Every month and through a complicated and well orchestrated sequence of hormonal changes, the ovaries will make one eggs each month. If intercourse occurs around the time of ovulation, and the egg is met by a sperm (actually needs many sperm cells) the egg will get fertilized. If we do not get pregnant that month, a period starts and we start all over again.

Due to the many changes that occur in the hormonal levels, hormone testing needs to be done on special days of the period.  While FSH is responsible for making eggs grow, LH will cause the release of the egg. Well timed progesterone usually means that ovulation has occurred. 

PCO or Poly Cystic Ovaries

To start, this is a bad name. The name is usually confused with ovarian cysts -which are a very different entity. PCO does not mean you have ovarian cyst. PCO 'cysts' do not burst, and will typically cause NO pains. 

The word actually means that there are many 'follicles' in the ovaries.  Too many eggs are trying to grow at the same time. The hormonal 'waves' that should happen in the normal cycle (as above) are lost, and therefore the ovaries get 'confused' and they are not able to make one egg each month as usual. 

This results, usually, in any combination of: irregular bleeding, delayed pregnancy, weight gain, extra hair growth, issues with blood sugar control, family history of diabetes, high blood pressure, etc. 

The treatment will usually include metfomrin (yes, the diabetes medication) Birth control pills (yes, depending on a few parameters) weight loss, low sugar and low carb diet, as well as methods to induce ovulation.

Those Tubes

The Fallopian tubes are the 'love lanes' for the egg and sperm. At the time of ovulation, the tube will suck the egg in, and will nourish it until it meets the flood of sperm cells that are swimming up from the vagina, through the cervix and uterus and into the tube.

Fertilization actually usually happens in the tubes. If for whatever reason the fertilized egg sticks to the tube and stays there, an Ectopic Pregnancy occurs. This needs special attention. 

The risk of ectopic pregnancy increases with fertility treatments. If you think you are pregnant during a fertility cycle (and for 3 months thereafter) please contact us within a few days. We do work weekends. 

The Uterus

The uterus is where the baby will stay for the duration of the pregnancy. It needs to first 'accept' the pregnancy, keep it safe and nurtured for the 9 months of pregnancy, and then push the baby out at the time of birth. 

The presence of fibroids, polyps, too many scars of previous surgeries, and some congenital conditions may all affect the uterus ability to perform its function properly. 

This may result in delayed pregnancy, recurrent miscarriages, preterm birth, abnormal presentations, (e.g. breech), etc. 

The dreaded Endometriosis

The word endometriosis means the presence of the cells that normally would line  the inside of the uterus, outside the cavity of the uterus. This results in pains in the pelvis that can sometimes be severe. It can also prevent pregnancy. 

Endometriosis is a hidden disease that we can only diagnose by having a look at it (that means looking into the inside of your abdominal cavity).

Interestingly there are ways of managing problems that come with endometriosis, and they are opposite to each other. 

So, if pain is really severe, we start by birth control pills, or Visanne, or Mirena, Or LHRH shots (Lupron). And yes, as you have noticed, you cannot get pregnant when you are doing any of these. 

Or, if you want to get pregnant, we go along with fertility medications that should help you get pregnant but does not necessarily improve the pain. 


The 'only' test we do for males is a semen analysis. It is a simple and straight forward test. We sometimes may add sperm function test, on top of the usual count test. 

Male disorders may include problems of performance, when there is no erection, so no intercourse is possible, and no semen is deposited to fertilize the eggs.

Or problems can be related to the semen examination under the microscope, where we may have issues with numbers, or percentage of movement, or type of movement of sperm.  These issues are not related to performance, and can only be diagnosed under the microscope.