FREQUENTLY ASKED QUESTIONS

 
 

When is the first day of my cycle ?

The first day of menstrual flow (not spotting) should be counted as cycle day 1.  If unsure, please wait for the first recognizable day of full flow.

 

 

What is a follicle ?

The follicle consists of the fluid filled sac that surrounds the ripening egg together with the sheath of supporting cells that surrounds it.  On cycle day one, a dominate follicle will be approximately 1-2mm in size.  A healthy follicle can grow up to 2mm per day.  The follicle is near maturity when reaching 16-20mm.

 

 

What size does the follicle have to be to ovulate ?

Minimum size of 18-20mm.

 

 

What is the soonest day I can test for pregnancy ?

The soonest day to test for pregnancy is the first day of your next expected period, trying to test any sooner will yield unreliable results and cause unnecessary stress.  Best is to wait until the expected date of your next period.  Doing a hCG blood test is the most reliable method of testing for pregnancy.

 

 

Some women have complained that cyclogest leads to discomfort due to constipation.  Is there a laxative safe for use in the 2-week wait after embryo transfer or should one simply live with the temporary discomfort

 

Cyclogest is progesterone and progesterone is a natural smooth muscle relaxant.  Due to the fact that the whole digestive tract consist of smooth muscle, constipation is therefore a “side effect”.  Fortunately, there are many stool softeners on the market that is quite safe during pregnancy and the time leading up to a pregnancy.  There are substances that do not get absorbed by the body but rather stays in the digestive system eg. Duphalac, Fybogel Orange etc.

 

 

What causes ovarian hyperstimulation syndrome (OHSS) ?

OHSS is set in motion by the administration of the hCG trigger injection and comes about due to the development of abnormally thin blood vessels in the ovary, a process known as vascular neogenisis.  This is due to the production of a protein known as “vascular epithelial growth factor”.  There are high risk groups and these include the following :

 

  • PCOS patients

  • Previous history of OHSS

  • Thin patients with little body fact (BMI less than 25)

  • High dose protocols where the dosage of the hormones being given is too high for the specific circumstances

  • Less than 35 years of age

  • Rapidly rising serum estradiol levels

 

It is therefore quite possible that 2 patients producing the same amount of eggs will have different outcomes in terms of OHSS.

 

 

Many websites quote the benefits of using a cough medicine like

Rubitussin with the active ingredient Guaifenesin to assist the sperm

traveling through the cervix.  Does this method have any merit ?

Unfortunately there is no evidence in any reputable source of the benefit that guaiphenesin has on the cervical mucus. Some people believe that the African potato, beetroot and garlic will cure HIV even though there is absolutely no evidence that it does anywhere in the world – pretty much the same scenario. 

 

 

Would it be factually correct that the sperm and egg are “allergic”to each other thus causing infertility ?

This is indeed correct.  The exact mechanism is not clear, making it more theory than fact.  There are for instance cases where 2 partners in a relationship fail to conceive after many years of trying with all possible help available. 

 

 

How do sexually transmitted infections (STI) affect a couple’s plans for getting pregnant ?           

Symptoms of a STI may include abnormal and often smelly discharge from the vagina or penis, abdominal pain, a burning sensation when passing urine and flu-like feeling and a high fever. 

 

Chlamydia and gonorrhoea

  • Chlamydia is usually symptomless.  In women, if it is not treated early, the infection can spread to the fallopian tubes and cause blockage, which in turn can lead to infertility or an ectopic pregnancy.  In men, untreated Chlamydia can cause damage to the sperm-carrying tubes and ducts in the testes and this can result in blockage and therefore infertility. 

 

  • Gonorrhoea is highly contagious and unprotected sex with an infected person transmits the infection in 90% of cases.  Twice as many men as women are infected.  Like Chlamydia, this bacterial infection is often symptomless but it can produce an unpleasant vaginal discharge and abdominal and urinary pain.  Untreated gonorrhoea often leads to pelvic inflammatory disease and blocked fallopian tubes.  Men show symptoms including discharge, abdominal pain and a high fever.

 

 

Pelvic inflammatory disease (PID)

  • This occurs when an untreated STI spreads up through the cervix and into the uterus, fallopian tubes and pelvis.  PID often causes painful intercourse but the disease can be symptomless and some women don’t realize there is a problem until they try to conceive.  The infection itself is easily treated with antibiotics.  However, if left untreated for some time, it can cause scarring or even blockage to the fallopian tubes.  If that is the case, fertility will be affected and you will run a greater risk of an ectopic pregnancy

 

Herpes

  • This is a common STI but one that very few people openly admit to having contracted.  The herpes simplex virus is dormant in the majority of the population, so they probably don’t even know they carry it.  There are two types of herpes viruses – HSV1 causes cold sores and HSV2 causes genital herpes.  Women may find that hormonal changes set off an attack around the time of menstruation.  Subsequent flare-ups occur when you are unwell, tired or under stress.

 

Trichomoniasis

  • This STI does not cause PID.  However, as well as causing an itching and burning sensation in the vagina and urethra (and for men, pain when urinating), it changes the consistency of the cervical mucus, making it difficult for sperm to get through.  As a result, fertility may be affected. 

  • Bacterial vaginosis : mycoplasmosis, ureaplasmosis, gardnerella

  • These bacterial infections are caused by microscopic organisms found in the genito-urinary tracts of men and women.  They are normally harmless and although they are not STI’s as such they sometimes proliferate and can be transmitted from one partner to another.  These organisms, which are often symptomless, are found in higher concentrations in couples who are having trouble conceiving.  A short course of antibiotics normally clears up these infections within a couple of days although the conditions tend to recur.

 

Candida

  • Although not an STI, a common condition that primarly affects the vaginal secretions is candida, also known as vaginal thrush or a yeast infection.  Candida albicans, which is present in our bodies, proliferates.  If left untreated, it can impact on your health in general, making you feel very tired and run down and damaging your absorption of essential nutrients.  Candida thrives on a poor diet that is high in refined sugar.  Eating live yoghurt containing lactobacillus acidophilus also helps to restore the natural flora in the gut.

 

 

Is it true that sperm determine the sex of a baby ?

Yes, it is the sperm that determines the sex of a child. 

 

 

Can a man have fertility problems if her has already fathered

children ?

If there has been more than a two-year gap since a man previously fathered a child, then yes, it is possible that he might no longer be as fertile as he was in the past.

 

 

Can illness affect sperm count ?

A bout of flu (or any other viral infection) can affect sperm count for several weeks.  It takes approximately 100 days for sperm to become fully mature.

 

Is it better to have frequent sex or to have sex only on specific days to allow sperm to regenerate ?

It appears that conception is more likely to take place if you have frequent sex, rather than abstaining and having sex only on, or just before, the day of ovulation.  Aside from the question of whether you have accurately predicted the woman’s impending ovulation, a man is likely to have fewer dead or immotile sperm if he has regular intercourse (every two or three days) as his supply is being regularly replenished with new healthy sperm and these are more likely to be able to fertilize an egg.

 

 

Which medications can affect fertility ?

Conditions such as inflammatory bowel disease, urinary tract infection, high blood pressure, and epilepsy may be treated using medication that affects fertility, depending on which drug is used.

Does being overweight affect male fertility ?

Women who are overweight are known to be less fertile than those of normal weight and it is now known that men who are overweight also have an increased risk of being infertile.

 

 

Can everyday activities affect sperm counts ?

Some of the things that you do as part of your everyday life may present some degree of risk to your fertility eg. Mobile phones, computer laptops, heat, environmental toxins etc.

 

 

How often should we be having sex ?

Couples who are trying to conceive often fall into the habit of having sex only around the time when they think the woman is fertile.  Before long, this becomes an unspoken pattern between them.  For a few days every month, they feel it is “worth it” having sex, even though they may have intercourse only a couple of times in that phase.  The rest of the month, nothing happens at all because there’s “no point”.  Yet, this is harmful on two counts.  First, if you are trying to conceive you need to maximize your chances by having a lot of sex. 

 

Secondly, if you are having sex only during a short period of time each month, by the time you have sex again the following month, the sperm waiting to be released are old.  As a result, a higher proportion will either be less motile, abnormal or dead.  It is better for a man’s fertility if sperm are regularly renewed through ejaculation.  If ejaculation does not happen very often, the chances of conception will be affected.  Given that the egg can only be fertilized in the first 24 hours after ovulation, and sperm can survive for an average of two to three days (potentially longer) in the female reproductive tract, it is important that regular quantities of fresh, active, healthy sperm are present and ready to attempt fertilization.  So, ideally, you should be having sex every two or three days throughout your cycle, not just around the time when you think you are fertile.

 

Do recreational drugs affect fertility ?

Whatever you may believe, there are no “safe” recreational drugs to use when you are trying to conceive, nor “safe” levels at which you can take them.  All recreational drugs have an effect on fertility, either because they damage sperm production or because they affect male and / or female hormone production.  Furthermore, while the effects of drugs on your metabolism are reversible, it may take a few months (and in some cases, years) for this to happen, during which time you may become pregnant and your unborn child may suffer from the effects of the drugs that are still in your system.  If you are an occasional user of recreational drugs, stop now.  If you are drug-dependent, you will need to seek professional help to ensure that you give up as quickly as possible, and to give yourself the best chance of conceiving a healthy child.  Examples hereof include marijuana, cocaine, opiates, ecstasy and anabolic steroids. 

 

 

What is the glycaemic index ?

The glycaemic index (GI) is an index, on a scale of 1 to 100, based on how quickly a particular food item is digested, metabolized and then released into the bloodstream as glucose.  It is a useful indicator of which foods are slow-releasing and will help to keep your blood sugar levels stable. 

 

Low GI foods (40 and under) have the slowest release of energy and you should eat as many of these as possible eg. Apples, plums, pears, peaches, cherries, apricots, green leafy vegetables, whole cereals, mushrooms, onions, avocados, wholegrain or rye bread etc.

 

Medium GI foods (41-60) can be eaten in moderation eg. Grapes, under-ripe bananas, sweetcorn, peas, raw carrots, wholewheat pasta, muesli, orange juice, grapefruit juice, unsweetened apple juice, kiwi fruit, mangoes, brown basmati rice etc.

 

High GI foods (over 60) should be eaten the least frequently and ideally with protein or fats to slow their absorption eg. Ripe bananas, watermelon, raisins, pineapple, baked potatoes, mashed potatoes, cooked carrots, squash, broad beans etc.

 

 

What are the top superfoods for fertility ?

           

  • Sex and libido foods – pomegranates, avocados, bananas, figs, dates, asparagus, almonds, garlic and oysters.

  • Brain foods – parsley, papaya, dates, spirulina, carrots, dried apricots, sweet potatoes, sunflower seeds and almonds.

  • Foods to protect sperm and eggs – blueberries, cherries, oranges, grapes, peaches, plums and tomatoes.

  • Sperm-boosting foods – zinc, vitamin C foods, seeds, grains, green leafy vegetables, kiwi fruit and tomatoes.

  • Food for healthy secretions – asparagus, bamboo shoots, broccoli, carrots, cabbage, celery, cucumbers, leeks, onions, potatoes, apples, avocados, cherries, mangoes, olives and peaches.

 

 

What effect does caffeine have on fertility and on pregnancy ?

Some studies have found a link between high levels of caffeine consumption in women and a delay in conceiving.  Those who consumed more than 300mg of caffeine per day – the equivalent of two cups of fresh coffee – were more likely to have a delay in conceiving.   As a precaution, you should aim to cut down on caffeine as much as possible while you are trying to get pregnant.  There is also some evidence to suggest that drinking large amounts of caffeine during pregnancy may increase the risk of miscarriage.

 

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