This is the first in a group of e-books that are distributed for the benefit of our patients and anybody who struggles with fertility.

Transcription

1 5 to Fertility

2 2 This is the first in a group of e-books that are distributed for the benefit of our patients and anybody who struggles with fertility. Like any medical advice that is available online, the suggestions made are not specific to any particular patient. What applies to a large group of people may not apply to you in your efforts to build a family.

3 3 Introduction Baby Steps is based on very simple suggestions that I give to almost all of my patients at their first visit. I spend a lot of time doing what I call reproductive counseling, which amounts to debunking a lot of myths in popular culture that relate to trying to have a family. It turns out that there is such a thing as trying too hard and that some of the things that couples pursue in their efforts to get pregnant are often counterproductive. Baby Steps is a simple, common sense approach to natural fertility. While it is aimed mostly at couples trying to conceive naturally at home, a lot of the information is also applicable to couples going through more advanced fertility therapy. In my clinic, I find that most patients are relieved when they hear this information. While most patients are actively taking a role in building a family, many are already struggling with the pressure that is created with each passing month. With every unwelcome menstrual period and negative pregnancy test, it often seems like the stakes are constantly getting higher. A very natural reaction is to try and control the situation. If you re like a lot of my patients, you spend a lot of time charting your basal body temperature, examining your cervical mucus, and peeing on a stick to determine the days that you are ovulating. You probably have an app for your iphone that tracks menstrual cycles. Your sex life very quickly becomes all about babymaking, and it s difficult to maintain spontaneity and intimacy when you re having sex according to a calendar. This e-book will help you understand natural fertility a little bit better, and hopefully convince you that it s time to throw out the calendars and the charts! Using the simple methods described in Baby Steps, you can create your best opportunity for natural fertility with a commonsense approach that couples find effective and less stressful.

4 4 BABY STEP 01: Trying Doesn t Help

5 5 Trying Doesn t Help Very early into your fertility journey, it is easy to become obsessed with the timing of your menstrual cycle. There is a perception amongst couples who are trying that the timing of ovulation is critical to success. Indeed, there are several commercially available products that you can purchase over-the-counter at the pharmacy that claim to enhance your fertility by identifying your most fertile days. When I first meet with couples, this is one of the first practices I discourage. Although the 48 hours that surrounds ovulation a statistically likely time for fertilization and pregnancy to occur, it certainly doesn t mean that it s the only time. There is actually a long-standing form of contraception based on avoiding fertile days throughout the month. The reason that not a lot of people practice the rhythm method anymore is that it is one of the least effective forms of birth control available. It also reminds us that there are lots of opportunities for conception throughout the month that may not be classified as fertile days.

6 6 BABY STEP 02: Just Do It

7 7 Just Do It The rule of thumb that I recommend to my patients is early and often. Early refers to starting intercourse shortly after menstrual bleeding has stopped. This will often be around the seventh or eighth day of the menstrual cycle. This will ensure that sperm are present prior to, during, and after the time of ovulation. If a woman has a 28 day cycle, ovulation is often predicted to occur in midcycle, or around the 14th day of a 28 day cycle. This approach is a little too simplistic, as it neglects the huge variability from one woman to another. As an example, older women tend to ovulate earlier in the cycle than younger women. As well, heavier women can have very unpredictable ovulatory cycles. Precise timing of intercourse around ovulation is difficult, stressful, and in some cases counterproductive. Often refers to the frequency of intercourse. Although having very little basis in fact, the every other day rule seems to have found its way into most of the bedrooms of couples trying to conceive. It has its basis in the assumption that intercourse that occurs too frequently will drop a man s sperm count to unsuitable levels. In actual fact, the highest pregnancy rates are associated with daily intercourse Although intercourse on alternate days yields a comparable pregnancy rate on a monthly basis, look at the results of a study of 221 couples trying to conceive: Daily intercourse (37% monthly pregnancy) Every other day (33% monthly pregnancy) Weekly intercourse (15%) monthly pregnancy It s quite clear that more frequent intercourse yields a higher chance of pregnancy. My suggestion the most couples is to start having sex earlier in the cycle and set a reasonable goal for frequency such as two times per week. I don t advise any monitoring such as basal body temperatures or LH kits. Preserving intimacy, spontaneity and enjoyment as part of your sexual relationship are far more important than trying to pinpoint the exact moment that ovulation occurs. Not only will you find the process less stressful, you ll also get pregnant more quickly.

8 8 BABY STEP 03: Release The Hounds!

9 9 Release the Hounds! In keeping with the perception that the middle of the cycle yields the highest fertility, a lot of men will focus sexual activity around the time of ovulation. Due to the perception that too frequent ejaculation lowers sperm count, a lot of men will abstain from sexual activity until the time that their partner is thought to be ovulating. As discussed in Step #1, this practice doesn t help increase fertility. And, on closer examination, it probably decreases the quality of the sperm. When thinking about sperm, a lot of men and women have an inaccurate perception of how sperm function how they are produced. Sperm are in constant production and constant supply, and they re meant to be used rather than stored. A mature sperm takes approximately 3 months to be fully formed, and sperm will be present in the testicles at various points in that assembly line. The sperm that are the most mature tend to be ejaculated first, and the longer they are stored without being ejaculated, the less likely they are to help create a pregnancy. Mature sperm that are held in storage that being ejaculated tend to break down and swim less effectively. As such, the chance of fertilizing an egg becomes less the longer that man hold onto sperm. This is why we encourage our patients to ejaculate more frequently, to increase the quality of the ejaculated sperm. Although the quantity of sperm does decrease slightly with successive ejaculations, it did not decrease to zero. Two sperm deposits close together generally have a higher chance of achieving pregnancy than a single ejaculate on its own. Ultimately, the goal is to expose the egg to as many sperm is possible, even if it s over several days. While it might be satisfying to think that we can pinpoint ovulation expose sperm to egg with tremendous accuracy, a shotgun approach is generally preferred.

10 10 BABY STEP 04: Get to Know Your Body

11 11 Get to Know Your Body An honest and accurate assessment of your own body is an important part of optimizing your fertility. In fact, a lot of patients present to our clinic having diagnosed themselves just by paying attention to their bodies. While I mentioned that the timing of ovulation is not crucial, the presence or absence of ovulation most certainly is. Most women are able to correctly identify whether or not they are ovulating. Moliminal symptoms, or symptoms which suggest ovulation, are actually far more accurate than most people give them credit for. Symptoms such as breast tenderness, midcycle pain, abdominal bloating and changes in cervical mucus are very reliable. Changes in cervical mucus are every bit as accurate in predicting ovulation as expensive LH kits. If you re not getting consistent moliminal symptoms, there is a significant chance that you re not ovulating on a regular basis. Particularly if you have risk factors such as advancing age or increased body weight, you may not be getting as many opportunities at pregnancy in a given calendar year. By listening to your body, you may be able to identify one of most common reasons for subfertility. Pelvic pain is another symptom of subfertility that a lot of women are able to identify on their own. Pain with menstruation, termed dysmenorrhea, can sometimes be a symptom I have an inflammatory condition called endometriosis. There is a very strong correlation between endometriosis and infertility. If pelvic pain is severe enough to require prescription medication or time off work, endometriosis is always a possibility. Another classic symptom of endometriosis is pain with intercourse, termed dyspareunia. If sex is consistently painful, you should be consulting a doctor. Early diagnosis of conditions like endometriosis is important; as the process progresses, its correlation with infertility become stronger.

12 12 BABY STEP 05: Healthy Pregnancy Starts Right Now!

13 13 Healthy Pregnancy Starts Right Now! You need to be honest with yourself if there are areas of your physical help you could improve. In Canada, approximate 20% of the population will qualify as being obese. The rates of Type 2 diabetes has skyrocketed in our society in the last 10 years. If you have additional risk factors, such as insulin resistance, high blood pressure, or a family history of type 2 diabetes, your body weight in metabolism likely plays a strong role in any difficulty becoming pregnant. Calculating a body mass index, or BMI, is a reasonably objective way of assessing your body weight. A BMI of greater than 30 is technically considered obese, and as the body mass index increases, both the incidence of infertility as well as a decreased response to fertility treatments are noted. This is true for men as well! Similarly, if your body weight is very low, particularly if you have a history of eating disorders or excessive exercise, difficulty in becoming pregnant is quite common. Both of these topics will be covered in a separate e-book on weight and metabolism.

14 14 At Fertility Ontario, we spend the time necessary to start our patients on the road to metabolic health. More patients become pregnant through weight loss and metabolic management than through more advanced procedures such as in vitro fertilization. Similarly, obvious lifestyle issues need to be addressed. Although people always ask questions about hot tubs and boxers versus briefs, a lot of patients ignore much more serious contributors such as cigarette smoke, excessive alcohol use, and drugs such as marijuana. The best rule of thumb seems to be everything in moderation. There is no evidence that moderate caffeine use or the occasional glass of wine contributes to either subfertility or miscarriage. Much higher dose of caffeine have been contributed to increased risk of miscarriage. And, as most people know, there is a risk of alcohol exposure to the developing fetus. Remember to give yourself a break every once in a while. On the other hand, substances such as cigarette smoke and marijuana use have such a dramatic affect on fertility that they cannot be recommended in any circumstances. We will develop these ideas more in a separate e-book on lifestyle choices. A lot of patients will abstain from caffeine and alcohol altogether, but modest use is perfectly acceptable.

15 15 The path to building a family is different for everyone.

16 16 We re here to help These simple tips are offered to all of my new patients and have helped many couples conceive spontaneously or shorten their time to conception. The underlying philosophy is based on common sense and basic biology rather than trying to control too many variables at once. For a lot of patients, it is difficult to let go of the monitoring and charting that becomes almost like a ritual over time. The challenge in that situation is to somehow change your focus. Rather than obsessing about frequency of intercourse or timing of ovulation, wouldn t it be better to devote your energy to something positive? Don t forget to nurture your relationship with your partner. Eat healthy. Stay active. Treat your body the way your baby would want it to be treated. The path to building a family is different for everyone. Relax. Don t panic. Stay positive. And we ll help you get there.

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