Are your health and fertility being affected by something invisible, something that you may not even know how to pronounce? While some of us have heard about BPA, phthalates (pronounced THAL-ates) have been discussed less often. Unfortunately what you don’t know about phthalates may, in fact, be hurting you.

So what are phthalates?

Phthalates are a group of chemicals added to plastics for a variety of reasons. Some phthalates are added to make the plastic more pliant and malleable, while others help scented products to retain their fragrance for a longer period of time. Still others help bright colors retain their vibrancy. Because of the variety of phthalate usages, you may have heard them called “the everywhere chemicals.” Phthalates can be found in a wide variety of items you encounter everyday, from shampoo to nail polish, from vinyl flooring to detergents and fabric softeners.

Just like these “everywhere chemicals” are added to products for various reasons, they can each act on the human body in a variety of ways. All phthalates, however, disrupt the endocrine system, which affects hormone production.

How might phthalates affect fertility?

Research indicates that women tend to have more side effects from phthalate exposure, possibly because they tend to use more phthalate-containing products on a daily basis. In fact, the average American woman uses 10-12 beauty and personal care products throughout the course of her day! Some sources have estimated that the average woman is exposed to over 150 hormone disrupting chemicals over the course of one day! Several studies have also shown that women living with endometriosis have higher levels of certain phthalates in their bloodstream than their peers without this condition. Other phthalates are known to interfere with egg development and cause genital malformations in fetuses of women who have exposure.

Although males may experience less exposure to phthalates through personal care products, they are still exposed to these chemicals many times over the course of a day. These exposures are not without their negative effects on men either: higher phthalate levels have been linked to diminished sperm count, poor sperm quality, and even an increase in the incidence of prostate cancer.

Phthalate exposure during conception and pregnancy

One convincing argument for decreasing your exposure to phthalates, particularly while trying to conceive, is the association between high levels of phthalate and pregnancy loss and preterm births. Phthalate exposure seems to be most risky for male fetuses, who cazz4n be born with malformations in the genital tract after in-utero exposure to phthalates. Children exposed to these high levels in the womb may also be more likely to experience congenital defects, slow growth, and a late onset of puberty.

How to reduce phthalate exposure

With all these risks and very little benefit to the consumer, you may find yourself wanting to decrease your phthalate exposure but feeling a little overwhelmed by all the changes you’d need to make. It’s usually not feasible (or financially prudent!) to replace every product at once. Baby steps are the way to go.

Get in the habit of reading labels on the products before you buy them. Phthalates can be listed as an abbreviation like DnOP or BBzP, or the ingredients may simply list “parfum” or “fragrance.” The easiest way to identify whether a product uses phthalates or not is to look it up on the Environmental Working Group’s “Skin Deep” database. The EWG is a nonprofit, nonpartisan group that helps consumers make informed decisions about a product’s ingredients before purchase. You can easily search the Skin Deep database by ingredient, brand, or product, and they even have apps for iPhone and Android for clean shopping on the go! 

Another baby step you can take is reducing the phthalates in your period products, like pads and tampons. The vagina and vulva are extremely permeable, and using chemical-laden products in this area of the body means phthalates are absorbed more quickly and easily. When looking for feminine hygiene products, then, it’s important to avoid any scented products on this sensitive part of the body. You can also spring for a menstrual cup, cloth pads, or “period panties,” which require more of an investment up front but can be reused cycle after cycle.

One very easy way to avoid unnecessary phthalate exposure is to stop using vaginal washes or douches. The vagina is a self-cleaning body part, and there is no need to wash it with soap or any other product. In fact, women who use these rinses just twice a month were found to have 152 percent higher levels of certain phthalates present in their urine!

Another area to examine is the health and beauty products you use that are applied to a very large portion of the body, such as lotions. Products like these also are not rinsed off of the skin after use, so there is more of an opportunity for phthalates to continue accumulating in the body throughout the day. Examining your hairspray ingredients might also be a small change with a big payoff, since this product is absorbed through the skin but also inhaled in fairly large quantities while it is being applied.

Replacing your scented household cleaning products can be cost effective too: you can use inexpensive castile soap, vinegar, baking soda, water, and a little elbow grease in place of those pricey, heavily scented cleaners.

Avoiding fast food and eating primarily whole foods can cut phthalate intake significantly, as well as adding many other benefits for your fertility! Dairy and meat are known to contain high levels of phthalates, so try to choose other sources of nutrition when possible. When preparing meals at home, focus on using glass or stainless steel food storage containers, particularly when dealing with foods with high fat or high oil content. You can also swap out your plastic water bottle for stainless steel while you’re at it!

Attempting to make all these changes at once can very quickly lead to overwhelm and burnout, but if you can replace items with phthalate-free alternatives when you need to replace them anyway, cleaning up your routine can be simple!

Do you have more questions about how phthalates and other environmental toxins might be affecting your health and fertility? Get in touch with us today!

Polycystic ovarian syndrome, or PCOS, is a collection of symptoms associated with an imbalance in reproductive hormones. This hormonal imbalance can lead to symptoms like weight gain, thinning of the hair on the head, heavier growth of hair on the face and torso, acne, and irregular menstrual cycles. Although PCOS is frequently discussed in relation to fertility, lots of inaccurate information about PCOS is conveyed as fact. Below we will take a look at some of the most common misconceptions about polycystic ovarian syndrome.

PCOS Myth #1: PCOS is rare.

Actually, it is estimated that about ten percent of women of childbearing age in the United States meet the diagnostic criteria for PCOS! Many of these women haven’t even been diagnosed. Personal health is a sensitive topic, and a diagnosis of PCOS may be difficult or painful for a woman to share, particularly if she is struggling to conceive. Thus many women are not comfortable talking about their diagnosis openly. But odds are that you know more than one person who is affected by PCOS.

PCOS Myth #2: Patients with PCOS have lots of cysts on their ovaries.

It would be easy to draw the conclusion that with a name like “polycystic ovarian syndrome,” PCOS would involve lots of cysts on the ovaries. In reality, PCOS is poorly named. The hormone imbalances involved in PCOS can cause changes in the ovaries, typically women with PCOS have a greater number of ovarian follicles than their age matched counterparts. Ovarian follicles are normal, and no treatment or surgery is needed.  Women with PCOS are not at greater risk of developing cysts. 

PCOS Myth #3: All women with PCOS are overweight. You can’t have PCOS if you are thin.

Although undesired weight gain is one of the hallmark symptoms of PCOS, nearly one third of women with PCOS are not considered overweight or obese. Lab work should be performed to assess for hormonal imbalances if other symptoms are present, because PCOS patients in a healthy weight range can still have other difficulties. And regardless of a patient’s body size, PCOS patients can benefit from healthy eating practices and adding more movement to their routines.

PCOS Myth #4: PCOS can be diagnosed through blood testing alone.

Because PCOS is caused by an imbalance in reproductive hormones, many patients believe that blood tests Unfortunately nothing about medical diagnosis is that simple. Although bloodwork is a vital part of the PCOS diagnosis, the process is much more thorough than that. Diagnosing PCOS involves a comprehensive physical examination which includes laboratory testing and pelvic ultrasound. Your provider will also take a detailed medical and menstrual history.

PCOS Myth #5: Irregular periods mean that you have PCOS.

PCOS can, and often does, cause irregular menstrual cycles due to problems with ovulation. But there are lots of other things that could be causing irregular cycles as well, so consultation with a medical professional is essential! If your menstrual cycles are longer than about 35 days, bleeding is significantly lighter or heavier than normal, or you experience spotting between periods, talk to your healthcare provider to determine the cause.

PCOS Myth #6: Oral contraceptives cure PCOS.

Oral contraceptives are frequently prescribed for PCOS, and they can help control symptoms and regulate your cycle. Birth control pills can play a role in the treatment of PCOS. However, these are not a cure. If you are trying to conceive, however, other options that are more in line with your goals can be utilized. Work together with your doctor to make a plan that is right for you.

PCOS Myth #7: A diagnosis of PCOS means I need to follow a specific diet.

Despite the popularity of the gluten-free and keto diet plans, you don’t need to try these diets to control PCOS symptoms. The Mediterranean diet is a balanced eating approach that is commonly used for PCOS, and includes foods that are rich in antioxidants, folate, and vitamin D. (These nutrients can all positively contribute to hormone regulation.) A Mediterranean diet includes minimally processed, whole foods. This means choosing fresh fruits and vegetables, fish, nuts, and including healthy fats such as avocados and olive oil. Limiting simple carbohydrates, as well as including lots of leafy greens, is also an integral part of the Mediterranean diet.

PCOS Myth #8: PCOS makes it impossible to get pregnant.

A large percentage of women diagnosed with PCOS may seek assistance to conceive with a medication like Clomid or letrozole. If you are attempting to conceive with a partner, both of you should be evaluated despite your PCOS diagnosis. The lifestyle modifications mentioned above may also help alleviate unwanted symptoms and gently encourage your body toward hormone regulation, which can lead to a higher chance of conception. Our integrative fertility practices combine traditional medicine, alternative therapies, and lifestyle practices, giving you access to the “best of both worlds” in your journey.

Do you have any of the signs and symptoms of PCOS, such as irregular menstruation, thinning hair, acne, or weight that can be difficult to regulate? Contact us today to schedule a consultation with Dr. Salem to discuss your options!

If you have struggled to conceive despite regularly engaging in unprotected sex, one of the many possible medical interventions that your doctor discusses with you might be intrauterine insemination, or IUI.

What is IUI?

IUI allows the sperm to bypass the vaginal canal and cervix by placing the sperm directly into the uterine cavity. The procedure is timed to happen as close to ovulation as possible to maximize your chances of conception. During intercourse, it is not uncommon for some sperm to be left in the folds of the vaginal wall, never quite completing its journey to meet the egg. Sperm can also encounter problems penetrating a tightly closed or scarred cervix or surviving a vaginal pH that may be slightly too acidic.

Why might I need IUI?

Although in-vitro fertilization may be the most well-known type of fertility treatment, IUI is both less invasive and less expensive. (Many insurance companies that cover IVF even require the patient to attempt a certain number of IUI cycles before they will cover any of the more invasive procedures involved in IVF.)

IUI may be recommended as a first line of treatment for patients trying to conceive using sperm from a donor. IUI may also be an option for couples who are unable to have sexual intercourse during the fertile period, either due to sexual dysfunction or a partner who travels frequently or is deployed. In cases of separation or donation, sperm can be frozen for use in future IUI cycles. IUI may also be a good option for couples dealing with sperm motility that falls in the borderline-low to normal range. Some cases of unexplained infertility, especially in females under the age of 38, may also benefit from IUI.

To be a candidate for IUI, patients need to have at least one open fallopian tube and a sufficient number of motile sperm.

What is involved in the IUI process?

Medications: IUI can be completed with or without medications to induce the growth of one or more eggs. Your doctor may recommend that you take letrozole or Clomid for five days, usually early in your cycle. Injectable medications can sometimes be used as well. Injectable prescriptions are typically a bit more powerful than oral medications, which is why most physicians prefer to try IUI with an oral medication first. You may also be prescribed a one-time hormone injection to trigger the release of one or more of the mature eggs.

Monitoring. Depending on whether a cycle is medicated or unmedicated, your provider will discuss ways to monitor your hormone levels. In a natural cycle, you will time your IUI or trigger shot with your natural ovulation. During a medicated cycle, this may include urine ovulation tests, bloodwork, or pelvic ultrasound. (Ultrasound is more commonly used when medications are prescribed along with the IUI cycle.)

Sperm collection and processing. A semen specimen is provided either by your partner or a sperm donor. The semen then undergoes a process called sperm-washing in a lab. Fresh or frozen semen can both undergo the sperm washing procedure. During this process, the sperm is separated from the rest of the seminal fluid.

Insemination procedure. The insemination itself is a fairly simple process. Once you and your physician have identified that you are ovulating, the washed sperm is placed into a very thin cannula with a syringe at the end. Most patients describe this procedure as causing minimal discomfort, and it might feel similar to a pap smear. Anesthesia is not required, and the insemination itself takes less than five minutes. You may be asked to remain on your back for several minutes after the insemination. There are no activity restrictions or bedrest requirements after IUI.

What is the success rate of IUI?

The overall success rate of each IUI cycle is between 10 and 20 percent, but much of this depends on the reasons for IUI being performed and the age of the female. Chances may be higher in patients with no known fertility challenges, such as couples unable to have intercourse due to travel or sexual dysfunction and patients using donor sperm. The age of the female is one of the most important determining factors to success rates of IUI cycles.

When do I find out if I am pregnant?

After undergoing a procedure like IUI, you will likely be anxious to find out whether or not it has resulted in a pregnancy.  Bloodwork or a urine pregnancy test should be accurate about 14 days after the IUI procedure. If you attempt a home pregnancy test before this time, you may receive a false positive result because of the hormones in the trigger shot.

If you are having difficulty conceiving, contact us today to discuss whether IUI could be an appropriate option for you!

Sexual intercourse, for the purpose of conception, can leave you with many questions you wouldn’t have otherwise thought about.  These questions are normal, common, and important. 


Let’s dive right into the top 5 questions people have about intercourse when trying to conceive.

1. When are the best days to have sex when trying to conceive? 

Having sex every day of the month will not increase your chances of pregnancy. In fact, there is a small window of time each month that a woman’s body is able – often referred to as the fertile window. The fertile window is about 5 days prior to ovulation, but the highest chances occur when intercourse occurs on the day before ovulation and/or the day of ovulation. This is why it’s important to know how to detect your ovulation, or find out if you have any ovulatory problems.


 Click here to learn more about ovulation detection.


2. How often should I have sex during the fertile window, when trying to conceive?


It’s easy to suddenly question how often you should be having sex. Daily or every other day within your fertile window is perfect. Your fertile window is the few days leading up to ovulation, plus the day of ovulation. 


While there is physically nothing wrong with having sex at different times of the month, those times won’t end in a pregnancy and some couples begin to experience sexual “burnout”. It has been shown that for some couples, trying to have sex every day and/or multiple times a day can cause excessive stress. If daily intercourse is not natural to you and your partner, it can lead to performance anxiety and sexual dysfunction. 


3. Does position matter?

There is no evidence that sexual position makes any difference in chances of pregnancy or fertility. Choose what is best for you and your partner. 


4. How long should I wait to get up after sex?

While there’s no harm in remaining flat after intercourse, there is also no evidence to suggest that it will help. It takes only seconds for sperm to enter the cervical canal. Healthy sperm swim, regardless of the position of your body. There’s no benefit to remaining flat so choose what is comfortable for you. 


5. Should I use a lubricant?

Let’s bust a myth. Using lubricant does not improve chances of conception. However, there are some lubricants that can actually harm your chances. Both water and oil-based lubricants have been found to interfere with sperm motility. There are some “fertility-friendly” lubricants on the market. Visit our Resource Page for a fertility-friendly option. These will not help increase your chances, but rather, it will have minimal interference. 


When in Doubt

Asking questions about sex can feel a bit embarassing for some. Especially if it’s a question they feel they “should” know.  As you enter your fertility journey, there truly are no bad questions. Your doctors have heard them all. So if questions pop up, be sure to contact your doctor. They understand how overwhelming and confusing trying to conceive can actually be and they will guide you in the right direction. 


If you’ve been having difficulty trying to conceive and want to explore treatment options, contact us to schedule a consult.  

Trying to conceive can be a stressful process for many women, especially those who may be experiencing difficulty resulting from infertility. Patients who achieve pregnancy but then experience a pregnancy loss may feel even more frustrated. Recurrent pregnancy loss is defined as having two or more pregnancy losses following a documented gestational sac in the uterus.  Causes of recurrent loss can be related to uterine anomalies, immune issues, chromosomal imbalances in either the male or female partner, hormone issues, and most common, chromosomal imbalances in the embryo. 

Uterine Anomalies:

One of the most common uterine anomalies contributing to recurrent pregnancy loss is called a uterine septum.   A uterine septum results from failure of the uterus to develop normally in a female fetus in utero.  A septum acts like a dividing wall in the middle of the uterine cavity. . The septum itself is composed of fibrous tissue that does not have much blood supply on its own. Therefore, if a fertilized egg implants on the septum, it may not receive adequate nutrients during the pregnancy resulting in the possibility of loss. Most physicians agree that a uterine septum increases the risk of a pregnancy loss and should be removed if found. 

Fibroids, or benign fibrous tissue  of the uterus, are another anomaly responsible for some pregnancy loss or difficulty conceiving. There are different types of fibroids, depending on their location within the uterus. Fibroids located within the uterine cavity where the embryo implants and grows are linked to pregnancy loss.  There is also an increased risk for miscarriage in women with very large fibroids. 

Fortunately, treatment for both uterine septum and fibroids within the uterine cavity is available. Both can be removed surgically through minor, outpatient surgery in a minimally invasive procedure called Hysteroscopy.  Sometimes a larger procedure called a Myomectomy is needed for the removal of larger fibroids. 

Immune issues:  

Immune issues can involve either overactivity or low activity. With overactivity, the body responds by attacking and damaging its own tissues. In low activity cases, the body has difficulty fighting off infections and is, therefore, more vulnerable to disease. Two conditions seen in patients with recurrent pregnancy loss that fall under immune causes are Antiphospholipid syndrome and 

Antiphospholipid syndrome,  is an immune disorder where the body makes antibodies that attack phospholipids. Phospholipids are major components of plasma membranes and the structural component of cells. In antiphospholipid syndrome, blood clots can form within arteries, veins, and other organs. Recurrent pregnancy loss or stillbirth may be an effect of aPL as the clots may affect normal placental function. . 

This disorder is believed to be genetic and rare, found to be present in less than 200,000 cases each year. Medical professionals can prescribe blood-thinning medications to reduce the risk of blood clots.

Inherited thrombophilias is an inherited DNA mutation which results in the body producing too much or too little of a blood-clotting protein. The relationship between inherited thrombophilias and pregnancy loss remains controversial amongst doctors. They have reported evidence suggests treatment with an anticoagulant does not improve pregnancy outcomes. 

Hormone issues:

While there are several examples of hormone disruptions that could affect infertility and pregnancy loss, some examples are abnormal thyroid levels, elevated prolactin, and polycystic ovary syndrome (PCOS).

Abnormal thyroid function, both hyperthyroid and hypothyroid, appear to correlate to pregnancy loss. Hyperthyroidism produces too much thyroid hormone and can cause body processes to speed up, as in an elevated heart rate and metabolism.

On the other hand, hypothyroidism is the effect of too little or no thyroid hormone being produced. Most of the time thyroid conditions may be treated with medications. 


Prolactin is a hormone secreted after childbirth which aids in breastmilk production. In some cases, elevated prolactin in a woman before pregnancy may lead to infertility and or pregnancy loss as hormone production affects the estrogen and progesterone levels. However, high levels of prolactin may signal hypothyroidism or pituitary tumors and should be examined further. Sometimes there is no cause for the elevated levels of prolactin, and it may be treated with medication. 

Hypothyroidism is usually managed with medications, and tumors may be removed surgically. Other causes of elevated prolactin may be medications or stress. 

PCOS is common within the United States, with over 200,000 diagnosed cases each year. There is some evidence that women with PCOS have higher rates of pregnancy loss. This may be due to elevated male hormones, and elevated insulin levels. 

One resolution may be maintaining stable blood sugar levels. Some medical professionals might prescribe medications such as Metformin. Diet is another method that can manage PCOS symptoms and may help reduce pregnancy loss.


Insulin resistance is similar to hormone issues listed above. When the body does not respond to insulin, glucose cannot be absorbed from the blood. The result can be prediabetes or diabetes.  There is currently evidence demonstrating that elevated blood glucose can be associated with increase first-trimester loss [R]. 

Within my clinic, I often screen patients with a fasting blood glucose test as well as screenings for insulin levels and HgbA1C. The results will provide a snapshot of what blood glucose has looked like over a 3-month period. 

Diet and lifestyle changes are usually recommended; however, medications such as Metformin may also be prescribed.

Chromosomal imbalances 

Balanced Translocation refers to a condition in which part of the chromosome has broken off and reattached to another location. Depending on the circumstances, a chromosomal translocation may be harmless, or it may cause serious health problems. 

In the case of balanced, or reciprocal, translocation many individuals are unaware they are affected until pregnancy. If an affected person’s cells attempt to divide to create egg or sperm cells, the irregular chromosome would contain extra or missing genetic material. It could lead to pregnancy loss, depending on the gene affected. 

The translocation can be diagnosed through a test called a karyotype; however, there is no treatment. 

Chromosomal abnormalities of the embryo account for the most common cause of first-trimester pregnancy loss. Unfortunately, there is no simple test, such as a blood draw, to determine the cause. Genetic testing after a pregnancy loss can be performed if pregnancy tissue can be collected and sent to the lab.  Pregnancy tissue can be collected in cases where a woman miscarries at home or if the patient has a procedure called a Dilatation and Curettage ( D&C ) .  If available the pregnancy can be tested genetically to confirm the presence of an abnormal number of chromosomes. 

If you’d like support with pregnancy loss, or you are experiencing difficulty conceiving , contact us and we can help you get tested and decide if treatment is right for you. 

Stress. Timed sex. Feelings of inadequacy. Disagreements. Fears. Different coping mechanisms. None of this sounds particularly romantic, right? These are just a few of the obstacles that infertility can add to your relationship with your partner.


What problems may arise? How should you go about addressing them? 


You can come out of your infertility journey with your relationship strengthened – but first, you must be ready to tackle the challenges.



Stress is synonymous with infertility. There are so many unknowns. Often, when a couple is diagnosed with infertility, a baby is something they’ve been trying for and planning on. To first learn that it may not happen – or happen the way envisioned – can be terrifying. Fear and stress go hand-in-hand. 


You and your partner are in this together. You decided you want to have a child. You’ve been trying. You may be committed to sticking together through the hard times, and it’s entirely possible to come out of infertility with a strengthened relationship. To get there, you first have to acknowledge the obstacles, and identify ways to overcome them. This is not easy, even for couples with the strongest bond. 


Sex and Infertility

You may be trying to conceive by timing intercourse at home on your own, or during treatment with your doctor.   Many couples opt to time their cycles so that they are having sex during the woman’s fertile window. A physician can help determine the best timing for intercourse with your partner.  


Scheduling sex can be so unsexy. It can begin feeling like a chore. The stress of having to perform sexually when not in the mood can take a toll on either/both partners.  This can be an ideal time to seek the help of a mental health counselor to navigate through this.


Especially if you start losing your desire for sex,or feel disconnected from your partner.  Know that this is normal and common. It is also something that you can overcome together with good communication.


Disagreements and Fights

When pursuing infertility options, there are a lot of decisions to be made. 


  • Do you feel comfortable with the treatment options presented to you? 
  • Do you have the financial means to support your treatment? 
  • Is it worth taking out a loan for treatment, not having a guarantee it will work? 
  • What part of your journey, if any, should you share with family and friends? 
  • Should you seek outside help for emotional support? 


The list goes on. You may find that you and your partner have different answers, and that adds stress and tension to your already difficult situation.


There is no quick-fix or one-size-fits-all approach to overcoming relationship hurdles. There are, however, things you can do to preserve the strength of your emotional bond with your partner. If you’re trying for a baby, there’s no better time to ensure that you and your partner know and understand each other to the best of your abilities. 


Communication is Key

The best tool is communication. As humans, we all handle our feelings differently. Some love to talk about every detail, some don’t want to talk at all. Sharing feelings regarding infertility can be scary – especially to people who manage stress privately. If that’s the case, get creative. Writing letters can be a great form of communication. It gives each person the ability to say everything they need/want, without interruptions. It also allows for time to process what’s being communicated so a thoughtful response can be given, versus a knee-jerk response, helping to limit arguments

Compromise When Possible

Keeping your relationship cohesive may require some sacrifice and compromise. It can be easy to get lost in your own feelings and forget that this is something you are both going through. Try and remember that even if they don’t show it outwardly, your partner is experiencing hardship, too. It’s imperative to find middle ground on things you don’t agree on. 


Take a Break

Infertility can be all-consuming. Give yourself permission to take a break and talk about other things. Do things together that take your mind off your fertility journey and bring up topics that make you feel connected to  your partner. Watch a comedy together to lighten the mood.  Schedule a fun date day or night doing something that you both enjoy.  Make an effort to spend time doing something that will help shift your focus away from infertility. 


Ask for Help

The emotional toll is something fertility specialists, like Dr. Salem, are very familiar with. Reach out to your physician for mental health resources. They get it. I encourage couples to work with a mental health professional early on in the fertility journey to help navigate the wave of emotions that often come with treatment.


There are also ways to reach support online. Resolve is an organization that provides resources and support related to infertility. There are many individuals openly sharing their journey online. There are also private groups you can join for support as well.


Infertility can be hard on relationships, but if you optimize your communication and accept professional guidance when necessary, you can end your journey feeling closer than ever to the person you love.

When it comes to fertility, one of the most important stages of a woman’s cycle is the ovulation phase. Ovulation is when the mature egg is released from the ovary. Ovulation generally takes place approximately mid-cycle, but the days can vary. If a woman experiences irregular cycles, she will ovulate irregularly (ogliovulation). Some women may have irregular cycles and experience anovulation


The Importance of Ovulation

The mature egg must be released from the ovary in order for pregnancy to occur. The window of ovulation is a small 12-24 hours, so knowing when your body ovulates can increase your chances of getting pregnant. More importantly, learning your body’s ovulation cycle, or lack thereof, can be an early indicator of the need for medical assistance. 


Am I Ovulating?

If your periods are regular, it’s likely that you are ovulating. However, there are exceptions and although you wouldn’t have a real period without ovulation, the endometrium can still shed, leaving you to believe (understandably) that you’ve had a period.


There are many ways to detect ovulation, but few are a guarantee. If you’re having trouble pinpointing your ovulation, or suspect you may not be ovulating regularly, it is important to seek advice from a medical professional. 


If your cycles are regular, there are a few ways you can try to identify your ovulation at home. 


BBT Charting

BBT is an acronym for Basal Body Temperature, which is the temperature of your body upon waking. Your BBT can rise slightly after ovulation. This method can help you learn when or if you are ovulating. Charting your BBT does not tell you when you are ovulating while it’s happening – it can only confirm it after it’s happened. Therefore, if you want to use the charting method, you need to commit to it for a few months. You’re looking for a pattern, to predict when your future ovulations will occur. While this can help give you insight into your ovulation patterns, there is a great deal of room for error. If you are sick, stressed, taking your temperature at different times of the day, or have disrupted sleep, you can get an inaccurate reading. Should you decide to keep track of  your BBT, here are some tips to help you get the most accurate results:

  • Take your temperature immediately upon waking. This means before you do anything. Even before you sit up! Since the temperature elevation is so small, even the smallest of actions can interfere. 
  • Use basal body temperature digital thermometer for accurate results.
  • Stay on a schedule and wake up at the same time each day. 


Urine Test Kits

LH (Luteininzing Hormone) is released from the body shortly before ovulation and that is what ovulation tests are detecting. Getting a positive result means you’ve had an LH surge, and ovulation will take place 12-36 hours later. It is recommended you begin testing on day 11 of your cycle and continue until you ovulate, or until day 20 (whichever comes first). The kits are similar to pregnancy tests, where you use a urine sample. The manual tests require you to compare a line to a control line and can be hard to read, leaving you more confused. Digital test kits are pricier but will give you a straightforward result. Be sure to follow the manufacturer’s instructions, as each brand and type of kit can vary. It’s important to note that these tests are not foolproof. It is possible to get a false positive. Additionally, if you have absent or irregular cycles, these tests will not be helpful and may prove to be nothing more than frustrating.


Pay Attention to Your Body

While none of these symptoms are a guarantee of ovulation, there are signs your body can give you. Keeping track of these can help you detect ovulation. You may experience some, all, or none.  Here are a few things to look for:


  • Ovulation pain: A sharp pain in your abdomen, approximately mid-cycle
  • Increased sex drive
  • Raw egg-like cervical mucus: Log the appearance of your cervical mucus throughout your cycle. When it becomes thicker and stickier, like a raw egg, you could be ovulating.
  • Breast tenderness: This is usually noticed after ovulation


I Think I’m Ovulating! What now?

If any of the above methods have helped you detect your ovulation, you want to have sex regularly 5 days before and the day of ovulation


When to See a Doctor

If  your periods are irregular, abnormally long, or abnormally short, the above methods may be of little-to-no help. If any of the following apply to you, it is time to see your doctor:


  • You are under 35 and you and your partner have had unprotected sex for 1 year
  • You are over 35 and you and your partner have had unprotected sex for 6 months
  • You have irregular cycles
  • You are 40 or older


When you are trying to conceive, those months of negative pregnancy test results can be painful as you count them off, waiting until your medical professional will refer you for additional testing.  The accepted definition of infertility is when couples do not achieve pregnancy on their own after one year of unprotected intercourse in women under 35 years of age, and after six months in women 35 or older. Other terms you may hear when referring to infertility may be “subfertility” or “fecundability.” Fecundability is perhaps more accurate because it refers to the probability of achieving pregnancy within a menstrual cycle. 


Infertility affects as many as 15% of couples within the United States every year. Of those couples, about ⅓  of cases are a result of a male factor, ⅓ of all cases are  a result of a female factor, and ⅓  from a combination male and female causes or unknown causes. [R]  The ability of a couple to become pregnant and sustain a pregnancy may be a result of biological, systemic, or environmental factors. 

Causes of Infertility


Some causes of infertility in the female partner are easily identified.  These may include physical causes such as tubal blockage, endometriosis scarring or inflammation that may affect implantation, or uterine abnormalities causing problems with achieving or maintaining pregnancy.


Other factors related to female infertility may be less immediately recognized and could include endocrine or systemic disorders including hormonal imbalances that affect ovulation (PCOS or hypothalamic disruption are two examples), premature ovarian failure, or excess prolactin. [R



Physical disorders such as testicular defects resulting from trauma, torsion, cancer, epididymitis, and hypogonadism are also reviewed. There may also be male reproductive tract disorders caused by infection or inflammation. 


Endocrine or systemic causes make up about 2 – 5% of male infertility cases. They refer to dysfunction of the hypothalamic-pituitary-gonadal axis, and like most hormonal pathways within the body, are sensitive to disruption and can be indicative of other disorders. [R]  


In approximately 2-5% of cases, no cause of male partner infertility can be identified, known as idiopathic infertility. 


You will find more detailed information about male infertility in my blog article Male Infertility.

What Happens When I See a Doctor for Infertility?


Many times the initial process or portions of an infertility consultation can be done by a general practitioner or an OB-GYN. They may begin a medical history, physical examination, or request lab work. For males, a semen test will also be conducted.


The medical professional will pay special attention to anything that might provide clues about infertility, such as sexual development during puberty, sexual history, any illnesses or infections, surgeries, medications, and exposure to environmental factors. Menstrual history, including absent or irregular periods, is especially helpful. [R


Bloodwork may reveal necessary information such as the presence of luteinizing hormone (LH) levels, including follicle-stimulating hormone (FSH), prolactin (a pituitary hormone) will also be collected. Markers for hormones affecting female fertility, estradiol, anti-mullerian hormone (AMH), TSH (thyroid), and progesterone function are also collected. 


For men, the semen analysis will provide valuable information regarding the health of the sperm through examining the number, motility, and shape of the sperm.


Should any preliminary tests or examinations return abnormal results, the individual or couple may be referred to a specialist for additional testing and evaluation.  There is sometimes a need for additional testing, which will be determined by your provider.


Integrative Treatment Options for Infertility


Fortunately, there are treatment options to support couples in their journey through infertility. I have chosen a model based on an integrative approach that combines natural methods such as yoga, meditation, acupuncture, and healthy foods, along with assisted reproductive technology. I have found these basic practices towards reducing stress, hormone balancing, reducing exposure to toxins, and achieving optimal wellness to support fertility and pregnancy enhance the body’s fertility and pregnancy ability. 


A list of resources and their benefits is included here . Additional articles are included in the blog to provide information on how each discipline can complement traditional medicine and your fertility journey. I also invite you to sign up for Dr. Shala’s resource eBook, Jumpstart Your Fertility, which provides simple practices you can begin with at home if you are experiencing infertility. 

If you’d like to schedule a consultation for fertility testing, contact Pacific Reproductive Center today. 

Endometriosis is said to affect 1 in 10 women during their reproductive years. Perhaps you are one of them. Effects of endometriosis can include painful periods, painful ovulation, pain during and after sexual intercourse, heavy menstrual bleeding, chronic pelvic pain, fatigue, and infertility. [R] This impacts your physical well-being and can impact your emotional health as well.  

What is Endometriosis

Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”) is found outside the uterus. The condition induces a chronic inflammatory reaction that may result in scar tissue.  [R


Endometriosis symptoms can include pain before and during periods, pain in between periods, pain during or after sex, pain when urinating or having a bowel movement (often during monthly periods), difficulty achieving pregnancy, and cysts of endometriosis on the ovaries called endometriomas, also sometimes called chocolate cysts.  [R] Other symptoms may include heavy bleeding during menstruation and fatigue. [R[  Some of the symptoms have been “normalized” to be associated with menstruation in general, and therefore, there seems to be an average delay of seven years between the onset of symptoms and a woman seeking treatment. [R


There is no known cause of endometriosis, but it appears to be related to complex interactions of immunologic, hormonal, environmental, and genetic factors. [R]  Women have a higher risk of developing endometriosis if their mother and/or sister(s) are also affected. Gynecological factors such as age when the menstrual period starts, prolonged menstrual flow, and short cycle interval may be possible risk factors. [R] There is some evidence environmental factors such as exposures to toxins such as dioxin (an environmental pollutant) and PCBs can correlate to endometriosis symptoms. [R]


While there is currently no cure for endometriosis, there are treatments available. Pain medications may alleviate discomfort symptoms, although they do not address other symptoms such as heavy bleeding, fatigue, or infertility. Birth control pills may also be an option in reducing pain symptoms, though this is not an option for treatment if you are trying to conceive. Additionally, some women may not want to be on a hormone-based medication for an extended period of time. Doctors may also recommend surgery such as laparoscopy to remove endometriosis tissue or a hysterectomy depending on the severity of symptoms [R]

Treatment options are considered in relation to the patient’s age, desire for children, the severity of symptoms, and the endometriosis stage and should be discussed with your provider. 

How Does Endometriosis Affect Fertility

Having a diagnosis of endometriosis does not automatically mean a woman will experience infertility; some women can achieve pregnancy without difficulty. Women who have endometriosis may experience difficulty in achieving pregnancy.  Studies show endometriosis is the cause of up to 50% of infertility cases. [R] The excess tissue growth may cause adhesions, scarred fallopian tubes, or inflammation of the pelvic structures. 

Because endometriosis may be caused by an excess of estrogen in the system, some women may also experience altered immune system functioning, changes in the eggs’ hormonal environment, impaired implantation of a pregnancy, and altered egg quality as a result of the hormonal imbalance. [R]

Endometriosis and IVF

Assisted reproductive technology is the first line of treatment in patients who experience infertility due to endometriosis. [R]  Studies seem to indicate that treatment’s success depends on individual patient factors play the most crucial role in the outcome. Treatment choice depends on the patient’s age, duration of infertility, disease level of progression, and childbearing wish. [R]
Integrative medicine may also provide support with pain management and stress during the IVF process for all patients, not just those with endometriosis. Yoga and acupuncture are two ways patients can manage pain and stress levels. A clean diet and lifestyle also promote healthier estrogen levels, which may support efforts in alleviating some symptoms of endometriosis. 

If have endometriosis and would like to explore treatment options, contact our clinic for an appointment. 

You’ve probably heard of BPA when shopping for things like water bottles, food storage containers, and even in your cosmetics like lipsticks, eye and face makeup, and nail lacquers. But do you know what it is and how it affects your health?

BPA, or Bisphenol A, was initially developed to be used as an estrogen-like compound for the pharmaceutical industry.  BPA was later used to manufacture plastics, and the plastic industry exploded in the 1950s. The chemical was presumed to be safe by the Environmental Protection Agency in the 1970s, with few animal studies in doses not relevant to humans.  BPA leaches out of plastics long after it is produced, and there are no requirements for companies to prove its safety. 

BPA and Health

BPA is an endocrine disruptor, meaning it mimics or interferes with the body’s endocrine system. Even in low amounts, exposure can alter the body’s endocrine system and lead to health concerns such as early puberty, breast and other cancers, reproductive problems, obesity, heart disease, and behavioral changes. 

BPA has been shown to decrease egg quality and a reduced ability of an embryo’s successful implantation in women. Some research has demonstrated infertile women have higher BPA levels. Elevated BPA seems to adversely affect estradiol levels, the number of eggs produced, egg quality, fertilization rates, and embryo quality. Increased levels of BPA may decrease the success rate of IVF treatments. [R]

Multiple studies have correlated BPA exposure with a reduction in various characteristics of sperm quality. Sperm concentration, total sperm count, and morphology were a few of the traits affected [R] Researchers found that BPA can affect sperm integrity even at low levels. 

Steps to Reduce BPA in Your Life

  • Ditch the Plastics. At the store, you will commonly see the claim “BPA-free” on products, but that doesn’t necessarily mean it’s safe. When BPA became a customer concern companies started exploring the idea of using other Bisphenols, like BPS, as a substitute in order to place the label BPA-free on the label as a marketing tool.  It is much cheaper for a company to replace the chemical in question with another chemical rather than safely reformulate it. While there are fewer studies on replacement bisphenols, evidence shows very similar side effects in those exposed to BPA. Other things to look for and avoid in plastics are PolyCarbonates (“PC”) or recycling code #7, as these may contain BPA. 

Seek alternatives such as glass or stainless steel water bottles, glass food storage containers, or natural food wraps such as beeswax for bringing lunches on-the-go. 

  • Choose Fresh or Frozen Over Canned.  Fresh, organic, locally grown, in-season produce is best when available. Otherwise, choose fruits and vegetables that have been flash-frozen to protect as many of their benefits. Canned fruits and vegetables may be at risk of exposure to BPA, which is often found inside the can linings. 
  • Practice Clean Beauty. A database of safe cosmetics and body care products can be found on Skin Deep, provided by the Environmental Working Group.  EWG is a non-profit, non-partisan organization dedicated to protecting human health and the environment. Some of the health and personal care products contained in the database are EWG Verified, meaning the products are free from harmful chemicals, provide full transparency in labeling, and follow good manufacturing practices. Other products rated on a scale from 1 to 10 indicating least to most damaging in terms of your health. BPA is one of the many toxins EWG screens. 
  • Limit Your Exposure to Receipts.  Paper such as sales receipts, plane, and concert tickets all have a BPA coating that gives them that smooth texture.  If your employment causes you to come in contact with a large volume of receipts, it’s essential to protect yourself from BPA exposure. You may ask to work with gloves and, if this is not an option, be sure to wash your hands often. If you are a consumer, you can limit your exposure by asking for an emailed receipt whenever possible, declining receipts you don’t need (this will help the environment too!), or by handling the receipt as little as possible and washing your hands with soap and water as soon as you are able. 
  • Avoid Use of Hand Sanitizers. Hand washing is always preferred to hand-sanitizer. However, due to COVID-19 and flu season around the corner, hand-sanitizer seems to be everywhere. When soap and water isn’t an option, use it, but know that hand sanitizer can increase absorption of BPA after touching receipts into your body of 10-100X! That’s an alarming percentage; stick to soap and water as a best practice. 

Reducing or eliminating toxins, such as BPA, is an easy step you can take at home to begin steps to a cleaner lifestyle. There are many other components to integrative medicine that can impact fertility that I suggest to patients.  You can learn more from my Dr. Shala’s eBook on integrative fertility tips, download it today.

Visit Pacific Reproductive Center

Pacific Reproductive Center® is a world-class fertility center in Southern California. With more than 70 years of collective reproductive clinic experience diagnosing and treating infertility, PRC is a leading provider of IVF and fertility care.

PRC is easily accessible whether traveling from local communities including Los Angeles, Orange County, Riverside or points slightly further including San Diego, Temecula, Inland Empire and La Jolla

PRC Torrance
3720 Lomita Blvd, Suite 200 Torrance, CA 90505
Monday – Saturday: 8am – 5pm
Sunday: Closed
PRC Glendale
116 E. Broadway, Suite 300 Glendale, CA 91205
Monday – Friday: 8am – 5pm
Saturday – Sunday: Closed
PRC Irvine
10 Post Irvine, CA 92618
Monday – Friday: 8am – 5pm
Saturday – Sunday: Closed
PRC Corona
381 Corporate Terrace Corona, CA 92879
Monday – Friday: 8am – 5pm
Saturday – Sunday: Closed
CALL TODAY! 866-423-2645

Lifestyle Tips for Fertility – For Free!