I DON’T KNOW IF I CAN GET PREGNANT

Material courtesy of March of Dimes (adapted for Kosovo)

What is ovulation?

Ovulation is when a woman's ovaries release an egg, usually 14 days before the first day of her period. When a couple has sexual intercourse and does not use birth control around the time of ovulation, a man's sperm swim to meet the woman's egg. When a sperm penetrates the egg, it's called fertilization or conception. The fertilized egg (embryo) then travels to the woman's uterus (womb), where it burrows into the lining of the uterus and begins to grow.

How do I know when I ovulate?

1.     If your period is regular (it comes the same number of days apart every month): AMC’s ovulation calculator can help you find out the days you’re most likely to ovulate. It uses the first date of your last menstrual period and the number of days between your periods. The ovulation dates are an estimate. The best time to have sex is two days before and the day that you ovulate. The more often you have sex during this time, the more likely you are to get pregnant. http://www.marchofdimes.org/pregnancy/ovulation-calculator.aspx

For example:

·        If you have 28 days between periods ovulation typically happens on day 14, and the most fertile days are days 12, 13, and 14.

·        If you have longer cycles, say 35 days between periods, ovulation happens on day 21 and the most fertile days are days 19, 20, and 21.

·        If you have shorter cycles, say 21 days between periods, ovulation happens on day 7 and the most fertile days are days 5, 6, and 7.

 

2.     If your periods are irregular (the number of days apart varies from month to month): There are a number of fertility tracking methods that can help you determine when you're ovulating. They are listed below. It's important to talk to your doctor to learn more about the most effective way to use them.

·        The temperature method: Use a basal body thermometer to take your temperature every day before you get out of bed. This is a thermometer that can measure really small changes in your temperature. You can buy one at a pharmacy. Your temperature rises about 1 degree just as you ovulate. Have sex as close as you can to this rise in temperature for your best chance of getting pregnant.

·        The cervical mucus method: Pay attention to the mucus in your vagina. It gets thinner, slippery, clearer and more plentiful just before ovulation.

·        Ovulation prediction kit: Ovulation prediction kits test urine for a substance called luteinizing hormone (LH). This hormone increases each month during ovulation and causes the ovaries to release eggs. The kit will tell you if your LH is increasing. You can purchase ovulation prediction kits at pharmacies.

If you use the temperature or cervical mucus methods, begin tracking changes a few months before you want to conceive. If you're using an ovulation predictor kit, begin using it about 10 days after the start of your last period.

INFERTILITY

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In this section you will find information about:

·         Infertility, its causes and treatment options in Kosovo

·         Unplanned pregnancies and details about your options and rights, including adoption and abortion.

Infertility & treatment options

If you have been trying to get pregnant for over one year (or 6 months, if the woman is over 35 and/or does not have a regular menstrual cycle), there might be a fertility problem.  

Infertility is nobody’s fault. It is a problem with the reproductive system of the woman and/or the man. It is not just a woman’s problem. Research has proven that in around half of all cases, the man was the cause or a contributing cause of infertility. Therefore, it is just as important for men, as it is for women, to be assessed during infertility evaluations.

Infertility is common. Statistics on Kosovo are not available, but in the U.S. the inability to have a child affects more than 10% of the population. Up to 90% of cases there are treated with medication or surgery, while IVF and similar treatments account for less than 3% of infertility treatments.

What causes infertility?

Women need normally functioning ovaries, fallopian tubes and uterus to get pregnant. In most cases, female infertility is caused by problems with ovulation.

·        Ovarian function – without ovulation, there are no eggs to be fertilized. The main symptoms of an ovulation problem include irregular or absent menstrual periods. There are several medical ways to test ovarian function, however it is a good idea to first start tracking your own cycle to detect if and when you are ovulating (see below for more information). Ovulation problems are often caused by:

o   Polycystic ovarian syndrome (PCOS) – a hormonal imbalance that interferes with normal ovulation. This is the most common cause of female infertility.

o   Age – the quality and number of eggs the ovaries produce decrease significantly over the age of 35.

o   Lifestyle issues – e.g. smoking, being overweight or underweight, consuming too much alcohol or caffeine, stress, poor diet and sexually transmitted infections (STIs). For example, in the U.S., up to 13% of female infertility is caused by cigarette smoking, and another 12% of infertility cases are caused by being over- or under-weight.

o   Other factors – include primary ovarian insufficiency (POI) that occurs when a woman's ovaries stop working normally before she is 40.

·        Fallopian tubes – blocked or damaged tubes will prevent semen from reaching the egg and the egg getting to the uterus. There are no symptoms. Doctors assess tubal problems through X-rays or by laparoscopic surgery. Tubal problems are most often caused by pelvic inflammatory disease, STIs, endometriosis, or surgery for an ectopic pregnancy or sterilization.

·        Uterus – the presence of fibroids or an anatomic abnormality (unusual shape) will affect a woman’s fertility. Doctors assess uterine problems typically with a transvaginal ultrasound.

·        Other - Abnormal cervical mucus can cause fertility problems as it can prevent the sperm from reaching or penetrating the egg. Endometriosis, when tissue normally found in the lining of the uterus grows outside the uterus, can cause fertility problems if it affects the fallopian tubes or ovaries.

Men need normally functioning sperm to get a woman pregnant. A specialist will test the semen’s number, shape and movement to see if, and how, male factors are contributing to infertility. Over 90% of male fertility problems are due to low sperm count and/or quality. Typical reasons for abnormal sperm include:

·        Varicoceles, an enlarged vein in the testicles.

·        Medical issues such as diabetes, trauma, infection, sexually transmitted disease, or prior chemotherapy treatment.

·        Unhealthy habits such as smoking and substance abuse.

·        Exposure to environmental toxins such as lead and pesticides.

Sometimes all the tests will come back normal and so it is impossible to predict the cause of infertility. It could be due to tiny ways in which the sperm functions, or egg fertilization occurs, or the ovarian follicles develop. Unfortunately, there are no treatment options in this case.

Fertility treatment options in Kosovo

If the tests show any abnormalities for the woman and/or the man, this doesn’t necessarily mean that either is infertile. There are many ways to treat fertility problems, each with their own advantages and disadvantages (including side-effects), costs and rates of success. The choice of fertility treatment will depend on the causes of the problem (in about 25% of cases there is more than one factor involved). Kosovo has numerous fertility clinics that treat patients not only from Kosovo but many neighboring countries.

What to know before starting fertility treatment:

1.     It’s going to be hard! Trying to get pregnant using fertility treatments can be really tough because of the uncertainty and potential disappointment, as well as the emotional rollercoaster caused by hormonal treatments. Anxiety and depression can be common. And it might feel like a full-time job or all that you can think about. So before you start, think about how you can cope with the challenge. Some ideas include:

·        Giving yourself permission to feel sad, stressed, angry, overwhelmed and/or a sense of loss. This is all normal. It’s also normal to blame yourself but don’t; a fertility problem is not your fault and even if you could have changed the past it is behind you, so focus on the future.

·        Talking to someone you trust or who is going through a similar situation. Our Difficulties Forum is an online community where people can anonymously talk to and comfort each other. If you don’t feel comfortable talking to anyone, try writing your feelings down in a journal.

·        Taking care of yourself by doing things that make you happy and to offer relief from the focus on fertility. If it is hard to be around friends with babies or who are pregnant then limit your contact with them (if you are comfortable doing so, explain why so they will understand).

·        Understanding that your husband might feel and act differently to you. He might not think about infertility or seem as upset about it as you. That’s OK. But it is important that you help each other during this time as undergoing fertility treatments take a toll on even the best relationships. Try telling your husband how you want to be supported. Most importantly, don’t blame each other for not being able to get pregnant; it’s nobody’s “fault”.

·        Setting limits on how long you will try and how much you will pay. It’s important to remain optimistic about the result, but realistic about your chances so that you can make the best choices for your family. Around one-in-three women who undergo fertility treatment will not ultimately be successful in having a biological child. So be sure to educate yourself by reading the information on this website and others, like BabyCenter.

2.     There are risks. There are some risks to medical fertility treatments, which you should talk through with your doctor. This includes a higher likelihood of pregnancy with multiples (e.g. twins) that results in a higher risk pregnancy. In addition, babies conceived using fertility treatments typically have more problems, such as premature birth, low birth-weight and birth defects. 

3.     Try these first. There are two key non-medical approaches to improving your fertility. These include:

·        Getting healthy – both the man and woman should stop smoking, achieve a healthy weight, cut down on alcohol and caffeine, exercise moderately and eat well.

·        Knowing your ovulation cycle – this is the first step in assessing female fertility problems and can be done at home. You track this over several months by: 1) Writing down changes in your morning body temperature; 2) Writing down how your cervical mucus looks; and, 3) Using a home ovulation test kit. We give you a detailed step-by-step guide to tracking your ovulation here.

Medical treatment options for women in Kosovo include:

·        Drug therapy – these regulate hormones and cause at least one egg to be released in each ovulation cycle. These are typically used for about 3-6 months before trying to get pregnant or before trying a different treatment option. Typically about one-in-three women fall pregnant within three months using this option.

·        Surgery – will repair problems like opening blocked fallopian tubes or removing fibroids.

·        Intrauterine insemination (IUI) – commonly known as artificial insemination, involves the injecting the woman with specially prepared sperm.

·        Assisted reproductive technology (ART) - includes all treatments where both egg and sperm are treated outside of the body. The eggs are removed from a woman's body, and then mixed with sperm to make embryos (or fertilized eggs). The embryo/s are then put in the woman's body. In cases where a woman’s eggs are not viable or she has no eggs, donor eggs may be used.

Medical treatment options for men that are available in Kosovo include:

·        Drug therapy – for hormonal disorders.

·        Surgery – to repair varicoceles and/or correct any obstructions.

·        IUI – injecting the woman with specially prepared sperm. In cases where a man’s sperm are not viable or present, donor sperm may be used.

·        ART – intracytoplasmic sperm injection (ICSI) is commonly used with IVF to increase success rates, and involves injecting a single sperm into an egg, which is then implanted into the woman. Again, donor sperm may be used.

Other conception options

1.     Surrogacy - For women with no eggs or unhealthy eggs or who should not be pregnant for health reasons. The surrogate agrees to be pregnant with the man's sperm and her own egg. For women with ovaries but no uterus

2.     Gestational Carrier - For women with ovaries but no uterus or women who should not be pregnant for health reasons.  The woman uses her own egg, which is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus.

Adoption

While not a direct alternative to conception, adoption does provide the opportunity raise and nurture a child. However, before considering this it is important that you and your partner are emotionally ready to move on, so take the time to grieve and feel loss about not being able to become pregnant. Adoptions are handled under your Municipal’s Center for Social Work so this will be your starting point.


 

Category: Getting pregnant

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