When it comes to fertility, one of the most important stages of a woman’s cycle is the ovulation phase. Ovulation is when the mature egg is released from the ovary. Ovulation generally takes place approximately mid-cycle, but the days can vary. If a woman experiences irregular cycles, she will ovulate irregularly (ogliovulation). Some women may have irregular cycles and experience anovulation

 

The Importance of Ovulation

The mature egg must be released from the ovary in order for pregnancy to occur. The window of ovulation is a small 12-24 hours, so knowing when your body ovulates can increase your chances of getting pregnant. More importantly, learning your body’s ovulation cycle, or lack thereof, can be an early indicator of the need for medical assistance. 

 

Am I Ovulating?

If your periods are regular, it’s likely that you are ovulating. However, there are exceptions and although you wouldn’t have a real period without ovulation, the endometrium can still shed, leaving you to believe (understandably) that you’ve had a period.

 

There are many ways to detect ovulation, but few are a guarantee. If you’re having trouble pinpointing your ovulation, or suspect you may not be ovulating regularly, it is important to seek advice from a medical professional. 

 

If your cycles are regular, there are a few ways you can try to identify your ovulation at home. 

 

BBT Charting

BBT is an acronym for Basal Body Temperature, which is the temperature of your body upon waking. Your BBT can rise slightly after ovulation. This method can help you learn when or if you are ovulating. Charting your BBT does not tell you when you are ovulating while it’s happening – it can only confirm it after it’s happened. Therefore, if you want to use the charting method, you need to commit to it for a few months. You’re looking for a pattern, to predict when your future ovulations will occur. While this can help give you insight into your ovulation patterns, there is a great deal of room for error. If you are sick, stressed, taking your temperature at different times of the day, or have disrupted sleep, you can get an inaccurate reading. Should you decide to keep track of  your BBT, here are some tips to help you get the most accurate results:

  • Take your temperature immediately upon waking. This means before you do anything. Even before you sit up! Since the temperature elevation is so small, even the smallest of actions can interfere. 
  • Use basal body temperature digital thermometer for accurate results.
  • Stay on a schedule and wake up at the same time each day. 

 

Urine Test Kits

LH (Luteininzing Hormone) is released from the body shortly before ovulation and that is what ovulation tests are detecting. Getting a positive result means you’ve had an LH surge, and ovulation will take place 12-36 hours later. It is recommended you begin testing on day 11 of your cycle and continue until you ovulate, or until day 20 (whichever comes first). The kits are similar to pregnancy tests, where you use a urine sample. The manual tests require you to compare a line to a control line and can be hard to read, leaving you more confused. Digital test kits are pricier but will give you a straightforward result. Be sure to follow the manufacturer’s instructions, as each brand and type of kit can vary. It’s important to note that these tests are not foolproof. It is possible to get a false positive. Additionally, if you have absent or irregular cycles, these tests will not be helpful and may prove to be nothing more than frustrating.

 

Pay Attention to Your Body

While none of these symptoms are a guarantee of ovulation, there are signs your body can give you. Keeping track of these can help you detect ovulation. You may experience some, all, or none.  Here are a few things to look for:

 

  • Ovulation pain: A sharp pain in your abdomen, approximately mid-cycle
  • Increased sex drive
  • Raw egg-like cervical mucus: Log the appearance of your cervical mucus throughout your cycle. When it becomes thicker and stickier, like a raw egg, you could be ovulating.
  • Breast tenderness: This is usually noticed after ovulation

 

I Think I’m Ovulating! What now?

If any of the above methods have helped you detect your ovulation, you want to have sex regularly 5 days before and the day of ovulation

 

When to See a Doctor

If  your periods are irregular, abnormally long, or abnormally short, the above methods may be of little-to-no help. If any of the following apply to you, it is time to see your doctor:

 

  • You are under 35 and you and your partner have had unprotected sex for 1 year
  • You are over 35 and you and your partner have had unprotected sex for 6 months
  • You have irregular cycles
  • You are 40 or older

 

When you are trying to conceive, those months of negative pregnancy test results can be painful as you count them off, waiting until your medical professional will refer you for additional testing.  The accepted definition of infertility is when couples do not achieve pregnancy on their own after one year of unprotected intercourse in women under 35 years of age, and after six months in women 35 or older. Other terms you may hear when referring to infertility may be “subfertility” or “fecundability.” Fecundability is perhaps more accurate because it refers to the probability of achieving pregnancy within a menstrual cycle. 

 

Infertility affects as many as 15% of couples within the United States every year. Of those couples, about ⅓  of cases are a result of a male factor, ⅓ of all cases are  a result of a female factor, and ⅓  from a combination male and female causes or unknown causes. [R]  The ability of a couple to become pregnant and sustain a pregnancy may be a result of biological, systemic, or environmental factors. 

Causes of Infertility

Women

 

Some causes of infertility in the female partner are easily identified.  These may include physical causes such as tubal blockage, endometriosis scarring or inflammation that may affect implantation, or uterine abnormalities causing problems with achieving or maintaining pregnancy.

 

Other factors related to female infertility may be less immediately recognized and could include endocrine or systemic disorders including hormonal imbalances that affect ovulation (PCOS or hypothalamic disruption are two examples), premature ovarian failure, or excess prolactin. [R

 

Men

 

Physical disorders such as testicular defects resulting from trauma, torsion, cancer, epididymitis, and hypogonadism are also reviewed. There may also be male reproductive tract disorders caused by infection or inflammation. 

 

Endocrine or systemic causes make up about 2 – 5% of male infertility cases. They refer to dysfunction of the hypothalamic-pituitary-gonadal axis, and like most hormonal pathways within the body, are sensitive to disruption and can be indicative of other disorders. [R]  

 

In approximately 2-5% of cases, no cause of male partner infertility can be identified, known as idiopathic infertility. 

 

You will find more detailed information about male infertility in my blog article Male Infertility.

What Happens When I See a Doctor for Infertility?

 

Many times the initial process or portions of an infertility consultation can be done by a general practitioner or an OB-GYN. They may begin a medical history, physical examination, or request lab work. For males, a semen test will also be conducted.

 

The medical professional will pay special attention to anything that might provide clues about infertility, such as sexual development during puberty, sexual history, any illnesses or infections, surgeries, medications, and exposure to environmental factors. Menstrual history, including absent or irregular periods, is especially helpful. [R

 

Bloodwork may reveal necessary information such as the presence of luteinizing hormone (LH) levels, including follicle-stimulating hormone (FSH), prolactin (a pituitary hormone) will also be collected. Markers for hormones affecting female fertility, estradiol, anti-mullerian hormone (AMH), TSH (thyroid), and progesterone function are also collected. 

 

For men, the semen analysis will provide valuable information regarding the health of the sperm through examining the number, motility, and shape of the sperm.

 

Should any preliminary tests or examinations return abnormal results, the individual or couple may be referred to a specialist for additional testing and evaluation.  There is sometimes a need for additional testing, which will be determined by your provider.

 

Integrative Treatment Options for Infertility

 

Fortunately, there are treatment options to support couples in their journey through infertility. I have chosen a model based on an integrative approach that combines natural methods such as yoga, meditation, acupuncture, and healthy foods, along with assisted reproductive technology. I have found these basic practices towards reducing stress, hormone balancing, reducing exposure to toxins, and achieving optimal wellness to support fertility and pregnancy enhance the body’s fertility and pregnancy ability. 

 

A list of resources and their benefits is included here on our site. Additional articles are included in the blog to provide information on how each discipline can complement traditional medicine and your fertility journey. I also invite you to sign up for my resource eBook, Jumpstart Your Fertility, which provides simple practices you can begin with at home if you are experiencing infertility. 

If you’d like to schedule a consultation for fertility testing, contact Pacific Reproductive Center today. 

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/

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.

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. 

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.

The holidays are typically a time for gatherings with family members, spending time with those you love, and celebrating family traditions. For couples struggling with infertility, the holidays and spending time with family may not hold the same joy and excitement as years past. During the holidays, couples struggling with infertility may get asked questions they don’t have answers to or don’t want to discuss with others.  This can bring about feelings of shame, guilt, inadequacy or a sense of loss. 

 

Oftentimes, family members have the best of intentions, not realizing how a couple experiencing infertility may be struggling in that moment.  It is common for couples to feel pressure from family members about their infertility journey, conceiving, and upholding family traditions. Couples who are experiencing infertility may get asked questions like “when are you going to have children” or “how are fertility treatments going?” Family members may try to place blame on one partner for not having a child, or struggling to have one. The couple may feel attacked, ashamed they are not “performing” or meeting their families expectations.  Feelings of guilt, loneliness, and sadness may increase and compound difficult emotions that are already present during a fertility journey. 

 

There are a few ways a couple can prepare when attending the holidays with family. The important thing is to build a support system amongst each other so they know how to reply to the family, and when it’s a good time to leave the holiday gathering or not attend at all.  

 

  1. Couples can gauge whether it’s mentally and emotionally healthy for them to attend these holiday gatherings.  It’s important they remember that it is not worth their mental and emotional wellness attending holiday gatherings that may cause anxiety, feelings of guilt and shame or place more pressure on them.
  2. Next, the couple can create clear boundaries to assist them with how much information they will share about their infertility journey with their family members.  They can determine certain details that they will choose not to share.  The couple can discuss what their responses will be depending on who asks questions.
  3. The couple can communicate clearly by letting family members know their infertility journey is not up for discussion. The couple can let the family know what is up for discussion and what is not. 
  4. Couples can let family members know to keep their story private.
  5. The couple can create a sign or gesture they will make to one another when it’s time for them to leave or when someone needs to go assist the other.  

 

Couples struggling with infertility may experience change in their family dynamics, especially during the holidays. Their feelings can take over making it difficult to communicate what they need or want from others.  

 

Couples may feel that family members are intrusive, or invading their space and privacy with inappropriate questions.  The couple can simply say no to the gatherings that they do not want to be a part of or to those being intrusive and invading their space.

 

Self-care is important for couples experiencing infertility.  They need to be able to recharge and rest when needed. A couple should create a plan around self-care they can establish, if needed, after attending a gathering that leaves them emotionally and mentally drained. For example, a night home alone watching movies, a hike, a walk to breathe some fresh air, visiting family or friends that are supportive or simply creating new family traditions that bring them peace and joy.

 

Struggling with infertility is challenging and the holidays may make things feel more intense. Finding effective communication, boundaries, and a self-care plan can help couples to maintain their emotional wellbeing through the holiday season.  

Exercise may already be a part of your everyday lifestyle. Most adults need both aerobic activity and strength training for overall health. The CDC recommends 150 minutes each week of cardiovascular exercise. That can be broken into smaller blocks of time, including anything from brisk walking to running and muscle-strengthening activities two or more times per week [R] But do the guidelines change if you are trying to conceive?  How does exercise impact your fertility?

Benefits of Exercise

 

There are many benefits of exercise, including weight management, blood sugar and insulin levels, improvement of mental health and mood, reduction of cancer risk, improved sleep, and improved sexual health, among others. [R] All of these facets can impact fertility in both men and women. 

Couples who are overweight may encounter more difficulties when trying to conceive. Women with a higher BMI may experience menstrual dysfunction and anovulation, placing them at risk for lowered conception rates or infertility.  [R] Increased weight in men has been associated with a lower testosterone level, poorer sperm quality, and reduced fertility as compared to men of average weight. [R] Exercise helps to increase metabolism, or how many calories you burn in a day. When combined with healthy eating, individuals may experience weight loss and lowered BMI, improving the chances of conception. 

Exercise can reduce the glucose in your blood and make you more sensitive to insulin. Insulin resistance affects ovulation, fertilization, and embryo implantation, causing first trimester miscarriages and infertility. [R

Stress hormones such as cortisol have been shown to play a role in the length of time needed for a couple to conceive successfully. [R] Cortisol also plays a role in your libido. It may sound like common sense, but having a low desire can affect your conception if you aren’t having sex within your ovulation window. Regular cardiovascular exercise was found to mitigate the health impact of psychological stress. [R

Exercise can help to mitigate the risk of certain cancers. This is particularly true of cancers which have increased risk related to BMI, insulin sensitivity, and increased estrogen levels. [R] According to the summary of the research cited, even recreational exercise levels showed benefits in reducing colorectal and breast cancer risks. 

Adequate sleep is necessary for maintaining optimal health. Irregular sleep patterns might adversely affect the hormone secretion impacting ovulatory cycles. The hormone disruption could additionally contribute to “insulin resistance and glucose intolerance potentially contributing to infertility and early pregnancy loss, particularly among women with PCOS.” [R] Exercise appears to have a positive correlation to sleep, especially in middle-aged and older adults. Regular exercise was found to have moderate and strong positive effects on overall sleep quality. In contrast, chronic exercise appeared to increase the total sleep time and sleep efficiency to some degree. [R

Finally, it appears exercise has a relationship to sexual health, including increased sexual drive, sexual activity, and sexual satisfaction. Obesity and inactivity have some relationship to sexual dysfunction, and in males, a high BMI can correlate to erectile dysfunction. [R] Among both men and women, moderate amounts of exercise appeared to stimulate sexual interest and behavior. [R] However, too much activity was associated with a decrease in testosterone, and other male hormones, which may decrease sexual desire [R]. Libido in men is dependent both on testosterone levels and on psychological factors

 

Exercise and Fertility

 

While it can be acknowledged that physical activity benefits overall health and well-being, does exercise specifically relate to fertility health? 

Lack of exercise or inadequate amounts of physical activity may result in health complications such as increased BMI, increased insulin resistance, and higher amounts of cortisol and estrogen in the bloodstream could affect poorer ovulation, fertilization rates, and embryo implantation. [R]  In males, lack of exercise and higher BMI has been linked to a lower testosterone level, poor sperm quality, and reduced fertility compared to men of normal weight. [R

When individuals begin exercising “too much,” it can also be counterproductive to fertility efforts as well. Studies done on both male and female athletes have shown that endurance training, such has long-distance running, has been linked to altering fertility. [R, R]  In some females vigorous exercise for extended periods can be linked with anovulation which can affect fertility. [R]. 

There appears to be an “upper limit” of exercise, especially when working with individuals who are elite athletes. In such cases, they may benefit from working closely with their medical professionals and trainers to develop a customized plan to ensure their well-being and fertility during conception efforts and pregnancy. [R[

The yoga asanas also help to strengthen the body and improve blood flow to the reproductive organs. Some research has shown improved blood flow and circulation as it relates to a higher abdominal temperature that may correlate to enhanced fertility. 

Physical activity such as yoga, pilates, and barre may be particularly helpful for fertility as the asanas, or physical poses, can bring a calming energy to the pelvis, stimulate the endocrine system and restore hormonal balance where needed. This applies to men as well as women.   [R]  Choosing yoga poses that target specific trigger points may help to regulate monthly cycles, improve libido, rebalance thyroid function, stabilize blood sugar, and support fertility health. To help support hormone balance, you might select poses such as fish pose, sun salutations, garland pose, mariachi’s pose, and the bound angle pose. Illustrations of these can be found here

Women who are physically active prior to receiving IVF or ICSI appear to benefit from physical activity and demonstrate higher success rates compared to women who are physically inactive. [R]  However, depending on your personal health history, your doctor may recommend you decrease your exercise levels. 

Integrative fertility may be a choice for you if you would like to combine natural and modern therapies in your fertility journey. If you are interested in a consultation to see if integrative techniques can further support your fertility journey, contact me for more information.

As a healthcare provider, it can be challenging to share everything that I’d like a patient to know about their fertility during one office visit.  A visit with a fertility specialist will typically include gathering medical history, explaining procedures, setings expectation for patients, and answer their questions.  Often, I wish I had more time during a visit to talk through all of the ways a patient can optimize their health for fertility.   This is what inspired me to write an eBook, Jumpstart Your Fertility – A Guide to Enhancing Your Fertility at Home.

I’m thrilled to announce that after many months of hard work, I’ve poured my integrative fertility knowledge into one FREE resource.  This eBook is packed with easy, everyday tips to improve your fertility at home.

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Infertility can affect as many as one in eight couples trying to conceive. While many people tend to believe infertility is “a woman’s problem,” male infertility is a factor in roughly one-third of all infertility cases (25% in combination with female infertility factors and 8% as a singular factor). [R]  Male infertility can be categorized as endocrine or systemic causes, testicular defects in spermatogenesis, sperm transport disorders, and idiopathic male infertility. [R]. Treatment is often available, and many couples are able to conceive after receiving a medical intervention. 

 

Types of Male Infertility

Endocrine or Systemic Causes

 

Endocrine or systemic causes make up about 2 – 5% of male infertility cases. They refer to dysfunction of the hypothalamic-pituitary-gonadal axis, and like most hormonal pathways within the body, are sensitive to disruption and can be indicative of other disorders. [R] Excess estrogen appears to have an adverse effect on the balance of the HPG axis. 

 

While some estrogen and estradiol are necessary for male biological function and reproduction, excess estrogen appears to be damaging to the balance of the HPG axis and could be a contributing factor to male infertility. As in women, excess estrogen in the body can be produced as a result of obesity, stress, or environmental factors [R, R, R]. 

 

Testicular Defects in Spermatogenesis

 

Some more common disorders that affect the testicles include trauma, torsion, cancer, epididymitis, and hypogonadism.  Infection and inflammation of the reproductive tract are significant causes of male factor infertility.

 

Depending on the nature of the trauma, it is possible scar tissue may result within the testicular tissue leading to reduced to halted sperm production.  Trauma did not appear to be a major cause affecting spermatogenesis, as early repair of any trauma seemed to preserve normal functionality. [R]  Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. Adequate sperm needed for fertilization can be produced from one testicle, While medical intervention may be possible to repair and preserve the damaged testicle, the effects of testicular torsion on fertility remain unclear. [R

 

If the testicular defect is a result of cancer, chemotherapy treatment could have an adverse effect on sperm production and fertility, so patients may wish to speak to their treatment provider about sperm banking before treatment begins. [R].   The epididymis is part of the male reproductive tract where spermatozoa acquire motility and the ability to fertilize the egg. When this area becomes damaged, usually through inflammation or infection such as a urinary tract infection or sexually transmitted disease, it can cause harm to the maturing sperm. 

 

Male hypogonadism is a condition where the body does not produce enough testosterone and other hormones needed for masculine growth and development during puberty or enough sperm or both. The condition may be acquired or congenital. 

Sperm Transport Disorders

 

In order for fertilization to occur, sperm must successfully reach the female egg. If there are difficulties in the sperm reaching the egg, it could be a potential cause of infertility. Sperm transport disorders account for 5% of male infertility cases. [R

 

Causes of sperm transport issues may be congenital, surgical, or acquired through infection or disease. Congenital causes may include the absence of the vas deferens, incomplete development of the sperm ducts, or lack of the seminal vesicles which store sperm. Surgical intervention might be a vasectomy. Infection or disease-related causes of sperm transport disorders could be a result of a sexually transmitted disease which has led to scarring. 

 

Idiopathic Male Infertility

 

Idiopathic male infertility, or IMI, affects approximately 10 – 15% of males in their prime reproductive age. [R] Men presenting with idiopathic infertility have no obvious history of fertility problems and both physical examination and endocrine laboratory testing are normal. However, semen analysis as routinely performed reveals sperm abnormalities that come alone or in combination. 

 

Testing for Male Infertility

 

When seeking support for male infertility, the initial evaluation typically focuses on detecting the small percentage of causes that can be treated to restore normal fertility. The remainder of the evaluation of male infertility is focused on determining which couples with male factor infertility might benefit from assisted reproductive technologies (ART). [R] A medical history, physical examination, and semen analysis are usually common. While additional components of the exam may go on to include endocrine testing, imaging of the glands and ducts, and genetic tests. [R]

 

Can Male Infertility Be Treated?

 

In cases where male infertility is related to hormonal imbalance, such as endocrine dysfunction or hypogonadism, sperm production or motility may be increased through the use of certain medical treatment. Usually, the focus is increasing testosterone production, increasing follicle-stimulating hormone (FSH) levels, and normalizing the testosterone to estrogen ratio. [R]

 

Depending on the nature of the testicular defect, surgery, hormonal intervention, or sperm banking may be an appropriate intervention for fertility. 

Sperm transport disorders may be resolved through surgery, as in the case of reversing a vasectomy, or through the use of IVF procedures. 

 

ART did not seem to be as successful with male infertility related to sperm DNA damage such as caused by cases of damage to the epididymis [R]

 

If you’d like to schedule a consultation for male fertility testing contact Pacific Reproductive Center today.