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Dr. Paulette Browne from SGF’s Fair Oaks, VA office talks with Today.com about common fertility myths and what is fact vs. fiction when it comes to fertility.

Myth: If your healthy, it’s easier to get pregnant.
While being obese makes it harder for women to get pregnant and men to impregnate women, there is no correlation between healthy eating and exercise habits and being able to conceive. There are plenty of women who have poor eating habits and are very fertile and the opposite of people who exercise regularly and eat well, but can’t get pregnant without assistance. The reality is—healthy habits don’t make women more fertile.

The real factor that impacts a woman’s fertility is her age. Women are born with all the eggs they’ll ever have, and the number will steadily decline as a woman gets older.

“Fertility declines with age,” says Dr. Browne. “The ovarian reserves are all the eggs you will have. At birth there are 2 million and at puberty there are only 200,000,” adds Browne.

Myth: Fertility drops dramatically after age 35.
While it’s true that a woman’s fertility declines as she gets older, most women’s ovarian reserve starts to diminish more rapidly around age 37 or 38.  And for some women, diminished ovarian reserve can occur in her 20s. “Thirty five was a little bit of a made-up number,” Browne said. Originally they called 35 ‘advanced maternal age’ because it was when they needed to decide to offer amniocentesis (a sampling of the amniotic fluid taken to test for genetic disorders).” “Some people’s fertility declines dramatically and some people’s fertility stays the same,” says Browne.

If you are trying to conceive, it’s important to follow the guidelines of age and length of time having unprotected intercourse to know when it’s time to seek help. This will give women/couples the knowledge they need to know when a fertility specialist is needed.

Myth: Celebrities get pregnant all the time in their 40s and 50s, it should be easy for me.
Most likely if you are getting pregnant in your 40s or even 50s, often those women are using eggs they froze previously or donor eggs from a younger woman. The chances of women in their 40s or 50s becoming pregnant naturally is much smaller, but that’s not to say it’s impossible. What is true is that women in their 40s and older have a higher rate of miscarriage than pregnant women in their 20s or 30s. And as women move further into their 40s, miscarriage rates increase, as does the likelihood of a chromosomal abnormality.

Getting pregnant with donor eggs from a younger women is the only fertility treatment option where the age of the female partner does not impact the outcome. Donor egg treatment is the same process as IVF except the egg used comes from a donor. Since donors are ages 21 to 32 and thoroughly screened, donor egg treatment is the most effective fertility treatment, with a 60 percent clinical pregnancy rate per embryo transfer.

Myth: Infertility is a woman’s problem.
Infertility does not discriminate. Men are just as responsible for not being able to get pregnant as women. The truth is, 40 to 50 percent of all infertility diagnosis are attributed to the male. Some of the common causes of male infertility include sperm production disorders (low sperm count or abnormal sperm parameters), obstructive problems (blockage prevents sperms ability to meet the egg), and immune system disorders (sperm can be weakened by natural antibiodies that hinder sperm from reaching the egg).

This is why, at SGF, we test both partners simultaneously—men have a semen analysis, and women have bloodwork and an ultrasound to determine the cause of infertility. A thorough work-up is key to helping couples achieve the ultimate goal of becoming a parent.

Myth: Relax and you’ll get pregnant.
This is probably the most frustrating phrase for people to hear who are struggling to conceive. There is no body of evidence that indicates that a woman’s level of stress affects her pregnancy rate.

Infertility is inherently stressful. Most individuals are used to planning their lives. They may believe that if they work hard at something, they can achieve it. So when it’s hard to get pregnant, they feel as if they don’t have control of their bodies or of their goal of becoming parents. With infertility, no matter how hard you work, it may not be possible to have a baby without help.

Decreasing stress may not increase pregnancy rates or treatment success, but it may improve feelings of well-being and quality of life as you continue on your journey to create or expand your family.

To learn more about fertility myths or to schedule an appointment with an SGF physician, please contact the New Patient Center at 1-877-971-7755 or complete the brief online form.

Dr. Rebecca Chason of SGF’s Annapolis, MD office co-authored an important article featured in the Capital Gazette about the options available to build a family after cancer treatment.

Cancer and Pregnancy

Thanks for advances in medicine, the survival rate from childhood and adult cancers continues to increase. With many cancer survivors still in their reproductive years, it’s important to consider how cancer treatment will affect their ability to have children in the future. Chemotherapy, radiation, and surgery can affect the quantity and quality of eggs within the ovary. Cancer treatment can also damage or cause a loss of reproductive organs. Because of this, women who are faced with a cancer diagnosis are encouraged to consider fertility preservation with the purpose of preserving their fertility before undergoing cancer treatment.

What options are available for fertility preservation prior to cancer treatment?

Fertility is a challenging subject, and for women with cancer, the majority feel as though their fertility is the single most concerning issue about their cancer treatment. To compound the issue, while the American Society of Clinical Oncology recommends that all physicians assess the risk for treatment-induced fertility, research tells us that the conversation about cancer-related infertility at the time of diagnosis is often less than adequate. For women who are faced with this diagnosis, it’s important to know that there are options.

Fertility preservation preserves, expands, and restores the future reproductive ability for patients with cancer. The process of fertility preservation involves retrieving a women’s eggs prior to cancer treatment. An embryologist will freeze them using vitrification technology. Your eggs will be available when you have completed your cancer treatment and you have been cleared to move forward with attempting pregnancy. A back-up plan is now in place should you need these eggs in the future.

Use of these eggs in the future involves thawing the eggs, inseminating them with sperm, and transferring the embryo into your uterus. With frozen eggs, your success for achieving pregnancy is related to your age when you froze your eggs—not your age at the time you plan to use them.

The Maryland Mandate now covers fertility preservation for patients with cancer.

Due to the efforts of SGF’s Drs. Mottla and Beall, and Loretta Trumble, CRNP, in addition to other collective efforts, on May 15, 2018, Maryland Governor Hogan signed the bill that will require insurers under the Maryland mandate to cover the expense of fertility preservation, sperm and egg freezing specifically, for people prior to medical treatments, such as chemotherapy for cancer, that likely would permanently damage a person’s reproductive ability. Maryland was the first state in the nation to enact infertility insurance legislation and is now the third state that also covers fertility preservation for people with cancer prior to cancer treatment.

Fertility Preservation Decision Making

Making a decision about fertility preservation at the same time you learn about your cancer diagnosis can be stressful and overwhelming.

At SGF, we have a specially trained team that works specifically with people with cancer. We will work directly with your oncology team to ensure we expedite your fertility preservation so that cancer treatment can quickly begin. Known as the oncofertility team, they help guide you through each step of the treatment process, from finding ways to afford treatment to the actual medical procedure. Due to the time sensitivity with treatment, you can expect an expedited treatment plan and to see a physician for consultation as soon as possible.

Once you decide to move forward with treatment, it generally takes 2 to 3 weeks to complete stimulation of the ovaries for the egg retrieval.

To learn more about fertility preservation options when faced with a cancer diagnosis, please contact our New Patient Center at 1-877-971-7755 or complete our brief online form.

The collective efforts of SGF physicians Drs. Gilbert Mottla, Stephanie Beall, and nurse Loretta Trumble along with RESOLVE: The National Infertility Association, The Ulman Cancer Fund for Young Adults, Ferring Pharmaceuticals, the American Society for Reproductive Medicine, the Alliance for Fertility Preservation, and Cervivor helped make fertility preservation for people with cancer now an affordable reality.

Changing Policy for Cancer Patients

Due to their collective efforts to change policy, on May 15, 2018, Maryland Governor Hogan signed the bill that will require insurers under the Maryland mandate to cover the expense of fertility preservation, sperm and egg freezing specifically, for people prior to medical treatments, such as chemotherapy for cancer, that likely would permanently damage their reproductive ability. Maryland was the first state in the nation to enact infertility insurance legislation and is now the third state that also covers fertility preservation for people with cancer prior to cancer treatment.

“I am incredibly proud to be part of this collaborative effort to change policy that directly benefits not just Shady Grove Fertility patients but all patients. The desire to have a family is almost innate for most, and for those whose heads are still reeling with the emotion and confusion that often comes following a cancer diagnosis, to have to grapple with whether or not to also afford the cost of fertility preservation treatment, seems exceptionally challenging and unfair. Patients can now preserve their fertility without having to worry about the financial burden so they can one day have the family they always dreamed of,” says Dr. Beall. “We’re proud that Gov. Hogan did the right thing and made this much needed option possible,” adds Beall.

“The passing of this bill will enable half of the patients who haven’t been able to receive treatment to date to receive treatment, and that gives people the potential to have families that otherwise wouldn’t,” says Dr. Mottla who was recently featured on Great Day Washington discussing his involvement in helping to pass the Maryland fertility preservation bill.

Fertility Preservation for People with Cancer

We have a specially trained team devoted specifically to people with cancer. We work directly with a patient’s oncology team to ensure they expedite fertility preservation so that cancer treatment is not delayed. Known as the SGF Oncofertility Team, this team helps guide each patient through every step of the treatment process. Due to the time sensitivity that comes with a cancer diagnosis, patients can expect an expedited treatment plan and to see a physician for consultation almost immediately.

To learn more about preserving your fertility or to schedule an appointment, please call our New Patient Center at 1-877-971-7755 or complete this brief online form. 

Women of all ages have heard the term ‘biological clock.’ “It can be stressful to know there is a time limit to fertility, but the good news is knowledge is power,” says Dr. Mark Perloe of SGF Atlanta. “Understanding your fertility and how fertility is impacted by age is key to being aware of potential obstacles and knowing when it might be time to seek help from a fertility specialist,” adds Perloe. Dr. Perloe breaks down your fertility and what to expect when getting pregnant in your 20s, 30s, and 40s.

Getting Pregnant in Yours 20s

Women in their 20s have the greatest fertility potential with a 20 to 25 percent chance of becoming pregnant naturally each month. The risk of chromosomal abnormalities is low, as is the chance of miscarriage. “Women in their 20s can still experience infertility,” says Perloe. The quality of a woman’s eggs might not be an issue, but they could have decreased ovarian reserve, issues with Fallopian tubes, or an ovulatory disorder such as polycystic ovary syndrome (PCOS) that could prevent them from conceiving naturally.

How to Boost Fertility in Your 20s

While bad habits from college or high school may still linger into your 20s, if you’re trying to get pregnant, it’s recommended to begin to prepare your body for conception by maintaining a normal BMI and having a well-balanced diet. Quitting smoking and limiting alcohol and caffeine consumption are important in order to achieve optimal health for pregnancy.

When to Seek Treatment for Infertility in Your 20s

For women in their 20s, SGF Atlanta recommends seeing a fertility specialist if you have regular cycles and have been having unprotected intercourse and no pregnancy after 1 year. “If there are known risk factors such as irregular menstrual cycles or no period at all, you should seek help immediately,” comments Perloe. It is also important to consider your partner and if he has any known issues that could affect your ability to conceive. What most people don’t realize is that male infertility accounts for nearly 40 to 50 percent of all infertility diagnosis.

Getting Pregnant In Your 30s

Women in their 30s have a 15 to 20 percent chance of getting pregnant naturally each month. “A woman’s fertility will begin to decline in her 30s, with the sharpest decline after the age of 35,” says Perloe.

How to Boost Fertility in Your 30s

The same recommendations apply for women in their 30s to prepare their body for a healthy pregnancy by maintaining a normal BMI and making healthy lifestyle choice. “I hear concerns from women who have been on birth control for many years that they are worried their fertility will be impacted. The truth is, once you stop taking birth control, most women will revert back to their historical menstrual cycle pattern and fertility will resume,” says Perloe.

When to Seek Treatment

For women ages 30-34, SGF Atlanta recommends seeing a fertility specialist if you have regular cycles and have been having unprotected intercourse and no pregnancy after 1 year. Women between the ages of 35-39 with regular cycles who have been having unprotected intercourse for six months and no pregnancy should see a fertility specialist after 6 months. If you have any known risk factors (no menstrual cycles, history of pelvic surgery, or a diagnosis of endometriosis), you should seek help immediately. “Time is critical for women in their 30s, which is why we encourage women to be proactive about their fertility. Early fertility intervention offers the best chances of success,” comments Perloe.

Getting Pregnant in Your 40s

Women in their 40s have less than a 5 percent chance of becoming pregnant naturally each month. For women ages 45-49, the chance of becoming pregnant with your own eggs is as low as 1 percent. Women can still get pregnant with donor egg treatment or if a woman’s eggs were frozen at an earlier date.

How to Boost Fertility in Your 40s

While factors related to age and fertility can’t change, it’s still encouraged for women in their 40s to maintain a healthy lifestyle by exercising, getting plenty of rest, and eating a well-balanced diet. Many women have found that yoga, acupuncture, and massage have helped them to relieve stress and stay physically and mentally healthy.

When to Seek Treatment

For women 40 or over, SGF Atlanta recommends seeing a fertility specialist right away. While women in their 40s have the same treatment options available (IUI and IVF) the chances of success decrease dramatically when using your own eggs because as you age, so do your eggs. As eggs age, they become more susceptible to chromosomally abnormalities that can prevent implantation or result in miscarriages. “While pregnancy in your 40s with your own eggs is possible, donor egg treatment might be a more realistic option,” says Perloe. A women who undergoes donor egg treatment will carry the child, but the egg will come from an egg donor who is in her 20s or 30s. “Donor egg treatment helps make parenthood possible for many couples and is one of the most successful forms of fertility treatment,” adds Perloe.

Regardless of your age, it’s important to know when to seek help from a fertility specialist. SGF Atlanta offers fertility treatments to help nearly everyone conceive. You and your physician will take your personal factors into consideration – age and diagnosis to determine a treatment plan that is right for you and offers you the greatest chances of success.

To learn more or to schedule an appointment with an SGF physician, please contact our New Patient Call Center at 1-877-971-7755 or complete this brief online form.

Receiving a cancer diagnosis at any age is excruciating, but for young men and women in their 20s, 30s, and younger there are additional concerns that need to be addressed fairly quickly as some effective cancer treatments can permanently damage fertility. The additional stress and costs leave many patients with a very difficult choice: pay for fertility treatment prior to cancer treatment, or risk losing the ability to have a baby in the future. Desireé McCarthy-Keith, M.D., M.P.H., Shady Grove Fertility Atlanta, recently joined Jazz 91.9 WCLK and host Paula Gwynn Grant to educate listeners on sexual wellness after cancer.

WHAT FERTILITY OPTIONS ARE AVAILABLE AFTER A CANCER DIAGNOSIS?

“We definitely want patients to think about their fertility when they have their diagnosis. That’s the time to speak with their physicians and to talk about options for preserving their fertility, because we know that many women are living beyond their cancer diagnosis and treatment. We do not want to wait to see them after they have beaten their cancer, when their fertility may have been affected by their treatment.  If we have that conversation initially, we can a lot of times step in and freeze a woman’s eggs or freeze sperm to prepare them for the future, so that when they come on the other side of their cancer, we can talk about having their family then.”

HOW HAS TECHNOLOGY REALLY HELPED US IN TERMS OF PRESERVING SPERM AND EGGS IN THE FACE OF CANCER, AND BEING ABLE TO PROTECT OUR FERTILITY AND HAVE CHILDREN LATER IN LIFE?

“We’ve definitely seen the field of infertility care and reproductive medicine evolve over the last 15-20 years where we’ve become much better in the ways that we can prepare and freeze sperm and eggs. The freezing techniques have improved so that the cells tolerate their procedure better and they’re healthier through the process and we’re able to work with them later. We’ve also had newer diagnostic testing – there’s a hormone produced by the ovaries called AMH or Anti-Müllerian hormone that we now order pretty routinely that can give us a quick idea about a woman’s ovarian function and her egg reserve, so that’s a test we’ve been using for several years and that gives us a good idea.”

WHAT PREVENTATIVE MEASURES CAN WOMEN TAKE TO SCREEN FOR CANCER?

“It’s very important for us to have your primary physician or your gynecologist stay in touch and have those routine exams, routine breast exams, screenings for cervical cancer, pelvic exam – and we can often identify these conditions earlier and work on the treatments that can have a better outcome.”

WHAT ARE THE SIDE EFFECTS THAT IMPACT FERTILITY AND SEXUAL FUNCTION AFTER CANCER TREATMENT?

“For the common female cancers, the chemotherapy regimens often used can really affect a woman’s ovarian function, and we know that women are born with all of their eggs and when they have certain exposures, those are exposures to the egg supply for the rest of their lifetime – it’s not something that goes away or that our egg supply is renewed. So when women receive chemotherapy for breast cancer, even sometimes women who are treated for those same agents for Lupus, will see permanent damage to their ovaries after those treatments, which is not reversible. We want to talk about ways to either collect their eggs beforehand or talk about different types of regiments and ways to protect the ovaries from those effects. Radiation can also affect the ovarian function permanently.”

WHAT ARE SOME OF THE THINGS YOU WOULD LIKE YOUR PATIENTS TO KNOW ABOUT BROACHING THE SUBJECT OF SEXUAL WELLNESS AFTER CANCER TREATMENT?

“We just remind them that these are medical conditions, and that we want to talk about them the same way we would talk about high blood pressure, diabetes or anything else. We want them to be comfortable to seek that information, and again the most important thing is for patients to be informed ahead of their cancer treatment at the time of diagnosis, which is very hard because it’s already a very difficult diagnosis. It’s stressful and they are frustrated and unsure about the future, and so it’s really hard, but we have to make time to focus on the future, again because many women and men are surviving their cancer and we don’t want to have those conversations too late.”

DO YOU HAVE SOME WORDS OF WISDOM ON SEXUAL WELLNESS AND FERTILITY AFTER CANCER?

“Getting a cancer diagnosis is hard and sometimes it’s hard to think about your fertility when you’re just trying to deal with that diagnosis, but we have to focus on it at that time – that is the crucial time to really think about down the line once I get past my cancer and my treatment if I want to have a family, what can I do now to ensure that that’s a possibility. Patients need to be advocates for their own healthcare, and to be an active participant. Engage with their physicians, come in with questions and information, bring a support person with them, and get all of the information that they can. Lastly, I would say that we have many options now for men and women who are diagnosed with a cancer, so that they can still have their family after they beat their cancer.”

To listen to the full radio interview with Dr. McCarthy-Keith, click here.

At Shady Grove Fertility, we have a specially trained team that works specifically with people with cancer. We will work directly with your oncology team to ensure we expedite your fertility preservation so that cancer treatment can quickly begin. Known as the oncofertility team, they help guide you through each step of the treatment process, from finding ways to afford treatment to the actual medical procedure. Due to the time sensitivity with treatment, you can expect an expedited treatment plan and to see a physician for consultation as soon as possible.

To schedule an appointment with Dr. McCarthy-Keith or any of our Shady Grove Fertility physicians, please call 1-877-971-7755 or fill out this brief form.

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.

Join the next Q&A Webinar, or take advantage of another SGF educational event, in person or online. View our events calendar to learn more.

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:

1. Online, social media community base. 23,000 people on Facebook sharing stories and giving hope.
2. In person support groups for anyone trying to conceive, where you are paired up with people going through similar situations.
3. 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.