Are your health and fertility being affected by something invisible, something that you may not even know how to pronounce? While some of us have heard about BPA, phthalates (pronounced THAL-ates) have been discussed less often. Unfortunately what you don’t know about phthalates may, in fact, be hurting you.

So what are phthalates?

Phthalates are a group of chemicals added to plastics for a variety of reasons. Some phthalates are added to make the plastic more pliant and malleable, while others help scented products to retain their fragrance for a longer period of time. Still others help bright colors retain their vibrancy. Because of the variety of phthalate usages, you may have heard them called “the everywhere chemicals.” Phthalates can be found in a wide variety of items you encounter everyday, from shampoo to nail polish, from vinyl flooring to detergents and fabric softeners.

Just like these “everywhere chemicals” are added to products for various reasons, they can each act on the human body in a variety of ways. All phthalates, however, disrupt the endocrine system, which affects hormone production.

How might phthalates affect fertility?

Research indicates that women tend to have more side effects from phthalate exposure, possibly because they tend to use more phthalate-containing products on a daily basis. In fact, the average American woman uses 10-12 beauty and personal care products throughout the course of her day! Some sources have estimated that the average woman is exposed to over 150 hormone disrupting chemicals over the course of one day! Several studies have also shown that women living with endometriosis have higher levels of certain phthalates in their bloodstream than their peers without this condition. Other phthalates are known to interfere with egg development and cause genital malformations in fetuses of women who have exposure.

Although males may experience less exposure to phthalates through personal care products, they are still exposed to these chemicals many times over the course of a day. These exposures are not without their negative effects on men either: higher phthalate levels have been linked to diminished sperm count, poor sperm quality, and even an increase in the incidence of prostate cancer.

Phthalate exposure during conception and pregnancy

One convincing argument for decreasing your exposure to phthalates, particularly while trying to conceive, is the association between high levels of phthalate and pregnancy loss and preterm births. Phthalate exposure seems to be most risky for male fetuses, who cazz4n be born with malformations in the genital tract after in-utero exposure to phthalates. Children exposed to these high levels in the womb may also be more likely to experience congenital defects, slow growth, and a late onset of puberty.

How to reduce phthalate exposure

With all these risks and very little benefit to the consumer, you may find yourself wanting to decrease your phthalate exposure but feeling a little overwhelmed by all the changes you’d need to make. It’s usually not feasible (or financially prudent!) to replace every product at once. Baby steps are the way to go.

Get in the habit of reading labels on the products before you buy them. Phthalates can be listed as an abbreviation like DnOP or BBzP, or the ingredients may simply list “parfum” or “fragrance.” The easiest way to identify whether a product uses phthalates or not is to look it up on the Environmental Working Group’s “Skin Deep” database. The EWG is a nonprofit, nonpartisan group that helps consumers make informed decisions about a product’s ingredients before purchase. You can easily search the Skin Deep database by ingredient, brand, or product, and they even have apps for iPhone and Android for clean shopping on the go! 

Another baby step you can take is reducing the phthalates in your period products, like pads and tampons. The vagina and vulva are extremely permeable, and using chemical-laden products in this area of the body means phthalates are absorbed more quickly and easily. When looking for feminine hygiene products, then, it’s important to avoid any scented products on this sensitive part of the body. You can also spring for a menstrual cup, cloth pads, or “period panties,” which require more of an investment up front but can be reused cycle after cycle.

One very easy way to avoid unnecessary phthalate exposure is to stop using vaginal washes or douches. The vagina is a self-cleaning body part, and there is no need to wash it with soap or any other product. In fact, women who use these rinses just twice a month were found to have 152 percent higher levels of certain phthalates present in their urine!

Another area to examine is the health and beauty products you use that are applied to a very large portion of the body, such as lotions. Products like these also are not rinsed off of the skin after use, so there is more of an opportunity for phthalates to continue accumulating in the body throughout the day. Examining your hairspray ingredients might also be a small change with a big payoff, since this product is absorbed through the skin but also inhaled in fairly large quantities while it is being applied.

Replacing your scented household cleaning products can be cost effective too: you can use inexpensive castile soap, vinegar, baking soda, water, and a little elbow grease in place of those pricey, heavily scented cleaners.

Avoiding fast food and eating primarily whole foods can cut phthalate intake significantly, as well as adding many other benefits for your fertility! Dairy and meat are known to contain high levels of phthalates, so try to choose other sources of nutrition when possible. When preparing meals at home, focus on using glass or stainless steel food storage containers, particularly when dealing with foods with high fat or high oil content. You can also swap out your plastic water bottle for stainless steel while you’re at it!

Attempting to make all these changes at once can very quickly lead to overwhelm and burnout, but if you can replace items with phthalate-free alternatives when you need to replace them anyway, cleaning up your routine can be simple!

Do you have more questions about how phthalates and other environmental toxins might be affecting your health and fertility? Get in touch with us today!

Polycystic ovarian syndrome, or PCOS, is a collection of symptoms associated with an imbalance in reproductive hormones. This hormonal imbalance can lead to symptoms like weight gain, thinning of the hair on the head, heavier growth of hair on the face and torso, acne, and irregular menstrual cycles. Although PCOS is frequently discussed in relation to fertility, lots of inaccurate information about PCOS is conveyed as fact. Below we will take a look at some of the most common misconceptions about polycystic ovarian syndrome.

PCOS Myth #1: PCOS is rare.

Actually, it is estimated that about ten percent of women of childbearing age in the United States meet the diagnostic criteria for PCOS! Many of these women haven’t even been diagnosed. Personal health is a sensitive topic, and a diagnosis of PCOS may be difficult or painful for a woman to share, particularly if she is struggling to conceive. Thus many women are not comfortable talking about their diagnosis openly. But odds are that you know more than one person who is affected by PCOS.

PCOS Myth #2: Patients with PCOS have lots of cysts on their ovaries.

It would be easy to draw the conclusion that with a name like “polycystic ovarian syndrome,” PCOS would involve lots of cysts on the ovaries. In reality, PCOS is poorly named. The hormone imbalances involved in PCOS can cause changes in the ovaries, typically women with PCOS have a greater number of ovarian follicles than their age matched counterparts. Ovarian follicles are normal, and no treatment or surgery is needed.  Women with PCOS are not at greater risk of developing cysts. 


PCOS Myth #3: All women with PCOS are overweight. You can’t have PCOS if you are thin.

Although undesired weight gain is one of the hallmark symptoms of PCOS, nearly one third of women with PCOS are not considered overweight or obese. Lab work should be performed to assess for hormonal imbalances if other symptoms are present, because PCOS patients in a healthy weight range can still have other difficulties. And regardless of a patient’s body size, PCOS patients can benefit from healthy eating practices and adding more movement to their routines.

PCOS Myth #4: PCOS can be diagnosed through blood testing alone.

Because PCOS is caused by an imbalance in reproductive hormones, many patients believe that blood tests Unfortunately nothing about medical diagnosis is that simple. Although bloodwork is a vital part of the PCOS diagnosis, the process is much more thorough than that. Diagnosing PCOS involves a comprehensive physical examination which includes laboratory testing and pelvic ultrasound. Your provider will also take a detailed medical and menstrual history.

PCOS Myth #5: Irregular periods mean that you have PCOS.

PCOS can, and often does, cause irregular menstrual cycles due to problems with ovulation. But there are lots of other things that could be causing irregular cycles as well, so consultation with a medical professional is essential! If your menstrual cycles are longer than about 35 days, bleeding is significantly lighter or heavier than normal, or you experience spotting between periods, talk to your healthcare provider to determine the cause.

PCOS Myth #6: Oral contraceptives cure PCOS.

Oral contraceptives are frequently prescribed for PCOS, and they can help control symptoms and regulate your cycle. Birth control pills can play a role in the treatment of PCOS. However, these are not a cure. If you are trying to conceive, however, other options that are more in line with your goals can be utilized. Work together with your doctor to make a plan that is right for you.

PCOS Myth #7: A diagnosis of PCOS means I need to follow a specific diet.

Despite the popularity of the gluten-free and keto diet plans, you don’t need to try these diets to control PCOS symptoms. The Mediterranean diet is a balanced eating approach that is commonly used for PCOS, and includes foods that are rich in antioxidants, folate, and vitamin D. (These nutrients can all positively contribute to hormone regulation.) A Mediterranean diet includes minimally processed, whole foods. This means choosing fresh fruits and vegetables, fish, nuts, and including healthy fats such as avocados and olive oil. Limiting simple carbohydrates, as well as including lots of leafy greens, is also an integral part of the Mediterranean diet.

PCOS Myth #8: PCOS makes it impossible to get pregnant.

A large percentage of women diagnosed with PCOS may seek assistance to conceive with a medication like Clomid or letrozole. If you are attempting to conceive with a partner, both of you should be evaluated despite your PCOS diagnosis. The lifestyle modifications mentioned above may also help alleviate unwanted symptoms and gently encourage your body toward hormone regulation, which can lead to a higher chance of conception. Our integrative fertility practices combine traditional medicine, alternative therapies, and lifestyle practices, giving you access to the “best of both worlds” in your journey.

Do you have any of the signs and symptoms of PCOS, such as irregular menstruation, thinning hair, acne, or weight that can be difficult to regulate? Contact us today to schedule a consultation with Dr. Salem to discuss your options!

If you have struggled to conceive despite regularly engaging in unprotected sex, one of the many possible medical interventions that your doctor discusses with you might be intrauterine insemination, or IUI.

What is IUI?

IUI allows the sperm to bypass the vaginal canal and cervix by placing the sperm directly into the uterine cavity. The procedure is timed to happen as close to ovulation as possible to maximize your chances of conception. During intercourse, it is not uncommon for some sperm to be left in the folds of the vaginal wall, never quite completing its journey to meet the egg. Sperm can also encounter problems penetrating a tightly closed or scarred cervix or surviving a vaginal pH that may be slightly too acidic.

Why might I need IUI?

Although in-vitro fertilization may be the most well-known type of fertility treatment, IUI is both less invasive and less expensive. (Many insurance companies that cover IVF even require the patient to attempt a certain number of IUI cycles before they will cover any of the more invasive procedures involved in IVF.)

IUI may be recommended as a first line of treatment for patients trying to conceive using sperm from a donor. IUI may also be an option for couples who are unable to have sexual intercourse during the fertile period, either due to sexual dysfunction or a partner who travels frequently or is deployed. In cases of separation or donation, sperm can be frozen for use in future IUI cycles. IUI may also be a good option for couples dealing with sperm motility that falls in the borderline-low to normal range. Some cases of unexplained infertility, especially in females under the age of 38, may also benefit from IUI.

To be a candidate for IUI, patients need to have at least one open fallopian tube and a sufficient number of motile sperm.

What is involved in the IUI process?

Medications: IUI can be completed with or without medications to induce the growth of one or more eggs. Your doctor may recommend that you take letrozole or Clomid for five days, usually early in your cycle. Injectable medications can sometimes be used as well. Injectable prescriptions are typically a bit more powerful than oral medications, which is why most physicians prefer to try IUI with an oral medication first. You may also be prescribed a one-time hormone injection to trigger the release of one or more of the mature eggs.

Monitoring. Depending on whether a cycle is medicated or unmedicated, your provider will discuss ways to monitor your hormone levels. In a natural cycle, you will time your IUI or trigger shot with your natural ovulation. During a medicated cycle, this may include urine ovulation tests, bloodwork, or pelvic ultrasound. (Ultrasound is more commonly used when medications are prescribed along with the IUI cycle.)

Sperm collection and processing. A semen specimen is provided either by your partner or a sperm donor. The semen then undergoes a process called sperm-washing in a lab. Fresh or frozen semen can both undergo the sperm washing procedure. During this process, the sperm is separated from the rest of the seminal fluid.

Insemination procedure. The insemination itself is a fairly simple process. Once you and your physician have identified that you are ovulating, the washed sperm is placed into a very thin cannula with a syringe at the end. Most patients describe this procedure as causing minimal discomfort, and it might feel similar to a pap smear. Anesthesia is not required, and the insemination itself takes less than five minutes. You may be asked to remain on your back for several minutes after the insemination. There are no activity restrictions or bedrest requirements after IUI.

What is the success rate of IUI?

The overall success rate of each IUI cycle is between 10 and 20 percent, but much of this depends on the reasons for IUI being performed and the age of the female. Chances may be higher in patients with no known fertility challenges, such as couples unable to have intercourse due to travel or sexual dysfunction and patients using donor sperm. The age of the female is one of the most important determining factors to success rates of IUI cycles.

When do I find out if I am pregnant?

After undergoing a procedure like IUI, you will likely be anxious to find out whether or not it has resulted in a pregnancy.  Bloodwork or a urine pregnancy test should be accurate about 14 days after the IUI procedure. If you attempt a home pregnancy test before this time, you may receive a false positive result because of the hormones in the trigger shot.

If you are having difficulty conceiving, contact us today to discuss whether IUI could be an appropriate option for you!