I am 45 years old and have four children. The youngest was born when I was 43. My husband and I have been trying unsuccessfully to become pregnant again. In the past 10 months we have tried fertility drugs and insemination. My question is this: About two to four days after I ovulate, I have cramping, like menstrual cramps. The cramps come and go for about three days and then stop. I menstruate 14 days after ovulating. What is this midcycle cramping? I have never had it until this last year. Does this cramping have something to do with why I am not becoming pregnant?

-- Joy

I cannot be certain as to the cause of your midcycle discomfort. It is likely due to ovulation. Pain occurring at this time is due either to leakage of the follicular fluid, or due to the enzymes that dissolve the outer wall of the ovary surrounding the follicle to let the egg escape.

After ovulation induction, the ovaries can swell, and your pain may be related to post-ovulation ovarian enlargement. This can best be determined by ultrasound. Some women with endometriosis can also experience pain beginning midcycle. A review of your symptoms as well as a transvaginal ultrasound may enable your doctor to determine the cause of your discomfort.

As to why you are not conceiving, it is most likely your age. Very rarely are 45-year-olds successful without the use of donor eggs. If you haven't already done so, you should undergo a clomiphene challenge test and day 3 FSH testing to evaluate ovarian reserve.