Personal Path To Pregnancy
Transcription
Personal Path To Pregnancy
Personal Path to Pregnancy The Secret to Making a Baby Lies in Choosing What’s Best for You - Traditional Strategies & Little Known Alternatives Doctors Often Don’t Discuss that Help You Increase the Odds of a Quicker Conception by: Beth Kiley © Personal Path To Pregnancy 2011 3rd Edition All rights reserved. No part of this ebook may be reproduced in any material form, stored in a retrieval system or transmitted or circulated in any form or by any means, electronic, mechanical, audio, visual or otherwise, without the prior written permission of the copyright owner. Applications for the copyright ownerʼs written permission to reproduce any part of this book should be addressed to the author, Beth Kiley at [email protected]. Warning: The undertaking of any unauthorized act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. Table of Contents Chapter 1: Does Mother Nature Need a Nudge? Sizing Up the Situation to See If Your Fertility Is at Risk Chapter 2: The ABCs of Conception – How to Boost the Odds of Having a Baby in Your Immediate Future Chapter 3: Are You Ovulating? Predicting Your Chances for Pregnancy While Minimizing Irregularities Chapter 4: Before You Turn to Your Doctor – Traditional and Alternative Tips to Help Hasten the Process of Pregnancy Chapter 5: How to Influence Your Fertility With Your Diet – What To Eat and Avoid Chapter 6: When Infertility Is an Issue – Dealing with the Tests, Emotions, and Outcome of a Diagnosis You Didn’t Want! Chapter 7: When A Condition Is Identified And What Does It Mean? 2 Chapter 8: When Medical Science Should Intervene – A Look at Today’s Breakthrough Technology for Increasing the Odds of a Baby Chapter 9: Conception Isn’t One Size Fits All – Mapping Out Your Blueprint for Making Your Dream Come True 3 Chapter 1: Does Mother Nature Need a Nudge? Sizing Up the Situation to See If Your Fertility Is at Risk When most couples decide to have a baby, they really don’t give very much thought to how difficult it might actually be. It seems simple enough…have sex…make a baby. The truth is, both men’s and women’s fertility levels are on the decline today. It’s quite possible that the trouble stems from the increased chemicals and pesticides in the foods we eat, toxins in the environment and the high stress levels of modern society. It seems that every little thing counts when it comes to trying to conceive a baby —from what you eat to what position you have sex. Now I don’t know your situation personally, but what I do know is that there’s a mountain of information out there, and I think you should be armed with all the knowledge you’ll need to map out your own blueprint to making a baby. It is your body, after all – not your doctor’s, not your best friend’s or wellmeaning mother-in-law’s – and certainly not the acquaintance you met on the Internet who declared nothing else works but her method. Your Personal Present, Past, and Future Path to Pregnancy Every woman has a different story, and this guide will cater to women in any situation. Maybe you’re just now considering parenthood and haven’t even really tried to get pregnant yet, but want to be informed before you get started. Or maybe you’ve tried every which way you know, and haven’t been able to get pregnant yet after months – or even years – of trying. Before you give up hope forever, you need to get to the end of this book and see what’s in it for you. 4 Some of you reading may relate to my story of how my personal path to pregnancy was achieved. I was married at 35 and about a year later, we decided to try and have a baby. After getting pregnant fairly quickly, I lost my first baby in a miscarriage at around 4-5 weeks. Although I was very saddened and confused, I wasn’t too worried, since many people told me that it was very common. I thought I was lucky because I got pregnant again so quickly. At 7 weeks I saw my baby’s heartbeat on the sonogram. But at my 10-week ultrasound appointment, they told me my baby’s heart had stopped beating. I was devastated, to say the least. And that’s when fear really set in. It took 3 more miscarriages before I was finally diagnosed with an immune related disorder that would require some treatments to prevent another miscarriage the next time I got pregnant. Imagine my surprise that my next step on the path to pregnancy was that I couldn’t seem to get pregnant again. We tried, but nothing happened for several months. Depression set in, as I wanted a baby so desperately, and I was terrified of not being able to get pregnant again. The battle between depression and desperation raged on and I joined online support groups and shared in the camaraderie of other women’s struggles and felt joy and jealousy whenever one of our own was able to conceive and bring a child into this world. While my desperation and frantic anxiety took root, it seemed like everyone else around me was getting pregnant. It was like it was “in the water” and I wasn’t getting to drink from the fountain. This was devastating. So, I logged onto the Internet and devoured information, researching in every spare minute to find out what I could do to help me get pregnant more quickly. I researched on the computer every day. I read books, articles, transcripts, research papers and published medical reports. Long story short, I spent every free minute I had learning everything written on the topic of getting pregnant. I even had two expensive consultations with top experts in the field of reproductive endocrinology (fertility doctors) to try to find answers. And you know what? There’s an absolute ton of information on this subject. It took so much time to simply sort through and make sense of it all. To separate the facts from the myths—the new research from the old. The wive’s tales from the truth. And even though I dug up all these buried resources, I wasn’t sure the techniques would work. But within two months of implementing some of the techniques I uncovered, I conceived and carried my first baby to term. She was a beautiful baby girl 5 and well worth the wait. And when we decided to try and give her a baby brother or sister, I conceived my son after only 1 month of trying. My husband and I took a very pro-active approach. I learned about all of these techniques in a desperate attempt to become a mother myself, and if it can help you in your quest to parenthood, then I’m happy to share what I learned so that you don’t have to waste time sorting through the mountain of information on the Internet. You have enough to deal with when trying to become a parent—the excitement, the disappointments, the fear, the nervousness, or quite possibly the depression and desperation that I went through. This guide is meant to be a thorough look at all of the options that are available to you—including dozens of strategies that people don’t talk about and doctors don’t seem to want you to know about. You will learn about various ways you can do something on your own to improve your fertility and therefore maximize your chance of conceiving a child the fastest way possible. You have choices, and I’m going to deliver them to you. When mainstream medicine doesn’t help you, or when you want to know the most modern methods people and scientists have developed for getting pregnant, it ought to be easy to access, don’t you agree? That was my goal in creating this guide, and I believe I have achieved what I hoped to accomplish in structuring it so that it’s easy and informative and can help you bring your dreams to fruition. You won’t have to waste your valuable time sorting through the endless, often conflicting information to learn what you can do to have your dream of a beautiful baby come true. ***What You Should Know About the Unknown*** There is a very important point I want to address before you get started. You need to know and understand this very important point. At the present time, there is still a lot about conception that remains unknown. When you think about it, it makes perfect sense, because if doctors knew everything there was to know about getting women pregnant, then the success rate for procedures such as IVF (in vitro fertilization) would be extremely high. The truth is, they are not. Even when the egg is fertilized in the lab and the resulting embryo is placed back inside the uterus where it is expected to develop into a baby, more often than not it doesn’t work. And doctors do not understand why. Clearly this reinforces the idea that conception is extremely complex, with many variables that are still unidentified. The best we can do is use the knowledge that we 6 have to improve fertility and therefore the odds of getting pregnant. And sometimes, there is disagreement among the medical community about what may improve or worsen your chances of getting pregnant. In those areas, I believe it is best to take a conservative approach and eliminate anything that even “may” hurt the chance of conception. I will touch on some of these issues in this guide. And my recommendations will typically be that when there is controversy among the fertility experts, it is best to err on the side of caution. In other words, better safe than sorry. Of course, you can choose the direction you want to take, as I will always point out when there is disagreement among the experts. You will be armed with the information and my recommendation and it is up to you to use the information as you see fit. There is one more point I want to address before we dive in to the information that is equally important. As you read through this guide no doubt every reader will have a different amount of knowledge already in place about getting pregnant. While it will vary for everyone, each of you will probably come across at least some information that you already know. For some it will be more than for others, but I’m quite sure everyone will learn enough to make a big difference in your ability to get pregnant. But here’s the important point. The most important thing I can tell you is that you must take action to bring about a change. If you are reading this guide to help you get pregnant, it is not important what you already know or what you have now learned. The only thing that is important is that you do something about what you know or have learned. I have done surveys in the past that I have found shocking. Women who tell me, yes, I already knew that… but when I ask, so are you doing anything about what you already know, all too often the answer is no. Learning about ways to increase your fertility are only helpful if you actually put what you learn/know into practice. Even if you read this guide and only learn a few new things (although I’m sure it will be a lot more than that), if I can just convince you to take action on what you learned/know…to make changes, even if they seem small and insignificant, that is the only way to have a chance at achieving your dream of creating a beautiful bundle of joy. Remember, many small changes can add up to a significant result. 7 PLEASE, do not scan through this book looking for the “magic secret”. I know other guides promise you that, but it simply does not exist. There are MANY things you can do to optimize your fertility, and most often it is by making small consistent changes that when added together will enable you to bring about the result you desire. Desperation Is Your Best Ally in Your Quest to Get Pregnant Being desperate is no picnic in the park. Who wants to feel hopeless, frustrated, and anxious on a daily basis? While it was horrible to go through, it did make me well educated in pregnancy-related issues. Instead of making you go through the same process – picking the minds of experts, talking to hundreds of women all over the world to see what worked for them – I decided to just compile what I learned and give you all of the options available to help you make a baby on your own – without budget-busting infertility treatments or years of waiting for it to happen. Maybe you’ve already been trying for several months or even years. Whether you’re a veteran at trying, or a complete novice just now starting on your own journey to motherhood, this guide will surprise you and show you that there is always something new to be considered in getting pregnant. I’ve personally tried many different methods, including the natural approaches (no boxers for the husband, no caffeine, tons of vitamins), traditional advice about how to combine Robitussin or Mucinex and water for improved cervical mucus, alternative options like acupuncture, and a long list of other strategies. Some worked, some didn’t. Some worked for other women. Some might work for you and some might not. But the point is, you need access to the variety of techniques and strategies in an organized way so that you can put your own personal plan together. Getting pregnant isn’t a cookie cutter issue – it’s not one size fits all. This book may have some methods you’ve heard of before. But it’s also sure to have some new information that’s not widely circulated and that you didn’t have before – details that could be the very key you need to unlock the secret to having a baby. 8 Pre-Conception Planning - 3 Months Ahead... Before we go any further, I want to talk a bit about pre-conception planning. Now I realize that many of you reading have already been trying for quite some time which has led you to purchase this ebook looking for help. Others may just be starting on this journey. That being said, the importance of good health and nutrition for at least 3 months before conception will have the most beneficial effect. It can properly regulate the menstrual cycle, balance hormonal activity, and may optimize egg quality. The same holds true for male fertility as it takes approximately 90 days for sperm to develop and fully mature and during this time, outside influences can affect the quality/quantity of the mature sperm. Please remember this as you start to make some of the changes and give it enough time to actually have an impact on your body. Will I Have a Problem Getting Pregnant? Most girls, when growing up, don’t consider whether or not they’ll be able to have a baby – they just assume they will one day. Then when the time comes that they’re actually planning it, they start to worry – even if there’s been no sign of a problem with their fertility. There are different levels of fertility. There are people who just happen to not be pregnant yet, and will greatly benefit from chapter 2. There are those who find themselves infertile after a year or more of trying to conceive. There’s also primary infertility (infertility without a previous pregnancy) and secondary infertility (infertility after having already conceived a child), and sterility, which means you have no chance of conception. If you’re wondering where you might be, you should know that 15-20% of couples in the United States alone encounter difficulties in getting pregnant. The causes range from minor issues like using a non-productive position during sex to a major reason, like one of the partners being sterile. Most women are worried because they are simply uninformed. Plus, there are a lot of myths floating around on the ‘net and offline that cause a lot of unnecessary stress and anxiety. 9 Here are some of the many reasons why you and your partner may be experiencing trouble getting pregnant if it’s been more than a year and you’ve had no luck making a baby: • Ovulation issues • Ovarian cysts (PCOS) • Sperm issues • Endometriosis • Blocked fallopian tubes • Fibroids • Stress • Weight gain Of course this list isn’t comprehensive, but it does include some of the more common issues that affect a couple’s chance of conceiving. And unfortunately, many couples who can’t conceive a baby after a year of trying, seem to have nothing medically wrong with either of them, and simply fall into the category of “unexplained infertility”, which is the medical term for “we don’t have any idea why you’re not conceiving.” Which raises a very interesting question. If so many couples have “unexplained infertility”, which means there is no obvious medical reason why they can’t conceive, doesn’t it stand to reason that there is a lot more to conception than the doctors know about? And then the idea that both men and women can make a variety of personal changes to improve their own fertility really does make a heck of a lot of sense, don’t you agree? It is becoming increasingly evident that when your body is not in optimum health, or is overloaded with toxins, or is not given enough nutrients, the body's ability to reproduce can be dramatically effected. Sometimes it may just take an alternative approach—a change in lifestyle or the use of alternative therapies for instance, to make conception possible. Conception is a miraculous and quite complex phenomenon—undoubtedly influenced by many subtle internal and external factors. It stands to reason that we all have the power to make changes within ourselves that can maximize our fertility and make the difference in our ability to conceive a baby. 10 As you go through this guide and choose various options that are available to you, you’ll learn more about what could be causing you and your partner a delay in becoming parents and find a solution to finally fix it so that you can look forward to your new bundle of joy arriving soon. How to Best Use This Guide If you’ve tried to get pregnant for the last few months and haven’t seen any results, that does not necessarily mean you’ll need infertility treatments! There is a whole treasure trove of home and self-treatments you can do on your own before you even consider going to an infertility doctor for invasive and very expensive treatments. This information is not readily distributed, so you want to make sure you exhaust your options before shelling out big money to a specialist when it may not even be necessary. The first place we’re going to start is with the basics. If you’re new to this, then you definitely want to read it carefully to see what they didn’t teach you in 8th grade sexeducation classes! If you’re a veteran, why not skim it over again anyway just to make sure there’s not something new in it that you didn’t know before? The key to your pregnancy may be a single sentence contained within chapter 2, and you don’t want to pass it over. 11 Chapter 2: The ABCs of Conception – How to Boost the Odds of Having a Baby in Your Immediate Future Some of what I’m about to share, you may already know – but there are always nuggets of information that you can apply that could very well be the answer to your hopes and dreams of parenthood. Formula for Fertility The path to pregnancy can be a bumpy ride. There are no guarantees and a million things that can affect your ability to conceive. Approximately 80% of women under age 35 get pregnant within the first year of trying. But for the remaining 20%, half will go on to get pregnant within two years after addressing some mild issues, while the other half will need medical science to intervene on their behalf. That’s great news for you – that means there’s a 90% chance you can conceive on your own! That’s what this guide is all about – and to help you determine when is the right time to find out if you happen to be one of the 10% of women who need extra assistance. Your age will have a lot to do with your chance at conception. In a society where 20% of all first time moms are over the age of 35, more and more women are dealing with the problem of not being able to get pregnant quickly and easily. Odds of getting pregnant in a given month, by age: • • • • Early 20’s: up to 25 percent Late 20’s and early 30’s: up to 15 percent Late 30’s: up to 10 percent Over 40: less than 5% 12 Number of women who achieve pregnancy within the first year of trying, by age: • • • Early 20’s: 94 percent Late 20’s and early 30’s: 70-85 percent Late 30’s: 65-70 percent Average number of months until conception, by age: • • • • Early 20’s: 4-5 months Late 20’s: 5-7 months Early 30’s: 7-10 months Late 30’s: 10-12 months One thing I just want to point out in case you missed it. Women in their twenties (at the peak of their fertility) still only have a 25% chance of conceiving in any one cycle. That means, when put another way, there’s a 75% chance you won’t get pregnant in a particular month even when you are in your twenties and at peak fertility. It’s important to point this out, because I think many women put too much pressure on themselves each month. They think that something is wrong if they don’t get pregnant in just a few months. But as you can see from those statistics, it is perfectly normal for it to take several months (up to 12) to get pregnant. Surprisingly, even race plays a small factor in conception. African American women have a 10.5% infertility rate under 35 years of age, while Hispanic women have a 7% infertility rate and Caucasian women deal with 6.4%. Keep in mind that when we talk about numbers and percentages, they’re just statistics. That doesn’t mean your case will strictly adhere to any certain group or timeline. So often I hear women who are struggling to conceive complain, how come other women who are overweight or smoke, drink or use drugs, or don’t even “try”, seem to get pregnant so easily, and yet I can’t? No one is saying that if you don’t follow the tips in this e-book, you won’t get pregnant. It’s not as if those habits are “contraceptives”, but they will reduce your overall fertility. So if you are having any difficulty at all, it’s best to do what you can to maximize your chances. Anything is possible, and with the tips you learn here, you can increase your odds. 13 Back to School – All About Our Bodies When they first teach you this stuff, you’re sitting in school taking notes on how not to get pregnant. But now you want the reverse lesson – where are those sex education teachers when you need them? We all know what a vagina and penis are, so we’re not going to get that basic with our crash course. But when you’re dealing with conception strategies, you may need a quick refresher on other body parts, so let’s look at how these contribute to your fertility. Your cervix is located in the lower part of your uterus and acts like a muscle to keep the baby from delivering before it’s time. It also creates a barrier between your body and nasty infections that could harm your baby in utero. If your doctor diagnoses any cervix problems, it may be remedied simply by having the doctor suture the cervix with a cerclage. The uterus is your womb. It’s an organ that holds your baby until it’s time for delivery. It’s lined with a thick endometrium, the blood lining that results in your period each month if conception doesn’t occur. Your ovaries come in pairs – each woman usually has two of them. They’re the containers your eggs come in! When you’re born, your ovaries have about 1 million eggs in them. By the time you hit puberty, you have only 300,000 to 400,000 eggs left. At age 50, you only have about 1,000 eggs remaining. Some of these are abnormal eggs. “Normal” eggs contain 23 chromosomes, which are the genes that will make your baby who he or she is. Near your ovaries are two fallopian tubes. This is where your egg comes in contact with a man’s sperm and hopefully, makes a baby! Your fallopian tubes are lined with fimbriae, which are hair-like “fingers” that move the egg along. His primary parts consist of testicles and sperm. The testicles are to his body what your ovaries are to your eggs – they create and hold his sperm. Sperm are produced every day, but they mature after 90 days. It is very important to keep in mind that if there is any damage to the sperm from elements such as heat, illness, or toxins (to be discussed later), it takes approximately (3) three months for new sperm to mature and be ready to fertilize an egg. 14 How a Baby Is Conceived Your menstrual cycle plays an important role in conception…Here’s the science behind exactly what happens during your monthly cycle. At the start of your menstrual cycle, your estrogen levels are low. Your hypothalamus (which is in charge of maintaining your hormone levels) sends out a message to your pituitary gland. Then, the pituitary gland sends out the follicle stimulating hormone (FSH). The FSH is what triggers a few of your follicles to start developing. One of these developing eggs will develop into the dominant follicle, which will then release one mature egg and the others will disintegrate. This is your ovulation. As the follicles are maturing they send out another hormone, which is estrogen. The high levels of estrogen will tell the hypothalamus and pituitary gland that there is a mature egg. At this point, LH (luteinizing hormone) is then released, and this is known as your LH surge. This surge causes the egg to be released in approximately 24-36 hours from the surge. The egg will then journey into the fallopian tube where it will hopefully be fertilized by sperm that is “waiting” there. After the egg is released, it leaves behind a kind of “shell” which is called the “corpus luteum”. The corpus luteum is responsible for releasing the hormone progesterone, which is necessary to prepare the uterine lining for implantation of a fertilized egg. The corpus luteum will continue to produce progesterone throughout the rest of your cycle (the luteal phase) and if you become pregnant, it will continue to produce progesterone until such time that the placenta takes over later on. If fertilization does not occur, the released egg will disintegrate and die within 12-24 hours. Around 12-14 days later, progesterone production will decrease, and your lining will be shed on what is considered day 1 of your menstrual cycle. When a man ejaculates inside a woman, he emits about 100 million sperm. Only approximately 200 of them survive to make it to the fallopian tubes and encounter the egg to try and fertilize it. Sperm usually live for approximately 3 days in a woman’s body if the conditions are right, although it is possible for them to live as long as 6 days. The egg is viable for 12-24 hours, however many experts believe it is probably closer to 12 hours. Given this time element, it is extremely important to get the timing of intercourse right. In fact, incorrect timing of intercourse is considered the #1 mistake couples make when trying to conceive. 15 If you don’t know when you’re most fertile, you may miss the window of opportunity that could allow you and your partner to have a baby. When you and your partner have sex right before you’ve ovulated, the sperm will enter through the cervix and swim up to the fallopian tubes. Approximately half will pick the right tube while the others will choose the left tube. The half that picked the correct fallopian tube (the side you are ovulating on) will have a chance at penetrating the egg. Within the next 24 hours, the sperm find your egg and surround it, each one trying to enter the protective layering. When one penetrates it, the others are locked out. The embryo then enters the uterus and hopefully implants itself in the wall. You miss your period – and a baby is on the way! Timing and Positioning Your Sex Just Right First of all, it’s important not to make sex a chore when you’re trying to conceive. I know it’s important to time it right – and sometimes that means someone isn’t in the mood. But it’s also important to maintain the love between the two of you to lighten an already stressful time. Happiness during lovemaking improves sperm. Don't be in a hurry when having sex with your partner. Take your time for foreplay and make sure that both of you are fully aroused before the penetration. Arousal is important because it increases the amount of secretions that are needed for the creation of semen. As a result, the volume of his ejaculate becomes higher. If you are having any problems in this area, click here for a great resource that can help with your lovemaking. When timing intercourse, you must make sure you’re near ovulation. Some women know this time just by tracking their own body functions and watching for signs (to be explained later). Others need a store-bought ovulation predictor test kit. Chapter 3 will go into much more detail on ovulation because it’s a vital part in your journey to pregnancy and I wanted to make sure I devoted a lot of insight into this topic. 16 Here’s an important tip...it is very important NOT to abstain from sex all month long in an attempt to “save up the sperm” for your fertile time. Try to have sex at least every five days during the time you are not trying to conceive in an effort to flush out the sperm. This will ensure that you have healthy sperm at the time when you really need them! If you’re not up for intercourse, just make sure your partner ejaculates at least every five days to keep the sperm fresh. In order to keep sperm counts high, it is best for the male to abstain from any sex (or masturbation) for about 3 days before you start “trying” during your fertile window. Remember, that means you should not “save up” sperm for more than about 3 days before you start trying during those few days leading up to ovulation. It is important to have intercourse before you ovulate so that the sperm is “waiting” for the egg before it is released. You should have intercourse either every day or every other day through the day of ovulation. It doesn’t make very much difference which option you choose (every day or every other day), unless you know that your partner has a low sperm count. If that is the case, the every other day approach is advised so you don’t reduce the sperm count too much. If there are no sperm issues, do what works best for you—if you’re up for every day-great! If not, every other day is effective too. One of the most critical factors is knowing how many days before ovulation you should begin to have intercourse. Is it better to start “trying” several days before ovulation or is it best to start trying on the day of ovulation or just the day before? While most sperm will only survive for 2-3 days, if conditions are ideal, sperm have been known to survive for up to 6 days (in good quality cervical mucus). So it is in your best interest to start having intercourse several days before your expected ovulation date to ensure the maximum number of sperm are waiting for the egg to be released. However, because sperm can weaken over a period of days, it’s not surprising that the highest chance for pregnancy occurs when intercourse happens two days before, one day before or on the day of ovulation. Statistically, the best chance for conceiving is on any one of those 3 days. Time of Day… Time of Year…Does It Matter? It’s been established that sperm counts are higher in the winter months than in the summer months. This may be because cooler temperatures are associated with enhanced sperm production. It’s also known that sperm counts are higher in the morning than other 17 times of day. While there has been no evidence that pregnancy rates are higher if you have intercourse in the morning, if your partner has any issues with sperm count, you may want to give mornings a try. Timing Is Critical…Don’t Make This Mistake Many experts agree that you have the best chance of getting pregnant if you don’t wait until the day you are ovulating to have intercourse. Starting to “try” a few days early does insure that there are sperm already waiting in the fallopian tubes when the egg is released. So what about the day after ovulation? Well, the experts are divided on this issue. Since it takes several hours for the sperm to get to the fallopian tube after intercourse, trying to conceive on the day after ovulation may result in the sperm arriving when the egg is already beginning to disintegrate. In this case, it is likely that you would not conceive, but it is still possible. And if you were to conceive with an egg that may be past its “prime”, you may have a greater risk of miscarriage. As stated earlier, this is one of those topics that has some controversy. Some doctors advise patients to continue to have intercourse even after you have ovulated, in hopes that the sperm can “catch” up to the egg before it dies. But there are some experts that don’t think this is a good idea for the reasons I just mentioned. So given this information, you can make your own choice but I personally would recommend not trying to get pregnant on the day after you have already ovulated to avoid the possibility of an increased miscarriage risk. Late Ovulation…Is This Why You Can’t Get Pregnant? While an ideal cycle is 28 days with ovulation occurring on day 14, for most women this is not their typical cycle. The fact is that different women have different cycle lengths, and one thing that you may not know is that how late you ovulate may have an impact on your ability to get pregnant and/or miscarry. Here’s why… Many fertility experts now believe that if a woman ovulates late in her cycle (day 20 or later), the quality of her egg may be compromised. In other words, late ovulation may mean poorer egg quality and also a uterine lining that is not ideal for implantation. Now that doesn’t mean that you can’t get pregnant if you ovulate late in your cycle. However, it is possible that a very late ovulation could make it more difficult to get pregnant or increase your risk of a miscarriage 18 If you find that you are consistently ovulating this late in your cycle, then you will want to make significant changes in your diet and exercise program and add appropriate supplements as described in Chapter 4 to help balance your hormones and regulate your cycle. Doing so should help you ovulate earlier (before day 20) and improve your chances of getting pregnant. Position Preference? To better your odds at conception, it’s important to know which positions give you an increased chance at having a baby. Sexual positions and after-intercourse routines can be personal, but as with everything when you’re trying to get pregnant, you might pick up a few tips you haven’t yet tried to use! You’d think it wouldn’t really matter which position you had sex in to conceive a baby. But when you’re trying for a baby, you want to do everything in your power to make thing happen faster. And gravity definitely plays a role. What you want is for your position during sex to offer the best way for the deepest penetration and contact with the cervix, while minimizing the chance of leakage. Rear entry is known among your veteran fertility warriors as being the best position for conception. Alternatively, the missionary (man on top) position and side by side, are considered to be optimal positions as well. Regarding leakage, here is a tip. Instead of your partner withdrawing after intercourse, have your partner keep his penis inside for as long as possible after his orgasm. This makes a good barrier and keeps the semen concentrated as close to the cervix as it can get. Another important tip has to do with your orgasm. Research has shown that if a female has an orgasm after her partner, the sperm get sort of “sucked up” into the cervix which helps to bring them faster to where they need to be going. It’s sort of a little booster to get them going on their way into your cervix. And always remember, after sex, elevate your hips for about 20-30 minutes by placing a pillow underneath your bottom, as this will help gravity get the sperm going in the right direction as well. Do not get up before that to go to the bathroom and especially do not douche. Any 19 leakage you experience after that is perfectly normal and you should not worry about it. What is leaking back out is the liquid that carries the sperm-it will not reduce your odds of getting pregnant. It should be noted that some women have what’s known as a retroverted uterus or tipped uterus. If your doctor told you that you have this, do not be alarmed or concerned. Fertility experts agree that this shouldn’t make it more difficult to get pregnant. However, because of the position of your uterus, you should probably alter the protocol described above for lovemaking. With a retroverted uterus, the best position is rear entry, and after intercourse, you should lie down on your belly instead of your back with a pillow underneath your hips to raise them up. Lubrication Generally the vaginal environment is very acidic. Surprisingly, the sperm actually need an alkaline environment to survive. So how do the sperm stay alive? What happens is that right before ovulation, the cervical mucus (vaginal discharge) changes to the consistency of raw eggwhites and it is highly alkaline and therefore much more "spermfriendly.” This allows the sperm to safely travel through the cervix. Before choosing a lubricant, realize that the very best lubrication comes from your own body. When you are trying to conceive it is especially important to increase foreplay, which will increase your natural lubrication and help the sperm to survive. However, if you still feel you need some extra help, you can follow these tips. Most store bought lubricants have a pH that is too acidic for sperm to survive and also contain other sperm damaging ingredients and therefore should not be used. This includes KY Jelly, vaseline, and baby oil. Some evidence is showing that canola oil and pharmaceutical grade mineral oil are sperm friendly, however it is still controversial so I wouldn't recommend it. There’s only one commercial product recommended for helping lubrication along and it’s called Pre-Seed. It’s “sperm-friendly,” so you don’t have to worry about creating a hazardous environment for the little swimmers. Many women have reported that they were able to get pregnant simply by using this product as they did not have adequate lubrication without it. Click here to learn more and/or to purchase Pre-Seed. If you want to try a home remedy, many women have used egg whites for lubrication, which are what laboratories also often use to store sperm. If you want to try this, take an egg out of the refrigerator and let it come to room temperature. Use the egg white immediately after cracking the egg open to avoid any infections. You would use it in exactly the same way that you might use any other type of lubrication, such as KY Jelly. While many women do use eggwhites for lubrication, be aware this technique does 20 carry some small risk, as there is always the “very” slight chance of salmonella when dealing with eggs. Beware Saliva and Soap Did you know that saliva can kill sperm? Well, it does, so definitely do not use saliva as a lubricant during intercourse. An alternative to using saliva is just plain warm water if you don’t want to use any of the recommendations above. And speaking of saliva, here’s another tip. Do not engage in oral sex during your fertile time, because the saliva can ruin the sperm’s chances of survival. This applies to oral sex on the male and female as the saliva on either the penis or vagina can damage sperm that it comes in contact with. Also, something else you may not have been aware of. Soap residue can also be harmful to sperm. So before having intercourse, if you’ve washed your hands, make sure they are completely rinsed off and do not have any soap residue remaining. You may have been doing some of the above things all along. But if you didn’t rush through the material, you probably learned a couple of new tips to put into practice. Soon, you’ll learn some other effective traditional and alternative methods couples are using all over the world to increase the odds of having a baby. Let’s start with how to determine when you’re ovulating... 21 Chapter 3: Are You Ovulating? Predicting Your Chances for Pregnancy While Minimizing Irregularities Ovulation is the time at which one or more eggs are released from the ovaries. It’s the most fertile time of a woman’s cycle and it creates the space in which the process of pregnancy can begin. In short, it’s the point of conception if a healthy sperm is available to fertilize this released egg. During the course of each month, eggs within the ovaries will mature and grow. Depending on the overall growth of the egg, each month the ovary will choose to release the most ready egg for fertilization into the fallopian tubes. The choice of which fallopian tube the egg will be released into varies from month to month as does the ovary that releases that egg. If for some reason a woman only has one fallopian tube (perhaps due to an ectopic pregnancy), she still has a good chance of getting pregnant with the remaining tube. Why Planning for Conception Is Best The reason why it’s important that you know about ovulation is because having intercourse more frequently throughout the month in hopes of catching the right time doesn’t necessarily increase your chances of becoming pregnant. In fact, it’s possible it can have the reverse effect. Here’s why. When a man ejaculates frequently, the concentration of sperm can be lower which can lead to problems with conception. But when you try to make an effort to have sex during the most fertile times of your cycle, you’ll allow the sperm to build up in higher numbers, allowing for an increased chance of conception. But as stated previously, never abstain for weeks at a time in hopes of “saving up” the sperm for when you are ovulating. It’s best to make sure the male ejaculates around 22 every five days when it’s not your fertile time, to flush out the sperm and keep them “fresh.” Then, during the several days before you will be ovulating, you can time intercourse every day or every other day to increase the number of sperm waiting in the fallopian tube for the egg to be released. Ways To Tell If You’re Ovulating If you want to get pregnant and are ready to start figuring out when the best times to have intercourse are, here are some basic things to look at that will indicate when you are ovulating. The countdown: The most scientific way to determine when you are ovulating works best for women whose menstrual cycles are very regular. That means that your cycle length is approximately the same every month. What you do is count back about twelve to sixteen days – that is your fertile time. For example, if your cycle length is usually 30 days, you would probably ovulate somewhere between days 14 and 18. The twelve to sixteen days between the time you ovulate and when your period arrives is known as the luteal phase. Let me explain a little further how this works… Every cycle is made up of two parts, the ovulatory phase and the luteal phase. The ovulatory phase starts on the first day of your period (full flow, not spotting) and ends on the day that you ovulate. During this phase, estrogen is the predominant hormone as it helps the egg to mature. The length of this phase can vary from month to month so that you cannot always accurately predict the day you will ovulate. One of the things that can cause a delay in ovulation is stress. So if you normally ovulate on day 14 for example, and you find yourself in a stressful situation early in the month, your ovulation can be delayed by a few days. Other things that can affect ovulation are travel and illness. The second half of the cycle is called the luteal phase. During this phase, progesterone is the dominant hormone. Once you ovulate, the number of days until your period comes will be fixed each month and will not be delayed by any outside conditions such as stress. It varies from woman to woman, but once you know the length of your own luteal phase, it will stay consistent from month to month. It is important that your luteal phase not be too short, as this would be a sign that there is a deficiency of progesterone, which can cause problems in maintaining a pregnancy. 23 Knowing this information, if you are going to get “stressed out” sometime during the month, hopefully it happens after you’ve ovulated, because then it will have no bearing on your cycle length. Remember, any stress early in your cycle can have the effect of delaying your ovulation which makes it more difficult to know when to time intercourse to conceive. Of course, most of us don’t have any control over ‘when’ we are stressed, but it’s helpful to be aware of when/how your cycle can be delayed by stress. That way if your period is “late” and the pregnancy test is “negative”, you may be able to think back to determine if you had any unusual stress in the first half of your cycle which could have caused the delay in your ovulation, and in turn, your period. Typically, the luteal phase can last from 12 to 16 days, with the optimum being around 14 days. Some doctors say anything less than 12 days could be a problem, while others think 10 days or less is worrisome. This is because the luteal phase is when your progesterone is building up your lining and if it's too short, (luteal phase defect) then your lining won't be built up adequately to support a pregnancy and the embryo will be unlikely to implant (or if it does you will likely miscarry). The only way to determine the length of your luteal phase is to keep track of the day you ovulate (will discuss some methods shortly), and then count the number of days until your period arrives. As stated earlier, it should be the same number of days every month, while the day that you ovulate can vary from month to month. . Basal Body Temperature (BBT) Charting: The best way to evaluate your cycle and especially to determine if you may have a luteal phase defect, is by temperature charting, also known as BBT charting. Basal body temperature is the temperature of your body at rest. Taking your temperature first thing in the morning, before you get out of bed, eat, drink or go to the bathroom gives you the most accurate reading of your basal body temperature. When charting your BBT, you will first need to purchase a special thermometer called a basal body temperature thermometer. You can get one in most any pharmacy. It records temperatures within a tenth of a degree and is the most precise thermometer. By charting your temperatures over a period of a few months, you will see patterns in your cycle which will help you to determine when you ovulate. 24 First, you need to check your body temperature each morning before you get out of bed and write down the temperature on a special chart used especially for this purpose. It is critical that you take your temperature around the same time every morning as soon as you awaken. If you don’t get at least 4 hours sleep, or if you are ill, your temperature will be affected. Generally speaking your temperatures will have very minor fluctuations on a daily basis of about a tenth of a degree The general rule is that you have ovulated when your temperature rises at least .2 degrees higher than any temperature from the previous 6 days, and it stays elevated for at least 3 consecutive days.. The reason being, right after you ovulate, the left over egg “shell” (which becomes a “corpus luteum”) releases progesterone in an effort to prepare your lining for the implantation of a fertilized egg. The release of progesterone causes the increase in temperature. That is why progesterone is known as the “warm” hormone. Unfortunately, BBT charting will only tell you that you have ovulated already—it cannot predict ovulation. By monitoring your temperature over the course of a few months however, you’ll begin to see a pattern emerge that can be helpful in several ways. For one thing, by charting you will be able to establish if you are in fact ovulating, which some women aren’t even sure of. Secondly, you can count the number of days in your luteal phase in order to determine if you have a luteal phase defect which may require progesterone supplementation in order to conceive. As mentioned previously, a luteal phase that is too short results in an endometrial lining that is unable to support a pregnancy. Also, even though you can’t use the charts to predict specifically what day you will ovulate, you will get a good feel for approximately what day each month you ovulate and can time intercourse better to coincide with your fertile window. Another side benefit of charting is you can probably determine if you are in fact pregnant without even taking a pregnancy test! If your temperature stays elevated for 18 days following ovulation, then you are very likely to be pregnant! Once your temperature drops a few tenths, it means you are likely to get your period that day or the next day at the latest. This information can be helpful as well –not in your quest to get pregnant—but it’s nice to have a warning that your period is due to arrive as sometimes it comes as a complete surprise when we are not exactly prepared!! If the BBT thermometer you purchased did not include any charts to use, you can go to this site which has charts you can print out: http://www.mymonthlycycles.com/bbtchartdl.jsp 25 Cervical mucus: Something that can give you a very good indication of approaching ovulation concerns cervical mucus (vaginal discharge). Throughout a woman’s menstrual cycle, the texture and the consistency of the cervical mucus will change. This is something you may not have ever paid attention to, but it is very important to be aware of when trying to get pregnant. As you get closer to ovulation, you will notice that your cervical mucus changes from somewhat creamy to the consistency of a raw eggwhite—clear, very stretchy and wet. This happens because the levels of estrogen are rising as the body prepares to release an egg. As a rule, if you aren’t sure when you will be ovulating exactly, you should start having sex as soon as you see the cervical mucus become similar to an eggwhite. You should continue having sex as long as you have this type of cervical mucus. Usually on the day of ovulation, the cervical mucus is the most abundant and stretchy. And you will know when you have already ovulated, as the cervical mucus immediately changes—it gets cloudy and kind of dries up—right after you’ve ovulated. Possible pain in the abdomen: Some women will also feel a twinge of pain when their ovary releases an egg. This is called mittelschmerz (which is German for ‘middle pain’) and this is felt by up to twenty percent of all women. The pain or the achiness can last anywhere from minutes to hours, depending on the woman and her sensitivity to the pain. You might also feel back pain that accompanies the lower abdominal pain. The problem for using this pain as an indicator of when to time intercourse, is that doctors aren’t sure if the pain is occurring right before, during or after ovulation. Obviously, if it’s occurring right after, it would not be a reliable method to time intercourse. Also, since the sperm live for several days, you would lose the opportunity for having intercourse a few times before ovulation, which allows for much more sperm ready and waiting when the egg is finally released! 26 Cervical Position Another change that occurs in your body as you approach ovulation is the position of your cervix. To check your cervix, make sure you have clean hands and be sure to check your cervix around the same time each day. It’s probably easiest to squat down and gently insert one or two fingers into your vagina and reach back until you can feel your cervix. Depending on the time of the month, there will be some noticeable differences. (you may have to practice this awhile before you can easily notice the changes). During the first half of your cycle, the cervix will feel relatively firm –like touching your nose— and dry, and the position will be low in your vagina (easy to reach). The entrance to the cervix will feel closed. But as you approach ovulation, the cervix will become softer and wetter, the entrance will start to open and the position of the cervix will become higher (harder to reach). When it gets to it’s highest point (difficult to reach, and the entrance to the cervix feels open, and it feels more like your lip than your nose, you are at your most fertile time and very near ovulation. You can remember this with the acronym SHOW – soft, high, open, wet. Just after ovulation, the cervix begins to get firmer and drier, the position will become lower and the entrance will begin to close. These changes in the cervical position, along with the changes in the cervical mucus, can give you a very good chance at predicting your most fertile time. Are Those Ovulation Kits Any Good? If you are the type of person who doesn’t want to evaluate all the signals from your body about your fertile time, there are other ways to help predict ovulation. With the invention of the home pregnancy test, women have been able to find out if they’re pregnant or not without having to go into the doctor’s office. Not only did this make pregnancy more private, but also more convenient. With at home ovulation predictor kits, women can begin to determine more scientifically whether or not they are in their fertile time of the month. These kits measure LH (luteinizing hormone) levels in a woman’s body. The way it works is these levels will generally surge right before a woman is ready to release an egg into the fallopian tubes. What’s great about these kits is that they can predict the best times for conception in advance of the release of the egg, allowing you to better time intercourse. The kits are 27 said to predict ovulation up to thirty-six hours in advance and increase your overall chances of becoming pregnant. It’s best to follow the directions on the package, but here are some basic guidelines. Try to test around the same time everyday, it’s usually best between 2 – 4pm, although any time between noon and 8pm is probably fine. Definitely do not test with first morning urine. The reason is that most women have their surge early in the morning and it can take several hours for it to show up in your urine. Also, try not to drink too much in the hour or two before testing as that will dilute your urine. HINT: Many women find ovulation test kits frustrating to use and claim that they never see a positive result. The fact is the surge is very short and it is possible to miss it if you test at the wrong time of day. If you want to improve the accuracy of these test kits, and don’t mind spending a bit more to pinpoint your ovulation, I would strongly recommend that you test twice a day, twelve hours apart. As stated earlier, never use first morning urine, so late morning, and then in the evening would be best. Usually the kits come with five tests, so if you have very irregular cycles, you may need to buy two kits in order to have enough and not miss your surge day. There’s a great site online that sells these tests at a discount, and you can buy them by the piece, so you’re not restricted to 5 in a box. It’s much cheaper than buying them in the drugstore, and they offer free shipping in the U.S./Canada. This is especially helpful if you are testing twice a day. Click here to purchase the ovulation test kits. What About Saliva Tests? Some test kits use your saliva instead of your urine to predict ovulation. The saliva tests work by detecting an increase in your salt content, which is an indicator that your estrogen levels have risen. When you look through the microscope at a dry saliva sample, you are looking for “ferning” or crystal patterns produced by the increase in estrogen that takes place prior to ovulation.. Many women prefer these to the “pee sticks” because the others have to be stored in a cool climate (which is hard to tote with you in your purse for on-the-go testing). It’s also less expensive. Urine tests are pricey and new ones have to be purchased on a continual basis. With saliva test kits, it’s a one-time purchase because it can be washed and reused. And the USFDA says they’re 98% accurate. (Plus, you don’t have to wait for a full bladder – you can test at any time)! 28 You might want to have a look at “Fertile Focus,” which looks like an attractive lipstick case. It’s affordable, portable, and offers a powerful 50X magnification glass lens for accuracy and ease of use. Or, you can try “Ovacue Fertility Monitor,” which is a unique and sophisticated electronic monitor which is so simple to use, you simply place the oral sensor on your tongue, and in one minute you have your daily test result. Better yet, this monitor electronically creates, tracks, and stores your data—it’s like having your own digital ovulation calendar. You can purchase Fertile Focus by clicking here and Ovacue by clicking here. Advanced Maternal Age The biggest obstacle most women over 40 face is two-fold: diminishing ovarian reserve (DOR) coupled with poor embryo quality. It appears that women have a much better chance of conceiving if they are under age 44. Unfortunately, many women in their mid forties or later are not aware of this. One reason is the false perceptions in the media, supported by several highly publicized celebrity pregnancies, which have suggested that women can continue to bear children until menopause. What these reports have failed to note is that many of these pregnancies were achieved using donor eggs. That being said, if your are in your late thirties or early forties, some of the recommendations that I’ve written about elsewhere in this ebook can be particularly helpful for you. You may have been told that you have an elevated FSH. The fact is, however, elevated FSH levels do not specifically cause a problem with conceiving; but rather they are a possible indicator of diminishing ovarian reserve, which means there may be a low amount of genetically normal eggs left to achieve a healthy pregnancy. However, FSH numbers can fluctuate from month to month. Some doctors think that any high number is a problem but others think that one high number is not necessarily an indicator of likely failure to conceive and prefer a second test for comparison. The best thing to do if you are dealing with advanced age and/or high FSH is to try the suggestions below. Many women dealing with advanced age and/or high FSH have found success by implementing these methods. You can do a search through this document by “keyword” for the topics below which I’ve covered in detail elsewhere: • • • • • • COQ10 DHEA Inofolic Royal Jelly Wheat Grass Acupuncture 29 In Summary When all of the measuring and calculating aren’t adding up to a pregnancy, you might have something bigger on your hands. In Chapter 7, I will cover ovulation disorders and other common obstacles to pregnancy such as endometriosis, blocked tubes, and fibroids. But now it’s time to start learning some more of what you can do to speed up the process of getting pregnant if you don’t have any of these specific problems. I want to start with things you can do on your own – and when you hear the word “alternative,” it doesn’t mean it’s unusual. Alternative just means the scientific medical community doesn’t focus on anything that is not scientifically proven. They tend to focus on what they can do for you medically, with drugs and treatments, not what you can do for yourself, which is often less expensive and less invasive. 30 Chapter 4: Before You Turn to Your Doctor – Traditional and Alternative Tips to Help Hasten the Process of Pregnancy You may be thinking that it’s taking longer to get pregnant than you had expected. And you may have already been advised by a physician to “just be patient.” Or, you may be on the verge of asking your doctor about infertility treatment options because you’ve just about run out of patience. But before you begin that lengthy process, consider some of the non-medical suggestions I’m going to talk about in this chapter. One of these may be the secret that unlocks your ability to conceive a child. Some of these methods might be familiar to you, but others might be new knowledge for you to consider. You owe it to yourself to carefully reflect on each topic and decide whether you want to give it a chance. Bear in mind that sometimes, what seems like a minor adjustment, could mean the difference in the miraculous world of conception. It is important to keep in mind that alternative therapies don’t offer a magic solution. However, the aim is to simply get both partners into optimum condition both physically and mentally, so conception can happen naturally. I’m going to include some traditional as well as alternative do-it-yourself methods to try out to increase your chances of pregnancy. Each of these suggestions have worked for some women, but aren’t appropriate for all. Try not to draw any conclusions about any particular strategy until you’ve given it a fair try. One or a combination of these suggestions might just be the winning combination that will ultimately be responsible for your success. 31 When “Just Relax” is Easier Said than Done Anxiety and worry can cause you to be unable to relax enough to conceive. They can also cause physical problems that will affect your body negatively. It’s a Catch-22. You can’t get pregnant until you relax and you can’t relax until you’re pregnant. More and more research studies are pointing to stress as one of the most common contributors to decreased fertility. Our lifestyle today contains enough stress on its own – but when you combine everyday stress with that of desperately desiring a baby, stress levels can climb to dangerous levels. If well-meaning relatives, friends and co-workers know that you’re trying to conceive, they might be adding to your stress by suggesting remedies (including, “just relax”) of their own. You may appreciate their input, but after awhile, knowing looks combined with a drawn out… “Well-l-l-l-l-l…?” can get on your nerves and actually cause you to be too anxious to conceive. There are ways to alleviate the stress and end the constant, irritating banter of others about your lack of luck in the pregnancy department. Maybe you and your partner can’t take an around the world cruise on the Queen Mary to relax – but there are alternatives that you can probably manage. The Mind – Body Connection is Key If you are tempted to dismiss the importance of emotional well being in your quest to become pregnant, please don’t. There is some very credible research which supports the notion that “the mind” is very powerful and can have a very strong influence over the “body.” There is more to getting pregnant than just making physical changes…it is critical that you address the emotional impact on your fertility as well. • Yoga/Meditation Among the most helpful stress-relieving methods, practicing Yoga and meditation on a regular basis can be a viable answer to reducing stress levels in your life. Yoga can help you control stress on many levels. The poses and deep breathing exercises help you to control your body and tell it exactly what you want it to do. 32 There is a wonderful yoga DVD developed specifically for fertility. You can watch a video clip by Clicking Here. Click Here to purchase Bend, Breathe and Conceive yoga DVD. Meditation helps to quiet your cluttered mind and restore control. Regular meditation promotes tranquility in your life when you need it most. I have found a site that offers many audio meditations that are a fantastic way to help you relax. The best part is that they are not going to cost you anything--they are available to that they are not going to cost you anything-listen to for FREE!! I suggest finding a quiet space/room where you can spend a few minutes listening without distractions. There are many choices...simply pick one and start! These are especially helpful to do at the end of the day when you are feeling the most stressed out after a hard day of work! Here’s the link: http://www.themeditationpodcast.com/episodes.html Yoga and meditation won’t solve all of your stress-related problems, but it will help you react to them in a way that will keep your mind and body calm. • Reflexology Reflexology is another natural remedy to promote relaxation. It involves applying gentle pressure to certain body points (usually hands and feet) and is gentle and calming on the entire body. A highly trained reflexologist will gently stroke and knead your feet, concentrating on the areas that will improve the functioning of your reproductive organs and glands. In the process, you’ll achieve a stage of deep relaxation. If relaxation is a problem for you in trying to conceive, try reflexology as a calming force to help you ease tension and handle life’s problems more efficiently. • Tapping (EFT) Tapping is a ground breaking mind/body technique also known as EFT. 33 This technique enables you to rid yourself of negative feelings, stress, sadness and despair that you may be feeling while you try so hard to have a baby. Instead, you will see positive changes in your outlook, emotions and mindset while you are trying to conceive. The biggest difficulty that couples face is that they simply cannot find ways to reduce their stress level even though they know it is probably harming their fertility. Sarah Holland and her program, The Fertile MIndset, offer a solution that works! Her success rate in her private practice where she is using these techniques on her infertility patients has been nothing short of overwhelming!! Sarah Holland teaches this holistic approach which unlocks the secret of how the "perfect mindset" for conception can bring you closer to your dream of having a baby. You can review her program here: Fertile Mindset Program • Bowen Technique The Bowen technique is a lesser-known therapy that has a surprisingly high success rate for treating fertility problems. This therapy involves a particular system of gently rolling, connective tissue moves that addresses the hormonal system and pelvic area. It is based on the premise that mental and emotional stress can cause tight muscles and restriction of natural blood flow, lymphatic drainage and nerve supply of the body, which can all effect fertility. Usually patients are seen on the first day of their menstrual cycle, and then a second session on day 14 of the cycle (with no intercourse in between sessions. To find a practitioner in your area please visit: http://www.bowtech.com/ • Massage Massage techniques have long been used as a way to relieve stress and stimulate circulation. It also serves to promote hormonal balance and increase nerve action in the womb. Swedish and Shiatsu are the better-known massage methods. Each is beneficial to relieving stress and tension. Both use essential oils and lotions to soothe the body 34 and create gentle warmth that stimulates circulation and releases harmful toxins or impurities. As your ovulation time approaches, you may want to try massage on a regular basis to help your body relax so that conception can more easily occur. • Talk Therapy Words can sting. Being told “it’ll happen when it’s right” or “just relax” may be meant to comfort you, but they’ll usually end up frustrating you even more when you’re trying to have a baby. Researchers are now seeing that talk therapy is helping many women conceive. Since stress is a direct contributor to infertility, when a woman learns how to ride out stressful events in her life and talk them out, she lessens her stress and increases her odds at conception. Click this link to read the full article. • Laughter Therapy Ever heard the phrase, “laughter is the best medicine?” Well it rings true for infertility, too. You may be shaking your head wondering, “How am I going to find any reason to laugh during this time when I’m so emotional and distraught?” In some studies, women exposed to laughter therapy during infertility treatments were able to get pregnant faster than women who did not participate. It doesn’t seem to take much, either – just 10-15 minutes a day. So go ahead – rent your favorite I Love Lucy episode or go with your partner to a comedy club tonight – and give your odds at conception a boost. • Hypnotherapy When you’re trying to get pregnant, your thoughts are often consumed with when it’s going to happen for you. Even when you’re consciously trying to avoid thinking of it, your subconscious mind is often focused on what’s going wrong or why it isn’t happening quickly enough. With hypnotherapy, you’re hypnotized and taught how to overcome the psychological barriers that could be contributing to your fertility issues. Although it won’t work for all, it does work for some women and it’s worth looking into. 35 • Exercise Exercise should become an important part of your life while you are trying to get pregnant. It will improve your immune system while reducing stress. You will have greater energy, will likely lose weight and gain muscle. As your health improves, you are preparing your body for a healthy pregnancy. Be sure you are exercising in moderation, as excessive exercise has been known to contribute to ovulation problems. • Plan a Relaxing Vacation or Weekend-Getaway Even if you can’t take a month-long cruise, you can probably plan a romantic, relaxing vacation. A weekend trip to a little inn or resort that you both enjoy can be relaxing and enjoyable – helping you forget the chaos of your daily life. While you’re there, try to plan a massage or reflexology session. If you’re uptight about getting pregnant while on a vacation, it will negate what you’re trying to accomplish. There are other methods that you might try for yourself. For example, if reading a good novel or drinking a hot herbal cup of green tea before going to bed is a relaxation tool for you, by all means try it on a regular basis. Relaxation and stress-relief have helped many a woman conceive – and you owe it to yourself and your partner to try and improve your chances of getting pregnant faster. Acupuncture – An Ancient Remedy Acupuncture has been used for centuries to treat and prevent illnesses. Channels of energy called meridians run in river-like patterns through the body, nourishing the tissues. Any obstruction in their movement can disturb the flow of energy and can lead to dysfunction and possibly disease. Acupuncturists say that placing needles in specific points along the meridians can unblock the obstructions and reestablish the regular flow of energy throughout the body. Some small studies suggest that acupuncture can normalize the endocrine system, which regulates the hormones that are necessary for reproduction. Acupuncture can increase blood flow to the uterus and ovaries, which may improve the quality of the eggs 36 they produce as well as help encourage the implantation of an embryo. It’s also theorized that acupuncture might help to trigger ovulation. Long, thin needles are inserted into specific areas along the pathways. By stimulating these pressure points, balance is restored and a natural healing process can begin. It’s an interesting fact that in a recent study comparing acupuncture to hormone treatments to promote pregnancy, both group results offered the same rate of success. But since acupuncture has no side effects, the conclusion was that acupuncture “offers a valuable alternative therapy for female infertility due to hormone disorders.” As recently as May 2006, a highly regarded medical journal, Fertility and Sterility reported on several new studies that were conducted to see if acupuncture could improve the rate of success for couples undergoing IVF. The results indicated that receiving acupuncture significantly improved the pregnancy rates for these couples. What’s really interesting is, the physiologic mechanism by which acupuncture seems to affect the uterus and reproductive system hasn’t really been identified, yet the researchers found that as a practical matter, it seems to work. Of course, some in the medical community dismiss the idea of acupuncture as a remedy for anything because there is no scientific evidence of “pathways” that conduct energy throughout the body. When it comes to mainstream medicine, treatments that aren’t exactly understood scientifically are often dismissed. But because of the obvious success rates in these studies, acupuncture is steadily growing in acceptance, and is now often recommended by fertility specialists for their patients. And just think, if it helps women who are undergoing IVF (who generally have more significant fertility issues), imagine the possibilities for those of you who just need a little helpful boost. A mixture of Chinese herbs is sometimes used in conjunction with acupuncture treatments. These herbs are touted by Chinese medicine to improve fertility in men and women. If you decide to try the acupuncture route to pregnancy, first determine what is required of acupuncturists in your state. Seek out a fully trained and licensed practitioner, preferably someone who specializes in acupuncture to improve fertility. You may also want to take into consideration that many insurance companies don’t cover acupuncture treatments, although it’s becoming increasingly popular to include in medical insurance plans. 37 Acupuncture may seem a little scary at first – needles being poked into your body – but a good acupuncturist will insert them so that you’ll never know that it’s happening. Not only that, it can be an extremely relaxing experience. I personally used acupuncture in my quest to become pregnant, and although I started out very skeptical of the whole process, I came to be a believer. Although of course I have no proof, I truly believe that acupuncture was one of the strategies that helped me conceive my children. I wholeheartedly recommend the 2-step approach of acupuncture and Chinese herbs. Acupressure– An Alternative I like the fact that acupressure can be done by yourself at home. Acupressure involves applying pressure to specific points on the body that flow along meridians to improve blood flow in the body and to foster the body's vital life force (also known as "chi"). It is very similar to acupuncture but you use your fingers instead of needles. It is thought that pressure applied to specific points on the hands and feet can help stimulate the ovaries, uterus, and adrenal, pituitary, thyroid, and parathyroid glands to balance hormone production. If you do not have the opportunity to see an Acupuncturist, I would recommend you try Acupressure as a less costly alternative. There is a great video that teaches you how to do this yourself at home. CLICK HERE for more information and to purchase. Get Plenty of Sun and Sleep Sleep helps restore many parts of our bodies, including the reproductive system. When sleep suffers over the long run, it can impact your hormone balance. Long term sleep loss can disrupt the menstrual cycle, which can then cause a delay in the time it takes to get pregnant. Lack of sleep can even cause you to stop ovulating altogether. Additionally, daily light exposure has an influence on ovulation and reproductive hormones. Current research suggests that the hormones that trigger ovulation, and even the sperm maturation process, are somehow tied into the body's biological clock Since the same part of the brain that regulates sleep-wake hormones also stimulates daily pulses of reproductive hormones for men and women, scientists suspect some feedback between these systems. 38 When your body is exposed to sunlight, it also gets some much needed health benefits, such as an added dose of Vitamin D. Sunlight also helps improve your mood, which is essential when you’re going through the process of trying to get pregnant. While sunlight is good for your health and contributes to a better reproductive system, you also want to make sure you don’t overdo it and get too much sunlight. This can lead to sunburns, retinal damage, and skin cancer. The bottom line is this, get plenty of rest and a good dose of daily sunlight (approximately 1 hour) to keep your reproductive hormones in check. Nightlighting Many women with irregular cycles have benefitted from addressing their nightlighting situation. This technique originates from the ancient theory connecting menstrual cycles to the phases of the moon -- women ovulate when the moon is full (light) and get their periods during a new moon (darkness). It was physicist E.M. Dewan who found that women's menstrual cycles became regular by sleeping in complete darkness most nights and then using a dim light bulb all night for a few days in the middle of the month. If you have irregular cycles, this is a good method to try to see if you can regulate your cycle and thereby increase your fertility. Start with the first day of menstruation as Day One. Sleep in total darkness for days 1-13. Days 14-16 sleep with a dim light on all night, such as a closet door light on with door almost closed, 15 watt night-light or dim hall light. This will encourage the ovulation process to begin. The rest of the time, sleep in total darkness again. For this method to be effective, it is critical to completely remove any light source in your room when sleeping in the “darkness” phase. Total darkness means that fifteen minutes after turning out the lights, you can't see objects in the room, including your own hands. Bedroom windows are covered with room-darkening blinds or curtains backed by light-blocking fabric. Cracks of light from under doors can be covered with a towel. Cracks around the edges of windows can be covered with aluminum foil. You should see your cycle regulate after doing this for about three or four cycles. 39 How To Increase Sperm Count - Boost Male Fertility Reducing stress and having good nutrition can have a huge impact on sperm production. In fact, if stress is present during lovemaking, it can result in significantly LESS sperm in the semen upon ejaculation. As mentioned in chapter 2, it is important to abstain from sex for approximately 3 days before you start having intercourse during your “fertile window” (the days leading up to ovulation). However, you can boost sperm counts even further by practicing an ancient Tantric Yoga Method during this abstinence period that requires a certain level of control over ejaculation. During the 3 day period of abstinence before ovulation is approaching, you are to engage in extended and stimulating foreplay with NO EJACULATION. When the urge to have an orgasm becomes too strong (for the male partner only), sexual contact is stopped until the penis becomes flaccid (soft). He can try cold water or whatever it takes for him personally. Then, when he is no longer showing signs of being aroused, you engage in the extended foreplay again and repeat the process. The idea is that the stimulation plus the gaining and losing of the erection over time, acts to “pump up” the sperm count (quantity) and quality. WARNING: This method should only be used if the male is able to control ejaculation. If he is not, and does ejaculate during this process, then you will have interrupted the 3 day abstinence that is beneficial before ovulation. It should be pointed out, it is also very helpful if you use extended foreplay when you are having intercourse during your fertile time. As mentioned earlier, stress during intercourse can reduce sperm counts; alternatively, highly stimulating and prolonged foreplay can serve to increase the number of sperm present in the semen upon ejaculation. 40 The Cervical Cap I’ve written about this product on my blog, but some of you may have missed it so I thought it worth mentioning again here. I checked it out and I think this is a fantastic product that everyone should try if you are looking to boost your odds of conceiving. It is rather inexpensive and can especially help those who are dealing with male factor issues such as low sperm count/motility. While there is no scientific evidence that this will work, I am a firm believer in listening to the evidence of other women who have tried it themselves with great success. Often doctors will not recommend something because there is no "scientific evidence", but if it works for many others, why not give it a chance as long as it seems reasonable and can’t hurt. The product is called SoftCup and it basically is a type of cervical cap that will allow you to concentrate the sperm right at the entrance of the cervix to boost your odds of conceiving. Here is the link--you can read many testimonials on that page from women who have used this method to conceive, many who were successful the first month trying it! http://tinyurl.com/softcup Vitamins to Revitalize Your Fertility Taking certain vitamins to increase your fertility quotient is another natural remedy that you should consider to help you get pregnant. If your body is missing certain vitamins it can affect your hormone levels, how you handle stress and damage your overall health. The use of nutritional vitamin supplements can benefit both you and your partner by balancing hormone levels, which are necessary for conceiving. You can’t expect that just because you eat a balanced diet that you get all the vitamins your bodies need. Everyone is different – but most people in today’s fast-paced world of fast foods and foods in excess need to add some sort of supplement to their daily diets. 41 Both partners should start with a good multi-vitamin (or prenatal vitamin for women) which should have adequate amounts of folic acid (at least 400mcg.) and iron (18mg), therefore not requiring additional supplementation of those two nutrients. Here is a list of additional vitamins that could be effective in helping you achieve successful conception and why they might be valuable to you. • Vitamin E – Increased fertility in both men and women has resulted from this powerful antioxidant. Studies show that a low level of Vitamin E in males decreases sperm production and supplementation may also improve sperm motility. In women, vitamin E helps to normalize hormone production and may improve egg quality. Studies show that vitamin E can increase sperm potency by 2 1/2 times. Two studies found that vitamin E supplementation lead to a 20% pregnancy rate in previously infertile men. Dosage: 400 IU daily (If possible, vitamin E should be D-alpha and not DLalpha. The reason is that D-alpha is natural and has a higher absorption and benefit rate. Food Sources: wheat germ, almonds, green leafy vegetables, vegetable oils, cold pressed oils, molasses, eggs, sweet potatoes, seeds, whole grains, and avocados. Note: Best taken with vitamin C but check with your doctor if you have anemia, blood clotting issues, hyperthyroidism, high blood pressure, liver disease or if taking blood thinners. • Vitamin C – Also a powerful antioxidant, Vitamin C blocks damaging free radicals. It can increase count and motility of sperm. It also reduces sperm agglutination (clumping), a condition where sperm tend to stick together, which reduces fertility. If you’re currently taking the drug Clomid to encourage ovulation, Vitamin C might increase your chances of a better ovulation by assisting in ovarian function and egg development. 42 Vitamin C may increase the amount of water in your cervical mucus, which will make it more plentiful. However, women should avoid very large doses of Vitamin C because it can have the opposite effect, and dry up cervical mucus. Dosage: Men – 200 to 1000 milligrams per day Women – Up to 1000 milligrams per day Food Sources: many fruits including grapefruit, orange, kiwi, and melon. Also broccoli, tomatoes, spinach, and sweet peppers. • Vitamin A – This vitamin contains necessary antioxidants and is valuable when taken both before and during pregnancy. Vitamin A helps with the production of cervical mucus. In men, this anti-oxidant protects sperm from the damaging effect of free radicals. A deficiency in Vitamin A is shown to reduce sperm volume and count, and increase abnormal sperm. Be sure that you use the beta-carotene (vegetable) form of Vitamin A. The animal form (retinol) can cause birth defects if taken in excess. Dosage: Up to 10,000 IU Beta Carotene usually found in a multi-vitamin Food Sources: carrots, sweet potatoes, cantaloupe, spinach, eggs, yellow fruits and vegetables, whole milk and milk products, dark green leafy veggies, and fish oils. • B Vitamins – While your partner can benefit from B12, you can benefit from taking B6, B12 and a B-Complex vitamin. For men, B12 will help increase the quantity and performance of his sperm. For women, when your body is deficient in B6, it builds up too much estrogen, causing your ovaries to shut down the production of progesterone. This can result in a luteal phase defect, which can be corrected with B6 supplementation. B-Complex vitamins help you reduce stress and maintain a healthy balance of hormones in your body. Lack of B-vitamins is very common in people who eat mostly refined and processed foods as well as those who smoke. 43 Dosage: B6 : 50mg - 100mg per day; B12: 1000 mcg per day; B-complex: contains 50mcg B12, 50mg all other B vitamins Food Sources: beans, nuts, legumes, eggs, meats, fish and whole grains Zinc – The focus of numerous studies in fertility of males and females, this nutrient is essential for your pregnancy and your future baby’s health. A deficiency of Zinc can lead to decreased fertility and also increase the risk of having a miscarriage. It helps women to more effectively utilize the hormones estrogen and progesterone, to achieve conception. Zinc deficiency is quite common, yet even a mild zinc deficiency can drastically reduce sperm counts. Zinc deficiency will also affect how long the sperm can live in the vaginal tract. In the journal Fertility and Sterility doctors reported that men with fertility problems who took a daily dose of 66 milligrams of zinc and 5 milligrams of folic acid for almost six months saw a 74% increase in their sperm counts. Dosage: 50 mg. with a full glass of water Works best when combined with folic acid to improve sperm count. # Food Sources: oysters, chicken, beef, crab and turkey, nuts, whole grains, fish, seafood, eggs, pumpkin and sunflower seeds, rye, oats, whole grains, legumes, mushrooms, and wheat germ. Note: If you take zinc for longer than a few weeks you should add 1-3 mg of copper to prevent a copper deficiency. • Selenium – Another antioxidant, increased levels of selenium have been found to produce higher sperm counts in men. Selenium deficiency causes fragile sperm with easily broken tails. Semen is high in selenium so it must be replenished regularly. It improves overall reproductive health in women and may help to prevent miscarriage. Dosage: 50-200 mcg per day Food Sources: liver, red meat, seafood, tuna, wheat germ and bran, whole grains, and sesame seeds. 44 • L-Carnitine (Amino Acid) – Many recently published studies indicate that both L-carnitine and L-acetyl carnitine improved sperm in a number of areas key to fertilization, namely sperm quality and sperm function. Dosage: 300 to 1,000 milligrams three times a day Food Sources: red meat, avocado • L-Arginine (Amino Acid) – Amino acids are the building blocks of life. The head of the sperm contains an exceptional amount of this nutrient, which is essential for sperm production. It helps increase both sperm count and quality. It can also help maintain a healthy uterine lining and may improve egg quality. Dosage: 1500 – 4000mg over the course of a day on an empty stomach Food Sources: Sunflower and pumpkin seeds, peanuts, sesame seeds, watercress, almonds, chives, broad beans and lentils. Also in protein foods such as meat, fish, eggs, brown rice, and quinoa. • Paba - (para-aminobenzoic acid) is a B-complex vitamin that stimulates the pituitary gland and sometimes restores fertility to some women who cannot conceive. A clinical trial reported that 12 of 16 previously infertile women were able to become pregnant after supplementing with PABA over several months. Dosage: Best to take as a blend in a B-complex vitamin (no more than 400mg daily of Paba) Food sources include molasses, mushrooms, spinach and whole grains. • Coenzyme Q10 - A nutrient used by the body in the production of energy. People produce less CoQ10 as they age and studies show that consuming additional CoQ10 has health benefits, including enhancing fertility in males and possibly in females. Dr. Yaakov Bentov, an Assistant Professor at the University of Toronto's Center for Advanced Reproductive Technology, says that as a woman ages, her eggs become less efficient during fertilization because the chromosomes don’t 45 replicate as well. “The egg needs to complete a demanding process and often when a women reaches her late 30s and early 40s, there is not enough energy in the cells,” he says. Studies have also found that Co-enzyme Q10 may also improve male infertility. A July 2009 study in The Journal of Urology looked at 212 infertile men who took 300 mg of the supplement for 30 weeks, and found that it improved both sperm density and motility. Coenzyme Q110 has antioxidant properties that offer protection to the fragile sperm cells as well as provide for proper energy production. This is believed to be how CoQ10 works to enhance male fertility. Dosage: Dosages vary widely. For females, 100-200mg twice a day is the typical dose. For males, a range of 20-100mg, twice daily. In a 2009 study published in The Journal of Fertility and Sterility, Bentov and his colleagues found that taking Co-enzyme Q10 actually helped to improve egg quality and improved fertilization rates in older female mice. “It may improve the quality of eggs by correcting their energy which improves the division of chromosome during fertilization,” Bentov claims. There haven’t been any actual studies on women, but it is believed that CoQ10 may also benefit older women by improving egg quality. Many top fertility centers are prescribing CoQ10 for their older female patients undergoing IVF. • Folic Acid – A vital component during your pregnancy to prevent spina bifida (a neural tube defect) in your child. It needs to be in your system at the time of conception so you should begin taking it well before you start trying to conceive. Also needed for sperm production, count, motility, and low morphological abnormalities. Dosage: minimum 400 mcg per day Vitamin C aids in absorption. Food Sources: Many sources including green leafy vegetables, dry beans, legumes, citrus fruits and juices, whole grains, poultry, pork and shellfish. • Magnesium Citrate – An essential vitamin which goes hand in hand with the “B” vitamins. Low levels of magnesium have been linked to miscarriage and infertility. 46 Dosage: 200 mg. Daily Food Sources: Kelp, green vegetables, bananas, molasses, brown rice, beans, rye, millet and buckwheat all contain magnesium. • Manganese - The metabolism of the female hormone estrogen depends on manganese. Therefore, a deficiency of manganese may significantly reduce fertility in women. Food Sources: Spinach, chestnuts, tea, oats, wholegrain cereals, wheatgerm, raisins, beans and nuts are all good sources of manganese. • Calcium – Before, during and after pregnancy you need 1000mg daily taken along with Vitamin D for absorption. Food Sources: There is plenty of highly absorbable calcium in green leafy vegetables, broccoli, cabbage, salmon, sardines, beans, enriched flour, and fortified juices. • Glutathione and Cryptoxanthin – These anti-oxidants may prevent damage to sperm that makes them sluggish and unable to fertilize an egg. It’s probably best to get these anti-oxidants from food sources rather than supplementation. Standard dosage computation: 10mg per Kg BW (Body weight) per day. Should be divided so that it is taken 2-3 times per day along with Vitamin C. Food Sources: Available in brightly colored produce such as leafy greens, tomatoes, peppers and oranges. • Geritol Tonic – Often referred to as a “Baby in a Bottle,” this highly potent liquid vitamin and mineral supplement is recommended by many women who personally took it and then conceived. It is supposed to work well in increasing cervical mucus. While there is no medical research regarding this supplement, since so many women across the Internet claim that it worked for them, I have decided to include it in this list. 47 Dosage: Follow directions on the bottle. While many women complain of the bad taste, others say to drink it with a cup of Green Tea and it smoothes over the ill effects. All of the above vitamin suggestions offer a means to increase your health and benefit both male and female fertility. The dosages listed should be used as a guideline. It’s always best to consult with a qualified professional when you make your purchase or follow the dosage suggestions on the bottle. Essential Fatty Acids (EFA’S) Omega-3 and Omega-6 are essential fatty acids (EFA’s) that are essential for maintaining good reproductive health. Unfortunately, our bodies cannot manufacture these EFA’s, so they must be obtained from outside sources -- from the food we eat or the supplements we take. EFA’s are very important to take when trying to conceive as they act as hormone regulators. Both Omega-3 and Omega-6 are also important in the development of sperm. It’s important to have a balance of these EFA’s however most people have much more Omega-6’s in their diet than Omega-3’s because Omega-6’s are found in eggs, meat, whole grains, cereals, polyunsaturated oils from vegetables and nuts, and most packaged foods and baked goods. Most often, western diets do not require supplementation of Omega-6 because they tend to be very high in Omega-6’s. However, it is essential to have a balance of Omega 3 and Omega 6 fatty acids, preferably in a 1:1 or 1:2 ratio. Unfortunately, many diets have a ratio as high as 1:30 of Omega-6 to Omega-3 and it is suspected that this could contribute to fertility problems. Food Sources of Omega-3: ground flaxseed, oily fish (mackerel, herring, salmon, sardines), walnuts, green leafy veggies. Food Sources of Omega-6: borage oil, black currant seed oil, evening primrose oil, are all high quality sources of this nutrient. Supplements: (1-7 grams per day) of flaxseed oil and ultra-refined (purified) fish oil (to avoid mercury and other toxins) (Do not take cod liver oil which may contain toxic levels of vitamin A). 48 Note: be careful of taking too much EFA’s if you are currently taking blood thinning medication. DHEA DHEA has recently garnered a lot of attention in the world of fertility for helping women with Decreased Ovarian Reserve (DOR) and Premature Ovarian Failure (POF). DHEA is a natural steroid hormone produced from cholesterol by the adrenal glands and in the body it is converted into testosterone and estrogen. The most abundant of all steroid hormones in humans, DHEA sharply declines as we age. It is most widely promoted for it’s “anti-aging” effects. Since it is a precursor to hormones such as testosterone and estrogens it may help increase follicular stimulation. DHEA has been shown in some small studies to improve IVF outcomes in women that are poor responders to IVF. Based on research conducted by the Center for Human Reproduction in New York, DHEA replacement therapy has been associated with increased embryo counts, increased embryo quality, improved fertility treatment results, and decreased miscarriage rates in some women whose primary fertility challenge is diminished ovarian reserve. In order to get the full benefit of of DHEA, it might be best to be taken in combination with fertility drugs so that the woman does release more than just one egg. Negative Effects Because DHEA often turns to testosterone in the body, it can also negatively affect fertility in women who already produce average to above average of levels of testosterone. High levels of testosterone, in extreme cases, can cause a woman to stop ovulating. Even moderately increased amounts of DHEA or testosterone can affect a woman's cycle and result in undesirable side effects including acne and excessive hair growth. Although DEHA is available over the counter in the United States, testing should be carried out by a physician in order to determine need and appropriate dosages. DHEA is not to be used if pregnant and should be discontinued as soon as a positive pregnancy test is achieved. DHEA should also not be used if you have PCOS, as this hormone may make this condition worsen. 49 Overall, the studies that have been done so far do not provide a clear picture of the risks and benefits of DHEA.…In the meantime, people who are thinking about taking supplements of this hormone should understand that its effects are not fully known. It is important to consult with your doctor before taking this supplement. For some further reading about this controversial supplement, have a look here: http://www.brinkzone.com/articles/dhea-the-most-underrated-supplement-for-women/ http://www.centerforhumanreprod.com/premature_ovaries.html http://www.sciencedaily.com/releases/2010/07/100701145535.htm Usual dosage: 25mg, 2-3x a day for a total of 50-75mg daily. Herbal Remedies for Fertility Problems Herbs, which are derived from plants and plant extracts, have been used to combat infertility since approximately 200 A.D. As with many alternative approaches, modern researchers have often passed over using herbs as fertility therapy because of the absence of conclusive data to scientifically prove their value. However, as more and more clinical data regarding these treatments appears, herbal fertility remedies are gaining popularity. There are increasing numbers of success stories told on discussion forums detailing how women turned to herbal therapies and became pregnant after nothing else worked. The ancient Chinese used herbs to treat infertility and believed that it regulated menstruation and increased sperm counts. They can be extremely useful in treating hormonal imbalances. Herbal remedies appear in many forms such as tinctures (extracts), capsules and teas. Some of the most popular herbs found to be effective in treating infertility are: • Chaste Berry (Vitex agnus castus) Vitex is probably the most well known and widely studied fertility herb. It works by stimulating the hormones involved in ovulation and restoring female hormonal balance. Vitex helps to correct luteal phase defects and helps to lower high prolactin levels, both of which cause fertility problems. It acts on the 50 pituitary gland, specifically on the production of LH (leutenizing hormone). The result is that it increases the production of progesterone, which helps to regulate the menstrual cycle. Vitex is not a fast acting herb and may need several months to build up in your system. Take during the first half of your cycle and stop when you’ve ovulated • Red Raspberry Leaf Red Raspberry Leaf has the reputation of helping to tone and strengthen the uterus. It also promotes hormonal balance by lowering high levels of excess hormones, thereby raising the levels of your fertility, and providing a stronger ovulation cycle, to create better condition for getting pregnant. It is also recommended to help the fertilized egg attach to the uterine lining and stay attached. It is a phyto-progesterone, which is a plant that acts like progesterone, therefore it can be used to increase progesterone levels in the body. Red raspberry leaf is very safe - it does not cause contractions per se, it just strengthens the uterus so that when you do get them, they will be nice and strong and healthy. You also have to do this over a long period of time - herbal infusions are a lot like exercising, you see benefits over a long period of regularly use. While most experts suggest that you can take it throughout the cycle, I have read some online reports from women who stop taking it at ovulation for fear that it can cause contractions leading to miscarriage. The majority of the herbalists do consider it safe to continue throughout the cycle, but whenever there is some controversy, you have to do your own due diligence and decide what you think is best for you. It is best to take it as an infusion (one ounce of dried raspberry leaves brewed overnight in a quart of boiling water). Strain the leaves, and drink hot or cold, with honey if you prefer. You can refrigerate leftovers. • Red Clover This herb is another highly touted fertility remedy. There are many stories of women unable to conceive, who drank up to a quart of red clover infusion every day for at least six weeks, and then became pregnant. It contains estrogen like compounds which promote estrogen production which can boost estrogen levels in women with estrogen deficiencies. Red Clover also contains calcium 51 and magnesium which can relax the nervous system and improve fertility. Red clover also has an alkalizing effect on the whole body, which creates a more sperm-friendly environment within your body. Famed herbalist Susun Weed considers it “the single most useful herb for establishing fertility. Red clover should NOT be used if you have endometriosis or have fibroids which are both conditions which have excessive estrogen. To make an infusion put one ounce of dried blossoms in a quart jar filled with boiling water, and steep overnight. May be taken throughout the cycle. (Best taken in combination with red raspberry). • False unicorn root Like red clover, it can help balance hormone levels by making up for a shortage of estrogen or encouraging your body to excrete excess amounts. It has a normalizing effect on the ovaries and strengthens the lining of the womb. Take during the first half of your cycle, and stop when you’ve ovulated • Dong Quai It is an ancient Asian herb which is known as the female hormone regulator. It acts like an estrogen “modulator” which activates or suppresses estrogen receptors within the pituitary to even out the hormones that bring on ovulation. It has also been attributed with helping to build a receptive uterine lining. Herbalists have differing opinions on whether this should be taken during the first or second half of your cycle. • Evening Primrose This can dramatically improve the production of more sperm friendly cervical fluid, also known as “egg white cervical mucus.” It may take a month or two to build up. 52 Take during the first half of your cycle and stop once you’ve ovulated. EPO is a prostaglandin and can cause the uterus to contract and the cervix to dilate. Therefore, once you ovulate you should replace it with Flax Seed Oil which also contains essential fatty acids without the prostaglandins. • Maca This Peruvian herb is at the forefront of many studies in increasing sperm count after a study was published in the Asian Journal of Andrology, 2001 showing a 200% increase in sperm count as well as seminal volume. Maca is used to increase fertility and libido in both men and women by regulating hormones. You can read more and purchase it here: http://www.tipsgettingpregnant.com/ maca.php • Green Tea It is a powerful antioxidant that enhances your reproductive health by reversing the effects of the environment on your body, such as aging, environmental toxins, stress, lack of sleep and eating too many processed foods. It can assist your body in the production of healthier eggs. Dosage: Just 1 cup or more a day doubles your odds of conception every cycle, according to a study in the American Journal of Public health. Take extra folic acid as green tea can interfere with the absorption of folic acid if taken in large quantities. • Dandelion Root Tea (sometimes called Dandelion Coffee) This is a great substitute for coffee (tastes very similar), without the caffeine. It has the added benefit of supporting liver detoxification which is very helpful for reproductive health. • Wheat Germ Oil Wheat germ is high in zinc, and vitamin E and is a great source of Omega 3 fatty acids. It may help to dilate both the fallopian tubes and the seminiferous tubules, making the transport of both egg and sperm easier. It also can improve sperm quality and quantity. 53 Dosage: 1/2 teaspoon to 1 tablespoon oil daily Royal Jelly • Royal Jelly is a fertility superfood which may help to increase the egg quality and quantities. Royal Jelly is rich in amino acids, lipids, sugars, vitamins, and most importantly, proteins. It contains high levels of vitamins D and E, and also has ample levels of iron and calcium. As all of these are essential to proper health and organ function, it is very easy to see how Royal Jelly can help with in assisting with fertility. It can also help with problems that are related to hormonal imbalance, such as polycystic ovarian syndrome (PCOS) or irregular menstrual cycles. A 2002 study found that when researchers fed this honey-like substance to ewes (whose placental physiology is close to that of humans), ovulation and pregnancy rates substantially increased. Dosage: Most manufacturers recommend 500 milligrams twice daily. If you know that you have an allergy to bee stings or even an allergy to honey, you should not take Royal Jelly. • FertilAid Supplement Rather than hand picking which herbal supplements you want to take, FertilAid combines several beneficial fertility herbs plus a prenatal vitamin, making it an all-in-one solution. There is a separate formula for Men and for Women. FertilAid is only available for purchase online. Click here to visit their website. Just for Men... Some options specifically for males to improve sperm function follow below: • Panax Ginseng (Asian Ginseng) 54 An effective herbal remedy for male infertility, Panax Ginseng is said to increase sperm count, motility and testosterone levels. • Pycnogenol Up to 60% of infertile couples have difficulty conceiving due to abnormalities in the male's sperm. An extract from the bark of a pine tree that grows along the coast of southwestern France may help improve sperm quality in men. The extract is called Pycnogenol and it is one of the most potent antioxidants known. In a landmark clinical trial published in the October 2002 issue of the Journal of Reproductive Medicine, 19 men were given 200 milligrams of Pycnogenol daily for 3 months. The researchers found that sperm quality and function was significantly improved. What was most exciting about the results, is that there was an improvement in sperm morphology, which usually does not see improvement from other treatments which just improve count and/or motility. It is believed that the Pycnogenol protects the sperm from oxidative damage. Pycnogenol is sold as an over the counter supplement. “By the men taking Pycnogenol® to increase normally functioning sperm naturally, couples may be able to avoid in-vitro fertilization and either enjoy improved natural fertility or undergo less invasive and less expensive fertilitypromoting procedures," stated Dr. Scott Roseff, author of the study. • Bee Pollen Considered a complete food, it is produced by the male part of flowering plants. It contains all the necessary vitamins and ten essential amino acids necessary for a complete protein as well as enzymes and coenzymes. It has been shown to improve sperm production in men. Summary *If you do some further research into fertility herbs, you may come across some others such as licorice root, lady’s mantle, black cohosh and ho shou wu. You 55 certainly may experiment with these herbs as well, but the ones I described above are the most popular ones recommended for enhancing fertility. Warning: Before using herbs to increase your chances of pregnancy, remember that herbs can be very powerful and have side effects. If possible, consult with a trained herbalist, naturopath or Doctor of Chinese Medicine for best results. Most importantly stop taking herbal supplements immediately when you become pregnant (unless you are specifically advised not to) and NEVER mix herbal supplements with fertility drugs of any kind. Ways to Increase Cervical Mucus Fertile cervical mucus is thin, watery, clear and stretchy and easily aids the sperm to swim through the uterus and into the fallopian tube, and to the egg. If there is a lack in this type of cervical fluid, it can impede and/or prevent fertilization. Also, this type of fluid helps the sperm to stay alive for several days inside the fallopian tube, thus enabling conception to happen even though you are ovulating several days later. Some women are very dry and have problems in producing an adequate amount of fertile quality cervical fluid. Here are six ways you can improve the state of your cervical mucus and help his sperm get to the finish line. • Mucinex – at first you may wonder what on earth a cough syrup has to do with fertility, but the logic is that it is an expectorant used to loosen and thin mucus in the lungs. Well, it happens to work elsewhere too!! It is critical that you only use the plain Mucinex, the one with no letters after the name. You might find a generic brand available which is fine too, but just check the ingredients and make sure it contains only one ingredient – guaifenesin. Take two teaspoons three times a day with water, starting about five days before ovulation and continuing through ovulation day. • Drink plenty of water so that your body isn’t dehydrated. Six to eight glasses per day can help make your cervical mucus wetter. • Vitamin A in the form of Beta Carotene – improves cervical mucus • Grapefruit juice – great source of vitamin C, which increases the amount of cervical fluid • Garlic – thins mucus, both in the lungs and cervical fluid 56 • Evening Primrose Oil – increases production of cervical fluid • Adding Wheat Germ to your diet can help improve cervical mucus You’ll notice that your cervical mucus changes throughout the month. Sometimes it will be fluid enough for the sperm to utilize and other times it will appear as if your body’s undergoing a drought! Remember, it is only when your cervical mucus is of “egg white” consistency that you are in your fertile period. Things That Might Hinder a Successful Conception In your quest to attain that perfect bundle of joy, there are certain foods, activities and lifestyles that you should avoid in order to achieve your goal. Most on this list are common sense items – like, “No Smoking.” Some items on the list, such as over the counter painkillers, might be new to your thinking. Look over the list and why they might inhibit attaining a successful pregnancy and ask your doctor if you’re confused about any of them. Lifestyle and environmental items that you should avoid if you’re trying to conceive include: • Alcohol – Alcohol can affect hormonal highs and lows in your body and this could affect your menstrual cycle and ovulation. Chronic alcohol consumption can cause birth defects. For men, alcohol has a negative effect on sperm production. • Nicotine – Besides the obvious impact on the baby after you conceive (premature birth, miscarriage, and low birth weight), nicotine can also affect fertility and impair your ability to conceive. Men should avoid smoking, as it’s also been found to have a detrimental effect on fertility. You should also avoid second hand smoke during the time you’re trying to conceive and afterward. • Medications - There are several prescription medications that can affect male fertility, most of them temporarily but sometimes permanently. Arthritis 57 medication, depression drugs, high blood pressure medication, drugs for digestive problems as well as antibiotics and cancer drugs are just a few of the medications that can lead fertility problems. Speak to your doctor if you are taking any of these medications. One very popular over the counter medication, Tagamet, should definitely be avoided because it causes abnormal sperm production. Instead use Zantac or Pepcid which does not affect fertility. Avoid over the counter painkillers such as ibuprofen and aspirin which can effect the ability of the embryo to implant into the womb. Instead use acetaminophen or Paracetamol (otherwise known as Tylenol), which are fine. Antihistamines, which dry up cervical mucus and have a damaging effect on sperm must also be avoided. • Herbs – While many herbs can be helpful for improving fertility as described earlier, some popular herbal remedies should be avoided. In a study published in the journal “Fertility and Sterility”, high doses of St. John’s Wort, Ginkgo Biloba and Echinacea resulted in damage to reproductive cells and also prevented sperm from fertilizing eggs. • Drugs – Marijuana, cocaine and other so-called “recreational” drugs can cause miscarriage, premature delivery and brain damage to the baby. Men who smoke marijuana frequently have significantly less seminal fluid, a lower total sperm count and their sperm behave abnormally. • Caffeine – High caffeine levels are thought to cause decreased fertility in women. If you’re trying to conceive, you might benefit from reducing your intake of drinks that contain caffeine. Although the research is mixed, one study reported as little as one cup of coffee a day can cut your chances of conception in half. Caffeine also raises the risk of miscarriage. For men, it is best to reduce caffeine intake as well. • Hot tubs – While it may seem romantic to indulge in a dip in the hot tub, it could ruin your chance at conception. The high temperatures can impact sperm two to three months in advance, so a single quick jaunt can ruin your chance to conceive for an entire quarter of the year! Women should also avoid this type of intense heat due to possible negative effects on her eggs. • Cell Phones - Using a hands-free device with a cell phone may affect male fertility if the phone is kept too close to the testicles, Cleveland Clinic researchers warn in the journal Fertility and Sterility. Men who use hands-free devices often carry their cell phones in their pants pocket or clipped to their belts at the waist 58 while talking. As a result, they may be exposing their testicles to damaging radiofrequency electromagnetic waves which can impair sperm quality. • Douching – Douching isn’t a good idea for anyone anyway, but when it comes to fertility, it alters the acidity of your vagina, washes away the cervical mucus, and can contribute to pelvic inflammatory diseases that will take time to clear up. • Tight underwear for men – A man’s testicles need to be at a cool temperature, so for the same reason you shouldn’t go hot-tubbing, he should steer clear of the tighty-whities and go with boxers while you’re trying to conceive. • The flu slows sperm production - An illness that causes a high fever can affect sperm production and sperm quality. But it won't affect fertility for approximately 3 months, since it takes that long for new sperm to mature. • Bicycling - Sitting on a bicycle saddle for more than 30 minutes at a time — especially while wearing tight fitting bicycle shorts — may raise scrotal temperature and affect sperm production. In addition, prolonged cycling can cause genital numbness — a sign of damage to delicate nerves and arteries. Choose a seat that's not too hard or narrow, and make sure it's adjusted to minimize pressure on your perineum. Take frequent rests while biking. • Too much exercise – Female athletes often have trouble conceiving because of menstrual cycle disorders. If you’re an avid exercise fanatic and you have irregular cycles, cut back to moderate exercise only. • Diet - Crash dieting and binge eating should also be avoided both before and during your pregnancy as it can have harmful effects on your hormonal levels. • Oral Sex – As mentioned earlier it is important to refrain from oral sex (any mouth to genital contact) during your fertile period as saliva can be very damaging to sperm • Lubrication - As mentioned earlier, avoid saliva and store-bought lubricants such as KY Jelly or vaseline and instead use natural lubrication or Pre-Seed • Weight issues – Surprise – twelve percent of all infertility cases stem from weight issues. If you are significantly underweight from poor eating or over exercising, you can’t menstruate, since a minimum of 22 percent body fat is necessary for normal ovulation and reproductive health. On the flip side, being overweight can alter hormone chemistry and help prevent conception. The good news is gaining or losing the weight, as the case may be, quickly restores fertility. 59 • Body Mass Index (BMI) is your weight in pounds divided by height in inches, divided by height in inches again, multiplied by 703. Example: 135 pounds, divided by 66 inches, divided by 66 inches again, multiplied by 703=BMI of 22. Doctors consider a normal BMI between 19 and 25 ideal. Fertility is impaired when a woman’s BMI is below 19 or above 25. The issue of weight no longer belongs just to women when it comes to fertility New research has shown that overweight men are more likely to experience infertility issues than normal weight men. It seems that for every 20 pounds that a male is overweight, his infertility increases by 10%. So there is good reason for both of you to get to a healthy weight—it is good for your health and greatly improves your chances of conception. Toxins – Avoiding the Hormonal Imbalance They Create If you haven’t heard of xenoestrogens before, then read this carefully, because this is an area that is getting a lot of attention in the scientific community because of it’s profound affect on fertility and other health concerns. What are xenoestrogens you may ask? Simply put they are manmade, estrogen- mimicking chemicals found in our environment. They are in our soils as pesticides, herbicides, fungicides and fertilizers. They are in our water and in our food supply–in animals, fish and grains. Many scientists believe that these estrogenic pollutants are responsible for the global trend of decreasing sperm count and function. For women, it is suspected that exposure to these xenoestrogens causes a hormonal imbalance that can lead to infertility, as well as endometriosis and breast cancer. The bottom line is this… Many of the chemicals now present in our environment have been proven to pose serious hazards to human health! And the declining fertility rate is likely to be one result of this. Here are the primary sources of xenoestrogens: 1. Plastics - PCBs in plastics which are released when the plastic is heated or used for hot food or drinks (microwaving in plastic containers for example). 60 2. Pesticides - Stored in the fat cells of fish, poultry and other food sources consumed by humans. 3. Growth Hormones – used to fatten up animals which are later consumed, such as beef, chicken, turkey, and pork. 4. Chemicals found in many household items including nail polish and remover, glues, paints, varnishes, cleaning products, lawn and garden sprays, indoor insect sprays. 5. Chemicals found in many personal care products such as soap, shampoo and fragrances. If you really think your health is unaffected by this, you’re likely wrong. However, there is GOOD NEWS!! When you are trying to conceive, it makes sense to try and eliminate as much of your exposure to these environmental hazards and it really is NOT that difficult to do. I am not suggesting that you need to make sure you are not exposed to any of these harmful toxins, because that would be nearly impossible. What I am suggesting is that you familiarize yourself with the most common ways you are exposed and make some effort to reduce your exposure as best as you can. Here are some ideas on how you can do this: • Avoid plastic packaging. If that is not possible, then at least avoid ingesting anything that has been heated in plastic. For instance, never microwave food in any plastic wrap or container, use glass instead. Also, never drink bottled water that was left in your car on a hot day. The chemicals in the plastic DO get into the food/drink, so please do your best to avoid this. • Avoid hormone-containing meat, dairy and poultry by purchasing organic, vegetarian or free-range options from your natural food store. Not everyone has access to hormone-free, organic meat and poultry, but what you can do is at least limit your consumption of these products if you cannot purchase hormone-free products. Include more beans and legumes in your diet and cut back some on the meat and poultry. Also, fish has far less of these toxins, as long as you choose those fish that are not high in mercury such as shark, swordfish, etc. (I discuss this in Chapter 5). 61 • Eat organic fruits and vegetables whenever possible. If this is not possible, then be sure to wash your fruits and vegetables thoroughly (preferably with a vinegar and water solution) before eating. • Drink natural spring water instead of tap water. • Eat broccoli, cauliflower and brussels sprouts which can help to reduce the effect of these toxins in your body. • Use protective clothing, proper ventilation and face masks to reduce the risk of absorbing toxins when using certain household and garden products. • If possible, use natural, organic personal care products. There is a wonderful site called “Skin Deep” which offers a detailed analysis of the chemicals and toxins contained in common personal care products that can impact your fertility and your health. You can look up any product that you are using to find out just how harmful it may be. Click here to go to the Skin Deep website. Finally, it could be very helpful to perform a body cleanse or detox to help rid your body of the toxins that have built up over time. After reviewing many of the products offered online, the one that gets the best overall reviews from customers is from Dr. Floras. Click here to read more about these products, and don’t forget to read the customer testimonials here. • Conclusion There are many strategies detailed above that can help you to achieve a successful pregnancy. Do not let yourself get overwhelmed or feel as if you have to do EVERYTHING in order to be successful. It’s important to learn ways for improving your fertility and to gain the power of knowledge which will allow you to make changes that can directly impact your fertility. Remain optimistic and if you aren’t achieving results after a reasonable amount of time, try to incorporate something else that you’ve learned in this guide. Next, I will take a look at diet, as more and more research points to the powerful effect it has on your fertility. 62 Chapter 5: How to Influence Your Fertility With Your Diet – What To Eat and What To Avoid Since the first edition of Personal Path to pregnancy, there continues to be research and conclusive evidence that confirms the link between diet and fertility. A Natural Diet Designed to Promote Fertility Proper nutrition is crucial to a healthy pregnancy and in producing a healthy baby – but it’s also a critical factor in balancing your hormones to make it possible and probable that you’ll conceive. Following an organic or whole food diet can greatly increase your chances to become pregnant because it will better provide you with the vitamins and minerals that you can’t find in foods robbed of natural nutrients from too much processing. Eating as much organic food as possible, as stated in the previous chapter will minimize the damaging impact of pesticides on your fertility. Here are some foods that are known for their fertility boosting potential: Fertility Boosters: • Spirulina– a food that contains key minerals and nutrients required for hormonal balance, regular ovulation, and strong healthy sperm. It contains protein (all of the essential amino acids), fertility enhancing vitamins and minerals along with phytonutrients and essential fatty acids necessary for optimal health and fertility. It’s also convenient and easy to take, although it doesn’t taste all that great (well, there had to be one downside, right?!) It is actually a blue-green algae and it comes in both powder and tablet form. It’s best taken by mixing it into a smoothie or some juice so you don’t notice the taste so much. You can find it in most health food stores or you can order it online here: http://tinyurl.com/getspirulina • Chlorella - Chlorella is a green, single-celled freshwater micro-algae widely recognized as one of the most potent nutritional whole foods on Earth. Chlorella is a 63 scientifically proven health aid with benefits that include removing heavy metals and toxins from your body, encouraging friendly bacteria growth to support digestion, and keeping your body alkaline (which is beneficial to the survival of sperm). Chlorella contains a wealth of important nutrients which includes more than 20 vitamins and minerals and all the essential amino acids. It is rich in beta carotene as well as chlorophyll and contains 60% protein. It also contains essential fatty acids, even more than Spirulina. About 30% of people can not tolerate chlorella. This may be due to a cellulase insufficiency: if you are unable to tolerate chlorella, it would be wise to consider adding a digestive enzyme supplement with cellulase in it to help digest the chlorella. • Wheat Grass– You might want to try incorporating wheatgrass into your diet. Wheatgrass is the baby grass of the wheat plant, which can be either freshly juiced or dried and made into a powder. Wheatgrass sprouts were found to contain highly active "fertility factors" in laboratory studies back in the 1930's. Wheatgrass’ nutrients include chlorophyll, proteins, 9 essential amino acids, enzymes, minerals (calcium, iron, magnesium, selenium, potassium, sodium, zinc), dietary fiber, and vitamins A, B, C, and E. Wheatgrass alkalizes and detoxifies the body. It's reported that wheatgrass may even lower your follicle stimulating hormones (FSH) levels. Here are some of the things wheatgrass does to possibly increase fertility: It is a great detoxifier and removes heavy metals from the body. It has been proven that a reduction in heavy metal body load increases the chance of spontaneous conception in infertile women and decreases the odds of miscarriage. Chlorophyll, particularly the concentrated kind found in grass juices alkalinizes the body and restores PH balance. An acidic vaginal environment is extremely hostile to sperm and an alkaline uterine environment is necessary for implantation and may prevent miscarriage. It’s best to take juice of fresh grass if possible. Even vacuum dried grass powder is available, which can be added in a cup of water, and drank after 20-30 minutes to derive the health benefits (however, some enzymes are lost). Take at least for 3 to 6 months to derive optimal benefits. If you are looking to purchase some online, Amazing Grass Organic wheatgrass powder is very highly rated. You can get it at a great price from: http://www.vitacost.com/Amazing-Grass-Organic-Wheat-Grass-Powder 64 • Pumpkin Seeds /Sunflower Seeds– naturally high in zinc and essential fatty acids (EFA’s) which are vital to healthy functioning of the male reproductive system. Eat 1/4 cup a day of raw pumpkin or sunflower seeds to help maintain a healthy reproductive system. • Garlic – Garlic contains many fertility boosting nutrients such as selenium, which improves male fertility and vitamin B6 which is a hormone regulator. • Honey – Rich in minerals and amino acids, honey has been known to enhance fertility throughout history. Many consider it to be a fertility “super-food” which nourishes the reproductive system for both men and women. • Cinnamon – Cinnamon is a sweet-tasting spice that has recently been shown to have a beneficial effect on stabilizing blood insulin levels. It has fertility enhancing properties, especially when combined with honey. Take 1/2 to 2 teaspoons of cinnamon mixed with 2 tablespoons honey. In China, Japan and Far-East countries, women who do not conceive and need to strengthen the uterus, have been taking cinnamon powder for centuries. Women who cannot conceive take a pinch of cinnamon powder in half teaspoon of honey and apply it on the gums frequently throughout the day, so that it slowly mixes with the saliva and enters the body. • Apple Cider Vinegar– Organic, unpasteurized apple cider vinegar can work to balance the pH and therefore improve fertility. You can take 2 teaspoons in a glass of water, sweetened with honey. Drink a glass twice a day. This should be used by both men and women. • Avocado - Avocado provides a great source of vitamin E which is a powerful antioxidant and an important fertility nutrient for both men and women. It improves sperm function and helps to regulate ovulation and improve cervical mucus. • Goji Berries – only recently introduced to the Western world, the goji berry is a sweet red fruit native to Asia. It has been used as a medicinal food for thousands of years, and has been studied extensively in modern times to substantiate its health 65 benefits. In Asia, it is widely believed to increase sexual fluids and enhance fertility. They are the most nutrient dense food on earth, containing the highest levels of antioxidants of any known food, 500 times more vitamin C by weight than oranges, more beta carotene than carrots, more iron than spinach, 18 amino acids, Vitamins B1, B2, B6 and Vitamin E, 21 trace minerals, and many natural compounds that promote health. Be sure to eat the whole berry, as many products on the market contain just a small quantity of goji berry extract. • Whole Grains – Whole grains such as oats, brown rice, whole wheat and quinoa are complex carbohydrates which release sugar into your bloodstream slowly. They contain an abundance of vitamins B, zinc and selenium which are essential for cellular reproduction, hormonal balance and the production of healthy eggs and sperm. • Green Leafy Vegetables – high in magnesium (vital for female hormone balance), folic acid and vitamin B6. • Nuts – high in B vitamins. Almonds are high in zinc; walnuts are high in zinc and omega 3 fatty acids. • Lentils and other beans – high in folic acid • Oysters – packed with zinc, which plays a role in semen and testosterone production in men and in ovulation and fertility in women. • Brown Rice – high in fiber and B Vitamins. Fiber strips old hormones and waste products from the system. Without this removal, old hormones re-circulate and create imbalances. • Protein – adequate protein is important for people trying to conceive. Lean red meat, skinless chicken and oily fish such as salmon are good sources of protein. However, be aware that eating too much meat will increase ammonia which can interfere with the implantation of the egg in the uterus. Too much red meat may also increase the body's acidity and affect sperm activity. Sperm are at their most efficient in an alkaline environment. 66 Basically, you want to add foods that are high in folic acid, zinc, vitamin C or any of the vitamins listed earlier that help in fertility. Always consult your doctor before adhering to any specialized diet. In general when trying for a baby it makes sense to choose good quality, unprocessed foods as they are more likely to be richer in vitamins, minerals and nutrients and also more free of pesticides and added estrogens that may disrupt the reproductive cycle. By supplementing a balanced diet and healthy lifestyle with the foods listed above you will be doing a great deal to maximize your fertility potential. Fertility Destroyers: Certain foods can actually lower your ability to become pregnant. If possible, it’s best to minimize or avoid the following which have been shown to harm fertility: • Peas – they are a natural contraceptive. There is a chemical in peas that has a strong anti-fertility effect (m-xylohydroquinine) for both men and women. Folk medicine has always ascribed contraceptive powers to peas,. They were being studied by Asian scientists hoping to isolate these substances to construct an inexpensive contraceptive. • Dairy – research in the United States and Finland reported that where per capita milk consumption is the highest, women tend to experience the sharpest age-related falloff in fertility. Some say dairy products can thicken cervical mucus. However, the latest research in Harvard’s “Nurse’s Study” states that full fat dairy products can help to prevent/improve ovulation disorders which can impair fertility. So the subject of dairy is controversial among fertility experts. (read more about this below) • Peanuts/Brazil Nuts – Particularly high in phytoestrogens (like soy), there is some suspicion that they can contribute to male infertility. This is a bit controversial as well because Brazilian nuts are very high in Selenium which is very beneficial to male fertility. • Pineapple Juice – There is an old wives' tale floating around the Internet that pineapple juice will help a fertilized egg implant. However, there is no scientific evidence that this is true and pineapple juice can actually cause more harm than good. In large doses, it can cause uterine contractions and bring on spontaneous abortions (miscarriage). 67 Therefore, only drink it in small quantities, if at all. • Gossypol – This is a toxic substance found in the cotton plant, which is mostly removed through hydrogenation when making cottonseed oil. Why should you care? Well, it greatly reduces male sperm count and sperm motility, and was actually being considered in China for use as a male contraceptive. While most of the gossypol is removed from the cottonseed oil, some of it is still there. So to be on the safe side, it's probably best for your partner to avoid products made with cottonseed oil. This would typically be some salad dressings and especially snack foods, such as potato chips. Be sure to read package labels and avoid any products that contain cottonseed oil. Remember read labels as not ALL chips contain cottonseed oil. • Additives - foods that contain additives, preservatives and chemicals can affect hormonal balance in your body. This means it’s best to stay away from processed foods as much as possible and try and consume whole foods as much as possible. In particular try to avoid MSG and BHA, two preservatives that may harm fertility. • Sugar – too much sugar increases your body’s output of insulin, a hormone that can affect the way your ovaries function. (this is described in detail in chapter 7) • Artificial Sweetener – Sugar substitutes such as Aspartame and Splenda should also be avoided as they contain chemicals which may be harmful to your health and fertility. For instance, aspartame breaks down into formaldehyde in your body (the substance used to preserve dead bodies). • Sodas - These should definitely be avoided as sodas are loaded with sugar or artificial sweeteners, chemicals, and sometimes caffeine, all of which can impair fertility. Replacing any soda you drink with water instead will be a positive step to improving fertility. • High Mercury Fish – the FDA says that women trying to conceive can safely eat up to 12 ounces (two servings) a week of low mercury fish, such as shrimp, crab, scallops, oysters, cod, pollock, tilapia, fresh water trout, salmon, canned light tuna and catfish. The FDA advises avoiding canned white tuna as well as swordfish, tilefish, king 68 mackerel, tuna steaks, shark, orange roughy, Spanish mackerel, marlin and grouper, because they have the highest mercury levels. Fish contains proteins and health omega 3 fats. You should not cut it out of your diet. Just be aware of the high mercury fish and choose wisely when you are purchasing your fish. • Wheat – some women can have an intolerance to wheat and not even know it, so try to substitute wheat with another grain when you can. Gluten Intolerance/Celiac Disease Gluten is a kind of protein that tends to exist in wheat, barley, and rye among other carbohydrates. Celiac disease and gluten intolerance are both known to be important causes of infertility and miscarriage which can easily be remedied by a gluten free diet. Celiac disease is quite serious as it results in an abnormal immune responses to gluten. Due to this reaction, people with celiac disease must maintain 100% gluten free diets. It can be very difficult to actually diagnose Celiac disease and there are a wide range of symptoms ranging from gastrointestinal problems (diarrhea, abdominal bloating, weight loss) to malnutrition without obvious gastrointestinal symptoms. Because it's difficult to diagnose, and because eliminating gluten can offer a healthy approach to eating, many women simply decide to try a month or two on a strict gluten free diet to see how they feel. Often they are surprised to find that it is not that difficult to follow a gluten-free diet and they feel much better after eliminating gluten from their diet. It is important to note that not all gluten free foods are healthy or good for your fertility. This is because many are made from white rice flour, refined corn starch and other nutrient poor foods with added sugar and salt. If you want to try a gluten-free diet, it is not going to help your fertility if you simply replace the gluten in your diet with processed, sugary gluten-free foods. Also, it is not helpful to simply eliminate "some" of the gluten in your diet and expect to see any positive results. If you want to try a glutenfree diet and see if it helps your fertility, you MUST eliminate 100% of the gluten in your diet. And remember to make wise choices when you replace the gluten in your diet of which there are MANY. 69 Good gluten free choices include (but are not limited to) all beans and lentils, many grains (such as millet, brown rice, quinoa, amaranth, buckwheat), all dairy, meats, poultry, eggs, seafood, fish, nuts, seeds, fruits, vegetables, herbs and spices. In short, you can buy most of the things that you are used to in a gluten-free form, and there are several gluten-free cook books if you like to cook from scratch. There is a whole world out there of beans and grains that you may never have thought to try before! If you want more comprehensive information about living gluten-free, you can visit: http://www.Celiac.com Controversial Foods – Helpful or Harmful? There are a few foods that have been described as both good and bad for fertility and I have listed both points of view for you to evaluate: • The Soy Controversy The data on soy’s effect on fertility is nothing short of confusing and contradictory, with some studies suggesting that soy might be helpful, and others suggesting that soy contributes to fertility problems. Soy contains phytoestrogens which are “plant based estrogens” and the ones found in soy are known as isoflavones. For every study that points to the benefits of soy as a good source of protein, there are other studies that speak to the damaging effects of isoflavones on the menstrual cycle. Also at issue is the possibility that Genistein, one of the isoflavones in soy, may cause damage to sperm. Generally, the studies that found a negative impact on fertility from consuming soy looked at soy consumption that was significantly higher than what most people would consume. It seems logical to conclude that minimal intake of soy proteins will not adversely affect your chances of becoming pregnant or maintaining a pregnancy. But, consuming large quantities of soy products is not recommended. Also, if you do decide to eat some soy products, it would be best to consume nongenetically-modified soy products such as tofu, tempeh and miso. It is best to avoid Western invented soy products such as soy sausages, soy protein powders, soy cheeses, etc. There are only two soy products, soy sauce and soy oil that do not contain isoflavones so they can be used without any concern. 70 • Pomegranate Pomegranate is a fruit used by ancient women to prevent conception. By 200 CE, Greek physicians widely distributed texts discussing the use of pomegranate as a contraceptive. Even today, pomegranate preparations are still used in some rural areas of Africa and Asia. Modern research has also shown that pomegranate does have contraceptive effects. In one study pomegranate reduced fertility in female rats by 50% and in another study on female guinea pigs, it was 100% effective as a contraceptive. This doesn’t mean the effect in women will be the same, however, the possibility for a reduction in fertility does exist. On the other hand, the pomegranate was also a symbol of fertility in many ancient cultures. Pomegranates are especially high in anti-oxidants and is currently being touted by some as a fertility booster for that reason. In one study from the journal Clinical Nutrition, researchers found that pomegranate juice improved fertility markers in male rats (sperm count and motility). It is believed that the powerful antioxidants may offer protection against damage to the fatty acids in sperm. Given that there are many other nutritional choices for getting anti-oxidants, I would suggest caution in eating pomegranates or drinking pomegranate juice until there is more conclusive data. • Milk and Dairy Once again, there is some controversy surrounding the issue of milk and dairy and the possible effects on fertility. Here’s why… Dairy products contain lactose, which the body breaks down during digestion into two smaller sugars - glucose and galactose, during digestion. Normally the liver converts the galactose into glucose , however some women (especially as they age into their thirties and older) have low levels of the enzyme needed to break it down and the result is a build up of galactose in the blood. It appears that galactose is harmful to the ovaries and may damage the unfertilized eggs which are developing. Milk, ice cream, cottage cheese, and especially yogurt, may harm fertility if you have any lactose intolerance. However, some groundbreaking new research by the Harvard School of Public Health offers some very different advice regarding milk and dairy products. Read more about it in the next section. 71 • Wild Yam There seems to be a popular misconception about a benefit of wild yam that I’d like to clear up. First, the wild yam is that which is found in Asia or Africa, not the “yam” you see in U.S. supermarkets which is really just a version of sweet potatoes. True wild yam is believed to contain hormone-like compounds that are very similar to progesterone. These are called diosgenin (the active component in wild yams), and it can be converted in a laboratory into progesterone. However, your body cannot convert diosgenin into progesterone, and wild yam does not naturally contain any progesterone that your body can use. Also to be noted, the sweet potato is a completely different vegetable, and does not contain these compounds at all. It’s a bit confusing because in the United States, soft sweet potatoes are typically labeled as yams. The Harvard Study In late 2007, researchers from the Harvard School Of Public Health reported on some groundbreaking research from the Nurse's Health Study which revealed some methods to avoid fertility problems caused by ovulation disorders. 18,000 women were included in the study, which looked at dietary and other factors in terms of their effects on fertility. The results of this study gained international attention, and you may have heard or read about it on TV or in the newspaper or magazines. The following is a brief summary of some of the results that they found. It should be noted that two of the diet recommendations (regarding dairy and soy) are a bit controversial, and I addressed both of them earlier in this chapter. They found that diet CAN affect the risk of ovulatory infertility. It’s important to note that no other cause of infertility such as tubal blockage, fibroids, endometriosis, etc. was correlated with diet. The only clear link between diet and fertility appears to be related to ovulatory function. Ovulation issues account for at least 30% of fertility problems, making them the number one cause of infertility. The two most common signs are irregular menstrual cycles or abnormal body weight. If your BMI (body mass index) is above 25, it may be contributing to an ovulation problem. There were four main diet components that were addressed in this study: 72 Milk - Milk has been a source of controversy with some studies showing that it helps fertility and other studies showing a harmful effect. This study found that women who ate at least one serving of whole milk or ice cream per day decreased their risk of ovulatory based infertility by 27%. Also, women who consumed many servings daily of low fat dairy products were almost twice as likely to have anovulatory fertility problems as those who didn’t. I’ll bet you’re liking the sound of that research, right?! Also, the more fatty dairy products the women ate, the more likely they were to conceive. The researchers speculated that this might be due to a fat soluble chemical found in fatty dairy food which improves ovarian function. Dr. Jorge Chavarro, who led the research, suggested that women “should consider changing low fat dairy foods for high fat dairy foods; for instance, by swapping skimmed milk for whole milk and eating ice cream, not low fat yoghurt”. It’s important to bear in mind that following this advice has the potential for causing weight gain in some women, which has already been established as causing fertility problems. So if that is a potential problem for you, try adding one serving of whole milk daily to your diet rather than ice cream which will be much higher in calories. Other choices of high fat dairy are whole milk , yogurt, cheese, or ice cream. Carbohydrates - not all carbs are created equal. Fast carbs have a high glycemic index and are quickly turned into sugar which causes weight gain and insulin resistance which in turn may interfere with normal ovulation. Examples of fast carbs are white rice, white bread, potatoes, cookies, ice cream and sodas. Slow carbs do not cause spikes in blood sugar and insulin and they are much better for fertility and include brown rice, whole grain pasta and dark bread. Whole grains, vegetables and whole fruit all contain slow carbs. The fiber in these foods promotes the excretion of toxins from your body. 73 Fats - Some fats are healthy for you and needed by your body; these are called essential fatty acids. Most fats found in our food fall under the heading of saturated or unsaturated. Many of you already know that saturated fats like butter are not good for your heart. Recently, it was discovered that one type of unsaturated fat, is also unhealthy. This type of fat is called a trans fat, and on package labels it is listed as “hydrogenated oil”. They are created specifically to allow processed foods to last longer on grocery shelves in the stores. Trans fats are bad for your heart and your fertility. Be careful with the following foods which can be high in trans fats: French fries, stick margarines, shortening, cookies, crackers, and many other packaged/processed foods. According to the study, the best fats to improve fertility are monounsaturated fats as well as the Omega-3’s mentioned previously. Sources of monounsaturated fats include olive oil, nuts, avocado, and seeds. Vegetable Protein - Most people are familiar with animal proteins such as beef, pork, chicken, turkey and fish. However, the study found that vegetable proteins appear to be better for your fertility. These include quinoa, beans (eaten with whole grains) such as lentils, soybeans/tofu, garbanzo beans, as well as nuts, and seeds. Exercise – In this study, exercise was also shown to boost fertility, and I have already addressed this topic earlier in chapter 4. Overall, many of the observations in the Harvard study do make a lot of sense, especially the idea that certain foods may influence levels of hormones involved in ovulation and conception. Many of the dietary recommendations are consistent with the type of healthy diet that is recommended for women who have PCOS, which I discuss in Chapter 7. However, the issue of milk/dairy and soy is controversial as it conflicts with other recommendations to avoid soy and dairy products. 74 Do You Have A High Acid Diet? Science has discovered that the diet of a healthy person is slightly alkaline, while the diet of an unhealthy person is more likely to be acidic (low pH). pH is a measure of the acidity or alkalinity of a solution, and the body will continually strive to maintain a balanced ph. When it comes to fertility, it is known that the vagina tends to be somewhat acidic, but when it is “too” acidic, some sperm will not be able to survive. Similarly, for males, if sperm have very low motility, it may be due to the body’s highly acidic state which can cause sperm to be immobilized. Also, a diet which is far too high in acid-producing animal products like meat, eggs and dairy, and far too low in alkaline-producing foods like fresh vegetables will result in an acidic condition which results in weakened body systems and reduced health. Foods like white flour and sugar and beverages like coffee and soft drinks all contribute to a high acid environment. Also artificial chemical sweeteners like NutraSweet, Equal, or aspartame, are extremely acid-forming. By changing your diet to include much more alkaline foods, you can change the pH of your bodies fluids and tissues to one that is pH balanced which will improve your overall health and fertility. It is important to note that a food's acid or alkaline-forming tendency in the body has nothing to do with the actual pH of the food itself. For example, lemons are very acidic, however the end-products they produce after digestion are very alkaline so lemons are alkaline-forming in the body. Similarly, meat itself is actually alkaline but it leaves very acidic residue in the body so, like nearly all animal products, meat is very acidforming. If you want to take steps to improve the pH balance of your body, try adding vegetable juices and raw vegetables, fruits, nuts such as almonds and hazelnuts, while avoiding meat, eggs, sugar and dairy. Here is a link to a site with a chart that you can use to check whether a food is alkaline forming or acid forming in the body: Click here to see the chart on Alkaline and Acid Forming Foods. Or for a brief summary, view the image below: 75 Conclusion: There is a lot of information in this chapter that will allow you to make good choices in the foods you eat which will have a positive effect on your fertility. Many fertility experts believe that changing your diet is one of the easiest ways to significantly boost your odds of getting pregnant. While most of the experts agree on how to do this, there are some areas where there is some controversy, such as with soy and dairy. In those cases, it may be best to eliminate those foods that are controversial from your diet and then if you don’t see results after a reasonable period of time, you can try adding them back in to your diet in limited quantities only. 76 Chapter 6: When Infertility Is an Issue – Dealing with the Tests, Emotions, and Outcome of a Diagnosis You Didn’t Want! You’ve tried for a year to conceive – and it just isn’t happening. What’s wrong? Is it me or is it him? Your emotions are raw and exposed and you may have entered a low point in your life and/or relationship. You may want to use this guide by putting some of the methods and strategies into practice for some time, before pursuing fertility testing. Alternatively, if it’s been over a year, you may want to have some fertility testing to look for medical issues that might be causing the difficulty. And then, you can go back and put some of the tips into practice. Either way, here is all the information you will need to understand about the various infertility tests. If testing for a solution or diagnosis is imminent, you’re probably both on edge about it. I know what you’re going through because I went through it myself. I had several miscarriages before conceiving my children and went through the seemingly endless round of emotions that you’re going through now. People who tell you to just take one day at a time may overlook the fact that depression keeps you from seeing that light at the end of the tunnel. You want answers – and you want them now! If you find yourself on an emotional roller coaster during this frustrating of all times, know that there are ways to deal with it effectively. You don’t have to feel isolated or misunderstood. And, most of all, you don’t have to let those perfectly normal and understandable emotions have a negative impact on your relationship with your partner. Find out all you can about what you might be experiencing and how to turn it into a “positive” by learning a little about yourself. 77 Before the Tests – The Impact on Your Emotions If you’ve been trying to conceive for months or even years, it’s bound to have had an impact on your emotions individually and as a couple. You’re wondering why – and the tests you’re about to take will probably answer that question. But do you really want to know the answer? Couples who are about to go through infertility testing run a gamut of emotions – from an impending deep sense of inadequacy to anxiety beyond belief. The worst thing you can do as a couple at this time is to keep your emotions to yourself. But finding neutral territory to state your fears and worries seems almost impossible. Should you talk about alternatives to having your own children such as adoption or surrogacy – or is it too soon to bring up the subject? Dealing with your emotions effectively before you begin the tests can help you face whatever the test results will ultimately tell you about the future. Some pro-active steps that can help get you past this difficult time include: • Journaling -- Writing down your thoughts can help you gain an understanding of the feelings and emotions that are bombarding you on every level. Journaling is especially helpful when you find the subject of infertility too painful or difficult to talk about with your partner, friend or family member. • Make it a point to talk to your partner on a regular basis – Your experience of the situation might be different from that of your partner’s, but he or she needs to know that you’re going through a difficult time and how he or she can help. Communication with your partner is crucial to overcome feelings of anger and blame toward yourself or the other person and rectify those feelings before they harm the relationship. • Talk to others who are having difficulty conceiving – Support groups or a new, online friend going through a similar situation can help you cope with your feelings right now. Even though your circumstances may be different from theirs, the bottom line is that neither of you has been able to conceive. Be sure to talk to your doctor about feelings of anxiety or anger. He or she may be able to offer some helpful advice. 78 • Focus on an activity or hobby – As simple as it may sound, any activity that can get your mind off of fertility issues, even for a few moments, could be an enormous coping tool while you’re going through this traumatic time in your life. The most important thing to realize during this upheaval is that you’re in it together – as a couple. Turn to each other for support and understanding whenever you can. Empathizing with each other will help prepare you for what you’re going to endure during testing and afterward – and to develop a bond that will be so important to raising your future child or children. Fertility Tests that Your Doctor Will Probably Recommend Recent scientific breakthroughs in fertility testing have made it possible to determine, without a doubt, if you and your partner are fertile enough to conceive. These tests are able to pinpoint the problem, if there is one, and provide the solution. The problem is that there are so many tests to endure. I went through most all of them, only to find out that I had an immune disorder that was eventually treated successfully. But I had to go through several of them to find that one solution. Tests to Determine Your Fertility Include: • Baseline Blood Tests Baseline blood tests are conducted after your period starts, usually on day 2-3. It’s a simple blood test where you get the results without undergoing anything more invasive than a needle prick. o Estradiol – This blood test measures hormone levels and can determine if a woman is ovulating or not or if you have ovarian cysts. o Progesterone – A test that measures progesterone hormone levels that’s also an indicator of ovulation. This hormone is necessary to help the embryo implant itself in the lining of your uterus. o Luteinizing Hormone (LH) – This test is given to both men and women to determine menstrual regularity and pituitary disorders in the ovaries or testes. If you have PCOS, then you may have higher levels of LH. 79 o • Follicle-stimulating hormone (FSH) – This test will probably be done on day three of your menstrual cycle. It determines if your ovaries are functioning properly or if you’re going through perimenopause. HSG (Hysterosalpingogram) HSG is an x-ray that’s usually performed in the radiology department of a hospital. Dye is injected into the uterus through the vagina and cervix. The dye fills the tubes and spills into your abdomen. It outlines your uterus and fallopian tubes, making it easier to see abnormalities, such as blocked fallopian tubes. Polyps, scar tissue and fibroid tumors in the uterus can also be seen and analyzed. This test can be somewhat painful, causing cramps. How painful it is will be different for everyone depending on your tolerance for pain and whether or not your doctor has to force more dye into your tubes if they’re blocked with debris. Take an ibuprofen before you go to your test. If you have gonorrhea or chlamydia, then the doctor may not perform the test since it can spread the infection as the dye is pushed through the fallopian tubes. You’ll have to be on antibiotics beforehand. Another reason they may not perform the test is if you’re allergic to shellfish or contrast dye. When the test is over, you may have a small amount of bleeding, sometimes mixed with the clear dye, which is normal. It’s best if someone can drive you to and from your appointment in case your cramping is moderate to severe. • Hysteroscopy If your doctor thinks you may have small polyps or fibroids inside your uterus, he may order this test. It’s an outpatient procedure where they insert a small tube through your cervix and into your uterus. They inflate your uterus with carbon dioxide to give them a better view of the surroundings. If he sees signs of fibroids or polyps, then he may conduct an operative hysteroscopy where he removes the tissue. If it requires extensive work, he may hospitalize you to perform the procedure. The pain can be moderate to severe, so the doctor will usually administer a local anesthesia or give you a Valium before the procedure. If you’re hospitalized, then you will probably get an epidural. 80 • Laparoscopy Doctors use laparoscopy as a tool to help them examine the pelvic organs and determine if there are problems with your uterus, fallopian tubes or ovaries that might contribute to your inability to conceive. A small incision is made in the abdominal area so that the doctor can insert the laparoscope, which acts as a camera. The camera can then help the doctor examine the pelvic organs. If there is endometriosis or scar tissue, they’ll remove it at that time. They can also remove infected fallopian tubes. This is an outpatient procedure that’s performed at a surgical center or hospital and the pain afterwards is mild. It takes about a week to recover from a laparoscopy. • Postcoital A postcoital test (also known as Huhner test) determines whether or not sperm can survive in your cervical mucus. Within 24 hours after intercourse, the woman visits the doctor’s office where the cervical mucus is analyzed. If the doctor determines that there are dead or stagnant sperm, he’ll then test for an antibody problem. He’ll be looking to see how the mucus looks, too, and if it’s a viable climate for the sperm to swim through. • Semen Analysis A semen analysis is performed when the fertility of the man is in doubt. A semen sample is gathered in the doctor’s office by the man masturbating into a container. If the results are to be reliable, they must be tested within 2 hours of collecting the specimen. Male infertility accounts for about 40% of all infertility cases. The doctor will analyze the sperm to see if all three components are intact – the head (which contains the genetic material), the midpiece (which has the energy needed to help the sperm swim), and the tail (which catapults him through the cervix and fallopian tubes and toward the egg. Ideally, your partner’s sperm sample should be 1.5-5 ml (a teaspoon), should have 20 million or more sperm/ml, should have 60% mobility, and 30% intact for size and shape (morphology). What this basically means is that you have sufficient 81 number of sperm, that they move well and in the right direction (motility), and that they are fairly normal in size and shape, ie. not deformed (morphology). They’ll also be checking the Ph of the sample, the presence of anti-sperm antibodies, and their ability to penetrate a hamster egg. This is known as the zona-free hamster-egg penetrating test. If the sperm can penetrate a hamster egg, it can penetrate your egg as well! Of the millions of sperm in the ejaculated semen, only about 200 actually reach the egg in a woman's fallopian tube. But, just one is needed to fertilize the egg. Unfortunately, what the analysis will not tell you is whether the sperm contains too many toxins or not enough nutrients to form a healthy embryo. Often, poor motility or lots of irregular shaped sperm can be an indicator that these issues may need to be addressed. Keep in mind that since it takes 3 months for your partner’s sperm to produce, you have to consider what his life was like at that time. Was he sick? Did you both go hot-tubbing frequently? These kinds of things can affect his test results. • Sonohysterogram A Sonohysterogram is used to diagnose tubal obstruction, detect fibroid tumors, polyps or abnormalities in the uterus and fallopian tubes. A doctor can also evaluate “incompetent cervix” in women who have had several miscarriages. The test is usually performed in the early stage of a menstrual cycle because it should not be performed on a pregnant woman. A saline solution is inserted through the cervix into the uterus and allows the doctor to better see abnormalities. This is an outpatient procedure performed in your doctor’s office and isn’t painful for most women. • Thyroid If you are having trouble getting pregnant, you need to make sure you don’t have a problem with your thyroid. A blood test determines if your thyroid levels (TSH and T4) are under control. In the next chapter I will cover how thyroid conditions can have an impact on your fertility. 82 • FSH and Inhibin B FSH is a hormone that can be measured by a simple blood test to the male and female. This hormone is secreted by the brain and encourages the presence of eggs in women and sperm in men. Inhibin B is a protein hormone produced by the ovaries. It is also measured by a blood test to the female and is done on the third day of your menstrual cycle. The day 3 Inhibin B test is used in order to predict ovarian reserve, including the egg quality and egg quantity. The amount of Inhibin B in your blood directly correlates to the number of eggs that you have in your ovaries. If you are diagnosed with low levels of Inhibin B from your doctor, then he or she may prescribe a synthetic estrogen. When you start taking this, the ovary starts reducing the amount of FSH and allows your ovaries a chance to produce an egg. • Endometrial Biopsy This procedure is conducted to take a sample of the lining inside of the uterus, known as the endometrium. They can use this procedure to rule out a luteal phase defect. If you’ve suffered repeated miscarriages, then an endometrial biopsy can be performed to see if this is the reason your body isn’t supporting a pregnancy. For infertility testing, it has to be performed at a specific time, three days before your period. It’s conducted either at your doctor’s office or in the hospital and you are usually instructed to take a mild pain medication like Motrin or Aleve before the procedure. You may also get a local anesthesia injected directly into your cervix. A tube will be inserted into the uterine cavity to extract a piece of the lining for examination. This can be somewhat painful and result in a small amount of bleeding afterwards. • Clomiphene Citrate Challenge Test (CCCT) This test measures estradiol and FSH. The test will be given again after taking a medication called clomiphene citrate for five days. Blood will be drawn at the doctor’s office on day 2 or 3 of your period. Then, you’ll begin to take Clomid (100 mg per day beginning on Day 5 of your period). This consists of taking two 50 mg tablets together each day at the same time. On day 10 or 11, after you’ve taken Clomid for five days, blood will be drawn again. 83 The results predict fertility potential and your likelihood of conceiving. If you have an abnormal CCCT, the doctor will probably tell you that the chances of conception and delivering a baby with your own eggs is improbable. • AMH (Antimüllerian hormone (AMH) level) TThis is a relatively recently developed blood test of ovarian reserve.The levels go down as a woman (and her ovaries) age, so the lower the AMH level, the lower the fertility potential. With ovarian aging, the first change is a decrease in AMH levels, followed by a decline in inhibin-B and finally by an increase in FSH levels. AMH levels do not vary significantly during the menstrual cycle and can therefore be drawn on any day of the cycle! Women who are overweight have 65% lower AMH levels than thin women, indicating that obesity may be associated with decreased ovarian reserve and/or with ovarian dysfunction. It should be noted that women with polycystic ovaries (PCOS) have high AMH hormone values. • Immune Disorders Your doctor may recommend testing for the following immune disorders: a) ASA – Antisperm Antibody: This test determines if sperm are not being produced because of problems in the systemic immune system. Women will be tested through a blood sample while men’s samples will be tested through a semen sample. b) APA – Antiphospholipid Antibodies: This is a popular test to see if these types of antibodies are circulating in your bloodstream and preventing the blood from flowing properly. If you’ve suffered multiple miscarriages, then your doctor will probably order this test. Its treatment can be as simple as taking a baby aspirin or other blood thinner such as Heparin. c) ANA – Antinuclear Antibodies: A test that measures abnormal antibodies that harm or work against the body’s tissues. If you test positive, it can mean that you have systemic lupus erythematosus (SLE). This can increase your risk for a miscarriage but can be treated with steroids. 84 d) ATA – Antithyroglobulin: Measures the presence of antithyroid antibodies. Your doctor may order this test if you’ve had unexplained miscarriages. It can be treated with steroids. e) AOA – Antiovarian antibodies: Used to detect levels of specific antibodies in the bloodstream. You may have high levels of this antibody if you’re having fertility problems such as premature ovarian failure or early menopause. During Fertility Testing – Loss of Control and Other Feelings Fertility testing is a life-changing experience that can cause thoughts and feelings that you may have never had before. There’s no reason for you to feel inadequate or isolated because you’re having these feelings. But you must recognize them for what they are and take the necessary steps to deal with them. When the medical fertility experts take over, you may feel that your life isn’t your own anymore. They’ll tell you what to do and when to do it and disrupt your entire life for an indefinite period of time. You now schedule your life – including sex - around doctors’ appointments – and you may become angry and frustrated. Sex may become robotic and you may even come to resent your partner. What used to be a private act of love is now scrutinized and analyzed by “professionals” trained to help you conceive. You may begin to resent pregnant women you see in a store or in your own family. Did she have to go through what I’m going through? Will I ever be where she is now? Use the same coping strategies during the testing that you used before the testing began – and here are some other tips that might help you through this stage: • Begin by acknowledging that this is going to be a fearful and anxious time for you – both individually, and as a couple. • Keep the lines of communication open and don’t be afraid to express your emotions. • Support each other through the testing process by attending appointments together and talking about them afterward. 85 • Don’t force yourself to go to baby showers or a child’s birthday party. This may be too painful for you at this stage and it’s perfectly understandable for you to want to avoid these types of gatherings. • Search the web, the bookstores and any other means of locating information about fertility, options and treatments. • Make copious notes and jot down questions that you want to ask the doctor at your next appointment. You should always find quiet times for yourself to think about what’s happening to you – your body and your mental state. Tell yourself over and over that what you’re feeling is normal and that you’re taking steps to correct the situation – whatever that may be. When You Can’t Cope Sometimes you may feel the need to talk to someone other than your partner, but infertility is such a personal subject that you might find it difficult to open up to a friend or family member. There are mental health professionals who can help you understand the emotions you’re feeling and successfully cope with them. It’s natural to feel overwhelmed by what you’re going through – and if you can find ways to cope, you’ll feel more in control. If you’re experiencing out of the ordinary thoughts or sensations such as those listed below, seek out a trained professional to help you through the crisis. Don’t think that you can do it alone. You should immediately seek help if you experience symptoms of depression that include the following conditions: • Sleeplessness, or sleeping too much • Lack of concentration • Loss of interest in being with family, friends or loved ones • Extreme anger • Lack of self-esteem • Thoughts of death or suicide 86 Prolonged depression, caused by stress, can sometimes cause a chemical imbalance in your brain that makes it impossible for you to function on a normal basis. Don’t be embarrassed or feel guilty because you’re having these thoughts. Do consult a professional who is trained in treating symptoms that arise before, during and after fertility tests and treatments. He or she can help you sort through issues, learn how to cope and deal with the grief you might be feeling. Be sure that any mental health professional you choose has extensive training in treating the psychological trauma of infertility and that he has a graduate degree and a license to practice in your state. Your doctor may be able to recommend someone – or, if you’re in an infertility support group, ask someone you trust for the name of a good professional. You may want to interview several before deciding on one that you feel comfortable with. After Fertility Testing – Coming to Terms With the Outcome No matter what the outcome of the tests may be, you may find yourself at a crossroads that requires even more decisions on your part. Do we continue with other fertility testing methods? Are there alternative treatments that we should consider? Adoption? In vitro fertilization? If you’ve been consulting with a mental health professional, proficient in the area of infertility testing, he or she may be able to help you sort out the facts in the decisionmaking process. Your doctor may also be of help by explaining other options to you – the impact and the probable results of each according to your particular case. After all that testing, worry and anguish, your diagnosis may be just what you’d hoped for – that everything is ripe and ready for a pregnancy, but it just hasn’t happened yet. In this case, you may decide to try relaxation techniques, diet, or any of the other numerous ways mentioned in this book that can help your system be geared up and ready when pregnancy does occur. You may get a diagnosis that fertility is a problem with one or both of you. It could be low sperm count, trouble ovulating or a number of things that your doctor will explain to you in detail. 87 The science of infertility has made such amazing progress that infertile couples have a wide array of available choices. It may involve surgery to remove cysts – or something as simple as taking hormone-boosting herbs or drugs. If infertility is your problem, today’s medicine, both Western and alternative, can usually provide an answer. The most devastating of diagnoses – that there’s no way you can become pregnant as a couple – requires even more serious consideration from you, as a couple. How badly do you really want children? Now what? Sometimes these decisions are overwhelming for a couple. This is when open lines of communication with each other becomes a tremendous ally in your quest to make the right decision for you both. Some topics that you’ll want to talk about include: • How long do you want to try before considering other options? Assuming that your fertility testing results proved that you’re both capable of conception and there’s nothing medically askew with either of you, you may want to set a limit of how long you want to try to conceive before considering other ways to have a family. Some couples aren’t willing to invest more years and put up with the stress of trying to conceive. This is a decision that you’ll need to make as a couple, perhaps with the guidance of your doctor. • Are you willing to try advanced fertility testing or undergo fertility treatments? Perhaps the tests were inconclusive and your doctor recommends taking the next step to discover whether or not fertility is a problem. More testing may cause further strain on your relationship or on yourself that you’re not willing to endure. You need to be able to state your feelings and emotions about this development in the clearest of terms and to decide what’s best for you and as a couple. Fertility treatments are very expensive and may not be a viable option for you. But if you decide that you want and need the treatments, get together with your partner to develop a financial plan that you can deal with. 88 Your insurance plan might cover fertility treatments to some extent – or you may need to talk to them and negotiate. If you do decide to pay for part or all of the treatments, prepare for the fact that it may not work. • Which fertility treatments are you willing to try and which won’t you even consider? In the next chapter, I discuss the plethora of fertility treatments available and the possible side effects and outcome of each. Study these methods carefully and research them on your own before you make a decision on acceptable fertility treatments. • Optimism is important. No matter what you decide, by all means practice optimism. Even if the diagnosis wasn’t what you’d hoped for, the next stage will require optimism as you delve into the options that are left. • Put off making a decision. You may want to try fertility treatments in the future, but right now you’re not sure of anything. It’s okay to delay making a decision until you feel sure that you can come to an honest and well thought out conclusion to your dilemma. If your fertility testing leaves you with an undesirable diagnosis, you’re bound to feel let down or depressed about the outcome. You may find yourself having a good cry if a friend or family member calls to tell you she’s pregnant. The strain of making it through the past months, years – or however long it took to reach this point – has taken a toll on you. Try not to be discouraged. Building a family can be an option for you no matter what the tests proved. Now, it’s time to focus on other matters – your job, your relationship – you! 89 It’s Time to Think About You! Your quest for pregnancy isn’t over yet. You’ve still got to make some decisions about what comes next. There are things to learn and possible methods to choose. But you deserve some rest and relaxation before you have to make another decision. Take some time to re-visit the journals you created –learn a little about yourself and the way that you, as a couple, interacted during the most stressful of times. If possible, take some time to get away and just have some fun. No fair talking about anything that has to do with fertility, babies or what you’re going to do about the future. There’ll be time for that later. Take care of yourself! Find a new activity that interests you or join a group that you’ll enjoy. The quest for pregnancy doesn’t have to be over, but if you set it aside, just for a little while, you may find that you have renewed energy and focus when it is time for you to revisit the issue. Now we’re going to go through the final phase –identifying conditions which can impact your fertility and the treatment options that medical science has to offer. Being informed and aware can make the process a bit easier to endure and knowing your options can help you and your partner get through this emotionally stressful time. 90 Chapter 7: When A Condition Is Identified – What Does It Mean And What Can You Do? It’s quite possible that you are familiar with a condition you may have that could affect your fertility even before actually trying to get pregnant. Perhaps you have never had regular menstrual cycles, or you were told years ago that you have endometriosis. In this chapter, I will discuss the various conditions that can have a tremendous affect on your ability to conceive and what your options are to effectively treat these conditions. Are You Ovulating? (Irregular Cycles) Most women have between 11 and 13 periods a year. Many women think that a regular period occurs every 28 days, but actually every woman has a unique cycle and it doesn't have to be 28 days to be normal. Your cycle can range from 24 to 35 days and still be normal--what's important is that it is approximately the same number of days in between cycles to classify it as a "regular" menstrual cycle. A regular period typically has “full flow” bleeding lasting for 5 days, but it is normal to menstruate for anywhere between 3 and 7 days. Approximately 30% of women in their reproductive years have irregular cycles. An irregular period is any type of bleeding that is abnormal when compared to your usual cycle. This would include a missed period, a late period, an early period as well as bleeding between periods. It would also include very heavy bleeding or very light bleeding. Having irregular periods, absence of periods, or abnormal bleeding often indicates that you aren't ovulating, a condition known as anovulation. If you have irregular periods, your cycle will be different every month and you won’t have any knowledge of when you are ovulating and when your period is due to arrive. If your period is longer than normal, say 36 days, it is still considered “regular” as long as it does arrive approximately every 36 days. However, irregular periods can make it extremely difficult or even impossible to track ovulation. 91 Irregular menstrual periods are often the result of hormones that have been thrown out of balance. Having an irregular cycle on occasion is nothing to be concerned about. Some of the reasons why you may have an irregular cycle occasionally or more often include: Illness Travel Stress: Worrying or feeling anxious can cause a hormonal imbalance. Diet: A poor diet, extreme weight loss or gain, being overweight or underweight, as well as eating disorders can all cause hormone imbalances. Exercise: Intense, strenuous exercise often causes irregular periods. Recreational Drug Use Breast-Feeding: Many women don’t have regular periods while breast-feeding. Peri-Menopause: Many women realize they are in perimenopause when they are in their forties and their cycles become irregular. If any of the above seem like they might be the cause of your irregular cycles, you can make appropriate changes which will have a positive impact on your cycles. Changes in diet and dealing with stress for example, are covered elsewhere in this ebook (so be sure to read it ALL!!). While the above are likely causes of anovulation/irregular cycles, it is important to rule out any of the following medical issues which may be causing the problem. If your doctor determines that you have any of the following conditions which are causing you to have irregular cycles/anovulation, then proper treatment should correct the problem. ๏Hormone imbalances ๏Liver Disease ๏Diabetes ๏Problems with glands – pituitary, adrenal, thyroid ๏Ovary issues (PCOS 92 The only way to determine what might be causing the anovulation is to talk with your doctor and have them run tests to make sure that nothing else is wrong. If you are noticing particularly irregular periods, or have gone a year or more with missed periods, see your health care professional. If you experience extreme cramping, heavy period bleeding, dizziness, nausea, or fainting you should also visit with your health care provider. Polycystic Ovarian Syndrome (PCOS): One possible ovulation complication in getting pregnant is PCOS, or polycystic ovarian syndrome. This is a condition that will affect anywhere from five to ten percent of women. Women with PCOS have ovaries that create many follicles each month that generate high levels of estrogen without producing and releasing a mature egg. PCOS can contribute to irregular periods, excessive weight gain, acne, male patterned baldness, and excess facial hair It usually goes hand-in-hand with insulin resistance. The excessive estrogen stimulates the uterine lining to build up and then it is eventually released in what may appear to be a menstrual period, but really is not, because ovulation has not taken place. The bleeding is irregular and infrequent. Women who have irregular periods and some of the symptoms of PCOS should be tested by their doctor. If your doctor suspects you have this condition, he or she can do a pelvic ultrasound to see if you have a lot of small follicles on your ovaries. He’ll also check your hormone levels. But there’s plenty that you can do to increase your chances of becoming pregnant when you have PCOS and the steps are generally based on controlling the symptoms that are above. Insulin Resistance – The Missing Link? For a long time, while doctors thought that PCOS was caused by the ovaries producing too much male hormones, they were not able to figure out why this was happening. However new research has shed some light on this issue. It seems that Insulin Resistance and Glucose Intolerance seem to cause the PCOS and resulting hormone imbalance that occurs with the condition. Normally the hormone insulin is responsible for bringing glucose (sugar) into the cells. Women with PCOS become resistant to insulin, which causes sugar levels in the blood to increase, which eventually causes glucose intolerance. The excess insulin is responsible for stimulating the ovaries to produce an excess of male hormones which then throws the whole hormonal system out of balance. 93 Many doctors will prescribe medication such as Metformin (glucophage) - which is normally used to treat diabetes - and/or Clomid to treat PCOS. Metformin Metformin (glucophage) has been used in the treatment of diabetes for about 40 years. The effects of the drug are therefore well known. It is a category B drug in pregnancy (safe, no known fetal malformations in humans). In the liver it suppresses gluconeogenesis (production of glucose), and in muscle and fat cells it enhanced glucose uptake and utilization. This effectively lowers glucose and insulin levels. In studies performed in 1998, 34% of patients taking metformin alone ovulated (compared to 4% taking a placebo); and when metformin was combined with clomid, 90 % of the patients ovulated compared to only 8 % that took the placebo. Thus, the combination of metformin and clomid markedly improved ovulation in PCOS patients by correcting the underlying metabolic problem. Often, benefits begin to appear after months, not weeks. Metformin is a very safe drug. However, it does have some degree of toxicity. Kidney toxicity, and less commonly, liver toxicity, is possible. To avoid nausea, it may help to start with a low dose and increase the dose very slowly. Nausea often goes away with time. If you start out at some dose and experience nausea then talk to your doctor about lowering your dose temporarily and slowly increasing after you give your body a chance to adjust. Just because you can't tolerate a particular dose now doesn't mean it's just wrong for you or that you will never be able to tolerate it. Maybe, maybe not, but unless you give it a chance, you won't know. Metformin may also cause diarrhea. A study notes that, unlike nausea, diarrhea may occur later even when the dosage has been stable over a long period. -Take with B12, Folic acid and Calcium Clomid As noted above, the combination of Metformin and Clomid is often used to treat PCOS. To read more about Clomid, go to Chapter 8. 94 Diet and PCOS While the above medications can be successful, it is best if this treatment is combined with a specific diet as well as an exercise program to reverse the insulin resistance naturally and help to balance your cycle. Here’s how it works. When you eat foods that are high in what’s called “refined carbohydrates” insulin levels increase to take the sugar from the blood and bring it to the cells. If you eat a diet high in refined carbs, the insulin levels spike very often and eventually they no longer are able to move the sugar from your blood into your cells, resulting in high blood sugar, and your cells are deprived of the energy they need to work properly. This is the reason many women with insulin resistance (and PCOS) crave carbohydrates and are very often tired. Basically, their cells are desperate for the sugar/ glucose (energy) which is in the blood but unable to get to the cells. Eventually, the body loses it’s ability to generate insulin appropriately.. The latest research indicates that the best approach is to change your diet by eliminating foods high in refined carbohydrates, and replacing them with whole foods, which take longer to digest and don’t cause a spike in insulin levels, but rather a gentler rise in insulin levels. Also, avoid coffee, alcohol, cigarette smoking or drugs as they all stimulate the stress hormones that exacerbate insulin resistance as well as providing numerous toxic chemicals which are harmful to fertility in general even if you don’t have PCOS. In order to make some changes to your diet, you need to understand about the Glycemic Index as well as the different types of carbohydrates. The Glycemic Index is a ranking of foods by how much they increase your blood sugar levels 2-3 hours after you eat them. The foods you’ll find in the index are carbohydrates, because those are the ones that are most likely to increase your blood sugar. You may have heard the terms "good" carbohydrate and "bad" carbohydrate, which usually correspond to whether a carb is "simple" or "complex". (bad=simple; good =complex). A simple carbohydrate is more processed than a complex carbohydrate. This means it is digested more quickly, raises the blood sugar more quickly and causes insulin spikes. A complex carbohydrate is usually less processed and tends to be digested more 95 slowly, therefore it is less likely to raise blood sugar. The glycemic index is a list of foods that are ranked by how they affect your blood sugar level. In general, low-glycemic foods are better at controlling your blood sugar than high-glycemic foods. So the less refined or processed the food is, the lower its glycemic index will be. And therefore the highly processed foods will have a much higher glycemic index. Here is a list of some foods broken down by whether they have a low, moderate or high glycemic index. By using this guide to make good food choices, you can have a strong influence on keeping your insulin levels stable. Low glycemic: barley black beans broccoli cashews cherries chickpeas grapefruit green leafy vegetables kidney beans lentils milk peanuts peanut butter pears plums soybeans strawberries tomatoes tomato soup wild rice plain yogurt Low to moderate glycemic index All-Bran apples brown rice 96 carrots garbanzo beans grapes honey ice cream kidney beans navy beans oranges peaches pears pinto beans potato chips Moderate to High glycemic bananas figs mangos potatoes (sweet and white) pineapple pita bread oat bran oat bread white rice raisins carrots brown rice kidney beans shredded wheat High Glycemic Index bagels beets cakes Cheerios dates corn flakes pies pretzels refined durum wheat pasta jelly beans parsnips 97 puffed wheat sweet corn white bread So just to recap, eating well is vitally important when you have PCOS. Your diet should be based around protein and vegetables, with carbohydrates being the low GI type. Here’s a great video to watch to give you the top 7 Diet Tips for PCOS: Watch this Video What About Dairy? Here’s the problem with dairy products...although they are low GI and contain beneficial calcium and protein, dairy foods can stimulate insulin production which is why they should be eliminated or reduced. A study conducted at Lund University in Sweden has shown that milk causes a strong insulin response, even though it is a low-glycemic food -- exactly the opposite of what you would expect. This effect seems to be due to some of the proteins in cows milk, which cause the increase in insulin. Most people are unaware of this, and eat dairy because it is low GI, so it’s very important to be aware of this if you have PCOS. Also to be noted, the lower fat milk products actually raise the blood sugar level higher than the full fat versions. So those who drink low fat milk to lose weight are not benefitting at all. It should be noted that the insulin spike does not happen with cheese, but rather with cows milk. Also, fermented dairy products such as yogurt had a lower insulin response than milk. So, if you choose to continue consuming dairy, switch to fermented products such as yogurt or kefir. Of course, your body still needs the Vitamin D and Calcium that dairy provides. To make sure you get the adequate amount of both, take a daily Vitamin D & Calcium supplement. Soy - Good or Bad? One of the most controversial topics regarding nutrition and PCOS is soy. Soy is a plant food that is also a complete protein, meaning it has all required amino acids. It is 98 also low in fat, contains essential fatty acids, numerous vitamins, minerals, and fiber. But soy contains phytoestrogens (plant estrogens) which can mimic estrogen in the body and have the potential to alter a woman's menstrual cycle. Women with PCOS (and other conditions such as fibroids and endometriosis), tend to be estrogen dominant and the consumption of soy can disrupt the delicate hormonal balance. Although more research needs to be done, it is probably best that you limit your intake of soy products, especially soy milk If you are going to consume any soy, restrict it to the fermented forms such as tempeh, miso and soybean sprouts rather than soy milk, soy cheese and other processed varieties Exercise and PCOS Exercise may be the single most important lifestyle factor for both preventing and reversing insulin resistance. Exercising results in the loss of abdominal body fat and reverses the loss of muscle mass associated with insulin resistance. Even an exercise routine as simple as incorporating brisk walking four times weekly dramatically improves endurance fitness, decreases body fat stores, tends to reduce food consumption, and decreases insulin resistance. A 2005 study showed that insulin resistance was improved by up to 25% in sedentary women with PCOS and insulin resistance following a 5-month moderateintensity exercise program. Promising Treatment for PCOS Inofolic is an exciting new product to treat PCOS and women with egg quality issues which is available in Europe. It contains the following ingredients per dose: myoInositol (2g) and folic acid (200 mcg). The recommended dosage is twice a day. There is also a product called Inofolic Plus which contains the myo-inositol and folic acid like the original, but also adds 3 mg of Melatonin which should only be taken once a day at night. The added Melatonin is beneficial for improving egg quality. Since this product does not seem to be available in the United States yet, you can purchase the ingredients separately by visiting your local health store. Myo-inositol, a form of inositol, is a member of the B-complex family of vitamins. It’s not an essential vitamin, as it can be manufactured by the body from food 99 sources, but it tends to be deficient in women with PCOS and older women, and restoring it can help regulate insulin enough to restore normal ovulation and assist with weight loss. Myo-Inositol is a key ingredient found in the follicular fluid of healthy eggs, so women who are deficient tend to have lower quality eggs. So in effect inofolic will help with egg quality and improve ovulatory function as it helps in balancing hormonal levels that are required for healthy ovulation in all woman. Inositol is very safe so there's no harm in trying it, but if you're already on a diabetes drug (Metformin) talk to your doctor first. If you want to get off Metformin, do it gradually and under your doctor's supervision. Myo-inositol is being used by top fertility clinics to help improve egg quality in women undergoing IVF, especially when poor embryo quality is a concern. Here's the research that supports the use of myo-inositol-- 2 small studies that look very promising: In a double-blind study published in the Sept-Oct 2007 European Review for Medical and Pharmacological Sciences, 92 women were split into two groups, and the placebo half got folic acid, while the test group got folic acid plus 4 gms daily of myo-inositol, for 14 weeks. The myo-inositol group had a much higher rate of ovulation, and they lost weight. In the other study, published in the Dec 2007 journal Gynecological Endocrinology, 25 women with PCOS took a combination of folic acid and inositol for six months. The results were that twenty-two out of the 25 (88%) patients restored at least one spontaneous menstrual cycle during treatment, and 18 (72%) continued to ovulate normally during the follow-up period. 40% of patients became pregnant. There is also a clinical trial underway (started February 2011) to study the potential effects of Inofolic Plus on abnormal ovarian reserve. Inofolic Plus® contains myo-inositol, folic acid plus melatonin. Based on the studies, myo-inositol seems to be a very effective treatment for PCOS, and for restoring fertility. Even better, it doesn’t have side effects and it’s relatively inexpensive, so definitely seems worth trying. Don't forget, if you have PCOS, it is also important to combine this treatment with proper diet (low glycemic) and daily exercise program. 100 About Chromium Chromium is an essential mineral that is needed for insulin activity in carbohydrate, fat and protein metabolism. Numerous clinical trials have shown that chromium as chromium picolinate reduces insulin resistance and improves blood sugar control. Many women will have side effects from glucophage such as bloating, cramping, diarrhea, flatulence and nausea and Chromium might offer an alternative to Metformin. Chromium picolonate is of possible interest in the treatment of PCOS patients due to its possible effects in improving insulin resistance. A few small studies have been performed in which women with PCOS were given chromium. A pilot study funded by the National Institutes of Health (NIH) examined the effects of chromium picolinate at a dose of 1000 mcg. per day. PCOS patients were given chromium but were instructed not to change their diet or exercise level. These PCOS patients experienced a 38% mean improvement in a measure of insulin resistance. These authors concluded that chromium picolinate, an over-the-counter dietary product, may be useful as an insulin sensitizer in the treatment of polycystic ovary syndrome. Progyluton for PCOS? Progyluton is a low-dose hormone medication that is sometimes prescribed to regulate the menstrual cycle when there is abnormal uterine bleeding. It is a combination of low dose estrogen and progesterone (too low to be used as a contraceptive). Many doctors prescribe it (rather than the birth control pill) for young girls and older women who have menstrual irregularities because there are fewer side effects. If you have PCOS, the “pill” can lessen the symptoms by halting ovulation and thus giving your ovaries “time off” from producing follicles. Unfortunately, that may help with symptoms but it does not help you if you want to conceive. That’s where Progyluton can help! Since Progyluton works similarly to the pill without being an actual contraceptive, it may be given to women with PCOS who are trying to conceive. In other words, this medication will lessen the symptoms of PCOS by regulating the menstrual cycle and although it won't help you to ovulate, unlike the “pill”, it won’t stop your ovulation either. Some doctors will prescribe other medications such as Clomid once menstrual cycles are under control with Progyluton, if you wish to conceive. 101 While your testosterone levels will go down while being treated with Progyluton and this can treat your irregular cycles, the drug won't address other issues related to PCOS, such as insulin resistance. As stated earlier, Metformin is sometimes prescribed for this. Always keep in mind that women with PCOS need to adjust their lifestyles to include eating a more appropriate diet plus daily exercise for their condition. Women with PCOS who want to go off their meds so they can get pregnant often find they become polycystic again, if they haven't made lifestyle changes such as a low-sugar diet. More Helpful Tips for PCOS Remember, it’s critical to try and cut down on sugar and carbs, plus add some moderate daily exercise to your diet plan. This works because excess sugar and refined carbs cause high blood sugar, which in turn causes high insulin which stimulates the ovaries to make androgens (male hormones). You can also try some of the following: Diindolylmethane, or DIM, is a natural supplement composed of broccoli and cauliflower and is known to reduce androgens, (among which is testosterone). Taken daily, 120 mg of DIM should help correct your hormonal balance. Calcium D-Glucarate is a calcium salt found in foods such as apples, grapefruit, broccoli, brussels sprouts, cabbage, lettuce, and alfalfa. Calcium D-glucarate is a powerful detoxifier of excess estrogens from the liver. This means that when your liver processes estrogens and toxins and dumps them into the bowel so that they will leave the body… that they actually do leave the body instead of being reabsorbed. Recommended Dosage: Take 200-300mg twice daily. Spearmint. Perhaps one of the best (and tastiest) herbs for lowering testosterone levels is spearmint. Studies performed at the University of Maryland Medical Center and at the Suleyman Demirel University in Isparta, Turkey showed that women drinking two cups of spearmint tea (1 cup twice a day) for five days significantly lowered their androgen levels. In addition to reducing the levels of free testosterone in the bloodstream, spearmint tea reduces some symptoms of hirsutism. N-Acetyl Cycteine (NAC) is a compound that is useful for insulin resistance, a factor that is key in the development of PCOS. A study looked at the effect of NAC on insulin secretion and insulin resistance in 6 lean and 31 obese women with PCOS. Most took 1.8 grams of NAC daily for 5-6 weeks. Those treated with NAC showed significant improvement in insulin metabolism and a significant drop in testosterone levels. Another study showed that taking NAC for two months resulted in decreased homocysteine levels. (Women with PCOS, especially those who take metformin may have elevated homocysteine levels, which is a risk factor related to heart disease). Also, a 102 study of 150 women with PCOS has shown that NAC appears to make Clomid more effective when taken together. Fish Oil for PCOS Since fish oil contains Omega-3 fatty acid, it can help minimize some of the symptoms caused by PCOS, most importantly insulin resistance. As stated previously, insulin resistance can change the way in which insulin is produced or used in the body. Many women with PCOS will develop either pre-diabetes or Type II diabetes. By taking a fish oil supplement, a woman may find that her resistance to the insulin produced in the body will be reduced, bringing her blood sugar level closer to the normal range. Although there are no conclusive studies that this definitely works, there have been reports of some promising results so it seems a worthwhile option to add to your routine. Here are some other ways Fish Oil might help PCOS sufferers: • Many women with PCOS are more likely to develop high blood pressure and high blood cholesterol. According to the University of Maryland Medical Center, studies have demonstrated that fish oil supplements (which contain Omega-3 fatty acid) can lower a person's blood pressure and also increase HDL cholesterol ("good" cholesterol) while lowering LDL cholesterol ("bad" cholesterol). Actually, a number of studies show that adding 3 grams of fish oil a day can significantly reduce a person's blood pressure. • Fish oil can also alleviate the symptoms of stress and depression which can be an issue for those struggling with PCOS and fertility problems. More Benefits: • In a study from the Department of Health Sciences at Gettysburg College, researchers gave one group of women 4gm of fish oil while another group took 4gm of safflower oil. Compared to the safflower oil group, the fish oil group gained lean muscle mass while and lost body fat. • Also significant, the group that took the fish oil had reduced levels of cortisol, a stress hormone that contributes to increased fat, especially in the mid-section. The finding was particularly significant for PCOS sufferers because women with polycystic ovarian syndrome often have elevated cortisol levels. 103 • This study also revealed that Omega-6 may actually increase androgen testosterone levels. Omega-6 fatty acids can be found in the following oils, and should be reduced if not completely avoided: corn, soy, sunflower, and safflower oils. So in summary, omega-3 fish oil can help to improve a number of PCOS-related issues, such as depression, chronic inflammation, heart disease, high blood pressure, high blood fats, diabetes and stress. You can also find Omega-3′s in other oils such as flax seed oil. However, the fatty acids in flax oil have to go through a series of metabolic steps inside your body before they become the omega-3 fatty acids. The problem is that many PCOS women have defects in these required metabolic processes and not enough of the “final” omega-3 fatty acid is created. So it's best to take the fish oil rather than flax oil to get your Omega 3's if you have PCOS. Warning: Patients who are taking blood thinners like aspirin, lovenox, coumadin or heparin should not take this medication because studies have shown a slightly elevated risk of bleeding. Be sure to purchase your Omega-3 supplements from a reputable company. The oils must be processed correctly to insure you get a standardized amount AND it’s as pure and clean as possible. Vitamins and Helpful Herbs:* False Unicorn can help to normalize ovulation in women with PCOS. It also can help to normalize follicular development and reduce the incidence of ovarian cysts in women with PCOS. It may also reduce the amount of estrogens produced by the ovaries. Chaste Tree (vitex), which is often taken to regulate the menstrual cycle, can also reduce testosterone levels, according to the University of Maryland Medical Center. This is one of the most important herbs for PCOS because it helps to stimulate and normalise the function of the pituitary gland, which controls the release of LH (luteinising hormone). Saw Palmetto works by suppressing an enzyme needed to convert testosterone to DHT. Extensive studies show that saw palmetto reduces hair loss and improves hair density in women with hair loss related to high testosterone levels. Saw palmetto helps women with PCOS especially if they have elevated DHT by reducing the amount of testosterone converted to DHT. Dosage: 160 mg twice daily Some other vitamins which are discussed in the Vitamin Section of Chapter 4 are especially helpful for those with PCOS. Go back and read the specifics in chapter 4 and be sure to include the following: 104 Calcium plus Vitamin D B-Complex Magnesium Citrate Zinc Royal Jelly *Warning You should not take any herbs if you are taking birth control pills, fertility drugs, hormonal treatment or other medication unless they are recommended by a qualified practitioner. Thyroid Dysfunction If you are having difficulty getting pregnant, before you move on to invasive fertility tests or expensive treatments, you need to make sure you don’t have a problem with your thyroid. The thyroid gland which is located in the lower front of the neck, produces hormones which are very important for regulating your metabolism. An underactive thyroid is called hypothyroidism. Symptoms of an underactive thyroid can include weight gain, constipation, dry skin, brittle nails, and hair loss. An overactive thyroid is called hyperthyroidism and can cause diarrhea, weight loss, and palpitations. Most of the problems with fertility occur with hypothyroidism, or an underactive thyroid. Hypothyroidism can cause an elevation in the hormone prolactin, the hormone that causes the production of breast milk in a woman after she gives birth. Excess prolactin can sometimes effect ovulation by suppressing the release of the hormones LH and FSH, causing low estrogen levels and lack of menstrual periods (amenorrhea). Another symptom of high prolactin is galactorrhea - milk production from the breast when you are not pregnant. Some women with hypothyroidism experience a luteal phase defect which also prevents pregnancy from occurring. This is because the embryo cannot implant properly if the endometrial lining is not built up properly as a result of a too-short luteal phase. A simple blood test for TSH (thyroid-stimulating hormone) is the best way to find a thyroid abnormality. If you are diagnosed with an underactive thyroid gland, thyroid hormone replacement can be very effective to restore fertility. Generally, it will take about 2 or 3 months to stabilize your thyroid hormones and you should not try to 105 conceive during this waiting period. When testing for thyroid dysfunction, it is also important to test for thyroid antibodies as well. If your doctor doesn’t typically test for these, you should insist that he does. The reason is that the presence of thyroid antibodies doubles the risk of early miscarriage, substantially increases the risk of recurrent miscarriages, and can also lower your chance of getting pregnant at all. The three tests that should be run for antibodies are: * Thyroid Peroxidase (TPO) Antibodies * Thyroglobulin/Antithyroglobulin Antibodies * Thyroid-Stimulating Immunoglobulins (TSI) Finally, here are some special tips if you are affected by infertility due to a thyroid disorder. 1. Have your doctor test for the full panel of thyroid levels when testing for TSH (thyroid stimulating hormone). This would include Free T4. 2. Find out the actual number for the TSH level. While many labs report a normal range of 0.5 to 5.5, some fertility experts now think a level of 2.0 or higher can cause fertility problems. 3. If you do have hypothyroidism and become pregnant, make sure to inform your doctor immediately. Your thyroid hormone levels must be monitored during pregnancy as low levels can affect normal fetal development or cause early miscarriage. Depo Provera and Birth Control Pills: The depo shot is supposed to prevent pregnancy for approximately 3 months. However, when you stop the shots, fertility does not automatically return at the end of the 3 month period. Ovulation will usually return within three to six months for most women, however it is possible that you may not have your cycle for 12 to 18 months after discontinuing the injections. So, unfortunately, it really varies from person to person and it could possibly be a long wait. Following Depo-Provera, there is no reported increase in miscarriage or birth defects. 106 Alternatively, when you stop taking birth control pills, your cycles tend to resume fairly quickly. It doesn’t matter how long you’ve been on the pill. Once the hormones are out of your body, your cycles will begin to get back to normal. It is even possible to get pregnant after stopping the pill before you’ve had a period. In fact, some women are most fertile during the three months after they stop taking the pill. For most women though, it takes a few months for your menstrual cycles to be back to normal. But remember, your cycles will go back to being as “normal” as they were before you started the birth control pills. So if you had irregular cycles before birth control pills, they are likely to still be irregular after you stop. The reason some doctors advise to wait until you’ve had a few normal cycles before attempting a pregnancy is not because there are any lingering effects that need to be “washed out.” Rather, if you wait for your cycles to completely return to normal, you can more predictably determine the length of your cycle, identify your fertile days, and be able to better date when you conceived once you actually do get pregnant. Other Possible Causes Of Ovulation Delays: You might also have problems with ovulation when the following occur during your attempts to become pregnant: •Increased stress Emotionally stressful times can also contribute to fertility problems, so try to keep your stress levels in check by using relaxation methods designed to calm your body, mind, and spirit (to be discussed more later). •Eating disorders Having an eating disorder can pose a risk to your health as well as your fertility. It would be best to get your eating disorder under control before attempting to get pregnant as there could be serious risks to the developing baby if you were to get pregnant. •Significant weight loss If you have lost a significant amount of weight, especially in a short period of time, it can effect your hormones and therefore your ovulation. This should stabilize with time if you are eating healthy. 107 •Excessive exercise Moderate exercise is actually good for your fertility as well as your pregnancy, however overly strenuous exercise can upset the natural balance of your hormones and cause anovulation. If you are doing strenuous exercise and your cycles are irregular, it would be a good idea to cut back some. Fibroids It is difficult to know just how many women have fibroids, since unless they cause a problem, a woman may not realize she has them. It is estimated that fibroids occur in up to 25 percent of women over the age of 30 and in nearly 40 percent of women after the age of 40. Uterine fibroid tumors ( myomas ) are a product of estrogen dominance (too much estrogen). Estrogen stimulates their growth, and lack of estrogen causes them to diminish. The good news is that most women who have fibroids will not have any problems conceiving or carrying a pregnancy to term because of their fibroids. A minority of women will have problems with infertility and pregnancy complications. There are two ways that fibroids can effect your fertility. The first is an inability to get pregnant at all; and in the second instance, although pregnancy occurs, it ends in miscarriage. One of the most common types of fibroid is called a submucous fibroid. This type occurs just beneath the lining of the uterus and can displace the lining as it grows. If a woman is unable to get pregnant and an evaluation determines that she does have a fibroid and no other apparent fertility issues, a myomectomy (to remove the fibroid) may be performed. This procedure does have a high success rate at curing this problem--up to a forty to eighty percent increase in fertility after the procedure. However, it is very important to make sure that there aren’t other infertility issue before having a myomectomy since the procedure itself, can cause scarring which could result in further fertility problems. It should be noted that one quarter to half of the women who have a myomectomy can expect to eventually develop additional tumors. Aside from surgery, another option that is being tested is the use of the drug leuprolide acetate (Lupron) to shrink the fibroids. This drug is the synthetic form of the naturally occurring substance known as gonadotropin-releasing hormone (also called GnRH). In several scientific studies, most of the women who have used the drug had 108 their fibroids shrink to half their starting size, so it may help women who are trying to become pregnant. However, it is important that you DO NOT get pregnant while taking the Lupron as it can cause birth defects. It also can cause some potentially bad side effects so make sure to discuss the pros and cons of the risks with your doctor. It is also possible to eliminate fibroids by altering your diet and adding herbal supplements/vitamins to control the hormonal imbalance (excess estrogen). Much of the diet recommendations in this ebook to improve overall fertility are especially helpful when dealing with fibroids such as increasing fiber intake (complex carbohydrates), eliminating processed foods and “bad” fats, reducing sugar, alcohol and caffeine, etc. Also, many of the vitamin supplements suggested are especially helpful when you are dealing with fibroids. Rather than list everything again here, I have found a very comprehensive article which summarizes the best ways you can make changes in diet, vitamins and supplements to help reduce fibroids and keep them from growing further. Here is the link-- be sure to read this informative article: Natural Healing for Fibroids I also discovered a “fibroid cure” that is offered online which you may want to check out as well--you can go here to take a look at this option for removing fibroids. I don’t have any personal experience with this product, so you have to decide for yourself if it’s something you want to consider trying. Endometriosis Endometriosis occurs when endometrial tissue (the uterine lining) is found outside the uterus. The tissue continues to react to the woman's menstrual cycle, building up, breaking down, and shedding, regardless of its location in the body. This results in internal bleeding and inflammation which can cause severe pain, scar tissue, bowel problems, and sometimes, infertility. However, not all women with endometriosis related infertility experience pain. The only definitive diagnosis of endometriosis is through a laparoscopy. A laparoscope is a tiny, lighted tube that is inserted into you through a small abdominal incision. A surgeon is able to see inside of you through this tube. Not everyone with endometriosis has fertility problems, but quite often, women with the disease are more likely to have trouble conceiving. It is estimated that 40% of women with endometriosis may experience fertility problems. Usually this is because the endometriosis causes tubal blockages and adhesions which reduces fertility. 109 Endometriosis may also cause problems with egg fertilization, development and implantation. The cause of endometriosis is still not clear, although much of the current research indicates a relationship with a woman's immune system. It has been determined that endometriosis does tend to run in families, but research has not yet concluded whether it’s actually a genetic or environmental cause. Although there are a variety of treatments for endometriosis, there is currently no cure. One treatment is surgery to remove the endometriosis through laparoscopy. Many of the other treatments involve medications which stop ovulation, but you cannot attempt to get pregnant when taking these medications which is usually for several months. One treatment that might be promising is Pycnogenol. There's promising hope that women who suffer from endometriosis might benefit from this powerful antioxidant which has also showed promise for improving male fertility. A study published in the Journal of Reproductive Medicine reveals that Pycnogenol significantly reduces symptoms of endometriosis by 33 percent. It is difficult to predict whether you will have trouble getting pregnant with endometriosis or not. If your doctor does determine that you have infertility from endometriosis, it is likely that he will recommend some form of advanced reproductive technology such as IUI (intrauterine insemination) or IVF. If you should decide you do not want to go down that road, there are some natural alternatives you can try. You may know that many illnesses and diseases have responded very positively to changes in diet, and endometriosis is no exception. It’s possible that a change in can help to minimize symptoms and control the pain. Dietary Changes One positive dietary change is to add “good” fats and eliminate “bad fats”. Simply put, this means adding omega 3 fatty acids by using flax seed oil, walnut oil or evening primrose oil and eliminating saturated fats, butter, and lard. Another positive change is to add fiber to your diet. Good sources of fiber are whole grains (excluding wheat and rye), beans, brown rice, fruits and vegetables. Foods to be avoided are refined sugars and flours, meat and dairy products (milk, cheese eggs), wheat and soy products. Of course you should also avoid the things that I speak about later in chapter 5 that all women trying to get pregnant should avoid, such as caffeine, alcohol and processed foods. 110 Adding kelp to your diet (or use supplement) and vitamin E can have very beneficial results if you have endometriosis. Try adding wheat germ to your diet as the vitamin E in wheat germ improves the healing of scar tissue caused by internal endometrial bleeding. In general, women with endometriosis should stick to a high-fiber, vegetarian based diet. If you suffer from endometriosis and want much more detailed information than I could possibly cover in this e-book, there is a website that I highly recommend you visit which is devoted entirely to the subject of endometriosis. Here is the link: http://www.endo-resolved.com/ Castor Oil Packs One of the treatments advised there is Castor Oil packs. Castor oil is a natural plant oil obtained from the seed of the castor plant.Castor oil, known for its emollient and lubricating properties. castor oil packs have a lot going for them to help endometriosis sufferers. They boost the body’s defense system; this will in turn boost and support a depleted immune system that is associated with endometriosis. Castor oil packs also help with pain, inflammation and swelling, as well as the detox process. If you wish to try this, you can get specific instructions on how to use Castor Oil packs using this link: http://www.endo-resolved.com/End_of_Endo-castor-oil.html Blocked Fallopian Tubes If you are seeing a fertility specialist because you haven't been able to get pregnant, one of the most common tests that is performed is a hysterosalpingogram (HSG) which involves injecting dye through your cervix which ultimately travels through your fallopian tubes and runs out if your tubes are clear. If the HSG reveals that you have blocked fallopian tubes , that means that your egg will not be able to travel down the tubes to meet with sperm and fertilize an egg in order to get pregnant. Blocked tubes also increase your risk of an ectopic pregnancy since the egg can get fertilized in the tube but the embryo gets stuck and then implant in the tubes instead of traveling back to the uterus. This is very dangerous and can cause infection if the tube bursts. It is important to note that in about 15% of cases, the HSG will indicate that your tube(s) are blocked when in fact they are not. This usually happens if the HSG is very painful and there is uterine cramping which results in a spasm in the tube which prevents 111 the dye from going through. While it may look as though the tube is blocked, in reality the dye is simply not getting through because of the spasm. Also of note, sometimes after an HSG is done, a woman's fertility may be slightly improved (assuming her results were normal). It's suggested that this may occur because the dye going through the tubes may itself remove any minor debris and also the procedure may temporarily widen (dilate) the tubes as it is going through. Some of the causes of blocked tubes include adhesions, infections, PID (pelvic inflammatory disease), scar tissue, and endometriosis. The number one cause of blocked tubes is a Chlamydia infection which some women never even knew they had. A tube can be blocked at the beginning (near the uterus) or at the end (near the ovary). Generally if the blockage is near the uterus, there is a higher success rate with surgery. One common types of blockage is called hydrosalpinx, which is a collection of watery fluid within the fallopian tube, usually as a result of damage at the far end of the tube, near the ovary. In most cases, a hydrosalpinx indicates that the fallopian tube is totally blocked at the far end. Whereas some women with a hydrosalpinx display no symptoms, many suffer from severe, chronic pain.. It not only causes the affected tube(s) to be totally ineffective, it may also lessen the effectiveness of various infertility treatments (e.g. in vitro fertilization [IVF]). Hydrosalpinx also increases the likelihood of miscarriage. Fluid from a tube which spills into the uterus would be toxic to embryos; therefore it decreases the chance for the embryo to implant successfully in the uterus. For this reason, fertility specialists often advise patients to have the affected tube(s) removed prior to undergoing IVF. Also, a hydrosalpinx in one tube often affects the other, resulting in two abnormal tubes. The procedure in vitro fertilization (IVF) was originally developed about 30 years ago to help women with blocked tubes to conceive. It is generally recommended as the best treatment option if it is found that you have blocked tubes. While surgery is also another option, it will be up to your doctor to determine if surgery can clear the blockage and /or repair the tube. This will depend on such factors as what caused the blockage, where it is located, and the extent and type of blockage. The less blockage there is, the more successful the surgery. Some blockages are just at one end of the tube and they have the highest success rate of becoming unblocked. If a woman has had a Chlamydia infection, there tends to be more extensive damage and blockages. Blockages due to Chlamydia have the lowest success rate of becoming unblocked. 112 There is also a new therapy showing some promise but unfortunately it is only available in very limited places in the U.S. because it requires trained therapists in a technique called "Wurn". This therapy (Wurn technique) has been shown to open tubes and return the ability to conceive naturally for women with hydrosalpinx and blocked fallopian tubes, regardless of the location of the blockage. Their success rate with these cases (61%) compares favorably with medical techniques, but without the risks or side effects of drugs or surgeries The company is called Clear Passage, and they have locations in the U.S. in Iowa, Florida and California. Go to: http://www.clearpassage.com for more information. Uterine Abnormalities There are some congenital deviations of the uterus that can effect an embryo's ability to implant and develop within the womb. If a woman has an abnormally formed uterus, this can cause a higher incidence of miscarriage or be an obstacle to carrying a pregnancy to full term. In women experiencing unexplained recurrent miscarriages, it is important to rule out the possibility of a uterine anomaly as the possible cause. Women with uterine anomalies can also experience higher rates of preterm labor, bleeding during pregnancy, and diminished fetal growth. A typical uterus is shaped like a small pear and has a hollow, triangular cavity. If there is failure of the uterine body to fuse completely, the uterine shape will be abnormal. The development of the ovaries is not affected by these uterine defects. There is a wide range of uterine abnormalities, and the effect on fertility varies: Bicornuate Uterus One of the most common abnormalities is a bicornuate uterus. A bicornuate uterus has two uterine horns. Pregnancy within a bicornuate uterus typically occurs within one of the horns and pregnancy outcome is usually as normal as for a fully developed uterus. Surgery is not necessarily required to fix this abnormality although it can be performed successfully. 113 Unicornuate Uterus A unicornuate uterus is half the size of a normal uterus and there is only one fallopian tube. Because of its shape, it is described as a uterus with one horn. This abnormality is quite rare. It develops early in life, when the tissue that forms the uterus does not grow properly. If you have a unicornuate uterus, you probably have two ovaries, only one of which is likely connected to your uterus. No surgery can be done and this malformation can increase the risk of late 2nd and early 3rd trimester loss because the uterus will "run out of room" and trigger premature labor. Septate Uterus A septate uterus is most commonly associated with miscarriages. In this abnormality, a midline septum is present which mistakenly forms during the hollowing process. Normal uterine lining does not grow over the septum, so if the embryo implants in the septum, it is unable to grow properly. A septum can be removed by hysteroscopy, which can provide a successful outcome. Understanding the type of uterine defect one has is critical, because this will determine if intervention is needed to increase your chances of a successful pregnancy. Miscarriage: There are many possible reasons for a first trimester miscarriage, most of them resulting from a chromosome abnormality. Unless there are complications, or you are suffering from multiple miscarriage (like myself), there generally is no waiting requirement to start trying again. The important thing to realize is that early miscarriage is VERY common and generally is NOT a result of anything you did wrong nor is there anything you could have done to prevent it or another one from occurring. Your cycle will usually return to normal rather quickly, and you will probably get your period about 4-8 weeks after the miscarriage if it was fairly early. While some 114 doctors may prescribe “waiting out” three cycles, it is advised more for emotional reasons than physical ones. It’s always a good idea to wait until you have at least one normal period so you are better able to determine when conception occurred. The time you need for an emotional recovery is often much longer than the physical one, so use your own judgement for determining when it is best to try again. Recurrent Pregnancy Loss (RPL): If you have experienced 3 early miscarriages in a row, then that would be classified as Recurrent Pregnancy Loss which requires extensive testing and treatment when a cause is identified. Unfortunately, many doctors do not do the complete panel of testing that is required to identify the cause, so you may need to do some research to find an doctor who can work with you to try and find the cause. Here is a link to a page that lists all of the possible testing that can be done for those experiencing recurrent miscarriages. You might want to print it out and discuss the various tests with your doctor: Recurrent Pregnancy Loss Testing Recurrent Pregnancy Loss - Immune Issues Unexplained Infertility/Implantation Failure If you have found a doctor who has done extensive testing and found that your recurrent miscarriages are related to “immunologic factors” such as high levels of NK (natural killer) cells, it means that an “over active” immune system can attack egg, sperm, embryo and even a developing fetus. This can result in difficulty achieving pregnancy, maintaining the pregnancy, or repeated miscarriages. Intralipid Therapy Intralipid Therapy is an exciting new therapy that has had some very good results for women with high NK cells experiencing repeated miscarriages. It has also proven helpful for women who have unexplained infertility and have experienced multiple IVF failures (implantation failure). Often doctors assume this is related to poor embryo quality, but it is worth exploring this therapy to address possible immunologic factors causing the IVF failures. 115 Intralipids have been shown to lower the activity of the natural killer cells component of our immune system. The method of administration is an IV infusion of 90 to 120 minutes duration and require that you are not allergic to soy or egg products, and also do not have a history of high cholesterol or liver disease. There are a few fertility centers in the U.S. offering Intralipid Therapy as well as locations in the U.K. I expect more centers around the world will begin to use this therapy as it gains popularity due to the fact that it is effective, inexpensive and without significant side effects. If this is something you are interested in, I suggest you visit this site with much more detailed information (it’s a bit technical, but very informative): Intralipid Therapy 116 Chapter 8: When Medical Science Should Intervene – A Look at Today’s Breakthrough Technology for Increasing the Odds of a Baby If your natural efforts haven’t worked and you’re ready to move on and give advanced reproductive technologies (ART) a trial run, you need to know how the procedures work so you’ll be physically and mentally prepared for it. How to Choose a Doctor The first thing you want to do is see your doctor and find out what kind of specialist he recommends that you go see. You want to see a fertility specialist (reproductive endocrinologist), not just an ordinary ob/gynecologist. Don’t just go to someone because your doctor, friend, or family member suggests them. Not everyone has the same needs and experiences, so you want to choose someone who’s right for you and your partner. Sometimes people (even doctors) recommend someone they happen to know – not necessarily someone that would suit your needs and interests most. Always ask why the person is recommended – is it because he or she is a member of a certain organization or is it because they have a reputation for having a solid success rate with infertile patients? You want a doctor who will do some preliminary testing to see what could be causing the delay in getting pregnant. You don’t want someone who just wants to try you out on different medications to slowly eliminate possible causes. Find out what timetable they have set up for their patients to try one method before moving on to something else. If a certain treatment isn’t working after four months, for instance, will he take a different approach? 117 Your personalities have to mesh well. You may not like a doctor who takes your case too seriously, preferring someone who can ease your fears and allay your anxiety. Or, you might not like a doctor who jokes around with a topic you’re taking very seriously. Any time you feel uncomfortable, it’s okay to move on and find a specialist that has the same approach you have in mind. You can find some specialists online at sites such as http://www.Resolve.org or http://www.inciid.org. These are great places to find others who are going through the same thing as you are. Treating infertility can be time consuming and costly, so weigh your options carefully. Of course your treatment will also depend on your reasons for infertility. You may feel like you’re on a roller coaster, moving from something as simple as blood tests and discussions about ovulation to injections and invasive surgeries. Clomid Can Sometimes Increase Your Odds of Conception Your regular ob/gyn may put you on Clomid before you even go to see a specialist. Clomid, or Clomiphene citrate, which is also known as Serophene, can help you release eggs and produce good eggs. Recent research however, has indicated that Clomid does not improve pregnancy rates unless it is specifically given as a treatment for ovulation issues. Some doctors will prescribe Clomid to patients who have “unexplained infertility” and in these cases, the latest evidence indicates it doesn’t improve the odds of getting pregnant. Clomid is usually taken for cycles of five days, beginning around day 3-5 of your menstrual cycle. You’ll probably start out taking one pill per day and then if nothing’s happened after one month, you’ll move up to 2-3 pills if you still aren’t ovulating properly. This drug tricks your body into thinking it’s low on estrogen, so the body counters by releasing GnRH, which creates more FSH. All of this works to help your ovaries produce more estrogen and stimulate a follicle to grow. Clomid has an 80% success rate in helping women ovulate. You’ll probably be asked to try Clomid for 3-6 months to see if it works. If it does, there may be a chance that you’ll conceive twins, or possibly triplets. The side effects can include hot flashes, headache, and breast tenderness. If you experience severe symptoms such as abdominal pain and severe bloating, you should call your doctor. 118 Unfortunately, Clomid does have some side effects which can impair fertility. It may have an adverse effect on your cervical mucus and cause your endometrial lining to be too thin. Letrozole – An Alternative To Clomid Letrozole, trade name Femara, is the latest drug being offered as an alternative to Clomid for ovulation induction. It is actually a drug developed to treat breast cancer, but since 2001 fertility doctors have been using it “off label” as an alternative medication to Clomid. Letrozole does not appear to have any negative effect on cervical mucus or the endometrial lining which is why it may be a better alternative than Clomid. There was some initial concern that this drug increased the risk for birth defects, but the research indicates that it is only related to birth defects when it is taken during pregnancy. Letrozole is a medication that is metabolized rapidly in the body. It is not thought to have significant levels in the blood or tissues for a prolonged period of time. Therefore, when taken to induce ovulation, it shouldn’t be in your system any longer at the time you were to achieve pregnancy. Minimally Invasive Treatment Options for Minor Issues If your partner’s sperm count is found to be a bit low, then your specialist will probably recommend artificial insemination in the form of an IUI (intrauterine insemination) cycle, where the sperm is delivered directly into the uterus via a threaded catheter. An IUI only takes a few minutes. Most women report that it isn’t painful – at least no more than a typical pap smear. Some cramping can occur afterwards, but it’s no more painful than during menstruation. Another option is for an ICI (intracervical insemination) to be done where they insert the sperm directly into the cervix. Sometimes you’ll be recommended to do more than one treatment at a time. Your partner’s sperm will be collected in a sterile container (or a special condom if your religion prohibits masturbation). Then the sperm is “washed” for an IUI, which means the sperm cells are removed from the seminal fluid and placed in a nutrient solution that may stimulate motility and enhance fertilization. 119 You only want to use these procedures when you’re sure your body has produced a good egg. To ensure this, your hormone levels will be monitored to see if your estradiol has risen to 150-300 pg/ml. You’ll also notice your LH surge right before the egg is released so that you can time the procedures just right. You’ll probably be asked to try artificial insemination 3-4 times while on Clomid before moving on to injectable infertility drugs. After four tries with injectables, it’s usually time to move on to IVF. Injectible Infertility Drugs After taking Clomid and trying artificial insemination, your doctor may have you start a round or more of injectible drugs. It probably sounds worse than it is if you’ve never done it before. The technique is called COH (controlled ovarian hyperstimulation), and it’s the injection of gonadotropins. These are what make your follicles grow, and since your follicles contain eggs, it is a major component of conception. Injections are sometimes a necessary evil in the race to conception. Pills such as Clomid have to pass through your digestive system and don’t get absorbed as well as a direct injection. Undergoing injections means going for more routine testing in the form of blood drawings and ultrasounds. You can either learn how to give yourself shots or have your partner learn how to do it. Most specialists have a video that shows you how to do it, and the nurses will walk you through it the first time. It takes some getting used to, but once you’ve done it a few times, you’ll feel like an old pro. Which drugs will you use? There are some choices. First you may want to determine if certain drugs are covered by your insurance, since many can be quite expensive. Price-wise, recombitant medications are more expensive but all are given subcutaneously. If needles make you cringe, then you may want to choose a subcutaneous medication. This simply means it can be injected into the fatty tissue just under the skin with a fairly small needle. Other shots require you to inject the needle deep into your muscle 120 tissue, which can make some people squeamish. These are called an intramuscular injection. Some women are even using pumps similar to diabetic pumps to deliver their hormones. Every 90 minutes it releases a small dose of GnRH. Your body reacts by producing LH and FSH and stimulating the ovaries to release an egg. You may also be injecting hCG (human chorionic gonadotropin), which matures your eggs and helps them get a release from the follicles. This, too, is an intramuscular drug but certain forms such as Ovidrel are now being released as subcutaneous. There are some side effects to injecting these drugs. Some women experience headaches, bloating, weight gain and mood swings. It’s a normal result of altering the hormone balance in your system. If you notice any of the symptoms below, call your doctor immediately: • Difficulty breathing • Increase in weight of more than 10 pounds in a short span of time • Difficulty urinating These symptoms may mean you’ve developed OHSS (ovarian hyperstimulation syndrome), which means your estradiol levels have risen to dangerous heights and you may need to be hospitalized. Sometimes booster injections are also necessary in the form of progesterone. This is a shot you give yourself after you’ve ovulated to make sure your progesterone levels stay high enough for implantation and maintenance of the pregnancy. These shots are also given intramuscularly. Implementing IVF Into Your Infertility Treatment In vitro fertilization is what many women consider to be bringing out the big guns to treat infertility. It’s not only high-tech, but it comes with a high price tag, so if you’re not covered under insurance, you may need to work out your finances before considering this option. IVF is when medical science uses a test tube to join your egg and your partner’s sperm, which is why it’s known as creating a “test tube baby.” While the rewards (a 121 baby!) may be great, there are some great drawbacks to IVF that you need to be prepared for. It’s not only an expensive option, but it’s time-consuming as well. If you hated the injection phase, then you won’t like IVF, either. Plus, you have to add on ultrasounds and more blood work to the mix. After undergoing all of this, you still won’t have any guarantee that you’ll have a baby in your future because IVF isn’t predictable. What worries most women is that they feel like after getting to this point, it’s the last hope. But in reality, you can always repeat your earlier options again, which often works for women who go through a second round. But you may find after IVF that you want to look at other options, like adoption or using a donor egg or surrogate. These are all options on the horizon if you choose to use them. IVF is actually only used by about 2% of infertile couples. The success rate is 25% for women under age 35 per IVF cycle. Once you reach 35-37 your chances are set at about 30%. It drops to 22% if you’re between 38 and 40, goes to 12% if you’re over 40 and after 45 you’re usually looking at donor egg options. The High Cost of IVF Each cycle of IVF can cost up to $10,000 or more. That probably doesn’t include blood work, drugs and ultrasounds, but each office is different, so check with the administrator. It’s a lot of money and time for many couples to invest. Insurance companies may turn you down for IVF coverage because it’s an expensive procedure that doesn’t have a high success rate, or that varies from one clinic to another. Sometimes your coverage will be partial. Your insurance may cover blood being drawn, ultrasounds, and certain medications. But then they won’t cover the actual procedures. Contact your insurance company ahead of time to find out where you stand in having to finance your infertility treatments. Some states mandate that insurance companies cover IVF treatments. The coverage may vary – for instance, West Virginia says insurers must cover infertility costs while Arkansas only requires coverage up to a $15,000 cap. There are some clinics that have an exchange program – you donate eggs to couples who need them in exchange for IVF treatment. The couple needing the eggs are the ones who will be paying the IVF costs for you. 122 For some reason, the more we spend on facing our infertility, the higher our expectations. While our hopes may rise a bit with an over-the-counter ovulation predictor kit, it isn’t nearly as emotional as when you undergo an IVF cycle and then find it didn’t work. Who Will Perform My IVF? How do you choose your doctor or clinic? Some women prefer to stay with their current specialist while others want to go somewhere where the procedure is common. Find out how many egg retrievals and embryo transfers the clinic does each year. Ask questions, and do your own research. The CDC publishes an annual Fertility Clinic success rate, and even though it runs a couple of years behind, the numbers don’t vary that much from year to year. You can access it here: http://www.cdc.gov/ART/ ARTReports.htm One of the most important factors in determining where you do an IVF procedure is the success rate of the clinic. Because this procedure is so costly, both mentally, physically and financially, it makes sense to invest in a clinic that will give you the highest chance of success. You would be surprised to find that there are great differences in success rates from one clinic to another. It might even be worth your time to travel to a clinic if you don’t live near one that has great success stats. Even though travel is another element to add on top of an already taxing procedure, it’s something you should consider if you are going down this road. What Happens During IVF? First you’ll be given a protocol, which is your particular blueprint for how the IVF process will be carried out. It will tell you what medications you’ll be on, and explain all of the procedures you’ll go through. Everyone will have a unique protocol, so don’t be tempted to go by what your best friend said she went through – study your own. Your first step will be in starting a cycle of drugs. Which drug you’re on will be determined by your age, your test results, and your ovulation circumstances. Sometimes the doses last 10 days and occasionally it goes up to 21 days. 123 After you’ve been on the injections for a few days, the clinic will probably ask you to come in for some monitoring so that they can see if your follicles are responding and if your estradiol is rising. If anything is amiss, they may change your medication or the dosage. You’ll usually be monitored every couple of days using blood and ultrasound and as you get closer to ovulation this may increase to every day. You have to take an injection of a drug called hCG approximately 35 hours before you go in to have your egg retrieval done. Your timing must be exact –if they tell you to take the injection at 2 o’clock in the morning, then make sure you do it at that precise time. When you go in for your egg retrieval, you’ll be given an IV after changing into your gown. They’ll go over your identity to prevent any mix-up with the eggs and then they’ll administer the medicine to make you go to sleep while the procedure is performed. The doctor goes in through your vagina with an ultrasound probe tipped with a needle. He uses the ultrasound to locate your follicles and punctures them to suck out the fluid, which is where your eggs will be when they look under the microscope. They’ll continue doing this until they empty the follicles – taking a total of 30-40 minutes. The embryologist will look for eggs that are round and mature. Even if the egg is immature, it might mature within 24 hours. During this entire process, your partner will be providing his semen sample. Sometimes they use frozen samples, but they always prefer a fresh batch if possible. That night, your eggs are incubated with your partner’s sperm in a petri dish. When the staff comes in the next morning, they check for fertilization. Frozen embryos are kept inside a liquid nitrogen tank temporarily until you’re ready for their use in a transfer. The embryologists will make sure they only transfer good embryos. You’ll usually find out the day of the retrieval how many eggs were viable and the next day, how many were fertilized. After a few days the embryos will be evaluated and your doctor will decide how many to transfer back into you. Any leftovers can be frozen and used at a later time if necessary. 124 The Transfer Process When the eggs are ready to be transferred, the doctor will make sure the lining of your uterus is ready to support the embryo. Anything over 7 millimeters is thick enough to allow the transfer to go forward. Some clinics conduct hatching techniques to help the embryo implant in the uterus. Assisted hatching is done the day of your transfer. They create a small hole in the shell of the embryo so that it can easily break through the shell and attach itself to the lining. Not all clinics do this. Ask whether or not your clinic will do a blastocyst transfer – where they allow the embryo to develop for five days and then choose the best ones to transfer. The success rate for this procedure is 70% compared to 50% with three-day IVF transfers. The downside is that by waiting until 5 days, sometimes the embryos that looked good on day 3, won’t make it until day 5. It is unknown whether these same embryos might have made it if transferred, as the environment in a woman’s body is much better for embryo development than the lab. You might be given a Valium as a sedative for the transfer, although it is probably not necessary. You lie down on the exam table with a full bladder. This enables the doctor to see your uterus better with the ultrasound. Again, they’ll verify your identity before the ultrasonographer places the probe on your abdomen so the doctor can see your uterus. The cervix is then washed and through a speculum, the catheter moves into the uterus and allows the embryos to be injected into the uterus. You may or may not be instructed to stay on the table lying down for about 20 minutes. Additionally, they may not allow you to do strenuous exercise, have sex, or lift anything heavier than 10-15 pounds. You will likely have to take progesterone injections after the procedure as stated above. Waiting after IVF Approximately 10 – 12 days after your IVF cycle is complete, you will likely take a blood test to determine if you are pregnant.. During the waiting period, you will probably have started wondering if your pregnancy has taken hold. This can be an emotional time. On one hand you’re happy that it’s over and on the other you’re anxious and worried that it won’t work – fearing what happens if it doesn’t. 125 Resist the urge to do a home pregnancy test. You may get a false positive or false negative. As stated, your clinic will conduct a blood test to see if you’re pregnant. If you are, some clinics will continue monitoring you to ensure the pregnancy sticks. They’ll monitor your hCG (pregnancy hormone) and progesterone levels to make sure the pregnancy is proceeding normally. What are the risks? Well, multiple births are common – by about 25%. That’s because 2-4 embryos are generally placed in the uterus during each cycle. There’s also a risk of ectopic pregnancy, where the embryo may implant in the fallopian tubes instead of in the uterus. The chance for ectopic pregnancy is twice what it is in non-IVF pregnancies. What if IVF doesn’t work? This is a personal choice. Many couples immediately sign up for round 2, while others move on to other means of improving their fertility. Don’t blame yourself – sometimes it just doesn’t work out the first time. It’s normal to grieve and feel angry about the situation. Make sure if your emotions are out of control that you take a breather from it all and recoup before you launch a new trial of attempting to get pregnant. Your doctor may recommend trying IVF for up to three times, back-to-back. If you and your doctor disagree about your future plans, you can always find a doctor who does agree with your stance. Assisted Reproductive Technology – Some Variations You may have heard about some other procedures similar to IVF, or that work hand in hand with IVF. Here is some brief detail on these: • ICSI (Intracytoplasmic Sperm Injection) - It involves injection of single sperm in to single eggs in order to get fertilization. It is used during an IVF cycle when severe male factor issues are present, such as reduced sperm count, motility or morphology. • GIFT (Gamete Intra-Fallopian Transfer) – It is a modified version of the traditional IVF technique. Instead of the fertilization taking place in a dish in the 126 laboratory, it occurs in the fallopian tubes, just like in a natural pregnancy. Both eggs and sperm are put into the fallopian tubes and conception happens naturally. • ZIFT (Zygote Intra-Fallopian Transfer) – It involves the transfer of embryos (zygotes) into the Fallopian tube 24 hours after fertilization. The aim is to achieve fertilization in vitro (in the lab), and then replace the early embryos in the fallopian tube, the normal site for fertilization. ZIFT offers the best of both IVF and GIFT procedures. It is suitable only for women who have at least one healthy fallopian tube. When to Say When Every woman and couple is unique in how much they’re willing to alter their lives to devote to fertility. Some will do whatever it takes for as long as it takes and let their physical and mental health take continual hits. Others have a line drawn in the sand and once it gets crossed, they sit down and make tough decisions about their future fertility efforts. There is no right or wrong answer. If you’ve been giving yourself injections for 6 months and you are emotionally breaking down from the physical endurance of it all, it’s okay to stop and try something different or take a break. You also have to tune into what your partner is undergoing because a man’s mental and physical health is at stake as well during this process. As a couple, come to terms with your blueprint for achieving pregnancy and find a common ground you can agree to on when it’s time to stop whatever it is you’re doing and take a different route to parenthood. 127 Chapter 9: Conception Isn’t One Size Fits All – Mapping Out Your Blueprint for Making Your Dream Come True Everything you’ve learned about improving your fertility has to be applied the way you feel is best. You don’t have to do something just because it worked for someone you know. I simply feel that women should have all options available to them and should know that sometimes it’s the simple things that can lead to major changes with regard to your fertility – things you can easily fix on your own without expensive procedures and doctor’s visits. When the day finally comes that you find yourself blessed with a baby, be sure to remember everything you went through and try to balance your excitement with empathy for those still struggling to find the right answer. You, like me, may experience the ups and downs of discovering you’re pregnant – only to end up losing the baby after several weeks of joy and bliss. When I look at my children, I am so glad that I discovered so many treatments to try and that I endured the emotional roller coaster that allowed me to eventually end up a mother after numerous obstacles. As you set out on your own personal path to pregnancy, remember that all of the advice in the world won’t be the answer to your hopes and prayer unless you follow through on what you feel is best for your body. 128 Through it all, make sure you take care of yourself as you dedicate your life and your time to finding your fertility. Ignoring your own needs won’t help you get pregnant any faster – and in fact it may delay the process. I wish you all the success in the world with your present and future journey and I welcome each and every one of you to share your thoughts and success stories with me so that others can learn what may work for them and deliver a bundle of joy to their waiting arms one day. The statements regarding any natural or herbal products have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. The information on my website or in this e-book is designed for informational purposes only and is not intended to take the place of medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your doctor. 129