Menstruation & Ovulation

If you’ve been trying to get pregnant or you’re thinking about trying for a baby –  the first step is to ensure you understand how pregnancy takes place in a woman’s body. 

Our early education teaches us that unprotected sex can lead to a pregnancy. On a very basic level, this can be true but there is a lot going on in a woman’s body and it’s not nearly as simple as we’re sometimes led to believe. A menstrual cycle takes place all month, and is not just the period itself.  Timing plays an enormous role in getting pregnant, and many people find it surprising to learn just how small that window of time is.  

If you’re trying to conceive it’s vital to know what your body is doing as you go about your day to day life. It’s important to note that bodies and their functions vary greatly. Below is a general outline of the menstrual cycle, and there are always exceptions to these “rules”. In fact, it is some of the exceptions that can be a barrier to your fertility, so knowing the how is the first step in understanding your individual cycle and how it can impact your fertility. 

The Phases of Menstruation

 

1. Menstrual Phase 

This is the phase in which a woman has her period. Medically, it is considered the first phase of the monthly cycle, often referred to as Day 1. It happens because the egg from the previous phase was not fertilized. Each month the lining of the uterus thickens in preparation for pregnancy. When pregnancy does not occur, the lining sheds, and this is what we commonly call a woman’s period.

 

2. Follicular Phase 

There is an overlap in phases. This one begins on the first day of a woman’s period and ends when she ovulates. FSH (follicle stimulating hormone) is released and stimulates the ovaries to produce follicles. These follicles (small, fluid-filled sacs) contain immature eggs, where one egg will mature and the rest will die. While less common, it is possible that two eggs may mature. The maturation of the egg triggers estrogen to increase and create a lining in the uterus (nutrient-filled home for a potential baby). This phase can last from 11-27 days.

 

3. Ovulation Phase

A more well-known phase is ovulation. This is when the ovary releases the mature egg and it’s picked up by the fallopian tube, where it potentially meets with sperm for fertilization. Ovulation takes place around day 14 and generally lasts 12-24 hours. If the egg isn’t fertilized in that time, it will die.

 

4. Luteal Phase

During this phase, the hormones progesterone and estrogen rise to keep the uterine lining thick. If a woman is not pregnant, these hormone levels will drop and the lining will shed, bringing it back to phase 1. 

 

When Does the Magic Happen?

Pregnancy occurs during the ovulation phase, which is a very short time frame.

 

It’s vital to know that every woman’s body is different and the length of each phase varies. This is why it’s important to learn your own body, and when your own ovulation actually occurs – or if you are in fact ovulating at all. It can be a confusing process, but learning this can help you navigate the journey of trying to get pregnant. If you have irregular periods or think you may or may not be ovulating while trying to conceive, it’s important to see your doctor right away. There could be an underlying condition impacting your efforts.

 

To learn more about ovulation here’s a helpful link: https://www.verywellfamily.com/signs-of-ovulation-1960281

If you want support learning about your own fertility, consider meeting with Dr. Shala, you can schedule a visit with her here: https://www.pacificreproductivecenter.com/contact/

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What You Should Know About Caffeine & Fertility

For many, daily coffee or tea is a way of life. Perhaps it’s part of your morning ritual, a mid-day pick me up, or a way to finish a meal. Breaking the caffeine habit can be challenging, especially when met with unwelcome symptoms like headaches, dizziness, nausea, fatigue, brain fog, and negative mood. And it’s no wonder caffeine has such an effect on us: it’s classified as a drug because it stimulates the central nervous system, typically causing increased alertness, a temporary energy boost, and elevated mood. 

 

Both coffee and tea, especially green tea, have been touted to some degree for health benefits. Both contain antioxidants and can prevent free-radical damage and reduce the risk of some diseases [R]. 

 

Despite some benefits, couples trying to conceive are cautioned to watch their caffeine intake due to its effects on the fertility of both men and women. 

Caffeine and Women’s Fertility

Evidence appears to be somewhat unclear in the impact of caffeine and fertility, as research sometimes yields different conclusions. Ovarian age is related to four factors, including egg reserve (antral follicle count), follicle-stimulating hormone (FSH) levels, inhibin B (a protein produced by eggs that responds to FSH), and estradiol (a female sex hormone produced by developing eggs). A study completed found that caffeine intake did not appear to affect these factors. [R]. 

 

However, more recent research completed in Japan appeared to indicate drinking coffee inversely correlates with AMH levels [R]. AMH is a hormone that helps doctors estimate the number of follicles in the ovaries and, therefore, a woman’s egg count. The conclusion indicated it is necessary to educate women about the impact their lifestyle has on their fertility. 

 

Studies have shown caffeine can reach follicular fluid (the fluid surrounding the egg) and cross the placenta [R]. Coffee consumption in females wasn’t associated with pregnancy rate, but high coffee consumption may be associated with miscarriage [R]. Caffeine intake is associated with early miscarriage in some large studies [R, R], but not in another [R]. 

 

Estradiol is a female sex hormone produced by developing eggs. The enzyme CYP1A2 is important in the metabolism of both estradiol and caffeine [R]. Multiple studies indicate that increased coffee consumption seems to correlate to less free estradiol and increased sex hormone-binding globulin [R, R, R]. Caffeine intake increases some urine estrogen metabolites [R]. However, some studies show no effects on estradiol level [R, R]. 

 

Caffeine and Men’s Fertility

Women aren’t the only ones impacted by caffeine consumption. It appears overall caffeine negatively affects sperm DNA and sperm count. The integrity of sperm DNA is essential to fertilization and embryonic development. The number of sperm a male produces is an indicator of overall health, and while it only takes one sperm to fertilize an egg, more healthy sperm can increase the chances of fertilization. 

 

One study showed that high doses of caffeine (308 mg) is associated with sperm DNA damage [R]. However, another study showed that it reduced sperm DNA fragmentation [R]. Also, some, but not all, studies show that male coffee drinking is linked to increased time to pregnancy [R]. In young Danish men, high cola and caffeine concentration was associated with reduced sperm concentration and total sperm count [R].

Conclusion

 

The evidence is somewhat mixed for caffeine and fertility in both genders. It’s possible that caffeine alone isn’t the problem but that it exacerbates other pre-existing conditions, lifestyle factors (sleep/stress), or susceptibility among people. Also, genetic variants, such as CYP1A2, may influence caffeine response [R]. 

 

It does appear high doses of caffeine activate the HPA axis [R], a hormonal response system activated in the stress response. It may be safe to consume caffeine (coffee, tea, dark chocolates) from organic sources and in limited amounts. Royal College of Obstetricians and Gynecologists (ROCG) recommends limiting caffeine intake to <200 mg/d or  two mugs of instant coffee [R].

 

Accustom yourself to drinking your coffee or tea black without added milk, soy milk, or sweeteners.  If you are a coffee drinker, light roasts appear to have slightly more health benefits as they are not as burned as dark roasts, and therefore they don’t contain the tars. Decaf coffee has had almost all of its caffeine content removed, although not all. It might be an alternative to caffeine, allowing you to participate in the rituals of coffee time without jeopardizing your fertility. When selecting a decaf, look for one that is a Swiss water processed coffee. The process of decaffeinating most commercial coffees is done by way of chemical extraction with methyl chloride – something you’ll want to avoid. 

 

Unsweetened organic green tea is another safe alternative for your small amount of caffeine consumption. I recommend avoiding colas and similar beverages. Organic dark chocolate with at least 60% cacao and few additives such as sugars and cream can provide approximately 12mg of caffeine per serving. 

 

For more information on how your nutrition and other lifestyle factors can impact your fertility, you can search my resources page or read additional articles on my blog. I also see patients in my offices in Los Angeles, Orange, and Riverside Counties, where I offer comprehensive integrative fertility treatments. You can contact us for an appointment here.

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Endometriosis and Fertility

Endometriosis is said to affect 1 in 10 women during their reproductive years. Perhaps you are one of them. Effects of endometriosis can include painful periods, painful ovulation, pain during and after sexual intercourse, heavy menstrual bleeding, chronic pelvic pain, fatigue, and infertility. [R] This impacts your physical well-being and can impact your emotional health as well.  

 

What is Endometriosis

 

Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”) is found outside the uterus. The condition induces a chronic inflammatory reaction that may result in scar tissue.  [R[ 

Symptoms

 

Endometriosis symptoms can include pain before and during periods, pain in between periods, pain during or after sex, pain when urinating or having a bowel movement (often during monthly periods), difficulty achieving pregnancy, and cysts of endometriosis on the ovaries called endometriomas, also sometimes called chocolate cysts.  [R] Other symptoms may include heavy bleeding during menstruation and fatigue. [R[  Some of the symptoms have been “normalized” to be associated with menstruation in general, and therefore, there seems to be an average delay of seven years between the onset of symptoms and a woman seeking treatment. [R] 

Cause

 

There is no known cause of endometriosis, but it appears to be related to complex interactions of immunologic, hormonal, environmental, and genetic factors. [R]  Women have a higher risk of developing endometriosis if their mother and/or sister(s) are also affected. Gynecological factors such as age when the menstrual period starts, prolonged menstrual flow, and short cycle interval may be possible risk factors. [R] There is some evidence environmental factors such as exposures to toxins such as dioxin (an environmental pollutant) and PCBs can correlate to endometriosis symptoms. [R]

Treatment

 

While there is currently no cure for endometriosis, there are treatments available. Pain medications may alleviate discomfort symptoms, although they do not address other symptoms such as heavy bleeding, fatigue, or infertility. Birth control pills may also be an option in reducing pain symptoms, though this is not an option for treatment if you are trying to conceive. Additionally, some women may not want to be on a hormone-based medication for an extended period of time. Doctors may also recommend surgery such as laparoscopy to remove endometriosis tissue or a hysterectomy depending on the severity of symptoms [R]

 

Treatment options are considered in relation to the patient’s age, desire for children, the severity of symptoms, and the endometriosis stage and should be discussed with your provider. 

How Does Endometriosis Affect Fertility

 

Having a diagnosis of endometriosis does not automatically mean a woman will experience infertility; some women can achieve pregnancy without difficulty. Women who have endometriosis may experience difficulty in achieving pregnancy.  Studies show endometriosis is the cause of up to 50% of infertility cases. [R] The excess tissue growth may cause adhesions, scarred fallopian tubes, or inflammation of the pelvic structures. 

 

Because endometriosis may be caused by an excess of estrogen in the system, some women may also experience altered immune system functioning, changes in the eggs’ hormonal environment, impaired implantation of a pregnancy, and altered egg quality as a result of the hormonal imbalance. [R]

 

Endometriosis and IVF

 

Assisted reproductive technology is the first line of treatment in patients who experience infertility due to endometriosis. [R]  Studies seem to indicate that treatment’s success depends on individual patient factors play the most crucial role in the outcome. Treatment choice depends on the patient’s age, duration of infertility, disease level of progression, and childbearing wish. [R]

Integrative medicine may also provide support with pain management and stress during the IVF process for all patients, not just those with endometriosis. Yoga and acupuncture are two ways patients can manage pain and stress levels. A clean diet and lifestyle also promote healthier estrogen levels, which may support efforts in alleviating some symptoms of endometriosis.  If you seek support around Integrative Fertility Medicine practices as part of your journey, you can contact our clinic for an appointment. 

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How BPA Exposure Can Impact Fertility

You’ve probably heard of BPA when shopping for things like water bottles, food storage containers, and even in your cosmetics like lipsticks, eye and face makeup, and nail lacquers. But do you know what it is and how it affects your health?

 

BPA, or Bisphenol A, was initially developed to be used as an estrogen-like compound for the pharmaceutical industry.  BPA was later used to manufacture plastics, and the plastic industry exploded in the 1950s. The chemical was presumed to be safe by the Environmental Protection Agency in the 1970s, with few animal studies in doses not relevant to humans.  BPA leaches out of plastics long after it is produced, and there are no requirements for companies to prove its safety. 

BPA and Health

BPA is an endocrine disruptor, meaning it mimics or interferes with the body’s endocrine system. Even in low amounts, exposure can alter the body’s endocrine system and lead to health concerns such as breast and other cancers, reproductive problems, obesity, heart disease, and behavioral changes. 

 

BPA has been shown to decrease egg quality and a reduced ability of an embryo’s successful implantation in women. Some research has demonstrated infertile women have higher BPA levels. Elevated BPA seems to adversely affect estradiol levels, the number of eggs produced, egg quality, fertilization rates, and embryo quality. Increased levels of BPA may decrease the success rate of IVF treatments. [R]

 

Multiple studies have correlated BPA exposure with a reduction in various characteristics of sperm quality. Sperm concentration, total sperm count, and morphology were a few of the traits affected [R] Researchers found that BPA can affect sperm integrity even at low levels. 

Steps to Reduce BPA in Your Life

 

  • Ditch the Plastics. At the store, you will commonly see the claim “BPA-free” on products, but that doesn’t necessarily mean it’s safe. When BPA became a customer concern companies started exploring the idea of using other Bisphenols, like BPS, as a substitute in order to place the label BPA-free on the label as a marketing tool.  It is much cheaper for a company to replace the chemical in question with another chemical rather than safely reformulate it. While there are fewer studies on replacement bisphenols, evidence shows very similar side effects in those exposed to BPA. Other things to look for and avoid in plastics are PolyCarbonates (“PC”) or recycling code #7, as these may contain BPA. 

 

Seek alternatives such as glass or stainless steel water bottles, glass food storage containers, or natural food wraps such as beeswax for bringing lunches on-the-go. 

 

  • Choose Fresh or Frozen Over Canned.  Fresh, organic, locally grown, in-season produce is best when available. Otherwise, choose fruits and vegetables that have been flash-frozen to protect as many of their benefits. Canned fruits and vegetables may be at risk of exposure to BPA, which is often found inside the can linings. 

 

  • Practice Clean Beauty. A database of safe cosmetics and body care products can be found on Skin Deep, provided by the Environmental Working Group.  EWG is a non-profit, non-partisan organization dedicated to protecting human health and the environment. Some of the health and personal care products contained in the database are EWG Verified, meaning the products are free from harmful chemicals, provide full transparency in labeling, and follow good manufacturing practices. Other products rated on a scale from 1 to 10 indicating least to most damaging in terms of your health. BPA is one of the many toxins EWG screens. 

 

  • Limit Your Exposure to Receipts.  Paper such as sales receipts, plane, and concert tickets all have a BPA coating that gives them that smooth texture.  If your employment causes you to come in contact with a large volume of receipts, it’s essential to protect yourself from BPA exposure. You may ask to work with gloves and, if this is not an option, be sure to wash your hands often. If you are a consumer, you can limit your exposure by asking for an emailed receipt whenever possible, declining receipts you don’t need (this will help the environment too!), or by handling the receipt as little as possible and washing your hands with soap and water as soon as you are able. 

 

  • Avoid Use of Hand Sanitizers. Hand washing is always preferred to hand-sanitizer. However, due to COVID-19 and flu season around the corner, hand-sanitizer seems to be everywhere. When soap and water isn’t an option, use it, but know that hand sanitizer can increase absorption of BPA after touching receipts into your body of 10-100X! That’s an alarming percentage; stick to soap and water as a best practice. 

 

Reducing or eliminating toxins, such as BPA, is an easy step you can take at home to begin steps to a cleaner lifestyle. There are many other components to integrative medicine that can impact fertility that I suggest to patients.  You can learn more from my eBook, download it today.

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