Articles, Blog

Fertility 101 – Q&A with fertility experts from Michigan Medicine

March 12, 2020

– Welcome to today’s
webchat, Fertility 101. And thank you for joining us. So my name is Ed Bottomley with the Michigan Medicine
Department of Communication. One in eight couples have trouble getting pregnant or
sustaining a pregnancy. Infertility is not an inconvenience, it’s a disease of the reproductive system that impairs the body’s ability to perform the basic
function of reproduction. Our goal today is to
provide helpful information for individuals and couples
who are trying to conceive and answer your questions
about getting pregnant. We know there’s no shortage of advice from well-intentioned
friends and family members, not to mention the internet. So we’re also ready to do
some myth-busting today and help you sort out
the myths from the truth. We’ll introduce our panelists in a moment but first I’ve got a
few housekeeping items. You can submit questions at any time, even now, for our panelists to answer during the Q&A portion of today’s chat. Questions can be submitted
by commenting on this video, but please note that
your name or profile name will be visible to others participating. Now if you prefer a more anonymous option you can always send a private
message to us via Facebook or email us [email protected], that’s [email protected] Now if you can’t stay for the whole chat or if you want to share the
recording with a friend, a video of the chat in its
entirety will be available on our Michigan Medicine
Facebook page later today and posted to the Michigan
Medicine YouTube channel soon after. So now to introduce our panelists. Dr. Samantha Schon is an
obstetrician and gynecologist specializing in reproductive endocrinology at Michigan Medicine. Dr. Schon did her undergraduate
and medical school training here at U of M,
before completing her residency at Washington University in St. Louis, and her reproductive endocrinology and infertility fellowship training at the University of Pennsylvania. Dr. Schon is also an
accomplished researcher, having earned a Master’s degree
in translational research. And named a woman’s reproductive
health research scholar. Her research explores the role of DNA modifications in human sperm. Next up we have Sharon
Dolt, a registered nurse at our Center for Reproductive
Medicine in Ann Arbor. Sharon works with men and women being seen for a wide range of
reproductive health issues. And finally, we know the
realities of finances being a major consideration for families considering fertility services. So we’re excited to be
joined by Melissa Medina, a financial counselor who
works with our patients here at the CRM. We’ll kick things off
today with Dr. Schon. Dr. Schon, let’s jump right
into the fertility 101. Can you share with us some
of the basic challenges couples face during
their fertility journey? – Yes, absolutely, thank you so much. So just to start with the basic
definition of infertility. We consider infertility as a
failure to achieve a pregnancy after 12 months of regular
attempts at conception. In patients over the age of 35, we typically recommend that
they come in for evaluation a little bit sooner than
that, so after six months. Other considerations are patients that have irregular periods,
a history of pelvic surgery, any prior history of
chemotherapy or radiation, and then again other
gynecologic conditions, such as endometriosis. The diagnostic evaluation
typically includes an evaluation of both the male and the female partner. For the female partner,
this typically involves blood testing and radiologic imaging, usually ultrasound and sometimes X-ray. And for the male partner, the cornerstone is the semen analysis. There are a number of reasons that couples can have difficulties conceiving. Some of the most common issues that we see are ovulatory disorders, such
as polycystic ovary syndrome, patients who have had
prior pelvic surgery, prior pelvic infections,
advanced age, obesity, smoking. And I think it’s important to note that in a number of couples
we actually don’t find a good explanation for what’s going on. And just to give you an idea of overall some of the fertility
treatments that we offer. We offer oral medications,
injectable medications, intrauterine insemination,
in vitro fertilization. We offer both donor eggs and donor sperm. We do a fair amount of
fertility preservation. And then we also have been
fantastic counseling services, both for our patients
with fertility issues as well as weight loss counseling and weight loss management. So that’s just sort of
a brief introduction and our wonderful nurse
Sharon is gonna debunk some of the most common
myths that we encounter. – Yes, so we’ve all heard old wives’ tales or myths about what you
need to do to get pregnant, what doesn’t work, what does. So I think one of the
things that we hear the most is this conception that
infertility is a woman’s issue and it’s not a man’s problem at all. When in reality about
a third of the couples coming in that are
struggling with infertility, it’s solely the man’s issue. Male infertility is a big problem. About a third of the couples, it is female infertility-related and then for the other third
it’s a combination of the two, or like Dr. Schon said,
there are some couples where we just can’t
identify a specific reason why they can’t conceive. Another myth or advice
that people tend to get is, if you relax it will just happen
or you’re trying too hard. And, as we said, infertility is a diagnosable medical condition that should be evaluated. So if you’ve been trying for over a year then you should talk with your physician or seek an appointment with a reproductive
endocrinology specialist. Another thing that we hear
or you may see portrayed in movies is that there is
like one day of the month that a woman can get pregnant,
or that you may have heard that you just need to
have sex all the time, and really neither of those is true. Timing is really important
when you’re trying to get pregnant, knowing your cycles and trying to figure out
when you’re ovulating is a good idea so I always recommend that everybody be tracking their cycles. You can also use something
called an ovulation predictor kit which is a urine test just
like a home pregnancy test except you’re testing every
day instead of just once. And that will give you a positive result right before ovulation. It is important to know that when you get a positive ovulation kit that
doesn’t mean you’re ovulating that day, it means the egg is gonna be released in about 24 hours. So when you’re trying to
time things there’s a window, a fertile window in every woman’s
cycle, if she’s ovulating, and that’s about five
days prior to ovulation. That’s because sperm does live within the female reproductive
tract for a few days. So during that five-day window having intercourse every
other day is recommended. You don’t have to have
intercourse every day, that can get a little stressful. Another myth that we do hear
is that, well I was able to conceive very easily the first time so I shouldn’t have any issues
with future pregnancies. Unfortunately age is a huge
factor in women’s fertility, so it can get harder to conceive, especially for women over the age of 35. Another thing that we hear
that people are worried about is the concern about multiple
pregnancy, so twins, triplets, higher order multiples, if
you do fertility treatment. We have ways of monitoring
fertility treatments and to minimize the risk of multiples. And if you do IVF we can control how many embryos are put into the uterus and so we can definitely minimize the chance of multiples that way. And then another myth, the
last one I’ve got for you, is that certain positions during sex or after sex are helpful
when trying to conceive. There really is no data
showing that certain positions are helpful with conception
and there’s no data showing that laying down after
intercourse or raising your hips for an extended amount of
time is helpful either. – Thank you, thanks for the overview, thank you for those myth-busting answers Let’s open the floor to questions now. So I’d like to remind our
audience that you can submit questions by commenting
on this video directly, by direct messaging us on Facebook or by emailing us at
[email protected] We’ll not use your name when
we read off your question, but do know that if you
comment directly on this video your name or your profile name will be visible to other participants. So let’s kick it off with some questions. First one I have is I’m
having regular periods but my ovulation
predictor kit is negative. Does that mean I’m not ovulating? – That’s a great question. The fact that you’re having regular cycles is a good indicator
that you are ovulating. Not everybody has luck with
those ovulation predictor kits, sometimes they you just
don’t have enough hormone in your urine for them to pick it up. So keep tracking cycles
but it doesn’t mean that you’re not ovulating, yeah. – So just to add on that
we see a fair number of patients that have both false positives and false negatives with the
ovulation predictor kits. If you’re having regular
cycles every 26 to 30 days the chances are that you
are indeed ovulating. And the best thing you can
do is really count backwards, so if you have a 28-day cycle
you’re probably ovulating around day 28, I mean around day 14. If you have a 30-day cycle, you’re probably ovulating around day 16. – Thank you, next question we have up, what’s the difference between
a blinking smiley face and a solid smiley face on
my ovulation predictor kit? – That’s also a great question, those kits can be fairly confusing. So there are different types of ovulation predictor kits out there. There are the more simple tests where you are actually
looking at two lines, trying to judge whether
they’re the same color or not. And then there are the digital tests where you get an empty circle, a flashing smiley face,
and a solid smiley face. With those ones, the flashing smiley face actually means you’re getting close but are not quite at peak fertility. I know that flashing
means like alert, alert. But in those cases, it just
means you’re getting close. If you’re trying to time intercourse that’s still a good time
to have intercourse. Like I was saying earlier,
about five days before ovulation having intercourse every
other day is a good idea. But when you get that solid smiley face that means that the egg should
be released within 24 hours. – Thank you. Thank you for that so the
next question we have, my husband and I have
been trying to conceive for a few years, can his
meds be hindering us? He takes anti-rejection meds
for a kidney transplant. – I think that that’s a great question and certainly medications
can affect semen quality. I would probably recommend
that your husband undergo a semen analysis to start. To determine if there is some
impact on his sperm quality or quantity, we have three
wonderful reproductive urologists as part of our practice so another option would be to see them directly. And I believe we also have
another webinar series with two of those coming
up in a couple of weeks. – We do indeed, the next question. What tests are the most
important to determine fertility? – Yeah, so well that’s
again a great question. As I sort of briefly
mentioned at the beginning, we typically start out
in the female partner assessing the ovaries
and the fallopian tubes. So from the ovaries
we’re generally assessing markers of ovarian reserve. We believe that women are
born with all of the eggs they’re ever gonna have and
that number declines with time. We check a number of different blood tests to give us an idea of ovarian reserve, which are really numbers
that are most helpful in determining how we
think patients will respond to medications but certainly
those can also be helpful in the evaluation. Another test that’s really important is assessing the fallopian tubes. So, as we mentioned
before, pelvic surgery, a history of gonorrhea, chlamydia, or pelvic inflammatory disease can all predispose the tubal factor. And so there’s a couple
of ways we can assess to make sure the fallopian tubes are open. That’ll also sort of assess
for the uterine cavity. And then the semen analysis
is also critically important. – One thing I’d like to add just so that people understand,
the fallopian tubes are the road or avenue where the egg can get from the ovary to the uterus, it’s also where the egg and sperm meet up so it’s really, really important
for the fallopian tubes to be open and healthy
for conception to occur. – Thank you, next question we have, it’s a little bit of a long one. My husband and I have
been trying to conceive for three years as of next month. We’re using Pre-Seed lube
and an ovulation tracker but have had no luck. I’m 36 and have had bad
periods since I was eight. I use a heating pad daily,
sometimes for hours at a time. I’m trying to cut back
on the amount of time I use it per day but it’s
a difficult habit to break. Could using the heating pad after sex be harming the chances of us conceiving? – No, so once the sperm
are inside of the body external application of heat is not going to harm the sperm. You’ve probably heard
stories about men should not be sitting in hot tubs or
having a laptop on their lap as that can harm sperm production, but once the sperm is
inside of the woman’s body that’s not an issue. – I will say, though, given your history I would recommend an evaluation. Certainly painful and heavy
periods could be a sign of things like endometriosis or fibroids, and given the amount of
time you’ve been trying I would recommend further evaluation. – Thank you, next question we have up, when would you recommend
Femara versus Clomid? – Yeah, so Femara which is
also known as letrozole, and then Clomid which is
also known as clomiphene, are two medications that
are very commonly used to induce ovulation. Femara or letrozole is
currently first-line for ovulation induction in patients with polycystic ovary syndrome. Clomid we tend to use in couples with unexplained infertility
or other ovulatory disorders. They work very similarly,
both sort of trick the brain into thinking that there’s
not enough estrogen around and can cause recruitment
of follicles and ovulation but there are some large
trials and data to suggest that Femara is the drug of
choice in patients with PCOS, and Clomid more so in couples
with unexplained infertility. Do you have anything to add to that? – Sometimes we’ll use one versus the other depending on side effects as well. Certainly if if somebody tries
one, like starts with Clomid but does have side effects with that, we can try switching to Femara. That’s another reason why we would choose one over the other. – Thank you, next question we have up. We were successfully blessed with twins through Michigan Medicine
via hormones and IUI. Now that the twins are 13 months
we’re now starting to talk and plan the future of our family. We’d like to have one more child but are very nervous of
conceiving twins again. So my question is, what are the chances we will conceive twins again? – So that’s a great question,
so first off congratulations. You must be very busy at home. So it depends on how you
conceived your twins, you mentioned IUI. Now with medications
like Clomid and Femara, the number one risk is the risk of twins and that risk is generally about 10%. We have methods of trying to control that and reduce that risk by sort of monitoring the number of follicles that you produce but overall that risk is really about 10%. – Thank you, next question we have up, does your clinic have
an age cutoff for IVF? – We will do IVF with a
woman’s own eggs up to age 42. Once you turn 43, you do have
the option of using donor eggs and conceiving with IVF that way. And then our upper limit
for embryo transfer for a woman is age 51. – Thanks and we have another
IVF question coming in. Will my insurance cover IVF? – Yeah, that’s a good question. There are states that mandate
infertility treatment coverage but unfortunately Michigan
is not one of those states, so it really will depend
on how your employer set up the plan. There aren’t any individual
plans that you can buy on the marketplace right
now that would cover IVF, it really is strictly
through your employer. So calling somebody in
your benefits department or calling your insurance directly would probably the best start for that. – Thank you, next question
up, do I need to stop drinking coffee if I’m
trying to get pregnant? – Yes, so you can limit
your caffeine intake. We recommend no more than
one to two cups a day. And you have to think about
are you drinking coffee and then tea and then pop or soda? Depending on what part of
the country you’re from, that has caffeine. So you do have to be aware of that – But you don’t have to stop entirely. – Exactly.
– So don’t worry. – Next question up, I
want to see a physician for infertility but I’m terrified that I will get pushed into
doing in vitro fertilization. Due to religious reasons
we’re not comfortable with doing IVF, are there
other patients like us who choose not to do IVF for
religious or ethical reasons but are still able to get pregnant? – Yeah absolutely, so to start off, there are sort of rare
situations where patients have to immediately start out with IVF, and it’s never sort of
pushing patients into it. It’s always a discussion of what your particular diagnosis is and then a discussion of what the various treatment options are, what
their success rates are, what their risks are, and thanks to Melissa as well, consideration of what the costs are. There are a number of
fertility options available that are not IVF. So I
think we talked about a couple of those at the beginning but again oral and injectable medications, intrauterine inseminations
are all options. – Thank you, so next question up, I’ve heard that IVF is really painful. I’ve always had a fear of needles and don’t think I can do
it, do you have any advice? – I do talk a lot of people through this. So IVF does involve the
use of frequent blood draws to monitor your hormone
levels and it does involve the use of injections that you do at home. That being said, I have
had a lot of people who do have pretty
significant needle phobias who are able to successfully
do an IVF cycle. The injections that you do for IVF involve use of very small needles and the discomfort isn’t
typically very bad with that. There is a mental hurdle to get over when you have to go
home and do an injection on yourself, but one thing I love about the Center for Reproductive
Medicine at Michigan Medicine is the fact that we have
two wonderful social workers who are able to counsel
you through that as well. So that’s a fantastic resource
to use if you are nervous or scared or stressed
about this process at all because it is a very stressful
process for most people. – Thank you, the next
question that we have, my wife and I are in a
same-sex relationship and are interested in having a baby soon. Does your office offer fertility services for LGBT patients? – Yes.
– Absolutely. – So we have a number of options in the setting of same-sex couples. One option is the use of donor sperm and we can do intrauterine inseminations. And oftentimes we can just do
that with your natural cycle, without the need of any other medications. We also offer many other services as well. We have partners who decide
that one would like to carry their partner’s egg so
that they sort of both get to be a part of the experience. So in those cases one partner
would undergo the IVF process, so we would retrieve the eggs from her and then those embryos
would then be transferred into the partner’s uterus
to carry the pregnancy. One other thing that we do
offer for same-sex couples who are men is you can
conceive using donor eggs and then you can use a gestational carrier for the pregnancy as well. – Yes.
– Thank you. The next question we have is an insurance one, can you explain what the University of
Michigan insurance coverage is for infertility treatment? – I sure can, so three years ago University of Michigan decided that it would be a wonderful addition to have IVF coverage for our employees. The coverage is just for IVF. Unfortunately it does not
cover the inseminations. But for the IVF coverage it is at 80%. You will have a 20% co-pay and that is a $20,000 lifetime benefit. But within that benefit
we’re finding that patients can have at least three
full cycles of IVF performed and that it consists of
the retrieval of your eggs, the fertilization, and an
implantation of the embryo, so it’s pretty great coverage. – They also do cover IVF medications. – Yes.
– If you get them at a U of M pharmacy. There is some limit to the coverage for two of the medications
that we use for IVF. One is called GONAL-f, that is
follicle stimulating hormone. The other is called MENOPUR
and that’s a combination of follicle stimulating hormone
and luteinizing hormone. So there is some limited coverage. Depending on starting
doses for the IVF cycle, you may be able to have
those two medications covered for one to two cycles typically. And then the rest of the medications there isn’t really a limit on. – Thank you, next question we have, my husband and I are
having fertility issues and it’s really stressful for us. Do you have any support
groups that you recommend? – Yes we do. So, as I mentioned before, we’ve got two wonderful social workers who counsel our patients. And they also do lead an
infertility support group as well as a pregnancy after
infertility support group. – And the next question we have is when is the best time to have sex to get pregnant and how often? – Right, so going back to that question, it depends on how you’re
tracking your cycles. So ideally you’d like to have intercourse around the time of ovulation. So, as I mentioned before, in an ideal 28-day cycle if you’re ovulating around day 14 , it’s best to probably have intercourse between days 12 to 14. If you’re using the
ovulation predictor kits it’s easiest to time the day and the day after you
have a positive surge on your ovulation predictor kits and again as we talked about before you don’t need to have
intercourse every day. Every other day around time of
ovulation is also sufficient. – Thank you, the next question we have up, this is a little bit of a theme here. My husband and I have been
trying for a year to conceive. We’re interested in seeing
a fertility specialist but I’m terrified of having multiples. My friends did fertility treatments and they ended up with triplets. – I think there’s been a big push especially in the past couple of years to try and reduce the incidence
of multiple pregnancies. Certainly with in vitro fertilization in patients that are under 35 we routinely only put back one embryo so we can reduce the risk of multiples. So in that case your
chance of having twins is only about 2%. In the past a lot of people underwent injectable, injectable cycles where they would release lots of eggs but there were no control over the amount that fertilized and that’s where you
tend to see these sort of large higher order multiples. So we’re very aware of
the risk of multiples in our clinic and do as much
as we can to reduce that risk. – Okay.
– Anything to add to that? – Yeah, we’re very committed
and we want everyone to have a healthy pregnancy and really the healthiest
pregnancies are singletons and so that really is our goal. – Great, next question we have up, I have polycystic ovary syndrome and have always been overweight. My gynecologist told
me to just lose weight and keep trying to get pregnant. I’m doing the best I can but I’m struggling with weight loss despite a healthy diet and walking more. What should I do? – Yeah, so that’s
certainly very frustrating. I think any patient who’s
been diagnosed with PCOS, it’s reasonable to come
in and see us anyways. One of the things we can offer is referral to a nutritionist as well as some of the
weight loss programs that U of M has to offer. I think if you’re trying your best sometimes the reality is that, well the reality is that it’s
always extremely difficult. But we will consider starting treatments even if you’re not able to lose the weight we just sort of have a discussion about what the risks of
obesity are in the setting of both fertility and during pregnancy. But again, with a diagnosis of PCOS I’d recommend coming in to see us anyway so we can have a discussion about what the risks are with that diagnosis and how we can help you have a baby. – Yeah, I definitely think it’s worth finding a provider
who is going to support you and give you resources or guidance in weight loss instead of
telling you to just lose weight. – Yes.
– Thank you, the next question we have, do babies born through
fertility treatments have a higher rate of birth defects? – Yes, so that, again,
is a great question. There are some large observational studies that have shown a slight increased risk in birth defects in
babies born through IVF, that while statistically significant the absolute increase is only about 1% and it’s unclear from those studies whether it’s actually the treatment itself or the underlying diagnosis. So overall we feel that our
treatments are very safe but again that’s an excellent question – Thank you, and the next question. Does your office offer
scholarships for patients who can’t afford IVF
or fertility treatment? – So the answer of that is
unfortunately we do not. But one nice thing about having your care at Michigan Medicine is that if you have an insurance plan that these services are not a benefit of that plan, Michigan Medicine does offer discounts towards the services that you receive and parts of your treatment can be set up on a payment plan, so that’s something that we can offer you. – Thank you, next question we
have up is on egg freezing. I’m in my late 30s and not
ready for children just yet. What’s the best time for
me to freeze my eggs? – So again, slightly difficult to answer but a fantastic question. As I mentioned before, we think that women are
born with all of the eggs they’re gonna have and that
number declines with age. The decline really picks up around age 35 and certainly by age 37. So with that decline
in the quantity of eggs we also see a corresponding
decline in quality of eggs. So if you’re in your 30s and you’re considering
delaying childbearing for a number of years
it’s definitely worthwhile to come in and have a
conversation with us. The eggs when you use them, your likelihood of pregnancy
is really determined by the age at which you freeze them, so freezing eggs at the age of 34 is gonna be much better than freezing eggs at the age of 39. A, because you’re probably gonna have a better response to stimulation but also because the
quality at a younger age is going to be much better than the quality at an advanced age. So it’s hard to give an exact number but if you’re in your mid-30s and you’re you know thinking about it I’d recommend seeing us.
– Excellent. – I do believe that we have a, we’re gonna have another
presentation in June about egg freezing you
can also tune into that. – The next question is an interesting one. What kind of time commitment is it to go through fertility treatments? – It’s a good question, it does depend on what
kind of fertility treatment you’re gonna go through. If you’re taking oral medication and timing intercourse then that may involve an
ultrasound appointment every cycle. If you get a little bit more involved where you’re taking oral medication and doing insemination and that’s gonna involve
an ultrasound appointment and appointment for insemination. When you kind of step that up and you get to injectable medications, then you’re talking about
increased frequency of monitoring and then if you’re
talking about an IVF cycle that is a pretty, pretty big commitment in terms of time. It requires frequent appointments over about a two week time frame when we’re monitoring you closely, making sure that you’re
responding well to the medications leading up to your egg retrieval. – I think one misconception
with the IVF process though is that when you’re
undergoing the stimulation you can’t do anything else. So we do our ultrasounds
and our blood draws first thing in the morning
starting as early as 7 a.m.. – That’s true.
– So you know, most of our patients you come
in you get your ultrasound and then you can still go to work so it’s not completely disruptive. Obviously you’ll need the
day of your retrieval off as you get anesthesia and the day of your transfer but while you’re undergoing
the rest of the monitoring and stimulation you
should still be able to go to work or carry out
your regular activities. – Thank you, that’s an important point. So next question is about
diabetes infertility. My husband has type 1 diabetes. We’re 34 years old and are concerned about our
likelihood of getting pregnant. Will his diabetes affect fertility and should we can be
concerned about our age? – So at age 34 you’re
certainly still young from the reproductive standpoint. It depends on how long you’ve been trying. So again, under the age of 35 we’d recommend a year of
unprotected intercourse. But certainly when there’s
other medical conditions it may be worthwhile to have some sort of
evaluation beforehand. With your husband’s type 1 diabetes it may be reasonable
to get a semen analysis on the sooner side, just to
make sure there’s no effect. And then certainly if you’re having any difficulties with sexual intercourse then
that would be another reason to come see us sooner. – Thanks, so the next question we have, and I’m delighted with all the
questions we’re getting here, I’ve heard that taking ibuprofen while trying to conceive
can cause miscarriage, is this true? – So we do recommend
that you avoid ibuprofen from around the time of ovulation until you start your next period and have, know that you’re not pregnant. Take a home pregnancy test because there is some
evidence that ibuprofen can interfere with early pregnancy right. – That being said if
you happen to take Advil because you have a headache, I would not freak out. It’s most likely not gonna
cause you to have a miscarriage. – Exactly.
– Next question we have up is about lubricants. I’ve heard that certain
lubricants can hurt fertility. What brands do you
recommend to your patients? – Yeah so there is a
commercially available lubricant called Pre-Seed that is specifically made so that it’s not harmful to sperm and that’s what we’re worried about when when you’re talking about
lubricants and fertility. Certain commercially available lubricants are harmful to sperm and can decrease their motility, so making sure that you’re
using something like Pre-Seed or something like
mineral oil or canola oil is actually a good lubricant that is not going to affect sperm. – Fantastic, now the next question, we’re getting a wide variety here. What do you think of
acupuncture for fertility? My friend went to a fertility clinic where they had an acupuncturist on-site. – So I think the data in
regards to acupuncture is mixed. That being said, it certainly
does not cause any harm and I think given that this
process is so stressful, anything that can help
you maintain your sanity while going through the
process is recommended. So you know we don’t have
an acupuncturist on-site but we definitely will
work with our patients if that’s something that
they’re interested in. – Another good question,
what’s the best brand of ovulation predictor
kit in your opinion? – So the one we recommend, just because it seems
to be the most accurate and easy to use is Clearblue
Fertility Test Sticks. So there are different
brands on the market, I talked a little bit earlier about how there are
kind of different types of fertility, or ovulation predictor kits that you can get. Some that are gonna be less expensive. That will give you a control
line every time that you test. And you have to look for a
second line to become darker. Darker than the control line to know that you’ve had a positive test. For a lot of people those are hard to use and they don’t necessarily
get consistent results. So stepping up from there, you’re gonna have
different brands of digital ovulation predictor kits. I think there’s a First
Response, Clearblue, and that you can have digital tests that either give you a yes, no answer or you can get the, slightly more expensive ones that are gonna give you negative, high and then peak fertility and
that’s where you get into those that have flashing and
then solid smiley faces. So for our purposes, we recommend the simpler digital tests because they’re easier to use. Easier to read and they
don’t lead to the confusion that the days with multiple results with high and then peak
fertility can lead to. – So if you’re trying to find a test that tells you sort of when the single or two best days are to have intercourse, then getting a test that
just gives you a yes, no as opposed to that flashing smiley face is probably best. – But if you’re just starting out and just trying to time intercourse, then that flashing smiley face is absolutely fine to use as well. – Great, next question is
on birth control pills. I am 23 years old and
on brth control pills, however I’ve heard that
birth control pills can hurt my future chances of pregnancy. Is this true? – So this is not something
that we think is true. Sometimes when you’re
on birth control pills for a number of years it can take awhile to sort of resume your menses afterwards but taking birth control pills, or really any of the forms
of contraception right now do not affect your chances of becoming pregnant in the future. – I’ve also had people ask
if using birth control pills saves their eggs because
they’re not ovulating every cycle and unfortunately it doesn’t preserve your
fertility in future years because age is an independent factor. So, that’s another thing to think about. – Okay next question we have. I am a 25-year-old woman, I was treated for leukemia
when I was a child, thankfully I don’t have the cancer anymore but I’m not ready for children just yet. Do you think I should see
a fertility specialist? – Yeah, so certainly
many of the treatments for different malignancies can impair sort of, the number of
eggs left in the ovaries. We have a wonderful fertility
preservation program at the Center for Reproductive Medicine and I think it would be
definitely worthwhile to come and touch base. Just to sort of have a discussion of what your particular regimen are. So there is you know, a
number of different regimens that can be used to treat various cancers and depending on what medication you get, the effects on the
ovaries can be different. So even if you’re not
ready for pregnancy yet I think it would be worthwhile to sit down with one of our specialists. – The next question, my husband has had a
vasectomy but we would like to have children. Will he need to have surgery? – Not necessarily. – I guess it depends on
your definition of surgery. – That’s true. – So, with men who have had a vasectomy, there are sort of a couple of options. So one option would be a
vasectomy reversal and again, I’ll defer to our reproductive
urology specialists who again, will be here
in a couple of weeks. A lot of that depends
on how long it’s been since they’ve had the vasectomy. Other options if they do not
wanna undergo a reversal are, we can surgically retrieve sperm and that can be used for the
in vitro fertilization process. So there are various options. – The other option is
considering using donor sperm. – Yes.
– If you know, partner is not comfortable
with any type of procedure. – Okay and the next question that we have, I’m a 34-year-old woman
married to a 48-year-old man who’s healthy. Does my husband’s older age
impact our chance of conception? – So, age can have some
impact on the quality of sperm but not to the same degree
that women are affected. So I’m sorry, I didn’t
see the age again of. Right, so at your age of 34, you know, you’re still right in the middle of your reproductive lifespan. So overall, your husband’s
age probably shouldn’t impact your chances of pregnancy. But if you’ve been trying for a year then I would still
recommend an evaluation. – Okay, and we are, we
have a few minutes left to, if anyone has any more questions. I’d like to remind our
audience that you can submit questions by commenting
on this video directly, direct messaging us on Facebook, or you can email us at
[email protected] We’re not gonna use your name when we read off your question but do know that if you comment directly on this video your name or profile name will be visible to other participants. And we’ve had quite a few
questions come in already. Let’s see if we have any more coming up. Looks like we might have a few. Melissa, what’s the, from your perspective, I feel like we haven’t asked you too many questions. What are some of the biggest
questions that you get? – I get a lot of questions regarding what the costs of IVF would be. So if we went under the assumption that you didn’t have
any infertility coverage with your insurance and a cycle of IVF including the medications can be about 16 to $18,000 and that
includes what discounts we can offer here. If you went somewhere
else the price would vary. Also if you were looking at trying to do an artificial insemination or intrauterine insemination cycle, if you didn’t have coverage for that, with the discounts that we offer it’s about $1000 a month or $1000 a try for the procedure of the insemination and also the ultrasound that we need to sort of time those things. So those are the main
questions that I get. It’s just, what is the average price. – Fantastic.
– Yeah. – And you three all work in, do you work in concert
with you two as well? – We absolutely do. We are.
– Yeah. – We work as a team every day. – I can tell.
– So usually when you come in for your visit, you’ll see the physician but you’ll also see both the nurses and Melissa before you leave.
– Yes. – So when we recommend
either an evaluation or a treatment you have an idea of exactly what that treatment entails, how you would take the medication, Sharon would you know,
sign the prescriptions before you leave and
then you have a chance to talk with Melissa as well. So you understand what it’ll mean for you. Melissa’s fantastic. She will look up your insurance
while you’re in the office and give you an idea of sort
of what the cost will be to you before you leave. – Yeah it’s always like a parade of people when you come in for an appointment.
– It’s a little overwhelming sometimes but I feel
like we work our hardest to give our patients the most information so they can make the best
decision for themselves. – Well and this is evidence of that. Do you think there are any questions that we might have missed out? I feel like at the end
of these Facebook Lives we often get oh I wish I
was asked this question or are there any ones that perhaps people haven’t asked? – I realize that I needed
to add a little bit more. Somebody had asked a
question about whether or not the IVF process was
painful and I talked about you know the injections and blood draws but I didn’t actually talk
about the egg retrieval process which is a big part of it. So I just wanted to add a
little bit more about that. So when you go through an IVF cycle, we do have to take the
eggs out of the body to be able to fertilize them in a lab. That’s how the process works, that’s what in vitro means. And when you have an egg
retrieval you’re actually asleep. We use deep sedation so
that you take a nice nap during the procedure so
you’re not feeling any pain and then following an egg retrieval, mild to moderate cramping is normal. Kind of like a period. But most times if you take Tylenol, that covers the pain and a heating pad. – Thank you for that addition to that question we had earlier.
I have a question for you. Could you tell me what PCOS is? Could you tell me more about that? – Yeah, so PCOS or
polycystic ovary syndrome is typically, well
there’s different criteria used to diagnose it. Most commonly we use
the Rotterdam Criteria which requires two out of the three. So the first is irregular periods. The second is either
clinical or lab evidence of excess male hormones and the third is ultrasound evidence of
polycystic appearing ovaries. So if you have two out
of the three of those, you can, that sort of makes the diagnosis. Importantly it’s also a
diagnosis of exclusion, so we do typically recommend obtaining some additional lab tests just to rule out some rare things that can mimic PCOS or you know, other medical conditions that can cause irregular periods. Importantly you know, PCOS is a disease that has a lot of metabolic dysfunction. So it’s important to sort
of have that diagnosis properly made because those patients are at risk for lifelong
metabolic disease. So risks of high blood
pressure, risks of diabetes, risks of high cholesterol, and it’s also important when
you are not having periods and you have sort of unopposed estrogen you’re also at risk of
developing abnormalities of the endometrial lining
and even endometrial cancer. So again, this is all
reason that if you’re having irregular periods you
should definitely see your gynecologist or your specialist to sort of understand whether or not you have that diagnosis and to recognize the monitoring that we recommend longterm. – Do lots of people have PCOS? – Yes, so it is extremely common and you know, ovulation disorders probably make up a third of
patients with infertility and PCOS comprises a
huge proportion of that. – Thank you, thank you
for answering that for me. So we did have quite a few questions that went into a little bit more detail and probably more detail
than we can properly give the attention they deserve
during today’s webchat. So your gynecologist
may be a good resource or our physicians would be
happy to see you in clinic. I’m delighted that we’re
getting all these questions but obviously some of them
are a little bit too detailed. Let’s see, what else can we, what other questions can we look into? – I think when we’re talking
about ovulatory disorders, one that may get overlooked
is hypothalamic amenorrhea. – Absolutely.
– And this is where you can actually stop having periods because you, your body
weight is on the lower side rather than the higher side. So if you are a marathon
runner or a triathlete or you’re just naturally very thin and you’ve stopped having periods that is something that you
should have evaluated as well. – Yeah again, in gynecology we
think of the menstrual cycle as a vital sign. So if you’re having
abnormalities in your cycle. Either too frequently or you
know, greater than 35 days then I would definitely
see your gynecologist to sort of delve into that. – Yeah, I have heard and
seen things on the internet that certain people believe
that missing your period or like not having periods at all is actually a sign of health
because the menstrual blood is thought to be a cleansing agent of the body and so if you’re not, if you’re completely clean or detoxed, you don’t have to have periods and that’s not the case at all. – Right and that’s a great
point because estrogen is still important. So you know, we worry about
your overall bone health as well as your cardiovascular health. So, that is important.
– Great. Well we have a couple more questions in and we probably only
have time for a couple more questions I think.
– Okay. – So the first one we have, I have a diagnosed genetic condition that I’ve been told has a 50%
chance of being passed down. It was recommended that if I
wanted to minimize this chance I have preimplantation
genetic diagnosis done. Is this something that Michigan Medicine has experience with? – Yeah, so we do a lot of
preimplantation genetic testing. And that typically involves two things. One is what you mentioned, preimplantation genetic diagnosis which is if you have a
particular genetic disease, so something like cystic fibrosis, they can actually, we can make probes and test the embryos to
see if they’re affected by the condition before
we do the embryo transfer. Not to be confused with
preimplantation genetic testing for aneuploidy which is where
we can screen the embryos for an abnormal number of chromosomes. So that answer to that is yes
we do that, quite frequently. – The next question we have. My ovulation predictor kit has my LH surge at day 14 to 15. Leading me to believe I
ovulate at day 16 or so, which seems relatively
late for my somewhat short 26 day cycle. Is this something of concern? – So that’s a little bit shorter than I would expect. If you’re having regular periods it’s not too terribly concerning but it is something we
could evaluate further with blood testing just
to make sure that one, your kits are actually turning positive on the true day of your LH surge and to sort assess for your
ovulation with a blood test. – Great, let us squeeze a couple more in. I’ve heard that exercise and stress can shorten the length of the
luteal phase, is this true? – So yes, you know. As Sharon was mentioning before, high intensity exercise and stress can affect the menstrual cycle. We think of it more as
affecting sort of ovulation, so it is possible that
it could be affecting the luteal phase. But more so we think the impact is on sort of that early follicular phase and the timing of ovulation. – Thank you and then the
last question we have, can you offer any diet advice? Good foods or foods to avoid? – Yeah, we, diet is
something that comes up quite a bit with fertility treatments and there is no one particular food that is like the secret to fertility. I’ve had people ask me
about pineapple before. So, pineapple isn’t
specifically good for fertility but eating a healthy,
well-balanced diet is. And especially as we were discussing, people with PCOS who may already have some metabolic issues, it
is important to watch diet in those cases. Eating low carbohydrate diets that are higher in vegetables
and protein is important. And can help lose weight as well. But when you’re trying to conceive just eating a healthy, well-balanced diet and avoiding harmful
substances like tobacco, recreational drugs,
excessive alcohol intake. I’m not saying that you have
to completely cut out alcohol but those kinds of things
are important to avoid. – Thank you so much. Well let’s close, we’re closing in on the
end of our chat today. So Dr. Schon, Melissa, Sharon, thank you all for sharing
your time and expertise with us today. Now all three of our panelists work out of our Center for Reproductive Medicine at Briarwood in Ann Arbor. Dr. Schon also sees
patients at our brand new West Ann Arbor Health Center, just off Jackson Road and
members of our fertility team also see patients at our
Northville Health Center in Northville, Michigan. Information about their
clinics is available at We have two additional
fertility webchats coming up like you brilliantly referenced earlier. Next month we’ll be chatting
about male infertility and in June you can join us to learn more about egg freezing and how to determine if that’s an option for you. So you can learn more about both at That’s While we’re talking about
finding information online we also want to point out
that you can find information about a wide range of
women’s health topics on our website in the Women’s
Health Program section. So just visit That’s Thank you to our audience for spending part of your afternoon with us. We hope today’s chat has been helpful. We have a brief survey that we’ve prepared to help us learn how we
can make chats like today’s more helpful for you. And to help us identify more topics you’d like to hear about. If you’ve registered in advance you’ll receive an email with the link or you can check the
comments on this video and we’ll have a link there
for you to follow as well. So thank you in advance for your time and if you’re interested in sharing the recording of today’s chat with others you’ll find it on our
Facebook page later today and on the Michigan
Medicine YouTube channel shortly thereafter. So again, thank you for joining us. Thank you to our panel and everybody have a wonderful afternoon.


  • Reply Adalyn Barber February 28, 2019 at 2:51 pm

    I think that we have to support medical progress. I also believe that it is great that surrogacy and IVF treatment are going to be more and more popular with each day. From my own experience, I can say for sure that it is great treatment which gives thousands of people a chance for happiness. Even people who have practically lost all hope can get one more chance. I have a practice of ART treatment five years ago. After a couple of senseless rounds of IVF we have almost given up. But then my husband asked me to change the clinic. He found impressive feedback about the Biotexcom clinic and its high rate of success. But after the first free consultation, we got to know that it is impossible for me to bear the child on my own. They recommended us to use the surrogacy program. And we agreed! Our all-inclusive programs cost us neatly 30K euro. However, we received great service and finally a positive result. Now I can say for sure that it was the best decision we have ever take. Every moment with our kid is incredible.

  • Reply Pinky Jones August 20, 2019 at 6:36 pm

    Hello my tubes are tied and I have a period tracker and it says I am 19 days past ovulation and it told me to take a pregnancy test what does it mean me and my boyfriend is actually trying to concieve a baby together so my question what can I do to concieve

  • Reply fertility expert September 6, 2019 at 1:14 pm

  • Reply Happy Wanderer October 1, 2019 at 12:33 pm

    Her voice… painful to listen to.

  • Reply liberacion7 December 3, 2019 at 11:45 am

    To understand more about pregnant program “Gοfαt Fanvuko” (Goοgle it), pay a visit to Goοgle. I was able to resolve my infertility concern at 44 years old. I was very excited during my menstrual period had been delayed. I now welcome parenthood and pregnancy.

  • Reply Melanie Molifie December 9, 2019 at 6:10 am

    I have PCOS, endo and fibroids. Clomid made me ovulate, amd Femara didn't. What could be the reason for this? I'll be seeing an endocrinologist in Jan. Yay!

  • Leave a Reply