You will be kept informed by your clinical care team regarding any pertinent information you need to know. If you have questions about the process, we recommend discussing this directly with your physician. 

SGF’s Orlando location offers a full-service embryology laboratory and is equipped with the latest technology to give patients every advantage on their journey to conceive, including HEPA-filtered clean air ventilation systems, heated work stations that simulate the In Vivo (Latin for “within the living”) environment, anti-vibration tables that prevent harm to specimens should the table shake, highly sophisticated inverted microscopes to better evaluate embryo growth and development, and advanced incubators and media, to name a few.   

FAQ

The post Orlando Lab Move FAQs appeared first on Shady Grove Fertility.

Why FSA/HSA benefits are important 

FSA and HSA funds allow you to set aside pre-tax dollars for eligible medical expenses, including fertility treatments. Whether it’s your first appointment or fertility testing to help diagnose potential challenges, these funds can be used to ease the financial burden. But be aware: FSA funds often expire at the end of the year, so it’s essential to take advantage now to ensure your hard-earned savings support your goals.  

Patient tip: Reach out to your benefit plan administrator in advance to understand FSA / HSA savings application and service reimbursements

Questions to ask your insurance carrier  

Understanding your insurance benefits is key to optimizing your care. As you prepare for your initial fertility consultation, consider asking your insurance provider these critical questions: 

• Is the initial consultation covered by my plan? 

• Do I need a referral from my primary care physician to see a fertility specialist? 

• Do I need authorization (reference CPT codes listed below)? 

• Does my plan cover fertility drugs or injectable medications? 

• Is there a maximum benefit amount for fertility treatments? This could be a dollar limit, cycle limit, or both.   

• Does my plan cover same-sex couples or domestic partners? 

Key insurance codes for your reference 

Understanding insurance codes can help you navigate your benefits more easily. Below are some important codes that may apply to your fertility care: 

• Testing for infertility: ICD-10 codes Z31.41, N97.9 

• Artificial insemination (IUI): CPT codes 58322, 58323, 89261; ICD-10 code Z31.89 

• In vitro fertilization (IVF): CPT codes 58970, 58974, ICD-10 code Z31.83 

• Egg freezing: CPT code 58970, 89337, ICD-10 code Z31.84 

Having these codes handy may help clarify your coverage options and ensure you’re making informed decisions about your fertility care. Please note these codes update yearly and may have changed.  

Prepare for open enrollment 

As we approach open enrollment season, it’s the perfect time to review your health benefits and ensure that your insurance plan aligns with your family-building goals. Open enrollment is a limited window when you can make changes to your insurance, so being informed and proactive is essential.  

Get started today 

Your FSA and HSA funds represent more than just savings—they’re an investment in your future. Every dollar you put toward fertility testing and treatment brings you one step closer to your goal. By scheduling a consultation now and making the most of your benefits, you’re setting yourself up for success in your family-building journey. 

Take that first step today and request an appointment. Together, we’ll turn your dreams into reality. 

The post Apply your FSA/HSA funds towards fertility care  appeared first on Shady Grove Fertility.

What is IUI? 

Intrauterine insemination (IUI) is a relatively simple and less invasive fertility treatment. During an IUI, sperm is collected, washed, and then directly placed into the uterus around the time of ovulation. This procedure increases the chances of sperm reaching and fertilizing an egg, making it a good option for couples dealing with mild male infertility, unexplained infertility, or ovulation disorders. Patients can expect to take Clomid for 5 to 7 days typically starting on day 3 of their menstrual cycle. Additionally, the physician may prescribe an Ovidrel injection prior to the IUI to trigger the egg release.  

Why choose IUI? 

• Less invasive: IUI is a less invasive procedure compared to IVF, involving a brief procedure typically done in a monitoring room and most often does not require any pain medication.  
• Fewer medications: During an IUI cycle, medications to help stimulate ovulation or assist with uterine lining may be administered; however, this course of medication is often smaller compared to an IVF cycle.  
• Lower cost: Due to the less invasive nature and fewer medications, IUI is more affordable than IVF.  
• Quicker to start: IUI cycles can often be started more quickly, with less preparation time than IVF. 

Considerations: 

• Lower success rates: An IUI cycle is generally attempting to achieve pregnancy rates similar to the standard chances of conception in each month if infertility weren’t a factor. This makes IUI ideal as a first-line treatment for many; however, may not be suited  for older women or those with more complex fertility issues. 
• Multiple cycles: Similar to non-assisted conception where it can take several months to become pregnant, it may take several IUI cycles to achieve pregnancy, which can be emotionally and financially taxing. 

What is IVF? 

In vitro fertilization (IVF) is a more advanced fertility treatment where eggs are retrieved from the ovaries and fertilized with sperm in a laboratory. The resulting embryo(s) are then transferred to the uterus. IVF is often recommended for couples with more complex infertility issues, such as blocked fallopian tubes, severe male infertility, or genetic concerns. 

Why choose IVF? 

• Higher success rates: IVF generally offers higher success rates compared to IUI, particularly for those with more complicated fertility challenges. 
• More control: During an IVF cycle, one or two embryos may be transferred back to the patient. This allows the embryology and physician team to select the most viable embryos as well as the option for genetic testing to ensure the healthiest embryos are transferred. 
• Flexibility: IVF can be tailored to individual needs, including options like using donor eggs or sperm, surrogacy, or using previously frozen eggs or embryos. 
• Overcoming obstacles: For couples facing physical barriers like tubal issues or severe male infertility, IVF may be the most effective option. 

Considerations: 

• More invasive: IVF involves daily injections, egg retrieval, and embryo transfer. 
• Higher cost: Both the medications and procedure costs for an IVF are often more expensive than those required with an IUI.  
• Emotional and physical demands: The process can be physically and emotionally demanding, requiring support from healthcare providers, partners, and loved ones. 

Which fertility treatment is right for you? 

Your fertility specialist at SGF will help you understand the best options based on your unique situation, but here are some general guidelines: 

• IUI may be right if: You’re dealing with mild infertility issues, prefer a less invasive approach, and are comfortable with a potentially lower success rate. In some cases, your insurance coverage may also require IUI cycles prior to moving to other treatment.  
• IVF may be right if: You’re facing more complex infertility challenges, have tried IUI without success, or seeking the higher success rates and flexibility that IVF offers. 

Compassionate care on your fertility journey 

At SGF, we understand that navigating infertility can be an emotional and challenging experience. Whether you choose IUI or IVF, we’re here to support you every step of the way with compassionate care and personalized treatment plans. Remember, there’s no one-size-fits-all approach to fertility, and we’re committed to helping you find the path that feels right for you. Your dreams of starting or growing your family are within reach, and we’re honored to be part of your journey. 

Medical contribution by Sally F. Vitez, M.D. 

Dr. Vitez’s is board certified in obstetrics and gynecology (OB/GYN) and board eligible in reproductive endocrinology and infertility (REI). Her research interests include male fertility, preimplantation genetic testing, the impact of obesity and optimizing fertility treatment outcomes. She is a member of the American Society for Reproductive Medicine (ASRM).  

The post IUI vs IVF: Which fertility treatment is right for you?  appeared first on Shady Grove Fertility.

What are NK cells? 

NK cells can be found in two areas: in the uterus, called uterine NK cells, and additionally in the blood stream, called peripheral NK cells.  

Peripheral NK cells 

The cells in the blood are the ones that earned the name – they are indeed “killers” as they fight off cancer cells and cells that have been infected by viruses.   

Uterine NK cells 

Uterine NK cells are quite different. They do not fight off viruses and cancer cells. Uterine NK cells have different receptors along their wall that make them completely distinct from the peripheral NK cells found in the blood. This means when you have your blood drawn to test for NK cells, this is testing for peripheral NK cells and not uterine NK cells.  

What are uterine NK cells’ function? 

Fact: Research shows that uterine NK cells do not kill embryos.  

Uterine NK cells are actually very important to remodeling and shaping the spiral arteries, which bring blood supply to the developing embryo, and thus have an important role in building a healthy placenta. 

“I live in Florida, so let’s use this easy analogy: when the ocean hits the sand, it starts to recede,” shares Rachel Sprague, M.D., who cares for patients in SGF’s St. Petersburg, FL location. “So, if you want to make a little tidal pool on the beach, you’ll need to make a canal through the sand that connects the ocean to the tidal pool – and you need to make the canal narrow enough for the ocean water pressure to push through and make the canal deep enough so it the water does not just pull back into the ocean. If you do not make that canal just right, it will not bring the water correctly from the ocean to your tidal pool. This is how I describe the uterine NK cells – they help carve the path for exchange of oxygen and nutrients from the uterus to baby.” 

Do uterine NK cells cause recurrent early pregnancy loss? 

The concern around recurrent early pregnancy loss and repeated failed implantation is that the uterine NK cells are actually malfunctioning rather than over-functioning.  By malfunctioning, they are not doing a good job at remodeling the blood flow (i.e. building the canal through the sand), leading to poor development of the placenta and putting the pregnancy at risk.  

“Does the maternal immune system have a role in pregnancy and implantation?” asks Dr. Sprague “Yes. But is the answer destroying these uterine NK cells? It is more complex than that. And we see that when we look at immunosuppressive options that block the maternal immune system — they do not work as well as we would hope.”  

Such therapies such as corticosteroids, IVIG, Granulocyte-colony stimulating factor, intralipids, intrauterine hCG, and low dose naltrexone are some of those medications that have been given routinely to patients in an aim to block the maternal immune system. However, these therapies lack any robust evidence that they are truly helpful, and on top of that, many studies also show that these therapies can have the reverse effect, leading to increased pregnancy loss. More importantly, as the studies are small, we lack import safety information for mother and baby. 

What is the solution? 

We are still learning more about how to modulate these cells – meaning, we are trying to teach them how to work better rather than to block their actions.  But we still need more time, effective studies, and safety information before we truly know how to do this.  

In the meantime, there are very good studies that support the idea that success is in the hands of the embryo. 

“Each embryo, just like each person, is very different,” shares Dr. Sprague. “And when we continue to transfer healthy embryos, success goes up and up and up. Thus, find the right embryo and this leads to our end goal of the right baby for you.” 

Medical contribution by Rachel Sprague, M.D.

Rachel Sprague, M.D., earned her medical degree from the University of Florida College of Medicine. It was during this time that her interest in reproductive medicine came to light when she was exposed to the concept of in vitro fertilization and the intricacies of early pregnancy. The interest intensified throughout her clinical rotations where she experienced first-hand the bond between patients and their physicians.

The post Natural killer cells: fact vs. fiction appeared first on Shady Grove Fertility.

But there is some wisdom that your Shady Grove Fertility team cannot impart because it comes from first-hand patient experience — from other patients who have walked in your shoes. For the unexpected and surprising experiences, SGF patients share 9 things no one else will tell you about fertility treatment.  

1. You may find yourself second-guessing everything in the beginning.

“At the beginning of my fertility treatment cycle, it felt like there were many steps, and as a result, many possible missteps. After hearing the medication regimen and the frequency of administering medications, it felt a little overwhelming. I was so worried I would do something wrong. The first night was nerve-wracking, to say the least! But as each day went on, I was surprised at how comfortable and confident I got with each medication. I quickly became the expert that my friends would come to when they started their cycles.” –Sarah

Treatment takeaway: 
A common theme that comes up with our patients is second-guessing:

• Am I giving myself the right amount of medication?
• Did I take the medication at the right time?
• Did I forget to do something important?
• Should I be eating differently?
• Should I be feeling something right now?
• Are my ovaries supposed to feel bigger? (Yes)

While these seem like inevitable questions, rest assured that your nurse and doctor will always be there to help answer your questions and address your concerns. It’s completely normal to ask many questions.

2. The egg retrieval is easy, but everyone recovers at a different pace.

“I was not that worried about starting fertility treatment, but as the egg retrieval grew closer, I found myself becoming nervous. I had never been under sedation before and I wasn’t sure what to expect. The procedure itself took about 20 minutes, and when I woke up, I felt surprisingly great! But while I’d been so focused on the procedure, I hadn’t given much thought to what recovery would be like. My nurse told me I could return to work the next day, so I expected to wake up feeling good to go. Overall, I was fine, but I definitely felt some discomfort, like a sensation of fullness. Two days later, I was as good as new.” –Charlotte

Treatment takeaway:
Most women feel fine the day after their egg retrieval, but it’s important to recognize that everyone recovers at a different pace. Some women will share similar feelings as Charlotte, with some residual discomfort. 

Some women may also experience nausea due to the anesthesia. These are completely normal reactions to a surgical procedure. If you have any concerning symptoms in the days following your procedure, it’s best to call your nurse or doctor. 

3. Taking a cycle off is not a bad thing.

“Sometimes, having to take a cycle off is a blessing in disguise. In our case, we had to take 6 months off for medical reasons. We embraced this time together. We took long weekends, started a brunch routine, and really enjoyed being married. While we were disappointed to learn we’d have to take a break, looking back now, we think it really saved our sanity and possibly our relationship.” –Deirdre

Treatment takeaway:
While being told that it’s best to take some time off or to skip treatment for a cycle can be difficult, our physicians have your best interest in mind. Taking some time off between cycles allows you the time to reconnect with yourself both physically and emotionally. 

Fertility treatment can be an emotional journey. Giving your mind and body a break and allowing yourself time to return to a few normal routines can be a positive experience that may offer you a different frame of mind when starting treatment again. 

4. You are expected to have a full bladder for the embryo transfer…which can lead to unintended consequences.

“Going into the embryo transfer, I followed my nurse’s instructions and drank 16 to 20 ounces of water. But what no one told me, or maybe I just didn’t pay attention to, was that this appointment would be different from all of the monitoring appointments. This appointment would be done with the traditional ultrasound, the type most people are familiar with from TV and movies. I was also not expecting the amount of pressure they would have to apply directly to my bladder in order to see the uterus. Midway through the procedure, I realized that I probably wasn’t going to make it through the transfer without peeing on the table. Needless to say, it happened and I was really embarrassed!” –Marianne

Treatment takeaway:
While most examinations require a transvaginal (internal) ultrasound, the embryo transfer requires an external abdominal ultrasound. Therefore, you must come to your appointment with a full bladder. The full bladder creates an acoustical window that allows the physician to visualize what’s below the bladder: the uterus. 

This makes it possible for the physician to then guide the catheter into the uterus for the embryo transfer. As Marianne discovered, the pressure required to visualize the uterus during the transfer can create an unintended consequence: peeing on the table. According to our clinical staff, she is not alone, and this occurs on average 1 to 2 times per week. So please, don’t feel embarrassed! 

5. Your embryo cannot fall out. We promise.

“After my embryo transfer, I became nervous about what I could or could not do. I wanted to run some errands, but to be honest, I was worried that the embryo might fall out if I moved around too much! While some activities like intercourse were off the table, the doctor assured me to go and have a carefree afternoon. I guess she was right because my husband and I went to lunch and did a ton of shopping that afternoon, and two weeks later we found out that we were pregnant!” –Sophia

Treatment takeaway: 
Many patients call their nurse after the transfer — worried that their embryo may fall out, possibly while going to the bathroom. We assure you that this is not possible, as the embryo is in a much smaller space than you may realize. As one physician said, “It’s like a grain of sand in a peanut butter sandwich.” 

Patients who pursue intrauterine insemination (IUI) are often concerned that sperm will fall out after the IUI is performed. But just like patients who experience an embryo transfer, your genetic materials aren’t going anywhere! Sperm will remain in the uterus. 

6. Believe in the power of what’s possible.

“When I first started treatment, I really wanted to be in control of every detail. It was super overwhelming. I was able to ask a ton of questions, which helped me to understand the process. But, after a while, I realized the importance of looking at the bigger picture. I learned that nothing is impossible if you focus on an overall goal instead of tasks associated with a goal.”–Megan  

Treatment takeaway: 
At SGF, we believe in the power of what’s possible. Your dream of becoming a parent is within reach and we encourage our patients to believe just as much as we do. While there might be some ups and downs along the way, we find ways to overcome those challenges with you. You are never alone in this process, and we are here to support you every step of the way. 

7. No matter how you feel about needles, you will likely become comfortable with them.

“Before starting my fertility treatment, I hadn’t had too many shots, let alone have to worry about giving them to myself! In the beginning, I was nervous, but I quickly grew more comfortable with each shot. By the time the cycle was complete, I couldn’t help but feel a sense of empowerment! I was finally able to take control of our situation, and do something that was actively helping my husband and I have the family of our dreams.” –Elizabeth

Treatment takeaway: 
Understandably, many people hate needles — hate the thought of them, the look of them, hate everything about them. But our patients were all pleasantly surprised at how tiny the needles were and considered themselves to be injection experts by the end of their treatment journeys. When you know that the needles will help you have a baby, they become far less scary. 

8. All sense of modesty will go out the window.

“At first, I was pretty nervous about privacy. Everybody I knew who was in fertility treatment was already comfortable about the world of “down there.” It wasn’t an attitude I could really understand. SGF did a good job at making me comfortable — with dim lighting in the ultrasound rooms and drapes — it seemed that by the end of my cycle, I had become as carefree as my friends were. Even when talking with other friends who were going through treatment, I was surprised at how open I became about my experiences.” –Kelly 

Treatment takeaway: 
At SGF, we have tremendous respect for your privacy. We do everything possible to make sure you feel as comfortable as possible during your exams and procedures. 

9. Fertility treatment doesn’t stop when you have a positive pregnancy test.

“When I first started seeing Dr. Levens, I thought he would help me get pregnant and I would quickly go back to my OB/GYN. I was not expecting to stay under his care for the first 8 weeks of my pregnancy! To be honest, I had grown so close to my nurse and the team at SGF that going back to my OB/GYN was harder than I thought it would be.” –Jessica

Treatment takeaway: 
Patients are often surprised to discover that a positive pregnancy test does not signal the end of their treatment. Once your embryo transfer is complete, we will continue to monitor your progress for the first 8 weeks of your pregnancy through several beta pregnancy tests (we are checking for at least a 66% increase in the beta level at each appointment), along with ultrasounds to detect a heartbeat. After 8 weeks, patients are referred back to their OB/GYN for the recommended prenatal care. 

Everyone has a unique fertility treatment path, but it’s always comforting to know that other people have experienced similar things, whether they’re awkward, scary, funny, or joyful. Our social media communities on Facebook and Instagram are wonderful places to connect with past and current patients to share stories and tips as well as offer words of hope and encouragement.

Medical contribution by Anne Hutchinson, M.D.

Anne Hutchinson, M.D., sees patients at SGF’s Newark, DE, office. Dr. Hutchinson is passionate about reproductive endocrinology not only for its cutting-edge science but also for the opportunity to form meaningful, lasting relationships with patients.

Editor’s Note: This post was originally published in August 2017 and has been updated for accuracy and comprehensiveness as of July 2024. 

The post 9 things no one tells you about fertility treatment, from fertility patients  appeared first on Shady Grove Fertility.

1. Get your medical records 

To obtain a full picture of your health history, as well as previous testing and treatments, it’s imperative that your new care team has a copy of your medical records. Due to patient privacy laws, most providers have a formal process for records requests. Once the request is received, it can take several days or weeks for a provider to fulfill, so that’s why we recommend this as a first step in transferring your care. If you have questions about the request process, we suggest first reaching out to your current provider for details. In some cases, SGF may be able to assist in that outreach as well. 

2. Schedule a new patient appointment 

With your insurance information in hand, you can schedule an appointment by filling out a scheduling form on the SGF website or by calling 888-761-1967 to speak with one of our new patient liaisons. 

For your convenience, we offer virtual or in-person new patient consultations. We understand that sometimes timing is tight, and our patients want to be seen as soon as possible. As such, while it is ideal for the care team to have your medical records in advance, it is not required. We want our patients to feel empowered to schedule their first appointment and move forward in their fertility journey without delay. 

Learn more information on scheduling and what to expect during your first appointment.

3. Transfer previously frozen materials  

If you have previously frozen eggs, sperm, or embryos that you want to use in future treatments, you will need to have them transported to an SGF lab. 

To start, patients should obtain the embryology report from their current or former provider, and if applicable, the IVF stimulation spreadsheet. 

Patients will then have a video consultation with an SGF physician, who will assign a nurse to work with you through the process. Patients will also be assigned a financial counselor and a clinical coordinator.  

All outside frozen embryos must be approved for acceptance by SGF’s risk management team, comprised of physician and lab directors. This process typically takes 1 to 3 months.  

When to switch providers 

Deciding where to go for family-building care can be a big decision. In some cases, there are valid reasons you may be considering moving your treatment to another fertility practice. If your current provider closes a location, SGF can help manage your transfer of care and guide you along the way in your new treatment plan. SGF has nearly 50 locations to choose from for virtual or in-person consults.  

There are also instances where a patient may seek a second opinion. Although physicians are medical experts, patients should never feel pushed into procedures that aren’t right for them or be afraid to ask about options that they feel might work. Patients should feel confident in the abilities and intentions of their chosen doctor. If they don’t, it’s time to get a second opinion. 

The post How to transfer your care to Shady Grove Fertility  appeared first on Shady Grove Fertility.

Dr. Erika B. Johnston-MacAnanny, a fertility specialist at SGF Richmond, explains the menstrual cycles, outlines what they might indicate for your fertility potential, and provides insight into what this tells your doctor about your reproductive health.  

Medical contribution by Erika B. Johnston-MacAnanny, M.D.

Erika Johnston-MacAnanny, M.D., FACOG, is board certified in both obstetrics and gynecology and reproductive endocrinology and infertility. Dr. Johnston-MacAnanny sees SGF patients in the Richmond – Stony Point and Richmond – Henrico Doctors’ – Forest locations.

What is a menstrual cycle?

Hint, it is more than just your period. 

The menstrual cycle is a series of changes a woman’s body goes through each month where the ovary releases an egg and the uterus prepares for pregnancy. The cycle can be divided into two phases: the follicular phase and the luteal phase. 

The first day of your periodis day 1 of your cycle and the start of the follicular phase.  Patients note this as the first day they see full flow menstrual blood.  During this phase, follicle stimulating hormone (FSH), is released from the brain to stimulate the development of a single dominant follicle which contains one egg. During its maturation, granulosa cells which line the follicle release estrogen (also known scientifically as estradiol) which stimulates growth and thickening of the uterine lining. The follicular phase concludes at the start of ovulation – the process of releasing a mature egg from the dominant follicle. The length of the follicular phase is variable between individuals, resulting in most variations of total cycle length.   Patients with low ovarian reserve may note a shortened follicular phase whereas women with polycystic ovarian syndrome may have an extended follicular phase. 

The luteal phase starts after ovulation and continues until the onset of the next menses. During this phase, the ovary releases progesterone which transforms the uterine lining and opens the window of implantation – the time during which the embryo can attach to the uterus. If pregnancy does not occur, the progesterone levels drop and bleeding occurs as the lining is shed. The luteal phase is usually between 12-14 days. 

Does the length of a menstrual cycle matter?

The length of a menstrual cycle is determined by the number of days from the first day of bleeding to the start of the next menses. The length of your cycle, while not on any form of birth control, can be a key indicator to hormonal imbalances and whether or not ovulation is occurring in a predictable manner. Hormonal imbalances can affect if and when ovulation occurs during your cycle. Without ovulation, pregnancy cannot occur naturally. 

Normal menstrual cycle:

Days: 24 to 35 days

Ovulation Indicator: Regular cycles indicate that ovulation has occurred

What do normal cycles tell your doctor? Cycles of a normal length suggest regular ovulation and that all of the sex hormones are balanced to support natural conception.

Short menstrual cycle:

Days: Less than 24 days

Ovulation indicator: Ovulation may not have occurred or occurred much earlier than normal

What do short cycles tell your doctor? Shortened cycles can be an indication that the ovaries contain fewer eggs than expected. This is typically a pattern seen in the years leading up to perimenopause. Alternatively, a short cycle could indicate that ovulation is not occurring. If blood work confirms this to be the case, conception without assistance can be more difficult.

What causes a shorter cycle? As a woman ages, her menstrual cycle shortens. Our eggs are a nonrenewable resource, we cannot grow more.  As the remaining number of eggs available in the ovary decreases, their quality also declines. These dysfunctional ovaries lose their ability to effectively communicate with the brain. Additionally, the brain needs to release more follicle stimulating hormone (FSH) to stimulate these abnormal eggs to mature and typically does so even in the luteal phase prior to the cycle being tracked, resulting in a shortened follicular phase and early ovulation.  

As a result, the dominant follicle is ready for ovulation earlier in the follicular phase and produces a shorter cycle length. In addition, sometimes bleeding can occur even when ovulation does not occur, which may appear as shortened and irregular cycles

Learn about fertility testing

Long or irregular menstrual cycle:

Days: More than 35 days

Ovulation indicator: Ovulation is either not occurring or occurring irregularly

What do longer cycles tell your doctor? Longer cycles are an indicator that ovulation is not occurring regularly, which can make conception difficult.

What causes long menstrual cycles? Longer cycles are caused by a lack of regular ovulation. During a normal cycle, the fall of progesterone leads to  bleeding. If a follicle does not mature and ovulate, progesterone is never released, and the lining of the uterus continues to build in response to unopposed estrogen. The lining gets so thick that it becomes unstable until it eventually sheds and bleeding occurs. This bleeding can be unpredictable, and oftentimes very heavy and lasts a prolonged period.  Heavy flow may result in health conditions such as low blood count, or anemia, for the patient. 

There are many causes of oligo-ovulation, the medical term used to describe when ovaries do not grow a dominant follicle and release a mature egg on a regular basis.  Polycystic ovary syndrome (PCOS), the most common cause for oligo-ovulation, is a syndrome resulting from disordered brain communication and stimulation from the anterior pituitary. This can result in an imbalance in the sex hormones and failure to grow a dominant follicle and unpredictable or absent ovulation. In addition, irregularities with the thyroid gland or elevations of the hormone prolactin can disrupt the brain’s ability to communicate with the ovary and result in anovulation.  The latter conditions are typically treated with oral medication to correct the hormonal imbalance. 

When menstrual bleeding lasts more than 5-7 days:

Days: More than 7 days

Ovulation indicator: It is possible that there is a hormonal problem resulting in a delay in follicular growth or a structural problem in the uterus making the lining unstable.

What do longer cycles tell your doctor? Prolonged bleeding tells your doctor that the ovary is not responding to the brain signals to grow a lead follicle. This can be a sign of a delayed or absent ovulation. Alternatively, there may be something disrupting the lining of the uterus.

What causes long periods of bleeding? There are many causes of prolonged bleeding. From a hormonal perspective, what stops a woman’s period is estrogen from the growing follicle. If follicular growth is not occurring regularly, then prolonged and irregular bleeding can occur. Intermenstrual bleeding or prolonged bleeding may be caused by structural problems like polyps, fibroids, cancer, or infection within the uterus or cervix. In these situations, should an embryo enter the uterus, implantation can be compromised resulting in lower pregnancy rates or an increased chance of a miscarriage. Although rare, a problem with blood clotting can also cause prolonged bleeding and this requires evaluation and care by a specialist.

What if I never menstruate? 

Days: Rarely or Never

Ovulation indicator: Ovulation may not be occurring

What does a lack of menstruation tell your doctor? Either ovulation is not occurring or there is something blocking menstrual blood flow. The patient will have difficultly conceiving without intervention.

What causes cycles to stop occurring? When a woman does not have a period, this can be caused by a failure to ovulate. Hypothalamic amenorrhea is a potential cause, as well as any of the hormonal imbalances that can cause irregular cycles can also stop the cycles completely.  It is common for women who are considered underweight or overweight by the body mass index (BMI) standards to stop having a cycle. The body requires a certain level of body fat for reproduction and menstrual cycles to occur, and many women who are able to gain or lose weight will see the return of a more predicatble menstrual cycle. 

There are several other causes that should be evaluated as well. If a woman has never had menstrual bleeding, there may have been a problem with the normal development of the uterus or the vagina. If a woman had menstrual cycles previously, but then stopped, this could be due to a problem with the uterus itself, like scar tissue inside the cavity, or may be due to premature menopause. If the uterus has not formed or if menopause has occurred, pregnancy is not possible. If the absence of menses is due to scar tissue inside the uterus, then this scar tissue will need to be removed as it can interfere with implantation. 

If you do not have a normal menstrual cycle, no matter the amount of time you have been trying to conceive, you should be evaluated by a specialist. Irregular or absent ovulation makes conception very difficult without intervention. 

For women with regular cycles, you should see a fertility specialists if you are:   

• Under 35 with regular cycles, unprotected intercourse and no pregnancy after 1 year 

• 35 to 39 with regular cycles, unprotected intercourse and no pregnancy after 6 months 

• 40 or over with regular cycles, unprotected intercourse, more immediate evaluation and treatment are warranted 

Editor’s Note: This post was originally published in October 2014 and has been updated for accuracy and comprehensiveness as of June 2024.

For more information about your menstrual cycle or to schedule an appointment with one of our physicians, please speak with one of our New Patient Liaisons at 877-971-7755 or fill out this brief form.

The post What Does Your Menstrual Cycle Say About Your Fertility? appeared first on Shady Grove Fertility.

Medical contribution by Jennifer E. Mersereau, M.D., MSCI 

Jennifer E. Mersereau, M.D., MSCI, is board certified in obstetrics and gynecology (OB/GYN) as well as reproductive endocrinology and infertility (REI). Dr. Mersereau received her medical degree from the University of Pittsburgh School of Medicine. Following her passion for women’s healthcare, she then completed her residency in OB/GYN at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, where she also earned her Master of Science in Clinical Investigation. From there, Dr. Mersereau completed her REI fellowship at the University of California in San Francisco, California.  

Learn more about advanced fertility treatment

In Vitro Fertilization (IVF)

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Please contact your financial counselor to proceed with family-building care using Cigna coverage.

If you are a new patient with Cigna coverage, please call 1-888-761-1967 to schedule an appointment.

FAQ

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We chatted with Dr. Kate Devine to answer all your questions about LBGTQIA+ family-building at SGF.  

What treatment options are available for LGBTQIA+ families at SGF?  

LGBTQIA+ individuals and couples who desire to have biologically related children can do so through personalized fertility treatment plans at SGF. Many of SGF’s treatment options for same-sex and transgender couples enable both partners to participate actively in the family-building process. 

• Intrauterine insemination (IUI)  
• In vitro fertilization (IVF)  
• Reciprocal IVF, also known as co-IVF  
• Donor egg and donor embryo  
• Donor egg or embryo with a gestational carrier  
• Fertility preservation for transgender individuals 
• Intended father treatment, also known as dual insemination 

Learn more about these options on our LGBTQIA+ family building page.  

What will my treatment plan look like?  

There are many ways to grow a family and the path that LGBTQIA+ couples or individuals choose will depend largely on personal choices and preferences. For your care team to determine which treatment plan works best for you, there are some things you want to start thinking about before your initial consultation. 

Same sex female couples should consider:  

• Who will carry the baby? 
• Who will provide the eggs? 
• Will you be choosing an ‘unknown’ sperm donor or do you have a known donor you would like to use? 
• Does one or both partners want to be part of the process? 
• Does either partner have underlying health issues that can affect the process? 
• What is your desired family size, i.e., how many children?  

Same sex female couples have the opportunity to share in the pregnancy through co-IVF, also known as reciprocal IVF. With co-IVF, one partner provides the egg and the other partner will carry the pregnancy. 

Same-sex male couples planning fertility treatment should consider: 

• Who will provide the sperm? 
• Will you be choosing an ‘unknown’ sperm donor or do you have a known donor you would like to use? 
• Is the gestational carrier someone known, or will it be someone identified through an agency? 
• What is your desired family size, i.e., how many children? 

Same sex male couples have the opportunity to utilize dual insemination wherein each partner provides sperm that can be used to create an embryo that can then be transferred to a gestational carrier to carry the pregnancy. 

Does insurance typically cover the cost of LGBTQIA+ family-building care?  

Coverage for fertility treatment is highly dependent on the insurance plan. SGF participates with several insurance plans and approximately 70% of our patients have some coverage for infertility treatment and 90% have coverage for their initial consultation.  

Learn more about insurance and benefits at Shady Grove Fertility.

Is the Shared Risk 100% Refund Program available for LGBTQIA+ family-building care? 

“Absolutely! The Shared Risk 100% Refund Program is offered for IVF, donor eggs, frozen embryo transfer, and returning egg freezing patients, which can include many of the treatment options available to LGBTQIA+ families,” shares Dr. Devine. 

Learn more about our refund programs for infertility treatment.  

Does SGF provide recommendations for legal considerations for LGBTQIA+ families?  

During your initial consult with an SGF physician, we can provide recommendations for legal adoption services.  

With reciprocal IVF for same-sex female couples, the birth certificate will have the name of the mother delivering the child, but the second mother may need second-parent adoption. Same-sex male couples are going to need to specify a certain legal contract with their attorney that says that they are the legal parents of that child. With the help of an attorney, the same-sex couple will be legally recognized as parents of the child born from a gestational carrier.

How does your practice approach providing affirmative care for the LGBTQIA+ community? 

“At SGF, we believe everyone should be able to have the family of their dreams,” shares Dr. Devine. “We provide world-class fertility care for our LGBTQIA+ patients in a friendly, compassionate, and inclusive environment. We truly believe in the patient-comes-first approach and are ready to provide a personalized treatment plan that works best for your family-building plans.”  

SGF also offers a free, virtual Queer Family Building Support Group for Washington, D.C., Maryland, and Virginia patients. For more information, see our events page.

Medical contribution by Kate Devine, M.D.

Kate Devine, M.D., FACOG, is board certified in obstetrics and genecology and reproductive endocrinology and infertility. She is active in fertility research, publishing on topics ranging from fibroids to egg freezing for fertility preservation. She continues her research goals and advancing those of Shady Grove Fertility as the director of research for the practice.

Editor’s Note: This article was originally published in June 2019 and has been updated for accuracy and comprehensiveness as of May 2023.

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