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
It is widely known that smoking is a deadly habit with lasting, harmful effects. It negatively impacts your lungs, increases your risk of cancer and heart disease and can lead to a long list of chronic diseases or conditions – but what you may not know is that it can also reduce your fertility, making it harder for you to get pregnant, with or without fertility treatment.1,2
Even with these facts, 23% of woman of childbearing age in the United States smoke, and a shocking 14% of pregnant women smoke, despite the well-documented risks.3 Exposure to secondhand smoke is even more common, impacting 37% of pregnant women.3
Think women who smoke are the only ones who are impacted by its harmful effects? Think again.
Impact of Smoking on Female Fertility
Women who smoke are twice as likely to be infertile as non-smokers.1 The risk increases with the number of cigarettes smoked.1 Ectopic pregnancies – pregnancies that occur outside the uterus – are also more common among female smokers, as smoking is believed to damage the fallopian tubes’ ability to move a fertilized egg to the uterus.4
Even infertility treatments, such as in vitro fertilization (IVF), can’t fully overcome the effects of smoking. According to the American Society of Reproductive Medicine (ASRM), female smokers need more ovary-stimulating medications during IVF, have fewer eggs at time of retrieval and experience 30% lower pregnancy rates compared with IVF patients who do not smoke.1
Reduced Number of Eggs
Women are born with all the eggs they will ever produce. Smoking causes eggs to die off at a faster rate, and once they are gone, they do not regenerate.1 Studies show female smokers enter menopause up to 4 years earlier than non-smokers.1
Increased Rate of Miscarriage
If a woman is able to become pregnant, women who smoke are at higher risk of losing a pregnancy through miscarriage.3 The risk of miscarriage increases with the number of cigarettes smoked each day (1% increase in relative risk per daily cigarette smoked).3 Smokers are also at a higher risk of placental abruption, which occurs when the placenta detaches from the uterus wall.3 Smoking also doubles the risk of abnormal bleeding during pregnancy and delivery, which can put both the mother and baby at risk.
Impact of Smoking on Male Fertility
Men who smoke are at an increased risk for lower sperm counts and impaired motility (the sperm’s ability to move).1 Smokers also have increased numbers of abnormally shaped sperm, and an increased likelihood of damage to the genetic material in the sperm, both of which decrease likelihood of successful fertilization.1
Smokers also report a higher rate of erectile dysfunction.1
Impact on Babies Born to Smokers
Smoking is not only harmful to parents trying to conceive – the effects are even more dangerous to babies. Babies with smoking parents are at increased risk of:
- Premature birth2
- Low birth weight, even with full-term pregnancy – children born with lower-than-expected birth weights are at a higher risk for medical problems later in life, such as diabetes, obesity, and cardiovascular disease1
- Lung and brain damage, which can have a lifelong impact2
- Birth defects, including cleft lip/palate and Down syndrome2
- Sudden Infant Death Syndrome (SIDS)1,2
Impact from Secondhand Smoke
Many of the effects of smoking on fertility are also present with exposure to secondhand smoke, particularly in women.1,5
The significant increased risks accompanying secondhand smoke is all the more reason for both partners to quit smoking if they are trying to get pregnant.
When to Quit
It is best, of course, to quit smoking before you are trying to conceive, but it is never too late. Even during pregnancy, the risk to the baby decreases if the mother stops at any point.
If you or your partner smoke and are pregnant, or hoping to become pregnant, ask your doctor for suggestions on how to quit.
You can do this! After all, is there any motivation to quit greater than having a healthy baby?
- “Smoking and Fertility.” American Society for Reproductive Medicine, 2014. Web. Accessed February 8, 2017. Available at: https://www.asrm.org/FACTSHEET_Smoking_and_Infertility/.
- CDC Smoking, Pregnancy, and Babies https://www.cdc.gov/tobacco/campaign/tips/diseases/pregnancy.html
- “Systematic Review and Meta-analysis of Miscarriage and Maternal Exposure to Tobacco Smoke During Pregnancy.” Pineles, BL et al. American Journal of Epidemiology. 2014;179(7):807-823. Accessed February 8, 2017. Available at: http://www.medscape.com/viewarticle/822558
- Rana P1, Kazmi I, Singh R, Afzal M, Al-Abbasi FA, Aseeri A, Singh R, Khan R, Anwar F. “Ectopic pregnancy: a review.” Arch Gynecol Obstet. 2013 Oct;288(4):747-57. doi: 10.1007/s00404-013-2929-2. Epub 2013 Jun 21.
- JD Meeker, MD Benedict. “Infertility, pregnancy loss and adverse birth outcomes in relation to maternal secondhand tobacco smoke exposure.” Curr Womens Health Rev. 2013 Feb; 9(1): 41–49.
Current IVF treatment best practices call for the transfer of only one embryo per IVF cycle1. Single embryo transfers are considered to be better for both the mothers and for the babies, but many patients are still reluctant to transfer only one.
We compiled the top three reasons patients tell us that they want to transfer two (or more) embryos, and asked Dr. Jason Franasiak, an infertility doctor with Reproductive Medicine Associates of New Jersey (RMANJ), for his thoughts.
Q: I’ve been trying to have a baby for a long time, and I want to speed things up. More than one embryo at a time seems like it would be faster, right?
A: Infertility is taxing – it consumes emotional, physical, and financial resources and adds stress in many circumstances. As providers, we understand that, and thus get why there would be a desire to push the envelope, so to speak, in order to reach the goal of pregnancy and a live birth. When you have been working hard for so long, it is nearly impossible to think about being “too successful.” But the truth of the matter is that the goal of fertility treatment is not simply pregnancy, but a healthy baby.
We know that one pregnancy and baby delivered at a time is healthier for mother and for baby in nearly every category that we are able to measure. These mothers have a lower chance of developing high blood pressure and/or diabetes during pregnancy, needing to be hospitalized prior to delivery, and requiring a cesarean section at the time of delivery. And this is only a partial list! The newborns have higher birth weights and require less time in the newborn intensive care unit (NICU).
When deciding to transfer one or two embryos it is important to ensure that your fertility provider utilizes modern laboratory technologies and can offer additional testing such as genetic testing of the embryo to ensure that the transfer of one embryo still yields a high chance of live birth in a given embryo transfer.
Q: I want two kids, and I would love to do IVF only once. I don’t mind the idea of twins. Why shouldn’t I try for twins?
A: As we discussed earlier, single-baby births are healthier and safer for both mother and baby. Thusly two successive, single pregnancies are safer than having twins – think quality, not quantity. We cannot lose sight of our primary goal – to build a healthy, happy family.
Q: Cost is a big consideration for us. Wouldn’t transferring more than one embryo save us money?
A: While this reasoning may sound logical, the fact of the matter is that transferring multiple embryos at the same time can actually be more expensive in the long run. It is more cost-effective to transfer one embryo with a resultant single pregnancy than it is to have a twin pregnancy. In addition, it is possible for single embryo transfers to maintain similar odds of achieving a successful pregnancy as transferring two embryos.
In a landmark study, Forman et al showed that it is possible to employ genetic testing of an embryo and transfer only one chromosomally normal embryo and still maintain the same success as transferring two untested embryos2.
While the success of this clinical protocol is remarkable, one of the most important things about single embryo transfer is the ability to dramatically reduce the number of multiple pregnancies. Indeed, transferring two untested embryos in high quality fertility laboratories can result in twin pregnancies in one-third to one-half of the embryo transfers. There is a downstream cost to twin pregnancies that most people don’t realize. Lemos et al shows that twin or multiple pregnancies significantly affects the medical needs of the mother and her children, which drive health care costs higher. The combined expense from the second trimester to 30 days after delivery for mothers, and up to the first birthday for the infants is approximately $20,000 for singletons, but $100,000 and $400,000 for twins and multiples, respectively. This study highlights the added financial burden, resultant of a non-singleton pregnancy, from transferring more than one embryo.
- Best practices of ASRM and ESHRE: a journey through reproductive medicine. Gianaroli, L et al. Fertility and Sterility, Volume 98, Issue 6, 1380 – 1394. Acessed January 10, 2017. Available at: http://www.fertstert.org/article/S0015-0282(12)02298-4/pdf.
- Obstetrical and neonatal outcomes from the BEST Trial: single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates. Forman, EJ et al. American Journal of Obstetrics & Gynecology, Volume 210, Issue 2, 157.e1 – 157.e6. Accessed January 10, 2017. Available at: http://www.ajog.org/article/S0002-9378(13)01081-8/pdf.
- Healthcare expenses associated with multiple vs singleton pregnancies in the United States. Lemos EV et al. American Journal of Obstetrics & Gynecology, Volume 209, Issue 6, 586.e1 – 586.e11. Accessed January 10, 2017. Available at: http://www.ajog.org/article/S0002-9378(13)01043-0/pdf.
Wouldn’t it be nice if we could find a magic combination of foods that would reverse infertility? As long as we are wishing, it would also be nice if those foods were delicious, low in calories, and easy to prepare. Ahhhh, if only wishing made it so!
Despite any myths you may have come across online, there are no magical food combinations that will instantly lead to pregnancy. There are, however, foods that can help aid your fertility, as well as foods that can inhibit it. Here’s an overview of the foods you should eat – and the ones you should avoid – when trying to conceive:
The Right Kinds of Protein.
Research has found that the optimum diet for increasing fertility (egg quality, embryo quality, pregnancy rates, birth rates) was 30% protein and less than 40% carbohydrates1. For most women, this means increasing the amount of protein they eat. But not all protein is created equal when you are trying to get pregnant: avoid deep-sea fish, such as swordfish, shark, king mackerel, and tilefish, as these can contain mercury2.
Stay Away from Fast Food.
Fast foods and processed food increase your exposure to trans fats and environmental toxins, both of which should be avoided when trying to get pregnant2.
When possible, it is good to choose foods with less pesticide exposure, such as organic fruits, vegetable, fish, and meat products2,3. The Environmental Working Group (www.ewg.org) has lists to make it easier to avoid foods that are particularly high in pesticides.
Take a multi-vitamin.
If you are trying to conceive, it’s a good idea to start taking a daily multivitamin with 400 micrograms of folic acid4.
- Russell, JB et al. “Does Changing a Patient’s Dietary Consumption of Proteins and Carbohydrates Impact Blastocyst Development and Clinical Pregnancy Rates from One Cycle to the Next?” Fertility and Sterility3 (2012): S47. October 23, 2012. Web. Accessed January 10, 2017. Available at: http://www.fertstert.org/article/S0015-0282%2812%2900901-6/fulltext.
- “Will Toxins in the Environment Affect My Ability to Have Children?” American Society for Reproductive Medicine, 2014. Accessed January 10, 2017. Available at: https://www.asrm.org/FACTSHEET_Will_toxins_in_the_environment_affect_my_ability_to_have_children.
- “EWG’s Healthy Home Tips: Tip 15 – Healthy Pregnancy.” Environmental Working Group. Accessed January 10, 2017. Available at: http://www.ewg.org/research/healthy-home-tips/healthy-pregnancy.
- Czeizel AE et al. “The Effect of Preconceptional Multivitamin Supplementation on Fertility.” J. Vit. Nutr. Res. 66: 55-58. June 6, 1995. Accessed January 10, 2017. Available at: https://www.researchgate.net/profile/Andrew_Czeizel/