What is the definition of infertility for women? 

The general definition of infertility is when a woman and her partner have had unprotected intercourse for 12 months and have not been able to get pregnant.  There are other considers to take into account such as medical history, advanced maternal age or other physical female conditions that don’t fit into this definition of infertility.  As an example, for women over the age of 35year, the definition may be unprotected intercourse for 6 months without getting pregnant. The greatest risk factor for infertility is a women’s age.

 

How common is infertility in women?

11% of women are affected by infertility. For women with infertility, it can be due to the inability to produce a healthy egg, an egg may be unable to travel to the uterus or can be unexplained. 40% of infertility is caused by these “female factor”.  10% of couples have unexplained infertility, not identifying a female or male factor.

 

What are some of the causes for female fertility?

A variety of medical issues can contribute to female fertility problems, including:

• Conditions affecting ovulation
• Endometriosis — a condition in which tissue that normally lines the inside of the uterus (endometrium) grows outside the uterus
• Bands of scar tissue between pelvic organs (pelvic adhesions) caused by a previous surgery or infection
• Blockage of the fallopian tubes, often caused by pelvic inflammatory disease, or a tubal abnormality
• Excessive prolactin in the blood (hyperprolactinemia)
• Conditions affecting the uterus

 

How do male partners affect fertility?

40% of infertility is due to what is called “male factor” and occurs from an abnormal semen analysis.  The shape, volume and motility of the sperm can be abnormal making it impossible to fertilize a woman’s egg.

 

What are some of the causes of male infertility

“Male factor” affects 40% of infertile couples—A semen analysis (SA) analyzes the shape, motility and volume of your partner’s semen to see if they are normal. It may be your partner is the cause of your inability to conceive, in which case it’s time for him to pay extra special attention to any harmful lifestyle habits. There are many things that can affect a man’s sperm count, including:

• Recreational drugs, including marijuana and cocaine
• Medication, including Propeica (Minoxidil), chemotherapy and radiation therapy
• Varicocele, which is an enlargement of the veins of a man’s testicle
• Smoking cigarettes
• Heavy alcohol use
• Pesticides, lead, and other environmental toxins
• Genetic factors
• Obesity
• Stress
• Serious medical conditions, including mumps, kidney and hormonal abnormalities 

 

Getting a semen analysis is an easy first step to see if your male partner has high quality sperm and proper motility—that is to say, if your partner is the culprit in your inability to conceive. 

 

Does advanced paternal age matter? 

Yes, it does. Age matters for men—just like it does for women—when it comes to fertility. Not only does a man’s age matter when his female partner is trying to conceive, but older sperm has been associated with a higher rate of “psychological disorders and developmental conditions like autism.” A JAMA Psychiatry study from 2013 found: “Kids born to men over 45 were 3.5 times more likely to be diagnosed on the autism spectrum and 13 times more likely to be diagnosed with ADHD than those born to the same men when they were 20 to 24.”

 

Does meeting the diagnostic criteria for infertility necessarily mean women or couples will never be able to get pregnant? 

Up to 90% of infertile couples will get pregnant and delivery a healthy baby. Once the diagnosis is made and an infertility treatment is given, a successful pregnancy will occur in the vast majority of cases. Identifying and correcting the problem is half the battle for these couples. 

 

What do you typically say to women who are given a clinical diagnosis of infertility?

A diagnosis of infertility can be devastating and stressful for a couple.  It’s important to be supportive and empathetic.  I always tell my patients to have a short term and long-term plan with the various infertility options.  

The likelihood of the couple getting pregnant is extremely high but it may take creative medical technology to make it to the finish line.  It may take this delicate group of women (and couples) longer to get pregnant but I can guarantee it will be well worth the wait!

 

What are some of the common factors that affect fertility?

Your fertility is affected by many factors—genetics, age, diet, body weight, lifestyle, medical and contraceptive history and stress. Some of these factors can be controlled more easily than others. 

It’s proven that stress leads to depression and anxiety, which can affect fertility, so in order to reduce stress it’s important to manage it. Relaxation training, mindfulness, yoga and acupressure are successful ways to battle the negative energy and help you towards and through pregnancy.

Lifestyle habits including alcohol, caffeine and smoking affects fertility-limit caffeine to one 12 oz cup a day and stop alcohol and smoking altogether. Smoking not only affects your fertility but also increases your miscarriage rate.  Smoking, especially for a long period of time, leads to poor egg quality and early menopause. Working the night shift may also affect the overall hours you sleep which may affect ovulation.

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Does having irregular periods suggest a fertility problem? 10

Irregular periods can be a potentially serious health concern especially as it relates to fertility. Any abnormal bleeding patterns could be a sign of underlying health conditions such as polycystic ovarian syndrome (PCOS) or premature ovarian failure which can affect your ability to ovulate regularly and conceive naturally.

 

What is polycystic ovarian syndrome (PCOS)?

No one really knows the cause of PCOS. What is known is that there are increases in hormones called androgens and a resistance to another hormone called insulin. High androgen levels, mainly testosterone, cause unwanted hair growth all over the body, oily skin, and acne. The hormone insulin controls the sugar or glucose levels in our blood. Higher blood levels of insulin cause you to feel hungrier which can lead to weight gain and obesity. In women with PCOS, estrogen levels tend to be in the normal range while testosterone is in a higher range than most women.

What are the symptoms of PCOS? 

The long list of symptoms associated with PCOS includes irregular periods, excessive hair growth, obesity, oily skin, acne, infertility, depression and anxiety, male-pattern baldness or thinning hair and infertility are physically and emotionally disruptive. If you are the 5 to 10% of women who suffer horribly from the symptoms of PCOS, there are treatment options available.

 Does PCOS affect fertility?

Yes! The bad news is that PCOS can have a negative impact upon fertility, often by impacting or preventing ovulation, and by increasing the risks for general health issues like weight, insulin resistance, blood pressure etc. The good news is that the fertility issues are very treatable with high success rates. Most women with PCOS may only need oral medications like Clomid or Letrozole to conceive. A healthy lifestyle significantly improves the chances for success with or without fertility treatment. 

How can you treat irregular bleeding caused by PCOS?

There is no cure for PCOS but treatment depends on the symptoms you are experiencing.  Treating each symptom separately will depend on how disruptive and annoying each one is in your life and daily routine.

Polycystic ovarian syndrome (PCOS) is known to cause irregular and troublesome periods. Hormones, including the birth control pill or progesterone, are typically used to regulate and balance out your periods. Long-acting reversible contraceptives also known as LARCS’s, include Depo-Provera, Norplant arm implants and intrauterine devices (IUD’s), are frequently used to control erratic bleeding.   

How can you treat excessive hair growth and acne caused by PCOS?

Spironolactone is a medication used to help control excessive hair growth.  The birth control pill is also helpful to treat unwanted hair. Alternatively, electrolysis and laser hair removal are ways to permanently get rid of the extra hair. 

A skin doctor or dermatologist may be the best way to avoid severe acne.  Anti-androgens (decreasing testosterone), such as spironolactone, can help reduce hair growth and acne.  Anti-androgens, antibiotics and special medicated skin washes are also used to keep the acne under control.

How do women with PCOS, who have irregular periods, get pregnant?

Since those with PCOS do not ovulate regularly getting pregnant can be tricky.  There are a number of medications you can take to ovulate more regularly.   Clomid is the most common medication to get your ovaries ready to cooperate with ovulation and pregnancy.  Clomid is given to help you ovulate regularly, making the egg available to become fertilized. If Clomid fails, Metformin and gonadotrophins are next on deck to get your ovaries working properly.  

How can you treat obesity caused by PCOS?

Many women with PCOS have a challenging time losing weight and tend to be overweight or obese.  For a teen this is not only frustrating but isolating and depressing. Seeing a nutritionist is often the best approach to making successful food choices and achieving weight loss. Eating foods that are plant based, nutrient-rich, fresh and unprocessed along with healthy fats is an ideal diet focusing on a lifelong diet strategy. Controlling your weight helps control irregular periods, excess hair growth and acne. 

 

 What can you do to prevent problems from PCOS during conception and pregnancy?

See your doctor! Preferably one that is very comfortable with treating patients with PCOS – a board-certified Reproductive Endocrinologist, is a good place to start. Try to optimize your sleep, your diet and get some exercise. Don’t focus too much on weight but do focus on getting at least 7-8 hours a night of good quality sleep, try to get in a lot of veggies and avoid sugar and processed foods, drink at least 2 liters of water a day and get at least 150 minutes a week of moderate intensity exercise. Remember that a good exercise plan includes a balance of cardio, strength, flexibility and balance. Women with PCOS really benefit from strength training. Strong core and upper and lower body strength help to lower insulin resistance, which supports your fertility and will lower your risk for gestational diabetes, help you carry your pregnancy well, help labor and delivery and post partum recovery. You do not have to be a gym rat but regular exercise is great for your mind and body and can make a huge difference for women with PCOS. 

 

How does maternal age affect fertility?

Fertility declines progressively with age. Fertility peaks between the ages of 20 to 24.  The aging of eggs is a well-known biological phenomenon and what is referred to as our “biological clock”. We know that fertility declines significantly in the mid-30’s and declines even more, closer to 40. Around 40yr, the ticking becomes louder and by 45, it can be deafening. Over the age of 40y, the eggs are less available and are of poor genetic quality. After 35year fertility declines quickly, especially as you get closer to 40year. Over 40year a woman will have a 50% miscarriage rate due to poor egg quality and quantity. 

 Women over the age of 45y have a less than 1% chance of getting pregnant each month.  If you are 45years old and trying to conceive, you will have a greater than 80% chance of a having a miscarriage, compared to a woman under 30yr who will have a less than 20% of having one.

 

How does obesity effect fertility?

Being over or underweight can affect fertility by causing hormonal disruption and being a major obstacle in getting pregnant. If you have BMI in the obese range or over 30 this will increase your risk for infertility due to ovulation problems.

 

If you are underweight, with a BMI <17, you have a low amount of body fat which causes irregular ovulations.  Irregular ovulations make it challenging to get pregnant. Studies have also shown that if you are obese or underweight there may be abnormalities related to the egg quality.

Maintaining a healthy weight increases your chance of having regular ovulation

 

What role can an OB-GYN play in helping an obese woman conceive?

Checking to make sure your patient’s BMI isn’t over 30 is helpful in avoiding hormonal disruptions that can negatively impact ovulation. Maintaining a healthy weight increases her chance of having regular ovulation and affords her a better chance of becoming pregnant.

Educating your patient is the most important thing you can do to help your patient and her partner get pregnant in a healthy way.

 

Is weight a factor in having a healthy pregnancy/carrying to term? 

 

It’s clear that gaining the right amount of weight during pregnancy involves eating a healthy and balanced diet so the baby is getting all the nutrients he or she needs and is growing at a healthy rate. In general, you will need to consume 100 to 300 more calories a day to meet the needs of a growing baby.  A woman should gain about 2 to 4 pounds during the first three months of pregnancy and 1 pound a week for the remainder of the pregnancy.

Guidelines for weight gain during a singleton pregnancy are as follows:

• Underweight women (BMI < 18.5) should gain 28-40 pounds.
• Normal-weight women (BMI, 18.5-24.9) should gain 25-35 pounds.
• Overweight women (BMI, 25-29.9) should gain 15-25 pounds.

Obese women (BMI, 30 or higher) should gain 11-20 pounds

 

Obese women have to start eating healthy foods, exercising regularly and maintaining a healthy BMI long before a planned pregnancy if they want to reduce pregnancy related complications due to obesity and excessive weight gain during pregnancy.   Not gaining enough weight during pregnancy can lead to a low-birth-weight baby and preterm labor. Women who have trouble gaining weight during pregnancy have to work closely with a nutritionist and high-risk obstetrician.

Obese women have to follow the strict guidelines in controlling their daily calorie requirement, limit weight gained and exercise regularly to minimize the complications of miscarriage, gestational diabetes, hypertension, pre-eclampsia, preterm labor, larger babies, shoulder dystocia, and C-sections. 

Obesity is an epidemic for women in the US. Since studies show that 50% of obese women gain more than the recommended weight gain during pregnancy it’s so important to stay focus and disciplined during pregnancy.  By starting before pregnancy, obese women will also reduce their risk of heart disease, diabetes, high blood pressure, cancer and other health problems.

 

What should women looking to start trying bear in mind in terms of their lifestyle habits? 

 

It’s best to plan at least 6-9 months ahead of actually getting pregnant so you can be your healthiest self before carrying your most vulnerable passenger. Women have to start eating a colorful and healthy diet, exercising regularly and maintaining a healthy BMI long before a planned pregnancy if they want to reduce pregnancy related complications due to obesity and excessive weight gain during pregnancy.  Working with a knowledgeable doctor and nutritionist who can support you and the baby will ensure a healthy outcome for both of you.

 

How does sexually transmitted infections affect fertility? 

Preventing sexually transmitted infections by practicing safe sex is important when it comes to fertility. Pelvic Inflammatory Disease “PID” is a common pelvic disease caused by sexually transmitted infections (STI’s) including Gonorrhea, Chlamydia and Syphilis.  A history of Pelvic Inflammatory Disease (PID) can lead to scarring and blockage of the fallopian tubes which can negatively affect the transport of the egg to meet the sperm, sabotaging conception. The fertilization of the egg by the sperm happens in the fallopian tube so knowing you have a history of PID can be concerning as it relates to the success of conception. Any of these STI’s can cause serious and, potentially, long term reproductive problems that include chronic pelvic pain and infertility. 

 

 What is endometriosis?

Endometriosis can affect menstruating women of all ages.  It’s known to affect 11% of women between the ages of 15 to 45y.  

Endometriosis is where tissue that normally lines the uterus is found outside the uterus. “Endometrial implants”, as they are referred to, can be found on the ovaries, fallopian tubes, bowels, bladder and anywhere else in the pelvis. 

It’s believed that 6 ½ million, or 11%, of women in the United States have endometriosis. This translates to 1 in 10 women. 30-50% of women with endometriosis may suffer from infertility.

 

How does endometriosis affect fertility?  

Endometriosis is found anywhere outside the uterus which can lead to scaring of the fallopian tubes. The egg travels into the fallopian tubes where it is fertilized by the sperm. If there is scaring and filmy adhesions of the delicate fallopian tubes  from endometriosis this can affect the egg’s ability to transport successfully to find the sperm. The scarring and blockage of the fallopian tubes can led to infertility.  

40% of women with infertility have endometriosis. Studies show a 3-to-11-year delay in diagnosis from the first onset of symptoms to the final diagnosis of endometriosis.

 

What are some symptoms of endometriosis?

The most common symptoms of endometriosis are related to pain which can be chronic and disruptive. Symptoms can be described as mild, moderate or severe. Pain is more commonly seen before and during the period and includes painful periods, painful sex, lower back pain and pelvic pain. Also, 40 % of women with infertility have endometriosis. Surprisingly, some women don’t have any symptoms at all!  Women who are not experiencing any symptoms may be “disease free” but it’s impossible to know the extent of endometriosis unless a laparoscopy is preformed to visualize scar tissue or endometrial implants.  The other confusing fact with endometriosis is it can appear microscopic even when performing a laparoscopy.

The onset of symptoms related to endometriosis varies person to person. Symptoms happen as a result of your menstrual cycles. With each period the endometrial implants will bleed no matter where they are located in your body.  The most common symptom is severe menstrual cramps. 

 

How can you treat endometriosis it?

The goal in treating endometriosis is to treat the symptoms. Medication is first used to treat the pain and heavy bleeding. Pain relievers like non-steroidal anti-inflammatory drugs and hormones such as the birth control pill, progesterone IUD or Lupron are recommended. Many believe that keeping your estrogen levels low can help reduce symptoms.  The birth control pill and Lupron help control estrogen levels.  Other lifestyle habits including regular exercise, acupuncture, avoiding excessive alcohol and caffeine all help keep estrogen levels low in the body and help reduce the symptoms associated with mild endometriosis.

Surgery is often needed when multiple medication treatments have failed, the symptoms are chronic and severe or issues related to infertility. Laparoscopy is performed to remove or burn the endometrial implants, which helps treat the symptoms and increases the chance of getting pregnant.

Hysterectomy, with or without removal of the ovaries, is often the last resort for treating women with chronic and disruptive symptoms from severe endometriosis. Endometrial implants can be found on the intestine, bladder, appendix and other surface areas in the pelvis and abdomen, and cause recurrent symptoms even after a hysterectomy (with or without the removal of the ovaries) is performed. The other problem with this elusive disease is endometrial implant can be microscopic meaning they cannot be seen with the naked eye so they may not be removed at the time of surgery.  It is rarely performed since there are effective medical treatments that allow women to live comfortably with mild to moderate endometriosis

 

Can uterine fibroids cause infertility?

Uterine fibroids are the most common benign pelvic tumors in women. Also known as leiomyomas and myomas, the size and shape of these fibroids vary and can be located anywhere in and around the uterus, negatively affecting a woman’s ability to conceive and carry a baby to term.

 

Does having multiple surgeries affect fertility?

A history of multiple pelvic surgeries can lead to widespread scaring and damaging of the fallopian tubes, having the same effect as PID. For example, a ruptured appendix can lead to extensive pelvic scarring, making conception difficult and challenging.

 

My prolactin producing tumor makes my period irregular. Can this cause infertility? 

Pituitary adenomas are benign tumors that can secrete excessive amounts of the hormone prolactin, which disrupts a woman’s period and ovulation. It’s common for women with pituitary adenomas to have irregular periods and difficulty conceiving.  Medications to control elevated prolactin levels, regulate irregular periods and ovulation make it possible to conceive.

 

What medications can affect my ability to conceive?

Medications, including long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin, as well as chemotherapy, radiation and recreational or illegal drug use (i.e., marijuana or cocaine) can hamper a woman’s ability to conceive.

 

Can stress cause infertility?

We know that stress can have a profound effect on one’s life. It can cause poor sleep and eating patterns, excessive drinking, drug use and other unhealthy habits. Stress also leads to depression and anxiety, which can affect fertility; so de-stressing one’s life is imperative on the road to pregnancy. In fact, studies show that infertile women who have undergone ten sessions of relaxation training and stress management had increased rates of pregnancy. (Domar Center at Boston IVF) Along those lines, mindfulness, yoga and acupressure are commonly used in the process to help reduce stress in order to conceive and have a healthy pregnancy. A psychologist can also be useful in uncovering the causes of stress and anxiety.

 

Does depression affect fertility?

     A history of depression and anxiety can increase your chance of infertility. It’s proven that stress leads to depression and anxiety, which can affect fertility. In order to reduce stress, it’s important to manage it. Relaxation training, mindfulness, yoga and acupressure are successful ways to battle the negative energy and help you towards and through pregnancy.

 

  

Are recurrent miscarriages a sign of infertility?

 

More than 2 miscarriages in a row can be a concerning sign of infertility. Only 2% of women will experience 2 miscarriages in a row. Recurrent miscarriages or having 2 or more losses occurs in 1% of women. The biggest risk factor for a miscarriage is being an older mom which means older and less healthy eggs.  The older you are when you conceive the greater the likelihood of having a miscarriage.  The majority of miscarriages (60%) occurs randomly and is due to a genetic abnormality. Women in their late 30’s and early 40’s are more likely to have miscarriages due to genetic abnormalities.

 

Menstrual cycle 101. You gotta know the basics

It is essential to understand when, during your menstrual cycle, you are able to conceive, since it is during the 24-hour period of ovulation that an egg is actually available to be fertilized. 

On average, women have periods every 28 days. Since that is only an average, most women don’t have a perfect 28-day cycle, so it can be challenging to know when an egg is available for conception. Typically, ovulation occurs fourteen days prior to the start of a period.  Some women produce a slimy egg white type discharge during ovulation, while others experience twinges or slight pelvic discomfort—some women may experience both discharge and discomfort. Whatever your “signs,” knowing when your ovulation occurs will make timed intercourse a rather straightforward process—depending on the cooperation and schedule of your partner. 

Since sperm lives up to 5 days, the idea is to have the sperm wait for the egg. For example, if you have determined that you ovulate on Day 15 of your cycle—Day one counting as the first day of your period—then your timed intercourse must be on Day 14, 15 and 16. Having intercourse on these days ensures that the sperm and egg are interfacing—which is basically the medical term for rendezvousing—in the hope of forming an embryo. Additionally, due to that 72-hour lifecycle, some experts suggest having intercourse on Day 10 and then abstaining until Day 14, that way there is fresh sperm ready to find the egg in the fallopian tube, where fertilization takes place.

 

What can be done to prepare yourself for pregnancy?

You and your partner (if you have one) should meet with your gynecologist or healthcare provider 6 months ahead of time to see if you are physically and mentally ready to have a healthy pregnancy.   You and your partner want to be your healthiest self before embarking on the most life changing journey of your lives.

 

• Medical History– A review of your medical history is important to ensure that you don’t have any underlying medical conditions, such as endometriosis, diabetes, high blood pressure, depression and seizures disorders that might cause problems during pregnancy or your unborn baby.  Good control of medical conditions prior to pregnancy is the key to avoid problems that can escalate during pregnancy and the post-partum period.  

 

• Family and Genetic History-Genetic or inherited disorders are important to identify in your family history.  Certain family disorders can put you and your partner at risk of having a child with an unexpected inherited medical condition.  Examples of this include a family history of birth defects, diabetes, seizure disorders, and developmental disabilities. A thorough discussion about your family’s genetic history will ensure nothing can be passed onto the baby. For example, if you or your partner is Jewish you would need to have a Tay Sach test to see if you are a carrier.  
• Controlling your BMI-Women with an abnormally high or low body mass index (BMI) can affect your chance of getting pregnant.  If your BMI is under 18 or over 30 this can cause hormonal disruption that can disrupt ovulation. Maintaining a healthy weight increases your chance of having regular ovulation and a better chance of becoming pregnant.

 

• Medication, Supplements, Herbs and other potential harmful drugs to avoid-Bring your paper bag of over-the-counter and prescription medications and herbs that you and your partner take on a daily basis for review. There are medications you might be taking that could be teratogenic or harmful to the embryo during the early stages of conception. Medications such as Rogaine (Minoxidil) commonly used for hair loss can also affect the quality of the sperm and should not be used during the pre-planning period.  Antibiotics that are commonly used for acene, such as Acutane and Tetracycline, pose potential harmful effects to the developing embryo.  Other OTC medications to avoid include aspirin and ibuprofen. Commonly used herbs to avoid include Dong quai, black cohosh, sassafras and mugwort.  

            

 

• Maternal Age– Fertility declines progressively with age. The aging of eggs is a well-known biological phenomenon and what is referred to as our “biological clock”. As a woman gets closer to 40, the ticking becomes louder and by 45, it can be deafening. Fertility peaks between the ages of 20 to 24.  After 35year fertility declines quickly, especially as you get closer to 40year. Over 40year a woman will have a 50% miscarriage rate due to poor egg quality and quantity. 

 

• Drug use of any kind including marijuana, nicotine, alcohol or other recreational drugs. Surprisingly, substance abuse is one of the leading causes of complications during pregnancy.  These drugs contain chemicals that are harmful during the pre-planning period and pregnancy.  These drugs also have byproducts that are found in the vaginal fluids, affect the quality of sperm and ultimately the ability for the egg and sperm to fertilize. Marijuana use is commonly used as a recreational activity.  Marijuana-smoking makes the sperm hyperactive and less fertile.  Men show smoke marijuana also have a much lower volume of sperm.  Chronic marijuana users have the harmful byproduct, cannabinoid, present in their urine up to 30 days or longer.  The effects of tobacco smoking also effects fertility.  Men who smoke have a lower sperm count and abnormal shaped sperm. Women who smoke have an increased risk of spontaneous miscarriage and possibly ectopic pregnancy.  Pregnant smokers have an increased risk of premature birth, lower birth weight babies and sudden infant death syndrome (SIDS). Marijuana, nicotine or other drug use, all contribute to infertility and should be stopped months prior to attempting pregnancy.  Alcohol use should also be stopped 3 months prior to pregnancy due to its well-known relationship to birth defects.  Bottom line is if you and your partner smoke, drink alcohol, or take drugs it’s time to quit and start becoming your healthiest self.  If your male partner has been a heavy marijuana user he should get his sperm tested to make sure they are healthy and normal.

 

• Caffeine use? This deserves its own section to clarify how caffeine can be consumed in a safe manner.  Moderate caffeine consumption > 200mg/day (12oz cup of brewed coffee) was thought to be a contributing factor in miscarriages and preterm labor. The good news for coffee drinkers is the studies currently do not show that moderate caffeine consumption will lead to an increase miscarriage rate or affect your chance of conceiving.   It’s recommended to limit your caffeine intake to 1 cup of coffee or 2 cups of tea/day during the pre-pregnancy period.  Know how much caffeine is contained in the foods and beverages you eat so you can keep the quantity under 200mg/day which is considered a safe amount before and during pregnancy. 

 

• Recurrent Sexually Transmitted Infections (STI’s)- A history of recurrent STl’s can cause infertility. Pelvic Inflammatory Disease “PID” is a common pelvic disease caused by sexually transmitted infections (STI’s) including Gonorrhea, Chlamydia and Syphilis.  Any of these STI’s can cause serious and potentially long term reproductive problems that include chronic pelvic pain and infertility. It’s important for your health care provider to know your STI history since recurrent infections can lead cause scarring and blockage of the fallopian tubes which can prevent pregnancy. You and your partner should get STI’s tested as part of your routine check list for getting pregnant. 

 

• Avoid yeast or bacterial infections-Keeping the vagina healthy and pH balanced is important when trying to conceive.  Recurrent vaginal infections can negatively change the delicate balance that can affect the helpful mid-cycle egg white discharge that helps the sperm swim upstream into the uterus and to the fallopian tube where fertilization occurs. Plus, having sex with a yeast or bacterial infection can be painful and uncomfortable. Everyday routines including diet, medications, stress, and fragranced body and laundry soaps can disrupt the pH balance making the vagina a hostile place for sperm to get the job done. The vagina is very much like your face – you need a special wash and routine to feel fresh and properly cleanse the area. I have been recommending Summer’s Eve’s Cleansing Wash for over a decade. It’s gentle, balanced to a woman’s pH and works to remove odor-causing bacteria, without leaving any unwanted residue like body washes. They have the most convenient Cleansing Cloths that can be used on-the-go when you can’t shower like after a work-out, before getting intimate with your partner when timed intercourse is most important.  

 

• It’s best for women to start taking folic acid three months before conception. Making sure that your prenatal or multivitamin contains at least includes 400mcg-1mg of folic acid is vital.  Folic acid has been shown to reduce the incidence of spinal defects, aka neural tube defects.  Another recent study showed women who took folic acid preconception also had a reduced incidence of autism. And taking additional omega 3 fish oil helps the healthy development of the fetal brain and visual system.  Additional vitamin D supplementation may also be needed if you are deficient.  Men should also take a prenatal supplement that contains the key vitamins, mineral and anti-oxidants that help reproductive health.

 

What is cervical mucus and why is it important in fertility?

The cervix is made of hard fibrous tissue with glands that secrete fluids to help keep the vagina moist, helps the sperm slide easily into the uterus in search of the egg during ovulation, helps produce a natural sexual lubrication and contracts during orgasm. Cervical mucus is secreted by the cervix when there is the release of the hormone estrogen during ovulation. The cervix sits directly at the back end of the vagina and serves as the gateway into the uterus. The word “cervix” is Latin for “neck”. The face of the cervix is the size of a quarter, its cylinder body is 4cm in length and is the go-between the vagina and uterus. 

Keeping track of your peak day of cervical mucus is the optimal time of ovulation, and the high fertility time of the month. Checking for cervical mucus is an easy and simple way to know if you are on track with ovulation.

 

 How do you check for cervical mucus?

As you get closer to ovulation, the color and consistency changes becoming clearer and slippery and this lasts during the high fertility window which is 3 to 4 day.

After washing your hands, fingers, and nails, you can do a “dip stick” test with your pointer finger. Place it high up into the vagina so you can touch the cervix which feels firm.  The clear, slippery mucus can be checked between your thumb and finger by stretching it to see its consistency. The mucus should look a lot like “egg-whites.  Once ovulation is over, the cervical mucus becomes thicker and whiter as you approach your period.

You may also notice ovulation cervical mucus when wiping yourself after urinating.  

 

What does cervical mucus look like during non-ovulatory times of the month?

While each body is different, cervical mucus generally goes through several stages of consistency:

Dry or sticky-Not yet ovulating.

Creamy-Ovulation may be coming.

  Wet-Close to ovulation

  Raw egg white consistency-Ovulation is approaching. This is the best time to have sex if you want to get pregnant.

 

How does checking cervical mucus work as a birth control? 

The cervical mucus method also known as “the Ovulation Method” or “Billing Method” has you track the consistency, color, texture and quantity throughout the month. During different days of your menstrual cycle, the quality of the cervical mucus will also change. The cervical mucus will become slippery and “egg-white” in appearance before and during ovulation and these would be the days to avoid sexual intercourse.  Once the slippery “egg-white” discharge disappearances the cloudy and sticky mucus is seen having sex is considered safe. The easiest way to identify the changes in cervical mucus is to rub and pull it between your thumb and index finger. 

Many women combine the “Ovulation Method” with the BBT Method to improve the chance of not getting pregnant and minimizing accidents.

 

How does checking your temperature work in finding ovulation?  

A woman’s basal body temperature (BBT) will naturally change during the menstrual cycle. When the egg is released from the ovary during ovulation, the BBT will slightly rise to identify times of high fertility.

If a woman keeps track of her BBT during her menstrual cycles using a special and ultrasensitive temperature tracker, she will be able to detect this subtle rise in body temperature. Tracking the BBT daily during several menstrual cycles, will allow a woman to identify the days of the month she should avoid having vaginal penetration sex to avoid getting pregnant.

 

Is it true that some women use basal body temperature as a natural birth control method? 

Women who have disruptive hormonal side effects from the pill or progesterone IUD, or recurring yeast and UTI’s from barrier methods, like the diaphragm and condoms, may like this alternative choice in preventing pregnancy. 

Natural family planning using the BBT method is cost friendly, with no hormonal side effects and allows you to be in touch with your body’s temperature rhythm. Anything that is considered “natural” often boasts a healthier, side effect-free and overall positive vibe. It may be true but one potential consequence is a higher pregnancy rate which can completely derail that positive vibe.

Some of the downsides using the BBT method to prevent pregnancy is how sensitive your body’s temperature can be when exposed to drinking alcohol, jet lag, illness, poor sleep habits, stress, smoking, sauna, jacuzzi and even using an electric blanket.

BBT planning work best for women who have regular and predictable menstrual cycles.  

How do ovulation predictor kits work?

Ovulation predictor kits are a more reliable and consistent way to determine ovulation.  These kits monitor the amount of luteinizing hormone in the urine what surges 12 to 36 hours before ovulation.   The main advantage in using ovulation kits is they are more accurate and less affected by external variables compared to using BBT.

 

How long does the conception process take, from the moment the egg meets the sperm until it becomes an embryo?

During ovulation, the egg is available to be fertilized by the sperm for 12 to 24 hours in the fallopian tube.  Once fertilization has occurred the egg will start to grow into an embryo over the course of 3 to 9 days and implant into the uterine lining. The embryo starts as a single cell, called a zygote, and over 7 days will mature into a multiple cell blastocyst. The blastocyst embryo will implant into the uterus by the 9th day following fertilization. 

How can adenomyosis can cause infertility?

Adenomyosis is a condition where the tissue and glands that normally line the uterus grow into the muscle wall of the uterus.  This tissue responds by thickening, breaking down and bleeding during each menstrual cycle leading to disruptive symptoms. Adenomyosis can also co-exist with fibroids and endometriosis.

Common signs and symptoms of adenomyosis include an enlarged uterus, painful periods, infertility, and heavy and irregular bleeding affecting women 35 to 50. The cause and association with infertility is medically unclear. It’s thought that the uterine muscular and cellular changes associated with adenomyosis make the environment less favorable for fertility, implantation, miscarriage and a term pregnancy.

Women with adenomyosis who get pregnant have an increased risk of preterm labor, pre-eclampsia (hypertension of pregnancy), intrauterine infection and cervical incompetency.

Diagnosis of adenomyosis is based on the symptoms a woman is experiencing and findings done on a pelvic ultrasound or Magnetic Resonance Imaging (MRI).  Since 1/3 of women don’t experience any symptoms adenomyosis is often underdiagnosed. 

 

How does cigarette smoking effect fertility?

Cigarette smoking- Smoking can affect fertility and increase your miscarriage rate. Heavy smoking, especially for a long period of time, causes poor egg quality and early menopause.

 

Can alcohol affect fertility?

It’s been found that alcohol affects a women’s fertility.  Women who consume alcohol while trying to conceive are less fertile. The current recommendation is if you are trying to get pregnant you should not drink any alcohol.  If you decide to drink it’s best to limit your daily consumption to one to two alcoholic drinks per week.

Drinking before you are pregnant will not affect a future pregnancy, but you may have trouble getting pregnant if you make alcohol a part of your daily diet.

For healthy living, we should focus more on prevention as a viable means to reduce the incidence of fetal alcohol syndrome, common cancers, and other medical conditions.  It’s important to know how much alcohol you are consuming weekly. 

For women 1 drink /day is acceptable.  This means one serving of a 5 oz glass of wine, one 12-ounce beer or one1.5 oz of hard liquor. Also if you take a day or two off from drinking each week this gives the liver time to recover from the negative effects of alcohol.

 

If you have any high-risk gynecologic conditions, what are the next best steps?

There are several medical conditions including irregular periods, persistent painful periods, polycystic ovarian syndrome (PCOS), endometriosis, uterine fibroids, adenomyosis, PID, obesity, women over 35yr and recurrent miscarriages that place you in a high-risk category for infertility. Meeting with a gynecologist or healthcare provider who can support and advise you through the fertility journey is helpful. These high-risk women may need medications to help them ovulate regularly or IVF cycles to conceive. Often meeting with an Infertility doctor is necessary. Most importantly is to take control of your fertility, ask questions and consult with experts.

 

How does masturbation help with conception?  

Whether or not female orgasm can help you get pregnant is unclear. Obviously, you can get pregnant without a female orgasm. It happens all the time!

Some theorize it’s just for fun, while others say it definitely helps with conception. One theory states that the purpose of orgasm in women is to make them feel relaxed and sleepy so that they will lie down after sex. The idea is that this may help the sperm reach their destination more easily. This thought is the contractions of the uterus help “suck up” the semen that gets deposited in the vagina, near the cervix. The orgasm then helps to move the sperm through the uterus and fallopian tubes where fertilization takes place.

When you first start trying, how often should you have sex? 

Since sperm lives for 3-5 days knowing when ovulation occurs makes timed intercourse a straightforward process.  The idea is to have the sperm waiting for the egg which lives for 24 hours. For example, if you have determined that you ovulate on Day 15 (Day 1 being the first day of your period), then you can have timed intercourse on Day 14, 15 and 16.  Having intercourse on these days ensures that the sperm and egg are interfacing with hopes of an embryo being formed.  Additionally, since the lifecycle of sperm is 3-5 days, some experts suggest having intercourse on Day 10 and then abstaining until Day 14 based on the example. This way there is fresh sperm ready to find the egg in the fallopian tube where fertilization takes place.  

Should you step up your frequency with age or after a certain amount of time of trying?

 

Now that you understand the timing of ovulation realize that it may take on average 6 to 9 months to conceive. Depending on your age, you have a 15 to 25% chance of conceiving each month if you are having timed intercourse. If you are timing your intercourse over a 3-month period, 50% of couples will conceive and if you are timing your intercourse over 6 months, 75% of couples will conceive. For women 35 years or older, if you have timed intercourse for 6 months and still haven’t conceived you should follow up with an infertility doctor. After 12 months of having timed intercourse approximately 90% of couples will have conceived. If you are younger than 35 years and have had timed intercourse for 12 months, and still haven’t conceived, you should follow up with an infertility doctor.  The incidence of infertility in the United States is roughly 10 to 12%.

Is it best to have sex everyday of the month to increase my chance of getting pregnant?

Since there is a detailed education about the lifetime of the sperm and timing of the egg’s appearance, it doesn’t make a lot of sense to have sex every day, all month long. Knowing sperm can live up to 5 days and the egg can live up to 24 hours, timing is everything. Having timed intercourse will ultimately bring you better success, and less frustration, in conceiving.

When is the best time to have sex during the month to get pregnant?

I spend a great deal of time giving a brief biology lesson on knowing when during the menstrual cycle pregnancy can occur.  Understanding when high fertility is during your menstrual cycle is essential. On average, women have a period every 28 days. Many women don’t have a perfect 28-day cycle and this can make it challenging to know when the egg is available for conception. Ovulation is the time when the egg is available to be fertilized over a 24-hour period. Typically, ovulation occurs 14 days prior to getting your period.  Some women notice an “egg white and slimy” discharge around the time of ovulation while others actually notice a twinge or slight pelvic discomfort. Since sperm lives for 3-5 days knowing when ovulation occurs makes timed intercourse a straightforward process.  The idea is to have the sperm waiting for the egg. For example, if you have determined that you ovulate on Day 15 (Day 1 being the first day of your period), then you can have timed intercourse on Day 14, 15 and 16.  Having intercourse on these days ensures that the sperm and egg are interfacing with hopes of an embryo being formed.  Additionally, since the lifecycle of sperm is 3-5 days, some experts suggest having intercourse on Day 10 and then abstaining until Day 14 based on the example. This way there is fresh sperm ready to find the egg in the fallopian tube where fertilization takes place.  

How can fertility apps help you conceive? 

 

I suggest purchasing an ovulation kit and downloading an ovulation tracker app like Flo, Glow, or Maybe Baby to help identify the fertile period of your cycle.  An ovulation predictor kit and ovulation tracker are the perfect tools to help you prepare and target the fertile days of the month.

 

The more a woman knows about her body, periods, cervical mucus, ovulation, and hormonal cycles, the better.  In order to get pregnant, it’s essential to know when you ovulate.  

 

I have seen many women over 45y, especially celebrities, giving birth to twins, how is this possible? 

Women over the age of 45 have a less than 1% chance of getting pregnant each month. If you pick up a People magazine or tune into Entertainment Tonight it highlights women giving birth to a child or set of twins at any age, especially those women over the age of 44. This can be incredibly misleading and create unrealistic expectations for adoring fans since it does not explaidn the low odds of having your own biological child or how expensive and time consuming it can be to use fertility magic to have a child after age 40y.  

Donor eggs are secretly popular in anyone who gets pregnant after the age of 44year, especially if they are having twins! Alternatively, woman are getting smarter about planning future fertility and freezing their eggs before their biologically clock breaks. Women who freeze their eggs under 40yr can defrost the healthy ones and use them at any age.

 

How can it be that IVF couples who were believed to be infertile  suddenly conceive on their own?

 

The truth is many of the “infertile” couples are really not infertile.  In this day in age of advanced technology and couples being impatient, the majority of couples are probably not infertile. Many couples seeking fertility treatment don’t necessarily need IVF treatment to conceive. It is not surprising that 30% of couples conceive naturally after stopping IVF treatments since many don’t necessarily need IVF to become pregnant in the first place.  More and more couple resorts to IVF prematurely due to the fear of being infertile.  One third of couples who have gone through infertility treatments end up getting pregnancy on their own without the use of infertility treatments.  The true cause of infertility that resorts to IVF is around 12% of couples.  However, anxious couples will seek out fertility treatment sooner than necessary in order to become pregnant. The bottom line is 10% of women have trouble getting pregnant.  By definition, infertility means not being able to get pregnant after one year of trying to conceive.  Many couples don’t want to wait one full year of trying to conceive to look into fertility treatment options. Time, patience and timed intercourse may be all you need to get pregnant. 

 

Why might a couple be able to conceive naturally at different points in their life, and not be able to in others (or even when undergoing IVF)? 

Trying to conceive successfully involves many factors including maternal age being at the top of the list. Infertility can be caused by maternal age, maternal anatomy and male factors.  One in eight couples has trouble conceiving.  Maternal age and issues related to male factor come into play when looking at causes of infertility.

 

When do medical guidelines suggest doctors should counsel their patients on fertility?

The American College of Obstetricians and Gynecologists released an opinion saying that women’s ability to have babies decreases gradually but significantly beginning around age 32 and then goes down more rapidly after age 37. 

It used to be to start having the fertility conversation around 35year but now we are having that tough conversation sooner with women.  It’s ideal to start counseling women in their early 30’s about family planning. It’s clear that a woman’s fertility starts to decline around 32year and takes a sharp drop after 37 years. Sooner than later is always best.

What is the best diet to follow while trying to conceive?

When it comes to a diet for couples trying to get pregnant, it’s important to focus on a balanced and nutritious eating plan that supports fertility and reproductive health for both partners. Here are some key dietary recommendations:

1. Eat a variety of whole foods: Include plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats in your diet. This provides essential vitamins, minerals, and antioxidants that support fertility.

2. Increase intake of folate-rich foods: Folate is essential for early fetal development. Consume foods like leafy greens, legumes, citrus fruits, and fortified grains to meet your folate needs.

3. Omega-3 fatty acids: These are important for hormone production and reproductive health. Include fatty fish (such as salmon and sardines), walnuts, chia seeds, and flaxseeds.

4. Maintain a healthy weight: Both underweight and overweight can negatively affect fertility. Aim for a healthy body weight by following a balanced diet and engaging in regular exercise.

5. Stay hydrated: Drink plenty of water throughout the day to support overall health and optimize reproductive function.

6. Limit caffeine and alcohol: High caffeine and alcohol intake may decrease fertility. It’s best to limit your caffeine intake and avoid alcohol when trying to conceive.

7. Minimize processed foods: Processed foods often contain unhealthy fats, added sugars, and additives that may negatively impact fertility. Opt for fresh, whole foods instead.

Remember, it’s always a good idea for couples planning to conceive to consult with a healthcare professional or a registered dietitian who specializes in fertility to get personalized recommendations based on your specific health needs and medical history.

What tests are done if my doctor thinks I have an infertility problem? 

If you suspect you have an infertility problem or are struggling to conceive, it’s important to consult with a healthcare professional or a fertility specialist. They will conduct a thorough evaluation that may include the following common blood tests:

1. Hormonal profile: Tests to assess hormone levels such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones.

2. Anti-Müllerian hormone (AMH) test: This test helps assess ovarian reserve, indicating the quantity of eggs remaining in the ovaries.

3. Prolactin level: Elevated levels of prolactin, a hormone involved in milk production, may interfere with ovulation.

4. Thyroid function tests: Thyroid imbalances can impact fertility, so checking thyroid-stimulating hormone (TSH) levels is important.

5. Infectious disease screening: Blood tests to rule out sexually transmitted infections (STIs) or other infectious diseases that can affect fertility.

6. Genetic testing: Depending on your medical history or family history, genetic testing may be recommended to identify any genetic conditions or chromosomal abnormalities that could impact fertility.

Please note that these tests are just a general overview. Your healthcare professional will determine which specific tests are most appropriate for you based on your medical history, symptoms, and other individual factors.

Why would I need a donor egg to get pregnant?

Using donor eggs give women of all ages a chance to carry and give birth to a baby. If you need to use a donor egg to get pregnant, it means that you are unable to produce healthy eggs or have low egg quality. There are a number of reasons why this could be the case, including advanced maternal age, certain medical conditions, genetic disorders, or previous unsuccessful fertility treatments with your own eggs.

Using a donor egg involves the process of in vitro fertilization (IVF) where the donor’s eggs are retrieved, fertilized with the partner or spouse’s sperm, and then transferred to your uterus. This allows you to carry and give birth to a child genetically related to your partner, while using the donor’s genetic material.

I gave my eggs to a close friend of mine who was 44years old and could not conceive on her own due to her age. Using my younger and genetically healthy eggs, she and her husband went on to have twins. It’s a gift that keeps on giving… not only for me but to my close friends as well.

How can acupuncture help with fertility? 

Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into specific points on the body. While research on acupuncture’s effectiveness for infertility is still ongoing, some studies suggest it may have potential benefits for certain women experiencing infertility. Here’s how acupuncture may help:

1. Increased blood flow: Acupuncture may improve blood flow to the reproductive organs, including the uterus and ovaries. Improved blood circulation can enhance the delivery of oxygen and nutrients to these areas, supporting better hormone balance and overall reproductive function.

2. Stress reduction: Infertility can be emotionally challenging, and stress is known to affect hormone levels and disrupt the reproductive system. Acupuncture may help reduce stress and promote relaxation, potentially benefiting fertility.

3. Hormonal regulation: Acupuncture may support the release of hormones involved in the menstrual cycle and ovulation, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), and progesterone. By regulating hormone levels, acupuncture may improve ovarian function and the chances of conception.

4. Support for assisted reproductive technologies (ART): Acupuncture is sometimes used in with ART procedures like in vitro fertilization (IVF) or intrauterine insemination (IUI). Research shows that acupuncture before and after these procedures may increase the success rates by improving embryo implantation and reducing stress.

It’s important to know that the scientific evidence showing the effectiveness of acupuncture for infertility is limited, and results can vary depending on the person’s circumstances. If you’re considering acupuncture as a complementary treatment for infertility, it’s best to consult with a licensed acupuncturist who specializes in fertility. They can give you personal care based on where you are in the fertility journey.