For many women, the dream of becoming a mother is one that starts at a young age. It isn’t until we grow up that we learn that the path to motherhood isn’t always as easy as those “birds and the bees” talks made it seem. Each woman’s journey to motherhood is unique, and often times we find ourselves facing barriers falling under the umbrella of “fertility issues,” and a mountain of questions that we don’t know how to ask.
After receiving so many questions relating to women’s health, we are so excited to partner with UCHealth and Dr. Natalie Rochester, to open up a conversation about fertility and get some answers from an expert. From cycle health to available resources, Dr. Rochester answers some of the most frequently asked questions about this important topic!
Q. We’re generally all taught about a “normal” cycle being 28-days, but how many women fall within this “normal” cycle? What is considered abnormal?
“Normal” cycles can be 26-35 days apart. When determining “normal”, a gynecologist will look at the patient’s age and medical history. In most women ages 20-40, cycles will be between 26 and 35 days. In the first 5-7 years of menstrual cycles and in the ten years before menopause we can see a normal shift/variation in cycle length. Multiple things can affect menstrual cycle length, including body weight, medical problems and hormonal status. Contraception use and pregnancy history can also affect cycle length.
Q. How does nutrition play into cycle health/regulation?
To have “normal” cycles one must have adequate calorie intake. The goal is to have a BMI (body mass index) that is in the normal range. Women who have a low BMI, who exercise too much, or limit calories to an extreme will have irregular or no menstrual cycles. Women who are overweight may experience longer cycles- meaning menses occurs less frequently. Women who are overweight can see improvement in cycle regulation with loss of 5 to 10% of body weight.
As for nutrition itself, a diet with a wide range of foods including fruits, vegetables, proteins, healthy fats and carbohydrates are needed to maintain healthy menstrual cycles. This well rounded diet also provides support needed for ovulation and early pregnancy development. Limiting alcohol and abstaining from tobacco and marijuana use are also important in cycle regulation.
Q. How can you best prepare your body for pregnancy and trying to get pregnant?
- Treat any medical problems you may have and have these well controlled prior to conception. If you have high blood pressure, diabetes or any other medical problems talk openly with your gynecologist about these conditions and how to optimize them before conceiving. Healthy moms make healthy babies.
- Eat a diet with fruits, vegetables, proteins, fats and carbohydrates.
- Begin using a supplement that contains folic acid.
- Remove exposures to toxins (alcohol, marijuana, tobacco etc.)
Q. If someone has been on the Pill or any other form of prescribed contraception for an extended period of time, how will that affect their ability to get pregnant?
Every birth control has a different length of time, where once that birth control is stopped, menstrual cycles resume. Most women on birth control pills will ovulate within the first two or three months coming off the pill. Injectable contraception stays in the body longer and we can see a delay in ovulation even after the final dose has been completed. Be prepared that stopping contraception can mean that you conceive “right away” (the first month you are off of birth control), or it may take up to a year. 85% of healthy women under age 35 will conceive in the first twelve months off of birth control.
Q. What is the best way to discuss fertility with your doctor? How can you best approach your doctor with concerns?
- ASK questions!
- I love it when patients come to visits with a paper in hand, stating “ here are my questions”.
- Let your provider know your plans- if you are at the stage of discussing contraception options, it is ok to discuss long term plans for birth control/conception/pregnancy.
Q. When is it the right time to start discussing fertility-assistance (IUI, IVF, further testing, etc.) after trying naturally to conceive? Is there a certain number of months, after which you should seek help?
Every patient and every provider may have a different answer for this. In my practice, depending upon maternal age and history, the time can be different. Of healthy women who have monthly cycles, about 85% will conceive within twelve months of timed intercourse. If you have tracked cycles and are having sex on a regular basis for one year it may be time to ask your provider for input.
If you are over age 35, have medical conditions or any other concerns, it is worthwhile to discuss your concerns with a gynecologist. Often times simple testing can determine if there is an ovulation, anatomic, or sperm cause of infertility. In those where a cause cannot be determined or who are unable to conceive, I recommend referral to an infertility specialist.
Q. At what point should you seek a referral to a fertility specialist? How far can your regular OBGYN take you in the process?
This depends on what testing you have completed. Your general gynecologist is comfortable and well trained to do initial infertility evaluation. We can determine if infertility is caused by medical conditions limiting ovulation, fallopian tube obstruction, anatomic changes or abnormal sperm testing.
If initial evaluation has failed to give clear answers, or if initial ovulation induction with a gynecologist has not resulted in ovulation or pregnancy, a specialist may be recommended.
Q. How common is miscarriage before your first child? After the first? Second? Do the statistics change after the number of children you’ve had? What are the medical conditions that can be cause for multiple miscarriages?
Miscarriage overall is common. Miscarriages occur more frequently as maternal age increases. Miscarriage is the most common complication of early pregnancy (<20weeks). After 15 weeks of pregnancy risk of miscarriage is 0.6% in women who have never been pregnant. As the pregnancy weeks increase, the chance of pregnancy loss decreases.
Risk of miscarriage for first time moms (based on maternal health issues) ranges from 8 to 20%. If mothers age is >40 then there is a 40%-80% chance of miscarriage. If a mother has had a prior normal pregnancy her risk of miscarriage is closer to 5%, with this rate dropping rapidly as the pregnancy age progresses. In mothers who have had two miscarriages, the risk of recurrent miscarriage goes up to 28-30%, and with three prior miscarriages, the risk of further miscarriage is >40%.
Multiple miscarriages can be caused by maternal/paternal age, genetic conditions in mother or fetus, uncontrolled medical conditions, exposure to substance, uterine structural issues and a host of other medical conditions.
Q. What kinds of fertility assistance is offered through UCHealth?
UCHealth has the ability to complete infertility counseling and testing, genetic testing, and health optimization. Basic infertility evaluation can be completed by gynecologists along with ovulation induction if indicated. More complicated infertility issues would be referred to infertility specialists who can perform IVF and IUI when indicated.
Natalie Rochester, MD
Vice Chief of Staff Greeley Hospital
Medical Practice Director Greeley/Loveland Clinics
I have been with the UCHealth OB/GYN team for 5 ½ years. I am passionate about providing a safe, caring environment for women of all ages. I am trained in care of GYN and OB patients, and love that my field allows me to care for women of all ages throughout all stages of life. My biggest joy as an OB/GYN is being with a patient from preconception, to pregnancy, and through postpartum care. My second passion is improving GYN care and is in non-invasive GYN surgery. I am the proud mother of two beautiful girls, a dog named Sam and the wife to the most amazing husband on the planet.