How Do You Get Pregnant?

So you’ve decided it is time to start or grow your family. It may seem odd to need a “how to” when we all learned at a very young age how babies are made! What they didn’t tell us back then is that it can be harder than you think to become pregnant. While some women will conceive very easily, others of us will take longer and could use a little (or a lot of) help. If you are in this group, or are not sure yet but want to expedite the process, there are some things that you can do to take the guesswork out of getting pregnant. Yes, women have been getting pregnant for ages, but now we have the knowledge to make the process healthier and more efficient. We’ll start with the basics.

Quit the Contraceptives

You have probably spent most of your adult sexually active life actively trying NOT to get pregnant. Now that you are trying, the first thing you will do is stop whatever method of birth control you are using.

Quit the contraceptives

If you have an implanted device like an IUD, you will need to have it removed by a physician. Normal ovulation can return as soon as it is removed, and assuming no other fertility issues, you could conceive immediately. The same is true with oral contraceptives. You can resume normal ovulation the first month after going off the pill. Some women will take longer, but it is a myth that it takes a certain amount of time….everyone is different.

If you have been tracking your ovulation as a means of birth control, you are well on your way. Just use the information to know when to have sex, instead of when NOT to!

Understand Your Cycle

You are not alone if you are an adult woman who has no idea when you are ovulating (or whether you do at all or even what that means!). If you have been on the pill, which regulates your cycle to the normal number of 28 days, you may have rarely paid attention to the calendar. Moreover, you do not know how your body will regulate itself once it is on its own. There are a few methods to become in tune with what your body is doing and when.

Ovulation is the releasing of an egg from the ovary. One egg is released each month in an attempt to meet with sperm and be fertilized. If this occurs, the fertilized egg will travel to the uterus where it will implant in the uterine wall and early pregnancy begins. If fertilization does not occur, the egg will join the shedded uterine lining in the menstrual period.

Do the Math

A normal menstrual cycle is 28 days. If you mark the first day of your period as day one, ovulation will typically occur on day 14. Your most fertile days are days 12-16 of the cycle, so a couple of days before and after ovulation. Sperm can live in the female body for 48 hours so having sex before ovulation occurs is a good way to maximize this fertile time.

Ovulation Predictor Kits

Ovulation predictor kits (OPK’s) offer another way to determine when you are able to conceive. OPK’s work by detecting hormone levels in the urine and are at-home friendly. The most common hormone to test for is the luteinizing hormone (LH). LH is always present in your urine but surges 24-28 hours before ovulation. This is the optimal time to have sex since the sperm will stick around through ovulation.

Fertility Monitors

Fertility Monitors are used to track fertility throughout the month by testing urine for LH. Some monitors are also able to test estrogen levels. It is recommended that you test your urine every day for a month to get a clear picture of a complete cycle. This will help you determine when you are ovulating and conception odds are high!

There are fertility monitors on the market that claim they can test fertility using saliva, but these are generally not recommended by medical professionals.

Cervical Mucus

Cervical Mucus (CM) is secreted from the cervix when stimulated by estrogen. Tracking the consistency of the CM can help you identify when ovulation occurs. In the beginning of your cycle as you approach ovulation, estrogen levels rise and the cervix responds to the call to duty by secreting more CM. The CM protects and nourishes the sperm as it makes its way to the egg. At this point, the CM has what is described as an “egg white quality”. It is clear and viscous.

The best way to track the changes in CM is to evaluate a sample daily and get to know what you are dealing with. With clean, dry hands, insert a finger into your vagina and remove, taking with it some CM. Feel the consistency by rolling between thumb and forefinger and pulling them apart to see the viscosity. Throughout your cycle you should be able to tell the difference between samples. Here is what you are likely to find:

  • After Menstrual Period: Directly after your period you will find the least CM. Many women experience vaginal dryness at this time. During this time, it will gradually be building back up, and it will go from dry to a thick, often yellow or white and cloudy, consistency. Biologically, its work is done for now. It is not needed to move sperm to the egg so it is in its rebuilding phase.
  • Approaching Ovulation: The CM will increase in moisture and volume.
  • Ovulation: At this time, the CM will reach its highest volume and most fertile-quality state. This is the egg-white phase. It will be very moist and a clear, stretchy consistency. When you detect this, you know it is the right time to try to conceive.
  • After Ovulation: The volume once again decreases and the CM becomes thicker as your period approaches.

Becoming familiar with your cycle of cervical mucus production is a great way to understand your ovulation cycle and fertility chances. If you have trouble detecting any changes in the CM, you should talk to your doctor.

Basal Body Temperature

Basal Body Temperature ChartAnother way to track your ovulation cycle is your Basal Body Temperature (BBT). This is the lowest temperature attained by your body during rest. It is most accurately taken at the moment of waking from a night’s sleep, before even sitting up or talking.

BBT charting is a commonly used method of tracking fertility metrics and ovulation, as the pre-ovulation BBT is typically one half to one degree lower than during or post-ovulation. Your most fertile days are the 2-3 days before your temperature goes up. Tracking for a least a full menstrual cycle will give you the best data about when or if ovulation occurs. A basal body thermometer can be used to determine the BBT, but a standard thermometer, as long as it gives you a reading to at least 1/10th degree, is acceptable.

BBT charting is a much more accurate way to determine whether you are ovulating normally than simply looking at the menstrual cycle. Plenty of women with regular periods do not ovulate correctly or at all, and normal ovulation can occur with an irregular cycle. BBT tracking is one of the more accurate methods there is to predict ovulation.

Get Your Body Ready

One of the best things you can do to help your body along in the quest to pregnancy is to get healthy. This means putting the right things into your body, taking the wrong things out, and getting yourself in the best shape you can for the major physical undertaking that is pregnancy and childbirth.

Maintain a Healthy Weight

This is the most important thing you can do to help your chances of conception. Being over or underweight will greatly affect your fertility. Both conditions are linked to anovulation, or the absence of ovulation. The ovaries and fat cells regulate estrogen, and too many or too few of these cells will affect the hormone levels in your body. The Body Mass Index (BMI) is a calculation based on weight and height. “Normal weight” is generally defined as a BMI of 19-24. 25-29 is considered overweight, and 30+ is obese. Fertility chances are greatly improved by being in the normal range of 19-24. Having a BMI under 19 can actually affect your fertility more that being slightly overweight. If you are trying to conceive, check out your BMI. There are many online calculators, but a visit to your doctor to discuss your weight and possible nutrition plans is the best option.

Eat the Right Things

A healthy diet full of fruits, vegetables, and whole grains is important for all people. This is especially true for you as you are starting to try to conceive. You are probably aware of the ways your diet needs to change once you are pregnant. But did you know that improving your diet while trying to conceive (and even before then!) will greatly improve your chances? Here are a few of the things to make a part of your diet to get your body prepared for pregnancy:

  • Whole Grains – Slowly digested carbohydrates that are rich in fiber help fertility by controlling blood sugar and insulin levels in your body. They are also a good source of Vitamin B & E. Replace your white rice and white bread with brown rice and whole grain bread.
  • Plant Protein – Protein from beans, peas, nuts, soy and tofu are shown to improve fertility. Try replacing a serving a day of red meat or poultry with these zinc & iron-rich plant protein sources.fertility foods
  • Full-Fat Dairy – Whole milk is an excellent source of protein and calcium and is shown to have positive effects on fertility, whereas skim or low fat milk can have the opposite effect. Now is not the time to cut calories on your dairy products! Drink a glass of whole milk a day, or have a bowl of ice cream or full-fat yogurt.
  • Fresh Fruit & Vegetables – There are endless benefits to a diet full of fruits and vegetables when it comes to promoting general and reproductive health. A big one is the abundance of antioxidants. These are a family of vitamins & minerals that act as the body’s natural cleansing and defense mechanism. Fruits and veggies are also excellent sources of Vitamins A, B, C & E, all of which are needed for reproductive health.
  • Good Fats – Monounsaturated, Polyunsaturated, and Omega-3 are all good fats that you want to start looking for and adding to your diet. They reduce inflammation and increase insulin sensitivity- both good for fertility. Once pregnant, Omega-3’s help with the baby’s brain and nervous system development and reduce the risk of premature birth. They are found naturally in avocados, nuts, pumpkin & other edible seeds, salmon, and sardines. You can also take fish oil supplements for Omega-3.

Don’t Eat the Wrong Things

  • Trans Fats – These saturated fats are strongly linked to heart disease and poor metabolism. it was recently discovered that in addition to these known effects, they are especially bad for women trying to conceive. If you are trying or planning to try, these should be eliminated from your diet and replaced with healthier mono- or polyunsaturated fats.
  • Caffeine – Research is divided on the issue of caffeine before and during pregnancy. Most sources say to limit caffeine intake to no more than two 5 oz servings a day, while some advocate eliminating it altogether. Some studies have linked high amounts of caffeine in the body to poor egg maturation. Once you are pregnant, caffeine you ingest can cross the placenta and affect the fetus. At the very least follow the advice to limit your intake, and starting before you are pregnant can only help the process.
  • Alcohol – Everyone should know to avoid alcohol when you are pregnant, as there is no medically-recognized safe consumable level. Recent studies have shown that even light to moderate consumption while trying to conceive can have negative effects on fertility. Alcohol can affect your menstrual cycle and ovulatory function. Start preparing your body for a healthy pregnancy by eliminating or lowering your alcohol intake now.
  • Some Herbal Teas & Supplements – While some botanicals offer health benefits to the body, there are some that should be avoided when trying to conceive or pregnant. These are licorice, sassafras, ginseng, and St. John’s Wort, to name a few. Ask your doctor about the inclusion on herbal supplements in your diet.

Here are some more fertility food facts…

Folic Acid

Folate is one of the B vitamins and helps the body make new cells. It is needed by all people, but is especially crucial for a woman who is trying to conceive or is pregnant. Women who are able to get pregnant should get 400-800 mcg/day. This is the same amount recommended for women throughout pregnancy. The reason to start this dosage before you have confirmed that you are pregnant, is that the earliest days after conception are critical and folic acid is required for normal cell development. The neural tube – from which the baby’s brain and spinal cord will develop – begins to form about 3 weeks after conception. Most women do not know they are pregnant this early. The presence of folic acid at this point in the pregnancy can prevent serious birth defects of the brain and spinal cord.

Folic acid is found in leafy, dark greens such as spinach and kale, lentils, and citrus fruits and juices. However, the body actually absorbs synthetic folic acid better than the natural kind, so it is recommended that you supplement your diet. Many breakfast cereals are supplemented with folic acid, some with the full 400 mcg. It is also recommended that you take a multivitamin containing at least 400 mcg of folic acid all the time, whether you are trying to get pregnant or not. Once you are pregnant, the requirement to mantain throughout your pregnancy is 600-800 mcg.

Choline

This is an often overlooked essential nutrient that your body can only synthesize in small amounts. Research shows that it, like folic acid, is associated with a lower risk of neural tube defects. It is also the precursor to the neurotransmitter responsible for muscle control and memory. Adding choline to your pre-pregnancy and pregnancy diet make have long-term benefits to both you and your child.

Daily recommendation for choline intake during pregnancy is 450 mg, increasing to 550 mg when breastfeeding. The highest amount of choline is found in beef and chicken livers, followed by wheat germ and then eggs (yolk). None of these offer the full required amount, and should be supplemented with a vitamin. Be aware though… not all prenatal vitamins contain choline. Make sure you find one that does.

Water

Yet another reason to drink plenty of water! Staying hydrated is important for general health and all people are encouraged to drink water throughout the day. There are benefits to fertility too! Drinking water increases and improves the quality of cervical mucus. This will help to facilitate better sperm movement when you are trying to get pregnant. Your follicles will be plump and healthy, and your body will be overall cleaner and more free of toxins. If you are like many and have trouble drinking plain water all day, add some lemon or lime. It tastes great and has the added benefit of vitamin C and other helpful antioxidants!

So what have we learned? When you maintain a healthy weight and make smart food choices you will be healthier, and will get the nutrients and lifestyle choices you need to keep your body, and your reproductive system, functioning properly.

Have Sex

Have sexAfter you’ve done everything you can to prepare your body and improve your fertility, now comes the fun part. You have to have sex.

DO have sex 3-5 days before ovulation. Sperm can live in the body for up to 48 hours, so you can maximize your chances of conception by covering the whole window of fertility each month.DO NOT use lubricants or chemical stimuli. Some contain spermacides which is a definite no no. Even some non-spermacide, water-based lubricants can negatively affect the sperm’s motility to the egg. Your natural lubricant is best, but if you need to use something to assist in intercourse, use a fertility-friendly lubricant such as Pre-Seed. This product has been found to best mimic your own cervical mucus to facilitate proper sperm motility.

DO enjoy yourself! Having sex with your partner on a schedule with your eye on the baby prize can be a stressful, and less than romantic, endeavor. Don’t let all of the pressure of trying to conceive get in the way of enjoying the process. Stress is harmful to your health and well-being. Relax and have fun!

Know When to Seek Help

All of the things we’ve talked about here will prepare you for getting pregnant and help your chances. However, some of us will need a little more help. Actually, a lot of us will!

Assuming you are doing everything right and your partner’s sperm is in tip top shape as well, you have about a 15-25% chance of getting pregnant in each ovulatory cycle. About 40% of couples will conceive within 3 months of focused, active trying, and 70% will conceive in 6 months.

And if you don’t fit into these categories? You are not alone. An estimated 15% of women, or 1 in 8 couples, experience some form of infertility.

Infertility is defined as the inability to conceive a child after one year of frequent, unprotected sex. If you are over 35, the time is reduced to 6 months. This is the time at which you and your partner should seek the help of a fertility specialist called a Reproductive Endocrinologist, or RE for short. Your OB/GYN may have to refer you so start there first.

They will asses your reproductive health, and that of your partner, and work out the best treatment plan for you. It may consist of vitamins, hormone supplements, or more in-depth testing and procedures to diagnose and fix a problem. In more complicated cases (about 3%), there are assisted reproductive technologies (ART), like intrauterine insemination (IUI) or in vitro fertilization (IVF).

But you are not there yet so don’t panic! Start by following the tips we’ve talked about to maximize your chances of getting pregnant. And know that there many options and so much help and support for you out there.

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Factors Affecting Male Fertility

There are many factors, environmental and otherwise, that can have an impact on a man’s fertility. Genetic or medically diagnosed infertility typically can’t be changed by lifestyle alterations. If your infertility is a result of genetics or an illness or medical procedure, then should consult a fertility specialist to learn about “assisted reproductive technologies” that are appropriate for your particular case. These assisted technologies are things like IVF, ICSI and IUI. As for the second category, environmental, you may be able to significantly impact your fertility just by altering your lifestyle. In this article we describe some of the most common environmental factors you should be aware of, and things you can try to help your journey to pregnancy along.

Factors Affecting Male Fertility

  • Illness – mumps, malaria, cancer, cystic fibrosis
  • Injuries – trauma to testes or surrounding area
  • Lifestyle – drugs, alcohol, smoking, obesity, strenuous and/or prolonged seated activities (horseback or bicycle riding)
  • Medications – chemotherapy treatments, anabolic steroids
  • Age – contrary to popular belief, male (paternal) age matters
  • Genetic defects – i.e. Klinefelter’s Syndrome

Fertility and Smoking

Male smokers have a 30% higher chance of being infertile. Smoking is particularly damaging to sperm cells and destroys them at the DNA level. If you needed another reason to quit smoking, THIS IS IT!

Some things you can do to prevent infertility

  • Don’t smoke!
  • Avoid heavy marijuana and alcohol use
  • Avoid excessive heat and compression to testes
  • Wear protective equipment in sports to protect testicles
  • Eat a healthy, balanced diet full of fruits and vegetables to provide necessary vitamins and minerals
  • Drink plenty of water

Male Fertility and Diet

We’ve talked about things to avoid in terms of fertility, now what are some things you can do to improve it? It is difficult to compile hard data on dietary substances that improve male fertility. However, improving overall physical health is definitely the first step before undertaking more intense fertility treatments. And the good news is you can make these chances for free and the earlier the better!

Some things to add to your diet:

  • Fruits and Vegetables: These are rich in Vitamins A, B, C & E. The antioxidant properties of these vitamins can protect sperm’s DNA. Vitamin A is found in leafy greens, carrots and apricots. The B vitamin folic acid has fantastic antioxidant properties and will keep the sperm free of chromosomal abnormalities. Vitamin C is found in citrus fruits, broccoli, strawberries, and liver. Wheat germ and almonds are excellent sources of Vitamin E. What is a way to get ALL of these in one amazing super food? The sweet potato!
  • Oysters: We’ve all heard that oysters are an aphrodisiac, maybe this is why! They are packed with zinc, a mineral known to increase the production of sperm and testosterone. Other foods that contain zinc (although not in as high quantity) are beef, poultry, dairy, nuts and beans.
  • Pomegranate Juice: Another super food. The pomegranate is an antioxidant-rich fruit shown to boost sperm count and quality. Plus it tastes great!
  • Pumpkin Seeds: These have a double benefit. They are a great source of zinc which increases sperm count and testosterone, and also of omega-3 fatty acids. Omega-3’s stimulate blood flow to sexual organs and improve sexual function. Everybody wins here! (hee, hee!). Other great sources of omega-3’s are flaxseed, almonds and fatty fish like sardines and salmon.
  • Water: Yet another benefit of drinking plenty of water. A man should drink half of his body weight in ounces of water per day. So, a 180 lb man should consume 90 ounces of water a day. Drink up!

And of course, more things to avoid:

  • Processed foods: While this goes for ALL people, it is especially important in men focusing on a fertility-friendly diet. Refined sugar and flour and fatty, fried foods should be avoided.
  • Soy: Studies are preliminary at this point, but some have shown a decrease in sperm count in men with a lot of soy in their diet.
  • High Mercury Fish: Mercury is linked to infertility in both men and women. The common culprits are swordfish, mackerel, and tuna. Trade these out for some of the omega-3-rich fish like salmon or zinc-rich shellfish for your seafood fix!
  • Caffeine: Are you a caffeine-addict? Most of us are. Research shows that too much caffeine, whether from coffee or energy drinks, can decrease sperm count. Try to cut back to no more than 2 servings a day.

The bottom line on diet is that every part of you is healthier, livelier and more functioning when you are filling your body with the high-performing foods it needs. With the addition of a couple of fertility boosters like zinc and folic acid, following the healthy living guidelines for all adults today will help protect your fertility.

These are claims based on general health guidelines and non-medical research. They are not meant to be treatments for infertility, and do not replace assisted reproductive technologies if required. Talk to your doctor before making any dietary adjustments.

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Causes of Infertility in Women

Infertility is defined as the inability to get pregnant after 1 year of unprotected intercourse. It is estimated that 10% of couples of reproductive age in the US are affected by infertility. Both men and women can experience infertility. We equally share the diagnosis, as men and women each represent one third of the cases of infertility. The last third is the cases where it is a combination of both the man and the woman. In almost 20% of infertility cases the cause can not be determined.

Infertility and Age

Age is a major factor in women’s fertility. A woman’s fertility peaks in her early 20’s and begins a decline that gets much steeper after 35. It is estimated that by age 35 a woman has lost over 90% of her eggs. As women are waiting longer and longer to begin to start a family, infertility is becoming a bigger and much more common issue. While age is one of the main determinants of fertility in women, there are various other conditions and occurrences that affect it as well. We’ll talk about some of them here.

Tubal Occlusion

This is an obstructed fallopian tube. It is the most common cause of infertility in women, as about 20% of cases can be attributed to this condition. If the tube or tubes are blocked the fertilized egg cannot reach the uterus. Blockages are often caused by pelvic inflammatory disease (PID), endometriosis, infections after previous childbirth, and intra-abdominal infections like appendicitis and peritonitis.

Treatment

One form of treatment is a tuboplasty which is a surgery to remove the blockage. You may choose to forgo surgery and attempt to overcome tubal infertility but using IVF to conceive. It is actually less expensive and less invasive (hard to imagine for those who have or are going through IVF!) than the tuboplasty. There are laparoscopic options, but this not a perfect fix as an increased risk for ectopic pregnancies has been seen in postsurgical women. The technology is quickly improving and the risks may change. At this point, you should look at the options with your doctor and determine which is right for you.

Endometriosis

Endometriosis occurs when the tissue that lines the uterus (the endometrium) grows outside the uterus on other organs. It can be found growing on the ovaries, fallopian tubes, the lining of the pelvic and abdominal cavities, vagina, cervix, bowel or bladder. As the uterine lining prepares itself monthly for fertilization, the tissue that has grown outside the uterus can over time begin to do the same. It can thicken and cause the other organs to crowd or fuse together, and cysts to form. It is estimated that 5 million women in the US have endometriosis. It is one of the most common health problems in women.

Symptoms of endometriosis include painful menstrual periods, chronic pain in the lower back and pelvis, pain during or after sex, spotting or bleeding in between periods, and infertility. If you have any of these symptoms, talk to you doctor or OB/GYN.

There is no real way to lower your chances of getting endometriosis, except to keep lower estrogen levels in your body. You can do this by exercising regularly, maintaining a low amount of body fat, and avoiding large amounts of alcohol and caffeine.

Testing for Endometriosis

  • Pelvic Exam – During a normal pelvic exam your doctor can look for large cysts or scars behind the uterus.
  • Ultrasound – With an ultrasound your doctor can determine whether there are any ovarian cysts. It will be either a vaginal ultrasound where a wand scanner is inserted through the vagina, or an abdominal ultrasound. These are the more common imaging tests that will be done, but a magnetic resonance imaging test (MRI) may also be performed.
  • Laparoscopy – The only way your doctor can determine for sure whether there is endometriosis is to look inside. While under general anesthesia, you will have your abdomen expanded by a gas so your organs will be easier to look at. Through a small cut in the abdomen, a lighted tube will be placed inside with a scope to observe. Your doctor will be able to diagnose by seeing growths this way, or they may take a sample to observe under a microscope.

Treatment

Unfortunately there is no cure for endometriosis, but there are ways to manage pain and the infertility that it causes. The treatments will depend on your age and your plans for having children. As always, talk to your doctor about what treatment is right for you.

Pain Medications

These are either over the counter or prescription medications used to alleviate the pain associated with endometriosis. They will not treat the problem and will not improve your chances of having children if that is your goal.

Hormone Treatment

These treatments will only be for women who do not want to get pregnant during the time of treatment. These can be in the form of:

  • Birth Control Pills – these will decrease the heaviness of your period.
  • GnRH Agonists & Antagonists – these are hormones that reduce the amount of estrogen in your body. You are effectively putting your body into menopause, and you will experience the symptoms associated with it (hot flashes, bone loss, vaginal dryness). It is common to undergo this treatment for endometriosis in preparation for IVF, in an attempt to keep quick-growing endometriosis at bay to create a window for conception.
  • Progestins – These hormones work against the effects of estrogen to shrink endometriosis. They will completely stop menstruation, but may cause irregular bleeding. A common progestin is Depo-Provera, a commonly used injectable birth control method.
  • Danazol– This is a weak male hormone that lowers estrogen and progesterone levels in a woman’s body. Menstruation will stop. Danazol is not used often due to its side effects (weight gain, breast shrinking, facial hair growth). Also, it does not prevent pregnancy and the presence of the hormone would be harmful to a baby in the event of a pregnancy.

Surgery

Surgery is usually the best choice for women with serious endometriosis. There are generally three surgical options:

  • Laparoscopy – Growths are removed or burned away. Can effectively treat endometriosis without harming surrounding tissue. It is minimally invasive and the recovery is quick.
  • Laparotomy – This is major abdominal surgery through with doctors can reach and remove growths inside the pelvis or abdomen. Recovery is that of longer than that of a laparoscopy.
  • Hysterectomy – The removal of the uterus, and, in some cases, the ovaries as well. This is only done when endometriosis has severely damaged these organs. It is a last resort as a woman can no longer become pregnant after the procedure.

Polycystic Ovarian Syndrome (PCOS)

PCOS affects 5-10% of women of reproductive age and is one of the leading causes of infertility in women. This syndrome causes high levels of androgens (male hormones), especially testosterone, to develop. This stops the ovaries from producing healthy, mature eggs, resulting in anovulaton, irregular menstruation, amenorrhea, and ovulation-related infertility. There are secondary effects of the male hormones as you would expect, including acne, hirsuitism, and obesity. It should be noted that not all women with PCOS have difficulties getting pregnant.

Treatment

If you are overweight and anovulatory, then weight loss and changing your diet can restore natural ovulation. The next step if weight and diet are not the issue, or are already addressed, is the introduction of Clomid. This is a medication used to stimulate ovulation. It is widely used to treat infertility in women and sometimes men, and is taken by itself or in conjunction with a cycle of IVF or IUI. Read more about Clomid here. If you do not respond to Clomid, more intensive assisted reproductive technologies may be attempted. These include controlled ovarian hyperstimulation, follicle-stimulating hormone (FSH) injections, followed by IVF. Surgery is not typically performed to reverse PCOS, but there is a laparoscopic procedure called “organ drilling”, in which a few small follicles in an ovary are punctured with a laser or electrocautery with the goal of resuming normal ovulation. There are concerns in the medical community about the long term effects or the procedure. Talk to your doctor about whether it is right for you.

Early Menopause

Early menopause is premature ovarian failure resulting in the absence of menstruation prior to reaching 40 years old. It can be a result of low ovarian growth hormone levels, exposure to radiation or chemotherapy, or an autoimmune disease where your body produces antibodies that attack the ovaries.

The symptoms associated with early menopause are the same as those with natural menopause. As the ovaries are producing less estrogen, you will experience irregular or missed periods. You may also experience vaginal dryness, hot flashes, bladder irritability and incontinence, changes in mood, sleeplessness, and decreased sex drive.

Treatment

Once early menopause has started in is unlikely to be reversed. Women experiencing it can take hormone replacement therapy to replace the estrogen that is lost. If you experience early menopause and you want to attempt to conceive a child, talk to a reproductive specialist about what assisted reproductive technologies are available to you.

Luteal Phase Defect (LPD)

The luteal phase of your menstrual cycle is the phase between ovulation and the start of the next menses. The phase normally lasts 12 days. During this phase, progesterone is produced and the uterine lining thickens and develops extra blood vessels in preparation for the fertilized egg. A defect in this phase occurs when the correct amount of progesterone is not produced after ovulation, or if the uterus does not respond to the progesterone.

The diagnosis of LPD is easiest done by tracking the basal body temperature (BBT). It is the progesterone that is responsible for the rise in BBT after ovulation, and failure of the BBT to rise can be an indication of hormonal deficiency. An extremely close monitoring of the menstrual cycle will tell a woman if their next cycle is starting less than 12-14 days after ovulation, an additional sign that the luteal phase is defective.

Treatment

Women can take a progesterone supplement during the luteal phase if the problem is the hormone release. If there is a deeper problem with the follicle development, then an ovulatory stimulant like Clomid may be prescribed. In most cases, LPD is extremely responsive to treatment.

 

Conclusion

There are many causes of infertility in women. While age is a major factor, any woman of reproductive age is can experience these conditions. The difficult thing is that most of us don’t know there is a problem until we decide we want to try to start a family. There are plenty of resources out there to help you navigate the tricky waters of infertility. You are not alone, and help is out there.

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Gender Selection

Today’s scientific advancements have made it possible to select the gender of your child. Embryologists are now able to create or identify embryos of a certain sex. The ability to do this grew out of procedures already in place to perform genetic testing for medical reasons. It has only recently been opened up to non-medical, elective reasons such as “family balancing.” Cost, eligibility requirements, and moral or ethical conflicts make this not for everyone. We’ll go through some of the details in this article so you can see what options are available out there.Gender Selection & PGD

Pre-Implantation Genetic Diagnosis (PGD)

In this procedure, embryos created through IVF are tested for genetic disorders and gender. It was introduced in 1989 solely as a way to help couples with genetic disorders reduce the risk of having a child with the same condition. It is still widely used today for this reason, and also for women over 35 with a history of miscarriages. The testing will select embryos that are most likely to implant and result in successful pregnancy. Very few (literally only 3 or 4 in the US, and almost none overseas) will perform PGD for non-medical sex selection.

The Procedure

A cycle of pre-IVF fertility medications, egg retrieval, and in vitro fertilization is done. The embryos undergo genetic testing before implantation, rather than just a microscope check as is done in a normal IVF cycle. The embryologist will determine the health of the embryo, any potential genetic abnormalities, and gender. At this point, a decision will be made as to what to do with the information you receive. In PGD, only two embryos will usually be transferred since the weaker ones have already been selected out.

Pros

PGD is almost 100% effective in selecting embryos of the desired gender for implantation. Just like IVF, you will have the ability to freeze embryos for later implantation and save the cost.

Cons

The procedure can cost of up to $20,000. Like the cost, it shares many of the same negatives of IVF—invasive procedures, medications, risk of multiples. Perhaps the hardest thing about undergoing this procedure for the purpose of gender selection is that you have to decide what to with the embryos of the unwanted gender. Even if you are certain that you want a boy or a girl, this can be a very difficult decision. Will you freeze them for later, destroy or donate them?

MicroSort

In this procedure, instead of selecting the already fertilized embryos by their sex, the male and female producing sperm are separated and then the desired gender producing sperm are inserted into the uterus using intrauterine insemination (IUI).

The Procedure

This procedure is based around the X chromosome having about 3% more DNA than the Y chromosome, and therefore the sperm cells containing the X chromosome being bigger. A sperm sample is colored with dye and illuminated with a laser. The bigger female-producing sperm will glow brighter than the male-producing sperm, as they have absorbed more dye with their bulkier selves. The sperm is then separated by sex and the desired gender sperm are transferred to the uterus via IUI. Microsort can also be used with IVF, but would only do so in infertility cases where IVF was required. The practitioners of this method claim that it is 90% effective in choosing girls, and 74% effective in choosing boys.

Pros

Microsort can be used to prevent transmission of X-linked disorders (those that women can pass to buys but not girls), such as hemophilia. Because this procedure does not require that IVF is used (unless it is necessary for fertility reasons), you do not have the costs or risks associated with the much more invasive procedure. You will also not have to decide what to do with extra embryos.

Cons

Microsort is not approved by the FDA. It very recently (Spring 2012) failed to pass the clinical trial portion of testing to achieve this approval. It is therefore not currently available in the US. Prior to this restriction, there have been around 500 babies born in the US whose gender was selected by Microsort. It is a very new procedure (first available in 1995) and as such, the risks are not yet known. And of course, it cannot guarantee gender because we are unable to completely exclude all of the sperm on unwanted gender in a semen sample.

Ericsson Method

This method of gender selection is named for the doctor who developed it, Dr. Ronald Ericsson in 1970. It is based on the theory that male producing sperm swim faster than female-producing sperm. Ericsson claims that the procedure is 78-85% effective in choosing boys and 73-75% effective in choosing girls, many in the medical community doubt these numbers.

Procedure

A semen sample is poured through albumin in a test tube. As the sperm naturally swim down, it is observed as the male sperm reach the bottom faster. Slow and fast swimmers are separated out and the desired sperm in introduced in the uterus or cervix via IUI or ICI. If the desired sex of the baby is female, then the woman is also given Clomid in conjunction with the procedure as it is shown to increase the chances of having a girl.

Pros

This is a much less expensive procedure, costing around $600. It is non-invasive and relatively safe. It is also more available, even in states where there are restrictions on gender selection procedures.

Cons

There is no guarantee of success. The claims of its effectiveness are disputed and some research says it is no higher than 50%.

 

There are many techniques that people have used for years to try and control the sex of their unborn baby. Everything from diet, sexual positions to the timing of intercourse is commonly used. Here are some of them:

Shettles Method

This method suggests scheduling intercourse on specific days of your menstrual cycle to get a desired gender. According to the theory, male sperm move faster but don’t live as long as female sperm. In order to have a boy, you should have sex as close as possible to ovulation. If you want to have a girl, then have sex 2-4 days before ovulation so that it is the girl sperm that is still around when you ovulate.

Another theory of the Shettles method says that more acidic environments are harmful to the male sperm, but do not affect the female sperm in the same way. Shallow penetration (and the sexual positions that best facilitate this) favors female conception because the area is more acidic, inhibiting the weaker male sperm. Conversely, deep penetration will deposit the faster swimming male sperm closer to the uterine opening where it is less acidic and will better its chances of out swimming the slower female sperm. Also, female orgasm is said to make the environment more conducive to male conception as it makes it more alkaline.

The claims are of 75-90% effectiveness, but they are widely disputed.

Whelan Method

This method also suggests scheduling intercourse on specific days of your menstrual cycle to get a desired gender. The Whelan method directly contradicts the Shettles method. It is based on the theory that chemical changes that may favor male sperm occur earlier in the menstrual cycle. If you want to have a boy, have sex 4-6 days before you basal body temperature (BBT) goes up at the start of ovulation. If you want a girl, wait to have sex 3 days before ovulation.

Dr. Whelan claims only 68% effectiveness in conceiving a boy, and 56% effective in conceiving a girl.

Sex Selection Kits

Yes, you can get an at home kit for everything! These are gender-specific kits based on the Shettles method. They include: A basal thermometer, ovulation predictor sticks, douches to prepare the vaginal environment, and vitamins and herbal extracts. These kits cost about $200 from several online sources and thousands have been sold across the US. These sources claim success rates of between 78-96%, but this is heavily disputed by the medical community.

Bottom Line on Gender Selection

This is a subject that is becoming increasingly controversial as we continue to make great strides in scientific research. As we acquire the knowledge and then the ability to do more and more, issues arise as to what and how we are to use that knowledge. Although many believe that any embryonic genetic testing is above and beyond our rights as humans, the main controversy here is the use of such technology for non-medical gender selection. To many of us who are struggling with infertility and clinging to that hope of someday conceiving a child, the thought that one sex is preferable to another is unthinkable. But the issue is out there, and it is only going to become more and more prevalent as the science gets better and more advanced. You and your partner will know what is right for you. There is plenty of information out there to read and to be informed about the options available to you.

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