Answers to the some of the most common questions posed by women on fertility, IVF, health and happiness
- My periods are irregular am I releasing eggs?
There are a number of different reasons why a woman may have irregular periods. The regularity of a woman’s menstrual cycle is determined in most cases by egg development and ovulation (releasing an egg). There are a number of hormonal irregularities that can be assessed in the blood if you have persistently irregular periods.
If a woman has irregular cycles then she may well be releasing eggs but the reliability and frequency of this may be abnormal. The commonest cause for irregularities of ovulation is a condition called Polycystic Ovarian Syndrome which affects 1 in 5 women. A GP or fertility specialist will be able to guide you and explain why your periods are irregular.
- How often should we be having sex?
There is an optimal window each month in the menstrual cycle when it is possible to conceive and for a sperm to fertilise an egg. This window of opportunity is close to ovulation itself and therefore it is always best to ensure you are having unprotected sexual intercourse every 2-3 days in the lead up to ovulation and afterwards. Research has shown that the highest chance of conception occurs when sex takes place in the three days prior to ovulation.
- I had chlamydia can this affect fertility?
Chlamydia is the most common sexually transmitted infection and it can damages a woman’s fallopian tubes affecting her fertility. Chlamydia is often silent without symptoms, though some women will experience mild spotting in their menstrual cycle. The infection causes inflammation in the reproductive tract and scarring and blockage of the fallopian tubes and can cause severe pelvic inflammatory disease (PID). Around 1 in 5 women who have fertility problems have blocked fallopian tubes and chlamydia is responsible in a large proportion of these cases for the problems that occur.
- I have painful periods does this affect fertility?
Women will often report pelvic pain and painful heavy periods. Some patients will also get pain with sex and fertility problems. An important condition that can affect your fertility and causes these symptoms is Endometriosis. It is a common condition that affects about 1 in 10 women. It occurs when tissue similar to the lining of the womb is found elsewhere. Commonly it is found in and around the pelvis and near to the womb, ovaries and fallopian tubes. In severe cases patients may have problems related to opening their bowels or their bladder.
- I don’t have periods am I ovulating?
The normal pattern of a menstrual cycle is to ovulate around two weeks before your next period starts. If a woman has no periods at all (amenorrhoea) or they suddenly stop having periods then it is important to seek specialist advice from either you GP or in a fertility clinic.
Some women have Polycystic Ovarian Syndrome (PCOS) and this condition is very common and affects the regularity of a woman’s periods. In some cases women with PCOS can have no periods at all. It should never be assumed that a woman is not releasing any eggs in this case though as women may still release and egg and fall pregnant. However, it is likely that ovulation is unreliable in these cases.
The concern when a woman’s periods suddenly stop or become irregular after years of normality is that this could be due to premature ovarian insufficiency (POI). This is an uncommon condition but can happen to women even when they are quite young. If you have a family history of this occurring to your mother or sisters always check with a specialist.
- Do I have a normal egg reserve?
The best way to assess a woman’s egg reserve is with a blood test called Anti-Mullerian Hormone (AMH) and this combined with an internal vaginal ultrasound scan of the ovaries to assess the Antral Follicle Count (AFC) is enough to calculate whether a woman has a normal egg reserve. This assessment can be performed in a fertility clinic.
- Do I need a fertility MOT?
There is no need for a woman to rush out and have a fertility MOT but it is a good way to put a marker in the sand. As many women are choosing to leave their fertility aspirations in life later due to career and other pressures this has become an increasingly popular assessment.