Facts About Folic Acid How much folic acid a woman needs 400 micrograms (mcg) every day. When to start taking folic acid For folic acid to help prevent major birth defects, a woman needs to start taking it at least one month before she becomes pregnant and while she is pregnant. However, every woman needs folic acid every day, whether she s planning to get pregnant or not, for the healthy new cells the body makes daily. Think about the skin, hair, and nails. These and other parts of the body make new cells each day. How a woman can get enough folic acid There are two easy ways to be sure to get enough folic acid each day: CDC urges women to take 400 mcg of folic acid every day, starting at least one month before getting pregnant, to help prevent major birth defects of the baby s brain and spine. About folic acid Folic acid is a B vitamin. Our bodies use it to make new cells. Everyone needs folic acid. Why folic acid is so important Folic acid is very important because it can help prevent major birth defects of the baby s brain and spine (anencephaly and spina bifida) by 50% to 70%. 1. Take a vitamin that has folic acid in it every day. Most multivitamins sold in the United States have the amount of folic acid women need each day. Women can also choose to take a small pill (supplement) that has only folic acid in it each day. Multivitamins and folic acid pills can be found at most local pharmacy, grocery, or discount stores. Check the label to be sure it contains 100% of the daily value (DV) of folic acid, which is 400 micrograms (mcg). 2. Eat a bowl of breakfast cereal that has 100% of the daily value of folic acid every day. Not every cereal has this amount. Check the label on the side of the box, and look for one that has 100% next to folic acid. To learn more about folic acid and how to prevent birth defects, please visit the Centers for Disease Control and Prevention website at www.cdc.gov/folicacid or call 1-800-232-4636 (CDC-INFO). National Center on Birth Defects and Developmental Disabilities Division of Birth Defects and Developmental Disabilities CS212882-A
Fact Sheet From ReproductiveFacts.org The Patient Education Website of the American Society for Reproductive Medicine Optimizing Natural Fertility What can I do to improve my chances of conceiving naturally? Before attempting pregnancy, a woman should make sure she is healthy enough for pregnancy by adopting a healthier lifestyle and taking prenatal vitamins. If she has a medical or genetic condition, she should seek advice from a medical professional before conceiving (becoming pregnant). What are my chances of conceiving? There is no simple answer. For women with regular menstrual cycles, your age and number of months that you have been trying to get pregnant are two factors that affect your chance of success. You and your partner have the highest chance of conceiving in the first three months of trying. For young fertile couples, the chance of conception is between 20% and 37% during the first three months. The chance of success increases to 80% by one year and 90% after two years of trying. Women over the age of 35 and men over the age of 50 have lower fertility rates. How often should a couple have intercourse? Surprisingly, long periods of abstinence (not having intercourse) can decrease the quality of sperm, and infrequent intercourse may decrease the chance of intercourse occuring around the time of ovulation. The highest pregnancy rates are seen when a couple has intercourse every 1-2 days during the fertile window. What is the fertile window? The fertile window is the time in a cycle when pregnancy can occur and is usually the six-day interval ending on the day of ovulation. Generally, ovulation occurs 14 days prior to the next menses (period), so a woman with a 28-day cycle will ovulate around cycle day 14 (that is 14 days after the start of her last menstrual period). That means that intercourse is most likely to result in pregnancy if it occurs within the six-day interval ending the day of ovulation. How do I know when I am ovulating? Because the fertile window is defined by the date of ovulation, it is important to know when the woman is ovulating. Several methods of determining ovulation have emerged. Cervical mucus and vaginal secretions start to increase 5-6 days prior to ovulation and peak 2-3 days prior to ovulation. These changes can be monitored to successfully identify the fertile window in many women. Urinary ovulation predictor kits can also be used to detect the rise in luteinizing hormone (LH ) that happens just before ovulation. LH is the primary trigger that results in the eggs being released from the ovary. Are there coital (intercourse) practices that can improve our chances of conceiving? Sperm ejaculated or released into the vagina reach the fallopian tubes within minutes regardless of position during intercourse. There is no evidence that sexual position, orgasm or prolonged rest after intercourse increases the chance of conception. Some lubricants (Astroglide, KY jelly, Touch, saliva and olive oil) used during intercourse may decrease sperm motility (movement) or viability and therefore should be avoided if possible. Others (Pre-Seed, mineral oil or canola oil) have no such affect and can be used as needed. Does diet affect fertility? Fertility is clearly decreased in women who are very thin or obese, but there is no evidence that normal diet variations affect women who are normal weight (body mass index 19-25) and having regular periods. The one exception is that a diet rich in mercury (found in some seafood) is associated with infertility. Smoking, heavy alcohol consumption (> 2 drinks per day), heavy caffeine consumption, and the use of recreational drugs have all been associated with reduced fertility. Therefore, women considering pregnancy should reduce alcohol and caffeine use; and they should also avoid smoking and all recreational drugs while trying to conceive. Revised 2012 For more information on this and other reproductive health topics visit www.reproductivefacts.org AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE1209 Montgomery Highway Birmingham, Alabama 35216-2809 TEL (205) 978-5000 FAX (205) 978-5005 E-MAIL asrm@asrm.org URL www.asrm.org
Fact Sheet From ReproductiveFacts.org The Patient Education Website of the American Society for Reproductive Medicine What are our chances of conceiving? The chance of a normal couple conceiving is 20% to 37% by three months, 75% by six months, and 90% at one year. Of those couples that do not conceive in the first year, as many as 50% will conceive in the next year. Couples that have tried without success to conceive should see a fertility specialist. About 20% of infertility cases are due to a male factor alone. Another 30% involves both male and female factors. How is male fertility evaluated? The first way a doctor evaluates male fertility involves a physical exam and medical history. After that, semen is evaluated. The semen is normally collected in a sterile containter by masturbation. The semen test gives important information about the amount, movement, and shape of sperm. If the sperm count is normal and the sperm are of normal shape and moving normally, the man is most likely normal. If the results are abnormal, the sperm should be examined. Illness or medications three months earlier can impair sperm ejaculated on the day of examination. Hormone blood tests also may be used to help evaluate male fertility issues. How often should a couple have intercourse? Surprisingly, long periods of abstinence can decrease the quality of sperm. Couples should have intercourse (sex) at least two to three times a week during the fertile period. A couple has more chances for pregnancy if they have intercourse every one to two days during the fertile window, and a pregnancy is most likely if a couple has intercourse within the six-day time frame that ends on the day that an egg is released (ovulation). Are there coital (sex) practices that can improve our chances of conceiving? Sperm ejaculated into the vagina reaches the fallopian tubes within minutes regardless of position during intercourse. Also, there is no evidence that orgasm or prolonged rest after intercourse increases the chance of conception. Some commercial lubricants and other substances used for lubrication such as saliva, olive oil and KY Jelly should be avoided during the fertile period. They may make the sperm move slower and decrease their ability to survive. You may want to discuss lubricant choices with your doctor since there are a few lubricants that are believed to be safe for use when trying to conceive. Does diet affect fertility? Obesity has been clearly linked to impaired sperm production. Overweight men interested in optimizing Optimizing Male Fertility fertility should attempt to attain an ideal body weight. Antioxidants such as vitamins E and C are found in most multi-vitamins. They have been found to result in a slight increase in both sperm count and movement. Fruits and vegetables also provide a natural source of antioxidants and should be part of a balanced and healthy diet. What are the effects of smoking and recreational drug use? Smoking is associated with reduced sperm quality. Men who are trying to conceive should consider stopping smoking immediately. Also, recreational drugs, including anabolic steroids and marijuana, are associated with impaired sperm function. They should not be used. Are boxers shorts or briefs better? Some studies suggest that wearing brief underwear may raise the temperature around the scrotum and cause a decrease in sperm quality. Choosing boxer underwear is one way to avoid this. The evidence from these studies is inconclusive. Regardless, avoiding situations that raise scrotal temperature (like hot tubs or using laptops on your lap) might improve sperm quantity and quality. Some medications, along with chronic medical conditions and high fevers, may impair the body s ability to make sperm. Ask your doctor how your medications or conditions affect your fertility potential. How can I improve our chances of conceiving naturally? Like many aspects of our health, a man s fertility is improved by adopting a healthy lifestyle. Maintaining an ideal weight, a diet rich in antioxidants (found in fruits and vegetables), as well as multi-vitamins may improve the quality of sperm. Reducing stress and controlling chronic medical conditions such as high blood pressure and diabetes may also improve a man s chances of impregnating his partner. Remember that any such changes in the man s lifestyle will take almost three months to show an improvement in sperm. Couples with underlying medical or genetic conditions should see a doctor so that they can increase their overall health before conceiving. Revised 2012 For more information on this and other reproductive health topics, visit www.reproductivefacts.org AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE 1209 Montgomery Highway Birmingham, Alabama 35216-2809 TEL (205) 978-5000 FAX (205) 978-5005 E-MAIL asrm@asrm.org URL www.asrm.org
Fact Sheet From ReproductiveFacts.org The Patient Education Website of the American Society for Reproductive Medicine Diagnostic Testing for Female Infertility An evaluation of a woman for infertility is appropriate for women who have not become pregnant after having 12 months of regular, unprotected intercourse. Being evaluated earlier is appropriate after six months for women who are older than age 35 or who have one of the following in their medical history or physical examination: History of irregular menstrual cycles (over 35 days apart or no periods at all) Known or suspected problems with the uterus (womb), tubes, or other problems in the abdominal cavity (like endometriosis or adhesions) Known or suspected male infertility problems Any evaluation for infertility should be done in a focused and costeffective way to find all relevant factors, and should include the male as well as female partners. The least invasive methods that can detect the most common causes of infertility should be done first. The speed and extent of evaluation should take into account the couple s preferences, the woman s age, the duration of infertility, and unique features of the medical history and physical examination. The following tests may be recommended as part of your infertility evaluation: Male Partner Semen Analysis: Although the semen analysis is obtained from the male partner, it is an essential part of the infertility evaluation. A semen analysis should provide information about the number, movement, and shape of the sperm. A semen analysis is necessary even if the male partner has fathered a child before. Hysterosalpingogram (HSG): This is an X-ray procedure to see if the fallopian tubes are open and to if the shape of the uterine cavity is normal. A catheter is inserted into the opening of the cervix through the vagina. A liquid containing iodine (contrast) is injected through the catheter. The contrast fills the uterus and enters the tubes, outlining the length of the tubes, and spills out their ends if they are open. Transvaginal Ultrasonography: An ultrasound probe placed in the vagina allows the clinician to check the uterus and ovaries for abnormalities such as fibroids and ovarian cysts. Ovarian Reserve Testing: When attempting to test for a woman s ovarian reserve, the clinician is trying to predict whether she can produce an egg or eggs of good quality and how well her ovaries are responding to the hormonal signals from her brain. The most common test to evaluate ovarian reserve is a blood test for folliclestimulating hormone (FSH) drawn on cycle day 3. In addition to the FSH level, your physician may recommend other blood tests, such as estradiol, antimüllerian hormone (AMH), and/or inhibin-b, as well as a transvaginal ultrasound to do an antral follicle count (the number of follicles or egg sacs seen during the early part of a menstrual cycle). Ovarian reserve testing is more important for women who have a higher risk of reduced ovarian reserve, such as women who: 1) are over age 35 years; 2) have a family history of early menopause; 3) have a single ovary; 4) have a history of previous ovarian surgery, chemotherapy, or pelvic radiation therapy; 5) have unexplained infertility; or 6) have shown poor response to gonadotropin ovarian stimulation. Other Blood Tests: Thyroid-stimulating hormone (TSH) and prolactin levels are useful to identify thyroid disorders and hyperprolactinemia, which may cause problems with fertility, menstrual irregularities, and repeated miscarriages. In women who are thought to have an increase in hirsutism (including hair on the face and/or down the middle of the chest or abdomen), blood tests for dehydroepiandrosterone sulfate (DHEAS), 17-α hydroxyprogesterone, and total testosterone should be considered. A blood progesterone level drawn in the second half of the menstrual cycle can help document whether ovulation has occurred. Urinary Luteinizing Hormone (LH): Over-the-counter ovulation predictor kits detect the presence of LH in urine and can detect a rise in this hormone that occurs one to two days before ovulation. In contrast to blood progesterone levels, urinary LH tests can predict ovulation before it occurs. Urinary LH testing helps define the times of greatest fertility: the day of the LH surge and the following two days. However, these tests can be expensive and should only be used by women with menstrual cycles that are consistently 25-35 days in length. Sonohysterography: This procedure uses transvaginal ultrasound after filling the uterus with saline (a salt solution). This improves detection of intrauterine problems such as endometrial polyps and fibroids compared with using transvaginal ultrasonography alone. If an abnormality is seen, a hysteroscopy is typically done. This test is often done in place of HSG. Hysteroscopy: This is a surgical procedure in which a lighted telescope-like instrument (hysteroscope) is passed through the cervix to view the inside of the uterus. Hysteroscopy can help diagnose and treat abnormalities inside the uterine cavity such as polyps, fibroids, and adhesions (scar tissue). Laparoscopy: This is a surgical procedure in which a lighted telescope-like instrument (laparoscope) is inserted through the wall of the abdomen into the pelvic cavity. Laparoscopy is useful to evaluate the pelvic cavity for endometriosis, pelvic adhesions, and other abnormalities. Laparoscopy is not a first line option in the evaluation of a female patient. Because of its higher costs and potential surgical risk, it may be recommended depending on the results of other testing and a woman s history, such as pelvic pain and previous surgeries. For best results, the infertility evaluation should be individualized based on each woman s specific circumstances. Revised 2012 For more information on this and other reproductive health topics, visit www.reproductivefacts.org AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE 1209 Montgomery Highway Birmingham, Alabama 35216-2809 TEL (205) 978-5000 FAX (205) 978-5005 E-MAIL asrm@asrm.org URL www.asrm.org
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE 1209 Montgomery Highway Birmingham, Alabama 35216-2809 TEL (205) 978-5000 FAX (205) 978-5005 E-MAIL asrm@asrm.org URL www.asrm.org PATIENT FACT SHEET Diagnostic Testing for Male Factor Infertility When a couple has trouble having a baby, there's about a 50-50 chance that the man has a problem contributing to the pregnancy. He might: Produce too few sperm to fertilize an egg Make sperm that are not shaped properly or that do not move the way they should Have a blockage in his reproductive tract that keeps sperm from getting out If you might have a fertility problem, your doctor will want to perform a complete history and physical, as well as several tests to find out what may be causing your infertility. Semen analysis Semen analysis is probably the first test you will be asked to perform. Semen is the fluid that is released when a man has an orgasm. Semen carries the sperm in fluids that should nourish and protect it. You will typically be asked to provide a semen sample by masturbating into a sterile glass jar. If masturbation is not culturally acceptable, your doctor can provide you with a special condom in which to collect semen during intercourse. The semen analysis provides a lot of information about the quantity and quality of both semen and the sperm it contains. Some of the things that are measured are: How much semen a man produces (volume) The total number of sperm in the semen sample (total count) The number of sperm in each milliliter of semen (concentration) The percentage of sperm that are moving (motility) If the sperm are the right shape or not (morphology) The analysis can also suggest if you have an infection in your reproductive system. The semen sample has to be tested within an hour of collection, which usually takes place in the doctor's office. You'll probably need to make two visits to provide samples on two different days more than two weeks apart, because samples from the same man can be different at different times. Collecting two samples makes it easier to tell if something really is wrong. You may be asked not to release sperm (ejaculate) for 2 to 5 days before you provide a sample. Hormone levels and reproduction Important chemicals in your body, called hormones, control sperm production. They also affect your interest in sex and your ability to have sex. Too much or too little of these hormones can cause problems with sperm production or trouble having sex. Two important hormones for reproduction are follicle-stimulating hormone (FSH) and testosterone (T). Your doctor may do blood work to check to see if you have the right amount of these hormones. If indicated, your doctor may check other hormone levels, including luteinizing hormone (LH), estradiol, and prolactin. Other testing (that may not be necessary in most men) If the semen analysis test results aren't normal, you may need to have more tests that can be performed by your doctor or you may be referred to a urologist. These tests will show: If enough sperm in the semen sample are alive ("vital staining" test) If antibodies have attached to sperm, making it hard for the sperm to move properly ("antisperm antibodies" test) If you have an infection or inflammation that affects your semen ("peroxidase staining" and "semen culture") More tests (but these won't be necessary for most men) If you've had the tests described above, but your doctor still does not know why you are having problems, additional tests may be necessary. These tests will tell your doctor: If the outer layer of the sperm is broken or intact ("hypo-osmotic swelling" test) If your sperm are moving the way they should ("computer-assisted semen analysis") If too many of your sperm have broken or fragile DNA ("sperm DNA testing") If you produce very few sperm (or if you produce no sperm), your doctor may want to perform a genetic test to see if there is anything abnormal with your genes that makes it impossible for you to produce sperm. These tests can also tell if there is a problem that you could pass on to a child. These tests will tell your doctor: If your sperm have the correct number of chromosomes (sperm aneuploidy testing) If you have a chromosome defect (chromosome analysis and/or Y-chromosome deletion testing) If no sperm are seen (determine if the sperm tubes are intact or perform a biopsy of the testicles) No semen test can fully predict fertility. Other than a semen analysis, not all tests discussed are appropriate for every couple. The American Society for Reproductive Medicine grants permission to photocopy this fact sheet and distribute it to patients. Revised 2008
OR 714.922.4100 SB 909.890.5511 Basal Body Temperature Chart Use a basal body thermometer (available at most pharmacies) to take your basal body temperature (BBT) as soon as you awake in the morning. Plot your BBT as a dot on the graph for each day in your menstraul cycle. Connect the dots with a line from day to day so you can see a pattern. The pattern may vary from cycle to cycle, but over time you will begin to see when you tend to ovulate. After ovulation, you ll see a spike in your temperature ranging between 0.5 and 1.6 degrees. You are most fertile two to three days before you ovulate and for about 12 to 24 hours after ovulation. Month: