The month of October is National Infertility Awareness Month. It is understandable that we appreciate the opportunity to inform the public about issues and current developments in this area. The 2009 annual meeting of the American Society for Reproductive Medicine will be held in Atlanta October 18-21. You can follow along on Twitter to see some of the topics that will be discussed by entering #ASRM09 on those days!
I would like to share some tips to improve your fertility. This problem affects some 7.3 million women and men in the United States, representing 15% of couples in their first reproductive years.
I want to start with age, because it’s one of the big ones. Women are born with 1-2 million eggs and by age 37 they have 25,000 left. How well you reproduce depends on a number of factors, but one of the most important is the age factor. The quality of those eggs starts to deteriorate after 30 years, and more importantly after 35 years, because of the poor quality of the eggs. There is no way to change the quality of eggs. Consider trying to start your family sooner rather than later. If that’s not possible, continuing to take birth control pills can prolong the viability of the eggs in a woman’s ovaries by putting the ovaries to rest. Seek help for infertility problems early instead of putting it off. If you are over age 35, create a well-defined, aggressive treatment plan with a set timeline. Don’t let your doctor reassure you that “everything is fine and you just have to wait for it to happen.” Basically I advise my patients over the age of 35, if there is no pregnancy after 6 months, go to a fertility specialist for a full and thorough evaluation (which should only take 1-2 months), make a treatment plan within a certain time and move successively through that plan. For example, if you start ovulation induction and intercourse, use that for 4-6 months, then move to IUI for just 4 attempts, then move on to IVF. As time goes by, your chances just get smaller, even with IVF.
The key ingredient here is good health and exercise in the years leading up to trying to conceive. It is recommended to exercise at least 5 hours a week. Good habits start early, but it’s never too late to start! Weight can also affect your ability to conceive in some cases, and too much above or below your ideal body mass index (BMI) can be harmful. To calculate your BMI, see the National Institute of Health website: http://www.nhlbisupport.com/bmi/. Aim for an ideal BMI, but don’t delay pregnancy to lose weight if you’re over 35.
Proper diet before starting your attempts to conceive is also important. It makes sense to eat plenty of fruits and veggies, but did you know that dairy products and yogurt have been shown to be equally important? A Harvard Medical School study suggests that whole dairy products, not skim milk, are responsible for protecting against ovulatory infertility. Another interesting finding is that folic acid improves ovulation in women, and sperm quality in men! It can be taken as a multivitamin and is found in foods such as oranges. Eliminating trans fats in women with diabetes also seems to help. Moderate intake of caffeine and alcohol is also important. Again, ideal weight is beneficial. No matter what anyone says, there are no diets or foods that “improve” fertility, but a healthy diet in general can help.
TEMPORARY SEXUAL ACTIVITY
Many couples trying to conceive use over-the-counter ovulation kits. There are some things you should keep in mind though. Most women ovulate 14 days before their next period. For example, if your cycles are 25 days long, you probably ovulate around cycle day #11. Your fertile window would then be CD# 9-13. Those are the days I would recommend intercourse. You must stop intercourse on CD#7 and wait until CD#9 to begin. During those five days, have intercourse once a day, ejaculating only once a day. Start using your ovulation kit on CD #9 (count back 16 days from the end of your average cycle). Remember that once the egg is released from the ovary, it is only receptive to sperm and can be fertilized for about 12 hours. If you have an irregular cycle, you may have another problem and you should see a specialist to determine what’s going on. But the absolute bottom line with timing is this, make it fun NOT scientific!! Your husband will become a reluctant participant if forced. Don’t tell him, “Honey, it’s my fertile time again, we need to have sex,” but he shouldn’t even know. You just have to pave the way to get him interested, excited and “horny”. That way you will both enjoy the experience and trying won’t be a chore.
KICK THE SMOKING
Almost all studies show that smoking affects fertility. In women, 10 or more cigarettes per day reduce egg quality. Smoking after conception has been linked to miscarriages and ectopic pregnancies. In men who smoke, there is a problem with a lower sperm count and also a lower sperm motility, which means that the sperm functions less well. The worst is smoking marijuana. Every chemical that enters your body enters your bloodstream, your cells, and your sperm and/or eggs. This is an absolute no no! The same goes for other forms of recreational drugs, including large amounts of alcohol. My rule of thumb is, if it affects your brain cells, then it affects your reproductive cells as well.
Couples trying to conceive can get stressed, especially if they’ve been trying for more than a few years. Yoga, acupuncture, massage, and meditation tapes made specifically for infertility patients all help. My patients are encouraged to use relaxation techniques. It helps them through the emotional ups and downs of the IVF process. The patients approach the procedure day much more calmly, relaxed and it can make a difference in how well the retrieval and moving are going. Going to a therapist for massage therapy or meditation therapy may also be covered by insurance, if it can be proven that there is an anxiety disorder. As mentioned above, make it fun and enjoyable, no homework.
SEE YOUR DOCTOR
You want a doctor who knows fertility inside out. Most of these types of doctors will be able to provide ALL levels of infertility treatment. Just like you don’t want a doctor who only does Clomid, you don’t want a doctor who only does IVF. You are pushed into the only thing they can do for you, Clomid or IVF. This is easy to screen for. . . just ask, “What levels and types of treatments can you perform for me?” Most importantly, infertility should be diagnosed and treated by a specialist physician, not GPs, nurses, PAs, or medical assistants.
WHEN ALL OTHERS FAIL…
If your fertility journey hits too many roadblocks, you may need to explore other options. Keep in mind that if you fail to conceive naturally, that is NOT the end of the road. I advise my patients: “Nowadays we can get almost anyone pregnant, it just depends on what I have to do to achieve the pregnancy”. There are many reasons why a woman or man may be infertile and visiting a good fertility specialist will surely narrow down the problem or even pinpoint where the problem lies. Treatment often varies from person to person, so don’t expect to find the answer in a forum or chat room! Blocked fallopian tubes, high FSH levels, abnormal sperm count or low motility, all these and more are responsible for infertility problems in many couples.
A diagnosis by a doctor is necessary to effectively determine the best course of action for the couple trying to conceive. But don’t let your doctor put you on Clomid without good reason. Clomid is NOT a panacea. It has a specific purpose, which is to induce ovulation in women who are not ovulating. If you have a regular cycle, it is a sign that you are ovulating. That means the problem is something else and Clomid won’t change that. Make sure the treatment you receive addresses a specific problem. Ask your doctor to explain his/her strategy, why they are using the treatment they recommend and what they are treating. Treatment without a specific reason is a waste of time and money, as is treatment without the completion of a full infertility evaluation. I can’t tell you how many patients I’ve seen who have had multiple cycles of Clomid or IUIs only to find out her fallopian tubes are blocked!
Stay positive, we’re here to help!