By Vasiliki A. Moragianni, MD, MS, FACOG, a speaker at RESOLVE New England’s upcoming 20th Annual Fertility Treatment, Donor Choices, and Adoption Conference on Saturday, November 2, 2013. Dr. Moragianni is an award-winning reproductive endocrinology and infertility specialist at Fertility SolutionsTM. She is passionate about providing individualized, state-of-the-art fertility care to individuals and couples who wish to build a family. She currently sees patients in Dedham, MA and Providence, RI.

What is infertility?

Infertility is defined as the inability of a couple to conceive after having timed, unprotected intercourse for 12 months (if the female partner is less than 35 years old) or 6 months (if the female partner is more than 35 years old). Timed refers to intercourse that occurs during the fertile time of the month, i.e. the “fertile window”.

What is the fertile window?

The fertile window refers to the days during the menstrual cycle when a woman is most likely to conceive if exposed to sperm. This is determined by first establishing when ovulation takes place (please read below for methods to determine ovulation). The fertile window begins 5-6 days prior to the day of ovulation and lasts until 1-2 days after ovulation. This accounts for the fact that oocytes (eggs) only survive for approximately 12-24 hours after ovulation, whereas sperm can survive for much longer in the female body.

How to determine when ovulation occurs?

There are several ways to determine when ovulation takes place. The most important point to remember is that these methods should be used for a woman to familiarize herself with her cycle and establish an ovulation pattern. Once this pattern is established, the woman no longer needs to use these methods (once determined that ovulation has occurred she has already missed the majority of the fertile window for that month). Methods to determine ovulation include:

  • Identifying symptoms, such as mittelschmerz (pelvic pain that occurs mid-cycle). This is very subjective and not experienced by every woman on every month, therefore very unreliable.
  • Basal body temperature charting. This should be consistently charted and it is not always reliable, especially since other factors can affect body temperature.
  • Cervical mucus examination. This is a very subjective method.
  • Ovulation predictor kits. These can be purchased over-the-counter and tend to be user-friendly and accurate, but somewhat expensive.
  • Pelvic ultrasound and hormonal blood tests. This is probably the most reliable, but also labor-intensive and expensive method.

What can cause infertility?

There are numerous factors that can lead to infertility. Either the female, the male, or both can be contributing to the difficulty of conceiving, thus a thorough evaluation of both should always be performed to help identify a diagnosis. A woman can have blocked fallopian tubes, absent or irregular ovulation, diminished ovarian reserve, uterine polyps or fibroids, autoimmune, infectious, or endocrinologic causes of infertility. A man can have absent or low sperm volume, count, motility, or morphology. As a result, the initial evaluation of a couple with infertility usually includes blood and ultrasound tests of the female, as well as blood tests and semen analysis of the male.

When to see a specialist?

Individuals and couples struggling with infertility, or who have concerns about their menstruation and/or ovulation, can consult a reproductive endocrinologist (RE). REs are physicians trained in obstetrics and gynecology who have further specialized in infertility. Your obstetrician-gynecologist can help you identify an RE who would be appropriate for you.

To learn more visit