Cycle monitoring is a method used by OBGYNs and fertility specialists to map out a woman's monthly menstrual cycle, in order to determine when ovulation is most likely to occur. Every woman has what is known as a fertile window; the days leading up to and including ovulation. This is the phase of the menstrual cycle when a woman is most likely to get pregnant. Because every woman's cycle is different, with many women experiencing irregular periods which can make it harder to predict ovulation, cycle monitoring is useful for couples trying to conceive, either naturally or with the aid of IVI (Intravaginal insemination) or IVF (Invitro fertilization).

Ovulation and the Menstrual Cycle

A typical menstrual cycle is approximately 28 days, but varies from woman to woman. Ovulation is the monthly process where an egg is released for fertilization by the sperm, and it is the only point in the menstrual cycle when conception is possible. Healthy sperm generally remain viable for up to five days, which is factored into the fertile window when calculating a fertility chart and menstrual cycle for a woman actively trying to conceive.

Many women are unaware of their ovulation schedule, and many myths abound about the length and duration of the fertile window. Because menstrual cycles can vary greatly from one woman to the next, a consultation with an OBGYN can help women determine their ovulation schedule once they have decided they are ready to become pregnant.

Determining Ovulation and the Fertility Cycle

The first step in cycle monitoring is measuring the basal body temperature. Although the variations in temperature can be slight, and OBGYNs have found the effectiveness of basal body temperature measurements in predicting ovulation to be inconclusive, it is still considered a basic step in charting fertility. During ovulation, the body releases elevated levels of the hormone progesterone, which can cause slight fluctuations in temperature. During ovulation, the cervix produces elevated levels of mucus designed to help the sperm make its way to the egg for fertilization. Monitoring mucus levels can help to predict ovulation. The mucus becomes more elastic, clear (resembling the texture and consistency of egg whites) during the fertile window.

The range varies from woman to woman, but days 1-5 are the beginning of the cycle, when menstruation occurs. Days 6-9 are dry with no visible mucus. From days 10-12 the mucus is sticky and thicker than during the fertile window. At the end of the fertile window the mucus becomes thick and sticky again, followed by dryness until the cycle begins again the following month. Measuring the cycle for a few months can help to determine both the duration and ovulation dates for each woman.

Worried that you may have PCOS? Find out more about this condition and what we can do to help.

Do you notice that you have irregular menstrual cycles? Do you sometimes skip your periods altogether? You could be dealing with polycystic ovarian syndrome (PCOS), a condition in which estrogen and progesterone levels are off kilter and can lead to to ovarian cysts. Find out more about this condition and how your OBGYN can help.

What causes PCOS?

Unfortunately, no one really knows what causes this condition, but it is believed that genetics and hormonal imbalances have some responsibility in who develops PCOS and who doesn’t. If your mother or immediate family member has this condition, you are also more likely to develop PCOS.

Women with PCOS also tend to have an overproduction of androgen, a male sex hormone. Androgen can affect how an egg develops or is released each month.

What are some telltale signs that I have PCOS?

Many women will start to notice that something is amiss one they start menstruating. Of course symptoms varies from woman to woman, but many people with PCOS notice that they have irregular menstrual cycles.

With the imbalance of hormones, some women may start developing more masculine characteristics such as:

• Excess hair on the face, chest, fingers or toes
• Thin hair
• Deeper voice

Besides these symptoms women with PCOS may also experience:

• Weight gain (usually caused by other chronic health problems like diabetes)
• Infertility
• Depression
• Abdominal pain
• Acne

How will a PCOS specialist treat my condition?

While there is no cure for PCOS, there are certainly ways to manage your symptoms. Your treatment plan will be tailored to what symptoms you are experiencing. Of course, a healthy diet and regular exercise are recommended for everyone who has been diagnosed with this condition.

Birth control pills may also be prescribed to help regulate hormones and your menstrual cycle, and they sometimes have the added bonus of improving your acne. For women with PCOS who are looking to get pregnant, fertility treatments may be recommended to help assist in successful ovulation.

If you are concerned that you may have PCOS, or if you are having issues with irregular periods, it’s time you talked to your gynecologist.

You're more likely to experience a birth control failure if you select a method that's not comfortable or convenient for you. Fortunately, there are plenty of effective birth control options available if you're not happy with your current method. Your OBGYN can help you evaluate the pros and cons of each option and make an informed choice.

Types of birth control available

Birth control options include:

• Barrier Methods: Barrier types of birth control physically prevent ejaculated semen from entering your cervix. Condoms are the most well-known type of barrier birth control. Other options include cervical caps, diaphragms and contraceptive sponges. Condoms also help protect you from sexually transmitted diseases (STDs).
• Spermicide: Spermicide is a cream, foam, gel or film placed inside your vagina to kill sperm. It's most effective when combined with other birth control methods, such as diaphragms, condoms or cervical caps.
• Intrauterine Devices (IUDs): IUDs are T-shaped devices inserted in your uterus at your OBGYN's office. The devices protect you from pregnancy for several years and provide reversible protection against pregnancy. Some IUDs release a hormone that thickens the cervical mucus and makes it difficult for eggs to attach to the uterine lining. Others secrete small amounts of copper to prevent sperm from moving.
• Hormonal Methods: Hormonal birth control thickens your cervical mucus and prevents you from ovulating, a process that occurs when you release eggs into the Fallopian tubes. Birth control pills are taken every day, while implants, patches, rings and shots can provide protection from three months up to three years, depending on the method.
• Natural Family Planning (NFP): If you choose NFP, you'll chart your monthly menstrual cycle and avoid sex during fertile periods. NFP doesn't work as well as other methods because ovulation doesn't always occur at the same time every month.

Factors that will affect your choice

Before you select a birth control option, you'll need to consider the method's effectiveness and ease of use. Will you remember to take a daily pill or use a condom every time you have sex? If not, a long-term birth control method may be a better choice.

Your health is an important consideration when selecting a birth control option, particularly if you're interested in hormonal methods. Although hormonal birth control is a good choice for many women, it may not be recommended if you smoke and are over age 35, or have a history of breast cancer, stroke, blood clots, migraine with aura, or other conditions.

Do you need a little help selecting a birth control method? Contact your OBGYN to schedule an appointment to discuss your options.

A Pap smear is one of the most effective tools an OBGYN has to be able to detect the early signs of cervical cancer. During this quick procedure, your doctor will collect cells from the cervix, which will then be tested to check for any abnormal changes in the cells. Most women begin getting Pap smears by the time they reach 21 years old. If your Pap smear results came back abnormal, relax. We know you may be concerned but there are several reasons your test results may have come back abnormal.

What can cause abnormal Pap smear results?

While there are many causes, you might be surprised to learn the something as simple as a cervical or vaginal infection could cause enough changes to the cervical cells to produce an abnormal Pap. In this case we may either monitor the infection to see if it goes away on its own or we may decide to provide you with medication. Other causes of an abnormal Pap smear include:

• Inflammation
• Herpes (HSV-2)
• Trichomoniasis
• Recent sexual activity
• Human papillomavirus (HPV)
• Dysplasia (abnormal cells; can be pre-cancerous)

It’s important to specifically address HPV, which is an STD that has over 100 different strains. The body will clear some strains of HPV over time while others may cause genital warts or eventually lead to cervical cancer. If we find unusual-looking cells during your test then we may recommend undergoing an HPV test.

How is an abnormal Pap smear treated?

The only thing Pap smear results tell your gynecologist is that there are abnormal cells within the cervix. This is only a test; this is not a diagnosis. What this means is that your gynecologist will need to perform a further evaluation that could include another Pap smear, a colposcopy (a simple procedure that allows your OBGYN to look into the cervix using a microscope) or a biopsy (to remove and test cervical tissue). This is something your doctor will discuss with you beforehand.

An abnormal Pap test is actually fairly common and most of the time it is not serious. If we suspect that infection is the cause we may need to do further testing to diagnose inflammation, a yeast infection, trichomoniasis, or herpes. Some women may require a repeat Pap smear if their results came back “unsatisfactory” due to recent sexual activity or using vaginal douches prior to the test. Women who have an abnormal Pap result will need to come back in a few months for additional testing.

Your annual women’s checkup is an important part of maintaining your health. Is it time for your appointment? Call your gynecologist today.

If you’ve just found out you are pregnant then you are probably getting ready to schedule your first prenatal care visit with your OBGYN. It’s important that you find an OBGYN that you trust, as they will be with you throughout your pregnancy providing care, monitoring the health of you and your baby, and offering important recommendations about your health, specific testing you should undergo and even creating your ideal birth plan.

If you aren’t dealing with a high-risk pregnancy then you won’t need to come in for prenatal care as often in the very beginning. As your pregnancy advances you’ll need to come in more regularly. If you are between the ages of 18 and 35 years old and healthy then you’ll need to come in for prenatal care about every 4 to 6 weeks for the first 32 weeks of your pregnancy. Once you reach the 32^ndweek then you’ll need to come in every 2-3 weeks until the 37^thweek. From the 37^thweek until delivery you will need to see your obstetrician once a week.

The first prenatal visit is often the longest one. During your first visit you can expect to provide detailed information about you and your family’s medical history. You will also undergo a thorough physical exam, as well as urine and blood tests to look for any health problems. We will also measure your height, weight, heart rate and blood pressure and perform a breast exam and pelvic exam.

If necessary, your gynecologist may also choose to perform a Pap smear, STI testing, and other screening tests (e.g. anemia; diabetes). Depending on how far along you are, an ultrasound may also be performed during your first visit to determine how far along you are and your expected due date. We may even be able to listen to the fetal heartbeat.

This checkup is also a time to ask us any questions or address any concerns you may have about your pregnancy, from what foods to avoid to what prenatal vitamins you should take. We can offer up advice to help you have the healthiest pregnancy possible.

It’s important that you schedule your first prenatal visit as soon as you get a positive home pregnancy test. Better yet, if you are planning on becoming pregnant it’s a good idea to see your gynecologist prior to getting pregnant for pre-pregnancy care.