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Normal Menstrual Cycles and Timing Intercourse

Image by Sarah Pflug

In reality, there is no normal!! The menstrual cycles and timing intercourse begins and ends with menstruation and is divided by ovulation into the follicular and luteal phases. The fertile window, during which there is a probability of conception from unprotected sex, is defined as the day of ovulation and the 5 days preceding it (the time window for sperm survival).

All available data suggests that there may be significant variability in fertile days- i.e.. not exactly 14 days before your next period!

We suggest tracking your basal body temperature AND your LH surge to determine your fertile days- and really try to determine if you are getting ovulation each month to time intercourse very well.

Late Ovulation

Late ovulation is when you ovulate (i.e. your ovary releases an egg) after day 21 of your menstrual cycle. Women with regular cycles consistently have periods every 21 to 35 days. … Very rarely, women have a normal 28-day cycle but ovulate around day 17, 18, or 19 instead of around day 14.

In true late ovulation, you will have a short luteal phase. Some doctors think that the uterus may not have enough time between cycles to build up its lining for an embryo to attach. That could theoretically lower your odds of getting pregnant, but it’s far from certain.

Any time your cycles are long and irregular, it’s a good idea to check in with your doctor to rule out PCOS, hyperprolactinemia or hypothyroidism. Getting treatment for these conditions can greatly increase your chances of getting pregnant and having a healthy pregnancy.

Azoospermia: TESE, MESA, and PESA

In some individuals, spermatozoa may not be present in the ejaculate. This condition is called Azoospermia. This can be either due to problems in sperm production itself or due to obstruction to the flow of semen during ejaculation. Reproductive tract obstruction can be acquired – as a result of infection, trauma, iatrogenic injury which can occur during bladder neck, pelvic, abdominal or inguino-scrotal surgery.

Congenital anomalies may be relatively uncommon in the general population, but can occur in up to 2 percent of infertile men. Best known condition is congenital bilateral absence of the vas deferens (CBAVD) which occurs in almost all men with cystic fibrosis.

Two techniques – Epididymal sperm retrieval & micromanipulation have revolutionized treatment of male infertility in the past decade. Men with congenital bilateral absence of the vas defences (CBAVD) or reproductive tract obstruction are now able to achieve pregnancies with use of these advanced techniques. You must know the normal Menstrual Cycles and Timing Intercourse.


PESA or Percutaneous Epididymal Sperm Aspiration (PESA), does not require a surgical incision. A small needle is passed directly into the head of the epididymis through the scrotal skin and fluid is aspirated. The embryologist retrieves the sperm cells from the fluid and prepares them for ICSI.


Microsurgical Epididymal Sperm Aspiration (MESA) is used in conditions like obstructive azoospermia, involving dissection of the epididymis under the operating microscope and incision of a single tubule. Fluid spills from the Epididymal tubule and pools in the Epididymal bed. This pooled fluid is then aspirated. Because the epididymis is richly vascularized, this technique invariably leads to contamination by blood cells that may affect sperm fertilizing capacity in vitro.


TESE or testicular sperm extraction is a surgical biopsy of the testis whereas TESA or testicular sperm aspiration is performed by inserting a needle in the testis and aspirating fluid and tissue with negative pressure. The aspirated tissue is then processed in the embryology laboratory and the sperm cells extracted are used for ICSI.