Frequently Asked Questions
- Infertility concerns only women only around 40 years old?
- Is oocyte cryopreservation something that concerns only women with cancer?
- What is folic acid and why is it administered as a supplement?
- Is infertility a woman’s problem?
- Using IVF means multiple births (twins, triplets)
- Do infertility drugs cause cancer?
- How is a hysterosalpingogram (HSG) performed?
- Why do I need to have a hysterosalpingogram?
- What is a hysterosalpingogram?
- Can stress cause infertility?
- What is basal body temperature?
- We are trying to conceive: when is the best time to have sexual intercourse?
- How can ovulation determine when I get pregnant?
- What is cervical mucus?
- How can I know when I ovulate?
- Ovulation -the oocyte is released
- How do the home use ovulation predictor kits work?
- How can I know when is the most fertile period?
- How do your hormones work
- How does my menstrual cycle work?
- If my menstrual cycle is not steady, will it be difficult for me to get pregnant?
- What is a normal menstrual cycle?
- Are there laws in Greece regarding Artificial Reproductive Techniques?
Infertility concerns only women only around 40 years old?
It is well known that female fertility declines with age. According to the American Society of Reproductive Medicine the problem of infertility also exists from the third decade of a woman’s life. Therefore, 8% of women aged from 20 to 29 years, 15% between the ages of 30 to 34, 22% between 35 to 39 and 29% aged 40 to 44 are infertile.
Is oocyte cryopreservation something that concerns only women with cancer?
The new technique of ultra rapid oocyte cryopreservation, known as Vitrification, yields survival rates up to 90%.
This procedure allows women to preserve their fertility prior to therapy for cancer (chemotherapy, radiotherapy) and prior to radical gynecological procedures.
It can be applied to women that wish to delay a pregnancy either due to their career, their studies or until they find the suitable partner.
What is folic acid and why is it administered as a supplement?
Folic acid is a vitamin from the vitamin B group, known as B9. Our body needs this to produce healthy red blood cells, noradrenalin and serotonin (chemical substances of the nervous system). It helps synthesize DNA (genetic material of the body) and is one of the main ingredients of the cerebrospinal fluid. Adequate folate intake during the preconception period, the time right before and just after a woman becomes pregnant, helps protect against a number of congenital malformations including neural tube defects (which are the most notable birth defects that occur from folate deficiency), such as spina bifida. It also reduces by 40% the risk of congenital heart defects, cleft lip, limb defects, and urinary tract anomalies.
Every woman wanting to get pregnant (therefore also women going through ART procedures) must take a daily supplement of folic acid and her diet must be rich in folate to reduce the risk of a problematic baby. The intake of folic acid must be continued until the end of the 1st trimester of her pregnancy.
Is infertility a woman’s problem?
Studies show that 40% of infertility cases are due to female factors, 40% due to male factors and 20% are due to both or to unknown reasons.
Using IVF means multiple births (twins, triplets)
The improvements that have been made in the field of ART, such as embryo transfer under ultrasound, improved embryo culture conditions, better embryo selection criteria etc allow for high success rates with a small number of transferred embryos.
The goal for all infertility specialists is to be able transfer one embryo, to have a low-risk pregnancy and to have a healthy baby.
Do infertility drugs cause cancer?
In 2009 in Denmark, a large epidemiology study was published, were 54.000 women took part over a 35 year period of time. This study states that: «No convincing association was found between use of fertility drugs and risk of ovarian cancer. Furthermore, no associations were found between fertility drugs and number of cycles of use, length of follow-up, or parity».
How is a hysterosalpingogram (HSG) performed?
The HSG is carried out at a radiology department. There you will be lye on a bed and a doctor will place a very thin catheter in the uterus through the cervix. A small amount of radiographic contrast (dye) will be pushed through the catheter. The dye fills the uterus and the fallopian tubes, if they are open and then spills into the abdomen.
Why do I need to have a hysterosalpingogram?
At ovulation the oocyte is released from the ovary and travels down the fallopian tube to finally reach the uterus. The fertilization of the oocyte is a process that occurs inside the fallopian tube Therefore, the fallopian tubes have to be open for the spermatozoa and the oocyte to come into contact. Tubal patency is checked through a hysterosalpingogram.
What is a hysterosalpingogram?
A hysterosalpingogram (HSG) is a special X-ray test of the lower abdomen.
Can stress cause infertility?
Infertility is a biological inability of a couple to conceive (disruption in the reproductive system). Stress can occur during the effort to conceive, but cannot cause infertility. However, the proper management of stress during the period of treatment can help in the achieving better results.
What is basal body temperature?
Basal body temperature (BBT) is the temperature that the body has when you wake up in the morning. Before you rise from your bed, place the special thermometer (available at pharmacies) in your mouth. This detects even the smallest changes in your body temperature that a normal thermometer cannot record. Most basal thermometers come with a blank basal body temperature chart. Make a few copies of this chart, in case it takes you several months to get pregnant. When you ovulate, the hormonal changes, cause a small increase in your BBT, that lasts at least until your next menstrual bleed. You may observe that your temperature rises certain other days, but does not remain high. You are probably not ovulating in this case. You are at your most fertile when the temperature rises and the days before this event. There are studies that support that you could conceive even if you have sexual intercourse within 12 to 24 hours after the rise in temperature. If you are pregnant, your temperature will remain high throughout the whole period of your pregnancy. It is useful to monitor your temperature for a few months to see if there is a specific pattern in your cycle. If you do not measure your temperature immediately after waking up, the result may not be accurate.
We are trying to conceive: when is the best time to have sexual intercourse?
Ideally, sexual intercourse should takes place as close to ovulation as possible (time of release of the oocyte from the ovary). The spermatozoa can survive 2-3 days, but the oocyte is only there for 12-24 hours. To increase your chances of conception it would be ideal for you to have sexual intercourse 1 to 2 days prior to ovulation. Hence a large number of spermatozoa will be present in the fallopian tube awaiting ovulation.
Of course it is not always possible to predict exactly when a woman ovulates. This depends on the length of the menstrual cycle, even though recent studies have shown that he window of ovulation may vary more than previously believed, even when the menstrual cycle is normal. At this point it must be noted that it is wrong for a couple only to focus their sexual intercourse during the potential ovulation period. This leads to increased stress levels, especially when there is a negative pregnancy test and also minimizes the pleasure of sexual intercourse, without significantly increasing the percentage of a positive outcome. At least 2- 3 times a week are enough to achieve a pregnancy in most couples. Increased number of sexual intercourse does not cause a problem.
How can ovulation determine when I get pregnant?
In order for the oocyte to be fertilized, you must have sexual intercourse during the time between 72 hours prior to ovulation up to 24 hours after it. The reason for this is because spermatozoa can survive for up to 72 hours, while an oocyte survives less than 24 hours. If you have sexual intercourse near ovulation you increase your chances of achieving a pregnancy. In fertile couples, there is a 25% chance of pregnancy per cycle. This means that approximately 75%-85% of women that have sexual intercourse, without using contraception will achieve a pregnancy within one year. You can increase your chances of getting pregnant if you learn to distinguish the various physical changes that your body encounters each month and hence being able to pinpoint your most fertile phase.
What is cervical mucus?
There are many different types of vaginal discharges, one of which is also cervical mucus. The type of mucus that your body produces provides indications regarding where you are in your menstrual cycle and hence when you are considered most fertile. You can check your cervical mucus using your fingers or toilet paper. During the days that you are not fertile, the mucus from your cervix will be thick and sticky (similar consistency to sticky rice). The day before and the day of ovulation, during which you are most fertile, you will have more secretions and the mucus should be stretchy and resemble raw egg white. The change in the amount and also the consistency of the cervical mucus is due to the increase in the level of estrogens that occurs during ovulation.
How can I know when I ovulate?
Some women realize exactly when they ovulate. Others however, have a difficulty to define the related body changes occurring during ovulation. If you consider becoming pregnant try to monitor your cycle for a period of time. Some signs of ovulation are:
- Breast tenderness.
- Discomfort in the lower abdomen and back pain
- Increased vaginal discharge, resembling egg white
- Small body basal temperature increase
Ovulation-the oocyte is released
As the estrogen levels rise, the levels of FSH drop temporarily and rise again accompanied by a surge in the production of luteinising hormone (LH) from the pituitary. This releases the most mature oocyte from the ovaries (ovulation). The oocyte is captured from the ends of the fallopian tubes. At this stage there will be a rise of about 1 degree in the basal body temperature. Under normal circumstances the cervix produces a thick layer of mucus that is very difficult to be penetrated by the spermatozoa. Exactly before ovulation, the estrogen levels change the layer of mucus, making it thinner and clear. This allows spermatozoa to penetrate the cervix, through the endometrium and up into the fallopian tubes, where fertilization takes place.
How do the home use ovulation predictor kits work?
Ovulation predictor kits are available at pharmacies without the need of a medical prescription. These kits detect the rise in levels of luteinising hormone (LH) exactly before ovulation. They are easy to use and usually more accurate than measuring basal body temperature. They can detect ovulation 24 to 36 ώρες before and therefore can increase the chances of conception from the first month of their use. However, they are not infallible. They can measure LH (giving a positive or negative result, but not a specific value measurement), but they cannot detect if ovulation has occurred. The levels of LΗ may surge even without the release of an oocyte from the ovary. Small level increases in LH may be observed before the LH surge that leads to ovulation.
For more accurate results follow the following instructions:
If you have a 28 day cycle, start the ovulation prediction kit on the 11th day and use it for 6 days (or for as many days as the producing company recommends).
If your cycle is long, for example 35 days, start on the 14th day for 9 days.
Woman that most frequently buy these kits are those that do not have a steady cycle and therefore are less satisfied by them. If your cycle varies between 28 and 40 days, ovulation can occur between days 14 and 26 of the menstrual cycle. These kits allow for the detection between 5 to 9 days.
How can I know when is the most fertile period?
One of the best ways to determine the most fertile period is to pay attention to your body and learn to detect the signs of your forthcoming ovulation.
Changes in your cervical mucus. As your cycle continues the amount of cervical mucus increases and its consistency changes. The increased amount and the changes in consistency portray the increased amounts of estrogens in the body. A woman is considered most fertile when the cervical mucus appears clear, stretchy and like egg white in consistency. The role of the cervical mucus is to nourish, protect and accelerate the spermatozoa in their direction towards the womb and the fallopian tubes until they meet the oocyte.
Measurement of basal temperature. After ovulation, the temperature of a woman rises 0,5 to 1,6 degrees Celsius. This change in temperature may not be perceptible immediately, but can be detected using a thermometer. This occurs because the release of an oocyte stimulates the production of a hormone called progesterone that causes the increase in the basal temperature of the body. A woman is more fertile 2-3 days before the increase in her basal body temperature.
How do your hormones work
The menstrual cycle is controlled by a series of hormones that are produced by various parts of the body:
- GnRH: A hormone that stimulates the production of gonadotropins (it is produced by the the hypothalamus that is in the brain).
- Gonadotropins: Follicular Stimulating Hormone (FSH) and Luteinising Hormone (LH) are produced by the pituitary gland, also located in the brain.
- Estrogens: Hormones produced especially by the ovaries.
- Progesterone: Also produced by the ovaries.
GnRH produced by the hypothalamus stimulates the pituitary to release FSH. FSH travels through the bloodstream and finally stimulates the ovaries to produce oocytes. Approximately 15 to 20 oocytes that grow in microscopic cysts, known as follicles, begin to mature in the ovaries. One follicle (rarely 2 or more) develops faster than the others and is referred to as the leading follicle. Why this happens is not clear, but possibly some sort of "natural selection" mechanism takes place. FSH also induces the ovaries to produce estrogens. These help the oocytes to further mature and also feed the endometrium (inner layer of the uterus) so that it is ready to support a potential pregnancy.
How does my menstrual cycle work?
A newborn girl has approximately 200.000 oocytes stored in her ovaries. Once her menstrual cycle begins at the age of 10-14 years old, many oocytes begin to mature and one or infrequently two of these oocytes are released each month from the ovaries. The released oocyte is captured by the fallopian tube and is carried along by hair like projections, called cilia, to the womb. If the oocyte is fertilized from a spermatozoon during its journey in the fallopian tube, it will implant once it arrives in the womb (approximately 5 days after fertilization - the blastocyst stage). If fertilization does not occur, the oocyte will be expelled along with the internal lining of the womb (endometrium), during menstrual bleeding.
If my menstrual cycle is not steady, will it be difficult for me to get pregnant?
The more unsteady your menstrual cycle the more difficult it will be to determine the day of your ovulation. However, if you do ovulate, then 2 to 3 times of sexual intercourse are enough.
What is a normal menstrual cycle?
An average menstrual cycle is 28 days - this is calculated from the 1st day of bleeding until the next 1st day of bleeding. Some women have a shorter menstrual cycle (21 days), while others have longer ones, up to 35 days. Shorter or longer menstrual cycles than the ones mentioned above are possibly not normal and it would be advised to see your gynecologist. It is advised to also see your gynecologist if you see bleeding between periods or after sexual intercourse.
Are there laws in Greece regarding Artificial Reproductive Techniques?
The first steps in regulating the field of IVF were made in Greece back in the ’80s, through the action of the national health council, and were mainly based on the regulations that other European countries had already introduced in the ART field. Although, in Greece, the birth of the first baby after IVF was achieved in 1984, the legal framework was created many years later.
The two laws that refer to the ART field, in Greece, are: Law 3089/2002 (articles 1455-1460) and law 3305/2005.