fertility tips Archives - Madison Women's Health

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Getting Pregnant with Clomid or Letrozole

There is a lot to know about getting pregnant with Clomid or Letrozole. It is estimated that 10% of women in the United States face infertility and have trouble getting pregnant. This condition can pose many challenges and doesn’t always have a clear cause. But it’s important to understand there are possible solutions. Let’s discuss two types of medications that are commonly used to treat infertility by acting on your body’s ability to ovulate (release an egg): Clomid and Femara.

Typically, women produce and release one egg each month, but some women do not ovulate regularly. For women who do ovulate each month, these medications are used to increase the follicles produced each month, which is called controlled ovarian hyperstimulation. For women who don’t ovulate regularly, these medications are used to induce ovulation.

Learning more about your options may help you and your OBGYN create a path forward as you navigate the complexities of your condition before you visit a fertility clinic.

What is Clomid (aka clomiphene citrate)?

Clomid, also known generically as clomiphene citrate, is an oral medication used to treat infertility in women. It is often a 50-milligram pill taken on days 3-7 or 5-9 of your menstrual cycle. Your OBGYN will typically start you on a low dose, and then increase it incrementally each month until it is clear you are ovulating.

How does Clomid work?

Clomid tricks the body into thinking that your estrogen levels are lower, which makes the pituitary gland increase follicle-stimulating hormones (FSH). Ultimately, this helps stimulate the ovary to produce eggs that can be released during ovulation. It essentially stimulates the ovarian follicles (tiny fluid sacs in the ovaries), which hold an immature egg. Encouraging this growth can help those immature eggs turn into mature eggs, be released, and meet with sperm in hopes of becoming fertilized.

Clomid can be taken as part of fertility treatment before intrauterine insemination (IUI), or in combination with IUI.

Is Clomid right for you?

Clomid is typically best for those who have been unable to get pregnant for about a year, or who have unexplained infertility. If you have irregular periods, talk to your doctor right away. They may suggest Clomid sooner (don’t wait a year). If you have polycystic ovarian syndrome (PCOS), a different medication called Femara (Letrozole) may work better for you than Clomid (more on that later).

If you have been diagnosed with hypothalamic amenorrhea, premature ovarian insufficiency or breast cancer, Clomid may not be a good fit for you.

Clomid side effects

Clomid’s side effects include hot flashes, mood swings, and pelvic pain. Other potential side effects include nausea, breast discomfort, blurred vision, headaches, and spotting. If you experience vision changes while taking Clomid, contact your OBGYN immediately.

In our experience at Madison Women’s Health, most women don’t complain of many side effects from this medication as they are only taking it for five days each cycle.

It’s worth noting that those who take Clomid have an increased risk of carrying multiple babies, like twins or more.

What is Femara (aka letrozole)?

Femara, also known generically as letrozole, is an oral medication commonly used for estrogen-sensitive breast cancer in postmenopausal women. In 2004, it became an off-label treatment for fertility, as it can help trigger ovulation in some women, especially women with PCOS. While it is not yet FDA-approved for fertility treatment, it is considered by many physicians to be a better choice than Clomid for anovulatory women.

To induce ovulation, letrozole is typically taken once a day for five days, beginning on days 3-7 or 5-9 of your menstrual cycle.

How does letrozole work?

Letrozole blocks a protein called aromatase, which helps make estrogen. Letrozole decreases the amount of estrogen in the body. Regarding fertility, lowering estrogen levels can help the body release other hormones and chemicals that can help immature eggs (known as follicles) grow and mature, increasing the likelihood of pregnancy.

Is letrozole right for you?

When deciding whether to prescribe Clomid or letrozole, your OBGYN will take into consideration why your ovaries may not be releasing eggs. If the cause is PCOS, then your OBGYN will likely recommend you take letrozole instead of Clomid.

If a different issue is affecting ovulation, such as hypothalamic amenorrhea or premature ovarian insufficiency, letrozole may not be beneficial. Ovarian insufficiency can occur when the ovaries are not functioning normally and don’t produce the typical amount of estrogen or don’t release eggs regularly. It can be confused with premature menopause.

If you have a history of breast cancer, letrozole would also be the medication of choice to help induce ovulation. Expect to have close monitoring by your oncologist.

Letrozole side effects

Common side effects of letrozole can include hot flashes, joint pain, exhaustion, headaches, nausea, spotting, cysts, and dizziness. (Women who are taking letrozole for breast cancer will have more side effects because they are taking much higher doses of the medication.)

Tracking ovulation

Before beginning infertility treatments, your OBGYN will want to determine if you’re ovulating regularly. This is important when it comes to conception because it is when the mature egg leaves the ovaries and travels down the fallopian tube, where it can be fertilized. Ovulation occurs approximately two weeks before the start of the next period or menstrual cycle, but this can vary based on your cycle.

If you have a regular menstrual cycle, there’s a good chance that you’re ovulating. However, some women may not experience a normal 28-day cycle or may have a condition that makes cycles less predictable.

Signs that you’re ovulating can include:

Cervical mucus secretions that are clear, wet, and elastic (like egg whites).
A positive result using an ovulation predictor kit (OPK). Ovulation predictor kits measure luteinizing hormone (LH) levels in your urine. Your OBGYN provider may recommend you begin measuring your LH levels around cycle day 10. You can purchase an OPK at most retail pharmacies.

Progesterone levels in the second half of our cycle are another way to help your OBGYN determine if you are ovulating. Or, if you are using ovulation predictor kits, your OBGYN provider may recommend you have your progesterone levels checked about seven to eight days after a positive OPK result (or peak LH).

We often recommend our patients use an app that collects all of this data in one place and helps to visualize what is happening. A popular app our patients enjoy using is FLO.

Effectiveness of fertility drugs

The effectiveness of the medications you’re prescribed varies on many things, including any other diagnoses you may have. For instance, if you have PCOS, your physician will likely begin at a lower dose of fertility medication and increase it if results are not seen within about three months. If ovulation is absent, the beginning step would be to address ovulation first. In 2019, the Clomid success rate was 21.4%. Letrozole has a similar success rate but has shown higher success rates with those diagnosed with PCOS.

How long does it take to get pregnant on Clomid or Letrozole?

This is a common question we are asked, but it has a complex answer. If you are ovulating already, these medications can speed up the process to become pregnant. If you’re not ovulating, then you could become pregnant within 6-12 months of taking these medications.

We start our patients on the lowest dose for these medications and typically increase the dose until they ovulate. There is no limit to the number of cycles you can take these medications, but if you have not achieved pregnancy after 9 cycles, you should be evaluated for other possible causes of infertility. Expect some additional bloodwork and an ultrasound to look at your fallopian tubes and uterine anatomy.

You can also read more about common infertility causes and treatments here.

Which fertility drug should you choose?

While these medications act similarly, the first step in any treatment should be to speak with your provider or fertility specialist. They’ll review a detailed history including other results, lab work, or medications you may be taking that can help determine the best choice for your body. It’s important to keep in mind that other diagnoses, like PCOS or potential side effects, can also impact your decision. Determining if you’re ovulating is a good initial step.

Speak with your OBGYN provider to get more information about fertility treatments and what may be the best option for you. We’re dedicated to helping you achieve your health and family goals and will do what we can before referring you to a reproductive specialist or fertility clinic.

Vicki Slager-Neary, OBGYN, WHNP, A.P.N.P, has been serving women in the Madison area as board-certified Women’s Health Nurse Practitioner since 2016. She has provided patient care for over 17 years as a nurse in the Emergency Department, Labor and Delivery, Fertility, and OBGYN. Vicki has extensive experience working in Reproductive Endocrinology and Infertility for the past 10 years. Her areas of special interest include preconception counseling and treatment, contraception, and pregnancy. Vicki has a wide variety of experience managing infertility conditions including PCOS, amenorrhea, recurrent pregnancy loss and unexplained infertility.

September 25, 2022/by Vicki Slager- Neary

Hormone Imbalance: What are the Symptoms and Treatments?

Women's Health

When you’re browsing social media or watching TV, you may have come across ads telling you to ask your doctor to “check your hormones” as the first step toward diagnosing and relieving a troublesome set of symptoms. It’s true that hormone imbalances can be associated with many problems, such as period problems, unwanted hair growth, fertility struggles, weight gain, and even difficulty sleeping. You should absolutely talk to your doctor about these things. But you may be surprised when your doctor tells you that they can’t just give you a “hormone check.”

A hormone check sounds simple—after all, we check cholesterol to get a handle on our heart health. However, your doctor can’t just give you a hormone test because a single test to check all your hormones doesn’t exist.

So if there isn’t a simple hormone test, how does your doctor discover hormone imbalances? And how can you learn what could be causing your symptoms?

Let’s look at problems caused by hormone imbalances and how your doctor could potentially determine which hormones may be responsible for your symptoms.

Reasons Your Doctor Can’t Give You a Hormone Imbalance Test

You may wonder why your doctor can’t give you a quick test to determine if all your hormones are in balance. Testing hormones is very different from testing cholesterol or iron in your blood because your hormone levels are always changing, day by day, even hour by hour. They change based on where you are in your menstrual cycle, when you last ate, what your other hormones are doing, how stressed you are, and many other factors. That’s why a single “hormone check” can’t really tell you if all your hormones are balanced.

Secondly, asking your doctor to “check your hormones” is a huge request. The human body produces more than 50 hormones! Hormones include melatonin (which regulates your sleep cycle) adrenaline (which prepares your body for “fight or flight”), oxytocin (the “feel good” hormone), cortisol (which helps your body respond to stress), and progesterone (which stimulates the growth of your uterine lining in the second half of your menstrual cycle), just to name a few.

The best way to discover if specific hormones are out of balance is by telling your doctor which symptoms you are experiencing so they can narrow down what should be checked and when. Your symptoms are your doctor’s first clues about what could be wrong.

Three Categories of Symptoms Often Caused by Hormonal Imbalances

When we see patients at Madison Women’s Health for hormonal imbalances, most of their symptoms and concerns fall into three categories:

Periods and period-related symptoms;
Fertility issues;
Problems at the beginning and end of the reproductive cycle (puberty and menopause).

Let’s first discuss these groups of symptoms. Next, we’ll cover the most common hormones your doctor may check based on your symptoms.

1. Period Problems and Period-Related Symptoms Caused by Hormone Imbalances

A common complaint of women who visit Madison Women’s Health is irregular periods or unexpected changes to their periods. A period is considered irregular when it occurs more often than before or less often than before, or if the amount and duration of bleeding has changed significantly for repeated months. Is your period suddenly much heavier than it has been? Or are you not having a period at all?

Keep track of your cycles, when you begin to bleed, and for how long. A popular app among our patients for tracking cycles is Period Tracker Period Calendar (available on iOS and Android), although there are many options. Let your doctor know how many days there are between your periods and what your typical flow is like. Discuss what is different and why you are concerned. Let them know if you’re under more stress than before, if you’ve changed your diet or exercise recently, or if you have a family history of irregular periods.

These changes could have a structural cause — having to do with your cervix or uterus — or a hormonal cause. Your doctor will likely want to perform a physical exam and may also check specific hormones on a specific day of your menstrual cycle.

2. Fertility Problems Caused by Hormone Imbalances

Another common time women ask for a hormone checkup is when trying to conceive. Typically, 84% of women get pregnant after a year of unprotected sex. When conception doesn’t happen, one reason could be a hormonal imbalance. To learn more, read our extensive article about fertility challenges here.

Again, it’s important to track your menstrual cycle, including the dates you have unprotected sex, to give your doctor a picture of what your reproductive cycle is doing. Keep in mind that your partner should also be tested for structural or hormonal issues if you have been trying to conceive for some time.

If you’re having your period too often (every couple of weeks), then your uterus can’t sustain a fertilized egg. If your periods are too far apart (6 weeks and longer), your ovaries may not be releasing eggs often enough into your fallopian tubes.

3. Puberty & Menopause Problems Caused by Hormone Imbalances

Getting First Period too Young or too Old

Typically, a girl will begin her period at a similar age to when her mother began getting hers. Some girls have their first period as early as 10 or 11. Others don’t get their first period until they’re 15 or even 16. If you or your daughter are outside those age ranges and are concerned about that first period, it is worth a visit to her Pediatrician, Family Doctor or OBYGN.

Common factors that affect when a girl begins her period are weight changes, environmental factors that stimulate the hormones, or adrenal gland problems.

Irregular Periods in Teens

Pre-teens and teenagers have very irregular periods as their bodies mature. Sometimes, teens have unusual bleeding because they aren’t ovulating regularly. In this case, they have some hormonal development that isn’t complete so the uterus isn’t getting a clear enough signal of what to do.

Issues During Menopause

When women approach their mid- to late-40s, their cycles may become irregular as they enter the perimenopausal stage. You can read more about what to expect in perimenopause in our recent article. Signs that you may be experiencing perimenopause include skipping periods and having lighter periods.

If your periods are becoming heavier, more frequent, prolonged, or with spotting between periods, you should mention this to your doctor. These changes could indicate menopause, but they could also be caused by abnormalities in your cervix or uterus.

Common Hormone Imbalances Women Experience

With more than 50 hormones affecting all aspects of how your body functions, your period, your fertility, your energy, and your weight, we’re going to briefly touch on the most common disorders and imbalances we see at our OBYGN clinic.

Polycystic Ovarian Syndrome (PCOS)

PCOS affects between 5% and 10% of women of childbearing age. PCOS causes ovaries to produce higher levels of androgens (male-type hormones), which can cause anovulation—lack of egg release each month from your ovaries. Instead of releasing eggs, the ovaries of women with PCOS produce multiple small cysts that further contribute to a hormonal imbalance.

Symptoms of PCOS Include:

Irregular periods caused by anovulation;
More hair growth (hirsutism) on areas typically associated with males (like on the face, chin, chest, abdomen, arms);
Acne, especially deeper, cystic acne that persists into adulthood;
Weight gain and a harder time losing weight;

Women with PCOS often have greater challenges managing their blood sugar, which can turn into Type 2 diabetes if a healthy diet is not followed. In addition, women with PCOS are at risk for cardiovascular disease later in life, and so their cholesterol levels should be watched.

What is Tested When Diagnosing PCOS?

Typical blood tests for PCOS to measure the levels of FSH (follicle stimulating hormone), LH (luteinizing hormone), testosterone, and adrenal gland hormones.
An ultrasound to look for cysts on the ovaries.

Treatments for PCOS

There is not a cure for PCOS, but the symptoms caused by PCOS can be treated. A few ways to treat PCOS include:

A healthy diet and exercise, which can help you lose weight and manage your blood sugar levels.
Medications that help manage your blood sugar levels can be prescribed.
Creams can be prescribed that help slow excess, male-pattern hair growth.
Birth control options to help regulate your hormones, as suppression of ovarian hormone release can help control symptoms and regulate periods.
Medications that can help your ovaries produce and release eggs, if pregnancy is your goal.

Thyroid Disorders

Hypothyroidism, when the thyroid produces too little hormone, can cause you to feel tired constantly and to gain weight. Hyperthyroidism, when the thyroid produces too much hormone, can result in weight loss and feeling like you have too much energy.

Whether you have too much thyroid hormone or too little, your period will be affected. It could become very light, could stop for several months, or could become very heavy and more painful than before. Many times, symptoms related to thyroid abnormalities are confused with menopausal symptoms. Read more about perimenopause here.

Problems with thyroid production could be caused by genetics, growths, or rarely thyroid cancer, but many times there is no other issue.

Symptoms of Thyroid Abnormalities Include:

Changes in menstrual cycle;
High heart rate and heart palpitations — more than 100 beats per minute. (Note: mention to your doctor if it is frequently over 80 beats per minute.)
Lack of energy, exhaustion, or trouble sleeping;
Unexplained anxiety or new depression symptoms;
Weight loss and weight gain;
Hot flashes or excess sweating;
Chills, unable to feel warm, especially in your hands and feet;
Hair loss not related to stress, recent pregnancy or age that leaves bald spots;
Muscles that ache without cause, especially in the neck area;
Feelings of “brain fog”;
Changes to vision or appearance of the eyes;
Swelling or growth on the neck.

What is Tested when Diagnosing Thyroid Disorders?

TSH (thyroid stimulating hormone—the “thermostat” of the thyroid gland), T4, T3, and sometimes thyroid antibody tests.
Please note that pregnancy, birth control pills, and a supplement called Biotin can affect some thyroid test results.

Treatments for Thyroid Disorders Include:

Prescriptions to slow down thyroid hormone production;
Prescriptions to replace thyroid hormones when the right amount isn’t being produced;
Surgery to remove some or all of the thyroid gland.

Estrogen Imbalances

Ninety-five percent of women do not have a significant estrogen abnormality until they begin going through menopause.

However, women with very low body fat (such as elite athletes or women with eating disorders) may experience extremely light or non-existent periods (amenorrhea). Too much estrogen could cause periods to be extremely heavy and prolonged, and is sometimes caused by body fat levels being too high.

Symptoms of Too Low or Too High Estrogen Include:

Irregular or absent periods because your body is not ovulating;
Painful sex;
Mood swings, worse PMS;
Hot flashes;
Breast tenderness;
Increased headaches and migraines;
Weight gain;
Fatigue.

Treatments for Estrogen Imbalance

Your doctor may be able to provide some relief from these symptoms with a method of hormonal birth control. Lifestyle changes such as adjusting exercise levels and maintaining a healthy weight can also help.

Progesterone Imbalances

Progesterone is produced by the ovaries (mostly after ovulation each month), the adrenal glands, the placenta during pregnancy.

Symptoms of Too Low Progesterone Include:

Irregular or absent period;
Difficulty becoming or staying pregnant;
Low sex drive;
Depression;
Some researchers believe that subtle changes in progesterone production after ovulation may contribute to increased PMS symptoms in some women

Treatments for Progesterone Imbalance Include:

Birth control with progesterone-containing pills/ring/patch, a progesterone IUD (if you’re not trying to get pregnant)
Progesterone tablets, capsules or suppositories to help while trying to conceive
Over-the-counter progesterone creams: apply to skin in the second half of your menstrual cycle for mild pre-menstrual symptoms

Prolactin Imbalances

Prolactin is produced by your pituitary gland. One of the reasons your body could be producing too much prolactin is a prolactinoma, which is a noncancerous growth on the pituitary gland. Hyperprolactinemia (too much prolactin) can also be caused by anorexia, liver disease, and hypothyroidism.

Symptoms of Too Much Prolactin Include:

Discharge from your nipples when you are not pregnant or breastfeeding, or feeling like your breasts are getting ready to let down milk;
Headaches and sometimes visual changes;
Irregular periods;
Fertility problems.

Treatments for Too Much Prolactin Include:

Evaluation of the pituitary gland with an MRI
Medications that can control high prolactin levels;
Surgery, if you have prolactinoma;

Risks of Not Treating Hormone Imbalances

Hormone imbalances, when left untreated, are more than just “annoying mood swings and bad PMS.” They can be indicators that something more serious — rarely, even cancerous — is happening in your body.

Not getting your hormones back in balance could lead to other problems, like elevated cholesterol, osteoporosis, obesity, lack of sleep, and more.

Although truly identified hormonal imbalances often need medical or even surgical intervention, a healthy lifestyle can improve low-level symptoms.

Do your best to get:

6-8 hours of sleep each day;
30+ minutes of vigorous exercise daily;
And a high-quality diet with enough protein and healthy fats and less sugar.

Conclusion

You know better than anyone when your body is feeling “off.” Maybe you don’t have energy like you used to, you’re not sleeping well, and you’re feeling anxious and depressed for no apparent reason. Maybe you’re developing hair in unusual places and losing hair on your head. Maybe your weight is changing and you feel like you can’t control what it’s doing — whether that’s weight gain or weight loss. Or maybe your periods are getting worse (or going away entirely).

At Madison Women’s Health, we want to empower you with education to make healthy lifestyle choices and support you along the way. While there isn’t one big hormone test that can let you know if your hormones are balanced, we will listen to your symptoms, ask you questions, and determine together what can be done.

We always want you to feel welcome to discuss your symptoms with us so we can help you feel like yourself again!

Dr. Mary Stoffel has been providing healthcare to women in Madison since 1990 and is a founding partner of Madison Women’s Health. Committed to the highest quality of care in all aspects of women’s health, she envisioned a practice devoted to personalized medicine grounded in communication and trust.

October 27, 2020/by Mary Stoffel

Getting Pregnant: Fertility Tips for Problems Conceiving

Blog, Fertility, Pregnancy

Thinking about getting pregnant and starting a family can be an exciting time. But when it takes longer than you expect to get that positive pregnancy test, you may start to wonder “Why am I not getting pregnant?”

As a Madison OBGYN, I meet with many women who are wondering what they can do to get pregnant faster. I enjoy supporting women in their “trying to conceive” journeys and want to answer the most common questions I’m asked as well as address misinformation that can be confusing and even hurtful.

Chances of Getting Pregnant by Age

Your age plays a role in your fertility. Women are born with a fixed number of eggs and your total number of eggs declines with age. The term “ovarian reserve” refers to your egg supply.

Women in their 20s have peak fertility. Their fertility starts a slow decline around age 32, with a more rapid decline around age 37.

A healthy woman in her 20s has a 25% chance of conceiving naturally each month.
A healthy woman in her 30s has a 20% chance of conceiving naturally each month.
A healthy woman in her 40s has a 5% chance of conceiving naturally each month.

When You Should See a Doctor About Getting Pregnant

About 80% of couples conceive in the first 6 months of trying. That number increases to 85% after 12 months. If you have regular menstrual cycles and have been trying to conceive for a year, then it’s a good idea to talk to your OBGYN about it. We will evaluate to see if there are other issues that make it harder for you and your partner to conceive.

If you’re over 35 years old, have this conversation with your doctor sooner—after you’ve been trying to conceive for 6 months. If you are in your 40s and want to have a baby, it’s better to speak with your OBGYN right away because often fertility treatments can be started right away.

No matter your age, if you know you have irregular periods (consistent cycles less than 25 days or greater than 35 days apart), get evaluated sooner. If you have other health problems, make a preconception visit to make sure these conditions are optimized prior to conceiving.

Before you are referred to a fertility clinic, your OBGYN can rule out and/or treat common issues. Sometimes we can recommend small changes that can help you get pregnant.

Madison Women’s Health OBGYN clinic refers patients to fertility clinics when:

you are 40+;
there is concern about early menopause;
after 3-6 months of using Clomid or Letrozole to induce ovulation (or a little longer if we can prove you are ovulating on these medications);
there are abnormal semen parameters that require intervention;
or there is any other reason to expedite your chances of conception.

Problems Conceiving? How to Prepare for Your First OBGYN Visit

Track your menstrual cycle. Cycle length and regularity are important for fertility. Tracking your menstrual cycle will help your doctor know if you are ovulating each month. Use a calendar or a tracking app to mark the first day your period begins (first day of red bleeding). Most apps have other parameters you can input, but your period is most important. Bring your calendar or app!
Know your medical history and family history of genetic conditions. If you are visiting Madison Women’s Health for the first time, be sure to bring your health records and any testing or blood work you might have done previously.

Best Apps for Tracking Your Fertile Window

When it comes to tracking your menstrual cycle and your “fertile window” (the days when you are most likely to get pregnant) you can go as high-tech or low-tech as you want. Whether you want a basic calendar or an app that syncs with all your devices, choose something you know you can use consistently.

There are hundreds of apps to help identify your fertile window, but only about 20 that research has considered to be reliable and easy to use. It’s important to choose an app that is based on accurate scientific data. The app that I recommend to my patients is the Glow App. It’s available on the iTunes App Store and on the Google Play Store. There are both free and paid versions. You can even join online communities with people who are trying to conceive (just be careful about following advice from people who aren’t medical professionals).

Getting Pregnant with Irregular Periods

If you have irregular periods, it’s important to discover what is causing them. Too-short or too-long of cycles can be caused by anovulation (not ovulating), thyroid conditions (hyperthyroidism, hypothyroidism), being underweight or overweight, extreme stress, and being near puberty or menopause. We have blood tests to help us find the cause.

Common Tests for Fertility

In addition to checking blood work, your OBGYN will also evaluate your uterus to make sure there isn’t anything about your uterine anatomy that makes it difficult to get pregnant.

At Madison Women’s Health, we can do a Saline Infusion Sonohysterogram, often called an SIS. After injecting saline fluid in the uterus, we use ultrasound equipment to evaluate the uterine cavity.

It’s also important to know if your fallopian tubes are open so a sperm and egg can meet. The hysterosalpingogram, or HSP, is like an SIS but uses an x-ray machine to view your uterus and test if your fallopian tubes are patent (open).

Testing Male Factor

Because male factor infertility is very prevalent (in approximately 10% of infertility cases, a male factor is the only identifiable cause), a semen analysis is an important step in the process. His tests are less costly and much less invasive. While we don’t evaluate male factor infertility at Madison Women’s Health, we can place the order for your partner to have a semen analysis done in Madison. Abnormal semen parameters warrant referral to a specialist for infertility.

Prescriptions to Induce Ovulation

If your test results show that you aren’t ovulating, your doctor may prescribe a medication to give your ovaries a boost. Clomid and Letrozole work by making the body think your estrogen is low. This makes the ovaries ramp up production of follicles that lead to ovulation.

Clomid has been used for many years without known adverse long-term effects. Common short-term side effects are hot flashes, nausea, bloating, mood swings, and headaches.

Letrozole is a newer medication used to induce ovulation. It is not FDA approved for this, but has been documented as safe and effective. We often recommend this instead of Clomid. Your OBGYN will work with you to prescribe the best medication for your situation.

Natural Ways to Increase Your Fertility

Not everyone needs or wants medical intervention to get pregnant. There are natural things you can do to increase your chances of getting pregnant each month.

Timed intercourse during your fertile window. If you’re tracking your cycle each month, you’ll know approximately when you’re ovulating. Have sex every 1-2 days during your fertile window, which is about 5-6 days before you ovulate. (For example, if you have a 28 day cycle, with day 1 being the first day of your period, you can estimate your fertile window to be days 9-14 of your cycle.)
Avoid using lubrication. Most over-the-counter lubricants inhibit sperm. If you need lubrication during intercourse, use a lubricant specifically made for couples who are trying to conceive, like Pre-Seed. You can also use canola oil or mineral oil.
Healthy weight. If you are underweight or overweight, you may not ovulate or have a regular menstrual cycle. If you are overweight with frequently missed periods, decreasing your weight by as little as 5% can increase your chances of having regular periods and conceiving.
Limit alcohol to 2 drinks per day. Cut alcohol completely out when you are actively trying to get pregnant.
Reduce caffeine. At typical levels of caffeine intake, there does not appear to be an association between caffeine consumption and inability to conceive. Some studies suggest that going overboard may not be helpful, however, so try to limit to no more than two 8oz cups of coffee per day.

Common Misconceptions About Increasing Your Fertility

When people find out you are trying to conceive or are having problems getting pregnant, you may get a lot of advice. People have good intentions but may have limited medical knowledge. It can get confusing sorting through all the health blogs, fertility forums, and more. It can also be painful when people think they have an easy solution to something that is so private and personal. Here are some common myths about getting pregnant and increasing fertility:

“Herbs, vitamins, teas and supplements will increase your fertility.” This is not necessarily true. Eat a healthy diet, take a prenatal vitamin, and exercise. Healthy women are more likely to have healthy pregnancies.
“This super food will increase your fertility.” There are many so-called fertility diets. If there was a super food that increased a woman’s chance of getting pregnant, everyone would use it! If a website endorses a specific food for fertility (like yams and pineapples), they are based on small, poorly done studies. They are full of antioxidants, however, which are great for overall health!
“Don’t worry, it’ll happen when you quit trying so hard.” First of all, I am sorry if anyone has said this to you. This statement simply adds guilt to the stress that infertility is already creating. At the most, the stress related to fertility troubles may slightly lengthen the amount of time it takes to get pregnant. Stress only affects your fertility if it prevents you from having intercourse or is affecting your menstrual cycle.
“Get in the right position.” Certain positions during sex, elevating your hips, lying flat for twenty minutes afterward do not increase the likelihood of conceiving.

If you come across any other advice that promises to be “the answer to all your fertility troubles,” be wary. Will it help you eat healthier? Does it encourage you to be active? Fertility is complex and there isn’t a right answer for everyone. Be sure the advice encourages healthy habits and listen to your doctor’s recommendations.

Focus on Your Health

One of the best things you can do to improve your chance of getting pregnant and have a healthy pregnancy is to optimize your own health. No matter what age you are, it is important to be cognizant of your weight. Eat a diet rich in vegetables, lean protein, whole grains, and healthy fats. Reduce your alcohol and caffeine consumption. Get regular exercise. Begin taking a prenatal vitamin right away. The healthier your body is when you are trying to conceive, the better your chances of having a healthy pregnancy.

The key point in all the fertility advice you may receive is this: be healthy, let us know if your menstrual cycle is abnormal, have timed intercourse, and see a doctor for a preconception visit if you have questions about your health before trying to conceive.

At Madison Women’s Health, we are here for you in your journey to pregnancy. We’re excited to be your partners as you grow your family! To make an appointment with one of our providers, call (608) 729-6300.

Dr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.

March 21, 2020/by Dr. Ashley Durward

Tag Archive for: fertility tips