When you are trying to have a baby and it isn't working, it seems like everyone around you is pregnant. Invitations to baby showers bombard you from all directions. It can be painful to see someone else living out what you so badly want for yourself, so, should you subject yourself to the pain of going to someone's baby shower or not?
I would like to state here that this article is based on my personal opinion and professional experience, not on scientific research. Don't take it as gospel!
Let's ignore for the moment your sense of obligation. Now the question is- will it be helpful or hurtful for you to go to the shower?
I think it's pretty clear that if you have just recently suffered a major disappointment such as a failed IVF cycle or a miscarriage, then you are probably better off staying away. Send a gift and regrets.
However, if you haven't just recently been disappointed, there might be some benefit to attending, even if it is also painful. Consider if the following might be true in your situation:
Fertility struggles can be a long haul. I read a novel called The Midwife of Hope River, and in that book the midwife repeatedly tells women in labour to push a little and blow a little. In other words, give yourself a break, but also push yourself a little. That advice might extend to the lengthy, painful toil of fertility struggles.
To make the decision, first, give yourself permission not to attend the shower even if you feel obligated to go. Second, tune in to your thoughts and feelings to see what the right path is.
If you do decide to go to a shower, psyche yourself up. Know that part of you will probably feel sad throughout the event. Here are some ideas:
Endometriosis is a condition in which tissue that normally lines the uterus grows where it should not. For example, it might grow on an ovary, or on the abdominal wall. Endometriosis can cause many different symptoms, either by causing inflammation or by taking up space. The most common symptoms are heavy menstrual bleeding, painful periods, pain with intercourse and constipation/diarrhea.
Endometriosis is also associated with infertility and miscarriage. In about 5 percent of infertility cases, endometriosis is the only cause. Endometriosis is present as a contributing factor in at least 25 percent of infertility cases. Sometimes endometriosis causes scarring that inhibits ovulation or fertilization of the egg cell, but it is probably the effect of endometriosis on the immune system that has the greatest impact on fertility.
Diagnosing endometriosis can be difficult because its symptoms can have many other explanations, and because the definitive method of diagnosis is by laparoscopy, which is quite invasive. Typically, the first step in diagnosis is to have an ultrasound done. An MRI might also be used. When both infertility and chronic pelvic pain are present, I design my treatment plan assuming that endometriosis is present.
The naturopathic approach to endometriosis addresses the multiple contributing factors:
Conventional treatment of endometriosis includes NSAIDs (for pain), hormones and surgery.
For most women, endometriosis will only delay having a baby, not prevent it.
Infertility. endometriosisinfo.ca/infertility_e.aspx. The Society and Gynecologists and Obstetricians of Canada. Online. Accessed Dec 4 2017.
Association between surgically diagnosed endometriosis and adverse pregnancy outcomes. Innie Chen, M.D., M.P.H., Shifana Lalani, M.Sc., M.D., Ri-hua Xie, Ph.D., R.N., Minxue Shen, M.D., Ph.D, Sukhbir S. Singh, M.D., Shi-Wu Wen, M.B., Ph.D. Fertility and Sterility. Nov 29 2017.
Endometriosis, especially mild disease: a risk factor for miscarriages. Alexandra Sabrina Kohl Schwartz, M.D, Monika Martina Wölfler, M.D., Vira Mitter, M.Sc., Martina Rauchfuss, M.D., Felix Haeberlin, M.D., Markus Eberhard, M.D., Stephanie von Orelli, M.D., Bruno Imthurn, M.D., Patrick Imesch, M.D., Daniel Fink, M.D., Brigitte Leeners, M.D. Fertil Steril. 2017 Nov;108(5):806-814.e2. doi: 10.1016/j.fertnstert.2017.08.025.
Dx with pelvic exam, US and MRI.
Imaging in the initial and preoperative assessment of endometriosis. Thomassin-Naggara I, et al. Presse Med. 2017 Nov 16. pii: S0755-4982(17)30442-6. doi: 10.1016/j.lpm.2017.09.020. [Epub ahead of print]
A preliminary evaluation of influence of body mass index on in vitro fertilization outcome in non-obese endometriosis patients. Garalejic E, et al. BMC Womens Health. 2017.
Stress During Development of Experimental Endometriosis Influences Nerve Growth and Disease Progression. Cuevas M, et al. Reprod Sci. 2017.
Environmental Manipulations as an Effective Alternative Treatment to Reduce Endometriosis Progression. Torres-Reverón A, et al. Reprod Sci. 2017.
A nice glass of cold Coca-cola on a hot day takes me right back to childhood and gives me a boost of energy. However, I keep pop in the 'treat' category rather than drinking it on a regular basis because I believe the sugar content is unhealthy.
A new study looking at beverage intake recently came out, and it provided another reason to suspect that drinking our calories is not good for us. The study found that the higher a woman's intake of sugared pop, the lower her chances of having a live birth after in vitro fertilization.
The study followed 340 women undergoing IVF. It compared women who drank no pop to those who drank more than one cup per day. Those who drank one or more cups of pop per day were 16% less likely to have a live birth from the IVF cycle studied.
Another study looked at how long it took women conceiving naturally to become pregnant. Unfortunately they did not tease out regular pop and diet pop, however they still found that the more pop a woman drank, the longer it took to get pregnant. They reported their results as the likelihood of getting pregnant in over the course of twelve menstrual cycles compared to no pop consumption.
As you can see, the impact of drinking pop is small unless you are drinking unusually high amounts. Even so, because it is an easy behaviour to change, I suggest it as a quick fertility 'win'.
Association between preconception maternal beverage intake and in vitro fertilization outcomes.RonitMachtingerM.D,AudreyJ.GaskinsSc.D.bcAbdallahMansurM.Sc.aMichalAdirB.Sc.aCatherineRacowskyPh.D.dAndrea A.BaccarelliM.D., Ph.D.eRussHauserM.D., Sc.D.fgJorge E.ChavarroM.D.bcg. Fertility and Sterility. Available online 3 October 2017
Caffeinated Beverage and Soda Consumption and Time to pregnancy. Elizabeth E. Hatch,1 Lauren A. Wise,1,2 Ellen M. Mikkelsen,3 Tina Christensen,3 Anders H. Riis,3 Henrik Toft Sørensen,1,3 and Kenneth J. Rothman1,4. Epidemiology. 2012 May; 23(3): 393–401.
Good thyroid function is an important prerequisite for fertility. Your thyroid gland is just below your Adam's apple and it sets the pace of your metabolism. Under function (hypothyroidism) and over function (hyperthyroidism) both cause problems with fertility.
Hypothyroidism is quite common so we will address that first. The textbook set of symptoms caused by hypothyroidism is:
You can also experience changes to your menstrual cycle with hypothyroidism: long cycles, heavy bleeding, and prolonged presence of fertile-quality cervical fluid.
When I suspect hypothyroidism, I order a set of four tests: TSH (the hormone that comes from the brain and tells the thyroid gland what to do), T3 (the active form of thyroid hormone), T4 (the inactive form of thyroid hormone) and Anti-TPO (a specific type of immune system attack on the thyroid gland). I use a smaller range of normal for these tests because the tighter range is associated with better rates of pregnancy, lower risk of miscarriage and better pregnancy outcomes.
If you think you might have a hypothyroid problem, you can do a test at home by taking your basal body temperature each morning. Your basal body temperature is your temperature before you get up and start moving around. Your temperature should be 36.1-36.4 degrees Celsius before ovulation and 36.44-37.0 after ovulation. If your temperatures are low, take that information to your naturopathic or medical doctor for further investigation.
Naturopathically, low thyroid function is treated by providing the nutrients important to the thyroid gland and using herbs to stimulate the thyroid gland. It may also be necessary to treat the immune system because immune system attack on the thyroid gland is the most common cause of hypothyroidism. If this treatment does not have enough impact, then supplemental thyroid hormone can be given.
The symptoms that hyperthyroidism produces are almost the opposite of those caused by hypothyroidism:
Hyperthyoidism causes light bleeding during periods. It can also cause problems for conceiving, increase the risk of miscarriage and cause problems for the postpartum period.
Besides the impact on fertility, thyroid problems have longterm health consequences. For example, hyperthyroidism can cause osteoporosis.
Again, myself and other naturopathic doctors have much more stringent standards for what constitutes good thyroid function. Even if you have had your thyroid tested and been told it was fine, a naturopathic doctor might have a different opinion.
Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. The American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum, Alex Stagnaro-Green, (Chair),1 Marcos Abalovich,2 Erik Alexander,3 Fereidoun Azizi,4 Jorge Mestman,5 Roberto Negro,6 Angelita Nixon,7 Elizabeth N. Pearce,8 Offie P. Soldin,9 Scott Sullivan,10 and Wilmar Wiersinga11. Thyroid. 2011 Oct; 21(10): 1081–1125. doi: 10.1089/thy.2011.0087
The fertile window is the handful of days during a woman’s menstrual cycle when it is possible to conceive. In order to conceive, sex has to take place within the fertile window. (If this is the first time you are hearing this critical information, you are not alone. Sex ed classes typically teach that sex at any time can lead to pregnancy).
The fertile window exists because egg cells do not last forever after ovulation. Once an egg cell is released from the ovary, that egg cell lasts only about twelve hours. At the most, if your egg cells last exceptionally long and you ovulate two eggs, you are fertile for up to 48 hours. That is a rare exception.
Fortunately, sperm cells can last for up to five days in a supportive vagina/uterus which greatly extends the opportunities for sex that leads to conception.
There are many ways of detecting the fertile window.
The are other methods of detecting ovulation, but these are the three most reliable ones that can be used at home.
Trying to time sex to correspond to the fertile window is called 'timed intercourse' in the scientific literature. A large review of timed intercourse had these findings:
Guidelines for doctors assessing infertility in the US and the UK advise against recommending timed intercourse because it can be stressful. I find this viewpoint to be paternalistic. Some couples might find it stressful but others will feel empowered by having the information and increasing their knowledge of their cycle patterns. Whether or not to do it should be the couple's decision.
As a naturopathic doctor with a special interest in this area, information from LH levels, basal body temperature charts and pattern of cervical fluid can provide me with useful information that can impact the treatment plan I recommend. In most cases, a little extra stress is a good trade-off for that information.
Cochrane Database Syst Rev. 2015 Mar 17;(3):CD011345. doi: 10.1002/14651858.CD011345.pub2. Timed intercourse for couples trying to conceive. Manders M1, McLindon L, Schulze B, Beckmann MM, Kremer JA, Farquhar C.
Fertil Steril. 2012 Aug;98(2):302-7. Epub 2012 Jun 13. Diagnostic evaluation of the infertile female: a committee opinion. Practice Committee of American Society for Reproductive Medicine.
Fertility: assessment and treatment for people with fertility problems. National Collaborating Centre for Women's and Childrens Health. Commissioned by the National Institute for Clinical Excellence. Feb 2004. RCOG Press.
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. It affects up to 10% of women in their reproductive years. It has implications for day-to-day life, fertility and long term health. The most widely accepted guide to diagnosing PCOS is the 2003 Rotterdam Consensus. To be diagnosed using these criteria, there must be two of the following present:
Additionally, some diseases that could cause similar symptoms must be ruled out: congenital adrenal hyperplasia, androgen secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinemia.
Symptoms of elevated androgens include male-pattern hair loss, and/or a condition called 'hirsutism', in which underarm, pubic, facial and chest hair become darker and coarser. The blood tests are the free androgen index and free testosterone.
Women suffering from PCOS skip ovulations and in extreme cases, don't ovulate at all. Without ovulation, conception cannot happen. So many women are affected by PCOS that it is the most common cause of infertility. Treatments offered by medical doctors include hormonal birth control (obviously not compatible with trying to conceive), metformin (for which the safety in pregnancy has not been sufficiently confirmed) and a surgery called ovarian drilling, which has fallen out of favour because it did not result in longterm improvement.
Finding an effective treatment for PCOS is important not only for fertility, but for long term health as well. Women affected by PCOS are more likely to develop low bone mineral density, mood disorders, diabetes and heart disease.
In my opinion, first line treatment for PCOS should be with a naturopathic doctor, combining diet advice, supplements and herbs. When I treat, PCOS, I have the following objectives:
Over time research has found a strong association between PCOS and sleep apnea. Sleep apnea is when a person periodically stops breathing while asleep. Sufferers may wake up in the night short of breath, snore, feel very drowsy during the day, be forgetful, have a sore/dry throat or wake frequently during the night. Sleep apnea should diagnosed using a sleep study, for which you have to go to a special centre and stay overnight. Medical doctors can provide a referral.
Despite having a genetic component, PCOS has a very positive prognosis. Seeing improvement in the frequency of ovulation takes time and consistent application of the treatment recommendations, but it is worth it- for fertility, for reducing the symptoms of high androgens, and for long term health.
Ann Endocrinol (Paris). 2017 Jul;78(3):176-185. doi: 10.1016/j.ando.2017.04.024. Epub 2017 Jun 9. Which origin for polycystic ovaries syndrome: Genetic, environmental or both? Fenichel P1, Rougier C2, Hieronimus S2, Chevalier N3.
Fertil Steril. 2004 Jan;81(1):19-25. Revised 2003 consensus on diagnostic criteria and long-term health risks relatedto polycystic ovary syndrome. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.
Centre for Menstrual Cylce and Ovulation Research. Anovulatory Androgen Excess (PCOS). http://cemcor.org/resources/topics/anovulatory-androgen-excess-aae. Accessed August 11 2017.
Med Hypotheses. 2017 Mar;100:54-58. doi: 10.1016/j.mehy.2017.01.012. Epub 2017 Jan 23.
Should metformin be included in fertility treatment of PCOS patients? Haas J1, Bentov Y2.
Endocr Connect. 2017 Jul 24. pii: EC-17-0129. doi: 10.1530/EC-17-0129. [Epub ahead of print]
Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature. Helvaci N1, Karabulut E2, Demir AU3, Yildiz B4.
If you are reading this because you have gone through a miscarriage, please accept my condolences. I have been through more than one miscarriage myself. The end of the precious hopes and sweet imaginings is heard to bear.
The official statistic is that ten to fifteen percent of pregnancies end in miscarriage. That means healthcare providers should have a solid plan for helping people through it, but like so many areas of women's health, it has been a neglected aspect of care.
In this article, I will summarize the approach I take in my practice. It is my personal attempt at a 'best practice'. First I will cover the physical considerations, and then the emotional. Please be forewarned that some of the information is graphic.
A miscarriage is simply the body expelling a pregnancy that stopped developing. Sometimes the miscarriage occurs without forewarning, other times an ultrasound reveals that the baby has died, or that there is no baby found within the gestational sac. Sometimes it is called spontaneous abortion, which can be confusing since we commonly use the word abortion to refer to having a pregnancy intentionally terminated.
Miscarriage can range from mildly painful to very painful with labour-like contractions. Expect to see blood, tissue, and clots. Some of the tissue may be recognizable: the fetus itself, the sac, the beginnings of the umbilical cord or placenta.
A missed miscarriage is when your baby has died but you have not yet passed the tissue. You will have three options: wait for your body to pass it, take a medication or have a surgery called dilation and curettage (D&C for short). Acupuncture can be used to encourage the tissue to pass. Misoprostol, one of the possible medications, is often associated with very heavy bleeding. It is best not leave home once you have taken it.
You may have heard of doulas who help with childbirth. Doulas are expanding their roles and some will help you through the process of miscarriage.
There are some important things to consider after a miscarriage is complete. Women who are Rh negative should receive Rh immunoglobulin after a miscarriage at twelve weeks or later to prevent a problem called hemolytic disease of the newborn in future pregnancies.
In women who have not had a baby before, a certain type of immune system reaction should be measured as soon as possible after miscarriage has occurred. It is called antithyroid peroxidase and it is related to the thyroid gland. Elevated levels can be associated with an increased risk of miscarriage and are very treatable with naturopathic medicine.
You may lose a lot of blood with a miscarriage. Initially, this will make you tired. Keep your hydration level up, allow yourself to rest and eat iron-rich foods. In those with a history of low iron levels, I recommend a supplement. I recommend having iron levels checked if fatigue lasts beyond eight weeks.
Sometimes the bleeding goes on for weeks. I recommend using a tincture containing astringent herbs. The astringent herbs close off the blood vessel of the uterus, which allows small pieces of remaining tissue to detach and decreases the loss of blood. Sometimes, prolonged bleeding indicates that larger pieces of tissue remain in the uterus. If you have a sense of fulness in the pelvis or normal menstrual cycles have not resumed, ask your doctor for a pelvic exam or ultrasound. Retained tissue is usually not dangerous, even if it goes on for many months. However, if you experience pelvic pain, fever or foul-smelling discharge, seek care right away because you may have a uterine infection.
Normal menstrual cycles typically resume within weeks and potentially right away. The usual advice is to hold off on trying to conceive until after your next period. This is to improve the accuracy of the estimated due date should you become pregnant right away. In my practice, I like women to keep track of their basal body temperatures to detect when ovulation occurs again, which provides an even greater level of accuracy in predicting due dates and also provides me with information if menstrual cycles do not resume normally. Some women find it either too tedious or too emotionally painful to keep track of their basal body temperatures, and that is okay.
Beyond the physical considerations after a miscarriage, we also have to care for and nurture our emotions too.
I want to stress that any emotional reaction you have to a miscarriage is okay, whether it be mild sadness or full-blown grief or a sense of relief. Whatever your emotions are, they are acceptable and normal and you can guarantee that other women have felt exactly as you do. It is common to experience greater levels of anxiety or depression for around six months after a miscarriage. I will often recommend herbs or supplements to help manage moods.
Sometimes you may actually experience intense fluctuations of emotion. Similarly to after a pregnancy, your hormone levels are changing rapidly. This re-calibration can dramatically impact your moods.
If you are able, taking time for self-care is a good idea. Check in with yourself about what would be most nourishing for you; self-care practices that work well for someone else may not work well for you. For example, some people will excuse themselves from attending baby showers after a miscarriage. I did that for a shower that was happening very shortly after I suffered a loss. After a period of time, though, I found that I received a lot of nourishment from being around pregnant friends and newborn babies even though I felt a little sad at the same time. It helped dispel my bitterness.
I like to recommend massage therapy for people going through difficult times. The physical touch is reassuring and increases levels of oxytocin, which combats feelings of isolation. Sometimes physical therapies can allow a release of emotions. Don't worry, massage therapists are accustomed to people crying during their appointments. I confirmed this with one of the RMT's I work with, Morgan Young, who told me, “It's a very natural and common situation that we are prepared and trained for.”
One of the burning questions people have after a miscarriage is 'Why did this happen?' The frustrating answer is that we will never know why any particular miscarriage took place. Fight the tendency to blame yourself. Many factors, maybe even most factors, affecting fertility are beyond the control of the individual. That being said, in my practice, I try to seek out factors affecting the risk of miscarriage that can be modified before a patient starts to try to conceive. If you wish to try to conceive again, you may wish to review these factors and see if there are any steps you can take to reduce the chance of another miscarriage, once you feel up to it.
No one ever wants to be tested in this way, but negotiating strong emotions is a testament to your resilience.
Miscarriage is a common experience, and my hope is that we will move towards managing it with more medical skill and greater compassion.
Practitioner. 2014 May;258(1771):25-8, 3. Diagnosis and management of miscarriage. Oliver A, Overton C.
Reprod Biol Endocrinol. 2013 May 14;11:40. doi: 10.1186/1477-7827-11-40. Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study. Grossmann M1, Hoermann R, Francis C, Hamilton EJ, Tint A, Kaitu'u-Lino T, Kuswanto K, Lappas M, Sikaris K, Zajac JD, Permezel M, Tong S.
Am J Obstet Gynecol. 2017 Jan;216(1):44.e1-44.e6. doi: 10.1016/j.ajog.2016.08.039. Epub 2016 Sep 6. Doulas for surgical management of miscarriage and abortion: a randomized controlled trial. Wilson SF1, Gurney EP2, Sammel MD3, Schreiber CA2.
Br J Health Psychol. 2015 Feb;20(1):36-44. doi: 10.1111/bjhp.12121. Epub 2014 Nov 5.
When mixed methods produce mixed results: integrating disparate findings about miscarriage and women's wellbeing. Lee C1, Rowlands IJ.
Vitamin D has received a lot of attention in recent years as study after study has shown the different ways that vitamin D deficiency affects our health. The role of vitamin D in bone mineral density is well-established. More recent explorations have found possible links between vitamin D status and immune system regulation, mood, weight management and heart health.
A very high quality review of the current evidence found that supplementing with vitamin D decreased the risk of death by any cause (formally referred to as 'all-cause mortality'). That is big news. In my opinion, that puts maintaining adequate vitamin D status right up there with the most established health habits: avoiding smoking, and eating lots of fruits and vegetables for example.
Of the many effects of vitamin D deficiency, some relate directly to fertility: normal production of sex hormones, frequency of menstrual periods in women with polycystic ovarian syndrome and sperm quality/quantity to name a few.
In a time when delaying having babies is the norm, it is good to know that higher vitamin D levels are associated with lower FSH levels, which may mean that having adequate vitamin D delays the end of our fertile years.
Looking beyond conceiving a baby, good vitamin D status may reduce the risk of adverse outcomes in pregnancy and allow the growing baby to have enough vitamin D for his/her growth and development.
Vitamin D should not be taken without having your blood level checked. Sun exposure, digestive system health, genetic factors, body mass index and dietary intake can all affect your vitamin D level so it is best not to make any assumptions about your current level. Having too high a vitamin D level comes with its own risks, so please monitor your vitamin D level and supplement with the help of a medical doctor, nurse practitioner or naturopathic doctor.
Cochrane Database Syst Rev. 2014 Jun 23;(6):CD007469. doi: 10.1002/14651858.CD007469.pub2. Vitamin D supplementation for prevention of cancer in adults. Bjelakovic G1, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, Gluud C.
Eur J Endocrinol. 2012 May;166(5):765-78. doi: 10.1530/EJE-11-0984. Epub 2012 Jan 24.
Vitamin D and fertility: a systematic review. Lerchbaum E1, Obermayer-Pietsch B.
Menopause. 2015 Mar;22(3):312-6. doi: 10.1097/GME.0000000000000312. Association between serum 25-hydroxyvitamin D and ovarian reserve in premenopausal women. Jukic AM1, Steiner AZ, Baird DD.
Curr Opin Obstet Gynecol. 2014 Dec;26(6):438-47. doi: 10.1097/GCO.0000000000000117. Vitamin D and pregnancy outcomes. Wei SQ1.
Nutr Res. 2015 Jul;35(7):547-56. doi: 10.1016/j.nutres.2015.04.010. Epub 2015 Apr 18. Effects of vitamin D supplementation during pregnancy on neonatal vitamin D and calcium concentrations: a systematic review and meta-analysis. Yang N1, Wang L1, Li Z2, Chen S1, Li N1, Ye R3.
Once you make the decision to try to have a baby, it's hard not to wonder how long it will take to get pregnant. This is particularly true if time starts to pass and nothing has happened.
Pregnancy may happen quickly. One study found that over 50% of respondents were pregnant after three cycles. If you have sex every day, your likelihood of conceiving each cycle is thirty-seven percent. If you have sex just once per week, your likelihood of conceiving each cycle is fifteen percent. The current recommendation is to have sex every 2-3 days.
It can also be completely normal to take a long time to become pregnant. Even if you are not pregnant after twelve cycles, the probability of naturally conceiving is still high; half of couples who do not conceive after one year will conceive in the next year, without treatment. When the female partner is less than forty years old, the chances of being pregnant after two years of trying is ninety percent or better, depending on age.
After stopping the birth control pill, there is a lower rate of conception, on average, for the first three cycles. Having a BMI over 30 can increase the time it takes to get pregnant.
If you have experienced infertility, it can be more tricky to make predictions. One prediction tool is available online. It requires both male and female partners to have had some testing done. You can access that prediction tool here.
You can get more insight into what is happening in any given cycle by using basal body temperature charting. Keeping track of your early morning temperatures can tell you if you ovulated, and can even tell you if you are pregnant sooner than a urine dipstick test can. I believe that tracking BBT can help couples conceive more quickly, but studies so far have not confirmed my belief, potentially due to variations in how well the technique is taught.
Hum Reprod. 2013 Oct; 28(10): 2856–2864. Published online 2013 Aug 19. doi: 10.1093/humrep/det333. Body size and time-to-pregnancy in black women. Lauren A. Wise,* Julie R. Palmer, and Lynn Rosenberg
Variation in couple fecundity and time to pregnancy, an essential concept in human reproduction. The Lancet. Volume 355, No. 9219, p1928–1929, 3 June 2000
Optimizing natural fertility: a committee opinion. Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Reproductive Endocrinology and Infertility
The American Society for Reproductive Medicine, Birmingham, Alabama. Fertility and Sterility. September 2013Volume 100, Issue 3, Pages 631–637
Fertility problems: assessment and treatment. Clinical guideline [CG 156]. National Institute for Health and Care Excellence. February 2013.
In male-female couples seeking help for infertility, I always recommend that both partners receive naturopathic care. There are a number of distinct reasons for this.
1. Male factor infertility is just as common as female factor infertility. Even with a normal semen analysis, other male health factors can affect pregnancy outcomes.
2. Over time, the 'normal' cutoff for semen analysis criteria has been lowered repeatedly. In other words, a normal semen analysis today would have been below normal a decade ago. In my opinion, this means that there is room for improvement even when the semen analysis has come back within normal limits.
3. Dad's health contributes to baby's health. We focus a lot on creating healthy pregnancies because we know that a healthy mom helps grow a healthy baby. More and more evidence is revealing that even though the father does not gestate the baby, his health at the time of conception can influence the health of the child.
4. It is easier to adopt lifestyle changes when you do it as a team. I often recommend changes that can be difficult to adopt, like eating more vegetables, or going to bed earlier. When both partners are making changes together, it is a lot easier. Feeling like a team helps both partners face the uncertainties of infertility feeling more resilient.
The historical focus on infertility as a woman's problem has produced a huge amount of shame for women. We all need to work together to dispel the myth that infertility is the fault of any one person.
Dr. Andrea hilborn, ND
Treating infertility in Kingston, Ontario.