General

by Dr. Isaac E. Sasson, MD, PhD

For patients faced with the frustrations of getting pregnant, the first visit to a fertility specialist can be daunting. For some, the fear stems from being assigned a diagnosis; and for others, it is the fear of the unknown or confronting the uncommon possibility of never being able to deliver a baby. And nearly every single patient, they will have to learn the our fertility vocabulary.

Starting with the initial fertility evaluation, which consists of a comprehensive review of the couple’s medical, reproductive, and family histories, patients are exposed to new terminology. Patients need to collect 4 pieces of data during their fertility work-up.

1. An ultrasound of the ovaries is performed on the third day of the menstrual cycle to determine the antral follicle count (AFC).
2. At this time, blood work is performed to evaluate critical reproductive hormones: follicle stimulating hormone (FSH), estradiol, and anti-mullerian hormone (AMH).
3. The fallopian tubes will be tested with the X-ray based test known as a hysterosalpingogram (HSG) to see if their are any blockages in the tubes.
4. A semen analysis is performed on a specimen provided by the male partner.

Do you know what all those words mean?

Fertility Vocabulary

Oocyte is the medical term for eggs.

Granulosa Cells line the ovarian follicle and nurse the growth of the oocyte.

The Follicle is the fluid filled sac in the ovary that contains the oocyte and is lined by granulosa cells. During a menstrual cycle, follicles grow from 20mm in response to hormones made by the pituitary gland in the brain.

Antral Follicles are ovarian follicles that measure between 2-10mm at the start of the menstrual cycle. These follicles represent the pool of oocytes that are available for recruitment, growth, and ovulation in a given month.

Antral Follicle Count (AFC) is the number of antral follicles counted on day 3 of the menstrual cycle. The AFC is a measure of ovarian reserve.

Ovarian Reserve is the size of the remaining egg supply.

Dominant Follicle, also known as the lead follicle, is usually identifiable around day 10 of the menstrual cycle. This follicle started the menstrual cycle as an antral follicle and grows more quickly then its neighbors, thereby selecting itself as the follicle that contains the oocyte that will be ovulated.

Follicle Stimulating Hormone (FSH) is a protein made by the pituitary gland at the base of the brain. It stimulates the antral follicles in the ovary to grow and prepares the oocyte for ovulation. When measured on day 3 of the menstrual cycle, it serves as a marker of ovarian reserve.

Anti-Mullerian Hormone (AMH) has many biological functions. The fertility specialist uses AMH levels as a measure of ovarian reserve. In the ovary, AMH is made by the granulosa cells of primary follicles, pre-antral follicles.

The Hysterosalpingogram (HSG) is an x-ray based dye test used to evaluate the shape of the uterine cavity and to determine if the fallopian tubes are open to capture the ovulated oocyte and transport the embryo to the uterus.

The Sonohysterogram (SHG) is an ultrasound-based test used to evaluate the uterine cavity. During this study, a small volume of saline is instilled into the uterus while an ultrasound is performed. This allows the fertility specialist to determine if fibroids or polyps (both benign) are protruding into the uterine cavity potentially disrupting embryo implantation.

The Endometrial Stripe (EMS) is measured by transvaginal ultrasound. This is the part of the uterus that grows during a cycle, bleeds during a period, and when pregnant, is the site of embryo implantation. The endometrial stripe is thin (about 4mm) at the start of the menstrual cycle and grows to more than 8mm in response to estrogen made by ovarian follicle. When adequately grown, your fertility specialist may describe the EMS as trilaminar, as it appears as three layers on the ultrasound.

I hope you find this fertility vocabulary list helpful and while it is your medical team’s responsibility to prepare and educate you on diagnosis and treatment options, learning your fertility vocabulary will help improve communication throughout your fertility journey.

Starting this fall, Dr. Isaac Sasson is available for new patient appointments in the Philadelphia area. To schedule a New Patient Appointment with Shady Grove Fertility please call 1-877-971-7755 or click here.

by Dr. Barbara Osborn, MD

How much exercise is OK while I’m trying to get pregnant?
This is a common and logical question our patients ask. Based on the existing literature, however, stating the link between exercise and fertility is a difficult to say with certainty.

Some facts have been well established.
1. Intense physical activity, such as that of competitive female athletes, can disturb the menstrual cycle, but moderate activity has little effect on the cycle.
2. Obesity is associated with decreased fertility. Weight loss in obese women can improve their fertility. Weight loss can also improve menstrual regularity in obese women with PCOS.

What about women with normal cycles?
There are two large studies looking at women who were about to start trying to conceive. Both used questionnaires to ask women about their level and duration of physical activity or exercise before they started trying to conceive.

One of these studies was published in May 2012 looking at 3,628 women in Denmark who were planning for conception. In normal weight women, vigorous activity (running, fast cycling, aerobics or gymnastics) was associated with decreased fertility. Moderate activity (brisk walking, leisurely cycling, gardening or golfing) was associated with modestly improved fertility. In overweight and obese women, however, both moderate and vigorous exercises were associated with improved fertility.

A similar study of 3,887 women was conducted in Norway (published 2009). These women were mostly normal weight (mean BMI 22.7). This study also found that women with the highest frequency, duration and intensity of physical activity were less likely to conceive. When looking just at duration of activity, both short (< 15 min/day) and long duration (> 60 min/day) were associated with decreased fertility, but those with moderate duration (16-60 min) had improved fertility.

Unfortunately, neither study asked the women what their activity was like while they were actually trying to conceive, only what it was before they started. These studies do suggest that exercise in moderation is best for normal weight women trying to conceive, but that overweight women might improve their odds with more vigorous exercise.

Exercise and Fertility – What is recommended for women in fertility treatment?
A small study performed in Turkey was published in 2009. This looked at 131 women about to start their first IVF cycle and evaluated activity both before and during the cycle. Although women were advised to just continue their normal activity, they had a tendency to decrease their physical activity during treatment. While 15 women met criteria for “high” activity before the IVF cycle, none of the women had high activity during the treatment cycle itself. There were 68 women who had low activity during the cycle and 63 with moderate activity. The mean BMI in both groups was 24.7. Moderate activity during treatment was associated with a significantly higher live birth rate (47.6%) than low physical activity (19.4%). Interestingly, the amount of activity the patients were doing before they started treatment had no correlation with live birth rate.

In summary, we have very little data on which to state a link between exercise and fertility. From the available studies, however, it seems that moderate activity such as walking and leisurely cycling seems to make the most sense for women trying to conceive naturally or through fertility treatment.

At Shady Grove Fertility, once a patient has had her IUI or embryo transfer, we suggest that she treat her body as if she is pregnant, recommending gentle to moderate exercise.

To schedule a New Patient Appointment with Shady Grove Fertility please call 1-877-971-7755   or click here.

Fertility Fact: There is no magic regiment or fertility diet that will increase the likelihood of egg meeting sperm.  That said there are ways to prep both the female and male body for healthy conception.

Folic Acid

Taking folic acid, or folate, as part of your pre-natal vitamin, has shown to reduce neural defects in unborn children. It is recommended to take a minimum of 400 mcg per day.

Calcium

Calcium is an important part of a women’s healthy diet to improve bone health. Pregnancy can do a number on the female body, and having a good supply of calcium will be necessary while your body is working hard to help your child grow. For women that are lactose intolerant or don’t take in enough calcium throughout the day, can check their pre-natal vitamin label to see if it is included or take a separate supplement.

Iron

When eating for two, a women needs to avoid anemia – which is particularly common in vegetarian moms-to-be. Check your pre-natal or pre-conception vitamin to see if iron is included.
> Read more about pre-natal vitamins.

Caffeine

It is recommended to reduce or limit caffeine intake to one beverage a day while trying to conceive. There have also been studies to show that consuming over 200mg of caffeine per day resulted in twice the miscarriage rate than women that consumed no caffeine. Which is why, at Shady Grove Fertility, we recommend that safest amount of caffeine is zero. Read more about caffeine during pregnancy.

Alcohol

As with most things, there are contradicting studies as to the impact of alcohol on fertility. SGF recommends limited alcohol consumption during while attempting to conceive. And once you are in your two-week wait or achieved pregnancy, it is recommend to completely remove alcohol from your diet.
> Read Dr. Eric Leven’s lifestyle advice for couples with infertility.
Every few months you might read in the news the next great fertility food or fertility diet that will magically help you conceive. While there is no harm in adding in certain foods to your diet just in case it might work, don’t go overboard! Taking too much of anything – including the healthy vitamins that are recommended – is a bad thing. So no need to double up on your vitamins, it won’t have double the impact on your health. And most importantly, talk to your medical team about a healthy fertility diet and lifestyle.

Note: The recipes we share on our “Recipe for Fertility” aren’t designed to improve your fertility rather are posted as good healthy food options while TTC and pregnancy.

To schedule a New Patient Appointment with Shady Grove Fertility please call 1-877-971-7755 or click here.