General

Did you know that the physicians at Shady Grove Fertility can show you your egg quantity? Egg quantity, also known as your egg supply or ovarian reserve, is the number of potential eggs that remain in your ovaries and is closely linked to your ability to conceive. In general, the more eggs you have, the better your chance of getting pregnant, whether trying with your partner on your own or through fertility treatment.

Measuring Egg Quantity

As stated previously, ovarian reserve is how many eggs a woman has—her current egg supply—and it’s possible to see how many eggs a woman has through simple testing. Ovarian reserve testing is typically performed on the third day of your menstrual cycle and includes an ultrasound to show you your ovaries and count the number of eggs you have available at that time, and a blood test to measure your reproductive hormone levels. The primary reproductive hormone levels that are measured include follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH).

FSH is the primary hormone responsible for the production of mature eggs in the ovaries and AMH levels can be helpful in understanding what treatments may be necessary, as high AMH (>3.5) predicts a good response to medication, and low AMH (<1) reveals a lower expectation of response. “Taken together we can predict what the ovarian reserve is going to be,” says Dr. Isaac Sasson, M.D., Ph.D. of Shady Grove Fertility’s Chesterbrook, PA location.

Balancing Egg Quantity and Quality

“When I think about eggs, I think about two pieces: egg quantity and egg quality,” explains Dr. Sasson. “Egg quantity, we can assess. Egg quality does not have a test. The best test for egg quality is your age.”

As a woman ages, the number of genetically normal eggs that are able to mature for a successful conception decreases. At age 25, 75 percent of a woman’s egg quantity is normal, at age 35, 50 percent are normal and by age 40, 10 to 15 percent are normal. It is important to note that even at peak fertility; a woman does not have 100 percent normal eggs.

While the quality of eggs does decrease with age, it is important to note that it does not mean you will not be able to conceive. The physicians at Shady Grove Fertility work with you individually to determine the right course of treatment to result in a pregnancy. Or, if you’re interested in egg freezing, our physicians can help determine if freezing right now is your best option. Dr. Sasson notes, “We need to find the right treatment for you, and very often a lot of our treatment is predicated on balancing egg quality and egg quantity.”

Your egg quantity is a main factor when trying to conceive, whether through expectant management by freezing eggs or through common fertility treatments. If you are interested in learning more about your egg quantity to better understand your fertility, please call 1-877-971-7755 to schedule an appointment and speak with a new patient liaison.

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On Tuesday, August 16, 2016, Dr. Jason Bromer, from Shady Grove Fertility’s Frederick, MD, office talked to the Frederick News Post about the struggles many overweight women face when trying to conceive. In addition, there have long been strong ties between obesity and pregnancy complications.
Bromer estimates that up to a third of his patients struggle to conceive because they are overweight. He encourages those patients to take control of their weight, stating “once pointed in the right direction, the problem is almost always fixable.”

Obesity and Pregnancy: The Impact on Your Hormones

Excessive weight most commonly affects your reproductive hormones, which often results in irregular ovulation, hindering the potential for conception.

Bromer says that among overweight women he sees more cases of polycystic ovary syndrome (PCOS)—which is the most common ovulatory disorder among women of reproductive age. Women with PCOS experience a hormonal imbalance that interferes with the signal between her brain and her ovaries. The condition can often involve small ovarian cysts, and can later lead to diabetes and heart disease if untreated.

Obesity and Pregnancy Complications

Not only are women with a body mass index (BMI) above 35 at greater risk for infertility, they are also more likely to experience miscarriage, according to Bromer. Overweight and obese women generally are more likely to lose a pregnancy because their uterus can be a less hospitable environment for an embryo to implant and grow well. Additionally, overweight and obese women have a higher incidence of gestational diabetes and high blood pressure, and are more likely to need a cesarean section, explains Bromer.

One the other side of the scale, underweight women also experience difficulties with conception. A few months ago, Pennsylvania-based Dr. Isaac Sasson told U.S. News about the problems underweight women and women recovering from eating disorders face before conception and during pregnancy.

For women who are under or overweight, Dr. Bromer says that once they achieve a healthy body weight, many times normal ovulation will resume, making fertility treatment unnecessary for conception.

Due to greater risks for both mother and child, Shady Grove Fertility does not begin fertility treatment for patients until they have reached a healthy BMI to ensure the safest, healthiest pregnancy for both mother and baby. Your SGF physician can provide details of BMI guidelines based on your personalized treatment protocol.

If you think you may have PCOS, are struggling to conceive, or would like to learn more about the link between obesity and pregnancy complications, Dr. Bromer is accepting new patients in the Frederick, MD office. To schedule a new patient appointment at one of our other office locations throughout Maryland, Pennsylvania, Virginia, or Washington, D.C. with another SGF reproductive endocrinologist, please contact our New Patient Center at 877-971-7755.

If the last time you thought about the specifics behind the birds and bees—more formally known as reproductive physiology—was in your junior high health class, you are not alone. When it comes to truly understanding how human conception works, many people are stumped. So how are babies made? Let’s take a look back and briefly review the fundamentals of female and male reproduction and how conception works.

Female Reproduction 101 – Egg Development & Ovulation

A woman’s internal reproductive organs include her vagina, uterus, Fallopian tubes, and ovaries. Within her ovaries are thousands of eggs waiting to be matured and ovulated. Each month several eggs are available, but most typically just one will grow big enough for ovulation.

As Dr. Isaac Sasson (Chesterbrook, PA) explains it, a woman’s brain produces follicle-stimulating hormone (FSH), which signals the eggs to grow within the follicles. Typically just one will fully develop, growing to about 20mm, and all others will die. This mature egg produces estrogen, which signals the uterus to develop its lining in preparation for a pregnancy.

The next step is ovulation, where luteinizing hormone (LH) is produced and triggers the ovary to release the egg. Dr. Sasson explains that LH is only present in the body for roughly 1 day per menstrual cycle and 24 to 36 hours after it appears, the egg will be released.

From there, the Fallopian tubes must find the egg. If successful, the egg will continue to live for about 1 day unless fertilized.

Male Reproduction 101 – Sperm Development

Like women, men also produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH). For men, FSH and LH are used to trigger production of sperm and testosterone within the testes. However, this is just the start of the sperm development.

From the point that the sperm is initially formed, it takes roughly 2.5 months for it to fully mature and develop. This sperm maturation process is why some men with poor sperm quality—as seen in a semen analysis—can make simple lifestyle changes and see improvements with sperm quality and/or quality within just a few months.

As a sperm matures, it is working its way through the male reproductive system and eventually is released during ejaculation. The sperms’ journey is far from over and just a few will make their way into the Fallopian tube with the chance to fertilize the egg.

How are Babies Made? Understanding Conception

Fertilization occurs at the chance meeting of a sperm and egg in one of the Fallopian tubes. Timing is critical during conception, as the egg will live just for 1 day within a Fallopian tube and the sperm can live in the woman’s reproductive tract for 3 to 5 days. This represents a couple’s fertility window. If a couple is trying to conceive, we advise having sexual intercourse in the days leading up to ovulation and on the day of ovulation.

Of the sperm that made their way to the correct Fallopian tube, the sperm will try to fertilize the egg by burrowing into the egg. Once one sperm makes it way in, the egg instantly changes, and prevents all other sperm from getting in. In this moment, a baby’s genes and gender are set.

The fertilized egg will remain within the Fallopian tube for a few more days but begins to divide quickly into many cells. It will then move from the Fallopian tube to the uterus with the hopes of implanting within the uterine lining where it will stay for the next 9 months.

When to Seek the Help of a Fertility Specialist

Any breakdown in this process—hormone imbalances, structural anomalies, and even poor timing of intercourse—can result in no conception.

In order to put yourself in the best position to build a family, women and men should be proactive in understanding their fertility health. For a man, a semen analysis can help show sperm quality and quantity. For a woman, hormonal testing, as well as an ultrasound and hysterosalpingogram (HSG), can provide a holistic look at her chances of conception.

For those who are currently trying to conceive, we recommend a simple fertility evaluation after:

• 1 year, if the female partner is under 35 with regular cycles
• 6 months, if the female partner is 35 to 39 with regular cycles
• 3 months, if the female partner is 40 or over with regular cycles

If you have irregular periods, ovulatory disorders, or a history of early menopause or premature ovarian insufficiency, we recommend you see a fertility specialist sooner. Early diagnosis and treatment leads to the best success rates.

The first step is simple—schedule an appointment to meet with a fertility specialist to determine your cause of infertility and then discuss your fertility treatment options.

For more answers to the most frequently asked questions about conception, read here.

How are babies made? To speak with a New Patient Center Liaison for more information or schedule an appointment call 877-971-7755.

Sexually transmitted infections (STIs), which were once more commonly known as sexually transmitted diseases (STDs), are infections transmitted through sexual contact or intercourse that are caused by bacteria or viruses. While not all sexually transmitted infections impact fertility or prevent a woman from having a healthy pregnancy, some sexually transmitted infections do impact a woman’s fertility. Many STIs go unnoticed because they have no symptoms, which is why it’s important that both partners get tested and, if necessary, treated to avoid any further complications.

What are the most common STIs that impact a women’s fertility?

• Chlamydia: This is one of the most common STIs that can adversely affect the fertility of both men and women. While Chlamydia is often a silent infection with no symptoms, Chlamydia can lead to uterine and tubal damage, and can cause pelvic inflammatory disease (PID), a more serious infection of the uterus and Fallopian tubes.
• Gonorrhea: Symptoms of gonorrhea include a painful or burning sensation when urinating and vaginal or penile discharge, although, like Chlamydia, it can also be asymptomatic. In some cases, gonorrhea can cause infertility through tubal damage.
• Herpes simplex virus 2: While this type of STI does not typically cause infertility in women, women are advised to avoid conception during an outbreak. Therefore, having to time when to conceive around symptoms can make getting pregnant more difficult. In men, however, the herpes virus may cause real fertility problems, including low sperm count and poor motility (sperm movement). Herpes can be very dangerous if contracted while pregnant, especially near delivery as the infection can be transmitted to the infant and cause serious and sometimes fatal infections.
• Syphilis: Syphilis infection can have serious long-term health effects if left untreated but typically has little impact on fertility.
• Human papillomavirus (HPV): HPV is a common virus found in sexually active individuals. While the virus itself may not directly cause infertility, in some cases, having HPV can increase your chances for cervical dysplasia, cervical cancer, as well as anal rectal cancers and head and neck cancers.

Do all sexually transmitted infections impact fertility?

The simple answer is no. Certain bacteria such as chlamydia and gonorrhea are most responsible for severe tubal damage and scar tissue. Others, like herpes and syphilis, can be particularly dangerous to a pregnancy. Certain types of HPV may cause precancerous cells or cancer of the cervix, and treatment for this could lead to other cervical conditions and infertility.

Are STIs treatable?   

There are treatments available for all STIs; however, in the case of HPV, while the warts and cervical dysplasia caused by HPV can be treated, the virus cannot be eliminated. Importantly, vaccination for HPV is now widely available.

Can I still get pregnant if I’ve had an STI?   

Yes. Pregnancy is certainly possible if you’ve had an STI in the past. However, STIs make it more likely that you will experience infertility.

What are ways to prevent STIs and infertility down the road?  

If you (or your partner) think you may be at risk for an STI, the best way to prevent STIs is to use condoms unless you have been tested for these infections. To prevent HPV, the vaccine is recommended for preteens at 11 or 12 years of age before they are exposed to the virus. For teenagers and young adults, the Centers for Disease Control and Prevention (CDC) recommends vaccination up to 21 in men and 26 in women. The vaccine is not recommended for anyone older than 26 because, by that age, those still sexually active have likely already been exposed to most high-risk HPV subtypes.

STIs pose a greater threat to fertility when they are diagnosed late. Regular check-ups and open discussions with your sexual partner will help protect you from an STI.
 

Eric A. Widra, M.D.

Executive Senior Medical Officer

Paulette E. Browne, M.D.

 
Many STIs go unnoticed because they have no symptoms, therefore, if you think you (or your partner) may be at risk, it’s important to get tested and, if necessary, treated. Even treated sexually transmitted infections can impact fertility. To learn more, please call 1-877-971-7755.

In its ongoing series on fertility, Business Insider asked SGF reproductive endocrinologist Dr. Shruti Malik what more than 60 percent of women of reproductive age who are on birth control will probably wonder: how long will it be before I can conceive after stopping birth control? Most women, says Dr. Malik, should return to normal menstrual cycles within a month or two.

However, for women who are stopping birth control after usage for a sustained period of time, Dr. Malik cautions that it may take a bit longer because the uterine lining needs time to thicken. “So a woman may take a few months to build up that lining before she has her period again,” Malik, of Shady Grove Fertility’s Fair Oaks and Woodbridge, VA offices, said.

Malik says a woman under 35 who is actively trying to get pregnant can expect about a 6 month timeframe once her body returns to a normal menstrual cycle. That’s because a couple in its first year of trying only has a 15 to 20 percent chance of conceiving naturally each month.

Women under 35 who have not conceived within 1 year—or women 35 and older who have not conceived within 6 months—should reach out to a fertility specialist to see if there are any underlying infertility causes.

Malik tells Business Insider that the body generally doesn’t need much time to bounce back after stopping birth control and advises that women should not go off birth control until they are ready to begin trying to conceive.

Dr. Malik’s interview is part of a wide-ranging series from Business Insider about fertility-related topics including egg freezing and when to see a fertility specialist.

Are you thinking about stopping birth control? To find out when you should consider talking with a fertility specialist, call our New Patient Center at 877-971-7755. 

Maintaining an ideal weight is something we know to be important for our overall health and well being, but what we have come to learn from studies is the direct effect of weight on fertility as well as the outcome of infertility treatment and pregnancy.

While often it is assumed the negative effect on weight on fertility is associated with being overweight, women who are underweight (BMI less than 19) may not be getting enough nutrients, which can cause their bodies to ovulate infrequently or not at all. In overweight women, an increase in insulin levels may cause their ovaries to reproduce male hormones and stop releasing eggs, which results in ovulatory dysfunction. With modest weight changes, both overweight and underweight women may resume ovulation on their own without the need for fertility medications.

For Men: The Effect of Weight on Fertility

Women are not the only ones who are affected by weight and fertility. Men suffer from similar complications, since being overweight or underweight causes changes in the body. Severe obesity in men has shown to impact fertility due to imbalances in hormone regulation tied to sperm production (low sperm count and motility, or sperm movement).

What is the ideal BMI if trying to conceive?

An ideal body weight can result in improved outcomes for both the mother and her baby. According to the Institute of Medicine, obesity is defined by a measure calculated by the height and weight of the patient to determine the body mass index, or BMI.

• Normal BMI
  • Defined by an index of less than 25
• Overweight
  • Defined by a BMI of 25 or greater
• Obesity
  • Defined by a BMI of 30-34.9 (Class 1 obesity)
  • Defined by a BMI between 35-39.9 (Class II obesity)
  • Defined by a BMI above 40 (Class III obesity)

You can determine your own BMI using the online BMI calculator found here.

Normal BMI Optimizes Fertility Treatment Success

When women are under or overweight, their BMI has been found to impair successful outcomes for fertility treatment. Some of the complications that can arise as a result of a high BMI may include:

• Lower response to medication used to regulate or initiate ovulation
• Greater need for carefully titrated dosing of medication, especially in patients with polycystic ovary syndrome (PCOS)
• In response to medications used to induce ovulation, women who are overweight or obese have a greater frequency of over-response and a higher risk of overstimulation and/or multiple pregnancies. If a multiple pregnancy occurs, there are greater obstetrical complications in patients with high BMI than in multiple pregnancies in patients with a normal BMI.
• More complications with in vitro fertilization (IVF) treatment
  • Fewer eggs retrieved
  • Greater difficulty retrieving eggs with increased risk of bleeding or injury
  • Greater anesthesia risk at the egg retrieval, including maintaining adequate airway, hypertension, and aspiration ^1,2
  • Greater difficulty with embryo transfer in visualizing the uterus and accomplishing the transfer effectively
  • Lower embryo implantation rates ³
  • Lower IVF success rates ^3,4

For those women who are overweight and get pregnant, there are increased risks of complications during pregnancy, which may include:

• Higher frequency of early pregnancy loss (miscarriage)
• Greater anesthesia-related surgical complications if any surgery is required (i.e., D&C for miscarriage)
• Greater frequency of hypertension, gestational diabetes, pre-eclampsia, still birth, and other pregnancy complications ^5,6,7
• Increased risk of requiring caesarean section delivery. The caesarean section rate is almost 50 percent in obese women ⁵
• Due to larger babies, there is a greater delivery complication rate for those delivering vaginally ⁶

It’s important to note, with all the potential complications and adverse effects, reduction in BMI through weight loss has been demonstrated to significantly improve fertility treatment success, lower complications of treatment, and lower complications of pregnancy.

BMI Guidelines for Treatment at SGF

At SGF, your physician will review your medical history and records at your first appointment to determine if there is any need for concern regarding BMI in order to begin treatment. He or she will also provide you with the appropriate resources—including recommendations for weight loss programs, nutritional counseling, dietary modifications, and/or an exercise regimen, if need be. The goal for both patient and physician should be for the patient to be in the best possible overall health before beginning treatment.

Editor’s Note: This post was originally published in December 2008 and has been updated for accuracy and comprehensiveness as of June 2016.

To learn more about the effect of weight on fertility or if you would like to schedule an appointment, please contact our New Patient Center at 1-877-971-7755. 
References for the Effect of Weight on Fertility: