Deborah Howell (Host): Ever wanted to unlock the secrets of your own fertility? Well, today on the Time to Talk Fertility podcast, Dr. Jane Nani, a Reproductive Endocrinologist and Medical Director of Third Party Reproduction, joins us to unravel the intricate process of ovulation, explain hormonal imbalances, and discuss lesser known facts about male fertility.

We hope it'll help you gain an understanding of the amazing intricacies of your body and use the power of knowledge to take control of your own reproductive health. Dr. Nani, it's so nice to have you with us today.

Jane Nani, MD (Guest): Well, thank you for having me, Deborah. I'm happy to be here.

Host: Wonderful. Let's jump right in. What's considered a normal menstrual cycle and what are some of the signs you don't have a normal menstrual cycle?

Jane Nani, MD (Guest): That's a very good question. And the vast majority of women who are now past puberty will start to get regular ovulatory menstrual cycles. And what that means, primarily, is they get their menstrual cycle in a normal sequence. The classic number is a menstrual cycle every 28 days, but only really about 20 percent of women of the reproductive years have that classic 28 day cycle.

Some are 29, some are 27. So generally we say 28 days plus or minus about five on either end. So those are considered normal menstrual cycles. But beyond that, we say that we expect this to be evidenced by some red, what we think of as red flow. And I say that in contrast of people, sometimes they're just getting a little brownish or spotty. That's not considered menses. This has to be a red flow that may last anywhere from about on average, three to five days.

Host: Okay, that's pretty specific. And how many eggs in general does a person have?

Jane Nani, MD (Guest): Women ovulate each menstrual cycle, generally one egg per cycle, and that's why most children are born one baby at a time. Now, it also stands to reason that this process to ovulate every cycle eventually does come to an end, but we call that menopause. And you know, so that's remote, the average age is 51.

So most women in the reproductive years have a lot of time, they're still ovulating before they get to that.

Host: Okay, got it. And how does that number of eggs change over time?

Jane Nani, MD (Guest): That's a very good question. It's not a set number, but women are born with all their eggs are going to have, and really the highest number is when they're in utero, in their mother's womb, at around two to 5 million.

And then by the time children are born, baby girls are born; it could be down to about 1 million. By the time they get to 37, maybe down to 25,000. You know, there's a steady decline, but it's very gradual over time. Very, very gradual.

Host: Sure. what are the hormones involved in reproduction and fertility and what do they do?

Jane Nani, MD (Guest): This is very intricate process. This is called in general, what we think of as from the brain to the ovary, we call it the hypothalamic pituitary ovarian access. So really what happens is that there's hormones that get secreted by the brain that cause the ovary to initiate a new ovulatory cycle. And this happens just very cyclically in normal women.

So every single month, there's one egg generally that grows to maturity and then ovulates.

Host: From all those millions, it's kind of miraculous, right?

Jane Nani, MD (Guest): Yeah. Yeah and it turns out, just to be more specific about the hormones, the egg that's destined to ovulate each cycle has to eventually produce enough estrogen to trigger what we call the LH surge. And that happens cyclically in women that are normal.

Host: While we're talking about hormones, what are some of the causes of hormonal imbalance?

Jane Nani, MD (Guest): Yeah, there are some women who may develop problems as they get older and have problems, what we think of as maybe a thyroid imbalance. And most often this runs in families. So many women may understand that maybe their mother has it. It's more common in women, of course. So their mother may have had a thyroid problem.

Now not all thyroid problems lead to abnormal menses, but if they're more pronounced, they can lead you to have absence of ovulation and irregular menses. And that's the hallmark of you're not ovulating.

Host: Okay, and then how do you know if you have a hormonal imbalance that could actually affect your fertility?

Jane Nani, MD (Guest): Let's say you're a, an individual that has had normal cycles every 28 days and all of a sudden they're spacing out. They're going to every 35 days and then the next month 40 days and then 60 days passes. When the cycles become irregular, this is pretty much evidence that you are not ovulating routinely.

The normal ovulatory individual is one who has a regular cyclic flow every month. Of course, the most common reason women miss their period in reproductive years is because they're pregnant. You know, we don't expect you to get your period while pregnant, but yeah, but other than that, yes.

Host: Okay, that's cycles. What about phases? What's the follicular phase and the luteal phase?

Jane Nani, MD (Guest): The follicular phase is the time of the cycle when the follicle is growing to maturity. This is right after the onset of the period. And usually it starts right after the onset of the period that the follicle starts to develop and it starts to produce estrogen. So the follicular phase is that early part of the cycle where the egg is developing but before ovulation and that's what we call the follicular phase and it's characterized exclusively by the development or the increase in estrogen production.

Host: Okay. And the luteal?

Jane Nani, MD (Guest): Luteal phase is the phase right after ovulation when the egg has been released from the ovary, comes down the fallopian tube, and then we call it luteal when the progesterone level goes up. So, progesterone is what characterizes what we call the luteal phase, and that lasts about 14 days total. And then somebody will find out whether they're pregnant, or they'll get their period.

Host: Okay. Boy, you have all the answers, don't you? All right.

Jane Nani, MD (Guest): Well, we've done this a while.

Host: Just a few more for you. When does ovulation typically occur?

Jane Nani, MD (Guest): Normally, ovulation occurs two weeks after the onset of the period. So you know, period by, we should talk about what is it, period. Cycle day one is the day you get the full flow. And again, I've mentioned we don't want to see just spotty. Full flow, red flow, that's cycle day one. And most women are ovulating by the 14th day.

Some are day 12, 13, 14, 15, 16. But in that window, roughly two weeks from the onset of the period is the ovulatory time.

Host: Okay. And so what are the causes of anovulation or the lack or absence of ovulation?

Jane Nani, MD (Guest): You know, sometimes this could be hormonal imbalances. For example, we mentioned thyroid. It could be that somebody unknowingly has too much, what we call prolactin hormone. Now prolactin hormone is the hormone that creates milk and when women are nursing, and sometimes that can go on even when someone's not nursing, go up when someone's not nursing, and that can cause anovulation.

Other things that cause anovulation are too much, what we call androgen or the male hormone; that can lead to anovulation and that's something that some women in reproductive year; it is the most common what we think of as the most common endocrinopathy women of reproductive years is polycystic ovary syndrome and that's what happens with them. Too much androgen hormone and that messes with the ovulation.

Host: Right, right. I know some people can feel it, but how can you figure out when you're ovulating or if you're not ovulating at all?

Jane Nani, MD (Guest): There are some signs of ovulation and not everybody experiences. Some people can feel it but i don't think that's common. But I think what's commonly noted that women should be able to appreciate at mid cycle, this should be at mid cycle, two weeks from the onset of the period, roughly, when the cervical mucus takes on a characteristic change, it becomes more copious and clear color, not white opaquey, and not gummy, but clear, colored like the egg white consistency, slippery like that; that is the ovulatory mid cycle mucus. And a lot of people can appreciate that. That's a sign of ovulation for sure.

Host: All right, switching gears completely, how is sperm made?

Jane Nani, MD (Guest): Interesting. Similar to the hypothalamic pituitary ovarian axis is the hypothalamic pituitary testicular axis, and the testes make the sperm. And interesting, we say women ovulate one egg per month. However, spermatogenesis in the male goes on throughout the life of the male.

About every 70 to 90 days. And they make sperm, not just one, they make sperm by the millions. So

Host: Mm,

Jane Nani, MD (Guest): The normal count is at least 15 million per milliliter of that ejaculate fluid. So that's quite a big difference.

Host: I'm sure. And does sperm production change over time?

Jane Nani, MD (Guest): Generally with men stay healthy, it really does not come to an end. It really doesn't. And you may hear about this sometimes, men can be quite elder. I think of people like Mick Jagger. Ha! You know, they, they have young partners, they still father children. So no, it doesn't really come to an end. As long as they stay healthy as they get older, but some men develop other kind of maladies as they get older and it can interfere with their sperm production.

Host: Anthony Quinn, age 80. Yeah. Okay. Seems unfair. Okay. How do you know if you're not producing sperm?

Jane Nani, MD (Guest): Well, it's really easy for guys. One of the things they should do is just sign up to do what's called a one single semen analysis. They produce a sample. It's a very quick procedure for the most part. We analyze the sperm in terms of overall count. The way it moves, what we call motility, and also how they look under the microscope, and that's referred to as morphology. And they're normal parameters that we look for. And most guys are normal, but every now you catch somebody who's got either a isolated low count or an isolated low morphology, most of these things are treatable.

Host: Okay, and what tests are available to gain a better understanding of your reproductive health?

Jane Nani, MD (Guest): Anybody of any reproductive age wants to understand if they are inherently fertile. For the women, there's tests that we do, right at the onset of the period, this is a single hormone level called the AMH. This will tell us in essence if she's fertile, you know, there's parameters that we look at for that AMH.

We also tend to do an ultrasound on that same day and image the ovaries and that will show us the potential eggs that are there at baseline. Usually when women are younger you have a lot of these at baseline. As you get older, fewer and fewer, but that's really gradual. So for women, it's really a blood test looking at the hormone and an ultrasound.

For a man, it's a semen analysis. You can tell right from those few tests whether you're fertile.

Host: Yeah, knowledge is power. Is there anything else you'd like to add to our conversation?

Jane Nani, MD (Guest): I'd say for young women and older women, it's always a good idea to understand their fertility. Now we say almost all women are inherently fertile. I think it's particularly the years after age 35, where more people, if they're not getting pregnant spontaneously; they may want to pursue taking a look at these, as I mentioned, these few little tests to make sure they are inherently fertile before it gets, before they get it to 45. Let's put it that way.

Host: You are a fount of knowledge. This such great information, Dr. Nani. Thanks so much for being with us today to share your insights and expertise.

Jane Nani, MD (Guest): I'm happy to do so and call on me anytime. Any questions? Thank you.

Host: Sounds great. And you can schedule an appointment to talk to a fertility specialist at 877-324-4483 or visit fcionline.com for more info. If you enjoyed this podcast, you can find more like it in our podcast library and be sure to give us a like and a follow if you do. That's all for this time. I'm Deborah Howell.

Deborah Howell (Host): Have yourself a terrific day.