Serious health consequences of delaying pregnancy, and the need for prevention of impaired fertility also known as subfertility and infertility

Simply put: We must talk prevention versus treatment of this health condition, which is not inevitable. On the present large scale, impaired fertility is anthropogenic – where anthropogenic means “caused or produced by humans”. When trying to conceive, it is highly advisable not to delay baby making beyond the optimal age of early 20s, and in any case to practice “focused intercourse”. In that connection (with said focus), “anthropogenic” acquires a positive connotation – even if my introduction is no longer exactly simply put!

Absolute Must: Focus on Fertile Window

The said focus on focused intercourse is an absolute must, and you save yourself a lot of grief that way because there can be no conception outside of the fertile window, whether subfertile or not. This should really be in your mind and in your heart when you are trying to conceive. And if you are, unfortunately, past the optimal age of early twenties, just try and don’t delay pregnancy any longer – for a good reason (or rather for several good reasons)!

To expand on this, let the scene be set by excerpts from a review in a medical journal written already 10 years ago by a consultant in reproductive medicine (director of an assisted conception unit in London): “ABC of subfertility. Extent of the problem”, BMJ 2003 August 23; 327(7412): 434–436 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC188498/).

QUOTE: One in six couples [17%] have an unwanted delay in conception. Roughly half of these couples will conceive either spontaneously or with relatively simple advice or treatment.

Most couples presenting with a fertility problem do not have absolute infertility (that is, no chance of conception), but rather relative subfertility with a reduced chance of conception… so that only 4% remain involuntarily childless. As each couple has a substantial chance of conceiving without treatment, relating the potential benefit of treatment to their chances of conceiving naturally is important…  END QUOTE.

Encouraging (isn’t it?)

This is rather encouraging, isn’t it? The cited reproductive medicine specialist states further that spontaneous conception has about a 30% conception rate in the first month of trying, and the chance then falls steadily to about 5% by the end of the first year. Such statistical pronouncements are just that. The following citation is unarguably meaningful – and we do not gloss over the “timing of intercourse during the natural cycle”.

“The likelihood of spontaneous conception is affected by [= is dependent on] age, previous pregnancy, duration of subfertility, timing of intercourse during the natural cycle, extremes of body mass, and [any] pathology present. A reasonably high spontaneous pregnancy rate still occurs even after the first year of trying. A strong association exists between subfertility and increasing female age. The reduction in fertility is greatest in women in their late 30s and early 40s. For women aged 35-39 years the chance of conceiving spontaneously is about half that of women aged 19-26 years.” QUOTE UNQUOTE.

These things have been covered in the various earlier posts of this blog, with appropriate emphasis on said timing of intercourse during the natural menstrual cycle. That’s because, even if you did have a previous pregnancy and you do NOT have an extreme body mass and/or a pathology causing the difficulty to get pregnant, you (and anyone else) can only conceive during the short fertile period, the so-called fertile window.

… but: “Be a young mother!”

And, I go again as far as urging you, “Be a young mother!” As I said, this earnest recommendation is for a good reason. Because, in addition to what I have told you about before (e.g. in https://biozhena.wordpress.com/2012/04/18/the-perils-of-ivf-of-arts-of-giving-birth-at-old-age-part-2/ ), now see and grasp this:

Serious health consequences of delayed conception are beginning to appear in medical literature; that is, serious consequences for the mother, for the would-be mum.

For example, in a paper titled “Subfertility and risk of later life maternal cardiovascular disease” published in Hum. Reprod. 2012 Feb;27(2):568-75 (http://www.ncbi.nlm.nih.gov/pubmed/22131387). The authors gave this background: “Subfertility shares common pathways with cardiovascular disease (CVD), including polycystic ovarian syndrome [PCOS], obesity and thyroid disorders. Women with prior no or just one pregnancy are at an increased risk of incident CVD when compared with women with two pregnancies.”

They concluded that subfertility among women who eventually have a childbirth is a risk factor for cardiovascular disease. As if we all did not know that even without subfertility adding to it, heart disease is the leading cause of death among women [see http://www.health.harvard.edu/newsweek/Gender_matters_Heart_disease_risk_in_women.htm or literally millions of other web pages].

Jiří Anderle / Jiri Anderle
Bestia triumphans II
lept, měkký kryt / etching, vernis mou
1984, opus 271, 65 x 95,5 cm
http://www.galerieart.cz/prodej_anderle_2.htm
For the “triumphant beast” and Giordano Bruno’s story see http://twitpic.com/8r5lyi

More reasons to prevent subfertility

But there is not just the cardiovascular risk, as if that were not enough! Concerns about cancer risk in connection with subfertility have been raised in medical literature already about a decade ago, such as in the paper “Cancer risk associated with subfertility and ovulation induction: a review” – published in Cancer Causes Control 2000 Apr;11(4):319-44 (http://www.ncbi.nlm.nih.gov/pubmed/10843444).

However, there “the only consistent association observed is an increased risk of endometrial cancer for women with subfertility due to hormonal disorders. While positive findings in some studies on fertility drugs and ovarian cancer risk have aroused serious concern, the associations observed in most of these reports appear to be due to bias or chance rather than being causal.”

So, as always, more investigations are needed but the health concern does not go away. The paper concluded: “To discriminate between the possible carcinogenic effects of various ovulation induction regimens, subfertility disorders, and reproductive characteristics associated with subfertility, future studies should include large populations of subfertile women with sufficient follow-up time.”

Well, the truth is that my purpose – and the purpose of bioZhena Corporation – is to make the population of subfertile women as small as possible, by helping every one of you to determine in every menstrual cycle the very narrow fertile window for your focused intercourse, the fundamental requirement for getting pregnant.

This fundamental requirement you already know, I trust. If not, explore the bioZhena’s Weblog for clarification (you can use Table of Contents at https://biozhena.wordpress.com/table-of-contents-links-to-biozhena-posts/ or try searching the blog by means of the widget in the margin on the home page, shown as Search bioZhena’s Weblog – enter keyword, hit Enter). It is frustrating that one of my recent blog pieces had to be on the subject of only the best that you can do for your fertility awareness in the absence of the Ovulona™ – because our Ovulona is not yet available to you due to our lack of financing (see https://biozhena.wordpress.com/2012/12/14/end-of-the-year-and-trying-to-get-pregnant/ ).

Anthropogenic, iatrogenic

Meanwhile, here is another medical-literature paper, this time about cancer risk of drugs that the healthcare industry uses to help women get pregnant – after helping women to prevent pregnancy with another (the big P) drug, the anthropogenic cause of what experts have called the epidemic of impaired fertility: “Ovulation inducing agents and cancer risk: review of literature” published in Curr Drug Saf. 2011 Sep 1;6(4):250-8 (find the abstract at http://www.ncbi.nlm.nih.gov/pubmed/22129320).

The authors give the following summary: “Over the past decades, the use of ovulation inducing drugs has been increasing. A possible causal link between fertility treatments (especially [the widely used] clomiphene citrate and gonadotrophins) and various types of malignancies, including cancers of female reproductive system, thyroid cancer and melanoma, has been postulated. The majority of the available studies on this subject suffer from methodological limitations, including the small number of outcomes, short and incomplete follow-up, and inability to control for potential confounders.

Concerning ovarian cancer, while early studies led to the suggestion of an association between ovulation inducing agents and increased risk of malignancies, the majority of data do not support a causal link.

An increased risk was recently observed in women giving birth after in vitro fertilization (IVF), but it appeared to be consequential to the infertile status rather than the effect of fertility drugs. More controversial are the results concerning breast cancer with some investigations suggesting an increased risk after exposure to ovulation inducing agents, especially clomiphene citrate, whereas others not supporting this concept. A possible trend towards an increased risk has been reported by some authors for endometrial cancer.

Altogether, current data should be thus regarded as a signal for the need of further studies rather than being definitive in them.” END QUOTE.

After introduction of the anti-conception Pill

I must emphasize and impress on you the fact that subfertility and infertility became a societal problem of increasingly large proportions only after the introduction of the anti-conception Pill. “After 3 and up to 15 months of contraceptive pill use, there is a greater loss of the S crypt cells than can be replaced.” The S crypts of the endocervical canal are needed for conception.

To further cite Professor Erik Odeblad : “Complications arising from the use of the Pill are very frequent. Infertility after its use for 7-15 years is a very serious problem. S crypts are very sensitive to normal and cyclical stimulation by natural estrogens, and the Pill causes atrophy of these crypts. Fertility is impaired since the movement of sperm cells up the canal is reduced. Treatment is difficult.”

You can find more on this in my earlier post, Difficult to conceive – Google evidence that pregnancy complications and trying-to-conceive concerns shot up after the Pill launch in 1960s. (Regardless of what contraceptive proponents tell you.)

MARINA RICHTEROVÁ – Golgota, Hommage a P. Bruegel, 1998 and The Juliet, 2000

(Picture from https://biozhena.wordpress.com/2012/04/18/the-perils-of-ivf-of-arts-of-giving-birth-at-old-age-part-2/marina-richterova-golgota-hommage-a-p-bruegel-1998-and-the-juliet-2000/ )

Ignored. Now, the consequences

I am reminded of an insight expressed on the floor of the US Congress after the Pill made a big impact on society in the 1960s. In 1970, Dr. Hugh J. Davies of Johns Hopkins University told the US Senate in the Nelson Hearings about the contraceptive Pill: “Never before in history have so many people taken such powerful medication with so little information as to its actual and potential risks. …With the introduction of such active ingredients, we are actually setting up a massive endocrinological experiment with millions of healthy women.”

Well, decades later we are reaping the consequences of the massive experiment. Said millions of healthy women are not quite so healthy, are they? It is high time to fix this man-made problem.

In an earlier post I wrote: Iatrogenic medicine kicking Hippocrates where it hurts the most. Was it in the blog piece last-linked above?

How baby-making late in life evolved into subfertility and infertility, difficult conception, too long TTC

Way back, in the pre-contraceptive Pill days, the difficulty to become pregnant was not a widespread phenomenon, and mums were  younger than many are nowadays. If you want to see graphical proof of how the phenomenon came about in the previous century, review the attached paper Google evidence of increasing prevalence of subfertility. Should you not be a subfertility or infertility sufferer, and therefore not familiar with the acronym, TTC stands for Trying To Conceive.

The evolution of subfertility and infertility (as a big-time societal phenomenon) in the U.S. can be summarized based on data from http://www.infoplease.com/ipa/A0005074.html#ixzz2GBMSkUKy  [Information Please® Database, © 2007 Pearson Education, Inc.] as follows.

In 1940, births to mothers over 29 years old (30 to 49) were apparently almost as numerous as births to mums of the optimal fertility age 20-24: The ratio of 30-49 years old to the optimal-age group was 0.91 [here referred to as ratio a) =  data for 30–34 plus 35–39 plus 40–44 plus 45–49, this sum divided by data for 20–24], and the number of births in the most fertile age group of mums represented 31% of all births in the U.S.

In case you did not check out the above-linked attachment https://biozhena.files.wordpress.com/2012/12/google-evidence-of-increasing-prevalence-of-subfertility.pdf : The high number of 1940 births to older mothers [high ratio a)] is not so surprising in view of the growing number of books on subfertility and infertility in the 1940s, as seen in the respective Google Ngrams shown here and discussed in the attached PDF paper.

Ngram 3: infertility and contraception

In the present analysis of the historical birth rates, the age group of 25-29 is considered kind of neutral (neither optimal nor too old) whereas the 30-34 years old group is included among the too old ages for optimal fertility. This inclusion could be disputed – if we did not face the subfertility/infertility phenomenon, in which age is a significant factor. In any case, excluding the 30-34 age group from the aged-motherhood definition only delays the trend reversal – observed below in 1980 – by a decade.

I interject here a citation from the post referenced and linked at the end of this post, so that you’ll be well aware of the link between conception difficulties and advancing age, and of the adverse effect of the use of the Pill.

QUOTE: People have a hard time accepting that getting pregnant is not as easy as expected, when they finally decide to want a baby – usually way too late, and after her use of the Pill. The drug makes healthy young women in their best years to postpone family- and baby-making, it damages their cervical S-crypts thus causing difficulty to conceive and, by encouraging promiscuous sex life, it has caused an enormous increase in the prevalence of sexually transmitted diseases that also lead to infertility. Not just a double whammy, a triple whammy on womankind.  Sad, sad, sad. … Advanced age of the would-be Mum works against her on account of the Mother Nature’s Probabilistic Rules and Regulations of Baby-Making… END QUOTE.

An obgyn’s article on female subfertility in the Lancet invokes “two main factors that determine subfertility: duration of childlessness and age of the woman”. It is not likely that an obgyn would be as critical of the Pill as yours truly, although there have been exceptions. No further comment on this is needed or offered in this blog post. Instead, I share that another medical article from Britain reported that “the incidence of infertility was 0.9 couples per 1000 general population. The average age of women was 31 years, and the average time attempting conception was 18 months… At 12 months, 27% of all couples in the study achieved a pregnancy spontaneously and a further 9% with treatment.”

Here are the 1940 US birth statistics data from the referenced infoplease.com source:

Year	Total	Under 15	15–19	20–24	25–29	30–34	35–39	40–44	45–49
1940	2,558,647	3,865	332,667	799,537	693,268	431,468	222,015	68,269	7,558

And this is the calculation for the present analysis of the data:

a) 729,310/799,537 = 0.912

(ratio a is the sum of births to age groups from age 30 to age 49 divided by births to age group 20 – 24)

b) 799,537/2,558,647 =  0.312

(ratio b is births to age group 20 – 24 divided by total births in 1940)

By 1950 and 1960, the trend was good because ratio a) declined from 0.91 to 0.86 and then to 0.80 while the number of optimally aged young mothers rose slightly to 32% and then to 33.5%. These pre-Pill years were good years from this perspective, and the trend continued – even after the contraceptive Pill was introduced (in the 1960s), at least initially.

In 1970, there was a drop in the total number of births from the total of 1960 (4,257,850 births) and a dramatic drop in the number of births by aged mothers [ratio a) was 0.47] – and the births by the most fertile age group were up to 38% of all births. As though the contraceptive Pill worked in this sense (but only if we do not look at the significantly increased births by underage girls, especially the under 15)… Here is the 1970 data from the above source:

Year	Total	Under 15	15–19	20–24	25–29	30–34	35–39	40–44	45–49
1970	3,731,386	11,752	644,708	1,418,874	994,904	427,806	180,244	49,952	3,146

Unfortunately, in 1980 – that’s some 20 years after the Pill was introduced – the trend started to reverse while the total births continued to drop (and underage births dropped, too): Ratio a) of the number of aged mothers’ births to the most fertile age group’s births rose to 0.58 and births by the most fertile 20-24 year old mums represented now only 34% of total US births. The bad trend toward older-age motherhood continued.

By 1990, there were even more births to aging mothers than births to the most fertile age group, with ratio a) standing at 1.15 and the number of births to mothers of the optimal age group having dropped to a mere 26%.

The bad trend continued so that in 2000 advanced-age mothers exceeded the optimal-age group with ratio a) at 1.45, and with the optimally aged mums at 25% of total births. The trend continued further so that in 2009 advanced-age mothers exceeded the optimally aged mums by a factor of 1.53 [= ratio a)] and the optimal age group’s births dropped to 24% of total births. Data for 2009 are the most recent available data.

Tamara de Lempicka Quattrocento, 1937

Is the difference between way back and now the reason for one other elevated readership statistic here on bioZhena’s Weblog? It is intriguing to see that during the months of the highest numbers of US births/deliveries (late summer and autumn, well before the year-end Holiday Season), a highly viewed post this year was the one published around the time of Mother’s Day: Why too many young and not so young ladies could NOT receive flowers on Mothers’ Day. Why so many trying-to-conceive, why so much infertility = https://biozhena.wordpress.com/2012/05/14/why-too-many-young-and-not-so-young-ladies-could-not-receive-flowers-on-mothers-day-why-so-many-trying-to-conceive-why-so-much-infertility/ Say thank you to the social and medical advances of the twentieth century – primarily those of chemical birth control, the Pill.

What do you think of all this?

P. S. The Alphabet of bioZhena (glossary/primer) is at https://biozhena.files.wordpress.com/2020/01/aaee-the-alphabet-of-biozhena-011207-with-tracking.pdf

Stress and fertility: How stress affects the inherently narrow fertile window

This blog post appears as the third result in Google search on “bioZhena” (without the quote marks). The complete title is:

Stress and fertility

How stress affects the inherently narrow fertile window

To read the whole post, click on either of the antique-book images or on Reblogged from bioZhena’s Weblog:

Before you go there, here is a little update. New research into stress and fertility was published since I wrote the blog post in December 2007, and here is a summary of an article titled “Stress puts double whammy on reproductive system, fertility” (see http://esciencenews.com/articles/2009/06/15/stress.puts.double.whammy.reproductive.system.fertility ).

 

QUOTE: The new research shows that stress also increases brain levels of a reproductive hormone named gonadotropin-inhibitory hormone, or GnIH, discovered nine years ago in birds and known to be present in humans and other mammals. This small protein hormone, a so-called RFamide-related peptide (RFRP), puts the brakes on reproduction by directly inhibiting GnRH.

The common thread appears to be the glucocorticoid stress hormones, which not only suppress GnRH but boost the suppressor GnIH – a double whammy for the reproductive system. END QUOTE

 

Unlike any other fertility monitoring technology, bioZhena’s Ovulona™ is a Smart Sensor™ in vivo monitor of folliculogenesis. Unlike any other fertility monitor, the Ovulona is basically involved with the always-present stress responses – through monitoring certain end-organ effects on folliculogenesis. The other techniques monitor only this or that circulating hormone – not good enough. The end-organ effect(s) is what counts.

 

Again, to read the whole post, click on either of the antique-book images or on Reblogged from bioZhena’s Weblog

 

For a 2012 update go to What is the mechanism of stress and how does it affect reproduction. An update. And: Be a young mother! (Ovulona™-related published scientific findings by others about disruption of fertility, about PCOS or Poly Cystic Ovarian Syndrome, how stress suppresses ovulation, about the hypothalamic amenorrhea of stress and postpartum blues/depression, about a CRH placental clock which determines the length of gestation and the timing of parturition and delivery, and the role of CRH in premature labor. How old age affects folliculogenesis as a stressor. Even how acute stress may induce ovulation in women.)

bioZhena's Weblog

Please click through to the 2019 revision of this post at

https://biozhena.wordpress.com/stress-and-fertility-fertile-window-ovulation/

How stress affects the inherently narrow fertile window

Stress can do unwanted things to a woman and her menstrual cycle. In a nutshell, stress can make a woman completely infertile in this menstrual cycle (e.g., LPD, see below), or it can change the timing of her fertile window (the time of ovulation included) within the menstrual cycle. Any of this can cause problems and lead to more stress…

The medical term is stress response, and it refers to the overall reaction of the organism to any adverse stimulus, whether it be of physical, mental or emotional kind, internal or external. The purpose is to adapt to challenge, and this goes on all the time. (C’est la vie! Real life is a never-ending series of stress responses.) Should the compensating reaction of the organism be inadequate or inappropriate, a…

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Instant detection of pregnancy and of Early Pregnancy Loss, EPL – the adversary of Trying To Conceive, TTC – especially after age 25

Early Pregnancy Loss is also known as #stillbirth or #miscarriage, or Early Embryonic Mortality (EEM), and the Ovulona™ is a tool of evidence-based personalized medicine.

After the optimum fertility age of the early twenties, achieving motherhood gets more difficult. It becomes even more essential than before to know your three fertile days, during which – and only during which – conception can occur.

The simple basic principle is: Fertility status detection must be easy and reliable. PLUS early pregnancy detection is really important, and it should be built-in, an integral part of the conception-aiding tool.

Why? Because:

1) early in pregnancy the conceived baby would be harmed by some of the medications taken by the woman, e.g. by a psychiatric medication with teratogenic effect (harmful to the fetus, causing a congenital disorder);

and 2) because of the annual 600,000 miscarriages – per CDC statistics – out of the 6 million US births, which means that at least some 10% of pregnancies are lost to early pregnancy loss (EPL), miscarriage, stillbirth.

Many EPLs go unnoticed. The EPL is a part of the TTC [Trying To Conceive] or subfertility/infertility problem. Our Ovulona monitor of FOLLICULOGENESIS IN VIVO™ is the prospective solution for managing the problem.

The Ovulona™ detects the 3 fertile days for conception, and it will also automatically detect pregnancy immediately upon conception. Similar to early pregnancy loss — its detection is the inverse of pregnancy detection, which both involve the follicular waves. Like this:

Follicular waves disappear = pregnancy detected

versus

waves reappear in early pregnancy =  early pregnancy loss detected.

Furthermore, the cyclic profile data captured by the Ovulona can be used by your healthcare provider to assess what is going on, and provide more effective help.

DIFFICULT USE OF EXISTING OPKs [Ovulation Prediction Kits] is shown in the following tweet by a @WannaBeMom: “1st month using opk. Do the lines usually start light and then get darker day by day or do they ever go back & forth b4 ovulation?”

Our electronic device will take the WannaBeMoms into a different world of baby-making.

Honey is Sweeter than Blood by Salavador Dali, 1941

For a woman in her 30s who has had a miscarriage or even two or three, “any delay in attempting conception could further decrease the chances of a healthy baby”, says CNN reporting on a medical study, http://www.cnn.com/2010/HEALTH/08/05/miscarriage.try.again.asap/ .

“Study: Women who conceive within six months of miscarriage reduce risk of another.”

November 2016 review and meta-analysis (data on more than a million women): “With an Inter Pregnancy Interval of less than 6 months, the overall risk of further miscarriage and preterm delivery  were significantly reduced.”

These are fundamental principles.

And another principle, not brought up by the CNN or by the study itself, is that a tool for monitoring the early stage of pregnancy for EPL is most desirable. We’d say, mandatory. The Ovulona device monitors (or tracks the process of) folliculogenesis in vivo, which includes the follicular waves that occur after ovulation. The waves disappear upon conception because the reproductive system does not go into another menstrual cycle – it’s pregnant.

In case of EPL, Early Pregnancy Loss (miscarriage), the waves will come back. Early Pregnancy Loss, or Early Embryonic Mortality, is quite a common sad experience of many of us.

The essential point made here is that the woman’s and her physician’s decisions should be guided by the folliculogenesis cyclic profile (and/or its distortion due to distress of any kind). The woman and her doctor should not make decisions or pass recommendations working in the dark, and the data, on which any decision should be based, must be personal to the given patient.

That’s what the Ovulona from bioZhena is for. Personalized medicine. Evidence based medicine.

Automatic pregnancy detection is inherent in the Folliculogenesis In Vivo™ cyclic profile (follicular waves disappear).

This is a screen shot of one of my narrated slides about “what’s going on here” – view (and hear) the slide at https://biozhena.files.wordpress.com/2015/07/single-slide-unprecedented-wealth-of-info-narrated.pps.

Note specifically that: The follicular waves, which occur after ovulation [when the body prepares for the next menstrual cycle], cannot remain in place after fertilization succeeds and conception takes place [because the post-ovulation regime change is even more profound]. That is the principle of instant detection of pregnancy. As opposed to the waiting for the HPT [Home Pregnancy Test] result.

HCG or Human Chorionic Gonadotropin laboratory signature of the biomarker – detected in a pregnant woman’s urine about 2 weeks into her pregnancy by a HPT home-use urine test – as a color change (into which color the HPT reduces the illustrated complex lab signature)

Should the conceptus [product of conception, early embryo] be lost to EEM, Early Embryonic Mortality (miscarriage), the follicular waves come back to be seen by the Ovulona. That’s the principle of early detection of the miscarriage, and of detecting the return of the non-pregnant condition.

Trying to conceive again should be based on the personal FIV™ [FOLLICULOGENESIS IN VIVO] cyclic profile data generated by the woman trying to have a baby. This is a principle of evidence-based medicine. Personalized medicine.

The Ovulona is intended to help people such as those writing in a forum as follows:

My partner and i started trying for a baby in jan And Concieved in the first month. Unfortunately in march at 8 weeks I had a miscarriage. We have been trying since with no luck. Could something be wrong. Please help this is really getting me down. http://www.netdoctor.co.uk/interactive/discussion/viewtopic.php?t=57881&f=5

We got pregnant the first cycle with both my ds and dd. I am most likely moving to cycle #11 with this baby. We did conceive on the second cycle of trying with baby #3 but we miscarried a week later. Nothing since then. I’m not sure why this time is taking so much longer. http://www.mothering.com/discussions/showthread.php?p=16029816

Can anyone advise? My daughter has been trying to get pregnant for several years. Her husband is fine. My daughter has now been asked to go for a scan which scared the life out of me (you automatically think something is horribly wrong). Can someone tell me what the scan is about – what sort of scan is it? http://www.netdoctor.co.uk/interactive/discussion/viewtopic.php?t=31528&f=5

The information contained in the folliculogenesis cyclic profile, as illustrated in the slide captured above, is meaningful and can help the healthcare provider to answer questions such as these.

Difficult conception tied to pregnancy complications – addressed

For, women bear great responsibility for the health of the yet to be born children.

“High-risk pregnancies are more likely in women who have difficulty getting pregnant, with or without help from hi-tech fertility treatments.”

Read more about this in the article from which this is cited, at: http://doctor.ndtv.com/storypage/ndtv/id/004480/type/news/Difficult_conception_tied_to_pregnancy_complications.html

In a nutshell, the article reports the outcome of an Australian analysis of the pregnancies of more than 2,000 subfertile women who sought A.R.T. fertility treatment between 1991 and 2001. The outcome is that these women were more likely to have pregnancy complications than a control group of twice as many women who became pregnant and “gave birth without using any assisted reproductive technique”.

The article gives as examples of complications higher incidence of pre-eclampsia (a potentially dangerous condition, marked by high blood pressure and protein in the urine) and of cesarean sections, premature births and low birth weight babies, and even higher infant mortality.

As if this were not enough, another, more recent, Hum. Reprod. 2013 Jan;28(1):125-37 review and meta-analyses of 14 studies, concluded that women with a long time to pregnancy are at an increased risk of preterm birth (https://www.ncbi.nlm.nih.gov/pubmed/23042798).

Clearly, none of this is music to your ears!

Now, it is logical to highlight the attributes of our Ovulona™ diagnostic technology in this context. The Ovulona is uniquely well positioned to assist, including the management of the early-stage pregnancies associated with subfertility and infertility.

The Ovulona™ addresses this, unlike any other conceptive-aid diagnostic device

The Ovulona FIV™ technology is unlike the various other conceptive-aid products (aka ovulation predictor kits and similar fertility self-help products such as certain smart phone apps) available in the marketplace today (the link added in January 2017). This is not only because of the unprecedented precision of determining the 3 days of the fertile window, which no other technique but our Folliculogenesis In Vivo™ (FIV™) technology can offer.

Allegory of Music by Francois Boucher

The other conceptive aids assume (but do not determine the boundaries of) a wider fertile window, and they merely assume ovulation without actually detecting it – because their techniques cannot detect it, and because detecting ovulation clinically is complicated and expensive.

The clinical detection of ovulation by ultrasound is also inconvenient and painful. It is painful because the technique is only about 80% reliable and so the good specialist will perform additionally two unpleasant tests (counting on your high pain threshold) in order to confirm the conclusion based on seeing the collapsed follicle in your ultrasound picture – the change seen the day after ovulation as a diminution of the presumed dominant follicle.

All this is also why medical scientists have had difficulties determining the fertile window. However, a very well designed 1992 study in Auckland, New Zealand showed the three days of the fertile window: 77% boys born on day 1 of the fertile window, 69% girls born on fertile day 3 (ovulation), and in between on day 2 of the fertile window, 70% boys and 30% girls (in that study of 55 births).

The 3-day fertile window was also evident in the data of a less well designed 1995 study that came out of the NIH. Both studies suffered from the use of inaccurate methods of estimating ovulation, resulting in data point outliers that they interpreted as indicative of a fertile window wider than 3 days – with much lower pregnancy rates on the flanks of said 3 days. Fertile window of 6 days has been in the public mind since the 1995 study that caused a sensation at the time (because 6 is much better than the previously believed 10 or even 13 or 14) – and so, the problems with achieving pregnancy have continued to this day.

An earlier post summarized this as follows [ https://biozhena.wordpress.com/2010/03/23/critique-of-birth-control-efficacies-in-nfp-as-published-by-marquette-university-researchers ]:

The old approaches to detecting fertility status are to be referred to as peri-ovulation methods. Where the prefix refers not to the Peri of Persian folklore (earlier regarded as malevolent!) but to the Greek meaning of about, around, near or enclosing – in this case ovulation. Surely, peri-ovulation or peri-ovulatory is a more palatable word than fuzzy.

In the context of the tie up between conception difficulties and pregnancy complications, the Ovulona FIV advantage is the following threesome – if “advantage” is even the right word. It really is a must.

The three things a woman needs to know to avoid unintended childlessness

There are three things that a woman experiencing difficulty to conceive needs to know. They are:

1. Know from your underlying folliculogenesis profile in the present menstrual cycle when exactly your 3 days of the fertile window occur.

2. Know within a couple of days after the detected ovulation whether your conceptive intercourse (intended to conceive) did or did not result in conception.

3. Know whether the early stage of pregnancy progresses well or not.

While numbers 2 and 3 are yet to be elaborated by bioZhena in clinical trials contingent upon funding, they are inherent in the principle of the FIV technique, discussed throughout the bioZhena’s Weblog .

https://biozhena.files.wordpress.com/2016/11/single-slide-narrated-best-wealth-of-info-in-menstrual-cycle-profile-signature.pps

The original medical paper, referenced in the doctor.ndtv.com article cited at the top, was not found in Fertility and Sterility issues of the last three months. But, one of the pertinent papers we did come across there revealed, based on a survey of several hundred female undergraduates at a North American university:

“Although most women were aware that fertility declines with age, they significantly overestimated the chance of pregnancy at all ages and were not conscious of the steep rate of fertility decline. Surprisingly, women overestimated the chance of pregnancy loss at all ages, but did not generally identify a woman’s age as the strongest risk factor for miscarriage.” The paper concluded: “Education regarding the rate at which reproductive capacity declines with age is necessary to avoid unintended childlessness among female academics and professionals” [Fertility and Sterility, Volume 93, Issue 7, 1 May 2010, Pages 2162-2168].

Chances of achieving pregnancy critically dependent on the timing of insemination

The reported overestimating of the chance of pregnancy – and by the same token also the predicament of people seeking to achieve pregnancy – can perhaps be understood in light of the following statistical factors.  Any woman has a 90% chance to be healthy at the time the sexual intercourse is occurring; the fertilization rate could then be intuited to average also 90%.  But it does not because of the inherent 25% loss to early embryonic mortality [EEM] or miscarriage, spontaneous abortion, so that a successfully inseminated healthy female has a significantly decreased chance of successful pregnancy.

As a consequence, the probability of achieving pregnancy is critically dependent on whether the insemination (natural or artificial) occurs at the right time (i.e. during the so-called fertile window). Contemplate the reason why this Bronzino picture of Allegory of Venus is so small.

Bronzino – Allegory of Venus

Here is how critical this timing is for healthy women: Even if the probability of determining the insemination time correctly were 90%, the resulting probability of successful pregnancy from any one particular insemination event would be only 55%.  Get this! Only 55% under perfect conditions. This is because the probability of pregnancy is the combination of four individual probabilities:  90% x 90% x 75% x 90% = 55%.

That is, the statistical formula for the probability of successful conception of pregnancy multiplies the probabilities of being in good health, of successful insemination, of not miscarrying the conceptus, and of the probability of correct timing of the conceptive intercourse. Thus:

P-health x P-fertilization x P-non-abort x P-insemination timing = P-pregnancy

For example, a 60% success rate of correct timing brings the overall rate of pregnancy down to a mere 36%, and this goes down to a mere 30% if the correct timing probability is only 50%, in healthy fertile couples.

But then, even a quick search for data on EEM (Early Embryonic Mortality] suggests that human EEM is likely much higher than the above-considered 25%, possibly even as high as about 83% (“only one embryo in six survives to term”), and certainly appears likely around 50% in healthy women. (Different studies come up with different results.)

Hence the probability of pregnancy is lowered from the approximate 36% or 30%, and it can be much lower if the timing of insemination (intercourse) is off, if the probability of correct insemination timing is low. See the adverse effect of wrong timing of the attempt to get pregnant (Insemination timing probability) on the probability of success (Pregnancy probability) in the following table.

Probability of pregnancy as a product of four probabilities:

Health	Fertilization	Non-abort	Insemination timing	Pregnancy probability
.9	.9	.15	.5	.06
.9	.9	.15	.9	.11
1	.95	.55	.5	.26
1	.95	.45	.5	.21

Pertaining to the health factor, another study published in the same specialist journal showed that women who were obese adolescents had significantly higher odds of remaining childless compared with normal weight women [ Fertility and Sterility, Volume 93, Issue 6, April 2010, Pages 2004-2011].

Women and the health of humankind

Childlessness is one thing, and the enormous responsibility that women carry on their shoulders is another. That is, responsibility for the health of the as yet unborn children. Like it or not, a woman’s health and lifestyle both have significant consequences for the offspring.

Alfons Mucha – Job

Cigarettes are a big huge problem, causing harm to your unborn, and that’s smoking at any time, not just in pregnancy.

Premature births, a big huge problem with serious consequences.

Difficult births requiring the use of forceps, the pincer-like tool they might use to pry the baby’s head out of you with – that, surely, the baby could do without, if only the birth were not difficult…

These are just a few examples highlighting the major responsibility of womankind for the health of humankind. Healthcare, its rules and regulations and funding, better be geared to that.

A few more peri-vernal equinox tweets on #conceiving, #fertility, achieving #pregnancy & #baby gender contrary to Shettles

While NFP users know that fertility awareness is a must for birth control

We all know that the peri in the title does not refer to any “one of a large group of beautiful, fairylike beings of Persian mythology…”. We know that “peri” is in fact a prefix meaning “about” or “around” and “near”, appearing in loanwords from Greek, such as in the title here [http://dictionary.reference.com/browse/peri].

Peri - 1865

And now for the last few tweets; again somewhat edited, since here we do not have the 140 character limit. And again with clickable links to further information, including the #hash tags with all sorts of tweets there by anybody using a given hash tag, in the manner of the Twitter social networking mechanism.

These tweets should do it for this departure into the so-called microblogging. Do check out http://to.ly/VCF for what a reliable #fertility tool is about. Read up on it http://to.ly/vUz

Here is a birth control product that will be in the competition category when we go into the birth control market: http://twitpic.com/1971ez – This is the device used to insert the ‘Mirena’ coil into the patient’s uterus. Sent via TwitPic. Retweeted by you and 1 other. The reason why this was re-tweeted by yours truly was to highlight the invasiveness of the pictured device, which bears no comparison with ours (quite apart from our device not inserting into the uterus). But, of course, our product is not out yet, with all its user-friendly and otherwise beneficial attributes. Any comments, dear reader, would be appreciated.

RT@pregnancyorg: Read about your cycles getting #pregnant before #conceiving http://ow.ly/1l765 — and then I suggest you also read http://to.ly/VCF and http://to.ly/vUz

RT@Averyugya81: ARTs [Artificial Reproductive Technologies] for #infertility treatment may pass on genetic defects – warns ART pioneer http://to.ly/1pOJ . This is reminiscent of the development when Father of the Pill Dr. Djerassi turned against oral contraception, promoting instead what he called “the Jet-Age Rhythm Method”, by which he meant fertility awareness (aided by technology, hence the reference to jet age)

RT@Averyugya81: How often do I have to have sex to get #pregnant? http://to.ly/1pPi

How often?

– Every day for 20 days with 69% chance of success, write statisticians http://to.ly/1phs (from day x to day y of your cycle)

If this continues to be pleasuresome, carry on for months on end to overcome the odds. Else, you need focus, and see my earlier tweets. Fight statistics! (With pleasuresome determination and with the aid of a deterministic timing tool… in the offing)

Again: The odds are against us! #pregnancy #birth control #fertility #startup angel-investor-find-and-match… same difference! Odds are very low (without that focus)

@pregnancyorg‘s gender selection http://to.ly/1qkx seems to perpetuate the Shettles recipe. However, evidence http://to.ly/1nyK http://to.ly/1qmz contradicts Shettles (whose claims have the reputation of not being backed by or based on any properly designed clinical studies). Here is a summary of a solid study, which – for the lack of “Perfect” – employed three “Imperfect Measures” of ovulation as defined in the previous post. The three gave similar results. Female births at (or near) ovulation, male births 2 days earlier (or so)

Birth distribution by gender - France et al., focused NFP TTC study

The uncertainty expressed by the “or near” and “or so” is the consequence of the “Imperfect Measures”, but the trend is clear. Also rather clear is that the low birth counts flanking the high ones are data outliers due to measurement errors inherent in “Imperfect Measures”. For more on this, go to the earlier post at https://biozhena.wordpress.com/2007/12/15/fetal-sex-pre-selection-%E2%80%93-the-fundamentals

Baby gender pre-selection will require a clinical study as stringent as the France et al. study was, but performed with our Ovulona instead of the inaccurate methods (BBT, Peak mucus, LH rise as opposed to LH surge apex)

Delville - Satan Treasures, 1895

RT@BabyMed: So can you get pregnant from having sex on your period? http://bit.ly/29yLQJ — THE absolute requirement is a RELIABLE #fertility monitor. (Persistent monitoring in the interest of evidence-based medicine)

RT@BabyMed: So can you get pregnant from having sex on your period? Yes, but only if the cycle is very short, which would be due to a very short follicular phase, which you can only detect with a RELIABLE monitor. (Not to track merely one, two or even three hormones in body fluids – you need to follow FIV™, Folliculogenesis In Vivo™)

RT@bioZhena RT@BabyMed: Furthermore, you want our built-in #pregnancy detection because it will see you #pregnant right away (not only about two weeks later), and – importantly – our device will also see if the pregnancy is lost, which happens quite frequently. See  https://biozhena.wordpress.com/2010/01/10/about-the-added-bonus-of-folliculogenesis-monitoring-automatic-pregnancy-detection . Early embryonic mortality is very high (according to some sources significantly more than 50%), and most of the losses of the conceptus occur early on, prior to 12 weeks. Mostly they occur sub-clinically, without the knowledge of the mother (by one expert source, 52% of all women who conceive experience early miscarriage…)             

RT@bioZhena: RT@BabyMed: Can #pregnancy result from sex on period? Yes, if it’s a very short cycle (due to a very short follicular phase) – which is unlikely – as the pre #ovulation phase is rarely that short. Since teenage cycles tend to be irregular and often short, this is of particular interest to sexually-active teens.  You must MONITOR your cycles if you don’t want any such surprise

RT@bioZhena: RT@BabyMed: Can #pregnancy result from sex on period? See here how unlikely it appears http://to.ly/1k9L . Unlikely, if the shortest follicular phase is 6 days. Menstrual bleeding would have to be as close to ovulation as 4 days, to make the answer unequivocally positive; that would mean cycle length of 18 days (or 16 to 20 days). Very rapid dominant follicle maturation. Until this (shortest follicular phase question) is investigated with our Ovulona monitor of Folliculogenesis In Vivo™ [FIV™], there is probably little data to invoke. I would be interested in any evidence.

Peri-vernal equinox tweets on #conceiving, #fertility status, achieving #pregnancy in the era of #infertility – “a modern epidemic”

NFP aficionados know that fertility awareness is for birth control, too

And language aficionados will know that the peri in the title does not refer to any “one of a large group of beautiful, fairylike beings of Persian mythology, represented as descended from fallen angels and excluded from paradise until their penance is accomplished.” Nor, for that matter, to “any lovely, graceful person.”

Peri or Paeri of Persian folklore and mythology

Peri is a prefix meaning “about” or “around” and “near”, appearing in loanwords from Greek [http://dictionary.reference.com/browse/peri]. Just like here, whereby we invoke the Spring Equinox – when the Sun rises exactly in the east, travels through the sky for exactly 12 hours and sets exactly in the west – this year on March 20. “And anyone standing on the equator at noon will not cast a shadow” [http://www.wilsonsalmanac.com/book/mar20.html]. Lovely!

So then, now for the tweets (a little edited, since here we do not have the 140 character limit, and – in the usual manner – with clickable links to further information, including the #hash tags).

1)         2009 sales of #fertility LH kits at $272M outpaced #pregnancy tests http://to.ly/1p8Q Not exactly surprising since ~30% of US women do not get #pregnant in 6 or 12 months 12:04 PM Mar 16th

2)         #Infertility is “a modern epidemic”. In 17 studies, 56% of the relevant sub-population (range 42–76%) in developed countries sought medical help http://to.ly/1pdo but less than 1/2 of them received care 2:30 PM Mar 16th

3)         Unintended pregnancies = “global epidemic”. US family planning is “uniquely deficient” (50%) http://to.ly/1pcB Cause: high contraceptive failure rates 2:34 PM Mar 16th

4)         Leading causes of unintended pregnancy are closely related to #contraceptive failure. Failure rates: 31% the Pill, 18% condoms, 5% 3-month injectable #birth control 2:43 PM Mar 16th

5)      Medscape OBGYN: #fertility awareness can be highly satisfactory #birth control & #family planning method http://to.ly/1peK http://to.ly/1peM 3:14 PM Mar 16th

6)      RT @bioZhena #fertility awareness [FA] is a great #birth control & #family planning method especially for women 30+ years of age, and those who are able to practice FA without a teacher 3:23 PM Mar 16th

7)      Statisticians: Best frequency of sex for unfocused conception attempts is every 2 or 3 days http://bit.ly/d9tCfm to avoid exhaustion. Else, everyday 5:32 PM Mar 16th

8)      RT@bioZhena But even sex every day for 20 days from day 6 to day 25 only computes as 69% probability of conception. So what else is new in the world of sub- #fertility, wanting #pregnancy but being put into the sub- #fertile category 5:34 PM Mar 16th

9)      Trying to get #pregnant without knowing when-to frequently does not work for a long time. Yet, often all that’s needed is knowing your actual fertile window in the present cycle http://to.ly/VCF 7:18 PM Mar 16th

10)  For #fertilityawareness, NFP for #pregnancy and/or #birthcontrol, we have the tool for you http://to.ly/VCF — or, rather, will have, once funded. Comments? 7:19 PM Mar 16th

Major studies decades ago revealed variability of menstrual cycles

But people are still naïve about the basic cause of the difficulty to achieve pregnancy

Sex education at school, its quality or otherwise, is likely to have much to do with fertility problems later in life. Many women (men, too, of course) can use the  keyboard with all their fingers (as well as their thumbs!) but have poor understanding of the basic functioning of their reproductive system.

colonial-classroom.jpg

That ignorance is well known, and is underlying the fertility problems. You should see the pregnancy doctors’ tweets – replying to some incredible questions, and then the talk of various mysteries!

A shining example is this tale of “mysterious conception”. For the whole story see the Alphabet of bioZhena under M, “Mysterious conceptions (OR THE NONEXISTENCE THEREOF)” on page 34 or thereabout, from which I cite:

QUOTE:  It appears that we must dwell on this topic, because of stories and notions propagated in various pertinent circles. This writing has been prompted by page 176 in the excellent 1999 book “Woman” by Nathalie Angier, where the Pulitzer laureate relates the story of the mysterious conception of her only child. Mysterious, because it occurred, she believes and makes her readers believe, outside of ovulation and of the fertile window.

The reason for this entry in the Alphabet of bioZhena is that there is NO SUCH THING AS MYSTERIOUS CONCEPTIONS, there is only lack of information, or ignorance of the facts. We might say, intellectual misconceptions lead to “mysteries” in terms of conception, of babies conceived supposedly when conception was biologically impossible, and vice versa, some women have difficulties conceiving for the same fundamental reason. We shall use Ms. Angier’s case to make this point. UNQUOTE.

To drive the point home, here is an excerpt from John J. McCarthy, Jr. and H.E. Rockette, “Prediction of ovulation with basal body temperature”, Journal of Reproductive Medicine, Volume 31 (No.8), Supplement, 742 – 747, 1986.

Referencing particularly large studies from 1967 and 1977, these BBT experts had this to say all those years ago (and never mind their “prediction” in the cited title whereas the BBT is well known to be no predictor):

QUOTE:  Cycle regularity is often assumed by both women and their physicians. The suggestion, that the BBT graph of the previous cycle can be used to identify the day of ovulation in the current cycle, requires nearly absolute cycle regularity. [However, note this:] The data collected by 1,085 women, who provided at least 6 or more charts each, were studied for cycle length variability. … The cycle length range was more than five days for 56% of the women who submitted 6 graphs, and for 75% of those with 12 graphs. … Absolute regularity was not demonstrated in as few as six cycles. Even when the cycle length that deviated the most was eliminated, less than 1% (8 of 1,085 women) had no variation in cycle length. When the number of cycles was extended to 12, no woman had variability of less than two days in cycle length. END OF QUOTE.

In real life, you realize, no cycle can be eliminated from the experience, and every day matters. Two days are very likely to make the difference between conception and the lack of it. And/or cause an unwanted pregnancy, for that matter.

Middendorf  – On the ball

The above findings are therefore the basis on which we can say quite categorically that nobody is as regular as a metronome (and nobody conceives in an anovulatory cycle), that there is no such thing as absolute regularity, whether 28 days or otherwise.

If you are in the sub-fertile category of people finding it difficult to become pregnant, you are likely to have cycle variability of more than 5 days over those months of your fruitless efforts that define your category. More likely than being one of the 0.74% of the population with no variation in cycle length, which under ideal conditions may also mean no variation in the time of ovulation. Persistent monitoring is well advised.

Variability of menstrual cycles and of ovulation timing

See how this complicates things whether you want pregnancy or want to avoid it

And yes, stress has something to do with it

In the previous post, I suggested that the terminology that speaks of sub-fertility or reduced fertility is misleading. If you did not stumble over it wondering why, then I am glad for you (I should say, for both of you!). Because you “got it” and you will now think of taking some appropriate steps, and those will NOT be to your insurance agent and/or – more likely – to your bank! (Referencing the high costs of the A.R.T., Artificial Reproductive Technologies.)

Because you understand that, until proven otherwise, your situation should be termed one of instant conceptive gratification cannot be obtained probably due to wrong timing. Nothing reduced or sub- about that! And, the adjective “conceptive” is meant to indicate that the hope is that the other kind of gratification has obtained. The one I referred to as physio-pleasure, but that would be a topic for another time…

Since you are not likely to have reviewed the menstrual variability references given in the previous post, I will document the notion of wrong time with our data. I mean the data from a small clinical trial carried out with a prototype of our core technology, the Ovulona™ for home use.

This trial was performed by an independent group at Marquette University NFP clinic – with patients attending the clinic to learn NFP for one of two reasons: either because they experienced difficulties in achieving pregnancy, or because they wanted to learn NFP [Natural Family Planning] as a means of birth control. Or, maybe, they wanted to use NFP for both, at different phases of their lives.

We can look at data of 10 women, 2 cycles each, reviewing here the ovulation data obtained with said prototype of our Ovulona device.

The data are systematically documented (along with two reference methods for comparison) in the attached 1-page document (Variability of menstrual cycles), and I am doing my utmost to boil it all down for you to as brief a briefing as possible.

Listing of two consecutively detected ovulation days (ovulation marker detected by our device), and noting whether the cycle was subsequently categorized as regular or irregular, goes like this:

Ovulation day number in 2 consecutive cycles

Patient #1	16 (regular)	17 (regular)
Patient #2	14 (regular)	17 (irregular)
Patient #3	17 (regular)	data absent
Patient #4	15 (irregular)	14 (irregular)

The list goes on, and you should know that “irregular” means “challenged”, and means something of a problem that our modern lifestyle presents to the biology of our women.

One patient provided data from her four cycles, and the variability was – not surprisingly – even more pronounced (-3 days, +3 days, -5 days).

The following table shows the wide spread of the differences between ovulation days in two consecutive menstrual cycles of 10 women attending said NFP clinic.

Summary of 10 patients, 2 consecutive cycles each

Patient #	Ovulation days in 2 consecutive cycles	Difference between those cycles	Regular cycles or not	Age	Has given birth already or not
1	16, 17	+1	both regular	35	mother
2	14, 17	+3	2nd  irregular	33	mother
3	17, NA	NA	first regular	42	mother
4	15, 14	-1	both irregular	33	mother
5	20, NA	NA	first regular	30	mother
6	19, 18	-1	both irregular	38	mother
7	16, 13	-3	both regular	29	no children
8	21, 24	+3	2nd irregular	19	no children
9	18, 13	-5	first irregular	41	no children
10	10, 12	+2	2nd irregular	22	no children

Differences from -5 to +3 days are recorded in this small sample, and the one woman with 4 cycle records showed 5 days difference, too, which illustrates that the more cycles are followed, the larger the spread of ovulation days and cycle lengths usually becomes (this is “cycle irregularity” in the conventional, usual sense).

These are differences between just two successive menstrual cycles. The situation becomes more involved when many more cycles are reviewed, as has been done in the studies years ago using BBT charting data. QUOTE: “The cycle length range was more than five days for 56% of the women who submitted 6 graphs, and for 75% of those with 12 graphs. … Absolute regularity was not demonstrated in as few as six cycles… When the number of cycles was extended to 12, no woman had variability of less than two days in cycle length. END OF QUOTE.

(For reference, go to my previous post at https://biozhena.wordpress.com/2010/03/10/major-studies-decades-ago-revealed-variability-of-menstrual-cycles/ .)

The data of those long-term studies of many menstrual cycles charted by many women are still used today by biostatisticians studying things such as the possibility of sequential predictions of menstrual cycle lengths – the cycle length being primarily dependent on the pre-ovulation part of the cycle (in the absence of any complications).

Here is a very good example of cycle length variability of a woman who charted well over a hundred of her menstrual cycles (ref.: Figure 1 http://biostatistics.oxfordjournals.org/content/11/4/741/F1.large.jpg in Paola Bortot, Guido Masarotto, and Bruno Scarpa, “Sequential predictions of menstrual cycle lengths”, Biostat (2010) 11 (4): 741-755 http://biostatistics.oxfordjournals.org/content/11/4/741.full).

Variability of menstrual cycle lengths of a woman who charted more than 100 cycles

I should remind you that our meaning of regularity is as indicated and documented in the attached summary, “Variability of menstrual cycles”. Regular cycles are those where our ovulation marker is within 1 day of LH peak or of the day of Peak mucus (Pk).

Our meaning of irregularity is defined as those cycles where the ovulation marker day data is not within 1 day of said hormone-detecting parameters (LH and estrogen, respectively), and is always higher – signifying delayed ovulation, delayed with respect to the hormonal signals.

As I said above, “irregular” in our parlance means “challenged”, and it means something of a problem that our modern lifestyle presents to the biology of our women. More often than not, the challenge is stress, which I discussed in this blog earlier in at least two posts. Our FIV technology (aka the Ovulona personal monitor) detects the effects of stress, and helps to deal with the consequences in terms of its effect on fertility status.

STOP PRESS

And now, go and check out the 2012 post “The fallacy of ovulation calculators, calendars and circulating-hormone detectors” at https://biozhena.wordpress.com/2012/02/13/the-fallacy-of-ovulation-calculators-calendars-and-circulating-hormone-detectors/

Why people cannot achieve pregnancy

In many cases – if not most – it is NOT because of clinical infertility.

Basic cause of “apparent” infertility

This article is about the basic cause of most disappointed efforts at achieving pregnancy. The basic cause of the disappointment is that intercourse is had at a wrong time. That is, not during the kairos time of your menstrual cycle, the right time, during which – and only during which – fertilization can occur and result in conception (that may lead to successful pregnancy).

Note that we are not talking here about the relatively few cases of real clinical infertility that are caused by certain organic problems such as, say, blocked fallopian tubes or similar.

We are referring here to what is termed by experts (medically classified) as reduced fertility or sub-fertility. This refers to the predicament of people who cannot achieve pregnancy for too long. We would say that even this terminology is misleading but it is well established in OBGYN medicine, so let’s work with it.

Of course, “cannot achieve pregnancy for too long” is medically expressed more quantitatively by postulating the number of months during which the attempts to conceive a baby turn out to be fruitless, disappointing. (Do we need to add that, as a consequence, what is supposed to be a significant physio-pleasure then often becomes a chore, with the stress only exacerbating the painful disappointment and the actual problem?) Yes, stress enhances the problem.

For many years, the number of months during which unprotected intercourse does not result in pregnancy (and is classified as sub-fertility/reduced fertility) was defined as up to 12 months. For 12 months of fruitless attempts to get pregnant you were sub-fertile, suffering reduced fertility. Only after a year, you became a case of clinical infertility.

More recently, as the prevalence of these problems increases, some medical authorities have extended this period of “advised patience” to as long as 2 years. Only after this extended period of advised patience in trying to conceive would the woman and/or couple be put into the clinically infertile category.

The basic cause of most failed efforts to become pregnant is simply wrong timing, wrong time within the menstrual cycle when the unprotected intercourse occurs with the intent to conceive a baby. This wrong time has much to do to with the continued belief, carried over from earlier times, that most menstrual cycles are “regular”. This is one of the myths. The exact opposite is true.

You can see evidence of that in data from 10 women attending a Natural Family Planning clinic. Differences from -5 to +3 days were recorded in this small sample, and these were differences between ovulation days in just two successive menstrual cycles (where cycle lengths ranged from 23 to 35 days). The variability becomes more extensive when more cycles are reviewed.

In fact, there is no such thing as cycle regularity. It is therefore essential to perform persistent monitoring, as the phrase goes nowadays, to determine the right time for a conceptive intercourse.

It was found decades ago that most women experience changes of even more than five days in the length of their consecutive menstrual cycles, and therefore also changes in the day of ovulation from one menstrual cycle to the next.

This fact of life is basic to the predicament of finding it difficult to achieve pregnancy – because you can get pregnant ONLY during the very narrow fertile window of 3 days; that is the day of ovulation plus the 2 days just before ovulation.

To read more about this, go to  https://biozhena.wordpress.com/the-fertile-window-is-3-days-wide-not-6-which-6-day-belief-originated-in-a-flawed-1995-study/. 

Fact:

Less than 1% of women would be found with no variation at all even for short sequences of only a few menstrual cycles, and absolutely no-one would be regular in twelve cycles. [Ref.: John J. McCarthy, Jr. and H.E. Rockette, “Prediction of ovulation with basal body temperature”, Journal of Reproductive Medicine 31 (No.8), Supplement, 742 – 747, 1986; also – and particularly – see refs. therein to the largest studies, i.e., to R.F. Vollman, “The menstrual cycle”, 1977, and A.E. Troelar et al., “Variation of the human menstrual cycle through reproductive life”, 1967.]

The research involved thousands of BBT [Basal Body Temperature] records obtained from correspondingly high number of women. The research was carried out when the hope was that the then new technology of the micro-computerized thermometer would provide the answer to the quest for a definitive tool for reproductive management. Well, it did not.

The BBT is not the answer, it cannot be. It’s not the solution because it is notoriously unreliable, whether micro-computerized or measured with an ordinary thermometer. Simply put, the BBT is affected by too many things, and it has been found to rise anywhere from 3 days before to 3 days after ovulation, despite the expected rise immediately after ovulation.

Comment:

The sympto-thermal method of NFP practice, also known as the Billings method, gets around the notorious lack of reliability of the BBT by having women perform certain anatomical observations “down there” and observations of the appearance of the fluid wiped off “down there”.

Subjective as this enhancement is, in reviewing a sufficient number of cycle records you would see that it is more likely the sympto- observations than the thermal measurements that, when lucky enough, are associated with recorded pregnancy-test positive. Basically, any of this helps the woman to stay focused, and the lack of accuracy is made up for by an as high frequency of intercourse as practical or desirable. Like shooting in the dark with an automatic weapon… (but then, if there is no target in the dark…)

I got off on this tangent, and should come back to the inherent variability of menstrual cycles and ovulation times in another post. To impress on you that this basic fact of life is particularly important when you are finding it difficult to get pregnant – probably because you are past the most fertile years, which are – or, rather, were – the early twenties of your life.