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Trying to Conceive? Read This

Monday, March 17th, 2014

Making the decision to have a baby can be overwhelming and frightening, but it can also be extremely exciting. Most people are able to conceive without difficulty. For some women, it happens very quickly, but for others it can take longer. Around 30% of women trying to conceive will do so within one month; 75% will succeed within six months. For some women, it can take as long as a year.

The first thing you should do is schedule an appointment with your gynecologist and inform him or her that you are planning to become pregnant. Talk to your doctor about any medical conditions you may have and how they may affect your pregnancy, such as diabetes, high blood pressure, heart problems, or a family history of any hereditary conditions such as sickle cell anemia.

Be sure to discuss any medications you are taking with your doctor, and do not stop taking them without talking to your doctor first, particularly if you are taking them for a medical condition. Obviously, you should not be taking any recreational drugs if you are trying to get pregnant; you should also avoid alcohol and tobacco, as should your partner.

Once you stop using contraception, your fertility will return to normal, as will your periods. There may be a short delay in ovulation after you stop hormonal contraception, but after this, your fertility will not be affected by these methods of birth control. It’s also fine if you get pregnant very quickly after stopping a hormonal method of birth control. This is not dangerous to your baby.

You can improve your chances of getting pregnant by making healthy lifestyle choices – both you and your partner.  I have found in my practice that if a woman is having difficulty conceiving and she is obese, the first order of business is to lose weight and to attain a normal body mass index (BMI = 18.5–24.9;kg/m2 ) before she pursues pregnancy.  One of the most important things you can do is to make sure you are eating a healthy, balanced diet. Eat a wide variety of fresh, whole foods to help ensure that you get all the vitamins, minerals, and other compounds you need. You should also have a pre-conceptional visit with your gynecologist and most likely (s)he will recommend you start taking folic acid (0.4 mg per day) – and not just an all-purpose multivitamin.

Some patients want to know when they can expect to be fertile. I personally believe that this is a recipe for disaster, i.e., trying to calculate when you are fertile rather than enjoying your partner and having intercourse at least three times a week.  My dictum is, “A watched ovary never ovulates.” Nonetheless, you may want to be familiar with your menstrual cycle. The “average” length of the menstrual cycle is 28 days, but this can vary pretty significantly from woman to woman and still stay within the realm of perfectly normal. The key is to know your individual cycle. Count the first day of your period as day one. If you haven’t already, start keeping track of this on a calendar (a menstrual calendar). After a few months’ worth of counting, you will get an idea of the timing of your menstrual cycle..

This is important, because ovulation will occur somewhere around 14 days before your next period starts, so this can give you an idea of when you will be most fertile. I am not a fan of patients sticking their fingers into their vaginas in order to assess their cervical mucus.  But, some are compelled to do so.  The character of the cervical mucus  changes with the timing of ovulation: around the time of ovulation, it becomes clear, slippery, and stretchy (Spinnbarkeit). At other times it may be creamier and thicker.  Whether thick or thin mucus, a patient should engage in sexual intercourse frequently throughout the month if she wants to conceive.

If patients want to get the Cadillac of tests detecting ovulation, they purchase an ovulation kit. These kits are used to test the urine for the luteinizing hormone, which will increase a day or so before you ovulate. If your partner feels forced into intercourse based on these ovulation kits (“performance anxiety”), then there needs to be a serious discussion about the ovulation kit’s effect on the dynamic of the relationship.  Many women find that these kits are unnecessary and that getting to know their own bodies and menstrual cycles is enough.

Despite their best efforts, many women aren’t able to get pregnant within the first few months of trying. Several factors can affect whether or not you conceive, including whether or not you ovulate (see your doctor if you think you might not be ovulating), whether implantation takes place successfully, your weight (obesity is a deterrent to conception, as is severe anorexia), your age (women over 35 may find that it takes longer to conceive), and the quality or quantity of your partner’s sperm.

If it seems to be taking too long for you to conceive (a year for most couples, six months or so if you are over 35), talk to your doctor about the possibility of fertility testing (for both you and your partner) to determine whether there is a physical problem that may need to be addressed. Finally, if you do conceive but have a miscarriage, the odds of you having a successful pregnancy in the near future are still very good.

– Yvonne S. Thornton, M. D., M. P. H.

Strenuous Exercise Temporarily Decreases Fertility

Thursday, February 13th, 2014

A study from NTNU (Norwegian University of Science and Technology) suggested that the combination of strenuous workouts and achieving pregnancy may be too much for the body to handle. Therefore, female athletes or heavy exercisers may want to ease up a little if they want to become pregnant.

It is well known that women who are involved in elite sports struggle with fertility more than others. Now it appears that women who participate in other types of extreme exercise may encounter more fertility problems as well. In a study that included 3,000 women, researchers at NTNU discovered that frequent and strenuous exercise may reduce fertility – but only temporarily, or while the hard training lasts.

None of the women in the study had experienced a history of problems with fertility, and all of them were of childbearing age and in good health. Two groups of women showed a higher risk of fertility problems: those who trained nearly every day, and the ones who exercised until they were completely exhausted. The ones who fell into both groups experienced the most fertility problems.

In addition, the effects of strenuous exercise on fertility appear to be transient, ending when the hard training slowed down.

The theory is that extremely demanding physical activity requires so much energy that the body can actually experience periods of a deficiency of energy, in which the amount of energy needed to maintain the mechanisms, hormonal and otherwise, to enable fertilization just isn’t there.

It is important to note that women who engaged in low to moderate activity had no fertility impairments, so there is no reason for women to stop exercising altogether while trying to conceive. In fact, exercise can reduce stress, which is good for fertility. Moderate exercise has been previously shown to improve insulin function and promote better fertility as compared to complete inactivity.

It appears that the worst choices for women trying to conceive fall at both ends of the spectrum: extreme physical activity and extreme sedentariness. Pinpointing what constitutes the perfect level of activity, however, can be tricky, because it can be unique to individual women. If your menstrual cycle is particularly long or nonexistent, this could be a sign that you are exercising enough to negatively affect your fertility.

A woman is considered to be infertile after a year of unprotected intercourse without a pregnancy occurring. In women older than 35, it makes sense to see a doctor sooner; perhaps after four to six months of trying unsuccessfully to conceive. There are many factors that can affect fertility in women, including problems with the fallopian tubes, the ovaries, or the uterus, problems with ovulation, and hormonal issues. Sometimes the reason for infertility cannot be pinpointed, and sometimes it may the male partner who has the fertility problem and not the woman. A doctor’s evaluation is the only way to find out for sure.

– Yvonne S. Thornton, M. D., M. P. H.

Multiple Births on the Rise

Monday, January 20th, 2014

If you feel like there are more twins, triplets, and more around than ever before, you’re not imagining it. Multiple births have increased since 1980, when one in every 53 babies born was a twin; in 2009, that number had risen to one in every 30. That’s a 76% increase in twin births in roughly 30 years.

One (smaller) reason for the spike is older maternal age. Older women are more likely to release more than one egg at a time (with or without fertility drugs), making multiple gestation a possibility more often. Incidentally, this does not pertain to identical twins, who are formed from a single fertilized egg.

Another reason, one which is responsible for a larger share of the increase, is the use of fertility drugs in women trying to become pregnant. Fertility treatments have attracted some attention in recent years following the birth of eight babies by the so-called “Octomom.” In that case, 12 embryos made from an IFV treatment were implanted into the woman’s uterus and the result was eight viable fetuses.

This was a clear case of poor judgment. Most cases of infertility are not treated with IVF, but rather with drugs that stimulate the ovaries to produce eggs. These drugs encourage hormone production, which aids in conception but also increases the chances of multiple gestation.

When women are undergoing treatment via fertility drugs, their doctors routinely monitor, via ultrasound and blood tests, how many eggs are being produced so that the couple can avoid trying to conceive during a month when there are too many. However, in some cases the monitoring is not done, or the couples disregard the advice given to them. Often doctors who have been demonized for “allowing” a woman to become pregnant with more than one or two babies during fertility treatments have actually given the woman advice that would have prevented the multiple pregnancy, had it been followed.   

There are good reasons to avoid having twins (or other multiples) whenever possible. Twin pregnancies are considered higher-risk pregnancies, and are usually more difficult for the mother than singleton pregnancies – especially older mothers, who no longer have the energy they had in their 20s. In addition, caring for more than one newborn baby at a time is exhausting, even when plenty of help is available. The exhaustion and expense factors increase exponentially with each additional newborn. It’s also extremely difficult to maintain social and emotional health during those early years with twins or more.

If you do find yourself pregnant with twins or more, take steps as soon as possible to maximize your odds of a healthy pregnancy and delivery, and learn all you can about ways to make taking care of multiples – not just as newborns, but through the challenging toddler and preschool years as well – as simple as possible.

– Yvonne S. Thornton, M. D., M. P. H.

Women with Eating Disorders More Likely to Have Reproductive Problems

Thursday, November 21st, 2013

According to a Finnish study, women with eating disorders have a greater risk of reproductive problems. Millions of women in the United States alone suffer from eating disorders, and some estimates place the number of women who will have an eating disorder at some point in their lives as high as 10% of the worldwide population. Although eating disorders do occur at most ages and in both genders, they are most commonly diagnosed in women of childbearing age.

The University of Helsinki and the National institute for Health and Welfare carried out the study by examining 15 years of data from over 11,000 women. The startling findings included the fact that women with anorexia were only half as likely as their peers to have children. The study also revealed that women with binge-eating disorder are three times as likely as their peers to have miscarriages.

In addition, bulimics have twice as many abortions as their peers. The exact cause for this was not clear, but it could be that because eating disorders can cause irregular periods; these women may also be inconsistent with contraception use. It’s possible that it could also have something to do with bulimics’ tendency to exhibit impulsive behavior.

Worse still, women with eating disorders continue to have fertility issues even after they appear to have recovered. Women who have ever had an eating disorder, even if they are now recovered, still find it harder to conceive as well as to carry a pregnancy to term.

The study certainly highlights the need for more research on this apparent link, because it’s possible that early recognition and effective treatment for eating disorders may help prevent fertility problems. Currently, only about 1 in 10 people with eating disorders receive treatment. Early intervention and long term treatment may help reduce the ultimate effects of the eating disorder, so increasing the number of those getting treatment is important.

Of course, fertility problems are only one reason why it’s crucial for women with eating disorders to seek treatment, and women should discuss treatment options with their doctors for the physical effects of the eating disorder as well as the psychological and psychosocial effects. Social well-being is just one area of mental health that can be dramatically impacted by an eating disorder. Eating disorders cause numerous physical health problems as well, including problems with heart health, osteoporosis, dehydration or electrolyte imbalances, and tooth decay, to name a few.

People suffering from eating disorders can call the National Eating Disorders Hotline at 1-800-931-2237 for information on treatment and referrals, or they can talk to their doctor about possible treatment options. If you suspect that someone you know has an eating disorder, talk to him or her about it. Eating disorders are serious illnesses that can be life-threatening, so don’t wait to get help.

– Yvonne S. Thornton, M. D., M. P. H.

Can A Myomectomy Prevent a Second Miscarriage?

Monday, February 18th, 2013

A miscarriage is a horrible experience for any woman. When the excitement of pregnancy is suddenly cut short by the unexpected news of loss, the grief is difficult to manage. Many women who go through this feel they need many months to heal after the ordeal, but some move on and feel ready to try again right away. Luckily, recurrent miscarriages are rare, but that’s not to say it’s easy to trust that the second pregnancy won’t go the same as the first.

Before we continue, let’s define some terms.  Miscarriage is a lay term for a “spontaneous” abortion, occurring before 20 weeks of gestation.  When most people hear the term “abortion”, they quickly recoil because they believe it to be an “induced” abortion, which is the loss of a pregnancy before 20 weeks by artificial methods.  Fibroid is a lay term for myoma, which is the appropriate term for a benign tumor of the smooth muscle of the uterus. This growth is not fibrous.

Studies show that women who had a miscarriage (spontaneous abortion) as a result of uterine fibroids (myomas) are more likely to have one in their second attempt. However, those same studies show that the surgical removal of said myoma can greatly increase a woman’s chances of having a live birth despite a previous miscarriage.

Fibroids (Myomas) are benign tumors that grow on the walls of the uterus, and they actually affect a significant number of adult women. Twenty-five percent of all women have myomata, with the percentage rising  to 50% in Black women.  When myomas grow into the uterine cavity and thus distorting the inner contour of the womb , they can cause miscarriages (spontaneous abortions). In other locations, such as growing on the outside of the uterus like Mickey Mouse ears (subserosal), they are absolutely harmless and women don’t even know they have them.

Once a doctor diagnoses myomas (myomata) as the cause of a spontaneous abortion (usually in the second trimester), he or she might recommend surgical removal before a second attempt at pregnancy. This surgery is technically called a myomectomy (not fibroidectomy), and it is a relatively safe procedure. Unfortunately, there is a 25% chance the myoma could come back over time, but in many cases, they don’t reappear until years later.   For further information about myomas and myomectomy, you are referred to my book, INSIDE INFORMATION FOR WOMEN on the topic.

If you have had one or more spontaneous abortions, your gynecologist should perform a comprehensive evaluation of your uterus to determine whether or not myoma played a role. This may include a sonohysterogram, and/or a hysterosalpingogram. Most often, spontaneous abortions are totally random, but in some cases, they are caused by an abnormality in the reproductive system. Should your doctor find intramural or submucosal myomata (myoma in the wall of your uterus), you should consider surgery before trying again. While a second attempt at pregnancy won’t make up for the disappointment of the first loss, addressing the problem and correcting it will go a long way in achieving a successful outcome.

 – Yvonne S. Thornton, M. D., M. P. H.


Fertility after Forty

Monday, February 11th, 2013

Many of my older patients come to me to find out whether or not it’s too late for them to have a baby. It’s not surprising in the modern world, as many women are waiting to start families until they have reached a comfortable place in their career and financial stability. However, there are risks to waiting. I’ve discussed these risks before, and I don’t necessarily recommend trying to have a baby after your biological clock has proverbially run out of batteries. However, I understand the desire for women older than 40 to reproduce, and it’s okay to try with the assistance of your doctor and OBGYN. The childbearing years (fertility years) typically are from 15 to 44 years of age, according to the definition.

If you’re hoping to have a baby after your early thirties have come and gone, discuss the risks thoroughly with your doctor. You should consider genetic consulting to make sure chromosomal abnormalities aren’t a threat, and you should be in the best shape of your life if you expect your body to take on the task of birth.

Once you start trying, you’ll realize you’re a lot less fertile than you used to be. By the time you turn forty, you only have approximately 2% of the eggs you were born with, so there is less of a chance for successful fertilization.

After age 40, you might want to consider fertility treatments if you’re serious about trying to conceive. Additionally, there are some natural ways you can boost your fertility. By achieving a healthy weight, you will improve the health of your reproductive organs, which is essential in the fertilization process. Eat a healthy diet and stay active. Relaxation is another proven method for enhancing fertility, so enroll in a yoga class and avoid stress when you can

If you really want to give birth after age 40, no one can stop you. Technology allows us to see into the medical future of our babies, so take advantage of it and decide if the risks are worth it. Just remember, conceiving and having a baby after age 40 is one thing.  Raising a child after age 40, is another. We all have different plans in life, and though yours might be riskier than someone else’s, there is no reason for you to deny yourself the joy of motherhood.

 – Yvonne S. Thornton, M. D., M. P. H.

There’s Something Genetic about Twins

Monday, November 12th, 2012

If you’re a mother of twins, you’ve probably had people come up to you and ask if twins run in your family. Many women have heard this before, but few are entirely certain whether or not the likelihood of giving birth to twins is truly genetic, or if it simply happens by chance. You might be surprised to find out that the notion isn’t entirely a myth. To understand the genetic forces behind having twins, you first need to understand how twins are born.

There are two types of twins a woman can have. Monozygotic twins are the ones that are identical, and their genetic build is essentially the same. These twins were formed after the mother’s egg was fertilized. The egg split into two and became two separate eggs, and eventually two separate people. Rest assured that this is simply a strange bodily occurrence, and there is nothing genetic about it.  It is nature’s cloning.

On the other hand, dizygotic twins are those that are fraternal. They might be different genders, and they look no more alike than regular siblings. These twins were actually formed when the mother released two eggs at the same time. Both eggs were fertilized separately and two people began to form. Here is where genetics come into play. If a woman has released two eggs at the same time, she is predisposed to hyperovulation. Most women release a single egg with every cycle, but women with dizygotic twins release two (or sometimes more in the case of multiples). Hyperovulation is in fact genetic. If your mother or grandmother experienced hyperovulation, you probably will too. Certain tribes in Africa are prone to multiple ovulation and consequently a high incidence of twinning.  Women of color, older women, women with several children (high parity) are more likely to have twins.  Conversely, Asian mothers are about half as likely to have dizygotic twins.

Women taking fertilization treatments using Clomid or Pergonal will be more likely to hyperovulate resulting in a dizygotic (or monozygotic) pregnancy or even higher-order multi-fetal gestations, such as Octomom.  Also, those women who are undergoing artificial reproductive technologies, such as in vitro fertilization, which may insert more than one fertilized egg into the uterus may have twins.   But these women are not genetically predisposed to carrying twins.  The bottom line is that if you or other members of your blood-related family are dizygotic twins and you’re trying to conceive, you might want to stock up on twice the amount of baby supplies.

PTSD from Infertility?

Monday, August 13th, 2012

Normally, when you think of post-traumatic stress disorder, you think of soldiers returning from battles with a foreign enemy, not women battling infertility.  Surprisingly though, researchers have found that women undergoing fertility treatments are highly likely to develop PTSD and are calling for a change in the definition of the disorder.

Based on a survey conducted by Allyson Bradow who is the Director of Psychological Services at Home of the Innocents, 50% of women who went through fertility treatments met the criteria for PTSD.  As a result of their stressful experiences, infertile women are 6 times more likely to suffer from PTSD than the general population.  This has led some to believe that perhaps the definition for PTSD needs to be expanded.  Currently, its definition limits its diagnosis to those who have “experienced or witnessed a life-threatening event or [an] event that could cause serious injury.”

Bradow believes that it should also be diagnosed for those who have experienced trauma due to the failure to meet expectations for life.

The ability to procreate is believed to be a fundamental life process.  Trauma is defined as a wound or injury.  The word origin of injury comes from the Latin “injuria”  (in = not + jus =  right) and its definition is to cause one to suffer hardship and loss undeservedly and unexpectedly.  Therefore, if one loses his/her ability to procreate, this satisfies the definition of trauma.  It is not uncommon for couples struggling with infertility to suffer from anxiety, depression, and other related symptoms.  Any time a person’s heart is set on something, particularly a life accomplishment like procreation, they are bound to react extremely emotionally to a negative outcome.  Some find procreation so important, that they feel they have not lived up to the expectations of life when they cannot conceive and are severely traumatized by it.  Whether or not this stress can be considered PTSD or not is yet undecided.  What is clear though is that infertility physicians and clinics need to ramp up their counseling services.  If infertility is an unfixable issue, then couples need help finding a way to be content with it, so they can live emotionally- and mentally-healthy lives.


– Yvonne S. Thornton, M. D., M. P. H.


Fertility Financing Becomes a Popular Option

Thursday, July 19th, 2012

How much is a baby worth to a couple trying to get pregnant?  It’s likely priceless, but to the lending industry, it’s worth millions.  Apparently, because of the steep cost of fertility treatments, some couples are turning to financing to get enough money to improve their odds of having a child.

One couple in Rockville, Md, Jill and Tom Clinton, tried desperately to get pregnant, but after a heartbreaking miscarriage, they decided to try a fertility clinic.  Unfortunately, the cost of the average in-vitro fertilization cycle is about $12,000 and their insurance wouldn’t cover any of it.  Additionally, it often takes several cycles to get good enough odds for a successful pregnancy.  In order to make it happen, they drained their savings and were happy to receive a baby boy from that investment.  When they wanted a second child though, there was no money left for fertility treatments, so their doctor told them about the possibility of getting financing.  After more research, they found that fertility financing companies are being created around the country and the industry is growing fast.  It’s so popular in fact, that Capex MD, the company the Clintons decided to use, funds a whopping one million dollars in fertility loans each month and that number is rising steadily.

It appears unclear as to why this new industry is growing so fast.  Some speculate that more couples are trying to get pregnant later in life and so are more likely to need fertility treatments, while others believe it’s simply the new option that is giving rise to the results.  Couples who previously couldn’t afford in vitro fertilization now have the option to get financing and so they do.  Either way, it is causing concern among medical ethics committees like the one at Langone Medical Center.  They wonder if lending companies aren’t taking advantage of the desperate nature of couples in this situation, seemingly holding a miracle right in from of them.  Arthur Caplan, head of the Langone Medical Center Ethics Division worries that couples are “not going to hear the failure and success rate, the interest rate, and what the risks are of the treatments.” Instead, couples may only pay attention to the idea that there is one more opportunity to allow them to give pregnancy another try.

– Yvonne S. Thornton, M. D., M. P. H.