Fertility & Infertility

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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.

Obesity Impairs Fertility More in Black Women

Monday, November 5th, 2012

Infertility can be heartbreaking to women trying to conceive. Dreams of holding a newborn baby in the delivery room are often put on hold as women who have been diagnosed as infertile seek alternative methods of conception. Infertility is technically defined as a woman’s inability to get pregnant after a year of trying with no contraceptive methods. There are numerous causes of infertility, but sometimes doctors are unable to determine the cause on a case-by-case basis. Often, infertility is a result of obesity. A recent study showed that obese black women are often more infertile than white women.


Healthy black women do not necessarily have a harder time getting pregnant than healthy white women. However, black women who are obese will have a harder time than white women in the same situation. Specifically, a larger hip-to-waist ratio was associated with infertility. The study could not confirm why women heavier in the lower body and hips area had a harder time getting pregnant, but it could be a result of inhibited estrogen metabolism caused by a large amount of fat. An increase in the resistance to insulin might also be to blame.


The results of the study should be an incentive for obese black women looking to conceive to lose weight. In addition to increasing fertility, a healthy weight prior to conception will make for an easier pregnancy and a healthier baby. However, the results should also be taken with a grain of salt. The results failed to study the health of the potential fathers, who might also have been obese. Obesity in men could lower their sperm count, which would make it even harder for obese couples to conceive.


Obese women, whether black or white, will have a harder time getting pregnant. Though these results suggest that infertility is more common in black women who are obese, women of either race should attempt to reach a healthy weight before trying to have a baby. Fertility will be increased, and you’ll have a happier and healthier pregnancy. If you’re having trouble conceiving, you should talk to your physician about ovulation treatments and the potential for an IVF.


– Yvonne S. Thornton, M. D., M. P. H.

Infertile? It Might be Time to Go Gluten-Free

Monday, October 29th, 2012

The gluten-free lifestyle is gaining popularity in American culture. Even at some of the most mainstream cafes and grocery stores, you can find gluten-free alternatives to your favorite breads and baked goods. Many people are giving up gluten because of the known health benefits associated with cutting it out of your diet. However, some people avoid gluten for a different reason. People with celiac disease suffer from abdominal pain, diarrhea, and weight gain when they eat gluten. The disease is actually fairly common, as 1 in every 133 people in the United States are afflicted with it. Unfortunately, negative reactions to gluten are not the only side effects of the disease.

Women with celiac disease are often infertile. Infertility is defined as the inability to get pregnant within a year after discontinuing contraception. So, while you could get pregnant eventually with celiac, it will be much more difficult. If you have celiac disease, you’ve probably noticed that your periods are sometimes irregular because your body cannot spare any resources, particularly iron. This is because your body has trouble absorbing certain minerals and nutrients, especially if you’re undiagnosed and still eating gluten. In fact, women who seem to be infertile are often tested for celiac disease because the two problems are so closely related. You ovulate less frequently when you have untreated celiac disease because you are malnourished.

Luckily, diagnosing celiac is the first step in recovery. If you have been infertile for a while and realize that you have celiac disease, cutting gluten from your diet might make fertilization of your eggs easier, and you will increase your chances of getting pregnant.

If you’re having trouble getting pregnant and you’ve been experiencing abdominal pain, diarrhea, weight loss, and a general ill feeling, it’s time to get tested for celiac disease. Cutting gluten out of your diet will be difficult at first, but the benefits will be well worth the sacrifice. Besides, giving up gluten is easier now than it ever has been before. Twenty years ago, people with celiac couldn’t even think about eating anything remotely close to bread or wheat. Now, gluten-free options are bountiful. People with celiac can eat everything from cupcakes to foot-long subs thanks to the popularity of alternative baking.

– Yvonne S. Thornton, M. D., M. P. H.

Legitimate Rape or Legitimate Ignorance?

Thursday, September 6th, 2012

In February, there was a hearing chaired by Daryl Issa for the House Committee on Oversight and Government Reform Hearing on the Contraceptive Coverage Rule.  Unfortunately, the panel was entirely male.  Talk about oversight!  This prompted many female members of congress to walk out of the hearing in protest, much to the confusion of the chair.  When asked about the walkout, Senator Kirsten Gillibrand said, “If our republican colleagues want to continue to take this issue head on, we will stand here as long as necessary.”  In August, women received a fresh reminder of the Republican male’s perspective on rape when Representative Tod Akin proclaimed, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

Women around the world are wondering what constitutes the difference between rape and legitimate rape.  John C. Wilke, who is not an obstetrician, but a general practitioner of almost 90 years old, and who is the former President of the National Right to Life Committee is the only doctor who supports Akin’s remarks regarding whether or not the reproductive system of a woman shuts down during rape.  With such credentials, it goes without saying that he may have a bias and outdated view of rape and the female body, and experts disagree with his supposedly medical explanation for his belief.  In fact, one in 15 raped women become pregnant, no matter what definition of rape you choose.  Are Akin and Wilke suggesting that those rapes were not legitimate?  I doubt it seemed that way to the women when it was happening.

The most disconcerting part of all of this is that representative Akin has the power to influence laws in our country.  In this day and age, we hope that men have at least the decency and empathy to listen to the voices of women in our country, and, heaven forbid, include us in panels and decision-making regarding our own reproductive rights.  Hopefully, there are a lot of women and understanding men out there willing to make their vote count in order to make a positive change for all of us.  I wonder, is it pure prejudice keeping men like Akin in the dark when it comes to women’s health issues and reproductive rights, or is it legitimate ignorance?


– Yvonne S. Thornton, M. D., M. P. H.

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.


Don’t Forget to Ask

Monday, August 6th, 2012

When you are pregnant, there are a lot of things running through your mind at once, most of them being questions.  As the date of delivery approaches, those questions become all the more important and all the more difficult to remember to ask.  Here are a few important ones that you should add to your list.

What if My Doctor’s Unavailable?

Although your physician may have set a due date, that is only a best guess as to when you will actually deliver.  Normally, your doctor will try to be available for a delivery in the week before and after that date.  However, extenuating circumstances or a very early delivery could cause them to be unavailable when you need them.  Instead of panicking when the time comes and taking whoever happens to be available, plan for this situation ahead of time.  Speak with your doctor about potential back-ups.  Ask who they recommend and if you can get their numbers for your on-call list.  It might also be a good idea to meet them, so if they do end up delivering your baby, you will have already established a relationship with them, making for a more comfortable experience.

 Who Can Come with Me?

Back in the day, women would bear their pain alone but for the doctors and nurses in the delivery room, but now, most moms want to bring in the father, or at least some trusted family member or friend.  For a standard delivery, this shouldn’t be a problem, but if there are complications, they may be asked to leave so that doctors have more room to work.  Normally, they will ask you to restrict access to the delivery room to one or two people and with all the chaos birth can bring, you’ll appreciate not having too many people around.  If you will be having a C-Section surgery though, having someone in the delivery room may or may not be possible.  Be sure to ask before promising access to anyone.

 Will Someone Be There to Show Me?

Some women panic a bit after going through delivery and finally getting the chance to be alone with their new baby.  They suddenly realize that they don’t know how to change a diaper or that breastfeeding is harder than it looks.  Luckily, there are people on staff at the hospital who can guide you through your first attempts at these tasks.  They can give you tips to help you get your baby to latch for breastfeeding and show you the proper way to take care of their sanitary needs as well.  Ask your chosen hospital about who they have available to go through these questions with you once you have delivered.

If you have more questions, be sure to join me for my live webcast, Inside Information for Women, every Thursday at 1pm Eastern.  I can take your call and do my best to answer any burning questions you might have regarding your pregnancy, delivery, or women’s health in general.  In the meantime, if your due date is approaching, be sure to write down the questions you have, so you will remember to ask each one at your next pregnancy check-up.  That way, when your baby and body are ready to deliver, your mind will be ready too.


– Yvonne S. Thornton, M. D., M. P. H.


It’s Called an Annual for a Reason

Thursday, August 2nd, 2012

It’s not news to OB/GYNs that women don’t exactly look forward to their annual exam.  We understand that it may feel more like a chore than a checkup when you’ve been told you have to do it every year.  Some experts though, have new recommendations, saying most women don’t need yearly cervical cancer screenings.  Before you start celebrating though, you may want to consider the many long-term benefits annuals have on your health.  As I have mentioned many, many times on this blog, ”A PAP SMEAR IS NOT A PELVIC EXAM.”

The new recommendations by the U. S. Preventive Services Task Force and the American Cancer Society were released March 15, 2012.   They recommend:

  • Women between ages 21 and 65 without risk factors (such as DES exposure or immunodeficiency) should undergo cytologic screening (a Pap smear) every 3 years.
  • Those aged 30 to 65 wishing to extend the screening interval could undergo screening with both cytologic exam and human papillomavirus (HPV) testing every 5 years.
  • Women younger than 21 should not be screened.
  • Women older than 65 who have been adequately screened previously should not be screened.

 The above recommendations may cause women to shirk going to their OB/GYNs for that dreaded pelvic examination because they are not having an annual Pap smear.

However, as we age, there’s no doubt our bodies change.  For the most part, those changes are normal.  Sometimes though, medical issues can develop.  Every time you go to an annual exam, you are getting checked to make sure everything is in healthy working order.  If you catch issues before they get too big, treatment and even cures can be more effective.  With the rise in so many types of cancer, you’ll want a professional checking to make sure there are no signs of tumors.  That is why pelvic exams, mammograms and cervical screenings are so important.  If you were to wait two or three years, it may be too late.  My health book, Inside Information for Women will explain all the aspects of a pelvic exam and an annual gynecologic examination.

You also have the chance during your visit with an OB/GYN to discuss your health and how it’s affecting your life, or how your life is affecting your health as the case may be, and that can bring up symptoms that you didn’t even realize were connected.  It can also provide you with valuable advice that will help you take care of your body.  With all the change people go through in a single year, it’s nice to know that someone with knowledge and compassion is there to make sure you remain in good health for many years to come.

The fact is women are such multi-taskers trained to take care of everyone that we forget to take care of ourselves. The point is, if we don’t take care of ourselves, we won’t be there to take care of others. Don’t have time for your annual checkup? It’s time that you find the time.


– 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.

Reversing the Biological Clock with Someone Else’s

Thursday, July 12th, 2012

Because so many women hold giving birth as one of their ultimate lifetime experiences, they don’t want to miss out on it because of infertility or the aging process.  Unfortunately though, as women get older, their ability to reproduce decreases.  With so many American women waiting until later in life to start their families, these upwardly mobile women are finding problems with fertility issues to be more common than they had expected.  For this reason, doctors have been working on adding to their various fertility treatments to help these older women give birth.  In vitro fertilization is one method that has gained a new strategy that seems to be reversing the biological clock of women over 40 years of age.

For women who are 43 years or older, the likelihood of getting pregnant, even with the help of three cycles of in vitro fertilization, is only 10 percent.  This is because a woman is born with all the eggs she will ever have and over time, the number of eggs of a woman significantly decreases from 1 million at her birth down to 34,000 at 36 years of age.  Not only are there less in numbers but the likelihood of the remaining eggs to function normally in the reproductive process becomes less.  However, researchers have found that when one uses a “donor” egg, i.e.,  when a young woman’s eggs are donated and in vitro fertilization is used in combination with these younger eggs, the chances of pregnancy increase to 60 or even 80%.   Nearly 250,000 women participated in this reproductive study by researchers at the Baylor College of Medicine and what they found was quite promising.  Even infertile, older women using donated eggs and in vitro fertilization had the same chances of getting pregnant as fertile young women using natural means.

Although these findings are exciting for those desperate to have a baby later in life, the process is not as easy as it sounds.  It is an expensive, unpleasant process, and not without its drawbacks.  It’s important to remember that the baby is not genetically related to the mother.  Some women find that less appealing (to be carrying a child that does not have her DNA).  Moreover, sometimes infertility is a sign of other reproductive problems that can cause issues during a pregnancy and long-term concerns for a child born in this manner.  For this reason, it is extremely important to consult with your OB/GYN before proceeding with such a program.  Many “older” celebrities have become mothers in this fashion.  But, keep in mind, healthy babies come from healthy mothers, so one should consider all other options before traveling down this path to motherhood.

You can read more about infertility in the chapter, “I’m not pregnant—and I want to be” in my health book, “INSIDE INFORMATION FOR WOMEN”.


– Yvonne S. Thornton, M. D., M. P. H.


Fertility Institute Plays God

Monday, June 25th, 2012

For many, having children is an important goal, and when they find that for some reason they cannot, it can be heart wrenching.  Couples can go through years of suffering attempting to conceive, only to find that they are infertile.  When this is discovered, some couples resort to expensive fertility procedures in an attempt to have a child.  One fertility clinic though, decided to capitalize on the desperation of would-be parents by holding a contest offering free in vitro fertilization to the winners.

According to the CDC, 11.8% of women are infertile and 7.3 million of them have used infertility services.  These services are extremely expensive though, and many couples cannot afford them.  Because the services are elective, competition for clients is fierce in the fertility market.  The Sher Fertility Institute decided to embark on a marketing campaign in which couples would compete for their services through a video contest.  Forty-five hopeful couples submitted heart-breaking videos about their struggle to conceive, hoping to woo the judges and win one free cycle of in vitro fertilization.  Only three couples could win, but the amount of attention the institute received more than accomplished their goal of marketing exposure.  Critics of the contest believe that the institute is making light of a very serious situation though, and that they are taking advantage of the desperation of infertile couples in order to boost sales.  With contestants who have suffered five or six miscarriages and even a stillbirth, it seems cruel to get their hopes up with a contest that appears to be the miracle they’ve been waiting for.  Additionally, it doesn’t cause other couples, watching the contest, to consider all aspects of making such a decision.

For the most part, experts seem to agree that in vitro fertilization is safe.  However, they also warn against complications and want would-be parents to be aware of the risks they’re taking.  Professor Nygren, a speaker at the World Congress of Fertility and Sterility in Munich, concluded that there are low levels of increased problems which can come with in vitro fertilization, but these “may be due to the fact that all patients undergoing IVF procedures are patients who already have reproductive problems.”  He also pointed out that there seem to be more complications associated with those who opt for Multiple Embryo Transfer instead of Single Embryo Transfer.

Although the winners of the Sher contest are likely ecstatic at their free IVF cycle, many others are disgusted by the institute’s advertising practices.  If you and your partner are struggling to have a child, be sure to speak with your OB/GYN about all of your options before jumping into a contest where doctors are playing god for a bigger paycheck.


– Yvonne S. Thornton, M. D., M. P. H.