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    3 months into Trying...
    An_249661 posted:
    Hello, this is my first time posting on this form and I'm looking for a little reassurance or tips. I'm 39 this week and conceived last year 4 months into stopping the Birth control but had a loss due to chromosome issues. We had since been trying for the last 3months and I'm concerned that I may not be doing all I can to ensure conception. I am charting and my cycles are pretty much exact to a 28 day cycle. I always feel major ovulation pain mid cycle so I know I am ovulating. At this age at what point should I panic? I don't want to get into my 40's and still trying for the first. Any tips, ideas, suggestions???
    David K Walmer, MD, PhD responded:
    Dear An...
    There are two directions that you can take. Maximize the timing of intercourse to coincide with your fertile window and/or go and get a pre-conception evaluation and counseling. Humans, by nature, have recurrent pregnancy loss, which is reflected by the fact that we don't see a positive pregnancy test every month that we time intercourse well. Most miscarriages occur between the time that you ovulate and the time that your menstrual period comes so you aren't aware that you were pregnant. Human embryos frequently have chromosome issues due to mistakes in cell division. As we age, the miscarriage rate (unrecognized and recognized) increases. The average age that a woman shows up in a fertility clinic asking for advice due to her age-related decline in fertility is 35 years. The simplest and least expensive form of assistance for age-related issues is to take medications that stimulate your ovaries to release more eggs (to try to counter balance the increasing inefficiency of the reproductive system). This can be done with pills (less expensive) or injections of pituitary hormones. There are other issues that should be looked at as well. Sperm parameters, anatomy of your reproductive tract to make sure that you don't have other reasons for a higher miscarriage rate. Your local fertility specialist can share a lot more information with you.
    With regard to timing. If you are ovulating normally, your fertile period is approximately 14 - 18 days before each menstrual period. Your partner should ejaculate once a few days before the fertile window and at least once in the fertile window. Women normally release their eggs ~14 days before the next period, which for you would be cycle day 14. That important day can be confirmed with an ovulation predictor kit that you can purchase at your local pharmacy. Good luck!

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    For more information, visit the Duke Fertility Center