Welcome to the Egg Whisperer Show. I’m so excited to be interviewing Dr. Shweta Nayak today about the Dos and Don’ts of how to get pregnant naturally. We get questioned all the time about when to have sex, how often to have sex, is caffeine safe, how much is too much alcohol. Dr. Nayak is here to answer these questions. She is a reproductive endocrinology and infertility specialist with The Reproductive Medicine Institute, in Chicago, Illinois.
Listen to our discussion on The Egg Whisperer Show Podcast.
Dr. Aimee: Welcome to the show, Shweta.
Dr. Shweta Nayak: Thank you for having me!
Dr. Aimee: Will you tell us about know what made you go into medicine, and why fertility medicine.
Dr. Shweta Nayak: I chose to pursue a career in reproductive medicine because I really felt like it was the perfect intersection between cutting edge science, personalized medicine, and just this amazing opportunity to be part of one of the most joyful journeys that a woman, a man, a couple takes in their lives towards building their family.
Dr. Aimee: When you’re trying to get pregnant, probably the most important thing is to find out if your age matters. Tell us about fertility and age.
Dr. Shweta Nayak: The single most important predictive factor for a pregnancy is age. Unfortunately, fertility declines with age in both men and women, although the effect is far more pronounced in women. If we look at relative fertility for a woman in her later 30s, it’s about half that of a woman in her early 20s. Men also have lower fertility rates as they get older, but we don’t see the effect really until they’re about 45 or 50 years old.
Dr. Aimee: Let’s talk a little bit about sex, or a lot about sex. I get this question probably two or three times a day. How frequent should people be having sex?
Dr. Shweta Nayak: Reproductive efficiency certainly increases the more sex that we have. Couples that have higher chances for conception per cycle are those couples that are together far more often. Generally speaking, having intercourse every day or every other day in the fertile window is the best chance to get pregnant for that month.
Dr. Aimee: How about having sex multiple times a day?
Dr. Shweta Nayak: Having sex multiple times a day probably doesn’t increase the chances for getting pregnant any more than having sex at the right times during the cycle within the fertile window.
Dr. Aimee: You answered that much better than me. I usually say, “I don’t want to hear about it. Don’t talk to me about that. That’s TMI.” Just kidding. There’s no such thing as TMI with me. But, literally, we get this question a lot, so I’m glad you answered it for us.
How do you know if you’re even fertile and when you should be having sex?
Dr. Shweta Nayak: The best clinical indicator that a woman is ovulating regularly is that she has regular cycles that are every 21 to 35 days. Women that have shorter cycles or longer cycles really should seek consultation with their fertility specialist or OBGYN to try to figure out what’s the cause for the irregularity.
There are other signs of ovulation, we call these moliminal symptoms, that occur around the time of ovulation. A common symptom, something called mittelschmerz, is the feeling of cramping and discomfort just after a follicle releases an egg. Other symptoms after ovulation include breast tenderness, pain, mood changes, water retention, and sometimes changes in appetite. All of these symptoms are called ‘moliminal symptoms,’ and are relative to having recently ovulated.
There are other clinical symptoms that may also indicate ovulation. Women can appreciate changes in cervical mucus. For instance, changes in estrogen levels drive changes in cervical mucus consistency. When estrogen levels are at their highest, cervical mucus is very slippery and clear. If couples have intercourse during this time, chances for conception are actually at the highest.
Dr. Aimee: I have these patients that reach out to me that say, “Dr. Aimee, I have no egg white cervical mucus. I feel nothing related to ovulation that I read about. How else can I monitor it?” What would you say?
Dr. Shweta Nayak: Using an objective measurement of ovulation (outside of monitoring clinical symptoms) is really useful. The most popular way to objectively monitor when ovulation might happen is with a urinary ovulation predictor kit. These are kits that you can pick up at your local grocery store or pharmacy, or even order them on Amazon. I always prefer the digital kits, because it leaves very little to interpretation.
It’s just a matter of peeing on a stick and getting a read out to say when one may be ovulating. It’s important to remember that these kits are not telling you that you are ovulating at that moment. Rather, it’s predicting that you will be ovulating very soon. The majority of the time, when a surge is detected with these kits, most women will ovulate within the next 24 to 36 hours, although a small number of women might ovulate up to 96 hours later.
There is newer technology available for ovulation prediction. An example is the Ava Bracelet. The Ava Bracelet is a device that women can wear at night and it measures several different things; temperature, heart rate, respiratory rate, perfusion, and also heart rate variability ratio. The preliminary studies that look at the Ava Bracelet correlated changes in these measurements to different phases in the menstrual cycle, ultimately seeing a signature that had a very high (90%) prediction of the fertile window.
Other devices that are used also utilize urinary LH and urinary hormones, but essentially digitize the information. You pee on a stick, but you insert or upload the information into a device that then gives you output, real time measurements of what that urinary LH looks like, so even more objective information about when you are surging and when you might be ovulating.
Dr. Aimee: There are so many tools out there. I think what was really helpful that you shared with us is that 24, 48, or even 96 hours later, so sometimes even having sex three days after you think you’ve ovulated might still help you get pregnant.
Another tool is the Proov Test. You mentioned the Ava Bracelet. That’s one test that can prove ovulation. There’s also this really cool ring, the Oura Ring, that’s very similar to the Ava Bracelet and looks at many of the indicators that you just mentioned.
Back to sex, though. How does position matter? Is doggie style better, missionary style, spooning? What’s the best position to get pregnant?
Dr. Shweta Nayak: This is such a common question. Truthfully, there is no one position that is more favorable than the other. I tell all of my patients that sperm is really motile. Just after intercourse, or really just after ejaculation, sperm that is near the cervix can actually travel quite quickly through the cervix, uterus, and tubes, and can be found in the abdomen within 2 to 15 minutes of ejaculation.
Whatever position works for the couple is what will work for getting pregnant.
Dr. Aimee: Exactly. I say the position that you enjoy the most is the one that’s the best. Honestly, we know from guys that are like totally stressed out in the collection room, if you’re not enjoying it — and no one enjoys putting sperm in a cup, you and I know both know that from our experiences with patients — they can get stressed out and they have a really low count all of a sudden when they’ve had higher counts before, maybe when collecting at home. So, realize that there is no one position.
Talking a little bit more about sex, let’s talk about lubricants when having sex. Do they hurt sperm and are there any that are good?
Dr. Shweta Nayak: Water based lubricants like AstroGlide and KY Jelly actually can significantly harm sperm motility. Some studies have shown that sperm incubating in these types of lubricants can exhibit relative reductions in motility by 60% to maybe even 100%.
In general, if a couple wants to use a lubricant, a safe one to use is Pre-Seed.
Other options include Canola oil and mineral oil, which also don’t seem to affect motility.
Dr. Aimee: I think sometimes people think that these pro-fertility marketed lubricants actually can improve fertility. I tell people just use it on the outside, it’s not going to help the sperm, it doesn’t do anything to get it anywhere faster, it just helps you enjoy sex so you have a better experience. You can certainly just go to your kitchen and find something for yourself, too.
The best fertility diet, what do you recommend?
Dr. Shweta Nayak: There’s not a lot of data, unfortunately, that specific dietary variations might improve fertility. However, this is a growing area of research. More recently, in the last several years, much more is known about certain types of diets in regard to outcomes with, let’s say, IVF.
In general, when couples ask about diet, my best advice is to stick to something as close to a Mediterranean Diet as possible. That is whole unprocessed foods, lots of fruits, vegetables, nuts, and really healthy fats, like olive oil, and protein sourced from fish and lean meats like chicken.
Dr. Aimee: What about prenatal? Do you have one favorite prenatal that you recommend to your patients?
Dr. Shweta Nayak: I recommend any prenatal vitamin that has at least 800 mcg of folic acid and 200 mg of DHA.
Dr. Aimee: Great. How about smoking, how bad is it really for your fertility?
Dr. Shweta Nayak: We know that smoking causes a lot of problems with our general medical health and wellbeing. Fertility is really no different. In fact, folks who smoke have a two-fold higher risk for experiencing infertility, as well as a longer time to conception.
In women who smoke, we can actually see an acceleration in the loss of eggs. Women who smoke may experience menopause, on average, one to four years earlier than expected for their ethnicity. This is really important, because the end of a woman’s fertility is roughly a decade before she goes through menopause. If we advance the age at which menopause occurs, we’re also advancing the age at which we encounter both subfertility and the end of our reproductive window.
For men, it’s no different. In men who smoke, we can see really significant changes in seminal parameters, including lower counts, lower numbers of sperm that have good progressive motility, and even higher numbers of abnormally shaped sperm.
Dr. Aimee: What about smoking marijuana or vaping? It’s legal in most states now, so a lot of our patients are doing it. Do you talk to your patients about that, and what advice do you give?
Dr. Shweta Nayak: In general, for vaping, I tell patients the same. Although, there’s not a lot of data about vaping and fertility or fertility treatment outcomes, I still advise best practice to stop this while trying to conceive and of course during fertility treatment.
Marijuana is the same. I think that in the upcoming years, now that recreational use and medicinal use is legal in many (if not most) states, that more research will be done to examine the effect on fertility. But what do we know about marijuana right now?
For men, we see that marijuana use, just smoking one marijuana cigarette a week, might have a significant impact on seminal parameters, just like cigarette smoking does. We have observed reductions in motility as well as higher numbers of abnormally shaped sperm. Although, we don’t know how this correlates with actual fertility or chances for pregnancy, these changes in seminal parameters are enough for me to advise men who smoke marijuana to stop while we’re trying to conceive.
For women, there have been some studies that have shown that women who have ever used marijuana or who are using during fertility treatment, may experience higher chances for early pregnancy loss compared to women who have never used marijuana or who are not using marijuana at the time of their fertility treatments.
Dr. Aimee: Thank you for that. What about alcohol, does alcohol consumption affect our fertility chances or pregnancy rates?
Dr. Shweta Nayak: Alcohol does increase the time to conception. We also see that folks that drink more than two drinks a day have a 60% higher chance for experiencing infertility. In general, there is no safe amount of alcohol to consume when we’re trying to get pregnant. Certainly, once we’re pregnant, we advise to not drink any alcohol at all. But is there a magic number?
Some studies have tried to look at what that magic number might look like when folks are doing IVF. Several studies have shown that the magic number might be somewhere around 50 grams. Couples that consume more than 50 grams of alcohol when doing fertility treatment have a 20% lower chance for pregnancy, compared to couples who drink fewer than 50 grams a week when doing fertility treatment or when preparing for fertility treatment.
So, what does that mean, what is 50 grams? A 4-ounce glass of red wine or white wine is roughly 12.5 grams of alcohol. A 12-ounce glass of beer is about 14 to 15 grams of alcohol. A 1.5-ounce of a hard liquor like vodka, gin, or tequila, is also about 14 to 15 grams of alcohol. In general, 50 grams is equivalent to four drinks or fewer.
Dr. Aimee: I can have 50 grams a day or 50 grams a week?
Dr. Shweta Nayak: 50 grams a week.
Dr. Aimee: Okay. That’s basically what I tell my patients, too, four servings per week. And a serving isn’t an entire bottle of wine in your glass, it’s literally 4 ounces and it’s not that exciting. For some people, it’s really hard to stop at 4 ounces. Don’t you think?
Dr. Shweta Nayak: Yes.
Dr. Aimee: It might be better for them to stop all together. But if you’re someone who can have a beer and stop, then drinking in moderation, our definition of moderation, is going to be safe.
What about coffee? How do you advise your patients about that? I have three cups of coffee right now on my desk here. Please, don’t take my coffee away. But what do you tell your patients?
Dr. Shweta Nayak: In general, what I tell my patients is moderate consumption of caffeine, like one or two cups of coffee a day, doesn’t appear to affect fertility or really increase risks once pregnant. One to two cups — by the way, that’s one to two 8-ounce cups of coffee, not a venti double shot espresso Starbucks order — is pretty safe.
Some studies have shown that consuming more than 500 milligrams a day of caffeine might increase the chances for experiencing infertility. While others have shown that consuming more than 200 milligrams a day might increase the chances for early pregnancy loss. So, the magic number here is one to two, no more than two, 8-ounce cups of coffee a day.
Dr. Aimee: I basically say the same thing. Then in pregnancy your heart rate goes up, you have problems sleeping, so sometimes even a decaf can keep you up. Transitioning to half-caf half-decaf is something that you can also consider doing. I totally agree.
Thank you, Shweta, for coming on today’s show and talking to us about the dos and don’ts of getting pregnant naturally. I hope everyone who is listening learned so much. I absolutely love the fact that you came on and I got to know you even better.
There is something on your website that just moved me so much. That was something about what inspires you as a fertility doctor. Can you share that with us?
Dr. Shweta Nayak: My patients truly are what inspire me every day. Their strength and resilience are what keep me going to fight for them and for their families. I’m always so honored and really just humbled to be part of their journey.
Dr. Aimee: That’s beautiful. Thank you for sharing that. Thank you so much for coming on today’s show. Is there anything else that you want to share with our listeners before we sign off?
Dr. Shweta Nayak: To everyone on their journey to building a family, hang in there, dig your heels in, it will happen. I’m here with you, I’m rooting for you, and wishing you all the best.
Dr. Aimee: I totally love that. Where can patients find you? Tell us about your Instagram handle and all that kind of stuff.
Dr. Shweta Nayak: You can find me on social media. I’m on Instagram as @Dr.Shweta.Nayak. You can also find me on our practice’s website. Again, I work at The Reproductive Medicine Institute and our website is www.TeamRMI.com.
Dr. Aimee: Awesome. Thank you so much, Shweta, for coming on.
Dr. Shweta Nayak: Thank you.
Dr. Aimee: Thank you to all you listeners out there. Please go to EggWhispererSchool.com if you haven’t signed up for the TUSHY class or the IVF class, and please subscribe to my YouTube show. See you guys soon. Bye.
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