Gynecological FAQ

Do I have a fertility problem?

The most commonly accepted definition of infertility is failure to conceive over one year of unprotected intercourse. This will happen to 10 to 15% of couples, and presumes that you have intercourse frequently enough to have the sperm and egg meet.

How often is that?

If you have regular periods every twenty eight to thirty days, ovulation should occur around day fourteen to sixteen. (Day one is the first day of your period.) It may be that you only need to pay closer attention to sex every other day beginning around day 12.

Sperm will live in the tubes for three to five days waiting for an egg to pop out. I have had many couples having problems who succeeded just by changing their timing of sex.

It takes longer to conceive when you are older. After 35 it is not uncommon to take 8 to 12 months to conceive. Earlier in life it is common in the first 3 to 6 months. 

What should I be doing? 

If you think you may have a fertility problem, keep track of your periods and mark when you had intercourse. 40% of fertility problems are male, and it might be worth going ahead and getting a semen analysis done through his family doctor. He needs to abstain from ejaculation for 48 hours prior to providing the sample.

Many men have problems with their virility and egos all tied up in their sperm counts. Be sensitive in how you approach the topic, and tell him that you will be going to the gynecologist after the results are obtained. Feel free to bring him along to the initial consultation.

The basic evaluation is fairly simple to understand. There have to be sperm of good quality. They have to meet with the egg at the right time. The passageway (cervix, uterus, and tubes) must be open. And finally the uterus must be able to accept the fertilized egg. There are tests to address each of these steps.

Call and make an appointment to discuss your situation. It doesn't hurt to take a few of the above mentioned steps to get a head start. Don't keep basal body temps. It creates too much stress. Stress and anxiety are among the hardest of things to deal with is these situations. We can check for ovulation by measuring blood tests for progesterone. Good luck. It will happen.

Gynecological FAQ

What is Bacterial Vaginosis?

Bacterial Vaginosis (BV) is the most common of vaginal infections. It will usually present as a gray-white discharge, and is often accompanied with a "fishy" odor. Often it is the odor which bothers women the most, and it is most noticeable after intercourse. The normal vaginal flora consists of predominantly lactobacillus acidophilus.

Acidophilus produces acid as it grows and suppresses the growth of other bacteria. If this balance is disturbed ( antibiotics, douching, etc.) other bacteria will overgrow. BV is not usually considered sexually transmitted, and treating the partner is unnecessary.

Treatment is aimed at killing the abnormal bacteria with antibiotics specifically not affecting acidophilus. Unfortunately, BV is commonly recurrent, and repeated treatments or modifications of behaviors such as douching may be needed.

Gynecological FAQ

What if I miss a birth control pill?

Generally, if you miss a pill, take it as soon as you remember. If it is the next day, and you haven't taken yesterday's pill take both pills that day to catch up. You generally won't get pregnant from missing one pill. If, however, you miss one of the first four or 5 pills in a new pack, you do have a significant risk of pregnancy.

Catch up on your pill and use protection (condoms, abstinence) for two weeks. If you miss two pills, many times you will have break through bleeding (bleeding when you are not supposed to be on your period). You should probably catch up on one pill, but taking three pills in one day will make many people sick (Nausea).

If you miss two pills in a row, one of the pills in the first week, or if you take antibiotics while on the pill, use a backup method for two weeks.

Gynecological FAQ

What's all the hype about the Mirena® IUD?

Mirena® provides over 99% contraceptive efficacy. Mirena® is a relatively new IUD, (Intrauterine Device), with the stem of the IUD impregnated with levonorgestrel, the progestin hormone found in many birth control pills. It is an extremely effective, very low maintenance, long lasting form of birth control. Once inserted, it is immediately effective, and lasts for 5 years. It is ideal for insertion when breast feeding, avoiding most of the initial side effects.

What side effects?
Well, Mirena® has the potential to completely eliminate your periods. This is accomplished by the high hormone concentrations in the uterus itself. The lining of the uterus gradually thins to the point that it no longer bleeds. The thinning of the lining is accomplished by bleeding it down to its thinnest possible thickness. When you are breast feeding the lining is already thin, and the "break in" time is very short. If you are not breast feeding, the bleed down period can be two to three months.

What does that mean?
Well, you may bleed irregularly for two to three months. Sounds terrible. However, this is similar to what can happen with other hormonal methods such as birth control pills or deprovera (the shot). Once you get through this time, many women will have either very light periods or no periods at all!

Is that healthy?
Yes. Bleeding represents failure to conceive, and the body preparing for the next cycle, attempting to conceive again. The bleeding with your period is not cleansing the uterus, and the lost blood wastes iron from your body. Imagine.... 5 years with no periods. Your ovaries continue to make your normal hormones, but the strong effect of the IUD directly on the uterus prevents bleeding.

How likely am I to really have no periods?
Most women will have only very light occasional bleeding. This is more likely if you are relatively thin. Heavier women make more estrogen, and are less likely to have complete absence of periods.

Doesn't this sound too good to be true?
It may be too much to expect. Some women will have pain from the presence of the IUD, which is a foreign body in the uterus. If you have exposure to more than one sexual partner, the risk of infection in the uterus and tubes may be increased.

Women with Bacterial Vaginosis (see "What is Bacterial Vaginosis?") may have more problems with bleeding and pain. A serious infection could make it harder for you to get pregnant. If you get pregnant with the IUD in place, you are more likely to have a tubal pregnancy.

Some women will absorb enough of the hormone from the IUD to have mild side effects such as oily skin or acne, breast tenderness, or moodiness. Sometimes the irregular bleeding persists and women just give up on the IUD.

Removal of the IUD, like insertion, is short office procedure performed through a speculum, like a pap smear. The insertion can cause painful cramping, so it is good to take ibuprofen prior to coming in for insertion. If you are not breast feeding, the IUD is inserted while you are on your period. Fertility returns immediately after removal of the Mirena®, unlike the shot, which may take up to one year to return to normal.

In summary, the Mirena® IUD is not a perfect product, it takes a commitment to the method to get through the initial break in time. But if you are the right candidate, and you make it through the first 3 months, it can be a life changing method. Freedom from pregnancy, nothing to remember to do each day, and hopefully, few if any periods. You may want to visit Mirena's website for more information.

Dr. Paul Daum, M.D. Provides Complete OB/GYN Services

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