It’s natural to start worrying if you have been trying to get pregnant for a few months without success. Remember, however, that it often takes about a year of unprotected sex to get pregnant. But once you approach the one-year mark (or the 6-month mark, if you are 35 or older) you should go see your gynecologist or a reproductive endocrinologist (a doctor that specializes in infertility) to determine whether you may be facing fertility issues.1
What it Takes to Get Pregnant
To get pregnant, four steps need to happen:
- An egg must be released from one of the woman’s ovaries (ovulation)
- The egg must move through the fallopian tubes towards the uterus
- The egg must be penetrated by a healthy sperm (fertilization)
- The fertilized egg must implant into the wall of the uterus (implantation)
Running into a problem at any of the four steps can cause a woman to be infertile and unable to get pregnant without medical intervention.
Causes of Infertility in Women
Women of reproductive age generally have a menstrual period every 24-32 days. Regular periods are a good indication that a woman is ovulating, or releasing an egg each month from one of her ovaries. If you want to confirm whether you are ovulating or track your cycle, you can use an over-the-counter ovulation predictor kit.
A woman with irregular periods is at higher risk for not ovulating. According to the Centers for Disease Control and Prevention, any of the following medical conditions can cause a woman of childbearing age to not ovulate:1
- Polycystic Ovary Syndrome (PCOS) – PCOS is a hormone disorder that can cause a woman to not ovulate. Symptoms include irregular or prolonged menstrual periods, excess hair growth, acne, and obesity.2 PCOS is the most common cause of female infertility.
- Excessive physical or emotional stress – Stress, especially prolonged and intense can cause a woman to stop menstruating.
- Diminished ovarian reserve (DOR) – The ability of the ovary to produce eggs is reduced because of congenital, medical, surgical, or unexplained causes. Ovarian reserves naturally decline with age.
- Premature ovarian insufficiency (POI) – POI occurs when a woman’s ovaries fail before she is 40. This condition is sometimes referred to as premature (early) menopause.
Absence of Healthy Sperm
About 20% of infertility is caused solely by a problem with the male partner, and it can be a contributing factor in another 30 to 40%.3 One of the first tests that should be done when a couple is not able to conceive is a sperm analysis to rule out male fertility issues. This is a relatively easy and inexpensive test to examine sperm number, shape, and movement.
Blocked Fallopian Tubes
A blocked or swollen fallopian tube will prevent the sperm from reaching the egg and the fertilized egg from reaching the uterus.1 Risk factors for blocked fallopian tubes include a history of pelvic infections, abdominal surgery, a ruptured appendix, gonorrhea or chlamydia, or endometriosis.1
Certain conditions in the uterus, such as fibroids or structural abnormalities, can interfere with the ability of the embryo to implant.1
What Increases a Woman’s Risk of Infertility?
Any number of factors can increase the risk of infertility in women, including:1
- Excessive alcohol consumption
- Drug use
- Being significantly overweight or underweight
- Excessive physical or emotional stress
If you have questions about your own fertility, speak with your physician, gynecologist or a reproductive endocrinologist to determine which steps you should take to help you begin your fertility journey.
- Centers for Disease Control. Infertility FAQs. Updated March 30, 2017. Accessed June 13, 2017. Available at: https://www.cdc.gov/reproductivehealth/infertility/
- Mayo Clinic. Polycystic ovary syndrome (PCOS). Access June 13, 2017. Updated September 3, 2014. Available at: http://www.mayoclinic.org/diseases-conditions/pcos/basics/definition/con-20028841.
- University of Wisconsin School of Medicine and Public Health. Male Factor Infertility and Sexual Health. Accessed June 13, 2017. Available at: http://www.urology.wisc.edu/specialties/male-factor-infertility-and-sexual-health/male-factor-infertility/.
Uterine fibroids can be very uncomfortable and are surprisingly common, affecting anywhere from 20 to 80% of women, mostly in their 40s and 50s.1 It’s important to be familiar with the symptoms and the treatment options, in order to make wise choices about your reproductive health and improve your quality of life.
What is a Uterine Fibroid? Am I At Risk?
Uterine fibroids, also known as leiomyomas or myomas, are tumors that grow in the wall of the uterus, ranging from multiple small masses to singular larger masses that are typically benign (non-cancerous). They are comprised of muscle tissue and can grow into the uterine space on the inside or outside wall of the uterus.
There are several factors that can increase your risk of developing uterine fibroids.1
- Age – Uterine fibroids develop as a woman ages and are most common during her 30s and 40s, and through menopause. Typically, the fibroids decrease in size during and after menopause.1
- Family history – If you have a family member who has been diagnosed with fibroids, you are at an increased risk. If your mother experienced fibroids, you are three times more likely to develop them. 1
- Ethnic origin – Some ethnicities are more susceptible to developing fibroids. By menopause, 80% of African-American women have uterine fibroids. In fact, African-American women tend to develop fibroids at a younger age and more frequently.2
- Obesity – Carrying extra weight can put you at higher risk for uterine fibroids. If you are extremely overweight, the risk rises to two to three times. 1
- Eating habits – A diet high in red meats is linked to an increased chance of fibroids, however, a diet rich in green vegetables can actually reduce the risk of developing uterine fibroids.1
How Do I Know if I have Uterine Fibroids?
The range of symptoms with fibroids can vary. Some women might not experience any symptoms, or only experience them in very mild forms. Others feel the effects quite severely, and experience debilitating pain and discomfort during their monthly cycles. The symptoms can include any combination of the following:1
- Menorrhagia (heavy menstrual bleeding), which in some cases can be heavy enough to cause anemia.
- Painful periods.
- A sensation of bloating or fullness in your pelvic region.
- Actual enlargement or bloating of your lower abdomen.
- Increased frequency of urination.
- Discomfort or pain during sexual intercourse.
- Lower back pain.
- Complications during pregnancy and labor, including a six-time greater risk of Cesarean section.
- And more rarely, reproductive problems, such as infertility.
What Should I Do If I think I Have Fibroids?
It’s important, especially if you identify any of the listed risk factors, to have yearly gynecological exams with a trusted physician. If you keep up with regular visits, update health histories, and routine pelvic exams, your doctor should be able to help you identify steps that you can take to minimize your risk. If you suspect that uterine fibroids are present, your doctor should also be able to feel if there are any masses and determine their size and location.
About a third of women who have uterine fibroids request treatment for the symptoms they are experiencing. You can talk with your physician about the options available to you. Treatment options are typically dictated by your age and your desire to preserve your future fertility.
Your physician will likely offer both surgical and non-surgical treatment options, and help you become familiar with the various procedures, like myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, or uterine artery embolization. Other interventions, such as thermal ablation, are also becoming more common.3
If you think you have uterine fibroids, schedule an appointment with your gynecologist as soon as possible to discuss your treatment options.
- gov. “Uterine Fibroids.” Updated February 6, 2017. Accessed June 13, 2017. Available at: https://www.womenshealth.gov/a-z-topics/uterine-fibroids.
- Creating a Family. “Infertility Issues in the African American Community.” Updated February 22, 2012. Accessed June 13, 2017. Available at: https://creatingafamily.org/infertility-category/infertility-issues-in-the-african-american-community/.
- Jacques Donnez, Marie-Madeleine Dolmans; Uterine fibroid management: from the present to the future.Hum Reprod Update 2016; 22 (6): 665-686. doi: 10.1093/humupd/dmw023. Published October 20, 2016. Accessed June 13, 2017. Available at: https://academic.oup.com/humupd/article-abstract/22/6/665/2420585/Uterine-fibroid-management-from-the-present-to-the.
Egg freezing is a big decision for a woman. Before deciding to freeze her eggs, a woman must consider her age, life plans, as well as the cost.
The average baby girl is born with up to 2 million eggs. Most of those will die off naturally (much like skin and hair cells), and by puberty, there are typically about half a million healthy eggs left. As a woman continues to age through her 20s and into her 30s, eggs die off more rapidly. The quality of the remaining eggs also declines. For this reason, it is, in part, biologically easier for a woman to become pregnant before her 30s.
Why Would I Consider Freezing My Eggs?
As you and your eggs age, your life is also unfolding. It is likely that other factors like career-building, relationships (or lack thereof), or other health issues will become topics to consider when deciding on the right time to start your family. If you need or want to postpone getting pregnant, elective freezing of your eggs is an option to talk about with your reproductive specialist.
How Does Egg Freezing Work?
The egg freezing process starts out much like a typical IVF procedure. It involves a course of 10-12 daily injections of IVF medication to force more eggs to mature that month, along with regular blood work and ultrasounds to monitor progress. The retrieval of the matured eggs is called harvesting, and is typically done under light anesthesia. An embryologist will check the eggs for viability, and the healthy eggs will be frozen. They can be kept frozen indefinitely until you decide to use them to try to get pregnant.
To use the eggs for a pregnancy, they must be thawed in an embryology lab, fertilized with sperm, and then transferred into the uterus. If the embryo implants, then the woman will become pregnant.
At What Age Should You Freeze Your Eggs?
Egg freezing has proven to be most successful when the eggs are extracted before the woman turns 34 years old.1 So, if you are in your 30s and thinking about starting a family, you should start planning and begin considering your options.
There’s No Guarantee Egg Freezing Will Work.
It’s important to remember that even in younger women (i.e., under age 38), the chance that one frozen egg will yield a baby in the future is around 2-12%. As women get older and egg quality begins to decline, the pregnancy rate per frozen egg drops further.1 You must remember that freezing your eggs doesn’t guarantee a baby.2
It’s equally important that you understand the physical, medical and emotional risks of pregnancy and of parenting at an older age. For these reasons, it’s vital that you seek the counsel and treatment of a trusted reproductive endocrinologist to help you be informed and comfortable with all the available facts about the procedures and outcomes.
How Would I Pay for Egg Freezing?
The costs of egg freezing are another factor to be considered. In some cases, insurance may cover at least a portion of the cost of elective egg freezing. However, many plans only cover this procedure in the case of premature menopause, cancer treatment and similar extenuating circumstances. Before pursuing egg freezing, connect with your insurance provider so that you can get a clear understanding of what aspects of the process may be covered. In most cases, you should be prepared to pay for the basic costs of preparation, retrieval, and storage of the eggs until you feel ready to proceed to fertilization.
So… is it worth it?
The choice is up to you. Egg freezing gives you the option to put family building on hold, but does not guarantee a baby. The decision requires careful consideration, and some homework. Work with your physician and/or reproductive endocrinologist to assess whether egg freezing is right for you and your individual needs.
- Mesen, Tolga B. et al. Optimal timing for elective egg freezing. Fertility and Sterility, Volume 103, Issue 6, 1551 – 1556.e4. June, 2015. Accessed June 13, 2017. Available at: http://www.fertstert.org/article/S0015-0282(15)00170-3/abstract.
- American Society for Reproductive Medicine (ASRM). “Can I Freeze My Eggs to Use Later if I’m Not Sick?” Updated 2014. Accessed June 13, 2017. Available at: http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/fact-sheets-and-info-booklets/can-i-freeze-my-eggs-to-use-later-if-im-not-sick/
When a couple struggles to get pregnant, their first thought is often that there must be something wrong with the woman. Infertility, however, affects both men and women. In fact, male infertility is the sole cause of a couple’s infertility about 20% of the time, and a contributing factor in another 30-40% of cases.1 To best know what is causing a couple’s infertility, it is important to educate yourself on male infertility, so you are able to rule it out, or take the necessary steps to address the issue.
How to Test for Male Factor Infertility
Male fertility is usually tested by a semen analysis. Semen is evaluated for three factors: the quantity of sperm (concentration), motility (movement), and morphology (shape).
A slightly abnormal semen analysis is not a reason to panic and does not mean that a man is infertile. A semen analysis helps doctors assess if and how the man’s fertility is impacting the couple’s difficulties with getting pregnant.2
What Causes Male Factor Infertility
Varicoceles are one of the most common causes for male infertility. This is a condition where the veins on the testicles are too large, causing the testicles to overheat, which can affect the number or shape of the sperm.3 Certain medical conditions, including cystic fibrosis, diabetes, mumps, kidney disease, and hormone imbalances, can also contribute to male infertility.1-3
What Increases the Risk of Male Factor Infertility?
According to the U.S. Department of Health and Human Services, the following factors can also increase the risk for male infertility:3
- Heavy alcohol use
- Smoking cigarettes
- Environmental toxins, including pesticides and lead
- Side effect of medications
- Radiation treatment and chemotherapy for cancer
What Can a Man Do to Improve His Sperm Quality?
Just as overall health can impact female fertility, overall health can affect male fertility, too.3 Lifestyle factors, such as avoiding heavy alcohol use, drugs and smoking will also improve sperm quality.
One recent study found that eating a healthy diet improved semen quality, especially in men with a low sperm count.4 A suggested healthy diet consists of eating lots of fruits, cruciferous vegetables, tomatoes, leafy green vegetables, legumes, healthy fats, fish, chicken, and whole grains, and limited amounts of sugar and saturated fats.4
- University of Wisconsin School of Medicine and Public Health. Male Factor Infertility and Sexual Health. Accessed June 13, 2017. Available at: http://www.urology.wisc.edu/specialties/male-factor-infertility-and-sexual-health/male-factor-infertility/.
- Centers for Disease Control. Infertility FAQs. Updated March 30, 2017. Accessed June 13, 2017. Available at: https://www.cdc.gov/reproductivehealth/infertility/
- gov. “Infertility Fact Sheet.” Updated June 12, 2017. Accessed June 13, 2017. Available at: https://www.womenshealth.gov/publications/our-publications/fact-sheet/infertility.html#h
- Oostingh, Elsje C. et al. Strong adherence to a healthy dietary pattern is associated with better semen quality, especially in men with poor semen quality. Fertility and Sterility, Volume 10, Issue 4, 916 – 923.e2. Accessed online June 13, 2017. Available at: http://www.fertstert.org/article/S0015-0282(17)30222-4/fulltext.
A previous post titled “Smoking and Infertility – A Family-Wide Risk” mentioned that women who smoke were at an increased risk for experiencing an ectopic pregnancy, citing the damage smoking causes to the fallopian tubes. While rare, smokers are not the only individuals who are susceptible to this type of complication during pregnancy.
Here are five things that you need to know about ectopic pregnancies:
What’s an Ectopic Pregnancy?
An ectopic pregnancy is a pregnancy that grows anywhere other than the lining of the uterus. That means that a fertilized egg (called an embryo) attaches to a fallopian tube, an ovary, the cervix or the outside wall of the uterus, and begins to grow.1 Approximately 2% or less of pregnancies in the United States are ectopic.2 These pregnancies are potentially life-threatening, but are treatable (more on that below). Education, early detection, and treatment are vital to the health of a woman dealing with an ectopic pregnancy.
What Makes an Ectopic Pregnancy More Likely to Occur?
It is possible to have an ectopic pregnancy without any evident risk factors, but a woman may be more likely to have an ectopic pregnancy if she:1
- Has had prior abdominal or pelvic surgery
- Has or has had a sexually transmitted infection (STI)
- Endometriosis (a condition in which uterine tissue grows outside the uterus)
- Smokes cigarettes
- Has had fertility treatment in the past
- Has previously had an ectopic pregnancy
- Became pregnant with an intrauterine device (IUD) in place
What are the Warning Signs of Ectopic Pregnancy?
The symptoms of an ectopic pregnancy can include abdominal pain, shoulder pain, dizziness, feeling faint and vaginal bleeding.3 If you are experiencing any of these symptoms and suspect you are pregnant, it’s very important to see your obstetrician/gynecologist as soon as possible, flagging any risk factors you may have. Your doctor will run a combination of blood tests and ultrasound scans to diagnose the ectopic pregnancy.1 A blood pregnancy test measures how much of the pregnancy hormone, human chorionic gonadotropin (hCG), is in the blood.1 An ultrasound of the lower abdomen will show whether the pregnancy is inside or outside of the uterus.1
What Are My Treatment Options for Ectopic Pregnancy?
There are three approaches to treating an ectopic pregnancy, depending on a woman’s symptoms and how far along she is:
- Non-surgical, medicinal treatment – Methotrexate, a drug typically used in cancer treatment, is administered by a medical professional. Follow up blood tests will be ordered to monitor changes in hCG levels. Most ectopic pregnancies are successfully treated with this method; however, the side effects and possible complications should be discussed thoroughly with your doctor for appropriate attention and care after taking the drug. Typically, this is done on an out-patient basis, with return visits to the office for follow-up.1
- Surgical treatments – Minimally invasive laparoscopic surgery is the most commonly performed surgical option for ectopic pregnancy. Very small instruments, inserted through small incisions in the abdomen, are guided by a small telescope, inserted through another abdominal incision, to remove the ectopic pregnancy and possibly other affected tissue or the fallopian tube. Sometimes, a laparotomy is required to get better access to internal bleeding, larger masses of scar tissue, and the pregnancy. The laparotomy is a larger incision and thus more invasive to the woman’s body. Both surgical options most commonly require some sort of in-patient care, hospitalization, and monitoring.1
- Observation / Monitoring – In some situations, ectopic pregnancy resolves on its own, even before it has been detected or diagnosed. It’s important that you know your body’s symptoms well, including your risk factors. Contact your physician immediately if you suspect you are experiencing an ectopic pregnancy.1
Will I Ever Get and Stay Pregnant Once I’ve Had an Ectopic Pregnancy?
Once you’ve had one ectopic pregnancy, you should consider seeking fertility care to plan for the possibility of a future pregnancy. While you are about 10% more likely to experience another ectopic pregnancy, you can indeed experience a successful pregnancy with careful monitoring and planning.1 In fact, if your first ectopic pregnancy left the affected fallopian tube intact and open, you have a 60% chance of future pregnancy.1 Early detection and monitoring of following pregnancies will be an important key to a successful pregnancy outcome. If you have trouble conceiving after you have had an ectopic pregnancy, it’s even more important to work closely with a fertility specialist who knows your health history and can walk you through pertinent testing and treatments to achieve a pregnancy.
- American Society for Reproductive Medicine (ASRM). “Ectopic Pregnancy Fact Sheet.” Updated 2014. Accessed June 13, 2017. Available at: http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/fact-sheets-and-info-booklets/ectopic-pregnancy/.
- net. “Ectopic Pregnancy.” Updated June 23, 2011. Accessed June 13, 2017. Available at: http://www.obgyn.net/tags/ectopic-pregnancy.
- gov. “Pregnancy Complications.” Updated February 1, 2017. Accessed June 13, 2017. Available at: https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/pregnancy-complications
When you ask a realtor the three most important factors in selling a house, you’ll likely hear: “location, location, location.” When you ask a fertility doctor the three most important factors in fertility, most will respond: “age, age, age.”
While we’ve made progress in getting out the message to women in their 20s and 30s of the importance of age and its impact on fertility, we still have a ways to go. Research has found that 30% of women believe that their fertility will decline gradually until menopause, and 31% thought they could get pregnant without difficulty at age 40.¹ In truth, most women are most fertile in their 20s and fertility starts rapidly declining after age 35; the chances of getting pregnant without fertility treatment at age 40 is only 5%.²
How Does Age Affect Fertility?
More women in the U.S. are delaying child bearing until they are in their 30s or 40s. About one-third of couples trying to conceive once the woman is over 35 face fertility issues. As women age, the following changes take place, and can impact fertility:³
• The ovaries become less able to release eggs.
• There are fewer eggs in the ovaries.
• The quality of egg health begins to decline.
• There is a higher risk of miscarriage.
What Other Fertility Risk Factors Should I Know About?
In addition to her age, a woman’s overall health should be considered when she is thinking about becoming pregnant. Specifically, consider the following lifestyle/health factors:³
• Tobacco and/or nicotine use
• Alcohol consumption, particularly if in excess
• Stress levels
• Insufficient or unhealthy diet
• Physical exercise and/or athletic training (or lack thereof)
• Being overweight or underweight
• History or presence of sexually transmitted infections (STIs)
• History of miscarriage
• Painful, absent or irregular periods
• Endometriosis or pelvic inflammatory disease
• Other relevant health problems, including those that cause hormonal changes (i.e., polycystic ovary syndrome, primary ovarian insufficiency, etc.)
• The presence of other health conditions which may impact fertility
It’s not just the woman’s general health that should be considered when a couple is trying to get pregnant. Your doctor can discuss with you the different factors that might be affecting your male partner’s fertility health.
I’m “Getting Up There.” What Should I Do Now?
If you are ready to try for a pregnancy, it is wise to start with a full check-up and consultation with your doctor. When you schedule the appointment, let him or her know that you and your partner are concerned about decreasing fertility. The appointment should include a review of both you and your partner’s complete health history. It can also be helpful to track your ovulation for several months before the appointment, in order to give your doctor a more complete picture.³
Depending upon your age, your history, and your initial fertility analysis, the doctor might also order further fertility testing. These tests can include:³
• Bloodwork – to check ovulation or hormone levels
• Ultrasounds – to visualize your ovaries
• Hysterosalpingography – a dye test to study the uterine and fallopian tube structure
• Laparoscopy – minor surgery using a micro camera inserted through small incisions to visualize the abdominal cavity
How Long Should We Try Before We Seek Infertility Treatment?
If you are 35 or younger, it is recommended that you try to conceive for a year before seeking medical treatment for infertility, unless you exhibit several of the previously mentioned risk factors that can be problematic when trying to conceive.3 If you have any of these risk factors, talk with your doctor sooner to explore your options.
If you are over 35, you should try for about 6 months before seeing your doctor. Your doctor will likely want to consider treatment options such as oral medications, surgeries, artificial insemination, or assisted reproductive technology.3 Make sure to have a thorough conversation about your options, including additional resources that your fertility specialist recommends for educating yourself. A solid relationship with a trusted fertility specialist can be your biggest asset in deciding what treatment path is right for you.
1. MacDougall K, Beyene Y, Nachtigall RD. Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40. Human Reproduction (Oxford, England). 2013;28(2):350-356. doi:10.1093/humrep/des409.
2. WomensHealth.gov. “Infertility Fact Sheet.” Updated June 12, 2017. Accessed June 13, 2017. Available at: https://www.womenshealth.gov/publications/our-publications/fact-sheet/infertility.html#h
3. American Society for Reproductive Medicine (ASRM). “Waiting To Have a Baby?” Accessed June 13, 2017. Available at: http://www.asrm.org/resources/patient-resources/google-adwords-landing-pages/waiting-to-have-a-baby/
Holidays in general are tough for those struggling to conceive, but Mother’s Day can be an especially painful experience. While the holiday is a wonderful opportunity to honor your own mother or the mother-figures in your life, it’s also bittersweet when all you want is the chance to be a mother to your own little one.
The emotions and expectations of the day can be staggering. So what can you do to protect your feelings and preserve your emotional wellbeing? Here are some ideas to help you get through Mother’s Day weekend.
Mother’s Day is more than just a date
Make a date to see your mom or your mother-in-law separately from larger gatherings that include family members who may not be as understanding about what you’re going through. Give yourself a special time to honor her in a way that is meaningful to you both, separate from the hubbub of the holiday. For women that are struggling to conceive who have lost their mother, or another important mother-figure, this holiday can be doubly upsetting. If your mother or loved one is no longer with you, it’s equally important to honor their memory – do so whenever is most comfortable and meaningful for you.
Give yourself some TLC
Try to take especially good care of yourself this weekend. Sleep in, get some extra time at the gym or read that novel you’ve been itching to start. Make time for whatever activities make you feel good. But remember: don’t overindulge in alcohol! Alcohol is a depressant, which means consuming too much can make you morose, overly emotional and possibly hung over – none of which you need on an already stressful day.
Make a game plan
Review past holidays – not just previous Mother’s Days – to identify where and when the major stressors happened for you. Talk with your partner/spouse and make a plan together to be proactive and address them beforehand this year. Planning to be with family and anticipating a barrage of intrusive questions about getting pregnant? Brainstorm some succinct and effective responses to have at the ready, or determine a code word or signal to discreetly let your partner know when you’ve had enough, and need to make a quick escape. You can also check out FertiCalm, an app designed to help women cope with the inevitably challenging social scenarios they face while trying to conceive (more on that below!)
Don’t be afraid to express yourself
Talk with your parents or in-laws about how this day feels for you. Acknowledge the difficulty of expectations and emotions that Mother’s Day evokes. Assure them that how you feel about the day isn’t anyone’s fault, and they didn’t make you feel this way. Use “I” statements to express your thoughts and feelings: “I find it hard to sit through church when the whole sermon is about the blessings of motherhood” or, “I dread family meals with all the focus on the grandkids.”
Set some boundaries
Consider limiting the time you spend this weekend with your family or friends who have children, if you feel that it is too stressful or painful. There’s nothing wrong with deciding together that you will only attend the big family luncheon for 2 hours, and that you’ll have a united response to share when it’s time excuse yourselves.
Why not consider skipping the day altogether? Go camping together or with friends. Plan a quick getaway for the weekend. Sundays aren’t exclusively for brunch – skip the brunch crowd, and schedule dinner with friends who are also struggling with the whole “Mother’s Day” experience.
Staying busy is a great distraction, so why not fill your time with a meaningful activity, like volunteering? Homeless shelters still need meals to be prepared and served. Nursing homes are full of women who might not have family to join them on this day. Volunteering will not only help to brighten someone else’s day, but will help lift your spirits, too.
Prepare for the worst
If you know you might react badly when under stress, decide in advance how you want to behave, and stick to it. Tell your partner or spouse about your approach, so they can be there to support you if things get tough. Tell your family in advance that it is hard for you, but you have committed to controlling your tongue or behavior. Again, try to avoid excessive alcohol consumption – this will only make it more challenging to stick to your plan.
Find your own meaning
This Mother’s Day, incorporate something into your day that is meaningful or brings you joy and happiness. For example, you could start your own tradition of planting flowers, or frame an empowering quote that reminds you that you are worthwhile with or without children.
Remember that you are not alone in your struggle. It’s important (and healthy) to confide in trusted family members and friends – help them to understand why you feel the way you do. If you need additional support, consider speaking with a reproductive psychologist (they do exist!) in your area.
There are more private solutions, too. Developed by two reproductive psychologists, the FertiCalm app provides women with coping tools to remain calm and in control while facing distressing scenarios, regardless of when or where they may occur. FertiCalm incorporates cognitive, behavioral and relaxation techniques helpful to women as they face the many stress-inducing situations they may encounter during their fertility journey, offering more than 500 custom coping options for over 50 specific situations which have the potential to cause distress throughout the family-building journey. FertiCalm is available to users for free, made possible through FertiCalm’s partnership with Ferring Pharmaceuticals. For more information, search “FertiCalm” in the Apple App Store or Google Play.
Don’t forget, your spouse and/or partner is likely feeling the impact of the holiday, too. Talk with him or her about it and share how you’re feeling with each other – you’re in this together. Maybe you can pull them back out (if applicable to your relationship!) when Father’s Day rolls around, too.
Adapted from Creating a Family’s Tips for Surviving the Holidays When You’re Infertile.
When it comes to fertility, we know that there is no shortage of misperceptions. Of all the myths circulating the message boards and social circles, those that relate to sex are perhaps the most common. How many times have you heard some variation telling you to place a pillow here, or put your legs there during sex to improve chances of conceiving? We’re guessing it’s been more than a few.
So, which sex-related rumors hold true, and which ones are simply fiction? Keep reading to hear experts’ responses to some of the most common sex-related myths.
MYTH #1: Certain sexual positions increase ability to conceive
According to Dr. Allan Pacey, Professor of Andrology at Sheffield University in the UK, and keynote presenter at the European Society of Human Reproduction and Embryology Conference in 2016, all positions are created equal when it comes to conceiving a baby: there is no evidence that any one sexual position is better than another for getting pregnant.
Contrary to popular belief, putting a pillow under your hips or having a male partner enter from behind will not increase your odds one way or the other. Your best bet? Keep going in whatever position(s) you prefer.
MYTH #2: Raising your legs in the air following sex will help you get pregnant
While many women who are trying to conceive stick their legs up the wall after sex or even bicycle their legs midair, no evidence supports this practice. Studies have shown it takes about 10 minutes for sperm to reach the egg in the fallopian tubes, regardless of what a woman does with her legs after sex. According to Dr. Pacey, remaining horizontal immediately after sex may help the sperm successfully reach the egg, but only for a few minutes after ejaculation – no additional leg maneuvers required.
MYTH #3: Having an orgasm increases my chances of getting pregnant
Believe it or not, this one isn’t totally a myth; studies have shown that women who have orgasms get pregnant more often, but perhaps not for the reason you may think. People often think that the contractions that occur during a woman’s orgasm draw the sperm towards the egg; however, a closer look at those studies indicates that the primary reason women who orgasmed more frequently had higher pregnancy rates is because they had sex more often, thus increasing their odds of conception. Pretty simple, right? We do more of what we enjoy.
MYTH #4: Abstaining from ejaculation in the days prior to sex increases sperm count and quality
We all know that the timing of sex is important; you need to have sex during or just before the ovulation phase, which is the most fertile time during a woman’s cycle, in order to conceive. But how often during that fertile window should you be having sex? Most healthcare providers agree; the more frequent, the better.
In addition to increasing the odds, frequent ejaculation has some unexpected benefits when it comes to sperm quality. Past studies have indicated that daily sex (or ejaculation) for seven days prior to intercourse or fertility treatment via intrauterine insemination (IUI) or in vitro fertilization (IVF) improved sperm motility and decreased sperm DNA fragmentation1. Researchers believe this may be because the sperm had a shorter exposure in the testicular ducts and epididymis to harmful free radicals, leading to healthier, stronger sperm.1
Recent research now indicates that even more frequent sex or ejaculation is better. A recent UK study examined IUI in 73 couples trying to conceive. The typical pregnancy rate for IUIs is about 6%.2 In this study, sub-fertile men were asked to produce two sperm samples within an hour to be used with the IUI fertility procedure. When the second semen sample was used, the pregnancy rate jumped to 20% — nearly three times the rate of the first samples.2 Although the study was small, researchers believe that these results would also be applicable to those conceiving naturally.
According to Dr. Adam Balen, Professor of Reproductive Medicine at Leeds University, “If you want to get pregnant, have lots of sex – as much as you want, however you want – and enjoy it.”
For more information or guidance on improving your odds for conception, be sure to speak to your healthcare provider or reproductive endocrinologist.
- European Society of Human Reproduction and Embryology (ESHRE). “Daily Sex Helps Reduce Sperm DNA Damage And Improve Fertility.” ScienceDaily, 1 July 2009. Available at: link
- European Society of Human Reproduction and Embryology (ESHRE). “Improving pregnancy rates in intrauterine insemination procedure,” Bahadur G et al. June 2015. Available at: http://www.posters2view.eu/eshre2015/data/495.pdf.
The predominant feeling when you first start trying to get pregnant is excitement. You imagine your future child as the perfect mix of you and your partner. You spend time thinking about the type of parent you will be (perfect, of course) and what your new life will be like. But as each month passes and you are not pregnant, slowly but surely, you may start to feel nervous. It’s natural to feel nervous – but how do you know when it’s time to stop dismissing your feelings of nervousness, and time to start worrying?
How Long Should I Try Before Going to a Doctor
Believe it or not, it’s normal to not get pregnant immediately or even within the first few months of trying – these things do take time! Infertility experts say that you should not worry until you have been trying to get pregnant with unprotected intercourse for 12 months (for woman under 35) or six months (for women 35 and over).1
For a couple that is trying to get pregnant, it is important to have sex when the woman is about to ovulate. You have lots of options for determining this timing, from taking your temperature each morning (basal body temperature),2 to monitoring your cervical mucus,3 to using over-the-counter ovulation prediction kits.1
The American College of Obstetricians and Gynecologists recommends that you have an infertility evaluation if:
- You have not become pregnant after one year of having regular sexual intercourse without the use of birth control.4
- You are older than 35 years and have not become pregnant after 6 months of having regular sexual intercourse without the use of birth control.4
- Your menstrual cycle is not regular.4
- You or your partner have a known fertility problem.4
If any of these apply to you, it’s time to consult a medical professional.
How to Get Help
A good first step is to consult a gynecologist. A gynecologist can help assess your fertility and can identify ways that you can optimize your fertility, whether through lifestyle changes or treatment options, such as oral fertility treatments. Together, you can assess what factors may be contributing to the issue, and determine if you should keep trying, or need to consult a specialist.
So how long should you wait before seeking additional help from a reproductive endocrinologist (RE)? Unfortunately, there is no “one-size-fits-all” answer to how long you should keep trying before going to see a specialist – it varies from patient to patient, and depends on your specific diagnosis and age.5 However, one thing is universal: timing is critical. The older you are, the harder it can be to become and stay pregnant.1 If you are struggling to get pregnant, do not hesitate – work with your gynecologist to establish a clear timeline, so that together, you can determine when you need to consult an RE and establish a course of action that meets your individual needs.
- American Society of Reproductive Medicine. Defining Infertility Factsheet. Retrieved March 4, 2017 from https://www.asrm.org/FACTSHEET_Defining_Infertility/.
- Mayo Clinic. Basal body temperature for natural family planning. Retrieved March 7, 2017 from http://www.mayoclinic.org/tests-procedures/basal-body-temperature/basics/definition/prc-20019978.
- Mayo Clinic. Cervical mucus method for natural family planning. Retrieved March 7, 2017 from http://www.mayoclinic.org/tests-procedures/cervical-mucus-method/basics/definition/prc-20013005.
- American College of Obstetricians and Gynecologists. Evaluating Infertility. Retrieved March 7, 2017 from http://www.acog.org/Patients/FAQs/Evaluating-Infertility.
- Creating a Family, the national infertility & adoption education and support nonprofit. Clomid, Medicated IUI, or Straight to IVF? Interview with Alison Zimon, a reproductive endocrinologist at Boston IVF, and Dr. Samantha Pfeifer, Associate Professor of Obstetrics and Gynecology at University of Pennsylvania Medical School. Retrieved March 7, 2017 from https://creatingafamily.org/infertility-category/clomid-medicated-iui-straight-ivf/
Using Health Insurance to Pay for Fertility Treatment
It’s no secret that fertility treatment can be expensive. Unless you are independently wealthy, chances are you’ll need to rely on your health insurance to cover the costs. Your health insurance policy will dictate everything, from whether in vitro fertilization (IVF) is covered, to which healthcare providers can provide treatments, to which tests will be paid for, to which medications will be covered. With so much riding on your policy, it’s important to make sure you consider how your healthcare policy will impact your fertility journey.
Basic Types of Infertility Insurance Coverage
All policies are different, so it’s important you understand the specifics of your individual policy, and what aspects of your fertility needs are covered. Though there are variations from plan to plan, most healthcare insurance policies address infertility in one of the following ways:
- No Fertility Insurance Coverage: Although not common, it is possible. Most health insurance policies usually cover at least some aspects of the infertility diagnosis, even if it does not cover treatments such as IVF. Diagnosis and treatment of conditions such as Polycystic Ovarian Syndrome (PCOS) and endometriosis are usually covered.
- Insurance Coverage for Infertility Diagnosis only: The insurance benefits cover diagnosing the cause of infertility. These policies may cover surgeries necessary to diagnose the cause, and may specify what type of health care provider can perform these tests and surgeries. This is the most common type of coverage among most major providers.
- Insurance Coverage for Infertility Diagnosis and Limited Treatment: The insurance benefits cover diagnosing the cause of infertility and limited treatment options such as clomiphene citrate (Clomid), or artificial insemination/intrauterine insemination (IUI) with or without injectable medications.
- Full Infertility Insurance Coverage: Currently, 15 states require insurance companies to offer fertility insurance coverage. Usually, there is either a limit on the number of IVF cycles that are covered, or, a lifetime dollar amount limit to be used for fertility treatment.
How to Determine Fertility Insurance Coverage in Your Policy
Ultimately, you are responsible for knowing your insurance coverage for infertility, but you can get help from the following places:
- Your insurance company
- Your employer’s human resources department
- The infertility clinic you are considering or are using
You’ll need to know your covered benefits, and any exclusions and/or restrictions associated with your plan. Get a copy of your healthcare plan’s “Evidence of Coverage” or “Certificate of Insurance” from your employer’s human resources department, or by calling your insurance company directly. The “Summary of Benefits” is usually not sufficient for the information you will need. If you already have a copy of this document, be certain that it is the latest version, as they change frequently.
Advocate for Insurance Coverage for Infertility Treatment
Infertility is a disease, and deserves to be covered by health insurance. Ask your employer to provide insurance that covers infertility; most employers who offer this coverage do so at the request of their employees – so ask! RESOLVE, the National Infertility Association has resources to help you ask the right questions.
- Creating a Family, the national infertility & adoption education and support nonprofit. Insurance Coverage For Fertility Treatment, Egg Donation, Surrogacy. Retrieved March 6, 2017 from https://creatingafamily.org/infertility/resources/infertility-insurance/.
- Resolve, the National Infertility Association. Health Insurance 101. Retrieved March 6, 2017 from http://www.resolve.org/family-building-options/insurance_coverage/health-insurance-101.html?referrer=https://www.google.com.mx/.
Seven Things You Should Know About Endometriosis
Endometriosis can take a physical toll on women – it can cause long, heavy periods, abdominal pain, and pain during or after sex.1 It can also cause infertility,1 which can be even more painful than the physical symptoms.
While almost 5 million women in the US suffer from endometriosis,1 it is still a misunderstood disease.
Here are seven things you should know about endometriosis:
- Endometriosis is a disease in which endometrium tissue, which normally grows inside the uterus, grows in an abnormal place outside of the uterus. Endometriosis patches can be found on or under the ovaries, on the fallopian tubes, behind the uterus, on the tissues that hold the uterus in place, or on the bowels or bladder.1
- While endometriosis can affect any woman who menstruates, it is most common in women in their 30’s and 40’s.1
- You are six times more likely to have endometriosis if your mother or sister has it.1
- Exercising regularly (4 hours a week) can lower your risk of endometriosis.1
- Not everyone with endometriosis will be infertile, but about 40% of infertile women have been diagnosed with endometriosis.2
- There is no known cure for endometriosis, but it can be treated depending on your symptoms and whether you want to have children. When pain is the primary concern, pain relievers, such as nonsteroidal anti-inflammatory medicines (NSAIDs), and hormonal medications, including birth control pills, are usually tried first.1,2
- If you have pain and cramping with menstruation that is not relieved with over-the-counter NSAID pain relievers, such as ibuprofen, acetaminophen or naproxen, you should see your gynecologist to discuss alternative options.2
- US Department of Health and Human Services | National Institutes of Health. Retrieved March 3, 2017 from https://www.nichd.nih.gov/health/topics/endometri/Pages/default.aspx.
- American College of Obstetricians and Gynecologists. (2011). Endometriosis. Retrieved March 3, 2017 from http://www.acog.org/~/media/For%20Patients/faq013.ashx.
Weight is one of the most emotionally-charged topics known to man (or perhaps more accurately “woman”). We all know carrying extra pounds can impair your health in a variety of ways, but being significantly overweight or underweight can also affect your fertility.1 In addition, it can make infertility treatments, such as intrauterine insemination (IUI) and in vitro fertilization (IVF), less likely to succeed.1
How Does Weight Affect Fertility?
Being significantly over or underweight can cause women to have irregular ovulation or sometimes no ovulation at all, which impacts an individual’s ability to conceive.1 Even if they have regular ovulation cycles, obese women may struggle to conceive.
What is the Ideal Weight for Fertility?
Many people are fixated on what they weigh, but there are more accurate ways to assess your health than looking at the numbers on your scale. Rather than looking at weight alone, look at your Body Mass Index (BMI), which assesses your weight in relation to your height.1 For maximum fertility, both men and women should be within the normal range for BMI (18.5 – 24.9 BMI).1,2
You can calculate your BMI using this calculator.
How Does Weight Affect IVF?
Being obese lowers the success rate of IVF and increases the rate of miscarriage.1 Further, obesity complicates the IVF process itself by:
- Lowering response to IVF medication, thus increasing the cost.3
- Reducing the number of eggs retrieved.3
- Creating greater difficulty of retrieving eggs, with increased risk of bleeding or injury.4
- Lowering embryo implantation rates.4
Obese women are at an increased risk for complications during pregnancy.1 They are more likely to develop gestational diabetes and high blood pressure, or pre-eclampsia.1 Obese women also have a higher chance of needing to deliver by cesarean section.1 Babies of obese mothers are at a higher risk of some birth defects and being significantly larger at birth.1
Weight and Male Infertility
Being overweight also affects fertility in men. Obesity in men can affect testosterone levels, lower sperm count, and reduce sperm motility (movement). 1 The rate of erectile dysfunction is also higher in obese men. 1
Best Way to Lose Weight to Increase Your Fertility
The American Society of Reproductive Medicine notes that changing your diet and lifestyle (for example, adding exercise to your daily routine) can be an effective step, but not always the appropriate first step if your age or your BMI is above 40.1 Weight loss surgery (bariatric surgery) is the most effective treatment for weight loss in women with a BMI greater than 40.1 You should consult with your doctor for help in determining the best way for you to lose or gain weight.
- “Weight and Fertility Fact Sheet.” American Society for Reproductive Medicine, 2014. Web. Accessed February 8, 2017. Available at: http://www.asrm.org/factsheet_weight_and_fertility/
- “Calculate Your Body Mass Index.” National Heart, Lung & Blood Institute. Web. Accessed February 8. 2017. Available at: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
- Pandey, Shilpi et al. “The Impact of Female Obesity on the Outcome of Fertility Treatment.” Journal of Human Reproductive Sciences 3.2 (2010): 62–67. PMC. Web. 8 Feb. 2017.
- “Obesity and Reproduction: A Committee Opinion.” American Society for Reproductive Medicine. Vol 104;5. 1116-1126. November 2015. Accessed February 8, 2017. Available at: link