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The monthly menstrual cycle from the onset of menses at puberty ovulates the eggs that form in the ovarian follicles of the ovaries. There are actually two ovaries in women.

These ovaries contain a lifetime of eggs. This menstrual cycle is controlled by an axis of functions, which connect the hypothalamus with the pituitary gland and the adrenal end.

The interplay of hormones in this axis is a biologic system of fertility. The egg development is the main function of ovulation. It is the hormones that feed this development and the ovulation.

The hypothalamus starts the process by producing thyrotropin-releasing hormone (GnRH) and sends it to the pituitary gland. The hormone stimulates the making of follicle stimulating hormone (FSH).

Both originating hormone and the resulting hormone are necessary in egg development. As the eggs in the ovarian follicles mature another hormone is released which is the estrogen.

Estrogen is the hormone that makes a body more female in character. The rise of the estrogen signals the hypothalamus to curb the production of gonadotropin, which induces the making of FSH.

The estrogen also stimulates the doubling of the uterine wall lining known as the endometrium. This is in anticipation of the arrival of the embryo.

Studying how to improve fertility will boost your possibility to get pregnant. There are natural medications obtainable to help out you conceive a baby.

Up to 1 in 20 women having their first baby will develop high blood pressure in pregnancy that will go away as soon as the baby is born. This is when the term “pregnancy-induced hypertension” is most commonly used.

One of the reasons you visit the doctor more often in the eighth and ninth months of pregnancy is to monitor you for high blood pressure, which grows more common toward the end of the pregnancy. Why are doctors so concerned about it?

High blood pressure has many bad effects. Babies whose mothers have high blood pressure tend to grow more slowly. There may also be a low level of amniotic fluid (oligohydramnios). When there is protein in the urine, indicating pre-eclampsia, the mother’s liver may not function properly, her blood may not clot as well due to a low platelet count, there may be inadequate urine production, and she may even experience heart failure. When pre-eclampsia is accompanied by seizures it becomes eclampsia, which is life threatening.

If you are taking medication for chronic high blood pressure when you get pregnant, you need to talk to your doctor about the particular medication. If you are taking ACE inhibitors, you need to be switched as quickly as possible to another medicine. These medications are harmful to the fetus. If you had high blood pressure before becoming pregnant, you have an increased risk of pre-eclampsia while pregnant.

If you have high blood pressure, your doctor may recommend nonstress tests and a test called a biophysical profile to learn whether the placenta is doing its job and the baby is continuing to grow normally.

Depending on the severity of the high blood pressure and the gestational age of the baby, early delivery may be recommended. No one knows what causes pre-eclampsia, but delivery is the only sure cure.

However, most high blood pressure is mild and does not require treatment with medication. We monitor it carefully and treat it with increased periods of rest, or occasionally, total bed rest.

Another nonmedical treatment that has been suggested recently is for the pregnant woman to stand chest deep in water. Somehow, this helps lower blood pressure, probably by pushing fluids back into the blood vessels. Lying in a bathtub isn’t enough; you must be standing upright. Avoid hot tubs because the heat can be bad for the baby. And don’t start any treatment like that without talking to your doctor first and continuing frequent blood pressure checks.

Fertility awareness is not just a contraceptive method, though. It has many other possibilities. Fertility awareness can also be used to conceive , to detect a pregnancy (which can sometimes be identified by a rise in body temperature), to confirm a woman’s suspected limited fertility , and to help understand and alleviate symptoms throughout the menstrual cycle. Indeed, it is a good idea for every woman to have some insight into her menstrual cycle, regardless of her contraceptive method.

Fertility awareness is not the most effective form of birth control, but it is one of the most “natural.” The reasons for using this method vary, but it’s a good option for many. A woman who has qualms about taking hormones and has a latex allergy, for example, might be an ideal candidate for fertility awareness.

Like barrier methods , fertility awareness may not be the best contraceptive option for those women who want to avoid pregnancy at all costs. Perfect use of fertility awareness is over 90 percent effective in preventing pregnancy in the first year of use, and can be up to 99 percent effective. However, actual use of this method, which includes a backup method or abstinence during the fertility window, is considerably less effective. Twenty to 25 percent of women get pregnant during the first year of use.

Women who choose fertility awareness should have a regular menstrual cycle and should be very comfortable with their bodies. This is definitely an “earthy” method, particularly for those who opt to use the very accurate technique of sampling and analyzing their cervical mucus. Since the fertility-awareness method does not require any barrier method for the majority of a woman’s cycle, the method does not protect against STDs.

There are three common techniques used for fertility awareness, but many women use them in combination with one another to ensure effectiveness of the method.

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In addition, pelvic inflammatory disease (PID) can increase the risk of infertility as well as the risk for ectopic pregnancy. “The problem with PID is that you don’t necessarily know you have it — or had it,” Chervenak said. “When you sleep with someone, you sleep with everyone they’ve ever slept with.”

One of the key players in PID is chlamydia, an infection that is a common cause of PID. In fact, about 75 percent of women who have chlamydia don’t even realize it. Chlamydia can cause scar tissue and cause the fallopian tubes that need to contract to move the egg along to remain stuck in place. “Chlamydia is the ultimate love bug,” Chervenak said. “You get it. It does the damage. And it goes away — often silently.”

In about 35 percent of infertile couples, the problem is with the man’s sperm. For example, he may not produce enough or they may not be active enough to reach the egg and fertilize it. “An interesting difference in the reproduction system of men and women is that men make new sperm throughout their lifetime but women are born with the number of eggs they’ll have in their lifetime,” Chervenak said.

“In fact, during the time our mothers were six months pregnant with us is when we had our greatest number of eggs. We’ve been losing eggs ever since,” she said. “In our 30s and 40s, we have far fewer eggs than we had in our teens and 20s. As a result, as we mature it may be more difficult for some women to achieve pregnancy.”

About 15 percent of infertility can’t be medically explained, says Parsons. Generally, most physicians advise patients to seek the help of a fertility specialist after one year — especially if you are 35 or older.

“But sometimes, the patient doesn’t want to wait that long,” Chervenak said.

In that case, the physician may try ultrasound to get a clear picture of the fallopian tube and determine whether it is functioning. For example, doctors can inject saline into the woman’s reproductive system to see if it travels effectively through the tubes. They can also get a look at the follicle to determine just when it’s going to release the eggs. That way, the patient is better able to time intercourse.

Experts have mixed opinions on just how often couples should have intercourse during ovulation. Some say every other day for the week that ovulation is expected to occur. More frequently, they say, reduces the concentration of the sperm. Others disagree.

“I tell my patients to have intercourse as often as they like,” Copel said. “The last thing I want them to think is that there are rigid rules to follow or they won’t get pregnant.”

Most experts agree that, if you think there is a problem, seek help. “It’s much better to rush in sooner rather than later,” Parsons said. “There are ways we can help and things we can do before we try fertility drugs without prescription.”

So is there any truth to the myth that all a woman simply has to do is to relax to conceive?

“I really don’t think so. Everybody has a story of someone they know who tried and tried without success to get pregnant, adopted, then got pregnant,” Copel said. “They say it’s just mind over matter. She finally relaxed and that’s how she got pregnant. Well, tell that to an infertile woman and you’re liable to get your head taken off. For most of these couples, getting pregnant is a matter of statistics catching up with them.

“Really, if getting pregnant was as simple as mind over matter, we wouldn’t need contraceptives or fertility drugs,” Copel said. “If you want to have a baby, don’t get discouraged. Keep trying.”

Surprisingly, the average woman’s chance of getting pregnant within one menstrual cycle is only about 25 percent. But before you toss out your birth control method, consider this: After three months of unprotected intercourse a woman’s chance of getting pregnant doubles to 57 percent and after six months it jumps to 72 percent. After one year of unprotected intercourse you’ve got an 85 percent chance of conceiving — and after two years it increases to 93 percent.

“The catch is that your body doesn’t know if this is your first month of trying or your 10th month,” said Dr. Joshua Copel, professor of obstetrics and gynecology and chief of maternal and fetal medicine at Yale University. He is also the pregnancy columnist for drkoop.com. “The sperm and the egg simply have to be at the right place at the right time.”

And that means the woman has got to ovulate — release mature, healthy eggs from her ovaries. Eggs are grown in a follicle in the woman’s ovaries. When the egg is mature, the follicle ruptures. The egg is released into the fallopian tube and heads toward the uterus. If fertilized, the egg makes its way to the uterus, attaches to the uterine lining and grows into a baby.

So, just exactly what is the optimum time for conception? If your menstrual cycle is 28 days, you will ovulate about 14 days before the start of your next period. “You’ve actually got a window of fertility of about 48 hours on either side of that 14th day mark,” Copel said. “The egg hangs around a while and the sperm hangs around a while.”

If your cycle is longer, you may ovulate a day or two later. If it’s shorter, you may ovulate a day or two sooner. “If your cycles are irregular, it may be harder to get pregnant — fewer releases of eggs lower the chance of conception over the course of a year,” Copel said.

If you’re taking oral contraceptives, most physicians suggest going off them for a few months before trying to conceive. This will help establish your own natural cycle — without hormones — and make it easier to determine when you’re ovulating.

The most accurate method of determining just when you’re ovulating is surprisingly simple — monitoring your morning body temperature with a digital thermometer. (Digital thermometers are more accurate than mercury thermometers.)

“Start taking it a few days before you think you might begin ovulating — just to establish your normal morning temperature. It’s usually 98 degrees before you get out of bed first thing in the morning,” said Dr. Anna Parsons, an associate professor of obstetrics and gynecology and reproductive endocrinology at the University of South Florida in Tampa. “When you begin ovulating, your morning temperature will jump by a half a degree. And that’s your signal that you’re in your fertile time.”

Another signal, says Parsons, is a dampness or mucus-like discharge that comes from the cervix. “If you’re trying to get pregnant, it’s a good idea to learn to identify the difference in your fertile time from every other day.”

In addition, if you’re trying to conceive, avoid using vaginal lubricants, douches and products with perfumes. “These can change the pH of the vagina, which can be counterproductive to conception,” Copel said.

For about 40 percent of women of childbearing age, problems with the ovulation process cause conception problems, says Dr. Judi Chervenak, assistant professor of obstetrics and gynecology and reproductive endocrinology and infertility at Albert Einstein Medical School in the Bronx, N.Y. She is also the menopause columnist for drkoop.com

“Infertility has been around forever, but we seem to be seeing more and more of it,” Chervenak said. “It seems to be a combination of women waiting longer to have their first child, aging ovaries and miscellaneous other problems.”

We were diligent.

Somewhere around August 30th, I felt a twinge and bought my first pregnancy test. I can comprehend what I read but for some reason, I thought the instruction on the box to “take the first day you miss a period” didn’t apply to me. If I was pregnant, even if the little sperm had just that instant broken through my egg — what else would that twinge be after all? — surely this magical little test would know. It was, after all, scientific.

Just look at the medical personnel in their crisp, white coats on the commercials. They know how accurate these tests are — ninety-nine percent! And for Pete’s sake, what does the “E” in EPT stand for, anyway? Early! Well, it was early, and I had to know. At least if I knew it was negative, I could concentrate on things other than every little twinge in my body — or could I?

Looking back, I now realize that had I bought stock in EPT that August, I would be a rich woman today and could live off my fortune. I had no idea that those alluring and seductive little white sticks with the absorbent tips and magical windows would have so much power over me.

At first, my husband shared my excitement. He would sit outside the bathroom door and wait while I took the test. Our routine was to sit together and stare at the test window for the full three minutes without saying a word. Time and time again we saw one line — disappointment. A few times we ran into each other digging through the bathroom trash can. We didn’t speak, but each knew what the other was thinking: Maybe that was just a slow test.

Sometime in October, almost two months and hundreds of dollars later, my husband read the fine print on one of the boxes. “Hey, did you know this only works after you’re already late?” he asked, trusting that I hadn’t thrown away all that money on purpose.

“I read that,” I answered, trying to think of a way to make my oh-so-scientific husband understand my obsession. “The E does stand for early,” I said. Even I knew I sounded pathetic.

He took the remaining test from my two pack and said, “You wait here.” Did he know something I didn’t? Could he take the test and somehow find out the news I had been so eager to know? He came back, and I looked up at him expectantly. I couldn’t bring myself to ask him. I knew, deep inside, that the test didn’t work like that, but something in me, although admittedly irrational, wanted it to.

“I’ll get it out for you once you’re a day late,” he said.

Was he serious? Had he actually hidden my test? My test? He had. He was staging his own private little intervention. How could he understand? He doesn’t have to feel all of those twinges down there and wonder all day. It’s not surprising he can be so calm, so patient. His body isn’t constantly working against his ability to concentrate on anything and everything else.

I admit that while I was home alone, I spent many hours that month searching for my test. It at least gave me something to do other than sitting around waiting for telling twinges. I couldn’t go out to the store and buy another one when there was a perfectly good test in the house, somewhere. Besides, our bank account was running pretty low by that time and I was sure to find it any minute!

I never did. True to his word, though, he faithfully brought out the test the first day I was late, just before Thanksgiving. I took the test alone in the bathroom, and before I could even wash my hands, there they were — two lines, at last!

I came out of the bathroom and told him the good news. We were completely and totally happy for a moment. Then a feeling of doubt crept into my mind. Ninety-nine percent accurate means one percent inaccurate. “Do you think I should go to the store and get another test, just to be sure?”

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The dangers of premature delivery include low birth weight and an underdeveloped baby who may have difficulty surviving outside the womb. However, due to advances in medical technology, the outlook for premature babies is fairly good. In addition, there are some things you can do, such as taking great care of yourself, to improve the likelihood of a healthy, full-term delivery.

While it can be linked to premature delivery, low birth weight is also a problem for babies born at term. Around the world, the “standard definition” for low birth weight is five pounds, eight ounces, and about half of all twins fall below this mark. Incidentally, studies have shown that the most direct link between diet and low birth weight is the amount of protein consumed by the mother during pregnancy. It’s not merely a matter of how much you eat, then, but also what you eat. “You are what you eat,” and so are your babies.

Another problem often cited in multiple pregnancies is that of a “crowded womb.” This condition provides an explanation for both premature delivery and low birth weight. Presumably a womb that is brimming with babies is likely to unpack its load sooner than one that is merely full. This idea, however, is the subject of heated debate, since many mothers have borne healthy, full-term twins and in some cases, these twins weigh upwards of seven pounds apiece.

One camp of experts argues that many problems associated with multiples, including premature deliveries and low birth weight, can be remedied if the mother gets proper nutrition and rest . Full-term babies are typically more healthy and need less medical assistance than do preemies.

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