Fertility & Infertility

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What Your Home Pregnancy Test Can and Can’t Do

Monday, April 28th, 2014

If you have just noticed that your period is late, your first inclination may be to run out and buy a home pregnancy test (HPT). With various brands now purporting to be effective as early as the first day of your missed period, it’s understandably tempting. However, be aware that these claims may not always be exactly accurate. You can improve your odds of getting an accurate reading by being familiar with when and how to take one of these tests, but understand that HPTs are no stand-in for the reliability of a test administered by a doctor.  These tests are from the urine and are imprecise.  The pregnancy tests taken from a blood sample are more accurate and will allow your gynecologist to see a “trend” in the amount of hormones in your system, in case there is an equivocal result.

How Soon Can You Take a Home Pregnancy Test?

Don’t get too excited about those tests that claim to work before your period is even late. Wait until a little later for the best results – once your period is a week late, go ahead and test. By this time, if you are pregnant, you’ll have enough HCG (human chorionic gonadotropin, the hormone produced in your body when you become pregnant) in your blood for the test to detect. Earlier than this, some HPTs aren’t precise enough to detect the smaller amounts of HCG present in the first days of pregnancy.

False Positive/False Negative Results

There are several factors that could interfere with the results of an HPT, including the design of the test itself, taking the test too early, and certain medications such as fertility drugs. Both false negatives and false positives are possible, but false positives are much rarer.

A false positive could occur after taking a medication such as a fertility drug that contains HCG, or it could mean that there was a pregnancy that was lost very soon after the fertilized egg had attached to the uterine lining. An ectopic pregnancy may also produce a positive HPT result, and this requires immediate medical attention. Most often, however, a positive result indicates a normal pregnancy. Either way, a positive result warrants an appointment with your gynecologist.

A false negative result is more likely than a false positive. This means that your HPT will indicate that you aren’t pregnant when you actually are. This can be life-threatening, especially if you are pregnant in one of your fallopian tubes or your cervix or your abdomen (ectopic pregnancy).  The pregnancy may rupture in the fallopian tube or cervix and cause hemorrhage leading to death. You may end up with a false negative if you take the test too early, check the results too soon (without following the package directions explicitly), or using urine that is diluted – for example, if you have recently drunk a lot of water. That’s why even though many HPTs claim to be accurate at any hour, your best bet is to take the test first thing in the morning, when more concentrated urine boosts your chances of getting an accurate result.  In the final analysis, you need to have the result confirmed in a doctor’s office.

What to Do After Taking the Test

If the test is positive, make an appointment with your gynecologist to confirm the pregnancy with a pelvic exam and a blood test.  Of utmost importance is to confirm that the pregnancy is actually in your uterus and not an ectopic pregnancy where it has an increased risk of rupture and hemorrhage. The sooner prenatal care begins, the better, so make this call immediately.

If your test is negative, and you have missed a period, you need to make an appointment to see your gynecologist as soon as possible. There are lots of reasons why you may miss periods, including stress, weight loss, strenuous exercise, and illness. However, if you missed a period, you are pregnant until proven otherwise.    Read more about pregnancy tests and early pregnancy in my women’s health book, “Inside Information for Women”.


– Yvonne S. Thornton, M. D., M. P. H

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.

Male vs Female Sterilization: Which Partner Should Get It?

Monday, December 30th, 2013

Sterilization is a procedure for men and women that stops them from being able to conceive. It works by creating a barrier so that the egg and the sperm cannot meet. In women, the fallopian tubes are cut or sealed off to keep the egg from travelling into the uterus. In men, the vas deferens is cut and sealed off to keep the sperm from moving from the testicles into the penis. This is also called a vasectomy.  

As sterilization is permanent, it should be used only by couples who are completely sure that they will never want to have children, or who do not want to have any more children. When this is the case, sterilization offers a great solution – not having to worry about birth control ever again is a great thing. For many couples, the only real question they have about sterilization is: which partner should get it?

One significant issue is the fact that male sterilization is safer than female sterilization. At least 14 deaths are attributable to female sterilization in the US each year; in men, that number drops to zero. Complications are also less common with male sterilization. For many couples, this fact alone is enough to help them make up their minds. However, this is far from the only factor for most couples, and even though female sterilization comes with a few more (remote) risks than male sterilization, it is still extremely safe.

Couples should consider and discuss all of the factors involved in making this decision. Perhaps one partner has the time available to take off from work and recover properly. Perhaps one partner is deathly afraid of surgery while the other has no problem with it. Whichever partner is chosen for surgery should understand and be okay with the fact that this type of sterilization is permanent. Yes, there are reversal operations, but they are extremely expensive and often do not work.

Male Sterilization

Vasectomies are done using local anesthetic. The operation takes only about 15 minutes. The scrotum may be bruised, swollen, and painful for a week or so; wearing tight-fitting underpants helps with support. Strenuous exercise must be avoided for several weeks. Most men find that the pain they experience is very mild. Men can have sex as soon as the doctor gives the green light, which is usually as soon as it is comfortable. However, there may still be sperm in the semen for a while after the operation. Men must have a semen test eight weeks after surgery to make sure that the sperm are gone before having unprotected sex.

Female Sterilization

There are several different ways of blocking fallopian tubes: cutting, tying, clipping, and more. This may be done under general or local anesthetic. Because this is a more invasive procedure than is involved in male sterilization, and because it often involves general anesthesia, women may find that they feel uncomfortable and unwell overall for a few days. Women typically need to take it easy and get plenty of rest for a week or so. They may experience pain as well as slight vaginal bleeding. Women will need to continue to use contraception for several weeks after the surgery.

With either male or female sterilization, patients should follow the doctor’s instructions for post-surgery care. Patients should also understand that neither option is 100% effective, although 99.9% comes pretty close. Couples should discuss all of these issues and decide what is best for them.

– 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.

Women Suffering From Endometriosis Impacted On Several Levels

Monday, September 23rd, 2013

Endometriosis is an incredibly common condition among women, affecting upwards of seventeen percent of the population, but there is little awareness of this condition outside of those who suffer from it. Unlike other debilitating conditions that are cause for concern, as well as sympathy, endometriosis often goes unrecognized among the general population—however, it can have a significant impact on not only a woman’s physical health and wellbeing but her psychological health and her ability to maintain a social life and presence, according to research that has been done over the past few years to determine the impact of this disorder among sufferers.

Endometriosis is characterized by a number of symptoms, from extremely heavy menstrual bleeding to pain both during menstruation and at other times of the month. This is caused by an overgrowth of the uterine lining, which moves beyond the uterus and into other parts of the body, including the abdominal cavity. There is no cure for this disorder, and the primary methods of management include medications and, in certain cases, surgical intervention.

Women who suffer from endometriosis must work closely with their doctor to manage their symptoms, but there is still little that can be done to eliminate the symptoms that she faces entirely. This makes the disorder much more debilitating, especially during menstruation, and may lead to increased anxiety and stress as a result of either dealing with the symptoms, or even simply the anticipation of symptoms.

In this same study, which identified several areas in which women with endometriosis might be affected, it was also pointed out that there must be more research done on the significant impact of this disorder on the partners and children of women who suffer from it. Not surprisingly, it is incredibly stressful for those close to the woman with the disorder to deal with the pain that she must endure and the extra measures that they must take so that their own lives are affected as little as possible by it.

There is a great need of support for women who suffer from endometriosis—that is something that cannot be disputed. However, there is also a great need for the families of women affected by endometriosis to receive support as well. This can be especially difficult for male partners and younger children who do not understand the very real physiological effects of the illness.

The best method of coping is, as always, to raise awareness of the issue and for those affected by it to become educated as much as possible on the disorder. While it can be debilitating, there is no reason that women who suffer from endometriosis, as well as their families, cannot live happy and fulfilled lives. It is not up to the woman alone to cope, nor should it be. By working together with their families, women can ensure a more positive outcome and a higher quality of life.

– Yvonne S. Thornton, M. D., M. P. H.


Not Receiving Influenza Vaccinations Increases Infant Mortality

Monday, July 8th, 2013

There has been a lot of talk about vaccinations in the past several years, and the camp of people on the side of going vaccination-free is getting bigger every year. That is something that frightens me as a doctor, as vaccinations are the single most effective way to prevent disease, not just among individuals but also among the general population, known as herd immunity.  Vaccination acts as a “firewall” in the spread of disease.  In herd immunity, the more folks that are vaccinated against a contagious disease, the less likely a single individual will become infected.

However, part of being a doctor is a willingness to look at all the evidence as it is presented to you. As the debate about vaccinations continues, an increasing number of researchers are looking at the effects that vaccinations have on individuals, and whether they have the potential to do more harm than good among certain groups.

Pregnant women are a group of major concern. There are a lot of steps and preventative measures that a woman must take in order to maintain the health of her child while she is pregnant, and vaccinations have always been recommended to prevent the devastating effects of the Influenza virus. Doctors in one study have conducted research on pregnant women and the influenza virus, as well as the mortality rates in the infants of those that choose not to be vaccinated.  While vaccinations against the Influenza virus pose no significant threat to women or to their unborn children, women who go without the vaccination show much higher rates of infection, and those that were infected show much higher rates of fetal mortality.  Another vaccine, known as Tdap, for tetanus, diptheria and pertussis (whooping cough), should be administered to all pregnant women in their third trimester (27 weeks to 36 weeks) in order to maximize the maternal antibody response and passive antibodies that will protect the newborn.

The results are not surprising to doctors, but they are worrying when you take into consideration the fact that this year, many women will choose not to be vaccinated, and will choose not to vaccinate their children. While many trends are silly but otherwise harmless, this “popular” trend could be absolutely devastating. There are certain vaccinations that should not be performed during pregnancy, such as measles, mumps and rubella (MMR), varicella (chickenpox), zoster (shingles), anthrax, BCG (tuberculosis), Japanese encephalitis, typhoid, yellow fever and smallpox, but women should trust their doctors to guide them in the right direction when it comes to making these decisions about the necessary vaccinations.  Choosing to vaccinate against Influenza, even while pregnant, poses virtually no risks. Choosing not to vaccinate could be a big mistake.

– 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.