Wednesday, February 25, 2009

How You Know If You're Fertile

In the wake of the octomom, patients have been asking me more questions than ever about fertility--they all want some, but not too much. So I'm often asked to check to see if they're able to have children, whether it's more kids or any at all. In order to be fertile, you need three working parts: your ovaries to regularly ovulate, your fallopian tubes to be clear to allow fertilization, and your uterus to be clear to allow implantation. Gynos can evaluate each of the three, based on your medical history, physical exam and sometimes testing.
  • Ovaries. The best sign of regular ovulation is regular menstruation. If your periods are coming regularly--21 to 35 days apart--you are most likely ovulating. Longer or shorter periods could signify thyroid or pituitary dysfunction, which can be diagnosed through blood testing. Gynos can also evaluate the general state of your eggs, or "ovarian reserve," through specialized blood testing on day three of your period.
  • Fallopian tubes. Scarring of the tubes sometimes occurs with pelvic inflammatory disease, endometriosis, or pelvic surgery. Your doc can order a special X-ray of your tubes called a hysterosalpingogram (HSG) if she suspects tubal blockage. If a blockage is found, there are multiple procedures that can be performed to clear the path.
  • Uterus. Uterine anomalies like a septum, polyp or fibroids can impede a pregnancy's implantation. Often these anomalies don't cause any trouble, but if you have a history of super-heavy periods or several miscarriages, your gyno may order an HSG to check out the inner contours of your uterus. If something there is making mischief, it can be surgically removed.

If you have regular periods and you've never had any gyno woes, your reproductive tract is likely in order. The hardest question I hear is "Can I put off trying to get pregnant for a year or two?" While I can determine how your gyno health is today, there's no test that can predict what will happen in the future. In other words, I can't tell you when you'll run out of eggs, or if another problem will develop. The best things you can do? Stay STD-free, in the best health you can...and when the time is right, go for it.

Do any of you worry about your fertility?

21 comments:

Max said...

This does not have to do with my fertility exactly, but I guess it could. Im 16 and I was 12 when I first had my period. For the longest time I would skip my period etc, but I knew that was normal because thats how it is when you first start, and I was also very active in sports. Well now that im 16 my period is pretty regular I haven't skipped or anything like I used to..Until this month and I am not as active as I used to be at all. Could stress possibly be why I'm late this month? I am also not sexually active.

Dr. Kate said...

Max,
If you're not on hormonal birth control, it's totally normal to skip a period once in awhile, or to "double up" one month and have two. Yes, it may be stress, but it may be just a random fluctuation of your hormones.

BlancaM.com said...

I am 21yrs old and I have been off birth control for about a year and since I have been missing a period every 3 months. I have had 2 periods in one month but only once. I also have spotting after very period. I am not very active. Is this normal or is it my inactivity and my weight?

Dr. Kate said...

Blanca, it's normal to skip a period (or to double up) once in a while, and some women just never have regular cycles. Being overweight does increase this risk. You could have your gyno do some blood tests (for thyroid and pituitary problems) to be sure that nothing else is happening. But this may just be what's normal for you.

OVER35 said...

To my knowledge i'm infertile.. I'm over 35 and has never had a child or been pregant. Back in 1988-89 I was told I had chlamittia, is this the reason I cant have kids?. I have always had heavy and irregular cycles before I became sexually active and there are 3 women in my family who could'nt bare children either..(Grate Aunts)

Dr. Kate said...

OVER35, it could be a couple of things impairing your fertility. Chlamydia can lead to scarring in your fallopian tubes; this can be detected with a special Xray called an HSG. But hormonal dysfunction can reduce your chances of ovulation, as well. If you want to conceive, a gyno can check all of this out for you...so you'll know for sure.

jina said...

i am 24 years old female i recently found out that i have hypothyroidism and i'm on levothyroxine...i have my periods on regular basis never skipped a period...but now i've started to get very light periods they usually lasts for 2 days and not very heavy..so i was just worried that if i have any problem. i have read somewhere that it can also causes infertility so i was really worried about it...is this something i should be really worried about?

Dr. Kate said...

Jina, it's true that thyroid disease can impair your fertility, by not letting you ovulate each month. But if you're getting monthly periods - even if they're lighter than before - it means you're ovulating just fine. Hypothyroidism is very common, and you'll likely have no problems getting pregnant. As for really light periods, they're not a sign of a problem, as long as they're monthly - so enjoy them!

elizabeth said...

I am 22 yrs old. My spouse and I have been trying to conceive for the last 3 months. As of today nothing. I'm worried I might be infertile. I suffered with an eating disorder for 3 years on and off. I also worked out a lot, during this time I didn't have a menstrual cycle for a year. I've reached a healthy weight and have been regular on my menstrual cycle for the last year.Could it be due to my eating disorder?

Winnie said...

I've always wondered if I can fall pregnant. There have been many occasions when I have had sex with my partner and haven't used contraception. I went off the pill and was off it for nearly a year when I started going out with him.
I've never had any problems with my uterus or the like, periods have been normal and like clockwork when off the pill (although I had small problems with heavy periods when I was in my teens- I'm now 33) or the nuvaring which I've used.
How do I check if I am fertile or am producing enough eggs? I'd like to have kids one day but aren't sure if I can...

Dr. Kate said...

Winnie, if you're having periods every month, that means you're ovulating - so for now, you ARE fertile from the standpoint of your ovaries. No test can tell you how many eggs you have in reserve, though, and at some point your egg quality will start to decline (most likely over 40). My guess is that you've just not had sex at the right time of the cycle to result in a pregnancy. Once you've actively tried for 6 months and haven't conceived, it would be time to see your gyno for a work-up.

Dr. Kate said...

Elizabeth, if your periods have come back and are regular, it's got nothing to do with your eating disorder (congratulations on being healthy, by the way). Even if your periods come like clock-work, it can take up to a year to get pregnant...even at 23. So be patient, and if pregnancy hasn't happened by the end of the summer, you can talk with your gyno.

shark byte said...

I am 23 years old. I have been told since I was about 10yrs I would most likely not be able to convieve a child. The issue that made this a problem was a diagnosis of leukemia when I was a child and a transplant when I was 10. I have never had a regular period and if I am not on hormone suppliments I do not have one at all. I have not been to see a specialist however I am reaching a point in my life where a baby isnt such a scary thought. Is there any possible way that there might still be a possability of biological children in my future?

kayla said...

I am trying to have a baby for the last seven months. And I can't conceive. Please help me?

Dr. Kate said...

Shark byte, I think you need to see a gynecologist as soon as you can. Since you haven't had periods on your own, I think your chances of conceiving are small--but the only way to know for sure is a blood test that your gyno can do. An FSH test can give your gyno a pretty good idea about the state of your ovaries. I wish you the best of luck.

Dr. Kate said...

Kayla, so many things can be happening, you should sit down with your gyno to review them all. She'll talk with you about your periods, your medical history, and do an exam, and together you can figure out what's going on.

baby woes said...

Dr. Kate,
I'm 31 years old, been taking birth control since I was 16. I quit taking the pill Dec, 09. I've yet to become pregnant. While I was taking the pill, my periods were regular and 5 days long. Since stopping them, my period is only two days long. Does this mean I may be infertile? What recommendations do you have to help me conceive? Is there any tests that can be done to determine that all my "parts" are in working order?

myangelz6361 said...

.I would like to know if I'm still fertile, because we've been trying to conceive for 2 yrs now and nothing has ever come of it. During those 2 yrs,I had pid for a few days ( once i felt the sharp abdominal pains, i was in the ER that same day,treated & sent home) last May.I have a daughter already, aged 8. But we want more kids,& she wants a playmate...Please give me some detailed insight and help very soon. Thank u for ur time & expertise.

Dr. Kate said...

Myangelz, the PID may have affected your fallopian tubes, by causing blockages and making it impossible for sperm to reach the egg. Since you've been trying for so long, I would see your gyno as soon as possible for an evaluation. Good luck.

Dr. Kate said...

Baby woes, the fact that you're having regular periods--even if they're short--is a very good sign. You can try an ovulation predictor kit to see if you are in fact ovulating. But all other testing (particularly of your tubes and his sperm) will have to be done through your doctor. If you haven't gotten pregnant by the middle of the summer, I would see your gyno.

myangelz6361 said...

THANKS AGAIN DR. KATE;)