General

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Achieve Optimal Health Before Treatment

As you prepare your body for fertility treatment, it’s important to remember this is a time for nurturing and nourishing. There are a few fertility-friendly lifestyle modification ideas that may help you de-stress, eat better, and manage your weight.

Optimal Fertility Health Tip #1: Be Physically Active.

At the Wellness Center at Shady Grove Fertility we encourage regular low-impact physical activity and moderate resistance weight training, which promotes weight management by helping reduce fat tissue and build lean body mass (muscle). Regular exercise is also associated with stress reduction and blood sugar regulation. While 30 to 60 minutes of physical activity each day has been shown to reduce diabetes, cardiovascular disease, and cancer risks, one study found that spreading out physical activity (5-min micro-bouts of moderate-intensity walking) multiple times throughout the day improved mood, decreased feelings of fatigue, and reduced food cravings at the end of the day. There is other research that indicates physical activity is the ‘first line’ of therapy for PCOS—to not only help manage weight, but to also help maintain blood sugar levels and promote more regular ovulation. So get outside and enjoy a brisk walk, leisurely bike ride, scenic hike, or refreshing swim. Your mind and body will thank you!

Optimal Fertility Health Tip #2: Choose Fresh Produce.

Nature’s bounty has much to offer us in the way of fertility-enhancing nutrients. Fresh fruits and vegetables provide our bodies with easily absorbable vitamins, minerals, antioxidants, and fiber for a satisfying natural energy boost. It is well known that women should consume adequate amounts of the B vitamin folate (600 mcg/day) during preconception and pregnancy to help promote fetal brain development and prevent neural tube defects. But did you know there are many other important vitamins and minerals that can enhance fertility too?

– Other B vitamins, like B6 and B12, are essential for hormone regulation and have been associated with lower risk for ovulatory infertility. A recent study even found that higher serum concentrations of Folate and vitamin B12 before assisted reproductive technology (ART) treatment was associated with higher live birth rates. Women can get their fill of B vitamins through whole grains, legumes (starchy beans), meats/poultry, fruits, vegetables, and eggs.

– Vitamins C and E are both powerful antioxidants found in and around follicles (eggs) helping to reduce oxidative stress within the ovary. While most people associate citrus as being high in vitamin C, bell peppers, strawberries, broccoli, and leafy greens are also wonderful sources of the vitamin. Vitamin E, on the other hand, is a fat-soluble vitamin, found in nuts/seeds and avocados.

With many different brands of vitamins on the market, it can be confusing to know which brand is most reputable when it comes to preconception and specialized vitamins. For this reason, Shady Grove Fertility is proud to recommend Luminary Vitamins and Theralogix to offer high-quality, evidence-based nutritional supplements patients can trust. 

Optimal Fertility Health Tip #3: Stay Hydrated.

With increased physical activity and added fiber from fresh produce, it is imperative to stay hydrated. The adult human body is nearly 60 percent water. This helps explain why even minor dehydration can lead to headaches, difficulty focusing, dizziness, constipation, fatigue, and muscle stiffness and cramps. Of course we need fluid for general hydration (especially in times of increased fluid loss like exercise) but we also need fluid for detoxification, digestion, and metabolism of food, and to lubricate our mucus membranes, muscles, and joints. We recommend shying away from sugary and artificially sweetened beverages. But don’t let that discourage you from being creative and jazzing up your hydrating beverage. Try adding a twist of fresh citrus, ¼ cup sliced fruit, a tablespoon of fresh fruit puree, or maybe even throw some sliced cucumber or mint into your water or seltzer for a refreshing treat.

Optimal Fertility Health Tip #4: Find Balance.

Shady Grove Fertility’s Wellness Center offers complementary therapies such as acupuncture, massage therapy, and nutrition counseling that are designed to treat the “whole patient.”

Stage-specific gummies designed by fertility doctors

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Why Is Maternal Age So Important?

Age is the biggest factor affecting egg supply. This is true for all women: the older you get, the fewer eggs you have. Your body does not produce more eggs, nor is there any available treatment to increase the quantity or quality of your egg supply.

Even though statistical trends have shown that the age of women at the birth of their first child has steadily been on the rise since the mid-1970s, a woman’s fertility peaks in her mid-20s, begins to decline around 27, and drops off more steeply after age 35. A woman’s fertility is measured by her ability to achieve a pregnancy on a given month. For women, the ability to conceive is tied to the quality of her eggs. As women age, hormonal changes begin to take place. There is a lot going on but of particular interest are the two main hormones controlling the development and release of the egg each month. These are follicle-stimulating hormone (FSH) and lutenizing hormone (LH).

A rising FSH level is linked to a decreasing egg quality. Decreased egg quality means it becomes more difficult for the sperm to fertilize the egg naturally. There may even be chromosomal abnormalities occurring within the egg itself, which is why we recommend an amniocentesis for pregnant women over 35.

Another factor to consider is the number of eggs. As a woman ages, the number of eggs in her ovarian reserve continually declines. Women are born with their lifetime supply of eggs—generally around 1 to 2 million. By the time a woman reaches menopause, typically in her early- to mid-50s, as many as a few hundred remain, potentially even less.

To illustrate this point, the natural pregnancy rate for women older than 30 is 20 to 30 percent per month but by age 40 the likelihood of conception occurring naturally drops to less than 5 percent per month.

Did You Know

You can ask your doctor to check your egg supply during a routine OB/GYN exam. Regardless of your age, you can request ovarian reserve testing, which is often covered by insurance, during a regular, annual visit to your obstetrician/gynecologist. This can help women proactively plan for the future and serves as a baseline for future comparison.

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Frequently Asked Questions About Conception

Maybe we all learned our lessons a little too well back in junior high’s sex ed class when we were told how easy it is to get pregnant. The fact of the matter is, getting pregnant is often more difficult than we realize, especially as we age. So, to set the record straight and hopefully avoid a few surprises and minimize the potential for disappointment, here are a few reminders on how to get pregnant.

Does taking birth control affect fertility?

In general, birth control pills do not affect fertility. Within 1 to 2 months of stopping pills, a woman’s menstrual cycle returns to what’s considered normal for her.

Birth control pills will “cover over ” a woman’s natural and possibly irregular cycle giving her a predictable monthly cycle. When she stops pills, her cycle returns to her normal and possibly irregular cycle and hence the pill gets the blame.

What should I expect if I’m coming off birth control and trying to conceive?

Within one to two cycles, all women who have a naturally strong ovulatory and regular cycle should be ovulating. You can use an ovulation predictor kit to help time intercourse with ovulation.

What are the chances of conception each month?

The rate of conception is highly dependent on the quality and quantity of the woman’s egg. According to the American Society for Reproductive Medicine, a woman’s best reproductive years are in her 20s. Fertility gradually declines in the 30s, particularly after age 35. Each month that she tries, a healthy, fertile 30-year-old woman has a 20 percent chance of getting pregnant. That means that for every 100 fertile 30-year-old women trying to get pregnant in one cycle, 20 will be successful and the other 80 will have to try again. By age 40, a woman’s chance is less than 5 percent per cycle, so fewer than five out of every 100 women are expected to be successful each month.

Why does egg quality decrease with age?

The concept of a woman’s egg quality has everything to do with the probability that an embryo will implant and is strongly related to the age of the woman’s egg and her ovarian reserve. We cannot determine egg quality by looking at an egg or measuring how receptive it will be to sperm, or even how well the embryo cells appear to be initially dividing.

We can test egg supply with ovarian reserve testing, but we do not currently have a test for egg quality; instead, the most reliable test for egg quality is female age.

Much of the problem with egg quality as women age has to do with an increased likelihood for chromosomal abnormalities to affect the eggs. Chromosomal abnormalities may affect the number of chromosomes, as in the case of Down syndrome or Turner syndrome, or the structure of chromosomes, which may show as chromosome translocation, duplication, or deletion. The bottom line, egg quality decreases and the rate of chromosomal abnormality increases as a woman ages.

While we weren’t using birth control for a few years, we’ve only been actively “trying” for 6 months with no success. Should we be concerned?

Often when couples aren’t on birth control they will avoid pregnancy by having the male partner withdraw prior to ejaculation. Withdrawing the penis before ejaculation is not an effective method of contraception. Something else is going on that you have not yet become pregnant.

Is there a best time to have intercourse?

The best time to have intercourse that will result in conception is during a woman’s luteinizing hormone (LH) surge. In an ideal 28 day cycle, this typically happens around day 14. The body releases the egg 24 hours after the peak of the LH surge. The egg only lives for 1 day after ovulation. If conception has not occurred, the egg dies and there will not be a pregnancy that month.

Ejaculated sperm can live in the reproductive track for 4 days, but optimal timing is with the LH surge so that sperm will be waiting in the Fallopian tube when the egg arrives. It is reasonable to try from days 12 to 16. Some people may choose to extend this from days 10 to 18. If there was only 1 day per month that a couple could engage in intercourse, then they should have sex at the time of the LH surge. Intercourse too early in the cycle or later in the month maybe important in a relationship, but it is recreational not procreative.

How do I know if I’m ovulating?

If you have regular and predicable cycle, then you are ovulating. Many women have an awareness of the changes in their body across their menstrual cycle. Some women note changes in the cervical mucus, others say they can actually feel the ovulation event. Once ovulation occurs and the egg is released, you may feel the effects of progesterone such as breast tenderness. However, if you don’t feel these things, you can certainly still be ovulating especially if you have a regular cycle.

Should I use an ovulation predictor kit?

One way to be sure ovulation is occurring is to use an ovulation predictor kit. There are many brands. Our patients have had good luck with the Clear Blue Easy kit, as it is very easy to interpret—a circle for negative, a smiley face for positive. Begin testing around day 12. It is good to have a couple of negative days, so that when you get a positive, you are sure it is positive

Are there kits you don’t recommend?

We do not recommend the digital kit, which provides information on high fertility (by measuring estrogen, and then a flashing smiley face that measures LH). It is expensive and does not provide additional useful information.

How often should we have sex?

People should do what feels natural. Getting pregnant can be stressful. Sex should not be stressful. Often couples (read: men) have trouble performing on demand. Attempting conception after several months of negative results can put a strain on couples and impedes the romance in a relationship. Our physicians typically say that having sexual intercourse every other day during the week of ovulation (days 12 to 18) is reasonable. If every day feels right for you, then go for it. Some couples are concerned that daily sex will deplete the amount of sperm the male has available. This is a myth

Is one position better to conceive?

No. They all work.

Do I need to lay with my legs up after intercourse?

This is not necessary. If it makes you feel more at ease, you can wait 5 to 10 minutes before getting up, although this is not necessary.

A lot of ejaculate spills out after withdrawal. Is this a problem?

No. More than enough sperm stay inside the vagina.

Discover What’s Possible Connect with Shady Grove Fertility
Schedule Appointment
or 1-888-761-1967

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How Many Eggs Do I Have?

In a recent Shady Grove Fertility survey, close to 50 percent of respondents said if they had had the opportunity to test for the amount of eggs they had left prior to experiencing infertility, they would have done so.

For women, egg supply, or ovarian reserve, is the number of potential eggs that remain in your ovaries. That quantity, or lack of, affects ease of conception and is closely linked to female factor infertility. In general, the more eggs a woman has, the better her chance of getting pregnant, whether trying with her partner on their own or through fertility treatment.

Women are born with all of the eggs they will ever have—a lifetime supply—generally around 1 to 2 million. As a woman ages, the number of eggs in her ovarian reserve slowly declines, with a steeper decline beginning around age 35. Also around this time, the quality of the eggs also becomes affected by more and more chromosomal abnormalities, until she reaches menopause, around age 50—at which point a few hundred eggs remain, potentially even less. This combination of reduced egg quality and increased age is why the rate of conception lowers over time.

Aside from age, the quantity and quality of your eggs can be influenced by other factors, such as premature ovarian failure, early menopause, and other health issues such as autoimmune disorders, cancer treatment, or surgery that involves the ovaries.

The most important thing to know is that your body does not produce more eggs, nor is there any available treatment to increase the quantity or quality of your egg supply; therefore, being proactive can make a difference.

If you’re interested in “checking the pulse” of your egg supply status, we encourage you to discuss ovarian reserve testing with your OB/GYN. He or she can order a test called the Ovarian Assessment Report (OAR) by ReproSource that measures egg supply by assessing several reproductive hormones against your age in order to determine if your egg supply is good, normal, or poor. It is the first ovarian assessment that provides a consistent laboratory result. What you learn about your egg supply can serve as a baseline to compare against future tests, if necessary.

If you are experiencing infertility or interested in egg freezing, your OB/GYN can initiate diagnostic testing and make a referral to Shady Grove Fertility. Or, you can schedule an appointment directly with a Shady Grove Fertility specialist. In fact, 50 percent of our patients are self-referred. When deciding which action to take, just remember to be proactive and factor age into the equation.

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It’s Never To Early To Be Proactive

At Shady Grove Fertility, we recommend women make sound nutritional and lifestyle choices before they become pregnant in order to have a much greater chance of having healthier, less complicated pregnancies and delivering healthier babies.

Fertility health checklist

  • Understand the drivers of your body’s reproductive and endocrine systems, and learn what modifications you can make to keep your systems running smoothly.
  • Know how to identify the early warning signs of infertility, such as irregular or absent menstrual cycles, pelvic pain, and polycystic ovary syndrome (PCOS).
  • Know whether birth control affects fertility.
  • Don’t just think about your desired age when you have your first child, consider how old you want to be when you have your last child. You can do this by calculating how many children you want to have along the age you should start trying to get pregnant, assuming an average 18 months between pregnancies.
  • Initiate a conversation with your OB/GYN about your fertility health.
  • Know what to expect from your OB/GYN if infertility is suspected, and know when it’s time to see a specialist.
  • Know why the concept of ‘reproductive aging’ really, really matters.

Another way to be proactive is to treat your body as if it’s pregnant while you’re trying to conceive. At Shady Grove Fertility, we recommend:

  • Take a preconception supplement with at least 400 mcg of folate daily.
  • Limit caffeine intake.
  • Abstain from alcohol.
  • Maintain a healthy body weight through a well-balanced diet and exercise.
  • Exercise with care. Intense physical activity, such as that of competitive female athletes, can disturb the menstrual cycle, but moderate activity has little effect on the cycle.
  • Lose weight if you are overweight or obese. Obesity is associated with decreased fertility and even moderate amounts of weight loss in obese women can improve fertility. Weight loss can also improve menstrual regularity in obese women with polycystic ovary syndrome (PCOS).
  • Quit smoking!!! You and your partner need to quit. Now. Right now. Smoking is like putting your eggs and sperm in an ashtray. Smoking will decrease your fertility rate by half. You can reverse this effect if you are smoke-free for 3 months.

Women who are generally healthy and have been unsuccessful in conceiving after several months of unprotected sex should consider getting help from a specialist. The American Society for Reproductive Medicine (ASRM) guidelines recommend that women under the age of 35 consult a fertility specialist after 1 year of unsuccessfully trying to conceive, while those 35 or older should schedule a consultation after 6 months. For women over the age of 40, we highly recommend a consultation with a fertility specialist as soon as possible.

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Can you think back to sitting in health education class in junior high and learning about the “birds and the bees” for the first time? Perhaps that was your last “formal” lesson on human reproduction and much of the basics have been forgotten since then. Don’t worry, you’re not alone. Let’s take a look back and briefly review the fundamentals of the female reproductive system and how conception occurs.

The fundamental building block of female fertility is the egg, also called an oocyte, ovum, or gamete. Surprisingly, the human egg is one of the largest cells in the woman’s body—about the size of a grain of sand and about 16 times larger than a single sperm.

A female is born with a finite number of eggs, generally around 1 to 2 million, the production of which occurs entirely in utero and ceases before birth. By the time a woman reaches menopause, typically in her early- to mid-50s, as many as a few hundred eggs remain, potentially even less. Armed with this knowledge, it’s easy to see why age is the biggest factor that affects egg supply.

A female’s internal reproductive organs are the vagina, uterus, Fallopian tubes, and ovaries.

The vagina is a muscular, hollow tube that extends from the vaginal opening to the uterus. The uterus is shaped like an upside-down pear, with a thick lining and muscular walls—in fact, the uterus contains some of the strongest muscles in the female body. The uterus is where a baby will grow. Each month, blood and tissue build up and line the inside of the uterus. If a woman’s egg is fertilized by the man’s sperm, then the fertilized egg would attach to this lining and a baby would begin to develop. If the egg does not become fertilized by the sperm, a woman does not become pregnant and the lining is shed during her menstrual period.

At the upper corners of the uterus, two Fallopian tubes connect the uterus to the ovaries, which produce, store, and release eggs into the Fallopian tubes in the process called ovulation. Within each tube is a tiny passageway no wider than a sewing needle, which can sometimes become blocked. During each menstrual cycle, an egg is released from one of the ovaries and it begins its journey down one of the Fallopian tubes in route to the uterus. Once the egg is in the tube, tiny hairs in the tube’s lining help push it down the narrow passageway toward the uterus. Again, if it is fertilized by a sperm, conception has occurred. If it is not, the unfertilized egg and the lining of the uterus leave the body through the vagina.

The Endocrine System

The endocrine system refers to the collection of glands that secrete hormones directly into the circulatory system to be carried towards distant target organs. The major endocrine glands include the pineal gland, pituitary gland, pancreas, ovaries (in females), testes (in males), thyroid gland, parathyroid glands, hypothalamus, and adrenal glands.

As part of the endocrine system the ovaries produce female sex hormones estrogen and progesterone. These hormones regulate the menstrual cycle and also play a very important role during pregnancy.

The pituitary gland contributes by regulating the sex hormones through the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). The FSH and the LH ensure proper functioning of the reproductive system. The FSH stimulates the maturation of ovarian follicles in the ovaries and LH helps in ovulation in females.

Since all components of the human body work in concert with each other, hormonal balance outside the reproductive system is extremely important to conception.

Discover What’s Possible Connect with Shady Grove Fertility
Schedule Appointment
or 1-888-761-1967

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