Infertility

Its ironic that so many young women spend the better part of our teenage years and early twenties worrying about getting pregnant, and then when their minds are finally ready to be pregnant, their bodies no longer are. ImageA couple weeks ago I was fortunate to have the opportunity to spend the day shadowing a nurse practitioner at an infertility and reproductive medicine clinic. I learned so much about the little things that are so frequently overlooked by most women (such as diet and exercise) and the significance it has on reproductive success. I hope this discussion provides insight and ideas for success when trying to plan for pregnancy.

The first topic that seems to have the greatest impact on fertility is diet and weight. Yes, it is those dreaded words that no woman ever wants to hear. While most of the women that came to the clinic were not necessarily obese, many of them could generally be considered at least mild to moderately overweight, and a small handful were slightly underweight. Image One of the first steps to improving fertility is to obtain a healthy weight. For the woman that needed to gain a few pounds, it wasn’t recommended that she consume all the Krispy Kreme donuts within a 10 mile radius, on the contrary, for both over and under weight women, they were advised to restrict the amount of carbohydrates in their diets, and eat foods high in protein and vitamin rich fats. While some of the providers admitted to being more carb-tolerant, some of the doctors are insistent about clients following a strict no-carb diet. While choosing between that bagel and getting pregnant might seem to be a no-brainer to the hopeful mother to be, it seemed that most women became more heartbroken learning some of the best fruits and “first line diet foods” were still off limits. As I mentioned earlier, women don’t want to hear that they need to go on a diet and lose weight. For the fluffy gal, its something she already knows, and doesn’t need to be told again. That being said, the explanation over WHY carbs are bad is brilliant, and it went something like this…

At the initial consultation, the nurse practitioner sat down to review lab results from their bloodwork. While most primary care labs check blood glucose, a less common lab is the amount of blood insulin. A very high majority of the women we saw at the clinic had high levels of insulin. ImageThe way this related to their fertility was explained as such: “When you eat meals that are high in carbohydrates, your body produces insulin, which is a hormone needed to transport the carbs into a usable form of energy in the cells. That is a normal response. However, insulin inhibits estrogen production, which is a major hormone of the reproductive system that is essential for fertility to help your eggs grow. When you eat a meal that is high in carbs, your insulin levels rise (which is a normal response), but while your insulin was up, you didn’t produce any estrogen that night.” This very cut-and-dry explanation was very enlightening, and made complete sense. While the actual physiology behind this concept is far more complex, coupling this diet with exercise to boost metabolism and lose weight is the first step women need to take to help in getting pregnant.

ImageAnother bright idea to improve chances of getting pregnant is to consider the type of lubricant used (if any), and how it may affects the quality of sperm. It might seem obvious to avoid a spermicidal lubricant if you are trying to conceive, but what about the rest of the commonly used lubes? In general, most of the water-based products are not beneficial to sperm quality, as they can decrease sperm motility and lifespan. ImageThey already have enough obstacles just trying to find that egg, why complicate things? Instead, some good alternatives to use (if needed) are natural oils such as mineral and cannola oil. Additionally, men should avoid wearing restrictive tight clothing, especially with excessive heat.

A very important concept to keep in mind is that there are only certain days that it is possible to conceive. While daily intercourse does seem to have s slight advantage (improved sperm quality), it is never the less essential to know the optimal time for intercourse (especially if you don’t have sex every day). The old school Natural Family Planning Method is one of the best ways to determine what days you are most likely to ovulate. Keep a menstrual diary. Record the first day you get your period. This is the single most important step to take to improve chances of getting pregnant. This is also very beneficial after you become pregnant, as it allows for accurate dating and gestational age of your baby. Most women have 28 day cycles, meaning from the first day of one bleeding period to the first day of the next. ImageKeeping a detailed diary month to month is very helpful to predict when you will ovulate, because in most normal cycles, ovulation takes place 14 days before menstrual bleeding occurs. It is a retrospective assessment that may not be apparent until a few cycles have been recorded. Additionally, you should make note of any irregular spotting in between periods, as this may indicate hormonal abnormalities and/or absence of ovulation.

Another good way to determine when you might be ovulating is by the quality of your cervical mucous. Most of us have noticed occasional differences in the color and consistency of the discharge on their underwear. Most of the time, during the infertile days of the cycle, the mucous is thicker, sticky, not as much, and may not always be apparent. Around the time of ovulation, the mucous becomes thinner, and more evident. The consistency is similar to that of an egg white. This is what you want to look for, as it usually changes within 1-2 days of ovulation. However, when evaluating vaginal discharge, know what is normal and what is not. Foul odor, green, yellow, or grayish color, or white, chunky consistency may be indicative of an infection. Being regularly screened for STD’s will help improve fertility, because STD’s such as chlamydia for example, can spread to the uterus, tubes, and ovaries, causing inflammation and structural abnormalities, that could contribute to problems with fertility later.

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Fertility is based on numerous complexities, that are beyond the depth of this discussion. That being said, infertility is also a complex issue that takes into account various disciplines, including age, medical history, hormones, male factors, STD’s, genetics, and much much more. Now I am by no means an expert in this subject; while I want to provide information learned from my experience at the infertility clinic, coupled with tid-bits of educational  information I’ve learned from class, I am only providing a non-formal discussion, and should not be substituted for a professional opinion =)

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