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Fertility Evaluation
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DUKE MEDICINE
Susannah D Copland, MD, MS posted:
Couples should consider seeing a doctor if they have been trying to conceive for a year without success (6 months for women over 35).
The beginnings of a fertility evaluation focus on eggs, tubes, and sperm. With regards to eggs, your doctor will want to confirm that you are releasing your egg and determine how many eggs remain. Signs that you are releasing an egg are regular, predictable menstrual cycles, positive ovulation predictor kits, shifts in basal body temperature, and/or a high progesterone level approximately one week before your period. Ovarian reserve, the number of eggs remaining in the ovary, can be evaluated with blood tests (FSH, AMH) and ultrasound for antral follicle count. Fallopian tubes can be evaluated by a hysterosalpingogram, an xray test where xray dye is injected into the cervix. The xray shows the cavity of the uterus and whether the tubes are open. Sperm are evaluated with a semen analysis to look for sperm number and motion. If a semen analysis is not normal, it will be repeated to rule out normal fluctuations. If it is normal either the first or second time, no further evaluation is needed. If it is abnormal twice, you will be referred to urology for further evaluation. The next steps in fertility evaluation and treatment will be based on results to the above tests. While these tests can identify some fertility factors, mother nature is more complex. Occasionally all the tests will be normal, despite a continued delay to pregnancy. Therefore, your doctor will discuss fertility treatment in the context of the evaluation you have completed.
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cyclonebunz responded:
Is their any reason to consult a doctor before a year if you are trying to concieve your first child for about 9 months and you are in your early 20s?
 
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tarheel76 responded:
Can stress cause a miscarriage? what are ways you recommend reducing stress for your patients? i have been highly stressed recently--mostly work related--and i'm a little over 4 wks pregnant from date of start of last menstrual period. I'm worried that the stress might harm the pregnancy...
 
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DUKE MEDICINE
Susannah D Copland, MD, MS replied to cyclonebunz's response:
I recommend discussing your plans for pregnancy with your OB-Gyn at your routine annual exam and pap smear. Your OB-Gyn will be able to discuss preconception counseling and identify risk factors for fertility. That said, if a woman is in her 20s, has regular predictable menstrual cycles, no history of prior pelvic infection or surgery, no family history of fertility problems or premature menopause, and her partner has no history of surgery, injury or infection to his reproductive tract, we would not embark upon fertility evaluation for one year. Ovulation predictor kits may help identify the fertile window to increase the chance of conception. If conception does not happen by one year, the information from the ovulation predictor kits may help in your discussion of ovulatory function with your fertility doctor.
 
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DUKE MEDICINE
Susannah D Copland, MD, MS replied to tarheel76's response:
It is unlikely that psychological stress could cause a miscarriage. Stress and miscarriage is a difficult area to study. Most research looks at woman after they have already had a miscarriage; a prior miscarriage increases the likelihood that a couple will be under stress in future pregnancies. That said, decreasing stress can only be of benefit for health and wellness. Therefore, I encourage all of my patients who are trying to conceive or already pregnant to take care of their health, both physical and mental. Techniques that I recommend include: identifying stressors and finding ways to eliminate or minimize them, acupuncture, massage, yoga, writing in a journal, cognitive behavioral therapy under the care of a psychologist, participating in activities that are relaxing (music, dance, walking). Reaching out to friends and family or joining a local mind/body wellness group can also be helpful. Good luck!
 
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lovemylife89 responded:
Wow your information was very helpful. I am 21 and my husband and i have been trying to conceive for over 2 years. I've tried the timing and ovulation kits. It's just not working and at times it can be pretty frustrating. I was on the depo-provera shot when i was 14. Being told it would regulate me periods i stayed on it for about 2 1/2 yrs. The last shot i had was in May of 2005. I didn't have a period the whole time i was taking the shot which my dr told me was normal for some people. It took about 6 months for me to have a period after i stopped taking the shot and a little over 3 years before i got back to a half way normal and predictable cycle. For 7 months my periods were exactly 4 weeks apart. Then for 2 months my body started having a period exactly every 5 weeks and that's where i'm at now. I've heard that the shot can cause infertility and i'm worried that could be the case since i havent had any luck conceiving. What is your opinion on this?
 
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An_191495 responded:
Hello. I'm in my early 30's and have been trying to conceive since March 2009. I conceived last year after only 3 months, but unfortunately had a missed miscarriage @ 10 weeks. At my 7 week ultrasound, I was told that I was measuring small for my dates. I had a d&c. Since then, my periods have been regular. I've been trying to conceive now for 14 months. I use ovulation predictor kits regularly and get positive results. I tried weekly acupuncture treatments for 6 months as well. My weight and overall health is good. I'm wondering if I should see my ob/gyn or a RE. Please advise. Thank you.
 
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lindgren28 responded:
my boyfriend and i have been tryin for 11 months now to get pregnant and it just not happening
 
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Annalitical1 responded:
Hi, I am 32 years old and have never had a menstrual cycle. I have seen many dr's and no one has ever told me why I don't. I have had ultra sounds and hormones. Nothing starts it and nothing helps. I have been married for ten years and my husband and I really would love to concieve. My dr just sent us to an IVF dr but my insurance doesn't cover it and it's rather expensive. I don't know what to do when I'm told I ovulate but don't continue the process. Any suggestions?
 
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kparson90 responded:
have been trying now for two years my boyfriend already has a child so i guess its not him but i didnt ovulate this past month and that makes me wonder if i ovulated in the past
 
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carmel_2010 responded:
I am confused about this trying to get pregnant process...how big does a follicle (egg) have to be so u can get pregnant....i am on 50mg of clomid and this is my 4th month i take it in 3-9 days of my cycle and i have only had 1 ultrasound but i take another monday....i have Polcycstic ovary syndrome and i have been overweight for about 10 years....i have been trying to get pregnant without medications for 3 yrs but no luck....i have 3 children and just wonder why this happens to people that have already had children...also i heard that u could get pregnant with twins on clomid.....??? is that true and whats the ratio???

Mindy
 
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An_191496 responded:
Have been using digital ovulation predictor test for the past 8 months (36 y/o) - i'm considering the over the counter fsh test -- how reliable is the first response fsh test or is it better to see a doctor for this test? Also, partner recently had a semen analysis which was ok -- bloodwork showed testosterone is slightly low (one digit below the low end # of the normal range) -- does that play a role in trying to conceive?
 
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Stanislaos replied to Susannah D Copland, MD, MS's response:
hi Doc

I just like to know wherther iam still going to have a baby or not, iam from Namibia, Windhoek, i just heve my tubs open in Feb 2010, and still mensturation, every month, but my cycel chance from the 25th to the 15th for the last 4 months and still trying so iam corncer my tubs are damage, i was on Clomiphene Citrate 2 time already but stll nothing please give me atwise what to do iam syill young 31yrs old, and realy desprite to give my husband a baby.
 
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yergy responded:
Hi am 22 years old and I'm trying to conceive for the past few months but my periods are really irregular. I will get it once a year or every 6 month. I don't have any health insurance because I can't afford it and I wanted to know if you have any recommendations for me.
 
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caseylynn33 replied to yergy's response:
Hi, I don't mean to get into your personal business but if you want to have a baby and have no medical insurance how do you plan on paying for it? Doctor visits get very expensive and so does giving birth, not to mention once your child is born. You should really think about that before conceiving a child.


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