Maryjane. Cannabis. Reefer. THC. Pot. Marijuana. Dope. CBD. Weed.  No matter how you refer to it, this controversial little plant has gotten a lot of media attention in recent years!  And as more and more states move toward the legalization of recreational marijuana, some may begin to wonder: Can cannabis use affect my fertility?


It seems like so many claims are being made that marijuana can help a wide variety of ailments… Could infertility be one of them? Or is it possible that marijuana could actually decrease your fertility and interfere with your efforts to conceive?

What’s the Difference Between Cannabis, Marijuana, THC, and CBD?

There are a lot of names used for cannabis that all have slightly different meanings. So let’s talk about that!  Cannabis sativa is the Latin name for an herbal plant. The word “marijuana” is typically used to refer to this plant and its many uses.  Marijuana has traditionally been thought of as an inhaled drug (either in a cigarette, cigar, or vape pen). But it can also be eaten in foods, or taken medicinally or recreationally as an extract.


Tetrahydrocannabinol, or THC, is the psychoactive component found in cannabis. It has a slightly shorter growth cycle than CBD. Most cannabis that is used for medicinal or recreational purposes has a high concentration of THC (normally between five and 35 percent). Products that contain THC can be used in foods, topical medications, and tincture oils.


Cannabidiol (often called CBD) is not psychoactive and has a longer growing cycle. Most CBD products have a very low percentage of THC (usually less than 0.3 percent THC). CBD can be used in food, beauty products, and medications.

How Does Marijuana Act in the Body?

People ingest cannabis derivatives for a number of different reasons. Most of these reasons involve an attempt to make their body feel a certain way after they consume cannabis.  Whether they are trying to relax, achieve a high, relieve pain, or increase appetite, marijuana acts in a variety of ways in the body.

Psychological Effects of Marijuana

Cannabis changes the way your brain processes information, so it can cause memory problems, especially with repeated use over time. Cannabis can also slow your reaction time, which can make driving and other tasks that require quick thinking skills more dangerous.


A brain chemical called dopamine is responsible for heightening the senses and causing a feeling of pleasure or euphoria. Dopamine is also one of the hormones responsible for the pain- and inflammation-relieving effects of marijuana use.

Physical Effects of Marijuana

Marijuana and its byproducts affect the physical body in a variety of ways.


  • Immune system: Unfortunately, THC can suppress the immune system, which can make you more immune to infectious illnesses caused by viruses and bacteria. But for those with autoimmune disease, suppressing the immune system can decrease flares of the autoimmune condition.


  • Eyes: Cannabis can lower the pressure in the eyes, which can help glaucoma symptoms.


  • Appetite and digestion: You’ve probably heard of someone who smokes pot getting “the munchies.” That happens because of the appetite increase that comes along with marijuana usage. This can especially help cancer or late-stage AIDS patients who are struggling with their appetites.

  • Respiratory system: Smokers who use traditional tobacco cigarettes know the risks of lung cancer, COPD (chronic obstructive pulmonary disease), and stroke. But it is less commonly known that smoking marijuana can have some of the same negative effects on the respiratory system. Cannabis smoke contains a lot of the same carcinogens and toxins as tobacco smoke.

  • Cardiovascular effects: THC also puts additional stress on the heart.

Can Marijuana Affect Fertility?

Just like cannabis affects all the other body systems, it has some effects upon the endocrine and reproductive systems as well. This is true for both males and females.

The Effect of Cannabis on Female Fertility

Long-term exposure to THC can affect the pituitary gland, slowing luteinizing hormone and prolactin hormone production. Women who smoke marijuana regularly are at risk of not ovulating because high doses of cannabis use can throw a wrench in your menstrual cycle.  Higher doses of cannabis can also interfere with a woman’s sex drive, which makes natural conception less likely.

The Effect of Cannabis on Male Fertility

Marijuana usage has been associated with lower sperm count, sperm quality, and concentration of sperm in the semen. It can also affect sperm morphology (shape), motility (ability to swim and maneuver through the uterus and fallopian tubes),, and viability (ability to successfully fertilize an egg).  Cannabis has been shown to reduce libido in males as well as females. In animal studies, cannabis usage led to atrophy of the testicles as well.

Still Have More Questions About Cannabis and Fertility?

Do you use cannabis medicinally or recreationally? Are you trying to conceive or considering fertility treatments? Be sure to mention your cannabis use to your fertility doctor to receive the best advice for your particular situation.  This is [particularly true if you rely on THC or CBD for your daily functioning. (This might include pain relief, controlling the symptoms of an autoimmune disease, or cannabis dependency.)


At Integrative Fertility M.D., we understand that your medical situation is unique. We would love to chat with you about how we can help you in your journey to conception and parenthood. Get in touch today to book a consultation!

If you follow world news at all, especially since the beginning of 2020, you’ve probably felt the burden of negativity weighing you down.  The same can be true in your personal life, your work life, or anywhere that people are present, if you look for it there is plenty of negativity to go around. 


So how could a little positivity possibly be a bad thing?

The truth is… it’s not! A positive outlook, at its core, is a great asset. In fact, there’s plenty of research backing up the benefits of taking a more upbeat outlook on life.  For example, when medical researchers studied a group of people with a strong family history of cardiac disease, they found that patients with a more positive outlook were a full third less likely to have a heart attack or other cardiac event!

So What Is Toxic Positivity? Can You Be Too Positive?

Dr. Susan David defines toxic positivity as “forced, false positivity. It may sound innocuous on the surface, but when you share something difficult with someone and they insist that you turn it into a positive, what they are really saying is, ‘My comfort is more important than your reality.” 

(This incredible quote from Dr. David was taken from her guest appearance on Brene Brown’s podcast.)

The Consequences of Toxic Positivity

While being overly positive may not seem too destructive on the surface, it has many consequences. This can even be true when we find ourselves speaking with toxic positivity in our own self-talk!

Denying Emotions

Toxic positivity can lead us to deny the reality of the emotions that we’re facing. Depending on your personality type, you may tend to deny your emotions (or at least the ones you deem negative!) in general. This rarely ends well. Usually, it ends up with the negative feelings building and building and building.


In the end, these feelings will be released. It’s only a matter of time. They might “seep out sideways” through passive aggression or snapping at a stranger in the grocery store. Or you might wind up having a major meltdown.  But regardless of how these feelings end up presenting themselves, the fact is this: emotions that you deny and repress never stay repressed.

Guilt for Feeling Negative Emotions

Some people tend to deny or repress emotions they don’t want to feel. Others of us feel that we have no choice but to experience feelings like sadness, fear, and anxiety. But even people who don’t struggle to feel their feelings can have a tendency to feel guilty for them!


And toxic positivity can intensify this guilt. But in reality, feelings are just that: feelings. They don’t define who we are, and we aren’t defined by our fears or worries. And we don’t need to feel guilty for being fearful or worried.


Fertility treatments can be trying, even in the best of circumstances! Worrying about the outcome of a treatment or test is a sign that you’re normal, not that anything is wrong with you!  People who operate in a mindset of toxic positivity will make statements like, “You should just be grateful for the things you have in your life!” “Everything happens for a reason!” “Don’t focus on unwanted test results!”  These kinds of statements are not helpful. In fact, they are dismissive of your true feelings.


But the fact of the matter is that it’s completely possible to feel more than one emotion at a time. The fact that you are disappointed with a negative pregnancy test doesn’t mean you are any less grateful for your friends, family, or all the other wonderful things in your life.

Not Seeking Support

One of the most dangerous things about toxic positivity is this: It can discourage us from seeking emotional support during the very times we need it most!  When we feel shamed for our feelings by others, we tend to shut down and not seek help from them again. No one wants to share their darkest feelings if we know that our supposed source of support is going to encourage us to “think happy thoughts!”

Things To Try Instead

Whether you are tempted to scold yourself or others for feeling sad and downtrodden, resist the urge to act as if life is all rainbows and unicorns.  Acknowledge your feelings, and let them flow through you. Sit with your grief. Acknowledge when you or a loved one has experienced a loss, even a perceived loss.  As painful as it can be, it’s important to acknowledge the possibility of undesirable outcomes.


Possibly the most important part of this process is acknowledging that poor outcomes are a possibility. And, that you can handle whatever comes your way. So much of toxic positivity comes down to a belief that we can’t handle the difficulties that life throws at us!


When you’re supporting others, empathize with them.  Let yourself feel the emotions that they are describing. Ask yourself how you would feel in their situation.  Avoid jumping straight into encouragement. Let them share their feelings without judgment.

Need a Place to Vent Without Being Told to Think Positive?


Life can seem uncertain, and you aren’t sure where this journey will take you. That’s completely normal.  Even though we are generally upbeat and positive at The Integrative Fertility M.D., we understand the road that you are walking during your fertility testing and treatments. We understand the confusion that comes with test results you weren’t expecting.


We empathize with the disappointment you feel when treatments don’t have the outcome you’d been hoping for. Even after pregnancy is achieved, mixed feelings are a normal part of the process! And even in your celebration, you might feel anxious, scared, or ambivalent. It’s okay (and healthy!) to acknowledge these mixed emotions.


If you need a place to turn for support without the toxic positivity, consider The Integrative Fertility M.D. for your fertility consultation, testing, and treatment needs. We are here to help and hold space for you!

Nothing beats getting all your necessary vitamins and minerals from a diet rich in nourishing, whole foods. But unfortunately, it’s just not always possible to achieve this with our modern diets. One day you’ll knock it out of the park with healthy fats, but neglect to eat enough calcium. The next day you cover your calcium and magnesium bases, but hardly get any zinc.

This is the reason you may want to include supplements as a part of your daily life. Though we shouldn’t rely on supplements to give us all the nutrients we need and neglect our eating habits, including some of the best supplements for fertility can help.

Prenatal vitamins

When you’re trying to conceive, one of the most important supplements to include in your routine is a prenatal vitamin. It takes an egg about three months to complete its journey to ovulation. So the nutrients you take in today are actually playing a huge role in healthy egg development and production months down the road!


Not all prenatals are the same, though. Be sure to read labels, and select a prenatal without artificial flavors, dyes, and hydrogenated oils. A lot of supplements on the market are coated with phthalates, which can disrupt your endocrine system in powerful ways.


Look for a prenatal that contains vitamin B12, choline, iron, calcium, selenium, zinc, iodine, and biotin. It should also offer vitamin A, most of which comes from beta carotene. Finally, be sure the brand of prenatal vitamin that you choose contains methylfolate rather than folic acid. Though most prenatals contain folic acid, methylfolate is the more bioavailable, readily-absorbed form. This is especially important if you have an MTHFR (methylenetetrahydrofolate reductase) gene variant.


A lot of the prenatals available at the grocery store contain vitamin D and DHA. These nutrients are both vital during pregnancy and preconception, but prenatals usually contain very little of either of these. Look for separate vitamin D and DHA supplements!

Vitamin D

A vast majority of people in the Western world have low vitamin D levels, despite all the “vitamin D fortified” foods we ingest. This is primarily due to the lack of sunshine that we get, since we spend most of our hours inside. And it’s pretty common for women with PCOS to have very low levels of vitamin D.


Vitamin D is fat-soluble, and it has hormone functionality. It’s actually a vitamin that your body produces in response to sun exposure and foods like eggs, liver, and fatty fish.


It’s incredibly difficult to get enough vitamin D from foods alone. In addition to adding a vitamin D supplement, though, aim to spend at least 20 minutes in direct sunlight every day to encourage vitamin D production. Know your skin type, though, and use caution if you tend to burn easily!


The research surrounding fertility rates and vitamin D levels is a bit mixed. One study concluded that vitamin D deficiency was associated with lower success rates of in-vitro fertilization in non-hispanic White women. But other data don’t show any increase in conception or live birth with vitamin D supplementation.


Levels of vitamin D can be lower due to inflammation, which could possibly be the reason we see lower levels in women with PCOS. Several small studies have suggested that vitamin D supplementation may help regulate the menstrual cycle in PCOS patients. More study is needed in this area, though.


Women with a vitamin D deficiency may also be at increased risk of gestational diabetes, preeclampsia, and premature birth.


There’s some evidence that males who supplement with vitamin D can have improved sperm motility. Higher vitamin D levels were associated with a higher chance of one’s partner conceiving.

Coenzyme Q10

Coenzyme Q10 is a nutrient that naturally occurs in the body. It’s a powerful antioxidant that has been shown to improve ovulation rates in women using Clomid. CoQ10 can also help to support improved egg quality during IVF cycles..


Men taking CoQ10 also showed a possible improvement of sperm concentration and movement.


While we definitely need more human studies on the benefits of CoQ10, it’s considered a safe supplement to take during conception and pregnancy, so most practitioners feel that it is safe and that the possible benefits outweigh the risks.


Myo-inositol is a sugar found in the brain, and it’s part of the group of B-complex vitamins. When studied in women with PCOS, it was shown to decrease insulin resistance and lower levels of serum testosterone. It also improved menstrual irregularities and increased ovulatory frequency! 


Pregnancy rates were increased in PCOS patients after they had taken myo-inositol for three to six months. And myo-inositol has also been shown to possibly improve egg quality during IVF. Gestational diabetes levels were also lowered in women who continued supplementing during pregnancy.


Myo-inositol can be a great supplement to consider if you’ve been diagnosed with PCOS!


N-acetylcysteine is a great antioxidant to add to your supplement routine to protect your cells from the stress caused by oxidation. Oxidation can reduce the body’s ability to produce a healthy egg, and antioxidants can help fight this oxidative process. This is especially helpful to your egg cells!


N-acetylcysteine can also benefit sperm quality. One study showed that men who took selenium supplements along with N-acetylcysteine demonstrated increased semen quality. 


N-acetylcysteine might also benefit women with PCOS by reducing their testosterone and insulin levels. It’s possible that N-acetylcysteine and myo-inositol could be an option for women who can’t tolerate the side effects of Metformin.

Don’t forget to discuss this with your care provider!

When we talk about supplementation, it’s important to remember that each case is different. Your unique history and medical issues may make any of these supplements inadvisable in your case. Be sure to discuss the advisability of adding these supplements to your routine with your fertility doctor.


Dr. Salem is extremely knowledgeable about the benefits and drawbacks of various vitamins and mineral supplements during fertility treatments, conception, and pregnancy. Request a consultation with her to discuss which of these supplements could benefit you!

No one wants to struggle with infertility, regardless of its origins. But if you’ve conceived in the past with no apparent difficulty, infertility can be particularly shocking.

What is secondary infertility?

Secondary infertility is when an individual or a couple has difficulty conceiving or carrying a pregnancy to term, despite having prior biological children with no difficulty.

About ten percent of couples who had no trouble conceiving previously will experience secondary infertility. Though it has many of the same causes as primary infertility, this topic doesn’t seem to receive as much attention in the media or in society.

Unfortunately, many couples struggling with secondary infertility find themselves suffering in silence. Well-meaning family and friends try to convince them that they should be content with the family they already have. Coworkers remind them that they already have one or more children and should just focus on that. Your Great Aunt Sue reminds you to “just relax, and it will happen when you least expect it!”

Sadly, there are even medical providers that fail to take your concerns seriously, not giving your case the attention it deserves simply because you have successfully conceived a child before.

But regardless of whether the desired pregnancy is the first child or the sixth, no one should be shamed by others for their desire to grow their family.

What causes secondary infertility?

There are multiple possible causes of secondary infertility. Many of them are the same factors that cause primary infertility. Unexplained infertility is also a common diagnosis. These difficulties in conception can occur at any point in the early pregnancy process: ovulation, sperm production and travel, fertilization, travel of the fertilized egg, or implantation in the uterus. These problems can originate with either a male or a female partner. Though it would be rare for both partners to have developed problems in the time since the conception of the prior child, this is also a possibility.

Here are a few possible causes of secondary infertility, though of course you’ll need to work with your healthcare provider to determine what specific factors are at play in your case.

  • Change in sperm quality and quantity. As a man ages or changes his lifestyle, the quality and number of sperm in each ejaculation can decline. This can be linked to smoking, alcohol intake,  changing testosterone levels and environmental exposures. Sperm morphology and motility can be checked through a semen analysis.
  • Endometriosis. Endometriosis happens when tissue similar to the uterine lining (“endometrium”) grows outside of the uterus, in places like the ovaries or fallopian tubes. This lining can cause scarring in the pelvis and on the fallopian tubes, making it impossible for the sperm to reach the egg or for a fertilized egg to pass through the fallopian tube to the uterus.
  • Uterine fibroids. Fibroids are noncancerous tumors found in the uterus. Some uterine fibroids occur in the uterine cavity and can make implantation difficult.
  • New medical problems. If you have been diagnosed with a new medical condition since your last pregnancy, this could contribute to secondary infertility. Polycystic ovary syndrome, diabetes, autoimmune concerns, uterine polyps, and pelvic inflammatory disorder are examples of conditions that may make conception more difficult than it has been in the past.
  • New medications. Likewise, if you are taking new prescription or over-the-counter drugs, this may affect fertility. Drugs taken for epilepsy, thyroid, pain medications, some steroids, and chemotherapy have been known to impact fertility.
  • Complications from prior pregnancy. Any uterine scarring can cause difficulty with the implantation process. Talk to your physician about your particular prior pregnancy and birth experiences to see if this could be a factor.
  • Complications from prior surgeries. Complications from prior surgeries can lead to scar tissue in the uterus or pelvis that can impact fertility.
  • Age. It goes without saying that both partners are more advanced in age than they were when the prior pregnancies were conceived. Because female fertility tends to decline in the mid-30s, the more a woman ages, the lower her egg quality tends to be.
  • Lifestyle factors. Habits frequently change after one becomes a parent. There are a few lifestyle factors that can possibly contribute to infertility. It’s harder to round up your child and the stroller and get out the door for a walk than it was when you just had to grab your keys and go. Maybe you’ve returned to a smoking habit you picked up in college. Perhaps you find yourself reaching for the wine bottle more often than you did before. It’s easy to slip back into these methods of coping in the busy years of raising small children. Focusing on eating whole, nutritious foods, moving your body more, stopping smoking, and cutting back on heavy alcohol consumption can contribute to a healthy lifestyle that can support fertility.

What is the treatment for secondary infertility?

Just as the causes of secondary infertility are similar to primary infertility, the treatments can be similar as well. After performing a thorough examination and history, your provider can order lab tests to check your hormone levels. A semen analysis is also commonly ordered to check the number and motility of viable sperm.

There are a number of treatments that can be helpful for secondary infertility. These can include medications such as Clomid or letrozole. Intrauterine insemination (IUI) or IVF may be considered as well.

When should I get help for secondary infertility?

If you’ve been having unprotected sex for more than a year, consider seeking medical help. If you are over the age of 35, this time period can be shortened to six months. And if you are over the age of 40 or you have been experiencing irregular menstrual cycles, contact a fertility specialist right away to get the help you need.

Secondary infertility can be a very unwelcome surprise, but The Integrative Fertility M.D. is here for you. Reach out – we’d love to help you with your family planning goals!

As if infertility isn’t overwhelming enough on its own, keeping track of fertility testing names, schedules, and results can leave you completely befuddled.

“Which tests? Are these blood tests or ultrasounds? This dye goes where, now?”

And how do you keep track of which blood draws need to take place on which days of your menstrual cycle?

We’re here to demystify this process for you!

Why would I need all these tests?

The results of these labs can help your provider determine the reasons that you’ve been struggling to conceive or maintain a pregnancy. And if you’re considering growing your family with fertility treatments, the results can also help determine what your next steps will be.

Important fertility tests

Here are 10 of the most common tests your provider may order when trying to assess the reasons behind your infertility.

  • Anti-mullerian hormone (AMH) level. AMH level is assessed through a blood draw, and it evaluates ovarian function. A low AMH level can indicate a low egg count, which could be the cause of your fertility struggles. But this isn’t always the case! AMH might be most useful in helping your doctor predict how you might respond to certain fertility medications.
  • Prolactin level. Prolactin is a hormone made in the pituitary gland in the brain. It’s the hormone that’s primarily responsible for breast milk production after birth. But unusually high levels of prolactin can be linked with infertility and irregular or absent periods as well, so this level can help pinpoint if that might be causing your difficulties conceiving. A normal prolactin level in a female who is neither pregnant nor lactating is less than 25 ng/mL.
  • Day 3 follicle-stimulating hormone (FSH) level. As its name indicates, FSH stimulates the ovarian follicle to be produced. FSH is the primary hormone responsible for selecting which follicle will be released. This follicle production then proceeds to ovulation. By testing this level very early in the menstrual cycle, your provider can get an idea of how hard the body is trying to stimulate follicle production. Simply put, an elevated FSH level can indicate that the body is having to do extra work to produce a follicle. FSH levels typically increase with age.
  • Day 3 estradiol level. This level is closely related to FSH, so it’s typically drawn along with the FSH test discussed above. If estradiol is elevated but FSH is normal, this can signal problems with the response of the ovary. Estradiol level less than 80 is considered normal at this point in the menstrual cycle.
  • Progesterone level. Progesterone is a hormone that rises in response to ovulation. A rising progesterone level can help confirm that ovulation is occurring, so this test is timed for about a week after suspected ovulation. Your progesterone levels will need to be interpreted by your care provider, of course, but low levels may suggest that ovulation didn’t occur or that post-ovulatory progesterone levels may be too low to sustain a pregnancy.
  • Hysterosalpingogram (HSG). Whereas a lot of these other tests look at your hormone levels, the HSG evaluates the patency (openness) of your fallopian tubes. The physician performing the HSG will pass a very small catheter through the opening of your cervix and insert dye into the uterus. After inserting the dye, a pelvic x-ray is taken. If the uterus fills abnormally, there might be a polyp, fibroid, or malformation of the uterus. If both fallopian tubes are unblocked, the dye will spill out through the fallopian tubes. If there are any blockages in the tubes, the dye will stop at the blockage.
  • Antral follicle count (AFC). This count is performed by vaginal ultrasound. Egg count and quality decrease as women age, and this test evaluates ovarian reserve. Your antral follicle count can give your provider an idea of where your fertility ranks in relation to your age. Because egg count decreases as you age, this number will be lower the closer you come to menopause.
  • Thyroid testing. Hypothyroidism (low levels of thyroid hormones) can prevent the release of the mature egg from the ovary, leading to difficulty conceiving. There are several blood tests that can help evaluate thyroid function, but one of the most common is thyroid-stimulating hormone (commonly referred to as TSH). Healthy levels of TSH can vary based on your specific case.
  • Diabetes testing. Fasting blood sugar levels can help determine if further testing for diabetes is warranted since diabetes can be associated with infertility.
  • Semen analysis. All of the tests above have been primarily performed on the female partner, but semen analysis is vital to the fertility treatment process! This is because male factor infertility can be the cause of up to half of cases of infertility. Semen analysis is normally one of the first fertility tests performed, as it is less invasive than others. Semen analysis is most accurate when it follows 24 to 72 hours of abstinence. It’s also important that the sample be examined within an hour after collection. The semen is examined under a microscope and the number, shape, and movement of the sperm are observed.

You might not need all these tests!

Though these tests are important, every case is different! Not every test on this list will be required before starting treatment for each patient. It’s vital that you discuss the specifics of your situation with a fertility specialist to understand which could benefit you!

Fertility treatments can be confusing, and it’s easy to become overwhelmed with the testing process. We understand the overwhelm and are here to walk you through the process! We also know that you may still have questions about some of these tests.

Regardless of the specifics of your fertility case, we consider it an honor to accompany you on your journey. Contact us today to consult with Dr. Salem about which of these tests would be best for you!

Researchers estimate that the human body contains approximately seven quadrillion bacterial cells! Most of us hadn’t even heard the word “microbiome” until just a few years ago. But now the concept of gut health and gut flora are all over the news! It seems like every week a new connection is made between gut health and some other facet of wellness.

Research has recently shown that the balance of bacteria in our guts affects not only our gastrointestinal systems, but our hearts, kidneys, and even our brains and mental health! The microbiota of the skin has gotten some media attention as well.

The uterine microbiome, though, hasn’t received as much press time as it deserves! In fact, until quite recently scientists believed that the uterine environment was sterile (meaning there were no microorganisms present in it at all.)

Flora and microbiome and endometrium, oh my!

Let’s start by defining some of these words! Just as you’ve likely heard the plant life in a certain area referred to as the area’s flora and fauna, the term “flora” simply refers to the normal, beneficial bacteria that resides in or on the human body. “Microbiome” is just another way of referring to this healthy bacteria.

In this article, we’ll be discussing the unique microbiome of the uterus, which is contained in the endometrium. The endometrium is the lining of the uterus. This is the cushioning where a fertilized egg implants at the beginning of a pregnancy. In a normal menstrual cycle, the endometrium becomes thicker after ovulation in order to prepare for a potential pregnancy. It is then shed during menstruation if no pregnancy occurs.

Learning more about the unique microbiome of the uterus

Advances in modern medicine have allowed physicians to study the endometrium’s microbial environment with more precision than ever before. Early studies suggest that the most common bacterium in the uterus are called Bacteroides and Lactobacillus.

One study compared samples from the endometrium and vaginas of 35 infertile women undergoing in-vitro fertilization treatment. The results of this study revealed an important discovery: the women with more non-Lactobacillus bacteria in their microbiomes had decreased likelihood of implantation, pregnancy, and live birth.

Currently there are limited studies about the impact of the endometrial microbiome on fertility levels and success with IUI, IVF, and other fertility treatments. However, testing has recently become available to assess the endometrial lining for various types of bacterial flora. Hopefully this will open doors in the future for the ability to treat a uterine microbiome that is not ideal for conception.

Where does this beneficial bacteria come from?

Currently the most common theory is that the flora that populate the uterus ascend from the vaginal canal. The vagina has its own microbiome, and it can fluctuate frequently. Immediately prior to ovulation, for example, Lactobacillus levels tend to stabilize, then these levels drop during menstruation.

But are there other external and lifestyle factors that affect the balance of bacteria in the vagina (and thus the uterus)? Studies suggest that this may be the case! Menstruation, sexual activity, and use of period products like pads, tampons, and menstrual cups. There is also some evidence that the use of a copper IUD can increase an imbalance in the vaginal flora. Some other studies, however, suggest that the flora of the vagina are only affected by ethnicity and number of sexual partners. Clearly there is much we have yet to learn on this subject!

Another microbiome?

No discussion of bacteria’s influence on reproduction would be complete without a brief mention of yet another microbiome: the placental microbiome. After a pregnancy is achieved, any elements that interfere with the communication between the embryo and the uterine lining can interfere with the pregnancy. An imbalance in the uterine or placental microbiome, then, might set off an inflammatory response that can be possibly linked to a poor outcome and loss of the pregnancy.

You might be aware that the immune system becomes slightly suppressed during pregnancy in order to protect the developing embryo. This happens so that a woman’s body doesn’t recognize the developing embryo as an intruder and thus attacks it as a foreign object. If there is a severe imbalance in the flora of the uterus and placenta, then, it makes sense that the body would attempt to eliminate this.  However, this attempt to exterminate the flora imbalance could lead to devastating consequences for a pregnancy.

You don’t have to struggle alone

These issues can be isolating and confusing, but we are committed to walking this journey alongside you and explaining all the nuances. Testing is now available to evaluate your uterine microbiome. Speak with your fertility doctor to see if you are a candidate for this testing based on your case!

To connect with Dr. Salem and her team, contact us today to arrange a consultation!

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!