to 6 cycles of charting your BBT. This occurs because charting and tracking your cervical mucous allow you to have sex during your fertile times. The egg only lives for approximately 24 hours, so timing is everything.

The chart also lets you pinpoint your normal cycle. It is a myth to assume that every woman ovulates on day 14 of her cycle. In fact, a woman's normal pattern can mean ovulation on day 10 or day 21. Using the chart makes it easy to find your normal ovulatory schedule.


In addition to rapid pregnancy achievement, charting can alert you to some potential problems or complications, including:

Anovulation. If your chart never shows a sustained bi-phasic pattern, characterized by the lack of a temperature rise, it is likely that you are not ovulating. Charting can alert you to this fact, allowing you to seek medical intervention.

A luteal phase defect. Ideally, the luteal phase is 14 days. A luteal phase shorter than 10 days can impair fertility, as it makes it difficult for the fertilized embryo to implant in the uterus. You can easily spot a short luteal phase on a BBT chart; it is seen by the absence of at least 10 high temperatures.

A thyroid condition. Both hyperthyroidism and hypothyroidism can impair fertility. An under-active thyroid can sometimes be seen in very low temperatures, while a hyper-active thyroid is manifested in unusually high temperatures.

Male factor infertility. If you are consistently having sex on your fertile days but fail to become pregnant, it may be due to a problem with your partner's sperm. Once again, charting can alert you to this fact and allow you to seek intervention.

This information is only the tip of the iceberg. I would encourage anyone considering charting to read Taking Charge of Your Fertility or a similar book. A wealth of information may also be found at The Waiting Game, StorkNet's Trying to Conceive message board forum where you can meet lots of other supportive women. Good luck! I hope all of you soon realize your dream of becoming mothers.

Fertility Awareness

Understanding your monthly fertility pattern (days in the month when you are fertile, days when you are infertile, and days when fertility is unlikely, but possible) can help you plan a pregnancy, or avoid pregnancy. But if you already understand your menstrual cycle and fertility pattern, and are having problems getting pregnant, there is help and support available. In 2000, one in 10 U.S. women of reproductive age had a problem with fertility. If you have a problem with fertility, learn all you can about you and your partner's health, and your options for treatments.


Fertility Awareness

The Menstrual Cycle

Being aware of your menstrual cycle and the changes in your body that happen during this time can be key to helping you plan a pregnancy, or avoid pregnancy. During the menstrual cycle (a total average of 28 days), there are two parts: before ovulation and after ovulation.

Day 1 starts with the first day of your period.

Usually by Day 7, a woman's eggs start to prepare to be fertilized by sperm.

Between Day 7 and 11, the lining of the uterus (womb) starts to thicken, waiting for a fertilized egg to implant there.

Around Day 14 (in a 28-day cycle), hormones cause the egg that is most ripe to be released, a process called ovulation. The egg travels down the fallopian tube towards the uterus. If a sperm unites with the egg here, the egg will attach to the lining of the uterus, and pregnancy occurs.

If the egg is not fertilized, it will break apart.

Around Day 25 when hormone levels drop, it will be shed from the body with the lining of the uterus as a menstrual period.

The first part of the menstrual cycle is different in every woman, and even can be different from month-to-month in the same woman, varying from 13 to 20 days long. This is the most important part of the cycle to learn about, since this is when ovulation and pregnancy can occur. After ovulation, every woman (unless she has a health problem that affects her periods) will have a period within 14 to 16 days.

Charting Your Fertility Pattern

If you are aware of when you are most fertile, this will help you plan or prevent a pregnancy. There are three ways that you can keep track of this time each month:

Basal body temperature method - This involves taking your basal body temperature (your body's temperature when you're at rest) every morning before you get out of bed, and recording it on a chart. You will begin to know your own fertility pattern, and you can see the changes from month to month. During the menstrual cycle, your body temperature remains at a somewhat steady, lower level, and begins to slightly rise with ovulation. The rise can be a sudden jump or a gradual climb over a few days. The rise in temperature can't predict exactly when the egg is released, but your temperature rises between .4 to .8 degrees Fahrenheit on the day of ovulation. You are most fertile, and most likely to get pregnant during the two to three days just before your temperature hits the highest point (ovulation), and for about 12 to 24 hours after ovulation. A man's sperm can live for up to three days in your body and is able to fertilize an egg during that time. So, if you have unprotected sex several days before ovulation, there is a chance of becoming pregnant then. Once your temperature spikes and stays at a higher level for about three days, you can be sure that ovulation has occurred. Your temperature will remain at the higher level until your period starts. Basal body temperature differs slightly from woman to woman, but anywhere from 96 to 98 degrees orally is normal before ovulation, and anywhere from 97 to 99 degrees orally after ovulation. So, any changes that you chart are very small and are in 1/10 degree. You can buy an oral basal body temperature thermometer or an easy-to-read thermometer, which has the degrees marked in these small fractions, at a drug store. If you can't find it easily, ask the pharmacist to help you.


Calendar method - This involves keeping a written record of each menstrual cycle on a regular calendar. The first day of your period is Day 1, which you can circle on the calendar. Continue doing this for eight to 12 months so you know how many days are in your cycle. The length of your cycle can vary from month to month, so write down the total number of days it lasts each time in a list. To find out the first day when you are most fertile, check your list and find the cycle with the fewest days. Then subtract 18 from that number. Take this new number and count ahead that many days on the calendar. Draw an X through this date. The X marks the first day you're likely to be fertile. To find out the last day when you are fertile, subtract 11 days from your longest cycle and draw an X through this date. This method always should be used with other fertility awareness methods, especially if your cycles are not always the same lengths.

Cervical mucus method (also known as the ovulation method) - This involves being aware of the changes in your cervical mucus throughout the month. The hormones that control the menstrual cycle also cause changes in the kind and how much mucus you have just before and during ovulation. Right after your period, you usually have a few days when there is no mucus present or "dry days." As the egg starts to mature, mucus increases in the vagina, appears at the vaginal opening, and is usually white or yellow and cloudy and sticky. The greatest amount of mucus appears just before ovulation, during the "wet days," when it becomes clear and slippery, like raw egg whites. Sometimes it can be stretched apart. This is when you are most fertile. About four days after the wet days begin, the mucus changes again. There is now much less and it becomes sticky and cloudy. You might have a few more dry days before your period returns. You can describe changes in your mucus on a calendar. Label the days, "Sticky," "Dry," or "Wet." You are most fertile at the first sign of wetness after your period, but maybe also a day or two before wetness begins. This method is less reliable for women whose mucus pattern is changed because of breastfeeding, use of oral contraceptives or feminine hygiene products, having aginitis, sexually transmitted diseases (STDs), or surgery on the cervix.

To most accurately track your fertility, it is best to use a combination of all three methods, which is called the symptothermal method.

Infertility

It is not uncommon to have trouble becoming pregnant or experience infertility. Infertility is defined as not being able to become pregnant, despite trying for one year, in women under 35, or after six months in women 35 and over. Pregnancy is the result of a chain of events. As described in the Fertility Awareness section, a woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus. A man's sperm must join with (fertilize) the egg along the way. The fertilized egg must then become attached to the inside of the uterus. While this may seem simple, in fact many things can happen to prevent pregnancy.

Reasons for Infertility

Age

There are many different reasons why a couple might have infertility. One is age-related. Women today are often delaying having children until later in life, when they are in their 30s and 40s. A couple of things add to this trend. Birth control is easy to obtain and use, more women are in the work force, women are marrying at an older age, the divorce rate remains high, and married couples are delaying pregnancy until they are more financially secure. But the older you are, the harder it is to become pregnant. Women generally have some decrease in fertility starting in their early 30s. And while many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35.

As a woman ages, there are normal changes that occur in her ovaries and eggs. All women are born with over a million eggs in their ovaries (all the eggs that they will ever have), but only have about 300,000 left by puberty. Then of these, only about 300 eggs will be ovulated during the reproductive years. Even though menstrual cycles continue to be regular in a woman's 30s and 40s, the eggs that ovulate each month are of poorer quality than those from the 20s. It is harder to get pregnant when the eggs are poorer in quality. Ovarian reserve is the number and quality of eggs in your ovaries and how well the ovarian follicles respond to hormones in your body. As you approach menopause, your ovaries don't respond as well to your hormones, and in time they may not release an egg each month. A reduced ovarian reserve is natural as a woman ages, but young women might have reduced ovarian reserve due to smoking, a prior surgery on their ovaries, or a family history of early menopause. Also, as a woman and her eggs age, if she becomes pregnant, there is a greater chance of having genetic problems, such as having a baby with Down syndrome. Embryos formed from eggs in older women also are less likely to fully develop, a main reason for miscarriage (early pregnancy loss).

Health Problems

Couples also can have fertility problems because of health problems, in either the woman or the man. Common problems with a woman's reproductive organs, like uterine fibroids, endometriosis, and pelvic inflammatory disease can worsen with age and also affect fertility. These conditions might cause the fallopian tubes to be blocked, so the egg can't travel through the tubes into the uterus. Certain lifestyle choices also can have a negative effect on a woman's fertility, such as smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder. Some people also have diseases or conditions that affect their hormone levels, which can cause infertility in women and impotence and infertility in men. Polycystic ovarian syndrome (PCOS) is one such hormonal condition that affects many women, and is the most common cause of anovulation, or when a woman rarely or never ovulates. Another hormonal condition that is a common cause of infertility is when a woman has a luteal phase defect (LPD). A luteal phase is the time in the menstrual cycle between ovulation and the start of the next menstrual period. LPD is a failure of the uterine lining to be fully prepared for a fertilized egg to implant there. This happens either because a woman's body is not producing enough progesterone, or the uterine lining isn't responding to progesterone levels at some point in the menstrual cycle. Since pregnancy depends on a fertilized egg implanting in the uterine lining, LPD can interfere with a woman getting pregnant and with carrying a pregnancy successfully.

Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm, and have a slightly higher risk of sperm gene defects. They also might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility. Men also can have other health problems that affect their sexual and reproductive function. These can include sexually transmitted diseases (STDs), diabetes, surgery on the prostate gland, or a severe testicle injury or problem. If you or your partner has a problem with sexual function or libido, don't delay seeing your health care provider for help.

Treating Infertility

You should talk to your health care provider about your fertility if you:

Are under 35 and, after a year of frequent sex without birth control, you are having problems getting pregnant, or are 35 or over and, after six months of frequent sex without birth control, you are having problems getting pregnant, or believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant).

Your health care provider can refer you to a fertility specialist, a doctor who focuses in treating infertility. This doctor can recommend treatments such as drugs, surgery, or assisted reproductive technology. Don't delay seeing your health care provider because age also affects the success rates of these treatments.


Tests

The first step to treat infertility is to see a health care provider for a fertility evaluation. He or she will test both the woman and the man, to find out where the problem is. Testing on the man focuses on the number and health of his sperm. The lab will look at a sample of his sperm under a microscope to check sperm number, shape, and movement. Blood tests also can be done to check hormone levels. More tests might be needed to look for infection, or problems with hormones. These tests can include:

an x-ray (to look at his reproductive organs)

a mucus penetrance test (to see if sperm can swim through mucus)

a hamster-egg penetrance assay (to see if sperm can go through hamster egg cells, somewhat showing their power to fertilize human eggs)

Testing for the woman first looks at whether she is ovulating each month. This can be done by having her chart changes in her morning body temperature, by using an FDA-approved home ovulation test kit (which she can buy at a drug store), or by looking at her cervical mucus, which changes throughout her menstrual cycle. Ovulation also can be checked in her health care provider's office with an ultrasound test of the ovaries, or simple blood tests that check hormone levels, like the follicle-stimulating hormone (FSH) test. FSH is produced by the pituitary gland. In women, it helps control the menstrual cycle and the production of eggs by the ovaries. The amount of FSH varies throughout the menstrual cycle and is highest just before an egg is released. The amounts of FSH and other hormones (luteinizing hormone, estrogen, and progesterone) are measured in both a man and a woman to determine why the couple cannot achieve pregnancy. If the woman is ovulating, more testing will need to be done. These tests can include:

an hysterosalpingogram (an x-ray to check if the fallopian tubes are open and to show the shape of the uterus)

a laparoscopy (an exam of the tubes and other female organs for disease)

an endometrial biopsy (an exam of a small shred of the uterine lining to see if monthly changes in it are normal)

Other tests can be done to show whether the sperm and mucus are interacting in the right way, or if the man or woman is forming antibodies that are attacking the sperm and stopping them from getting to the egg.

Drugs and Surgery

Different treatments for infertility are recommended depending on what the problem is. About 90 percent of cases are treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems. It is important to talk with your health care provider about the drug to be used. You should understand the drug's benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women. If needed, surgery can be done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.

Assisted Reproductive Technology (ART)

Assisted reproductive technology (ART) uses special methods to help infertile couples, and involves handling both the woman's eggs and the man's sperm. Success rates vary and depend on many factors. But ART has made it possible for many couples to have children that otherwise would not have been conceived. ART can be expensive and time-consuming. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Also, some states have laws for infertility insurance coverage. Some of these include Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Rhode Island, Texas, and West Virginia.

In vitro fertilization (IVF) is a type of ART that is often used when a woman's fallopian tubes are blocked or when a man has low sperm counts. A drug is used to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed and placed in a culture dish with the man's sperm for fertilization. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman's uterus, thus bypassing the fallopian tubes. Gamete intrafallopian transfer (GIFT) is similar to IVF, but used when the woman has at least one normal fallopian tube. Three to five eggs are placed in the fallopian tube, along with the man's sperm, for fertilization inside the woman's body. Zygote intrafallopian transfer (ZIFT), also called tubal embryo transfer, combines IVF and GIFT. The eggs retrieved from the woman's ovaries are fertilized in the lab and placed in the fallopian tubes rather than the uterus.

ART sometimes involves the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby. And if a woman does not have any eggs, or her eggs are not of a good enough quality to produce a pregnancy, she and her partner might want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner, but the surrogate will give the baby to the couple at birth.

A gestational carrier might be an option for women who do not have a uterus, from having had a hysterectomy, but still have their ovaries, or for women who shouldn't become pregnant because of a serious health problem. In this case, the woman's eggs are fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. In this case, the carrier will not be related to the baby, and will give the baby to the parents at birth.

Counseling and Support Groups

If you've been having problems getting pregnant, you know how frustrating it can feel. Not being able to get pregnant can be one of the most stressful experiences a couple has. Both counseling and support groups can help you and your partner talk about your feelings, and to help you meet other couples like you in the same situation. You will learn that anger, grief, blame, guilt, and depression are all normal. Couples do survive infertility, and can become closer and stronger in the process. Ask your health care provider for the names of counselors or therapists with an interest in fertility.