The month of October is National Infertility Awareness Month. We understandably appreciate the opportunity to educate the public about current issues and developments in this field. The 2009 annual meeting of the American Society for Reproductive Medicine will be held in Atlanta on October 18-21. You can follow on Twitter to see some of the issues to be discussed by entering # ASRM09 in those days!
I would like to share some tips on how to improve your fertility. This problem affects an estimated 7.3 million women and men in the United States, representing 15% of couples in their best reproductive years.
AGE
I want to start with age, because it is one of the greats. Women are born with 1-2 million eggs and by the age of 37 they have 25,000 left. How well it reproduces depends on several factors, but one of the most important is the age factor. The quality of these eggs begins to deteriorate after 30, and more significantly after 35, due to poor egg quality. There is no way to change the quality of the egg. Consider trying to start your family sooner rather than later. If that’s not possible, continuing to take birth control pills could extend the viability of the eggs in a woman’s ovaries by putting them to rest. Seek help for infertility problems early rather than putting it off. If you are over the age of 35, develop a well-defined, aggressive treatment plan with a set timeline. Don’t let your doctor assure you that “everything is fine and you just need to wait for it to happen.” Basically, I advise my patients over 35, if they don’t get pregnant after 6 months, see a fertility specialist for a full and thorough evaluation (which should only take 1-2 months to complete), create a plan treatment in a set time frame and move through that plan sequentially. For example, if you start with ovulation induction and intercourse, use them for 4-6 months, then go to IUI for only 4 attempts, and then move on to IVF. As time goes on, your chances are getting smaller, even with IVF.
HEALTH
The key ingredient here is good health and exercise in the years leading up to trying to conceive. It is recommended to exercise for 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 get pregnant, in some cases, and being too above or below your ideal BMI (body mass index) can be harmful. Check the National Institutes of Health website to calculate your BMI: http://www.nhlbisupport.com/bmi/. Try to have an ideal BMI, however, do not put off pregnancy to lose weight if you are over 35 years old.
DIET
A good diet is also important before beginning your efforts to conceive. It makes sense to eat a lot of fruits and vegetables, but did you know that dairy and yogurt have been found to be equally important? A Harvard Medical School study suggests that whole dairy products, not skim, are responsible for protecting against ovulatory infertility. Another interesting finding has been that folic acid improves ovulation in women and, in men, the quality of sperm! It can be taken as a multivitamin and is found in foods like oranges. Eliminating trans fats in women with diabetes also appears to help. Moderate intake of caffeine and alcohol is also important. Again, the ideal weight is beneficial. No matter what they say, there are no diets or foods that “improve” fertility, but a healthy diet can help in general.
SCHEDULED SEXUAL ACTIVITY
Many couples trying to conceive use over-the-counter ovulation kits. However, there are a few things to keep in mind. Most women ovulate 14 days before their next period. For example: if your cycles are 25 days long, you are most likely ovulating around day 11 of the cycle. Your fertile period would then be CD # 9-13. Those are the days when I would recommend intercourse. You should stop intercourse on CD # 7 and wait until CD # 9 begins. Have intercourse once a day for those five days, only one ejaculation per day. Start using your ovulation kit on CD # 9 (counting back 16 days from the end of your average cycle). Remember, 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 irregular cycles, you may have another problem and need to see a specialist to determine what is happening. But the absolute bottom line over time is this, make it fun, NOT scientific! Your husband will become a reluctant participant if he is forced. Don’t tell him, “honey, it’s my fertile time again, we have to have sex”, rather, he shouldn’t even know. You should set the stage for her to get interested, excited, and “turned on.” That way, both of you will enjoy the experience and it won’t be a chore to try.
STOP THE HABIT OF SMOKING
Virtually all studies show that smoking misses fertility. In women, 10 or more cigarettes a day reduce egg quality. Smoking after conception has been linked to miscarriages and ectopic pregnancies. In men who smoke there is a problem of lower sperm count and also less mobility of the sperm, which means less functionality of the sperm. The worst thing is smoking marijuana. Any chemical that enters your body enters your bloodstream, your cells, and your sperm and / or eggs. This is an absolute no no! The same is true for other forms of recreational drugs, including large amounts of alcohol. My general rule of thumb is that if it affects brain cells, it also affects reproductive cells.
RELAX
Couples who are trying to conceive can become stressed, especially if they have been trying for more than a few years. Yoga, acupuncture, massage and meditation tapes made specifically for infertility patients help. My patients are encouraged to use relaxation techniques. It helps them overcome the emotional ups and downs of the IVF process. Patients approach the day of the procedure in a much calmer and more relaxed manner and it can make a difference in how well the recovery and transfer go. Going to see a therapist for massage therapy or meditation therapy may also be covered by insurance, if an anxiety disorder can be shown to exist. As mentioned above, make it fun and enjoyable, not homework.
SCRUTINIZE YOUR DOCTOR
You want a doctor who knows fertility to the core. Most of these types of doctors will be able to offer ALL levels of infertility treatment. Just as you don’t want a doctor who only does Clomid, you also don’t want a doctor who only does IVF. You will be pushed to the only thing they can do for you, Clomid or IVF. This is easy to spot. . . just ask, “what levels and types of treatment can you perform?” Most importantly, infertility should be diagnosed and treated by a medical specialist, not by general practitioners, nurses, physician assistants, or physician assistants.
IF ALL ELSE FAILS …
If your fertility journey runs into too many roadblocks, you may need to explore other options. Keep in mind that if you don’t achieve pregnancy naturally, that is NOT the end of the road. I advise my patients: “Today, we can get almost anyone pregnant, it just depends on what you have to do to get pregnant.” There are many reasons why a woman or man may be infertile and a visit to a good fertility specialist will certainly reduce or determine 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 of this and more explain infertility problems in many couples.
A diagnosis from a doctor is necessary to effectively identify the best course of action for the couple trying to conceive. But don’t let your doctor prescribe Clomid for you without good reason. Clomid is NOT a miracle drug. It has a specific purpose, which is to induce ovulation in women who do not ovulate. If you have regular cycles, it is a sign that you are ovulating. That means the problem is something else and Clomid will not change that. Make sure the treatment you are receiving treats a specific problem. Ask your doctor to explain his strategy, why he is using the treatment he recommends, and what he is treating. Treatment without a specific reason is a waste of time and money, as is treatment without a full infertility evaluation. I can’t tell you how many patients I’ve seen who have been on multiple cycles of Clomid or IUI only to find that their tubes are blocked!
Above all, keep a positive attitude, we are here to help you!