Four Little Words Lots Ofimplications
Many women in our high-riskpregnancy practice have ongoing medical problems that can reduce fertilityand cause pregnancy complications.
As medical care improves their baseline healthand quality of life, three things can happen:
- Menstrual irregularities might improve,increasing ovulation
- They feel better and have more sex and
- They misinterpret a singlestatement: You cant get pregnant.
These four little words can be taken in twovery different ways. Providers often intend to say thepatient shouldnt get pregnant untilher medical condition improves. But many patients come into our office pregnantafter hearing those words. They interpreted the statement to mean it was physically impossible for them to becomepregnant.
“The bottom line is that words matter in health care. Doctors must be cognizant of the words they choose when speaking with patients and patients must feel empowered to ask clarifying questions.”
Robyn Horsager, M.D.
In the study mentioned above, researchers noted that the pregnancy rate of patients on dialysis over time was fairly stable. That suggests providers havent gotten better at communicating this message to our patients, and this failure in communication can happen in any setting.
Some chronic health conditions, such as heart disease, diabetes, or high blood pressure, can affect a womans chances of becoming pregnant and increase the risk of pregnancy complications.
You Could Have A Blocked Fallopian Tube
A blocked fallopian tube could be a result of endometriosis, or other scar tissue or adhesions, says Dr. Uhler. In that case, the egg cant make its way down into the uterus to be fertilized. Typically, laparoscopic surgery takes care of the blockage.
Sometimes, doctors will do a test called a hysterosalpingogram, explains MD, an ob-gyn at Yale-New Haven Hospital. This test injects a dye up through your cervix and out the fallopian tubes, to see if your tubes are blocked or open, Dr. Minkin says. And, she adds, the procedure can even help open the tubes up.
You’re Still Drinking And Smoking
As Dr. Curtis puts it, “Why take a chance with drinking alcohol, smoking, or drugs if you know it could negatively affect fertility?” He warns his patients that the early part of pregnancy is the most critical in the development of the fetus. “My advice is, if you are not using protection, then with regards to drugs, alcohol, and smoking, act as if you’re already pregnant.”
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Things To Avoid When Trying To Conceive
Trying to conceive is one big waiting gameyou never can predict whether this is the month that pregnancy test will turn positive. Thankfully, there are a few things you can do to boost your odds of getting pregnant each month. For instance, you can track your cycle, take prenatal vitamins, eat healthy and even, just for good measure, take a cue or two from a few old wives tales. But sometimes what you dont do is just as important. Heres what to avoid when youre trying to get pregnant.
Genetic Issues Affecting Conception
Genetic problems generally relate to chromosomal abnormalities and single gene issues. These often cause embryo implantation failure and pregnancy loss, as well as possibly resulting in birth defects when a child is born with a chromosomal or single gene defect.
Chromosomal disorders can relate to one or more of an embryos chromosome pairs containing either one too many or one too few chromosomes. When the chromosome is not paired correctly, it is called aneuploidy. A chromosome may also have an abnormal structure. Both kinds of chromosome problems can be present in the female egg and/or the male sperm.
Single gene defects result from the embryo inheriting a genetic flaw from one or both parents. The gene could be one that results in cystic fibrosis or muscular dystrophy in birth. These single-gene defects can also cause embryo implantation failure or pregnancy loss.
Genetic issues often can be identified through preimplantation genetic screening, two types of embryo evaluation during IVF that can identify either form of genetic issues.
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How Common Is Infertility
While some people seem to have an easy time having a baby, others struggle. Infertility is quite common, though. About 12% to 15% of people struggle to have a baby, and infertility affects around 1 in 8 heterosexual couples. How do you know if you’re not able to have a baby? There are some signs of infertility that you should see your doctor about.
When Can You Get Pregnant
Whether you are trying to get pregnant or trying to avoid getting pregnant, it’s important to understand your menstrual cycle and how it relates to your fertility. There are a lot of myths and misinformation surrounding fertility. Once you learn exactly how and when pregnancy can happen, you’ll have a better idea of when you can and can’t get pregnant.
You can get pregnant if you have unprotected sex anywhere from 5 days before ovulation until 1 day after ovulation. You can’t get pregnant if you are not ovulating because there is no egg for the sperm to fertilize. When you have a menstrual cycle without ovulating, it’s called an anovulatory cycle. There are a lot of underlying issues that can cause this. It’s a common reason for infertility.
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Amp Up On Energy Drinks Or Espresso Shots
Rest and relax. Remember, you’ll be awake many long nights once the baby arrives. When it comes to caffeine, the message is moderation. A couple of cups of coffee a day shouldn’t affect your chances of getting pregnant. But if you have a double shot of espresso, 3 diet sodas, and a chocolate bar during the day, it’s time to cut back.
Stress Lifestyle Factors And Infertility
Stress can push people toward unhealthy behaviors that have been proven to impact fertility. For example, when you’re stressed out, you may:
- Sleep too much or sleep too little
- Have a harder time sticking to healthy eating habits
- Skip your regular exercise or push yourself to exercise too much
- Drink too many alcoholic drinks
- Drink too much caffeine, especially if you’re sleep-deprived
- Lose interest in having sex
All of these are habits that can affect your ability to conceive, so it’s worth exploring each of them.
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What Are Sexually Transmitted Diseases
An STD is one that is passed from one person to another mainly through intimate sexual contact, which can be heavy petting, vaginal or anal sexual intercourse, and oral sex. There are dozens of STDs including syphilis, gonorrhea, chlamydia, herpes, human papillomavirus and others. But gonorrhea and chlamydia are the ones most likely to cause subfertility .
Most sexually active people are familiar with the term STD, and probably STI . The terms are often used interchangeably. But technically the sexually transmitted infection occurs before the sexually transmitted disease, which follows from the infection. STI or STD, you dont want either one.
About 20 million new cases of STDs occur every year, according to the Centers for Disease Control and Prevention . And roughly 75 percent of women will get some type of STD in their lifetime . STDs are most common in women under age 25, and up to 80 percent of women with chlamydia get it between age 15 and 25.
According to the CDC, there were a record number of cases in 2016 for gonorrhea, chlamydia and syphilis. Though we hope for these numbers to drop for subsequent years , decreased government funding for health centers has already led to increased costs for testing in several areas, resulting in fewer people getting evaluated.
Two Types Of Missed Period
In medicine, a missed period is called amenorrhea. Physicians categorize amenorrhea in two major types: primary amenorrhea and secondary amenorrhea.
Primary amenorrhea is a condition in which a female older than 15 years of age has never had any period, i.e. her periods have not started yet. The reason can be genetic or due tocertain diseases.
Causes: Lack of presence of uterus from birth, immature development of uterus and genetic abnormalities are some of the common causes of amenorrhea.
A condition in which the female is not having her periods from past three months or more is categorized as secondary amenorrhea.
Causes: The causes of secondary amenorrhea can be various, including polycystic ovaries , underweight, anxiety and stress, tumor of pituitary gland, etc. It can also mean pregnancy but it is noteworthy that no period, not pregnant can also be the case.
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You May Have Uterine Fibroids
Another potential cause of infertility issues is uterine fibroids. Essentially, theyre benign tumors that grow inside the uterus. If theyre in the uterine cavity, they can prevent a fertilized egg from implanting on the uterine wall.
If you have uterine fibroids, your doctor may do a hysterosalpingogram test as well as an ultrasound to see if they would affect fertilization and implantation. They can also be surgically removed.
Confusion Spreading Across States About Abortion Laws
Texas’ current heartbeat ban enables private citizens to sue anyone who helps someone get an abortion after about six weeks. If the lawsuit is successful, plaintiffs can receive up to $10,000. Then there’s a trigger law designed to take effect 30 days after the Supreme Court issues its judgment that makes abortion a felony with no exceptions for rape or incest. Providers can be fined at least $100,000 for each violation. Lawyers also warned Rubino that Texas has an old abortion ban that was never formally repealed after the original Roe decision.
“My lawyer told me, ‘Unless they are on that table dying in front of you, you cannot do an abortion on them or you are breaking the law,'” she said, adding, “How am I supposed to help people from jail?”
Many doctors now face a similar predicament. Most abortion bans that have gone into effect since Friday or will become law soon make exceptions for life-threatening situations that arise in pregnancy. But theres no clear legal definition of which conditions qualify for those exceptions, or how severe they have to be for a doctor to perform an abortion free of liability.
Harris told NBC News that doctors in states where abortion is now illegal will likely “wait to that very last minute when its clear that a patient will die to do the procedure, and thats just not an ideal time to do any kind of intervention.”
Experts expect more maternal deaths as a result.
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When To Seek Help If Youre Having Trouble Getting Pregnant
Theres no downside to reaching out to your doctor any time you or your partner have a concern about conceiving. But in general, experts recommend talking to your doctor if youve been actively trying for a full year and are under 35, or if youve been actively trying for six months and are over 35. If youre over 40, its worth talking with your doctor right away.
You should also talk with your doctor if you have a health issue thats known to increase the chances for infertility. These include irregular periods or no periods, periods that are very painful, endometriosis, pelvic inflammatory disease or more than one miscarriage. Your partner should talk with his doctor if he has a history of testicular trauma, hernia surgery, chemotherapy or infertility issues with a previous partner.
Premature & Early Menopause
Premature menopause is when the final period occurs before a woman is 40. The reason for premature menopause may be because:
- your periods stopped spontaneously but early
- you have had surgery to remove both ovaries
- chemotherapy has caused ovaries to fail
Early menopause is when the final period occurs before a woman is 45. Again the reasons may be spontaneous, surgical or chemical.
Effect on fertility
With premature and early menopause, the ovaries run out of eggs earlier than expected and they are unable to produce an egg or the hormones required for pregnancy.
Very rarely, , a woman may have a spontaneous pregnancy after a diagnosis of premature/early menopause.
Sometimes, premature/early menopause is diagnosed when a woman has sought help for fertility. If the ovaries fail to respond to the hormones used to produce eggs or if eggs fail to fertilise, these may be signs of premature/early menopause developing.
For a woman who has gone through premature/early menopause, depending on her circumstance her options for having children include:
- a donor egg
- surrogacy with a donor egg
To explore the best option for you, ask your doctor for a referral to a fertility specialist who is a member of one of the in vitro fertilisation clinics.
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How Is Infertility Defined
Infertility is defined as the inability to become pregnant after one year of unprotected sex for women under 35 and six months for women 35 and older.
The vast majority of people will become pregnant within the first 12 months of trying to conceive with regular unprotected intercourse, says Cross. After six months to a year of trying depending on a womans age we recommend that a couple comes in for an infertility evaluation. At that point, its more likely that theres a problem preventing pregnancy.
Your Partners Infertility Could Be Hurting Your Chances
Men can struggle with fertility due to hormonal or genetic reasons, or environmental factors, Dr. Uhler says. It could be anything from a problem in the pituitary gland signaling hormones in the testes, a blockage in the testes, or exposure to toxins and chemicals, like BPA , alcohol or drugs, thats causing difficulty for your partner.
The easiest way to get to the bottom of the issue is to have your partners doctor perform a semen analysis to study everything from sperm count to shape to motility of the swimmers. Lifestyle-wise, experts recommend a balanced diet and exercise, quitting smoking and vaping, and taking a daily multivitamin for men.
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Abstaining From Vaginal Sex
What Causes Fertility Problems In Women
The main reason for infertility in women is that you don’t ovulate, which means your ovary doesnât release an egg. A condition called polycystic ovary syndrome is the main cause.
Other issues can affect fertility:
- Problems with your fallopian tubes, which carry eggs from the ovary to the uterus. Sometimes your tubes can get blocked by scar tissue from an infection or from a condition called endometriosis.
- Smoking can lead to fertility problems in women.
- Being overweight or underweight can also play a role.
- If an egg does make its way through your fallopian tubes, many things can stop it from implanting in your uterus.
- Cervical mucus can damage sperm or slow their progress.
In women, fertility drops with age, especially after age 35. Getting pregnant after age 45 is rare.
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Supporting Women Before During And After Pregnancy
Ideally, wed like to visit with you before you become pregnant. We will discuss your unique concerns and gather a team of specialists to guide your care. Our high-risk pregnancy team sees patients on the same campus as other specialized providers, so we take a team approach to navigating complex pregnancies.
For example, depending on your condition, your specialist might recommend changing your medication dosage during pregnancy or using a different type of treatment. A dietitian might recommend adding supplements or including more of a certain type of food in your diet. A physical therapist could suggest exercises to strengthen certain muscle groups affected by your condition.
If its necessary to make improvements to your health before you become pregnant, we will work with you to find effective and safe contraception based on your condition.
The bottom line is that words matter in health care. Doctors must be cognizant of the words they choose when speaking with patients and patients must feel empowered to ask clarifying questions. If a provider has told you that you can’t get pregnant, make sure you understand what they really mean and don’t hesitate to get a second opinion if having a baby is important to you.
Research On Stress And Fertility
There have been studies that link stress to lowered fertility, but there is also research that suggests otherwise. The American Society for Reproductive Medicine states, “Even though infertility is very stressful, there isn’t any proof that stress causes infertility.” And in the case of moderate stress, a 2019 study noted no negative effect for women who were trying to conceive.
Even so, other studies demonstrate the opposite effect. A 2018 study by the Boston University School of Public Health, for example, found that women who had high levels of perceived stress experienced lower levels of fertility than those with less stress. Researchers also observed that in situations where one partner was significantly more stressed than the other, there was a lowered chance of conception.
It is important to note that despite a lack of long-term effects on the ability to get pregnant, extreme stress can affect fertility in the short term. For example, you may experience an irregular period during an unusually stressful time, but then find your cycle returns to normal after the heightened anxiety has passed.
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