When it Comes to Your Fertility: What is Fact vs. Fiction?

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The week of April 22nd is National Infertility Awareness Week. It also happens to be my birthday week. Coincidence? I think not. I love talking about fertility. You could even say it’s “in my blood” to practice this type of medicine as my Dad and Grandfather did too.

I thought what better way to celebrate the week than to have a little fun talking about what’s fact vs. fiction when it comes to your fertility. Please bear with me as I got a lot of joy in planning this show and my jokes will crack me up but are not guaranteed to have you in stitches. That’s okay. As long as you’re learning something then it’s okay by me.

Okay, let’s get into it!

Fact or Fiction…

I call this a fertility fiction. This is perpetuated by well-intentioned doctors that tell patients that after their pregnancy a second will be easy. That is not always true. I have so many patients come to me with a condition called, secondary infertility. That’s a very common condition and so many patients have it and it’s likely attributed to the age of the egg, the quality of the sperm, endometriosis or fibroids of the uterus.

If you’re having trouble getting pregnant with baby number two, then please ask more questions. Get checked. You’ve heard me on my Egg Whisperer soap box as I talk about this all of the time.

Here’s my recommendation:

After your delivery at your post-partum check-up, ask for your AMH level to be tested. Talk to your doctor about the most ideal interpregnancy interval based on what they know about you. If you’re 40 and wanting to wait until you try for another kid, then you may want to consider embryo freezing. I want you to be able to have the family size that you’ve always wanted.

One day I may not have to talk about these things if there’s something we can inject in the ovaries so we can continue to grow more eggs. Wouldn’t that be awesome if we didn’t have to freeze our eggs or go through IVF? Until that day, I will continue to spread the message to get your fertility levels checked and to think about fertility preservation options, early and often!

I call that, fiction! It’s harder to get pregnant when we’re older. When you are over 40 the chance that pregnancy has a balanced set of chromosomes is really low. It isn’t surprising when someone had a miscarriage, but it’s no less heartbreaking. My approach is to be as aggressive as you feel comfortable being. Learn about your fertility and talk to your doctor about what tests you can do. Use that pregnancy to guide you. What can you learn from that miscarriage? Whatever you do, please don’t blame yourself for the miscarriage. Doing testing on pregnancy tissue if you’ve had a miscarriage it may guide you and your doctor about what to do next.

Fiction. It absolutely matters! There’s no such thing as, “oh my partner has really low sperm count, but they move really fast! So it shouldn’t matter!” Ladies — that’s what we call sperm sugar-coating. It does matter!

Women take prenatal vitamins. Men should take vitamins too! I recommend something like an antioxidant blend, vitamin D, CoQ10, fish oil. You can also do other things like making sure you’re not overheating (cooking) your balls, that you’re avoiding smoking, drinking, and marijuana. There are common sense suggestions.

In short, please pay attention to sperm quality. Nutrition is important too. Preconception well-being and paying attention to your fitness and lifestyle. These are so important on both sides, for women (eggs) and men (sperm).

You know the saying, “it takes two to tango”? Well, the same thing when it comes to making a healthy embryo it takes a healthy egg and sperm.

This is totally true! This is a fact. Just because you have one blocked tube, doesn’t mean you can’t get pregnant naturally. However, we don’t know which side we ovulate on so this can be tricky. How do we know if we have a tube blocked? The hysterosalpingogram or other ways of documenting this like a laparoscopy, a saline infusion sonogram, and there are a number of other procedures too. Talk to your doctor if you’ve been trying for a while or maybe you have risk factors like endometriosis or a ruptured appendix. Get your fallopian tubes checked! By now you’ve likely heard me talk about the TUSHY method, so you know what the “T” stands for — your tubes! Get ’em checked!

When we ovulate we don’t alternate sides. It’s like a flip of the coin and if you’re ovulating from a blocked side, the open side won’t pick up that egg. I’ve seen it happen once in ten years. It’s highly unlikely, but I know that it is possible, but it’s not wise to rely on that happening. Seek help! Talk about taking fertility pills to help yourself ovulate from the open side and hopefully that will help. If not, then that’s what IVF is for.

Well, that’s kind of a fact. The reason is you can get pregnant with IVF. You don’t need fallopian tubes to get pregnant in your uterus. IVF bypasses the tube. The tube is the embryo transport system. When you take eggs out and you make an embryo in the petri dish and place an embryo inside the uterus the tubes have nothing to do with it.

You don’t need tubes to ovulate regularly. You don’t need tubes to have regular periods. People often ask me, “well — where does the egg go? What happens to it?” They have these ideas about eggs being these really big things — like a chicken egg — but that’s not how eggs are in a human body. An egg is microscopic. Think of it like water in the sunlight. When you see an egg and it doesn’t get fertilized and it has nowhere to go, it’s really not a big deal. When you have the egg white cervical mucus that’s not the egg coming out either. That’s your body’s natural response to estrogen levels as they rise during ovulation and your period? That’s not the egg either! That’s just the uterine lining coming out.

So when your estrogen level goes up and your progesterone level goes up, and then they both come down after ovulation, well the lining comes out. This is a totally natural process. Please don’t worry too much if you have a blocked fallopian tube as with the help of IVF you can still get pregnant.

That’s fiction. The age of the sperm absolutely matters. There are a lot of things that can happen with older paternal age. Some of them are increased risk of conditions like schizophrenia, autism, imprinting disorders like Beckwith Wiedemann syndrome. So these are things that we talk to our patients about. What is advanced paternal age? Some people say as early as thirty-five or forty. Some people say not until fifty. But here’s what I do. I look at sperm quality through some testing called a sperm DNA fragmentation test. I look really closely at the sperm and I do whatever I can to make that DNA fragmentation percentage as low as possible, hopefully under 25%. Through lifestyle changes, managing existing disease (like diabetes), avoiding processed foods, and taking supplements men can actually improve the quality of their sperm. My advice: talk to your doctor about your sperm health!

I’m calling this one, Fiction. Marijuana in my humble opinion is not safe. Studies have shown it can bind to receptors in the lining of the uterus and could block implantation. The same with fallopian tubes as it might affect how the embryo is transported. In men it can change the hormone levels in a man, raising estrogen and lowering testosterone. Certainly, that can’t be good for sperm health.

You know the saying, everything in moderation. The same applies here. Chronic use of the chronic…that’s something I worry about with my patients. (Insert knee slap here). If your partner is dealing with so much going through IVF it can be stressful, but I urge you to find another way to deal with this stress. Go on walks, meditate, take melatonin, drink tea, but be mindful of what you’re doing and if it may harm your fertility.

I’ve had people come to me and say, hey if JLo can have babies at 40 then I can too! She looks amazing, right? I wish fertility was skin deep, but it’s not! Looking in the mirror and taking a selfie and sending it to me to check your fertility, maybe one day, but not today. Until that day we have things like FSH, estradiol, and AMH levels to guide us. An ultrasound of the ovaries where we look at the follicle count called the antral follicle count and we put all of that information together and talk to patients about what their fertility rates are at their age. Of course, being in great shape and healthy will only help, but that said don’t want to see a fertility doctor if you feel out of shape. We just want to help you reach your goals and create the family of your dreams.

I wish that I had that magical power. Unfortunately, MD doesn’t equate to a medical deity. I can work with what patients have, but I don’t have the ability to create something that’s not there. Sometimes patients have to do multiple cycles to get one healthy embryo. If you’re considering doing embryo freezing, maybe consider doing it earlier in your life. Similar to the type of vacation we do for retirement or vacation planning. Why not apply that same planning mindset to a family. Infertility is not preventable. All of us will run out of eggs in our lifetime. It’s unavoidable. I’m hoping through this show and others that I will prevent heartache in someone and get them to start their family younger or preserve their fertility when they can.

Fact. You actually don’t need ovaries to get pregnant! Women can get pregnant after menopause. How? If you have embryos frozen, you take estrogen and progesterone and then implant an embryo inside your uterus. This process should not make you fear that there’s some sort of emergency. I have a lot of patients come to me over the age of 45 or early 50s. The word is out, you don’t need regular cycles or ovaries working to become a parent. You can get creative to reach your goals.

This one cracks me up. If you know a bit about me you know that I have fun with April Fool’s day. Here’s the thing. This is a fact. It is possible. Does society need men to have uterine transplants? Hmm, maybe not now, but maybe eventually. I’m going to predict in about 20 years there’s going to be someone that signs up for a uterine transfer.

IUI is intrauterine insemination or the turkey baster approach to fertility. Here’s how it works. Around ovulation time you’ll produce a sperm sample, bring it into my office and then I’ll make the sperm sparkling clean. We call that sperm or semen wash. We then take the sperm that’s prepped from the semen and put it into a syringe attached to a catheter and we deliver it to the top of the uterus. You would think if we are giving sperm that type of boost that it would be at least 50%, but it’s not. At best, pregnancy rates with IUI are around 15%. I have patients ask my all the time, why it didn’t work. I tell them it’s because you’re human. If you’re going through the process ask your doctor how many IUIs it may take to get pregnant and what you may want to change about your approach if it’s not working. If an IUI cycle doesn’t work these are the types of questions I typically ask myself: should I increase the number of eggs ovulated, should I change how I approach the IUI — perhaps consider a double IUI. Should I add something? For instance, there’s a device called Zymot. Should I add that to the IUI procedure process? There are lots of things to think about. Supplements. Maybe we should be adding things. If she’s not already doing coQ10, add that.

This is total fiction. I talk with patients from all over the world who come to me after being at other clinics. One of the first things I ask is to understand what the quality of their embryos were. So many patients tell me their doctor told them the quality doesn’t matter or that they don’t know it. In my humble opinion I respectfully, totally disagree with that. Quality does matter. The stronger the embryo the higher the chance your implantation will work and turn into a healthy pregnancy. So if you haven’t done it already, please request a copy of your embryology report. Ask your doctor to be upfront. Get a clear answer from them on what your chances are of getting pregnant with the embryos or frozen eggs you have. Nobody regrets freezing more eggs. Nobody regrets freezing more embryos. The only thing people get mad about is if they weren’t told the truth about what their chances are and were not given the opportunity to do more when they still had eggs. So you do need to find out the embryo quality. Find out when it was frozen, what the quality means, what grading criteria they use. What the pregnancy rate is for each embryo frozen. Get educated on your own fertility by asking more questions.

Fiction! We make a cyst every single month when we ovulate. It’s called cyst of ovulation. It grows to the point where it’s about 2–3 centimeters or so until the egg comes out and then the cyst typically goes away. Sometimes it can take a month or two, you may get pain or need to go to the emergency room if the pain is too much. If there’s a cyst that you or your doctor are concerned about it’s worth scheduling frequent follow-ups to monitor it every 6–8 weeks and if it’s not going away and continues to be worrisome plan to remove it. Just know that cysts come and go and they are normal. Find out as a baseline if you have a cyst and if it will go away. Know your body before you begin any treatment.

This is fiction. There is a slight increase chance of hepatic cancer in kids born from IVF. It is very minimal. A 1.17% increased risk of hepatic cancer so the studies did not show that IVF causes childhood cancer, but when you’re looking these studies online or reading attention-grabbing headlines, you may believe things that simply are not true. I like lists. I like questions. I ask patients to write down and send me their questions. Please do not believe Facebook fertility trolls. They are out there. Please don’t listen to them. Listen to your gut and talk to your doctor.

Fiction! If this was true, I’d set up pineapple stands on every corner. If it were true I’d send every patient home with a gift card for McDonalds and a pineapple. They do not improve implantation rates. Foods that are anti-inflammatory or the Mediterranean diet, sure they may help.

I’d say that maybe 2–5% of my patient visits I get this question. This is total fiction. It’s called gravity. When semen is ejaculated into the vagina it will come out. The sperm cells will travel up to the uterus. The semen that comes out you don’t want it in the uterus. You want the sperm cells. There are sexual positions that I do recommend…here it is..the ones you enjoy. There isn’t one that’s better than another. The one that you’re comfortable with and that you’re enjoying? That’s the right one.

Fiction. I’ve had patients ask if they can stay in the room after IUI and masturbate. Sure, of course you can. But it’s not going to impact the pregnancy rate. This is my world. I talk about babymaking. I talk about every possible thing related to making babies. These are topics that maybe people aren’t comfortable talking about, but I am. I hope that by talking I can remove stigma and taboo and encourage everyone to do what they need to do to live a joyful life.

Fiction. I wish there was a way so that people could get the gender they hope, but the only thing that really matters is to have a healthy pregnancy and baby. There is no trick. There are people that go through IVF to give themselves a higher chance of having the gender they want in a baby and I think that’s okay.

That’s it for this show. As always please reach out if you have any questions or topic suggestions for future shows.

Send me a note: email@eggwhisperer.com

You can also catch more of me and topics like this through the Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!

Fertility Doctor, Reproductive Endocrinologist, Egg Whisperer: www.eggwhisperer.com

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