General

by

Dr. Ricardo Yazigi

by Dr. Eric Levens

Ready for a fertility fact? Forty percent of women with fertility problems aren’t regularly producing an egg that can be fertilized (anovulation).

The vast majority of problems with ovulation are accounted for by a condition known as polycystic ovary syndrome (PCOS). Other fertility problems resulting in irregular menstrual cycles include ovarian failure or inadequate signals from the brain that control the menstrual cycle (hypothalamic dysfunction).

To get a better sense of potential underlying fertility problems, at my initial fertility evaluations I often ask “Are your periods regular?” and “How far apart are your cycles?” I want to get a sense of how frequently ovulation is occurring.

The typical menstrual cycle is between 24 and 35 days. When menstrual cycles are irregular in duration or outside this normal range, this frequently indicates a problem regularly producing an egg.

Today, there are many high-tech devices lining pharmacy aisles, all designed to predict ovulation (some even have digital smiley faces). Nevertheless, few tests are as important and as simple as a thorough menstrual history. Denoting when your menstrual cycle begins on a calendar is as simple as it comes and I encourage patients to bring these calendars with them to their initial consultation if their cycles are in question.

In a 2003 study by Malcolm in the journal Obstetrics and Gynecology, the authors reported that a normal menstrual cycle predicted ovulation 99 percent of the time.

While I frequently use high-tech solutions to solve many fertility problems, it’s just as important today as ever to remember to listen to a patient’s history. It may tell more about the underlying problem than any test.

Once again, I want to thank you for reading my blog and best of luck achieving a fertile future.

by

Dr. Ricardo Yazigi

by Dr. Anitha Nair

Every day I meet healthy women who are ready to become mothers who share a similar story. Often they have used birth control pills for many years, starting as a teens, in order to regulate their menstrual periods. Now when ready to start a family, they have done all of the right things: started prenatal vitamins, consulted with their OB/Gyn for pre-conception counseling, and stopped taking birth control pills. Then they patiently wait for their bodies to begin ovulating again. After stopping the pill, some are surprised to find that their cycles are very infrequent sometimes stretching months before a menses will occur. Friends and family may keep saying “you’re young, it takes time”… but without a menstrual cycle it seems as though all of the effort is futile. Even without any other symptoms or health problems, patients just know something is wrong.

Many of these patients with menstrual cycle irregularities have Polycystic Ovary Syndrome (PCOS). PCOS is caused by hormonal imbalances that prevent ovulation. It is estimated that 5-10% of reproductive age women have PCOS and it is the most common cause of ovulatory dysfunction associated with infertility.

> Read “Easy Treatment for Ovulation Disorders”

Some of the common symptoms associated with PCOS include spans of heavy, irregular periods to not menstruating at all, acne, excessive hair growth on the face, obesity, and infertility.

While medical history and a pelvic exam can usually help your physician diagnosing whether you are suffering from PCOS, some other tests such as blood hormone levels, ultrasounds and endometrial biopsies may be needed to confirm the diagnosis.

Treatment of PCOS will depend on your specific needs. Obesity may make the condition worse, so losing weight may help improve the hormonal imbalance. Other medications such as hormones or insulin metabolism medications can improve irregular or heavy periods. Early diagnosis and treatment can reduce the development of acne and facial hair. If your goal is to become pregnant, then your doctor may prescribe a medication to stimulate ovulation.

> Read “Fertility & Weight Loss”

So many of the patients who share this history will tell me, “There were times when I thought maybe I just wasn’t meant to get pregnant”. Often they will hear that they must wait a full year before seeking help and are afraid to seek out a specialist. If you have irregular cycles and are trying to start a family and you don’t think things are right, see someone, don’t wait. The good news is that with treatment most patients with PCOS will go on to conceive and have healthy pregnancies.

by

Do you write your own fertility related blog? Or even just read one that you think is great?
Whether it is advice, tips, or a journal of your fertility journey – we would love to see it! (And link to it!)

We are currently looking for quality blogs to link to from our blogroll.
Send us a message or leave a comment to start the sharing.

by

Dr. Ricardo Yazigi

by Dr. Eric Levens

Claims abound that nutritional supplements will improve our health are constantly in the headlines. While nutritional supplements may provide some health benefits including pregnancy-related outcomes, nutritional supplements may not be as safe as they would seem, especially when considering early fetal development.

I frequently get asked about vitamins with respect to fertility. Many patients are surprised to learn that excessive vitamin intake may result in serious medical conditions and have been associated with fetal malformations. This is especially the case for fat-soluble vitamins (A, D, E and K). In general, additional nutritional supplementation outside of a standard prenatal vitamin is not necessary. A typical prenatal vitamin will provide sufficient vitamins and minerals for a healthy early pregnancy. The amount of vitamin A, for example, in standard prenatal vitamins (4,000 to 5,000 IU) is considered the maximum recommended dose before and during pregnancy.1

Another concern with nutritional supplements is that numerous supplements have been found to contain contaminants such as toxic plant materials, heavy metals and even prescription medications, to name a few. These compounds pose serious potential consequences for a developing fetus. Prior to 1994, dietary supplements (vitamins, minerals, amino acids, and botanicals) were considered food additives and thus were required to demonstrate safety prior to product marketing. Since the passage of the Dietary Supplement Health and Education Act, supplements are now presumed to be safe until shown otherwise. Relaxed Federal regulation, largely unknown by consumers and physicians alike, has created an environment in which hazardous supplements may be produced with little product liability. To date, more than 140 contaminated products have been identified, but this likely represents only a small proportion of the total contaminated products available today.2

There has been little conclusive research demonstrating a benefit of nutritional supplements for fertility or early fetal development. A notable exception is folic acid. Folic acid has been shown to reduce the incidence of a specific birth defect known as neural tube defects by as much as 36 percent.1 As a result, the Centers for Disease Control and Prevention and my former agency, the US Public Health Service, recommend that women of reproductive age take 0.4 mg of folic acid daily before conception and during the first trimester. For women with a prior history of a pregnancy affected by a neural tube defect and for women taking anti-seizure medications, 4 mg (10 times the amount) of folic acid in the months in which conception is attempted and for the first trimester is expected to reduce this risk by a remarkable 80 percent.

Nutrition is an essential component of preconception care for all patients. The combination of a well-balanced, varied diet that is consistent with a woman’s food preferences and a standard prenatal vitamin should be sufficient to meet the dietary needs of a developing pregnancy.

Please feel free to write comments on this blog and as always, I wish you the best in your pursuit of a fertile future.

References:
1. American College of Obstetricians and Gynecologists. (2007). Guidelines for perinatal care. Elk Grove Village, IL
2. Cohen, P. A. (2009). “American roulette — contaminated dietary supplements.” N Engl J Med 361(16): 1523-1525.

by

Dr. Ricardo Yazigi

by Dr. Ricardo Yazigi, MD

Clomiphene (Clomid, Serophene) is a medication commonly used for the treatment of infertility. Although its use is widespread, its effectiveness is often limited when it is not properly utilized.

Indications

Clomiphene is a pill, taken orally, for 5 to 7 days to induce ovulation. Therefore, the best indication for the use of clomiphene is for women who do not ovulate on their own. Typically those women do not have menstrual periods or do have them but very seldom or irregularly.

Clomiphene is also appropriately used in conjunction with artificial insemination (AI), also called intrauterine insemination (IUI). Most of the time, this combined treatment is offered to women who have unexplained infertility or endometriosis. In these instances, clomiphene may be capable of facilitating the maturation of more than one egg, most of the time two. Therefore, there is roughly a 5% chance of a multiple pregnancy with the use of this medication. When multiple pregnancies occur, it will most often be twins – triplets are extremely rare.

Side Effects

Clomiphene may have short-term as well as long-term side effects. Hot flashes and mood swings are the most common side effects. Long-term side effects are multiple pregnancy, and more rarely ovarian hyperstimulation syndrome (OHHS) and ovarian cancer. OHHS can occur in the rare situation in which the ovary may have a large number of mature follicles, which can produce some swelling and inflammation of the ovary with resulting abdominal discomfort as well as other laboratory abnormalities. The occurrence of ovarian cancer is quite debatable. The standard practice at present is to restrict the use of fertility drugs to less than twelve cycles as the chances of ovarian cancer are thought to increase after that. When a pregnancy is achieved and a baby is delivered, however, the chances of ovarian cancer drop to the levels observed in the general population, suggesting that a term delivery has a protective effect on ovarian cancer. Because of the aforementioned risks of cancer, fertility specialists restrict the number of treatment cycle with clomiphene to the minimum necessary, in order to leave room for more advanced treatments if necessary.

Success Rates

Many women conceive with clomiphene. However, if you haven’t gotten pregnant after taking this medication within 3-6 months, it may be time to move on to more aggressive treatment. Generally, three rounds will be enough to determine whether more aggressive treatments are in order.

by

Dr. Ricardo Yazigi

by Dr. Eric Levens

As we continue into the holiday season, it is important to take a look at the lifestyle choices we make each day. Modifiable lifestyle practices such as diet, weight, alcohol, and caffeine consumption, have an important impact on your chances of not only have a child but having a healthy child.

Awareness of the potential implications of these factors, particularly during early fetal development (week 3 to week 8 of pregnancy), provides an opportunity to prevent adverse pregnancy outcomes.

Diet

Fertility rates are clearly decreased among over- and underweight women. Obese (BMI > 35) and underweight (BMI < 19) women have a two- to four-fold increase in the amount of time that it takes to achieve conception.1 Moreover studies have consistently shown that fertility treatments are less successful at the extremes of body weight; however, by normalizing weight, a woman increases her chances of pregnancy and live birth.

> Find out your BMI

While body weight has been shown to impact pregnancy outcomes, there is little data to suggest that restrictive diets, such as vegetarian or low-fat diets, improve fertility. A well-balanced diet along with a prenatal vitamin containing folic acid is essential to a healthy pregnancy.

It is critical that women who are pregnant or trying to conceive take steps to avoid bacterial infections such as salmonella, campylobacter and listeria, and limit methyl mercury consumption which may cause adverse pregnancy outcomes.

Some foods to avoid while pregnant or pursuing pregnancy:

  • Unwashed fruits & vegetables
  • Soft cheeses
  • Unpasteurized milk
  • Undercooked meats (including sushi)
  • Raw eggs
  • Coldwater fish (including shark, swordfish, mackerel)
  • Tuna (limit to two 85 gram meals per week)

Alcohol

The effect of alcohol on female fertility has not been clearly delineated. Some studies suggest that alcohol consumption adversely affects female fertility. One study of more than 7,000 women noted that the risk of infertility was increased nearly 60% among those women who consumed more than two alcoholic drinks per day.2

As a result, alcohol consumption should be limited when attempting conception and should stop altogether during pregnancy, as there is no safe level of alcohol consumption that has been established.

Caffeine

Most evidence has suggested that moderate caffeine consumption, one to two cups of coffee per day, before or during pregnancy does not adversely impact pregnancy outcomes or fertility chances. However, caffeine consumption of more than five cups of coffee per day has been associated with a 45% decrease in pregnancy. Moreover, miscarriage is increased among women who consume more than two cups of coffee per day.

In the end, there are important modifiable dietary considerations when attempting conception and in early pregnancy. Recognizing these dietary factors should help to improve your chances of a fertile future.

References:
  1. Hassan, M. A. and S. R. Killick (2004). “Negative lifestyle is associated with a significant reduction in fecundity.” Fertil Steril 81(2): 384-392.
  2. Eggert, J., H. Theobald, et al. (2004). “Effects of alcohol consumption on female fertility during an 18-year period.” Fertil Steril 81(2): 379-383.

2026 Shady Grove Fertility

Also of interest