Tag Archives: early menopause

TRYING TO GET PREGNANT: 14 FERTILITY MYTHS DEBUNKED

Posted in Health by

We live in the era of informatics. Knowledge is easily accessible to us: we can learn virtually anything by just googling it. But paradoxically too much information many times leads to misinformation.

When it comes to fertility issues, there is a lot of disinformation going around. Therefore, it is no surprising what a recent survey showed: knowledge regarding ovulation, fertility, and conception issues is limited among women, and many tend to believe certain myths and misconceptions.

These are 14 fertility myths most people believe, but that science has debunked:

MYTH #1.  Maternity wise, 40s is the new 30s

Our life expectancy is longer, and we tend to postpone maternity due to career or study purposes. From that aspect, the 40s can be easily regarded as the new 30s. Unfortunately, this is not true for our ovaries: by the age of 30, a healthy woman has about a 20% chance of conceiving each month, by the time she reaches 40 her odds drop to about 5%.

This is one of the most commonly believed misconceptions: unaware of the age-related fertility decline, many women start seeking  help to conceive in their 40s, when they may have already missed the opportunity to become parents. 

You should be aware that there is a biological clock, and it’s ticking! If for personal reasons you cannot have a child right now, you may freeze your eggs to use them in the future.

MYTH #2. Certain sex positions increase the chances of getting pregnant

You will find plenty of (mis)information on this topic! In general, it is said that the best positions for getting pregnant are the missionary position (the woman lying on her back, her partner on top) and the “doggy position” (rear vaginal penetration, with the woman on her hands and knees) because they provide the deepest penetration, allowing the man to ejaculate closer to the opening of the cervix. 

In fact, there’s no scientific evidence to prove that. This belief is largely based on a single study that looked at the position of the penis in relation to these two sex positions, but it didn’t address pregnancy chances at all.

Therefore, no position seems to be better when it comes to maximizing your chances of making a baby. Sperm can be found in the cervical canal just a few seconds after ejaculation, and within 5 minutes in the tube, regardless of the coital position.

MYTH #3. Lifting your legs in the air for 20 minutes after having sex will help you get pregnant

You have probably heard this one: “lie in bed with your feet in the air after having sex to increase your chances of getting pregnant”. In fact, this is not (totally) true. You may lay in bed for 10-15 minutes after intercourse, as by this time the sperm have largely reached the cervix, and many may even be inside the tube.

In fact, a new study challenged both beliefs: women having artificial insemination were split into two groups – one that rested on their back with their knees raised for 15 minutes after the procedure and one that got up immediately. It turned out that, after several courses of treatment, 32% of the immobile group fell pregnant, compared with 40% per cent in the active group.

Therefore, there is no need to put pillows under your bottom during intercourse to get an advantageous tilt, or to perform cycling motions with your feet in the air.

MYTH #4. If we have sex every day the sperm becomes too weak, reducing our chances of getting pregnant 

How often should we make love to boost our chances of pregnancy? You will find all sorts of advice on the web: every other day, 3 times a week, every single day! Which one is correct?

One thing is clear: abstinence intervals greater than 5 days impair the sperm number and quality. Nevertheless, there is not much difference whether men ejaculate every day or every other day. Most fertility specialists used to recommend intercourse every other day, as this would increase sperm quality, particularly in men with lower sperm counts (oligozoospermia). However, recent studies show exactly the opposite: oligozoospermic men had better semen quality with daily ejaculation!

Recent scientific evidence suggests that making love every day confers a slight advantage: the highest chances of pregnancy (37% per cycle) were associated with daily intercourse, although sex on alternate days had comparable pregnancy rates (33%). On the other hand, we should keep in mind that the “obligation” to have sex every day may induce unnecessary stress to the couple, resulting in lack of sexual desire, low self esteem, and ultimately reduced frequency of intercourse.

Therefore, reproductive efficiency is highest when you have sex every day or every other day. The optimal frequency, though, is best defined by each couple’s own preference.

MYTH # 5. We only have sex when I ovulate, on day 14 of my cycle

Ovulation (when the egg drops from the ovary into the tubes) occurs once a month, usually between day 11 and day 21 of the cycle (measured from the first day of your period).

Each woman ovulates on her own schedule. While it is usually said that a woman with a 28-day cycle ovulates on cycle day 14, that’s not necessarily true: a study found that fewer than 10 percent of women with regular, 28-day cycles were ovulating on day 14.

We know that sperm cells are able to survive in the reproductive tract of a woman for about 5 days, and that once the egg is released, it will die in about 12-24 hours. Therefore, the fertile period -or “fertile window”- is a 6-day interval ending on the day of ovulation.

To boost your odds to become pregnant, have sex before and during ovulation, every day or every other day. If your cycles are irregular and you cannot figure out your fertile days, you may use an ovulation predictor kit, or otherwise visit a specialist, who can help you find your fertile window.

MYTH # 6. Smoking doesn’t affect our chances of getting pregnant. I will quit smoking as soon as I get pregnant

You are most likely aware that smoking during pregnancy is dangerous, as it can lead to miscarriage, premature birth, low-birthweight babies and -according to recent studies– congenital malformations.

But you should also know that smoking is harmful for your fertility: smoking as few as five cigarettes per day is associated with reduced fertility, both in women and men, and this seems to be true even for secondhand smoking. It has been estimated that smokers may have a 10-40% lower monthly fecundity (fertility) rate, and that up to 13% of infertility is due to smoking.

Smoking can affect ovulation, as well as the ability of the fertilized egg to implant in the uterus. The effect of tobacco is so harmful for the ovaries that menopause occurs, on average, one to four years earlier in smoking women than in nonsmoking ones.

Men are also affected by tobacco: decreases in sperm density, motility, and abnormalities in sperm morphology have been observed in men who smoke, which impact a man’s ability to fertilize an egg. 

Therefore, before trying for a baby, do yourself a favor … and put out the cigarette for good!

MYTH # 7. You don’t need to worry about your age. There’s always IVF

Another common misconception! Many women believe that, if age-related infertility strikes, they can overcome their problem by getting treated with in vitro fertilization (IVF). In fact, just as natural fertility declines with age, success rates with IVF also decline as a woman gets older.

According to the USA Center for Disease Control and Prevention (CDC), women younger than 35 years old have 33% chances of having a baby after IVF; for women ages 38 to 40 the success rate drops to 17%, while those 43 to 44 years old have only 3% chances of giving birth after IVF (using their own eggs).

IVF is not a guarantee to have a baby, and does not extend a woman’s reproductive life. Despite the number of celebrities having babies in their mid-40s and beyond, they may have not necessarily used their own eggs. While every woman has the right to keep her privacy, there is a wrong perception left that fertility treatments can extend a woman’s fertility span. There is a very low probability of improving success of conceiving after age 43 by using assisted reproduction using your own eggs. Nevertheless, you may opt to use oocyte donation (eggs of a younger woman) if age-related infertility stands in the way of parenthood.

MYTH # 8. A woman can’t get pregnant if she doesn’t have an orgasm

For men, things are clear: no orgasm, no pregnancy, as ejaculation occurs during orgasm. Well, that’s not entirely true: semen can be released during intercourse prior to orgasm in the so-called pre-ejaculation fluid, or pre-come (read more here).

For women though, getting pregnant has nothing to do with an orgasm. But could female orgasm improve the chances for conception? The answer is not clear.

Researchers have wondered for years about the purpose of female orgasm, and many theories have been proposed: 

  • Just the pleasure it provokes, so that women want to reproduce and preserve the species!
  • The “poleaxe” hypothesis: orgasms make women feel relaxed and sleepy so that they will lie down after sex and the sperm reach their destination more easily.
  • The “upsuck” theory: the contractions of the uterus “suck up” the sperm released in the vagina and help them travel through the uterus to the tubes.
  • Pair bonding: the hormones produced during orgasm (such as oxytocin and prolactin) contribute to warm feelings towards her partner.

Orgasms are not necessary to get pregnant, but there are plenty of good reasons to have one! Nevertheless, it is not uncommon that women trying to conceive link the desire for an orgasm with their desire to have a baby; this leads to psychological pressure and difficulty achieving orgasm, adding frustration to a process that is supposed to be pleasurable…

Try not to consider the orgasm just as goal to get pregnant. Enjoy the intimate time with your partner, without any pressure. If you have an orgasm, great. If not, that’s fine, too!

MYTH #9. We’ve already had one child, so conceiving again will be easy

Perhaps, but it’s no guarantee. Many individuals experience secondary infertility, or difficulty conceiving a second or subsequent child. 

Secondary infertility may be caused by age-related factors, both for you and your partner. Sometimes, a new underlying medical condition develops. Eventually, a fertility issue that always existed gets worse; while it didn’t prevent pregnancy before, now it has become a problem. A previous pregnancy may actually be the reason you don’t get pregnant again: surgical complications or infection after childbirth may have provoked scarring, which may in turn led to infertility.

Things change with time. Even if you got easily pregnant on your own before, if you’re struggling to have another child talk to your doctor, who can advice you on the next steps to follow.

MYTH #10. Infertility is a woman’s issue

Typically, the causes of infertility break down like this: 

  • Approximately one third of the couples struggle with male infertility;
  • In another third, the problem is female infertility;
  • The remaining third will either face both male and female fertility issues, or a cause will never be found (unexplained infertility).

Common causes of female infertily are: age, PCOS (polycystic ovary syndrome), tubal or pelvic issues, endometriosis, and family history. 

Common causes of male infertility tend to be from prior surgery, infection, or a problem present at birth.

As part of the preliminary work-up to determine the cause and treatment of infertility, both women and men will need to undergo clinical and specialized complementary exams.

MYTH #11. Men’s age doesn’t matter

While some men can father children into their 50’s or 60’s, men’s fertility isn’t age-proof: it starts declining in their 40s, although less drastically as compared to women’s fertility.

As a man ages, the concentration of mobile, healthy sperm and semen volume overall will decrease. It is clear now that men over the age of 40 have higher chances of having children with chromosomal abnormalities, causing miscarriages in their female partners. Moreover, researchers have found a direct link between paternal age and an increased risk of autism and schizophrenia. 

A man’s age does matter. While men may not have a complete drop off in fertility like women do, “advanced paternal age” is something couples should be aware of. Men’s biological clock is also ticking!

MYTH #12. If I take good care of my general health, my fertility will be in check too

Whereas a healthy body and mind may boost fertility in certain cases, most infertility situations cannot be resolved by a lifestyle or diet change, particularly those related to age.

It is a common belief that certain diet types can help you get pregnant. There is no evidence that vegetarian diets, low-fat diets, antioxidant- or vitamin-enriched diets will increase your chances of having a child.

A woman’s weight plays a role in fertility: those who are either very thin or obese may find it hard to conceive. If you are trying to get pregnant, learn more about some lifestyle tips to boost your chances of getting pregnant here.

MYTH #13. If a man can ejaculate, his fertility is fine

Many myths surround male fertility and their sexual performance. It is a common (and unfortunate) myth that if a man’s fertility is compromised, this means his sexual performance is the problem. This is not true. Problems with sperm count, shape, and movement are the primary causes of male infertility. 

Another common myth is that you can tell there is a problem with the sperm just by looking at the semen. In fact, even men that have no sperm cells at all (azoospermia) usually have normal-looking semen. 

For the vast majority of men with infertility, there are no visible or obvious signs that anything is wrong. Healthy erectile function and normal ejaculation are not guarantee that the sperm is in good shape.

That said, erectile dysfunction can be a possible symptom of infertility; it may due to low testosterone levels or a physical injury. Difficulty with ejaculation can also be a signal certain medical problems. But these are uncommon signs of male infertility.

If you are struggling to get pregnant, have your partner check in with his doctor. A semen analysis will help clarify whether his sperm are fit for conception.

MYTH #14. The birth control pill will affect your future fertility

All scientific evidence agrees that hormonal contraceptives do not make women sterile. Moreover, they may confer increased likelihood of pregnancy with long-term use, and in certain cases they can also preserve fertility. Read more on the contraceptive pill here.

 

To summarize:

Myths and misconceptions regarding fertility and conception are, unfortunately, widely disseminated. This is a serious problem, as misinformation may lead not only to unnecessary stress, but also to take wrong decisions…

Get yourself well informed! Consult your gynecologist, who can help you with any concerns you have. Your doctor can also give you some tips on lifestyle changes to optimize your fertility, prescribe some exams, and tell you when to come back if you don’t achieve pregnancy on your own.

Last, a good piece of advice: if you want to get pregnant, have lots of sex – as much as you want, whenever you want – and enjoy it! After you have had sex, do whatever you want – just don’t smoke 😉

 

Photo credits

Intro: pixabay.com; 1: rma-fl.com; 2: motherandbaby.co.uk; 3: romper.com; 4: pixabay.com; 5: wsaw.com; 6: babycenter.com; 7: nexter.org; 8: irishtimes.com; 9: health.clevelandclinic.org; 10: thefertilechickonline.com; 11: businessinsider.com; 12: hayatouki.com; 13: livescience.com; 14: pinterest.com

EGG FREEZING: IS IT FOR ME?

Posted in Health by

Ann is 36 years old, she is single and hasn’t met “Mr. Right” yet… She feels her biological clock is ticking, and is afraid of not finding the right partner in time to have children.

Marie, age 35, is an executive employee at a big multinational company. Although she would like to have a family, she believes that motherhood at this time will affect her career.

Both of them are wondering the same thing: Should I freeze my eggs?

Egg freezing, also called oocyte cryopreservation, has been around for many years now. But lately it has been extensively discussed in the media, especially since Facebook and Apple announced that they will be paying egg freezing for their female employees (read more here).

You have most likely heard of egg freezing, but how is the procedure? Is it safe? When to do it? Is it a sure thing?

In this article we will clarify the most important aspects of egg freezing and discuss some realities you need to know in case you decide to embark on this venture…

What is egg freezing? Why should I consider it?

egg freezing human-eggEgg freezing means that a woman’s eggs are extracted from the ovaries, frozen and stored for future use.

Fertility declines with age, and this is due to ageing of the ovaries and eggs (oocytes). Unlike men, who produce spermatozoa throughout most of their lifetime, woman are born with a lifetime’s egg supply: we have about 2 million immature eggs at birth, when we reach puberty there are about 300.000 left, and each month we lose several thousands. By the time we are 30 years old, 90% of the eggs are already gone, and only 3% have remained when we reach 40.

But it’s not only quantity that matters, it’s also quality. As the body ages, the oocytes age as well, and their genetic material may become damaged. This is the reason why older women have reduced fertility, but also increased risk of pregnancy loss and having a baby with certain defects such as Down syndrome.

Unlike the eggs, the uterus is not affected by ageing and is able to carry a pregnancy in the 40s and beyond; this is true even for menopausal women.

Therefore, if we pick up the eggs and freeze them, eggs’ quality will remain unaltered with time: let’s say you freeze your eggs at 30 years old, and you put them back in your 40s, your eggs will still be 30 years old!

Who are the candidates for egg freezing?

Egg freezing beautiful-business-woman-looking-what-time-is-it–Women who want to delay motherhood for social reasons, usually due to career or study obligations, or because they are not in a stable relationship. This is the most common reason egg freezing is requested and carried out, although scientific societies’ opinions worldwide are divided in this matter. While the European Society for Human Reproduction and Embryology (ESHRE) endorses it by stating: “Oocyte cryopreservation should […] be available for women […] who want to protect their reproductive potential against the threat of time”, the American Society for Reproductive Medicine (ASRM) stands more cautious, concluding: “There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging”.

Although social egg freezing will be the focus of this article, there are other situations where egg freezing is, beyond any doubt, an invaluable tool:

–Women diagnosed with certain cancers. Some cancer treatments such as chemotherapy, radiotherapy or surgery may damage the ovaries, leading to sterility. Thus, freezing the eggs before therapy may preserve fertility in these women.

–Women with high risk of going into early menopause:

  • women carrying a faulty gene or chromosome known to cause early menopause;
  • those with a strong family history of early menopause.
  • those having a defective gene (such as BRCA1 and 2 genes) related to high risk of ovarian cancer, when removal of the ovaries is considered. In such women, if childbearing has not been completed, egg freezing may be an option before surgery.

–Certain couples undergoing in vitro fertilization (IVF):

  • When for religious or legal reasons the embryos cannot be frozen. This is a common situation in countries such as Italy, where embryo freezing is forbidden by law.
  • If the man is unable to collect sperm, or when men with severe infertility do not have no sufficient spermatozoa to fertilize all available eggs. In such cases, the eggs can be frozen for use at a later date.

How is the procedure I should go through to freeze my eggs?

egg freezing woman-giving-herself-ovarian-stimulation-injectionIn order to freeze the oocytes, a woman undergoes a hormonal treatment, aimed to stimulate the ovaries to produce multiple eggs. There are several protocols for that -the so-called short and long protocols- depending on ovarian function and also how urgent the procedure is (e.g. when egg freezing is done before cancer treatment).

Initially, a medication is used to turn off natural hormones, sometimes together with birth control pills. After that, hormone injections are self-administered during 10 to 14 days to mature the eggs.

When the eggs are ripe, they are aspirated through the vagina with the aid of a needle, under ultrasound guidance. The procedure is usually done under mild sedation. The eggs are immediately frozen, in most centers with a method called vitrification.

Once a woman decides to attempt pregnancy -this may be months or years later- the oocytes are thawed, injected with a single spermatozoon and left in an incubator to fertilize. After two to five days, the resulting embryos are transferred into the uterus with a thin catheter.

It should be mentioned that some women from whom few eggs are retrieved may need to undergo several stimulation cycles in order to have a reasonable number of oocytes cryopreserved (the ideal number would be 20 to 30).

 Age issues…

What is the ideal age to freeze my eggs?

Egg freezing woman on clock resized 2

From the biological point of view, the answer is straightforward: the younger, the better. Here is why: a woman in her 20s is expected to have 15 to 25 eggs available for freezing. Since the oocytes are of good quality, about 4 to 5 eggs will be needed to produce one baby (some eggs will not survive the thawing process and others will not fertilize). Someone in her 40s, though, will produce in the best of the cases 8 to 10 eggs, but (statistically speaking) 25 eggs may be needed to produce one baby, because the eggs will be of lower quality…

But at what age should a woman take the decision to freeze her eggs? This question is more difficult to answer. Ovarian function is not equal for every woman. While certain women in their early 30s have already diminished ovarian function, others in their 40s have excellent hormonal levels… An ideal time frame would be between 30 and 35, but again, we should be cautious as this may not apply to every woman.

In order to help you decide when to freeze your eggs, some experts suggest to monitor regularly the ovarian reserve by measuring a hormone called Anti Mullerian Hormone (AMH), which is very reliable to show how the ovaries work.

What is the age limit to freeze my eggs?

According to ESHRE, cryopreservation for women older than 38 should not be recommended, unless prior assessment of the ovarian reserve justifies the procedure. In many centers, the upper limit is 43, because this is the age when pregnancy rates drop dramatically. Again, there may be exceptions according to a woman’s ovarian function.

What is the age limit to use my frozen eggs?

Egg freezing New York magazineAs stated above, the uterus is not affected by ageing. There have been reports of women having children -with egg donation from a younger woman- in their 60s. But there is a point where a pregnancy will not benefit neither the woman, nor the children. The ASRM advises against embryo transfer (either fresh or frozen) in women over 55, because over that age the maternal and fetal risks seem to be higher. Many centers set the limit of 50, which is the age limit established by law in many countries.

How well does egg freezing work?

Pregnant HeartOut of all the frozen eggs, about 90-95% will survive the thawing process. When the thawed eggs are fertilized, the results are comparable to those with IVF using fresh oocytes: 36 to 65% pregnancy rate, according to different studies. Like with IVF, success rates are clearly linked to maternal age at the time of freezing, the younger the women, the higher the pregnancy rates.

These results, although  impressive, show that egg freezing is not a 100% guarantee of success; of all women freezing their eggs about half of them will become pregnant.

How long can the eggs remain frozen?

Egg freezing liquid-nitrogenEgg freezing is a relatively recent procedure, but the practice of freezing embryos has been around for many years, and pregnancies have been achieved with embryos frozen for more than 20 years. So we expect that, most likely, the same will apply to frozen eggs.

Is it a safe procedure?…

…For the woman?

Egg freezing petri dishObtaining oocytes for fertility preservation is a very safe procedure, although not entirely without risk of complications. The medications taken to stimulate the ovaries, the procedure of egg pick-up and the anesthesia required are all possible sources of complications. Briefly, the medications’ side effects are usually mild, as one of the most feared complications in assisted reproduction, the ovarian hyperstimulation syndrome, is very rare (this is because the embryo transfer is deferred). The remaining risks are estimated as follows: risks from the anesthesia: in 1/10.000; risk of severe hemorrhage from the egg retrieval procedure: 1/2.500; risk of infection: less than 1/500. For a more detailed analysis of complications, check here.

…For the baby?

Egg freezing babyTo date, more than 5.000 babies have been born from frozen eggs, and the available data seem to be reassuring. The largest study on this subject analyzed 900 babies; no increased rate of birth defects was observed. Of course, since this is a relatively new procedure, it will take many years of follow-up to confirm egg freezing safety.

Unanswered questions…

Egg freezing Woman holding clockThere are still many controversial issues and debate surrounding egg freezing; from women feeling egg freezing is “as liberating as the contraceptive pill”, to those believing this is just a -very lucrative- business, pushing women to consider “a must” to freeze their eggs and to feel “irresponsible” if they don’t do it. This debate has been even more fuelled by Apple and Facebook’s decision to pay the procedure to their employees…

At the present time, some questions remain to be answered:

  • Will egg freezing become a standard procedure, a sort of insurance each woman will have?
  • Will it push women to become mothers at a later age, leading to a generation of older parents?
  • Is egg freezing the future of fertility? Will this procedure contribute to medicalize conception?
  • Can we / should we fool our biological clock?
  • Will companies force women to devote their lives to their jobs, to eventually “discard” them in their 50s? Should women’s efforts be directed towards achieving more benefits for working mothers, rather than getting egg freezing payed?
  • What will happen to all the frozen, unused eggs?
  • What are the psychological risks of the procedure, especially for women who froze their eggs but did not become pregnant?

The bottom line…

  • Egg freezing is not a warrant for future pregnancy. Delaying childbearing you may risk missing the opportunity to eventually have a child.
  • This procedure should be regarded as a “plan B”: an emergency measure in case you fear you won’t be able to have children before running out of eggs.
  • Before deciding to freeze your eggs, you should discuss extensively the procedure with your doctor, in order to learn risks and chances of success in your particular case.
  • What is more important, all women should be aware that there is an age-related fertility decline in women. Therefore, when possible, you should not delay childbearing. The biological clock does tick!

 

More info at gofertile.eu

References:

The American College of Obstetricians and Gynecologists: Oocyte Cryopreservation. Committee Opinion, Number 584 -January 2014

ESHRE Task Force on Ethics and Law: Oocyte cryopreservation for age-related fertility loss. Hum Reprod. 2012 May;27(5):1231-7.

Practice Committees of American Society for Reproductive Medicine; Society for Assisted Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril. 2013 Jan;99(1):37-43.

Cobo A1, Diaz C. Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2011 Aug;96(2):277-85.

Egg Freezing for a Future Pregnancy: What to Know. WebMD

Photo credits

Intro: Getty images; oocyte: scitechdaily.com; career woman: youqueen.com; hormone injection: fssc.com.au; intra cytoplasmic sperm injection: Wellcome images, Flickr.com; ideal age: Tatyana A, Flickr.com; age limit to use frozen eggs ffemagazine.com; pregnant heart: Olivier Martins, Flickr.com; Egg freezing: midlandfertility.com; safety for the woman: theage.com.au; for the baby: Daniel James, Flickr.com; unanswered questions: Stefano Corso, Flickr.com; young pregnant woman: Tips Times Admin, Flickr.com.