If you’ve been diagnosed with PCOS (polycystic ovary syndrome), you are likely familiar with at least a few of its hallmark signs. But did you know that up to half of all women with PCOS are at risk of developing a mental health condition? Since so many mental health challenges go undiagnosed, this means that perhaps some of the most devastating effects of PCOS aren’t even being connected to PCOS.

A quick overview of PCOS

Simply put, PCOS is a reproductive hormonal imbalance. This doesn’t always mean that the ovaries have multiple cysts (though its name certainly does seem to suggest this!) More commonly, signs of PCOS include irregular menstrual cycles, thinning of hair on the head, thicker and darker hair growth on the face, acne, and undesired weight gain.

What’s the connection?

The symptoms described above are the ones most frequently discussed with PCOS. But it is just as important that we discuss the mental health implications of PCOS. These conditions span the gamut from mood disorders to eating disorders. Studies have found a significantly increased risk of major depressive disorder, generalized anxiety disorder, binge eating disorder, obsessive compulsive disorder, and bulimia.

Unfortunately hormonal birth control, often prescribed for the control of PCOS symptoms, has also been linked to depression. This can often be a chicken-egg scenario, where it is unclear which factor led to the mood dysregulation. It’s always best to chat with your healthcare provider about your particular situation!

In years past, people believed that the mental health struggles of PCOS patients were caused by poor body image. It was thought that this poor body image resulted from undesired physical changes such as acne or weight gain. Research has since debunked this belief. In reality, PCOS patients deal with depression in similar numbers, regardless of their body weight or skin condition.

Treatment matters!

Unfortunately, patients have sometimes been told that their PCOS doesn’t need treatment if they are not currently trying to get pregnant. This leaves the mental health implications of PCOS ignored and untreated, which is completely unnecessary!

Depression, anxiety, and other mental health challenges can be difficult to deal with. This can be especially true when you’re dealing with infertility, which has emotional challenges of its own.

When you’re dealing with symptoms of depression, anxiety, or any other mental health challenge, it’s important that you focus on the basics of health. Work on developing proper sleep hygiene, including a regular bedtime and wake-up time. Take a walk around the block and stretch on the floor a bit. Self-care during this time is vital, so don’t be afraid to make time to read a novel or just kick your feet up. Work to reduce stress wherever possible.

Avoid overly restrictive diet plans, and concentrate instead on reducing processed foods. Keep quick snacks in your kitchen, like fresh fruits and veggies that are already cut up, string cheese, Greek yogurt, or nuts available. These are easy to grab on-the-go or when you just don’t have the energy to prepare a meal. (Lack of energy and motivation can often be a very real part of mental health challenges!) There is no “correct” way of eating that is perfectly suited to every PCOS patient, but all can benefit from reducing processed foods.

Many antidepressant medications are safe for use during fertility treatments, but be sure that all your healthcare providers are aware that you are currently trying to conceive.

Don’t try to go it alone!

But don’t try to do it all alone! Reach out to a friend or family member who cares about you. There is also a large array of mental health support groups available, both in-person and online. Find a licensed mental health professional who can help you work through some of the challenges in your life. There are even therapists who specialize in mental health and infertility!

If you have been diagnosed with PCOS, it is vital that you collaborate with your healthcare provider to seek optimal physical and mental health. PCOS is not reversible and currently has no known cure. But you can support your body and mind through lifestyle modifications that can make a huge impact on the way you experience PCOS!

Next steps

Have you been diagnosed with PCOS, or do you believe you may have any of the symptoms mentioned above? Dr. Salem’s unique, integrative blend of alternative and conventional medicine is tailored to suit the individual needs of each patient. This holistic view accounts for both physical and mental wellbeing. We understand that each of these aspects impacts the other.

Reach out to us to schedule a consultation to discuss your options. We look forward to meeting with you!

“How do our ages affect our chances of conception?” This is one of the top questions that patients ask each day in fertility clinics around the world, and it is becoming more and more relevant. More individuals than ever are choosing to delay their attempts to conceive due to educational choices, career opportunities, or personal decisions. (In the United States, the average first time mother gives birth around five years later than she would have in 1972.)

Fortunately, there is fairly clear data to answer this question! A woman’s age is one of the most reliable factors in predicting natural conception and her success with various fertility treatments. The quality of a woman’s eggs as she ages is the main concern.

How does aging affect a woman’s eggs?

Many people are surprised to learn that a woman’s body doesn’t continue creating eggs throughout her lifetime. Female infants are born with all the eggs they will ever have. (This number is usually around one million eggs!) This number declines to about 300,000 by the time she begins menstruating. Eggs continue to decline in both quantity and quality throughout a woman’s lifetime until she reaches menopause. This decline unfortunately means that the rate of fertility declines with age as well.

This decline in egg count and egg quality continues regardless of whether or not a woman is ovulating regularly or at all. Women who don’t menstruate regularly due to hormonal birth control, reproductive hormonal imbalances, pregnancies, or lactation still see a steady decline in their egg quality and number of remaining eggs. Modern medicine hasn’t yet found a way to slow this process.

Now, this decline in fertility can be very different from female to female. (Average age at menopause is 51, but this can be affected by a broad range of factors including hormonal contraceptive use, smoking history, childbearing, and physical activity level.) This fertility decrease generally coincides with the timing of a woman’s menopause, so women who enter menopause earlier will likely see their egg counts decreasing earlier as well. 

Why do eggs decline in quality with age?

After being released from the ovary, eggs divide their genetic material. When a mistake happens during this division process, the egg will contain an abnormal number of chromosomes, which can lead to congenital anomalies, high risk pregnancies, and pregnancy loss. This division of genetic material becomes more difficult with age, and it becomes more likely that these chromosomal abnormalities will occur.

While a woman attempting to conceive in her twenties may have a one-in-four chance of conceiving in any given month, someone who is over forty has around a 3 percent chance of natural conception during each menstrual cycle. Sadly, pregnancy loss is also much more common as maternal age increases.

What about male partners? 

Is sperm quality affected by age as much as egg quality? While age does impact male fertility, the impact does not seem to be quite as large, and the correlations are not as clear. Male aging is associated with some decline in level of sexual health, but it is important to keep in mind that these correlations don’t necessarily mean that age is their cause.

As a man’s age advances beyond about 40, he can see an increased risk of genetic damage to the sperm. This can lead to chromosomal abnormalities in his offspring, such as Down syndrome or XYY syndrome. Sperm morphology (size and shape) and motility (ability to swim) decrease as age progresses. Older men are more likely to produce offspring with autism and schizophrenia, and the partners of these men more commonly experience miscarriage and pregnancy complications such as preeclampsia. These female partners are also more likely to require a cesarean birth due to higher risk pregnancies.

Sexual dysfunction can also lead to fertility concerns, as issues like erectile dysfunction and reduced libido may affect his ability or desire for intercourse, further reducing the chance of conception with his partner.

There is hope!

The information above might seem a bit overwhelming, but our intent at The Integrative Fertility M.D. is to arm you with the data you need to make informed decisions about your care. Due to the potential concerns mentioned here, we recommend seeking help in conceiving after six months of unprotected sex if you are over the age of 35, right away if you are over age 40, or whenever you have any concern about your age.

Dr. Salem has personally worked with hundreds of couples where one or both partners were in their forties who have gone on to have successful pregnancies and healthy births. Our unique combination of traditional medicine and natural lifestyle modifications can help optimize your fertility regardless of your age.

Do you have more questions about your age and fertility? Connect with us to consult with Dr. Salem about how to maximize your chances of conceiving regardless of your age. We look forward to hearing from you!

When you’re going through fertility treatments, there can be many stressors involved. Emotions and tensions can both run high. It’s not uncommon to feel anger, jealousy, hope, anxiety, isolation, optimism, desperation, or heartbreak throughout the course of a menstrual cycle. It’s even normal to feel all these emotions in a single day.

Because of the wide range of emotions, medications, and procedures involved in fertility treatments, it’s natural to stay focused on the end goal of achieving a pregnancy and carrying it to term. It can be easy to hyperfocus on this desired outcome. Resist the temptation to put your head down and “grin and bear it” through the difficulty. Make time for yourself despite the stress.  Self care can involve many aspects of life, and many items on this list may not resonate with you. Don’t let taking care of yourself become just one more thing on your to-do list. Pick out a few of these suggestions to try implementing and see how they work for you!

Aim to spend more time outdoors. Besides just helping you get more vitamin D and boosting your immune system, spending time outside can help boost serotonin production and increase your mood. Many people say that spending time in nature helps them to put the stress of their daily life into perspective. Bonus points if you can incorporate exercise into this outside time!

Take time to connect with your significant other. If you are undergoing fertility treatments with a partner, it can feel like infertility has taken over your relationship. This can be especially true of your sex life. Do a check-in to see how he or she is feeling, and be open and honest about what’s going on with you.

Find a therapist. Fertility treatments can be stressful! Having a mental health professional available to help you process your emotions can be a lifesaver. There are even therapists who specialize in infertility topics.

Practice meditation or prayer. Regardless of whether you consider yourself spiritual or religious, implementing a few quiet minutes per day for meditation or prayer can help you feel centered and provide some strength to carry with you throughout the day.

Journal. Whether it’s jotting down a few things you are grateful for at the end of each day or focusing on how you feel about the latest fertility treatment you are trying, journaling can assist you as you process your thoughts. Even if you scribble your thoughts on a napkin that you proceed to throw in the garbage, the process of putting pen to paper (or paper towel?) can help you organize your thoughts.

Make sleep a priority. Sleep can sometimes seem like a waste of time when there is so much to do, but it makes a real difference in our moods and health. Commit to a specific bedtime every night for a week and see what kind of difference it makes!

Connect with friends. Whether it’s reaching out to a friend through a quick text message or meeting for a meal, friendship can be a great source of support during difficult times.

Take time to relax. Relaxation is different for each of us, but some suggestions may include getting a facial or a pedicure, going for a hike, reading a novel, or taking a warm bath.

Seek out healthy snacks. Keeping blood sugar in balance and including plenty of protein and healthy fats can make a world of difference in mood and energy level.

Reach out to others in your community. Pitching in to help with a recycling drive or women’s shelter may not feel like self care, but giving back to the community can be a great way to gain perspective on the world and help someone else when you feel helpless about your own situation.

Be mindful. Take sixty seconds at several points throughout the day to zero in on what you are feeling in that moment. Suspend judgment of your environment or your feelings and just focus on being present in that moment.

Keep yourself hydrated. Even though we know the benefits of hydration for general health, it’s tempting to use caffeinated beverages to give you the energy to power through your day. Make sure to have a water bottle with you at all times, and take sips from it frequently throughout the day.

Give yourself grace. Infertility and some of the medications used during fertility treatments can lead to mood swings. Acknowledging this in advance can help mitigate a little of the frustration you feel if you find yourself being impatient. You’re allowed to be human!

Let it go. We all hold tension in different parts of our bodies. If you know that you tend to furrow your eyebrows, tense your shoulders, or clench your fists when you’re anxious, check in with your body throughout the day. Work to consciously release these muscles.

Go on a social media hiatus. The modern day “miracle” of social media allows us to stay in touch with friends and family all around the world! But it can also lead us to compare our own real lives to the highlight reel that others choose to post. Stepping back from social media (especially when you’ve been dealing with feelings of jealousy or resentment) can be an important part of self care.

Self care doesn’t have to be fun!

When self care is mentioned, many of us immediately think of some of the fun, indulgent activities listed above, like getting a massage. But self care can be anything you do to take care of your future self! If you’re stressed out about what to make for dinner this week, sitting down to make a meal plan can be self care.

Infertility can be stressful, but we are here to help you navigate the process every step of the way. Reach out to see how we can help you!

We all need it to survive, but very few of us feel that we get enough of it on a consistent basis. What are we talking about? Sleep.

You know you feel more alert, energetic, and ready to take on the day ahead after a good night’s rest. But a solid 8 hours of sleep may feel like a pipedream in our hectic, fast-paced society. We know we should aim for 7 to 9 hours of quality sleep per night, but it can be difficult to make rest be a priority when there’s so much else to be done. Particularly when you’re undergoing fertility treatments, getting enough sleep can feel like just one more item on the “to do” list.

Why sleep matters

Beyond the advantage of waking up feeling refreshed and motivated to take on the day, research has shown that a lack of sleep is linked to health problems like heart disease, high blood pressure, and diabetes. Part of this may be due to the fact that sleep-deprived people also tend to have less energy to make health-conscious decisions, and exhaustion may lead to seeking out simple carbohydrates like candy for a quick energy boost.

Sometimes the insomnia-stress cycle can seem endless: when you’re experiencing stress, anxiety can keep you staring at the ceiling for hours. But being deprived of sleep can also cause higher levels of stress, which can lead to more sleeplessness!

Experiencing stress is very common when you’re facing the challenges that come with infertility, and it can be difficult to make sleep a priority when you have so much on your mind. While current research is inconclusive about a connection between stress and fertility, we do know that anything you can do to boost your general wellbeing can also help your fertility.

Here are a few things you can do to get more rest despite the uncertainty of infertility.


Ways to optimize your sleep and care for your health

Here are a few steps you can implement to make your sleep as restful and rejuvenating as possible.

  • Wake up at the same time each day. Though it may seem counterintuitive, waking up at the same time each morning (yes, even on weekends!) can help “reset” your internal clock so that you know you’ll be tired when bedtime arrives.
    • Incorporate regular movement into your day. One of the many benefits of exercise is that it can lead to more restful sleep. It’s ideal if you can schedule your workout earlier in the day so that your body has time to wind down a bit before bed, though.
  • Limit caffeine. Caffeine, while safe in moderation while trying to conceive, can keep you awake much later than intended if you consume it too late in the day. If you find yourself having difficulty sleeping after drinking coffee, tea, or eating chocolate, try to limit these treats to earlier in the day. (Limiting caffeine consumption to before lunchtime or early afternoon is usually sufficient.)
  • Cut back on the bedtime snacks. Try to stop eating about 2 hours before you’d like to go to sleep. This gives your digestive system a chance to settle down for the evening and can also cut back on heartburn or indigestion that can keep you awake.
    • Limit screens before bed. Make it a goal to unplug from your devices about an hour before lights out. Artificial blue light inhibits the production of melatonin, an important sleep hormone, which can keep you awake much longer than you had planned!
  • Find a calming evening ritual. Since you’re not checking social media or reading one last chapter on your e-reader, find some activities that you find relaxing to help you settle in for the night. This could include journaling, a warm bubble bath, some gentle stretching, or meditation.
  • Keep your bedroom cool and dark. You can hang room darkening blinds in your windows if street lights keep you awake. A little bit of ambient noise such as a fan can help to cover up any sounds from traffic and other disturbances outside. Keeping your bedroom at a cool, comfortable temperature is also more conducive to sleep. (Most experts recommend a temperature between 60 and 68 degrees.)
  • Make your bed your “sacred space.” As tempting as it may be to try to catch up on email or take business calls from the comfort of your bed, this can form an association in your mind between your bed and your work. Find another place to check your laptop, even if it’s just a chair beside the bed, and try to limit your in-bed activities to sleep and sex.

Do you struggle with keeping a regular sleep routine due to stress from your busy life, anxiety related to fertility treatments, or any other roadblocks to healthy sleep? Contact us today to set up a consultation with Dr. Salem to discuss how we can help you!