Jason Bromer, M.D., of SGF’s Frederick and Hagerstown, MD locations, is board certified in reproductive endocrinology and infertility, and obstetrics, and gynecology. Dr. Bromer recently hosted a webinar about trying to conceive (TTC) and helped address concerns for those facing setbacks. Below you will find his insightful question and answer segment about all things trying to conceive.
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Q: Once pregnant, can outside factors such as foods, caffeine, alcohol, and exercise cause miscarriages, or are miscarriages mainly predetermined due to abnormal chromosomes?
Dr. Bromer: Miscarriages are mainly predetermined due to chromosomal reasons. Approximately 70 percent of miscarriages for women under 35 and 80 percent for women over 35 are due to chromosomal reasons. A number of other things can cause miscarriages, including anatomy and hormone disorders. Food, caffeine intake, and exercise have some effects on fertility, but are less of a problem as long as everything is in moderation. Alcohol causes significant problems, which is why it needs to be avoided during pregnancy.
Q: If I’ve already had multiple miscarriages at my age, why would I ever not miscarry?
Dr. Bromer: It is true that all eggs are the same age. However, some eggs are genetically abnormal, and some are not. They become genetically abnormal as your age increases. As your age increases, the percentage of eggs you have that are genetically abnormal compared to younger, genetically normal eggs increases.
Q: If you have one or more miscarriage(s), does that make miscarriages more likely?
Dr. Bromer: Your chances of having a miscarriage are no different if you’ve had one prior miscarriage. Having two miscarriages makes your chances of a third miscarriage increase very slightly. Three or more miscarriages causes the chances of your next pregnancy to result in a miscarriage to rise slightly again.
We recommend a consultation with a fertility specialist after two miscarriages.
Q: What is the timing of clear white discharge vs. cervical fluid with ovulation? Should we be having intercourse on the day of clear discharge, right before, or right after?
Dr. Bromer: Always earlier. Clear mucus is a sign of a lot of estrogen, which proceeds ovulation. Sperm can live in the body for 3 to 4 days. Mucus returning to that consistency is the time to have intercourse.
Q: What test do you perform to diagnose the reason for miscarriage?
Dr. Bromer: We’ve talked about genetics; most genetic abnormalities are random, but some are not random. Performing a Karyotype test looks at the chromosomal makeup of each partner. A structural test can also be performed to see the shape of the uterus, due to the fact that congenital or acquired abnormalities of the uterus can have an effect. We look at several hormones such as the thyroid and prolactin, we screen for diabetes (another hormonal disorder), and we look for blood clotting disorders that can cause blood clotting in a newly developing placenta.
Q: Is there a correlation between regular use of pain killers and male infertility?
Dr. Bromer: NSAIDs are not good for you in great amounts (aspirin, Motrin, Aleve), but are not strongly correlated with male factor infertility. Long-term use of opiates in high doses can suppress the output of hormones in the pituitary gland (a gland in the brain that is needed to produce sperm). Long-term narcotic use can have a big effect on male fertility. Narcotic use can have effect on sexual function as well, thus affecting the chances of becoming pregnant.
Q: Does exercising too much have an effect on fertility?
Dr. Bromer: Exercising and maintaining a healthy weight and lifestyle is always good, but potentially too much can affect your body. When it is excessive, it can lead to excessive weight loss that affects your menstrual cycle. If your menstrual cycle is affected, it suggests you are not having a normal ovulation.
Q: If I have a BMI that puts me overweight, how much should I lose to become pregnant?
Dr. Bromer: 20-25 is normal BMI, so striving towards that is always the best option. You should always aim to be below 35 for better pregnancy outcomes. If your BMI is over 44, it is considered dangerous to become pregnant.
Q: What treatments are available for males who went through with a vasectomy?
Dr. Bromer: Avasectomy reversal is an option that will allow to conceive naturally. You can also extract the sperm from head of the epididymis (ahead of the blockage) to perform IVF with that sperm.
Q: What is diminished ovarian reserve?
Dr. Bromer: Diminished ovarian reserve is a term for a decreased number of eggs. This is identified through testing, or by function. Tests include an AMH test or ultrasound to look at ovaries if values are abnormal. You can also tell by the function, which is just a response to stimulating treatment to provide evidence of diminished ovarian reserve. Number of eggs and quality of these eggs do not correlate. With a low ovarian reserve, you can still have a good chance of good quality eggs.
Q: Will PCOS affect my ability to get pregnant?
Dr. Bromer: Likely, yes. It is a hormonal disorder and one of those symptoms is irregular periods, a sign of irregular ovulation. A possible solution to this is ovulation inducing therapy.
Q: Can you have regular periods and not be ovulating?
Dr. Bromer: Spontaneous periods (without medicine) shouldn’t occur in the absence of ovulation. Having regular cycles is good evidence that you’re ovulating.
Q: In general, how many rounds of timed intercourse does it take to get pregnant?
Dr. Bromer: Most couples who are fertile will conceive within 4 or 5 ovulatory cycles. Timed intercourse for the infertile population depends on timed ovulation. Within three cycles of timed intercourse, there is around a 40 percent chance of getting pregnant. After three cycles and no results, it is recommended to move on to new therapy.
Q: How reliable are commercial ovulation predictor kits when trying to conceive?
Dr. Bromer: If they’re working for you, they’re probably accurate. This means that it is producing results that show most days you are negative, and then there is a brief window that you are positive when ovulating. If it is telling you every day that you are ovulating, it is likely not reliable or working for you properly. You ovulate around 24 hours after the kit turns positive. Try to have intercourse the day the kit turns positive and then again the next day. For women with hormonal imbalances, the kits are not that accurate because of hormonal reasons.
Q: Can stress prevent you from ovulating?
Dr. Bromer: Yes. Cycles may become irregular.
Q: What type of emotional support does SGF provide for couples trying to conceive?
Dr. Bromer: Shady Grove Fertility offers support on 3 levels:
- Online, social media community base. 23,000 people on Facebook sharing stories and giving hope.
- In person support groups for anyone trying to conceive, where you are paired up with people going through similar situations.
- 5 full time available social workers available to meet with you for individual counseling.
Q: Does nutrition affect fertility?
Dr. Bromer: Your nutrition affects your fertility to an extent. Moderation is everything: a healthy balanced diet and not excessive amounts of alcohol and caffeine are suggested.
Q: What are ways to improve fertility?
Dr. Bromer: The best thing to do to improve your chances of conceiving is to have a fertility evaluation with a physician to identify areas that you can be helped.