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What is PCOS and What Do I Do About It?

If you’ve been recently diagnosed with Polycystic Ovary Syndrome (PCOS), you’re likely experiencing mixed emotions, and feeling overwhelmed. While there may be a lot to learn about the disease, arming yourself with information about PCOS will help you manage your symptoms better so you can get on with the business of life.

 

What is PCOS?

 

Polycystic Ovary Syndrome (PCOS) is a disorder of the endocrine system that occurs in women of reproductive age.1 Women with PCOS can develop follicles, or small collections of fluid, in their ovaries, which prevents the eggs from being released during ovulation, leading to missed or irregular periods, which in turn can cause infertility, and/or the development of cysts in the ovaries.

As a result, PCOS can lead to the following symptoms:

  • Irregular menstrual cycle – infrequent, irregular or prolonged periods are the most common sign of PCOS. This could cause you to miss a month or more of your cycle, or cause your cycle to vary significantly from month to month.1,2
  • Hirsutism – this is the presence and growth of too much hair on your face, chin, or parts of the body where men usually have hair. 1,2 This symptom of PCOS affects up to 70% of women with the syndrome.2
  • Acne – break-outs on your face, chest, and upper back.1,2
  • Hair Loss – you might experience thinning hair or hair loss on the scalp, including male-pattern baldness.2
  • Weight issues – weight gain or difficulty losing weight is a very common symptom of PCOS.
  • Darkening of skin – this happens particularly along your neck creases, in the groin, and underneath your breasts.
  • Skin tags – these small excess flaps of skin occur commonly with PCOS and often appear in the armpits or neck area.

 

Who is at Risk for PCOS?

 

PCOS is most commonly diagnosed in women who are in their 20s and 30s and affects one in 10 women of child-bearing age.2 Additionally, you might be at increased risk if you are obese or if you have a mother, sister, or aunt with PCOS.2

Unfortunately, the exact cause of PCOS is not known. Hormonal imbalance, genetics, and certain lifestyle factors, like diet and nutrition, are thought to cause to PCOS.1,2

 

How Can I Manage My Symptoms?

 

While there is no known cure for PCOS, there are things you can do to manage and alleviate your symptoms. These lifestyle changes are not only beneficial for the management of PCOS, but they can also improve your general health and fertility.

  • Healthy diet and exercise – This is especially pertinent for PCOS patients who are overweight or obese. It’s been found that losing even 5-10% of your body weight can significantly improve the discomfort of PCOS.2
  • Birth control– Hormonal birth control, like the pill, can be helpful in in balancing the hormones that drive excess hair growth and cause acne/breakouts. Birth control can also help regulate the menstrual cycles, and lower the risk of endometrial cancer.2
  • Laser Electrolysis/Professional Hair Removal – Some women turn to electrolysis, laser hair removal and/or other types of professional hair removal for relief from the excess hair growth with this treatment.2
  • Acne Medications – Many patients with PCOS use topical ointments and antibiotics to manage the break-outs prompted by the hormonal imbalance.2

 

Can I Get Pregnant with PCOS?

 

Generally, the success rates for achieving pregnancy for a PCOS patient range from 15-20% with the more conservative approaches, and up to 40-60% for more advanced fertility treatments.3 If you want to get pregnant and you suspect you have PCOS or you have already been diagnosed, make sure you are working with a doctor that specializes in fertility, like a reproductive endocrinologist (RE).

If you are living with PCOS or have been just diagnosed, it’s important to take care of yourself. It is also a good idea to build a good support network of friends and family to help you cope with the symptoms and adjust to the necessary lifestyle changes you may need to make. Most importantly, make sure you work with your healthcare provider to determine a treatment approach that meets your specific needs that you feel comfortable with.

 

References

  1. Polycystic Ovary Syndrome (PCOS). Mayo Clinic Staff. Published August 29, 2017. Available at: http://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439. Accessed October 11, 2017.
  2. Polycystic Ovary Syndrome. Office on Women’s Health, U.S. Department of Health and Human Services. Published July 26, 2017. Available at: https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome. Accessed October 11, 2017.
  3. Q&A with the Experts: Odds of Getting Pregnant with PCOS. [Interview with Dr. Alan Martinez]. Published February 10, 2016. Available at: https://creatingafamily.org/infertility-category/odds-of-getting-pregnant-with-pcos/. Accessed October 11, 2017.

Five Things You Should Do Before Your First Visit to Fertility Clinic

It’s not uncommon to procrastinate making the first appointment at a fertility clinic. Maybe it’s because you are hoping that you may be able to get pregnant on your own and just need a little more time, or you are still grappling with the idea that you are indeed facing fertility issues. Or, it could be that you are anxious about what this visit will bring and the path it will lead you on, including the decisions you will have to make.

No matter the reason for your hesitation, remember that you’re not alone: many women/couples report feeling anxious or hesitant to make that first appointment. While it can certainly be overwhelming, a little preparation beforehand can help make the experience a little easier.

 

5 Things You Should Do Before Your First Visit to a Fertility Clinic

 

  1. Bring your insurance card. Insurance coverage for fertility care/treatments can be challenging to navigate. Fortunately, your clinic will have staff that is experienced in reviewing policies to see if any part of the visit might be covered.1
  2. Bring your spouse or partner. They need to be a part of this discussion, and can provide emotional support before, during and after your appointment3 Plus, it never hurts to have another set of ears present during the appointment, to make sure you’re absorbing all of the information that’s being shared.
  3. Bring your full medical file sent to your clinic. Better yet, have them sent to your fertility clinic in advance.3
  4. Bring any results of general and recent health tests. This is especially important if you have been tested or treated for fertility issues by your gynecologist or another fertility clinic.3
  5. Start tracking your ovulation a few months in advance. You can do this using a smartphone app, ovulation predictor kits, or basal body temperature charts. Bring these results/apps with you.3

 

Always remember that both you and your fertility clinic want the same thing — for you to get pregnant and deliver a healthy baby! Stay positive, be prepared, and remind yourself that you are taking a critical first step in your fertility journey.

 

References

  1. What to Expect from Your First Fertility Clinic Visit [Podcast interview with Dr. Beth McAvey]. (2015, July 15). Available at: https://creatingafamily.org/infertility-category/what-to-expect-from-your-first-fertility-clinic-visit/. Accessed October 11, 2017.
  2. Ficarra, B., RN, BSN, MPA. (2010, September 10). Empowered Patient: Bring a Family Member or Friend with you to Your Doctor’s Appointment. Available at: http://healthin30.com/2010/09/empowered-patient-bring-a-family-member-or-friend-with-you-to-your-doctor%E2%80%99s-appointment/. Accessed on October 11, 2017.
  3. Mayo Clinic. Infertility. (2017, August 17). Available at: http://www.mayoclinic.org/diseases-conditions/infertility/diagnosis-treatment/drc-20354322. Accessed on October 11, 2017.

 

Five Things You Should Know About Premature Ovarian Failure

Do you experience hot flashes? What about skipped periods, or unexpected/irregular periods that inconvenience your life? These common symptoms of menopause are troublesome enough when you are a woman “of a certain age” and are expecting them, but if you are under the age of 40, those symptoms warrant a deeper look.

Premature Ovarian Failure (POF) affects 1 in 100 women under 40 and requires a full evaluation from a gynecologist or reproductive endocrinologist (RE).

 

What Are the Most Common Symptoms of Premature Ovarian Failure?

 

The most common symptoms of Premature Ovarian Failure are similar to what many women experience in menopause or with estrogen deficiency:2

  • Irregular or skipped periods (amenorrhea), which could be present for years or develop after a pregnancy or after stopping birth control pills
  • Difficulty conceiving
  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Irritability or difficulty concentrating
  • Decreased sexual desire

 

What Causes Premature Ovarian Failure?


Premature Ovarian Failure has a variety of causes, but in about 90% of cases, the cause is not known.3 The most common cause is a history of cancer treatment, including radiation or chemotherapy. Autoimmune issues can also cause Premature Ovarian Failure, if the body’s immune system attacks organs of the endocrine system such as ovaries, thyroid or adrenal glands.1  Premature Ovarian Failure can result from deficiencies in pituitary and ovarian hormones.1

 

Am I at Risk for Premature Ovarian Failure?


There are three main categories of risk factors for Premature Ovarian Failure:

  1. Age – Though it is possible for adolescent and younger women to develop Premature Ovarian Failure, your risk increases between the ages of 35 and 40.2
  2. Family history – If you have a family history of premature ovarian failure, you are at increased risk. In this case, your doctor should do a full evaluation to determine what syndromes or other serious potentially serious medical issues might be present.1,2
  3. Multiple ovarian surgeries – if you have had repeated surgeries for issues like ovarian endometriosis or other conditions you are at increased risk.2

 If you identify with these three risk factors, or if you have received chemotherapy for cancer treatment in the past, you should consult your gynecologist or reproductive endocrinologist to discuss your individual risk, and any necessary measures you should take.

 

How Does Premature Ovarian Failure Affect My Fertility?

 

One of the primary complications of Premature Ovarian Failure is difficulty conceiving.1,2 The deficiency of estrogen and the failure to produce eggs healthy enough for conception results in a loss of fertility.1,2 You must seek treatment from a doctor that specializes in infertility, like a reproductive endocrinologist (RE).

 

What Are My Options for Treatment of Premature Ovarian Failure?

 

Once your doctor has diagnosed Premature Ovarian Failure, he or she will recommend treatment plan based on your symptoms and goals. Work closely with your doctor to find what path of care feels right and comfortable for you. Educate yourself about the condition and talk honestly about how you feel regarding side effects, complications, and outcomes of whatever treatment you choose together.

 

  • Hormone Therapy – Replacement of the hormone estrogen may be useful in reducing hot flashes, restoring regularity of your monthly cycle, and preventing osteoporosis, which is a common complication of estrogen deficiency).2
  • Vitamin Supplements and Nutritional Support – Calcium and Vitamin D are helpful in prevention of osteoporosis. Focus on a healthy diet and regular exercise are also good for preventing weight gain, heart disease and bone health.2
  • Mental Health Support– It is not uncommon for a woman diagnosed with Premature Ovarian Failure to struggle with grief or depression. Find a mental health professional who can help you work through your feelings about this disease and find coping skills.

 

For a comprehensive discussion on the causes and treatment of Premature Ovarian Failure, listen to this podcast from Creating a Family https://creatingafamily.org/infertility-category/premature-ovarian-failure-causes-and-treatment/ with Dr. Timothy Hickman, Medical Director of Houston IVF, a Board Certified Reproductive Endocrinologist, and former member of the Executive Board of the Society for Assisted Reproductive Technology.

 

References

  1. Ebrahimi M, Akbari Asbagh F. Pathogenesis and Causes of Premature Ovarian Failure: An Update. International Journal of Fertility & Sterility. 2011;5(2):54-65. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059950/. Accessed October 11, 2017.
  2. Premature Ovarian Failure. Mayo Clinic Staff. Published October 27, 2016. Available at: Accessed http://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/dxc-20255567. Accessed October 11, 2017.
  3. From National Institute of Health, Eunice Kennedy Shriver’s National Institute of Child Health and Human Development, https://www.nichd.nih.gov/health/topics/poi/conditioninfo/Pages/causes.aspx
  4. [1] From Resolve.org, Premature Ovarian Failure – What Do I Need to Know? http://www.resolve.org/about-infertility/medical-conditions/premature-ovarian-failure-what-do-i-need-to-know.html

Should You Use Acupuncture When Trying to Get Pregnant?

Acupuncture is becoming an increasingly common alternative or complementary treatment to traditional Western reproductive medicine. In fact, many fertility clinics offer acupuncture and other traditional Chinese medicine within the clinic or refer patients to an acupuncturist. So how do you know if acupuncture is right for you in your path to achieve pregnancy? Keep reading to learn more about the practice, and to see if it’s something you might want to consider.

 

What Exactly Is Acupuncture?


Acupuncture is the ancient Chinese practice of medicine in which tiny needles are inserted strategically into the skin. There is a wide range of types and sizes of needles, points of insertion and styles of acupuncture practice. In the United States, traditional acupuncture is the most commonly-practiced style of acupuncture[1]

 

How Can Acupuncture Help Infertility?

 

  • Stress Reduction – There’s no question about it: trying to get pregnant is inherently stressful! Unfortunately, stress can have a negative impact on conception; research shows that higher levels of stress are clearly associated with a longer time-to-pregnancy and an increased risk of infertility.2 Acupuncture is considered by many fertility specialists to be a complementary tool in improving relaxation and reducing stress, which is important for women who are trying to conceive.
  • Improvement of Blood Flow and Organ Function – Acupuncture has been shown to improve the volume of blood flow and the quality of that blood to reproductive organs. This is particularly true if you find a good acupuncturist who is trained and knowledgeable about the multiple facets of reproductive issues or infertility.3
  • Management of Symptoms and Side Effects – Acupuncture has been shown to help manage the difficult symptoms associated with conditions that impact the reproductive organs, like Polycystic Ovary Syndrome (PCOS), fibroids, and endometriosis. Additionally, many have found relief for side effects like bloating or nausea that can often come with certain fertility medications. Your male partner or spouse might also find some improvement in sperm count or quality using acupuncture.1

 

Where Do I Find an Acupuncturist Trained in Treating Fertility Issues?

 

If your clinic does not already have an acupuncturist with whom it works closely, you can find one who

specializes in fertility issues and is certified with the American Board of Oriental Reproductive Medicine (http://www.aborm.org/). He or she should also be registered with the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) and/or the American Board of Medical Acupuncture (ABMA).

 

How Do I Get Acupuncture Treatment Started? What Will It Be Like?


Once you’ve found a certified and registered acupuncturist, you can expect that the first appointment will be much like any other first appointment with a fertility specialist. He or she will ask you a lot of questions about your health history, lifestyle (diet, stress levels, exercise, sleep habits) and your fertility concerns. There will likely also be an exam, including feeling your pulse and looking at your tongue. The actual acupuncture (insertion of the needles) might also happen at this first appointment and can take about 30 minutes to an hour. Most patients report little to no pain, although you might feel some dull ache, pinch or slight shock sensation.1

 

Is Acupuncture Expensive? Is it Covered by My Insurance?


Many insurance plans are now offering coverage for alternative or complementary treatments like acupuncture. Look over your policy to get familiar with the coverage you have. When you call to make your first appointment, be sure to talk with the scheduler about your individual insurance plan and the coverage it offers. If your plan does not cover alternative care, speak with the staff providing the acupuncture about fee schedules and payment plans before you begin treatment. Financial surprises will not help reduce your stress!

While many people are wary of alternative or complementary care like acupuncture, it’s important to know that many reputable and ethical fertility-care providers have come a long way in their understanding of its benefits. Finding an infertility treatment plan that is tailored for your needs and your comfort with non-traditional care is very important. Your reproductive specialist can be a great resource for what options are available and what can be truly beneficial in helping you get pregnant. Speak with him or her about your questions and concerns about acupuncture, so that you can come up with a treatment plan together.

 

References

  1. American Society for Reproductive Medicine (ASRM). “Acupuncture and Infertility Fact Sheet” Updated 2015. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Acupuncture_and_infertility_treatment.pdf. Accessed October 11, 2017.
  2. D. Lynch, et al; Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study, Human Reproduction, Volume 29, Issue 5, 1 May 2014, Pages 1067–1075. Available at: https://academic.oup.com/humrep/article/29/5/1067/2913997/Preconception-stress-increases-the-risk-of. Accessed October 11, 2017.
  3. Complementary Care for Fertility Treatment: Nutrition, Acupuncture, and Counseling [Podcast interview with Mark LeWinter]. (2012, May 23). Available at: https://creatingafamily.org/infertility-category/complimentary-care-for-fertility-treatment-nutrition-acupuncture-and-counseling/. Accessed October 11, 2017.

 

5 Things You Should Do When Struggling to Get Pregnant

When you’ve been trying to get pregnant for a while with no success, it’s very common to feel the need to “do something” to improve your chances. Some women feel the need to take back some control in what can feel like a very helpless situation. Others have a hard time waiting for results, and feel compelled to take action. Whatever it is, know that you are not alone!

Of course, the most important thing you can do when trying to get pregnant is work with your HCP/RE to determine a treatment plan that is right for your unique needs. That said, it never hurts to supplement your treatment plan by incorporating some small, health-conscious changes into your daily life.

Here are five small things you can do to help improve your health, and ensure you’re as healthy as possible while you’re trying to conceive:

 

Five Things To Do To Help You Get Pregnant

 

  1. Eat Healthy. While it’s unnecessary to go overboard or get extreme in your eating habits (no fad dieting!) there are small tweaks you can make to your diet to optimize your nutritional intake. Research has shown that maintaining a high-protein, low-carbohydrate diet can improve your chances of getting pregnant.1 It’s also a good idea to avoid certain ingredients/additives, like artificial sweeteners.2
  2. Get enough sleep. Research shows that getting enough sleep is very important for fertility health. And not just for you, but for your male partner too.3 Adults should be getting about 7 to 8 hours of sleep a night.3
  3. Exercise in moderation. It’s widely known that regular exercise is an important part of your physical and emotional health, but did you know that research also indicates that regular exercise can have a positive impact on fertility?4 While extreme physical exertion can be risky, moderate physical activity can actually improve your fertility.4
  4. Live and enjoy life.  Giving up those things that you love or that make your life pleasurable while you are waiting to become pregnant can make you feel worse about the process.5
  5. Stay Positive. This one can be challenging, but it’s one of the most important things you can do when struggling to conceive. Preserving your emotional health and wellbeing throughout the process is just as critical as maintaining your physical health. Surround yourself with positive influences. Find a good support group focused on fertility issues, or a reproductive psychologist (they exist!) who can help you handle the emotional challenges that you may face. Stay connected to good friends and family who will support you and encourage you along the way. It’s perfectly normal and natural to get discouraged at different times throughout the process; make sure you have the support you need when times get tough.

Whether you’re trying on your own or working with a fertility specialist to get pregnant, these tips can be easily incorporated into your day-to-day life, and help you maintain your physical, emotional and mental health while you’re trying to conceive.

 

References

  1. Russell, J. B. (2012). Does dietary protein and carbohydrate intake influence blastocyst development and pregnancy rates? [Abstract]. Fertility and Sterility,98(3), S233-S234. Available at: http://www.fertstert.org/article/S0015-0282(12)01583-X/fulltext. Published October 24, 2012. Accessed October 11, 2017.
  2. Halpern, G. et al. Artificial sweeteners – do they bear an infertility risk? Fertility and Sterility, 106(3), E263. Published September 2016. Available at: http://www.fertstert.org/article/S0015-0282(16)62172-6/fulltext. Accessed October 11, 2017.
  3. Single Best Thing You Can Do to Improve Your Fertility in 2017. Creating a Family. Published February 2, 2017. Available at: https://creatingafamily.org/blog/single-best-thing-to-improve-fertility/. Accessed October 11, 2017.
  4. Wise, LA et al. A prospective cohort study of physical activity and time to pregnancy. Fertility and Sterility, 97(5), 1136-1142. Published May 2012. Available at: http://www.fertstert.org/article/S0015-0282(12)00259-2/abstract. Accessed October 11, 2017.
  5. Lifestyle Choices that Increase Your Chances of Getting Pregnant [Podcast interview with Dr., Sheeva Talebian]. (2015, January 21). Available at: https://creatingafamily.org/infertility-category/lifestyle-choices-increase-chances-getting-pregnant/. Accessed October 11, 2017.

One Quick Change to Your Diet That Can Help You Get Pregnant With or Without Fertility Treatment

 

It’s widely known that nutrition and diet can affect your fertility. While there is no miracle food or diet that will cure all infertility issues, research indicates that there is one dietary change that you can make which may improve your chances of getting pregnant, with or without fertility treatment.

If you’re thinking you’ll need to stock up on fancy dietary supplements or expensive organic juices, think again! The “secret ingredient” is probably something you already consume as a part of your daily diet: protein.

Believe it or not, research suggests that a high-protein diet is an important factor for women who are trying to conceive.

 

So what’s the deal with protein?

A study led by researchers at the Delaware Institute for Reproductive Medicine (DIRM) analyzed the diets of 120 women going through IVF at the same clinic, all ages 36 and 37 and all with the same general BMI. Interestingly, patients whose daily diet included protein at over 25% of total intake had two times the number of embryos available for transfer and four times the pregnancy rates.1 Further research found that the optimum diet for increasing fertility (egg quality, embryo quality, pregnancy rates, birth rates) was 30% protein and less than 40% carbohydrates.1 Lead investigator Jeffrey B. Russell, MD expanded the study to 350 women and found the same results.

“Protein is essential for good quality embryos and better egg quality, it turns out,” said Dr. Russell. Dr. Russell also noted that traditionally BMI was a main factor of concern, but doctors were finding poor quality embryos among even thin and healthy women. When studying the nutritional journals of study participants, he was surprised by the large percentage of women who were eating more than 60% carbohydrates each day and 10% (or less) protein.1 These diets were associated with poor quality embryos.

 

When Should You Change Your Diet if You Are Planning on Trying to Get Pregnant?

Start soon! Dr. Russell now instructs his infertility patients maintain a diet comprised of 25% to 35% protein and 40% or less carbs for three months before they begin IVF treatment. Of course, you should speak with your own HCP before altering your diet significantly; he or she will be able to help you make healthy, safe changes to your diet based on your individual needs.

When choosing protein, consider the following:

  • Focus on lean proteins: For the best sources of protein, alternate between poultry, fish, and non-meat options such as nuts, beans, quinoa, and peas.
  • Look for plant-based proteins: Try to get some of your protein from plants and grains. Adding foods like beans, peas, soybeans or tofu, or nuts, whole-grain cereals, spinach, beans, pumpkin, tomatoes, and beets will help you create variety.

 

It’s OK to start slow! You don’t need to make a drastic change right away; start by slowly swapping out some carbs for proteins, giving yourself time to adjust. Find fun, easy recipes to create low-carb, high-protein versions of your favorite meals.

Most importantly, remember that this is not a weight-loss program – this is all about nutrition, and is designed to promote better eating habits, to help patients get healthier as they try to conceive.

 

References

  1. Russell, J. B. (2012). Does dietary protein and carbohydrate intake influence blastocyst development and pregnancy rates? [Abstract]. Fertility and Sterility,98(3), S233-S234. Available at: http://www.fertstert.org/article/S0015-0282(12)01583-X/fulltext. Published October 24, 2012. Accessed October 11, 2017.

 

What Causes Infertility in Women

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:

  1. An egg must be released from one of the woman’s ovaries (ovulation)
  2. The egg must move through the fallopian tubes towards the uterus
  3. The egg must be penetrated by a healthy sperm (fertilization)
  4. 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

Ovarian Function

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

 

Uterine Receptivity

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

  • Age
  • Smoking
  • 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.

 

References

  1. Centers for Disease Control. Infertility FAQs. Updated March 30, 2017. Accessed June 13, 2017. Available at: https://www.cdc.gov/reproductivehealth/infertility/
  2. 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.
  3. 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/.

 

 

 

 

What You Need to Know About Uterine Fibroids

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.

 

References

  1. gov. “Uterine Fibroids.” Updated February 6, 2017. Accessed June 13, 2017. Available at: https://www.womenshealth.gov/a-z-topics/uterine-fibroids.
  2. 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/.
  3. 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.


 

Should I Freeze My Eggs and If So, When?

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.

 

References

  1. 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.
  2. 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/

 

 

 


 

Male Factor Infertility

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
  • Drugs
  • Smoking cigarettes
  • Age
  • 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

 

References

  1. 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/.
  2. Centers for Disease Control. Infertility FAQs. Updated March 30, 2017. Accessed June 13, 2017. Available at: https://www.cdc.gov/reproductivehealth/infertility/
  3. 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
  4. 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.
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