1 in 6 couples have difficulty getting pregnant in this country. 50% of the time, it’s because of a sperm issue. There are steps you can take to improve your sperm counts and hopefully shorten your time to your next successful pregnancy. Just because you’ve achieved pregnancy easily in the past doesn’t mean you don’t have a sperm problem now. Semen quality can change over time and here are several reasons why:

1.Lifestyle factors: Drinking too much alcohol can affect sperm quality. Studies show that men who drink more than 4 servings per week may have a sperm issue. Cigarette smoke and nicotine containing products are also toxic to sperm cells. They affect the ability of the sperm cells to swim. Being overweight may cause excess heat transmission to the testicle and hormone imbalances that also decrease sperm quality. Stress can affect your sex drive so do what you can to decrease stress. Laptops, saunas and steam rooms all heat up the testicles and can decrease sperm quality. The good news is that the sperm life cycle is short – only a couple months. So any lifestyle changes you make today, can improve your chances in a short period of time. Taking vitamins can also help.

2. Anatomic issues: If you have groin pain, you may have a varicocoele. A varicocoele is a dilated vein around the testicle which transmits heat to the sperm cells and decreases their fertilization potential. Your doctor will be able to do a simple exam to assess you for a varicocoele

3. Hormonal issues: You may be feeling tired because of a stressful work life but it could be also explained by a hormonal imbalance that is also affecting your sperm quality and ability to conceive. Simple blood tests will help you determine if a hormonal issue is affecting your ability to conceive. A low testosterone level, low Vitamin D level, and abnormal thyroid function can affect both your mood and your sperm quality.

4. Medications: There are several medications that can decrease sperm quality. Review the medications you take with your doctor and confirm that they are safe to take when trying to get pregnant.  

A fertility specialist can order a semen analysis for you. This simple test can help you figure out why you’re not getting pregnant easily. Depending on the results, your doctor may speak to you about options such as intrauterine insemination, in vitro fertilization, and other procedures to give your swimmers the boost they need.

If you’re eager to get pregnant and are wondering if it’s time to see a fertility specialist, you might be right. There are a number of factors to take into account when deciding whether it’s time to see a fertility specialist.

1. If you’re over 35 and have been trying for at least 6 months to get pregnant, it’s time to see a fertility specialist. This is because as a woman ages it becomes understandably more difficult for her to conceive.

2. If you’re over 37 and trying to get pregnant, you should consider seeing a fertility specialist and not wait before seeking professional advice. Just because you seek professional advice doesn’t mean you are signing yourself up for fertility medications. Seeking advice will give you the knowledge about your body that you may not already have.

3. If you have irregular cycles, you shouldn’t wait before seeing a fertility specialist. Irregular cycles could be a sign of an ovulatory disorder called polycystic ovary syndrome, hypothalamic amenorrhea or decreased ovarian reserve. The good news is that if you figure out why your cycles are irregular you may improve your chances of conceiving without professional help.

4. While it isn’t uncommon to have painful periods, if you think your periods are more painful than average, you may suffer a condition that can cause infertility called endometriosis. Endometriosis can not only affect egg quality but it can also affect whether your tubes are open. A fertility specialist can help in the diagnosis and possible treatment of this condition.

5. Heavy bleeding can also be a sign that there is something blocking your ability to get pregnant. Benign fibroids and uterine polyps are conditions that can be treated. A fertility specialist can do diagnostic tests to assess whether this could be your issue and a simple outpatient surgery may solve your bleeding problem and help you get pregnant.

6. It takes two to make a baby so if your male partner has a chronic medical problems or is overweight, it’s time to see a fertility specialist. A simple semen analysis may explain why you may have difficulty.

This is definitely a time where knowledge is power. There are many options available to you and many treatments available for any fertility problems that you may encounter.

Now why would you ever want to be the best fertility patient? Well it’s simple, if you’re the best patient; you may help improve your chances of success.

Fertility is one of those things that we have absolutely no control over. I wish! Going through fertility treatments requires a lot of work and to make it worth your while, learn how to be the best patient.

Rather than feel like you’re a victim because of your fertility diagnosis, empower yourself and start chanting your new mantra, “it’s going to happen one way or another!”

Here are some tips on how to be the best fertility patient ever:

1.Know who you’re seeing. Sounds funny, right? Wrong! So many patients think they’re seeing someone who has had extra training in fertility when in reality, you’re not. Many general ObGyns (the doc who does your PAP smear for you) feel comfortable helping women with fertility issues but if you’re not pregnant within a couple months, it could be time to see a reproductive endocrinology and infertility specialist. You can find a local one by going to this link: www.fertilitylifelines.com . Put in your zip code and you will find clinics close to you. Once you find the clinics closest to you, start making phone calls and meeting people. Not every clinic is going to be right for every woman. Meet a few of your local docs because the relationship with your fertility doctor is sometimes a short one (quick success) or a longer one (if your case is harder than you originally thought).

2. Know your history and your fertility diagnosis!It’s so important for you to know what you’ve had done and where you’ve been. I have patients who have had several IVF cycles before coming to me and have no idea why they did IVF or what happened during the cycle. My suggestions:

• Keep your records with you and take notes: The best patients will have all their records with them at their first visit and even carry a binder with all their past cycle notes with them to some of their  visits just for reference if they’re needed. Have a folder that contains all your blood work and know what is being checked and why. Bring in your questions or better yet, depending on the office you’re working with, email them ahead of time. Bring a pad of paper so you can take notes.

• Repeat tests: If it’s been more than a year since you’ve had a blood test, consider repeating it. Things change over time and you don’t want to miss an opportunity to increase your chances if you can. Make sure you’ve had a recent semen analysis, had your tubes checked and your ovarian reserve evaluated.

• See your Doctor often: After you’ve done a treatment that isn’t successful, go in and see your doc in person and review the cycle and what everyone learned from it. Take what you learned and turn it into a positive. The way I like to see negative pregnancy tests is: they are just one more hurdle we had to go through before we get the positive. Do whatever you can to enjoy the journey. If you are pregnant, talk to your doctor about what tips they have about staying pregnant.

3. Stay healthy :Keep healthy in your life and tend to your relationships. All of my patients become the best fertility patients if they aren’t already.

• Find your fertility community: Ask your doc for a referral to psychologist. Find a fertility friend (either someone online or in person) who you can share all your information without any judgment. When someone asks you “when are you going to start having kids,” simply say, “We’d love to one day.” Keep it simple and don’t let the faux pas of your friends and family bother you. And if people ask your personal questions just say, “I don’t like to answer personal questions.” Simple! As women we are so used to apologizing. You don’t need to feel sorry for not opening up your heart and soul to every stranger around you.

• Meditate: Your mind is a powerful fertility tool in all of this. Work with a professional hypnotherapist (www.ahigherperspective.com) or buy CDs through www.circleandbloom.com

• Consider Traditional Chinese Medicine: Why would a medical doctor want her patient to work with a Doctor of Chinese Medicine? Because what they do works. I’ve seen it time and time again. Ask your fertility clinic for local referrals and work with someone who does fertility acupuncture and knows this area of Chinese medicine well.

If we believed everything we read in the tabloids, we would think that anyone who was over 40 could get pregnant easily with IVF and have twins the first go around. I wish this were the truth. This is what you should know…If you’re over 40, you have a 5% chance of getting pregnant in every menstrual cycle. If you’re going to try to get pregnant over 40, see your local fertility specialist now.

Fertility is not skin deep. It doesn’t matter how great you look on the outside. So many of my patients over 40 look like they could easily pass for early 30s, even 20s. We were born with all the eggs we will ever have and we run out of eggs over time.

This is what I recommend:

1. Talk to your doctor about your fertile potential. Have your FSH and estradiol levels checked as well as an antimullerian hormone level. Your doctor can do an ultrasound and measure the number of follicles on your ovary. This assessment is called an antral follicle count. There are hormones that we check that can tell you if you are fertile or not. One of the hormones your doctor will check is a follicle stimulating hormone level (FSH). FSH is a hormone secreted by the brain. As your FSH level rises, your fertility declines. If you have a high FSH and your doctor tells you pregnancy is not possible with your own eggs you can consider using donor eggs (eggs of someone in their 20s).  Know that 10-15% of IVF cycles in this country are now being done with donor eggs. When a man runs out of sperm, we use donor sperm. Women now have options for them too.

 2. Learn the risks associated with getting pregnant over 40.  Autism risk and risk of chromosomal abnormalities go up as we get older. Knowing your risk will make your more knowledgeable about how to approach your pregnancy once you are pregnant.

 3. Maintain as healthy a lifestyle as possible: make sure you have a normal body mass index (calculate it with a simple online calculator), don’t drink excess alcohol and limit caffeine intake. Exercise to keep not only your body in shape but your mind in shape and take time to tend to your relationships with your partner and your surrounding community and friends.

 If you’re trying to get pregnant over 40, know that you’re not alone. Understand your fertile potential and learn about your fertility treatment options.  

If you’re one of my patients, you’ve probably heard me mention probably most of the things on my blog…..including the one thing I say over and over: it takes 3 things to have a baby: eggs, sperm and tubes that are open. Learn about all 3 and you can figure out why a couple is having a problem conceiving. I’d like to officially add emotional health to the list……I think that emotional health is essential when trying to conceive and if you don’t have emotional health, that in and of itself could possibly affect your chances of conceiving.

People who are emotionally healthy are in control of their emotions and their behavior. When bad things happen, they’re able to bounce back and move on. Mental and emotional health takes an effort to build and maintain. As couples are trying to conceive, they should not only spend energy on their physical health but do things to boost their mood, build resilience, and get more enjoyment out of life.  Every patient of mine will have their own ideas about how they can build and maintain their emotional health.

Here are some tips:
1. Take care of your physical health: eat right and maintain your weight.

2. Do things for fun! Remember when you were dating? You did things that were fun for both of you. Talk about those things and start doing them more often. Go to a funny movie, take a walk on the beach, listen to music, go to a concert or theater show, or get together with friends. Doing things just because they are fun is no indulgence. Play is an emotional and mental health necessity.

3. Make time for deep thought and appreciation.  Think about the things you’re grateful for. Mediate, pray, enjoy the sunset, or simply take a moment to pay attention to what is good, positive, and beautiful as you go about your day. If you don’t have time to see a psychologist and/or hypnotherapist, you can go to www.circlebloom.com for meditations that can take you through your fertility treatments.

Hope this helps!

The answer is no. I read a great article in Reviews in Obstetrics and Gynecology. Take the time to read it because it talks about how one important difference among prenatals is the source of folic acid.

Just click here and you can read it: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250974/

Then after reading it, you’re going to do what I did and you’re going to ask, which prenatals contain L-Methylfolate? So then I foudn this source: http://www.empr.com/prenatal-vitamins/article/125903/. You can find the prenatals that contain L-methylfolate. Or you can just buy L-methylfolate separate from your prenatal.

Hope this article helps!

Really cool new way to monitor ovulation is coming to the US. This device has been available in Europe since 2009. Check out this Youtube video to watch a demonstration: http://youtu.be/Eu70WJ_k4Aw

A sensor is worn under the armpit and measures subtle changes in basal body temperature which is indicative of ovulation. The reader wirelessly receives the sensor data and predicts when you are most likely to become pregnant up to six days in advance. A number of additional parameters can also be entered into the reader unit to improve the prediction quality. The recorded data can be visualized by connecting the reader unit into your computer. Cool stuff!

It’s not easy getting pregnant. It gets harder when you’re over 40.

If you’re thinking of waiting to get pregnant until you’re 40 (something I hear over and over) or you are trying already and you’re over 40, take the time to read these two articles. These articles are must reads:

http://www.parentcentral.ca/parent/babiespregnancy/pregnancy/article/1110159–motherhood-after-40-ethical-debate-rages-over-how-old-is-too-old-to-become-a-mother

http://www.huffingtonpost.com/glenn-d-braunstein-md/why-women-men-shouldnt-ta_b_1179850.html

The most recent celebrity mom over 40 is Robert DeNiro’s wife who had a baby through a gestational carrier at age 56. They haven’t confirmed whether donor eggs were used but if the embryos used were created recently, they weren’t created with her own eggs. Before you consider trying over age 40, start off by seeing an infertility doc. Don’t wait to see the fertility doc after several months of not conceiving. Your fertility doc will be able to talk to you about your fertile potential and give you the best plan of action to help you meet your goals.

Happy 2012! This will be your best year ever. If you’ve started fertility treatments and haven’t gotten pregnant yet, it may be time to go back to your Doctor and ask “Do you know who I am?” I don’t mean literally but figuratively. This is a good time for you to reconnect and say, “I’d like to review my history with you and see if you’d like to order any other tests that could potentially help us improve our chances of conceiving.”

I personally have a one year rule on everything. If it’s been one year and you haven’t had your thyroid levels checked or had a repeat semen analysis  or a cavity or tubal evaluation – it’s time. I’ve also seen plenty of patients who have been down the fertility treatment path without ever having had a pelvic ultrasound, only to find out after years of trying that a fibroid (benign tumor in the uterus) was the reason behind their fertility problems.

So take the time to either see a Reproductive Endocrinology and infertility specialist for the first time this year or just go back in and ask your doctor to review your entire fertility chart  to make sure that all the testing has been done and is up to date.  If there is a concern about ovarian aging, repeat levels like FSH and AMH and an antral follicle count just so that you can understand more about your body.

Take charge of your health this year and keep all medical records in a file at home and understand why each test is being done and what it means for you.

I ask all my patients, “Do you know why things haven’t clicked yet?” The reason why I ask this question is because I want all my patients to know and understand their fertility issues so that they feel like they understand why I’m guiding them along a particular path of treatment. If you’re confused about why something is being done – just ask.

As always, I hope this helps

There’s a lot about fertility  we are yet to discover. Scientists are discovering more every single day about what it takes for a sperm cell to fertilize an egg. This year, UCSF scientists uncovered hoe progesterone switches on a sperm’s internal electricity which is involved in giving the sperm enough power to push toward the egg. This discovery could lead to understanding more about fertilization. Fertilization problems are difficult to diagnose. 

Two recent articles in the scientific journal Nature — one by Lishko and Kirichok, another by researchers in Germany — provide the first evidence that progesterone activates sperm tails by binding to a protein on the sperm’s surface, called CatSper. Scientists have long suspected that progesterone from around the egg triggers sperm tails to pump harder in the final stages of fertilization. The tail’s normal undulations switch to a one-sided flicking motion, like a whip being cracked against the ground.

 Called “hyperactivation,” the whipping motion is thought to give sperm a last-minute boost to the egg and help one lucky winner poke through the egg’s protective vestments. In fact, in vitro experiments show that fertilization cannot happen without hyperactivation. But until now, researchers couldn’t explain how progesterone transmits its signal. Read the rest of this entry »