8+ Days Late? 12 DPO Negative Test: What It Means!


8+ Days Late? 12 DPO Negative Test: What It Means!

A unfavourable end result on a being pregnant take a look at administered 12 days post-ovulation (DPO) signifies the absence of detectable ranges of human chorionic gonadotropin (hCG) within the urine or blood. This hormone is produced by the creating placenta after implantation. Whereas a unfavourable end result at this stage might be discouraging for people making an attempt to conceive, it’s essential to grasp the elements that may affect take a look at accuracy. As an illustration, the sensitivity of the take a look at used and the exact timing of ovulation are key determinants.

The timing of implantation, which generally happens between 6 and 12 DPO, considerably impacts hCG manufacturing. Early implantation permits for faster detection, whereas later implantation might delay the rise in hCG ranges. Moreover, variations in particular person hormone manufacturing charges can affect the timing of a optimistic take a look at end result. Traditionally, correct being pregnant detection relied on ready till a missed menstrual interval; nonetheless, fashionable testing applied sciences permit for earlier, albeit probably much less definitive, outcomes.

Given the complexities outlined above, subsequent sections will delve into the potential causes for a unfavourable consequence at this juncture, discover really useful actions primarily based on particular person circumstances, and supply steering on when to contemplate additional investigation if being pregnant stays a risk.

1. Check Sensitivity

Check sensitivity is a crucial issue when deciphering a unfavourable end result at 12 days post-ovulation. It defines the minimal focus of human chorionic gonadotropin (hCG) a take a look at can reliably detect. Understanding this threshold is crucial for precisely assessing the probability of being pregnant at this early stage.

  • Minimal Detectable hCG Degree

    House being pregnant exams range of their sensitivity, with some detecting hCG ranges as little as 20 mIU/mL, whereas others require ranges of fifty mIU/mL or increased. A much less delicate take a look at might return a unfavourable end result even when being pregnant is current, however hCG ranges are beneath its detection threshold. This distinction in sensitivity instantly impacts the reliability of the take a look at at 12 DPO, when hCG ranges should still be comparatively low.

  • Affect on Early Detection

    The power of a take a look at to detect low concentrations of hCG is essential for early being pregnant detection. At 12 DPO, hCG ranges in pregnant people are sometimes simply starting to rise. A extremely delicate take a look at will increase the chance of detecting these low ranges and offering an correct optimistic end result. Conversely, a take a look at with decrease sensitivity is extra prone to yield a false unfavourable at this stage.

  • Comparability of Check Sorts

    Various kinds of being pregnant exams exhibit various levels of sensitivity. Blood exams, usually administered in a scientific setting, typically supply increased sensitivity in comparison with over-the-counter urine exams. This distinction in sensitivity contributes to the upper accuracy of blood exams in early being pregnant detection. Consequently, if a urine take a look at yields a unfavourable end result at 12 DPO, a blood take a look at may present a extra definitive reply.

  • Affect of Check Expiration and Storage

    The sensitivity of a being pregnant take a look at might be affected by elements akin to its expiration date and the way it has been saved. Expired exams might produce inaccurate outcomes because of the degradation of the reagents used to detect hCG. Equally, improper storage situations, akin to publicity to excessive temperatures, can compromise the take a look at’s sensitivity. Due to this fact, verifying the expiration date and making certain correct storage are important to acquire dependable outcomes.

In abstract, the sensitivity of a being pregnant take a look at performs a pivotal position within the accuracy of outcomes obtained at 12 DPO. Selecting a extremely delicate take a look at and contemplating the potential for elements which will compromise sensitivity are essential steps in precisely deciphering a unfavourable consequence at this early stage of potential being pregnant.

2. Ovulation Timing

Correct willpower of ovulation timing is paramount when deciphering the importance of a unfavourable being pregnant take a look at end result at 12 days post-ovulation (DPO). A miscalculation in ovulation timing can instantly affect the interpretation, probably resulting in a false unfavourable. As an illustration, if ovulation occurred later than initially estimated, a take a look at performed at what’s believed to be 12 DPO might, in actuality, be administered earlier within the implantation window, earlier than hCG ranges have risen sufficiently for detection. The consequence is {that a} non-pregnant state could also be incorrectly inferred.

Varied strategies exist for monitoring ovulation, together with basal physique temperature monitoring, ovulation predictor kits (OPKs), and cervical mucus remark. Nonetheless, every methodology carries a level of inherent variability and potential for error. For instance, OPKs detect the luteinizing hormone (LH) surge that precedes ovulation, however the exact time of ovulation following the surge can range by 12-48 hours. Basal physique temperature monitoring confirms ovulation retrospectively, offering much less predictive accuracy for the present cycle. These inaccuracies in ovulation monitoring underscore the significance of contemplating a variety of potential ovulation dates reasonably than counting on a single, definitive timepoint when deciphering take a look at outcomes.

In conclusion, the accuracy of ovulation timing profoundly influences the interpretation of a unfavourable take a look at at 12 DPO. A delayed ovulation, even by a day or two, can considerably scale back the probability of hCG detection at this stage. Due to this fact, people experiencing a unfavourable end result ought to take into account the potential of a miscalculated ovulation date and, if being pregnant continues to be suspected, repeat testing a number of days later or seek the advice of with a healthcare skilled for additional analysis.

3. Implantation Window

The implantation window, the interval throughout which the uterine lining is receptive to embryo implantation, considerably influences the end result of being pregnant exams performed round 12 days post-ovulation. The timing of this window, usually occurring between 6 and 12 days post-ovulation, instantly impacts the presence and focus of human chorionic gonadotropin (hCG), the hormone detected by being pregnant exams.

  • Timing Variability

    The exact timing of the implantation window can range amongst people. Whereas it typically falls inside the 6-12 DPO vary, deviations can happen. If implantation happens later inside this window, and even barely outdoors it, hCG manufacturing will not be adequate for detection by 12 DPO. This variability contributes to the potential for a false unfavourable end result at this stage.

  • Affect on hCG Ranges

    Implantation marks the start of hCG manufacturing by the creating placenta. The sooner implantation happens, the earlier hCG ranges start to rise. Conversely, delayed implantation leads to a later surge in hCG. A being pregnant take a look at administered at 12 DPO might not detect being pregnant if implantation occurred on day 11 or 12, as hCG ranges may nonetheless be beneath the take a look at’s detection threshold.

  • Elements Affecting Implantation

    A number of elements can affect the success and timing of implantation, together with uterine lining thickness and receptivity, hormonal steadiness, and embryo high quality. Suboptimal situations can delay or forestall implantation, thereby impacting hCG manufacturing and the accuracy of early being pregnant exams. Situations akin to skinny endometrium or hormonal imbalances can impede implantation.

  • Medical Implications

    In assisted reproductive applied sciences (ART), akin to in vitro fertilization (IVF), the timing of embryo switch is fastidiously coordinated with the girl’s cycle to maximise the probability of profitable implantation. Nonetheless, even with exact timing, variations within the implantation window can nonetheless have an effect on being pregnant outcomes. A unfavourable take a look at at 12 DPO following an embryo switch doesn’t definitively rule out being pregnant, and additional testing is often really useful.

In abstract, the implantation window’s timing is a crucial determinant within the reliability of being pregnant exams performed at 12 DPO. Variations in implantation timing, influenced by a large number of things, can result in a unfavourable end result regardless of the presence of a viable being pregnant. Understanding the interaction between the implantation window and hCG manufacturing is crucial for precisely deciphering early being pregnant take a look at outcomes.

4. hCG Manufacturing Fee

The speed at which human chorionic gonadotropin (hCG) is produced following implantation has a direct bearing on the reliability of being pregnant exams, notably round 12 days post-ovulation (DPO). A unfavourable take a look at at 12 DPO might stem from inadequate hCG manufacturing to achieve the detection threshold of the take a look at. This underscores the importance of understanding particular person variations in hCG manufacturing charges. As an illustration, if implantation happens on the sooner aspect of the window (6-7 DPO), hCG ranges typically rise extra quickly. Nonetheless, ought to implantation be delayed to 10-12 DPO, the corresponding hCG enhance might not attain a detectable focus by 12 DPO, resulting in a unfavourable end result, even in a viable being pregnant. This cause-and-effect relationship highlights that the timing of hCG enhance, decided by the speed of manufacturing, is a crucial element in deciphering a unfavourable end result at 12 DPO.

Variations in hCG manufacturing might be attributed to a number of elements. The well being and viability of the creating embryo play a task, as more healthy embryos are likely to provoke extra sturdy hCG synthesis. Moreover, particular person physiological variations affect hormone manufacturing. Some people naturally exhibit slower preliminary hCG manufacturing charges in comparison with others. In instances of ectopic being pregnant, the hCG manufacturing charge could also be considerably decrease than in intrauterine pregnancies, typically leading to delayed or faint optimistic take a look at outcomes. Moreover, sure drugs or underlying medical situations can have an effect on hormone manufacturing, additional complicating the interpretation of early being pregnant exams. The sensible software of this understanding is {that a} single unfavourable take a look at at 12 DPO just isn’t at all times definitive and requires additional analysis, particularly if there are threat elements or a powerful suspicion of being pregnant.

In abstract, the hCG manufacturing charge is a key determinant within the accuracy of early being pregnant detection. A unfavourable end result at 12 DPO can typically be attributed to inadequate hCG ranges, ensuing from both late implantation or slower-than-average hCG synthesis. The problem lies within the variability of those elements amongst people. Due to this fact, repeating the take a look at after just a few days or consulting with a healthcare skilled is advisable to verify the end result and rule out potential issues, thereby linking the understanding of hCG manufacturing charge to the broader aim of correct and well timed being pregnant analysis.

5. Check Accuracy

The accuracy of being pregnant exams considerably influences the interpretation of outcomes obtained at 12 days post-ovulation (DPO). Whereas exams are designed to detect the presence of human chorionic gonadotropin (hCG), variations of their efficiency and potential for error can result in inaccurate outcomes, together with false negatives.

  • Sensitivity and Specificity

    Check accuracy is outlined by its sensitivity and specificity. Sensitivity refers back to the take a look at’s capability to accurately establish a being pregnant when it’s current, minimizing false negatives. Specificity, then again, displays the take a look at’s capability to accurately establish the absence of being pregnant, minimizing false positives. Decrease sensitivity will increase the probability of a false unfavourable at 12 DPO, particularly when hCG ranges could also be low. Due to this fact, understanding the sensitivity and specificity of a take a look at is crucial for correct interpretation.

  • Affect of Consumer Error

    Consumer error constitutes a major issue affecting take a look at accuracy. Incorrect execution of the take a look at process, akin to improper timing or inadequate pattern assortment, can compromise the end result. Moreover, misinterpretation of the take a look at end result, notably with faint traces, can result in inaccurate conclusions. Adhering strictly to the producer’s directions is crucial for minimizing user-related errors and enhancing the reliability of the end result at 12 DPO.

  • Interference from Exterior Substances

    Sure exterior substances and drugs can intervene with being pregnant take a look at outcomes. Diuretics, for instance, can dilute urine, probably decreasing hCG focus and resulting in a false unfavourable. Moreover, some drugs containing hCG could cause false positives. Due to this fact, people ought to concentrate on potential interferences and disclose any drugs or substances used when discussing take a look at outcomes with a healthcare supplier.

  • Check Storage and Expiration

    Improper storage situations and expired take a look at kits can compromise the integrity of the take a look at reagents, impacting accuracy. Publicity to excessive temperatures or humidity can degrade the reactive parts, resulting in unreliable outcomes. Likewise, utilizing a take a look at past its expiration date will increase the probability of inaccurate outcomes. Reviewing storage tips and expiration dates is crucial to make sure the take a look at’s validity at 12 DPO.

In abstract, take a look at accuracy is a multifactorial facet essential for accurately deciphering being pregnant take a look at outcomes at 12 DPO. Sensitivity, specificity, consumer error, interference from exterior substances, and storage situations all play a task in figuring out the reliability of the take a look at. Recognizing these elements may also help people make knowledgeable choices about retesting or searching for additional medical recommendation primarily based on their particular circumstances.

6. Doable Error

The potential for error is an intrinsic ingredient within the interpretation of a unfavourable being pregnant take a look at end result at 12 days post-ovulation (DPO). These errors can originate from numerous sources, every contributing to a probably inaccurate evaluation of being pregnant standing. Comprehending the character and origins of those errors is crucial for people searching for to interpret take a look at outcomes precisely.

  • Check Execution Errors

    Improper execution of the take a look at protocol represents a major supply of error. This consists of inadequate urine pattern, timing inaccuracies in studying the take a look at end result, and failure to observe the producer’s directions exactly. For instance, studying the take a look at earlier than or after the really useful timeframe can result in a false unfavourable. The implications of such errors within the context of a unfavourable end result at 12 DPO are substantial, probably inflicting undue nervousness or untimely cessation of fertility remedies.

  • Faulty Check Kits

    Though uncommon, the potential of a faulty take a look at package contributing to an inaccurate end result exists. Manufacturing defects, improper storage resulting in reagent degradation, or expiration of the take a look at can all compromise its accuracy. As an illustration, a take a look at saved in excessive humidity may yield unreliable outcomes. That is particularly related at 12 DPO, the place early detection is essential, and a defective take a look at may result in a false sense of safety.

  • Physiological Interference

    Sure physiological elements can intervene with take a look at accuracy. Extreme fluid consumption resulting in diluted urine can scale back hCG focus, leading to a false unfavourable, notably at 12 DPO when hCG ranges could also be marginally detectable. Equally, sure medical situations or drugs might affect hormone ranges, though that is much less frequent. Understanding these potential interferences is significant in accurately deciphering a unfavourable end result.

  • Ovulation Miscalculation

    As mentioned beforehand, inaccurate estimation of the ovulation date can considerably affect the interpretation of a unfavourable take a look at at 12 DPO. If ovulation occurred later than initially believed, the take a look at is perhaps carried out prematurely, earlier than hCG ranges have risen to detectable concentrations. For instance, relying solely on calendar strategies with out confirming ovulation with ovulation predictor kits or basal physique temperature monitoring can result in miscalculations. It is a crucial consideration when evaluating a unfavourable end result at this early stage.

In conclusion, the interpretation of a unfavourable consequence at 12 DPO should take into account the potential for error stemming from take a look at execution, package defects, physiological elements, and ovulation miscalculations. Recognizing and mitigating these potential sources of error enhances the accuracy of being pregnant evaluation and guides subsequent actions, akin to retesting or searching for medical recommendation, thereby enriching the understanding of a unfavourable end result at this important stage.

7. Re-testing Timeline

Following a unfavourable end result on a being pregnant take a look at at 12 days post-ovulation (DPO), establishing an applicable re-testing timeline is crucial. This timeline ought to account for the physiological variables influencing hormone detection and the potential for initially inaccurate outcomes. The next sections element elements influencing the willpower of this timeline.

  • Organic Variability and hCG Ranges

    Human chorionic gonadotropin (hCG) manufacturing reveals particular person variations. Implantation timing, which generally happens between 6-12 DPO, influences the initiation of hCG synthesis. Consequently, even with a viable being pregnant, hCG ranges could also be beneath detectable thresholds at 12 DPO. Re-testing must be timed to permit for adequate hCG accumulation if implantation occurred later inside the typical window. Ready at the least 48-72 hours submit the preliminary unfavourable take a look at supplies a extra correct evaluation, as hCG ranges typically double each 2-3 days in early being pregnant.

  • Check Sensitivity Concerns

    The sensitivity of the being pregnant take a look at used impacts the re-testing timeline. Much less delicate exams might require increased hCG concentrations to yield a optimistic end result. If a low-sensitivity take a look at was used initially, switching to a extra delicate take a look at throughout re-testing can enhance the possibilities of correct detection. Regardless, permitting just a few days for hCG ranges to extend stays essential. A second take a look at, carried out with a extra delicate assay, might present a definitive reply after the re-testing interval.

  • Affect of Luteal Part Size

    The size of the luteal part, the interval between ovulation and menstruation, varies amongst people. A shorter-than-average luteal part might immediate earlier menstruation, rendering additional testing pointless. Conversely, an extended luteal part warrants continued monitoring, particularly if signs suggestive of being pregnant persist regardless of the preliminary unfavourable end result. Adjusting the re-testing timeline primarily based on typical cycle traits permits for a extra tailor-made strategy to being pregnant detection.

  • Medical Steerage and Intervention

    Persistent unfavourable outcomes, coupled with indications of being pregnant or considerations relating to fertility, necessitate medical session. A healthcare skilled can assess particular person circumstances, conduct blood exams for quantitative hCG measurement, and rule out ectopic being pregnant or different issues. Looking for medical steering ensures applicable diagnostic measures and avoids extended uncertainty when preliminary dwelling exams are inconclusive. Subsequent interventions might embrace ultrasound imaging if blood exams point out a potential being pregnant however location must be decided.

In conclusion, figuring out the re-testing timeline following a unfavourable consequence at 12 DPO requires cautious consideration of organic variability, take a look at sensitivity, cycle traits, and potential medical interventions. By accounting for these elements, people can optimize the accuracy of subsequent exams and make knowledgeable choices relating to their reproductive well being. The target is to steadiness the need for early detection with the necessity for dependable and conclusive outcomes.

8. Various Causes

A unfavourable being pregnant take a look at end result at 12 days post-ovulation (DPO) prompts consideration of a number of potentialities past the absence of being pregnant. The presence of sure medical situations or physiological elements can mimic being pregnant signs whereas returning unfavourable take a look at outcomes, thereby necessitating the exploration of different causes. As an illustration, hormonal imbalances, akin to thyroid problems, can manifest signs much like early being pregnant, together with fatigue, temper adjustments, and menstrual irregularities. These situations can lead people to suspect being pregnant, solely to be met with a unfavourable take a look at. Equally, ovarian cysts or current hormonal contraception use can disrupt regular menstrual cycles and hormone ranges, probably delaying or masking menstruation and creating the impression of being pregnant. In such cases, the absence of detectable hCG, as indicated by the unfavourable take a look at, serves as an important diagnostic clue, directing additional investigation towards these various etiologies.

Ectopic being pregnant, though initially producing being pregnant signs and probably a faint optimistic take a look at later, might current with a unfavourable take a look at at 12 DPO if implantation just isn’t occurring within the uterus. The situation requires speedy medical consideration, and a unfavourable take a look at inside the typical window mustn’t fully dismiss the chance, particularly if different signs are current. Moreover, sure drugs, akin to diuretics, can dilute urine and quickly scale back hCG focus, probably leading to a false unfavourable. Psychological elements additionally play a task; stress and nervousness can disrupt menstrual cycles, inflicting delays that mimic being pregnant. Due to this fact, a complete analysis, incorporating medical historical past, bodily examination, and probably additional diagnostic testing, turns into crucial when confronted with a unfavourable take a look at at 12 DPO alongside persistent pregnancy-like signs.

In abstract, whereas a unfavourable take a look at at 12 DPO typically signifies the absence of being pregnant, it’s crucial to contemplate and examine various causes that could be accountable for the presenting signs. An intensive differential analysis, guided by a healthcare skilled, can guarantee correct identification of the underlying challenge and immediate applicable administration, whether or not it includes addressing hormonal imbalances, managing underlying medical situations, or offering psychological help. Acknowledging the position of those various causes enhances the scientific utility of early being pregnant testing and promotes holistic affected person care.

Incessantly Requested Questions

The next questions deal with frequent considerations and misconceptions surrounding a unfavourable being pregnant take a look at end result at 12 days post-ovulation (DPO). The solutions supplied intention to supply readability and information knowledgeable decision-making.

Query 1: What’s the probability of being pregnant regardless of a unfavourable take a look at at 12 DPO?

The chance of being pregnant with a unfavourable take a look at at 12 DPO is diminished however not eradicated. A number of elements, together with variations in implantation timing, particular person hCG manufacturing charges, and take a look at sensitivity, can affect the accuracy of early outcomes. Repeating the take a look at after just a few days is advisable.

Query 2: What actions are really useful following a unfavourable take a look at at 12 DPO if being pregnant is desired?

If being pregnant continues to be suspected, proceed monitoring for early being pregnant signs. Re-testing in 2-3 days with a extremely delicate take a look at is really useful. If menstruation doesn’t happen and subsequent exams stay unfavourable, seek the advice of a healthcare skilled for additional analysis.

Query 3: How does take a look at sensitivity affect the accuracy of a unfavourable end result at 12 DPO?

Decrease take a look at sensitivity can result in false unfavourable outcomes at 12 DPO, as hCG ranges could also be beneath the detection threshold. Utilizing a take a look at with a sensitivity of 20 mIU/mL or decrease is preferable for early detection. Nonetheless, even with a delicate take a look at, timing stays essential.

Query 4: What are the potential non-pregnancy associated causes for signs mimicking early being pregnant whereas testing unfavourable?

Hormonal imbalances, thyroid problems, stress, and up to date hormonal contraception use can produce signs much like early being pregnant. These situations can disrupt menstrual cycles and hormone ranges, creating the impression of being pregnant regardless of the absence of hCG.

Query 5: Is a blood take a look at extra dependable than a urine take a look at following a unfavourable dwelling take a look at at 12 DPO?

Blood exams, notably quantitative hCG assays, typically supply increased sensitivity in comparison with urine exams. They’ll detect decrease ranges of hCG and supply a extra definitive evaluation of being pregnant standing. Consulting with a healthcare supplier for blood testing is advisable if considerations persist.

Query 6: What steps must be taken if subsequent exams stay unfavourable, however there may be nonetheless a powerful suspicion of being pregnant?

Persistent unfavourable outcomes, coupled with ongoing being pregnant signs, necessitate medical analysis. A healthcare skilled can conduct a complete evaluation, rule out ectopic being pregnant or different issues, and advocate additional diagnostic measures, akin to ultrasound imaging.

A unfavourable end result at 12 DPO necessitates cautious consideration of particular person elements and take a look at traits. Re-testing and medical session, when applicable, guarantee correct evaluation and knowledgeable administration.

The next part will present a abstract of key takeaways and actionable suggestions primarily based on the knowledge introduced to this point.

Navigating a Unfavorable Outcome

The interpretation of a unfavourable being pregnant take a look at at 12 days post-ovulation (DPO) requires cautious consideration. The next factors supply strategic steering for navigating this example.

Tip 1: Affirm Ovulation Timing Exact willpower of ovulation is paramount. If utilizing ovulation predictor kits, correlate outcomes with basal physique temperature monitoring to validate timing accuracy.

Tip 2: Assess Check Sensitivity Decide the sensitivity degree of the take a look at used. A take a look at with a sensitivity of 20 mIU/mL or decrease is most well-liked for early detection. Much less delicate exams might require increased hCG concentrations.

Tip 3: Repeat Testing Strategically Following a unfavourable end result at 12 DPO, re-test after 48-72 hours. This timeframe permits for potential hCG doubling if being pregnant is current. Preserve constant testing situations.

Tip 4: Take into account Various Causes Examine non-pregnancy associated elements which will trigger pregnancy-like signs. Discover hormonal imbalances, thyroid problems, or treatment unintended effects with a healthcare supplier.

Tip 5: Search Quantitative Blood Testing If uncertainty persists, request a quantitative hCG blood take a look at from a healthcare skilled. Blood exams supply elevated sensitivity and accuracy in comparison with urine exams.

Tip 6: Consider Luteal Part Size A shorter-than-average luteal part might point out earlier menstruation, whereas an extended part warrants continued monitoring. Adapt the re-testing timeline primarily based on typical cycle traits.

Tip 7: Doc Check Outcomes and Signs Preserve a meticulous file of take a look at dates, outcomes, and any skilled signs. This documentation supplies beneficial info when consulting with a healthcare supplier.

The secret’s to grasp {that a} unfavourable end result at 12 DPO just isn’t definitive and warrants additional analysis primarily based on particular person circumstances. Knowledgeable decision-making is crucial.

The next article part supplies concluding ideas and complete suggestions.

Concluding Evaluation of a 12 DPO Unfavorable Check

The investigation right into a “12 dpo unfavourable take a look at” has revealed a multifaceted state of affairs requiring nuanced interpretation. It has been demonstrated {that a} unfavourable consequence at this juncture just isn’t invariably indicative of the absence of being pregnant. The confluence of things, encompassing take a look at sensitivity, ovulation timing inaccuracies, variability in implantation home windows, and particular person hormone manufacturing charges, can collectively affect the accuracy of early being pregnant detection. Due to this fact, a definitive conclusion can’t be drawn solely primarily based on a single take a look at administered at this early stage.

Given the inherent complexities and potential for error, it’s incumbent upon people experiencing a unfavourable end result to contemplate the broader context of their reproductive well being. Subsequent testing, coupled with skilled medical evaluation, stays important for making certain correct analysis and knowledgeable decision-making. The knowledge contained inside this exploration underscores the need for a cautious and evidence-based strategy when deciphering early being pregnant take a look at outcomes, emphasizing that complete analysis, reasonably than remoted findings, is the important thing to successfully managing reproductive well being considerations.