Stress and fertility

Stress interferes with fertility because when you’re experiencing chronic stressors, your brain produces more hormones like cortisol and epinephrine, which can interfere with your ovulation. More importantly, stress can impact other factors such as weight problems, sleep deprivation, and lack of sex drive. All of these can significantly interfere with fertility and make conception more difficult, which is where yoga comes in play.

Yoga and other athletic pursuits are an important part of weight and stress management, which in turn, can lead to higher fertility rates and greater chance at conceiving. The stretching and breath techniques practiced during yoga can help relieve stress by releasing endorphins, your body’s “feel-good” hormones.

Physical benefits of yoga

• Slow your mind and release stress and tension: Practicing gentle yoga such as Hatha or Kripalu once a day, alongside other activities such as meditating, allows your body to get rid of all your daily stressors and increase wellness.
• Strengthens your pelvic floor: These muscles are essential for pregnancy and even your sex life. Squats are a good way to help tone these integral muscles.
• Aligns your hips, pelvis, and lower back: Positions such as bridge facilitate lower body alignment and stimulates your endocrine and immune systems.
• Brings you closer to your partner: Yoga can wring out your insides and release emotion, helping connect and build emotional and physical strength with your partner.

Read more

• 5 herbs to boost fertility
• Can fertility supplements help me conceive?

Sources

• Smith C, Hancock H, Blake-Mortimer J, Eckert K. “A randomised comparative trial of yoga and relaxation to reduce stress and anxiety.” Complementary Therapies in Medicine. 15(2):77-83. Web. June is 7, 2015.
• Gyorgy Csemiczky, Britt-Marie Landgren, Aila Collins. “The influence of stress and state anxiety on the outcome of IVF-treatment: Psychological and endocrinological assessment of Swedish women entering IVF-treatment.” Acta Obstetrica et Gynecologica Scandinavica. Volume 79, Issue 2, pages 113-118. Web. December 24, 2001.
• Louis GM, Lum KJ, Sundaram R, Chen Z, Kim S, Lynch CD, Schisterman EF, Pyper C. “Stress reduces conception probabilities across the fertile window: evidence in support of relaxation.” Fertility & Sterility. 95(7):2184-9. Web. June 11, 2015.

Ever wondered, “What’s the difference between an STI and STD”, “Is HIV the same as AIDS” or “What’s a finger condom”? Rather than taking the query to your search bar, keep reading.

What you should know about sexually transmitted infections (STIs)

Below, you’ll find definitions of all the terms in the sexually transmitted infection lexicon you could possibly need to know, broken down by categories.

First, what’s the difference between an STI and STD

STD: STD stands for sexually transmitted disease. Disease implies symptoms. So, sexually transmitted infections are only diseases when there are symptoms (for example: bumps, itching, or discharge) present.

STI: The now-preferred term in the sexual health space, STI stands for sexually transmitted infection. The switch from disease to infection took place to reduce stigma around these infections and to acknowledge the fact that the majority of these infections are asymptomatic.

All STIs are either curable or treatable

Curable: A curable STI is an STI that can be cleared up completely with the proper medication. Curable STIs include: gonorrhea, pubic lice, chlamydia, syphilis, and trichomoniasis.

Not only can curable STIs be cured, but they should be — leaving an STI untreated puts you at risk for things like pelvic inflammatory disease, infertility, and even death in the case of syphilis. That’s why it’s so important to get tested after every new sexual partner. And, if positive to talk to your provider and come up with a cure plan.

Treated: STIs that cannot be cured can be treated. Meaning, the symptoms associated with that STI can be managed with the help of lifestyle changes, and/or medication. Treatable STIs include: HIV, HSV, and HPV.

An example of treating — but not curing — an STI, might include taking valacyclovir or acyclovir, an oral antiviral medication that can either be taken daily (suppressive therapy) or at the first sign of outbreak (intermittent therapy). What makes most sense for you will depend on factors like cost and frequency of outbreaks. Because research has suggested a link between the number of outbreaks in HSV-positive people and stress, managing stress levels is another example.

Types of sexually transmitted infections, explained

AIDS: Also known as HIV Stage 3, AIDS (acquired immunodeficiency syndrome) develops when the HIV virus severely damages a person’s immune system.

In the U.S., most people who are HIV-positive never develop AIDS because they’re on medications that prevent the infection from progressing to AIDS. Due to lack of access, globally AIDS is much more common, but numbers are dropping.

Chlamydia: Caused by a bacteria, chlamydia is a curable STI that infects 4 million Americans each year, the majority of who are under 25 and women.

When symptoms appear, they usually include abnormal discharge, pain or frequent urination or bleeding after sex and/or between periods — but chlamydia is usually asymtomatic. The infections and accompanying symptoms can be cured up with proper antibiotics.

Crabs: Also known as pubic lice, crabs are itty-bitty parasites that feast on blood that are found on pubic hair (and other course body hair). Typically, crabs are transmitted during intimate contact between the pubes of a person with crabs and the pubes of someone else.

The most common symptoms of crabs is genital itching, but you may also be able to see the white-colored, micro-crabs crawling around between your legs. Crabs can be cured through special over-the-counter creams or shampoos. Important: Because crabs lay eggs (known as nits), after treatment then nits need to be removed with fingernails or comb.

Genital Warts: Genital warts are fleshy skin tags caused by a few strains of HPV (see “HPV” below). These contagious warts may be accompanied by itchiness, but can be treated with topical medication or by being removed by a healthcare provider.

Gonorrhea: Also caused by bacteria and also curable, gonorrhea is an infection responsible for half a million new STI cases in the United States each year.

Much like chlamydia, gonorrhea is hard to recognize due to its often asymptomatic nature. But, when symptoms do pop up they usually include: genital itching, bleeding, abdominal pain, abnormal genital discharge, and soreness and sore throat. To diagnose and get the medicine that will eliminate the infection from your body, go to your local walk-in clinic or healthcare provider.

HIV

Short for human immunodeficiency virus, HIV is a viral infection that attacks the body’s immune system making it hard for the body to fight any other infection, including common, everyday viruses. Wrongly known as a gay man’s virus, HIV is an STI that can affect all people.

Hepatitis A

A contagious viral liver infection caused by the Hepatitis A virus, Hepatitis A typically clears up on its own within a few months. Hepatitis A is not just sexually transmitted — it can also be transmitted through contaminated foods.

Hepatitis B

Hepatitis B is a contagious viral liver infection caused by the Hepatitis B virus that can be transmitted via exposure to the bodily fluids of an infection person. The difference between this form of Hepatitis, however, and the others is that Hepatitis B can be prevented with a vaccine.

Hepatitis C

Hepatitis C is a viral liver infection that can be spread through blood, breast milk, or pregnancy. Untreated, the infection can become life-threatening. But diagnosed and with proper treatment, the infection can be cured 90 percent of the time.

HPV

With more than 100 different strains, human papillomavirus (HPV) is the most common sexually transmitted infection in the world. Symptoms, long-term health risks, and treatment vary strain-by-strain.

HSV

Better-known by its full name, herpes, HSV is a lifelong viral infection caused by the herpes simplex virus that can be managed with proper care.

There are two distinct strains of the herpes infection: HSV-1 and HSV-2. Often, these are incorrectly re-named as “oral herpes” or “genital herpes” but both strains can affect areas like the vagina, anus, penis, or mouth.

Molloscum Contagiosum

Molloscum contagiosum is a viral infection spread through skin-to-skin contact, that causes benign bumps along infected areas. Sometimes the bumps will fade away on their own, other times they are removed through cryotherapy, laser therapy, or topical therapy with the help of  a healthcare professional.

Trichomoniasis

Often called “trich”, trichomoniasis is a sexually transmitted infection caused by a parasite that can be cured with a dose of antibiotics. Symptoms are trichomoniasis are rare — especially in people with penises. But when symptoms do appear, they often include discharge, genital itching, and pain while urinating.

Syphilis

Syphilis is a progressive bacterial infection spread through sexual contact. The symptoms of the infection vary based on how long it’s been in your system, and range from a skin sore to fatigue and fever to liver dysfunction. If caught early enough it can be cured with a single shot of penicillin, but left untreated for too long the infection can spread to the brain and other organs, becoming life threatening.

Barrier methods and birth control

Here’s some information on protection options people can apply to help stay safe during sex.

Barrier

Barrier is the general terms for a physical barrier that is designed to prevent direct skin-to-skin contact or fluid exchange during a sex act. Most common is the external condom. But there is also the internal condom, dental dam, glove, and finger condom.

Occasionally, certain birth control methods which do not prevent skin-to-skin contact or fluid exchange, but are highly effective at preventing a sperm from meeting an egg during vaginal intercourse — the sponge, cervical cap, diaphragm, and spermicide — are also qualified as a barrier.

Birth Control

Also known as contraception, birth control is designed to help prevent unwanted pregnancy. There’s a variety of different types of birth control options, which all function differently as well as feature  slightly different levels of effectiveness.

Condom

There are a few different types of condoms: finger condoms, internal condoms, and external condoms. But typically when people say “condom” they’re referring to the external variety. (See: “external condom” below).

Dental Dams

Dental dams are sheaths of latex designed to prevent direct contact between a mouth and an anus or vagina, and therefore reduce the risk of STI transmission.

External Condoms

External condoms are tight latex, polyurethane or polyisoprene tubes designed to go over a penis during vaginal, anal, or oral intercourse to protect against STI transmission and/or pregnancy. They are also often used on dildos and other pleasure products to increase ease during clean-up as well as to allow for sex-toy sharing between non-fluid-bonded partners.

Finger Cots

Sometimes called finger condoms, finger cots are micro-sized external condom designed to fit over a single digit. While most commonly worn by doctors sporting paper cuts, they can also be warn during vaginal or anal fingering to keep from or reduce the risk of STI transmission.

Fluid Bonded

Refers to sexual partners who have intentionally decided to forgo barriers and exchange bodily fluids during sex. Prior to becoming fluid-bonded, sexual partners typically discuss current STI status, potential risks, pregnancy prevention (if applicable), as well as relationship rules moving forward.

Internal Condoms

Formerly known as female condoms, internals condoms are soft, long tubes that are designed to line the vaginal or anal canal in order to prevent fluid exchange or skin-to-skin contact during vaginal or anal sex. Bonus: They are typically made out of nitrile as opposed to latex, making them a great alternative for those with latex allergies.

PEP

Post-exposure prophylaxis is a series of pills someone who was (or may have been!) exposed to HIV can begin taking up to 72 hours after exposure to prevent transmission of the virus.

PrEP

Pre-exposure prophylaxis, as the prefix suggests, is a daily oral medication that can be taken by an HIV-negative person at risk of coming into contact with the virus, in order to greatly reduce the risk of the virus being transmitted.

Reviewed by the Ovia Health Clinical Team

Sources

• “Chlamydia – CDC Fact Sheet (Detailed).” January 19, 2021. Centers for Disease Control and Prevention (CDC). CDC. January 19, 2021. https://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm.
• Cohen F, Kemeny ME, Kearney KA, Zegans LS, Neuhaus JM, Conant MA. Persistent Stress as a Predictor of Genital Herpes Recurrence. Arch Intern Med. 1999;159(20):2430–2436. doi:10.1001/archinte.159.20.2430. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485171.
• “Sexually Transmitted Diseases.” National Institute of Allergy and Infectious Diseases. NIH. August 6, 2015. https://www.niaid.nih.gov/diseases-conditions/sexually-transmitted-diseases.

Here’s the latest from the Ovia Health Clinical Team, including answers to your questions and some practical guidance. 

If I’m pregnant and I get COVID-19, will the infection be worse?

It’s possible. Research indicates that pregnant people and recently pregnant people (within 42 days of giving birth) are at higher risk for significant complications from COVID-19 than their non-pregnant peers. This means that while the overall risk for severe illness is low, there is an increased risk of hospitalization, intubation and mechanical ventilation, blood clots, and requiring intensive care. There is also an increased risk of adverse pregnancy outcomes, including preterm birth and possibly an increased risk of pregnancy loss when compared to pregnant women who did not get COVID-19. 

These risks are compounded for Black pregnant people, who have long experienced nearly twice the risk of preterm birth when compared to white people. Many studies have demonstrated that race is likely an independent risk factor when it comes to healthcare outcomes like preterm birth, separate from other risk factors like income or education. That race-related risk may stem from chronic stresses of societal racism as well as the race-related inequalities that have been identified within the healthcare system. 

Pregnant parents who test positive for COVID-19 should be offered a discussion about the medication Paxlovid. You can read more about that here.

What can I do to prevent infection?

Prevention is no different for pregnant people than it is for anyone else. Follow the advice that you receive from your local health department, from the CDC, and from your healthcare provider. Avoid going to public places if you think or know you have COVID-19, to prevent spreading it to others. 

If you know local rates of Covid are high, wear masks when indoors and practice social distancing. Being vaccinated has been shown to provide protection against severe COVID-19 disease. However, you can still get sick and pass the illness on to vulnerable people who aren’t vaccinated or cannot be vaccinated (like newborns).

Is hand sanitizer safe in pregnancy?

Yes, Yes, YES. The CDC reports [3] that handwashing with soap and water is more effective than hand sanitizer. However, you can’t take the sink in your car or on a walk or to the grocery, so make sure you use hand sanitizer regularly in addition to handwashing. Furthermore, it’s often much easier to wipe hand sanitizer on your children’s hands than it is to get them properly washed, so consider this a regular habit as well.

If I get COVID-19, will I pass it to my fetus?

The most recent research on the topic says that transmitting COVID-19 while pregnant is very rare – for moms in North America, the rate was about 0.1%. This does not include the risk of passing it to your newborn during routine care postpartum. However, studies suggest that people who tested positive for COVID-19 during pregnancy are more likely to have complications, such as preterm birth [6]. There is no evidence that cesarean delivery reduces the risk of infection for Baby, so this is not recommended.

What about during and after birth?

It is extremely important that you call your healthcare provider before you go to the hospital if you think you have COVID-19. Once at the hospital, your provider knows what to do to reduce the risk that your baby (and the healthcare professionals who care for you) will become infected.

Keep in mind that testing positive for COVID-19 when in labor may cause changes to your birth plan and hospital stay. You may want to consider extra precautions in the last weeks of pregnancy to avoid this.

What is the risk to my baby? And what about the risk to my other children?

Children seem to be at less risk of becoming really sick with COVID-19 than adults are, but infants make up the bulk of serious cases and hospitalizations in children under 17. Current evidence suggests that babies are not likely to get COVID-19 from their mothers as long as preventative steps are taken, such as wearing a mask around your baby, washing your hands for 20 seconds prior to holding your baby, and having them sleep 6 feet away from you. You should still do everything you can to reduce the risk of exposure. Children with certain underlying conditions are at risk for complications from COVID-19, so it is important to keep them safe and communicate with their pediatrician.

Is breastfeeding safe if I think I have COVID-19?

There are many benefits to breastfeeding for parents and babies. It appears unlikely that COVID-19 can be transmitted through breast milk, though helpful antibodies can be passed along! 

If you test positive for COVID-19, this may impact the care of your newborn. In-hospital, the CDC recommends discussing with your provider the risks and benefits of caring for your newborn while sick. Mildly ill people generally room in and care for their newborns. If you are seriously ill, this may not feel like a physically possible or safe option. Once you are home, wash your hands frequently — and always before touching your baby. Wear a mask when you are within 6 feet of your baby or another person. If you have a caregiver who lives with you, they should also wear a mask whenever caring for your baby.

We know that with other illnesses, you pass antibodies to your baby through your breast milk. Antibodies are what your body makes to help fight off illness. The research into COVID antibodies in breastmilk is really encouraging and suggests that antibodies are passed through breast milk after infection or vaccination. 

What if I’m trying to conceive and not yet pregnant?

There’s no evidence that COVID-19 or any similar viruses impact conception or cause birth defects if you are sick when you conceive.

Should pregnant people get the COVID-19 vaccine?

Multiple well-respected clinical organizations, including the ACOG (the American College of Obstetricians and Gynecologists) and the ACNM (American College of Nurse-Midwives), recommend the vaccine to people who are trying to conceive, pregnant, and breastfeeding [11].

The first clinical trials for the COVID-19 vaccines manufactured by Pfizer-BioNTech, Moderna, and Novavax did not include participants who were known to be pregnant or breastfeeding. This is typical for pharmaceutical research. Recent studies have included pregnant people and show that there is no increased risk and that vaccines given in any trimester do not negatively impact pregnancy outcomes. In addition, vaccinating in the second or third trimester may offer additional protection to your newborn.

Additionally, none of these COVID-19 vaccines contain a “live” virus. This means you cannot get COVID-19 from the vaccines. In general, vaccines that do not contain “live” viruses are safe during pregnancy and do not have increased risks for infertility, miscarriage, fetal anomalies, or stillbirth. Side effects of the COVID-19 vaccines include pain at the site of injection, fever, fatigue, and chills. These typically go away after a couple of days. These side effects are normal and expected and are indicators of your immune system doing its job to learn to protect you from the virus. There have been very rare reports of unexpected, adverse reactions from the vaccines. A severe allergic reaction called anaphylaxis can happen in very rare cases. The incidences of these adverse events are so low that getting vaccinated remains safer than potentially getting infected with COVID-19. [12].

You can also reach out to the experts at Mother to Baby for more information. Your midwife, doctor, or other healthcare professional is also a great resource for more information about the COVID-19 vaccine. Ultimately, you are the one who knows what is best for your body and your family.

Reviewed by the Ovia Health Clinical Team

Sources:

Dara D. Mendez, Vijaya K. Hogan & Jennifer F. Culhane “Institutional racism, neighborhood factors, stress, and preterm birth”. Ethnicity & Health. 19:5, 479-499. October 18, 2013.

Jasmine D. Johnson et al., “Racial Disparities in Prematurity Persist Among Women of High Socioeconomic Status,” American Journal of Obstetrics & Gynecology 2. 2(3), 100104. Nov 10, 2020

James W. Collins Jr et al., “Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination,” American Journal of Public Health. 94(12), 2132–2138. December 2004.

Braveman Paula, et al. “Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes” Frontiers in Reproductive Health. Vol. 3. 684207 September 2, 2021.

How long does it take (on average) to get pregnant?

Many factors can influence how long it takes to get pregnant, including your cycle, general health, fertility conditions, age, and lifestyle.

Getting pregnant faster

Although it takes the average female up to six months to conceive, there are ways to improve fertility health and reduce time to pregnancy. Staying healthy through diet and exercise and taking folic acid supplements can greatly increase your chances of conceiving, relative to those who don’t do these things. Individuals who track their fertility data to pinpoint their ovulation are also able to speed up their time to conception. Even your mood might help with your fertility: some studies have found that happier emotional states correlate with faster conception.

How long is too long?

Although any female without a condition of infertility or sterility can get pregnant naturally before menopause, some may take a bit longer than others. Doctors recommend that couples who have not conceived after one year of trying seek a fertility consultation to determine if an alternative route to conception might be explored, whether it’s in vitro fertilization (IVF), surgery, or fertility medication. It’s recommended that women over 35 should seek a fertility consultation after six months of trying.

If you have any questions about trying to conceive or your fertility health in general, don’t hesitate to reach out to your healthcare provider for more information.

Read more

• Does pregnancy loss impact future conception?
• Trying to get pregnant for more than a year

Sources

• Dr. Walter Willett. “Nurses’ Health Study II.” National Institutes of Health. United States, 1989-. Web.
• “Nutrition During Pregnancy: FAQ001.” ACOG. American College of Obstetricians and Gynecologists, 4/15/2015. Web.

Gina Nebesar, Co-Founder of Ovia Health

I was so excited to speak with my two dear friends Becca and Jean Ann recently. Just this year they started on the crazy journey that is parenthood with their beautiful baby girl, Roz. They’re total badasses at home and at work, they’re incredible people, and now they have this gorgeous family. Their TTC journey took them a little while, and IVF helped them get pregnant, and I’m really grateful they could share their story – including incredible advice about choosing and buying sperm, real talk about IVF shots, and really candid conversation about adjusting to life as new moms.

IVF success stories: Two moms talk about growing their family… and how

I want to start by saying congrats! I know you just celebrated your 5 year anniversary, a big milestone. And an even bigger milestone is the birth of your baby girl! I’d love if you could start by telling us a little about your beautiful family.

Becca: We did just celebrate our five-year wedding anniversary, and in April we had our baby girl Roz. She’s almost 5 months old. And it’s been great so far!

I just left town for the first time, and left her alone this weekend with Jean Ann, her other mom. And in that 48 hours she learned how to roll over, without me there! And now she sleeps on her stomach, so I came home to a totally different baby. But I feel like she’s changing every single day, so it’s really awesome.

I love hearing about how people make the decision to start a family. Could you tell us a little bit about your journey to becoming parents?

Jean Ann: Because we’re two women, one question that I asked a lot is how we decided who will carry. And when your partner basically says, “One thing I’ve always wanted to do in my life is be pregnant and give birth, like, totally unprompted,” you’re like, “Cool, that seemed too easy.” Becca had always wanted to do that, and I’m still sort of on the fence – it doesn’t seem like something I have to do. So Becca had decided that she was excited about that a few years ago, and eventually I got more excited about it.

The first thing we had to do was choose a sperm donor. That was probably one of the biggest decisions we’ve ever made. Because you have to decide if you want an anonymous donor or someone you know. And we actually had a good friend who offered. And we took it pretty seriously, but ultimately decided it was important for us to have our own separate family unit. So then we looked at a lot of the websites for sperm. It’s basically like a KAYAK for sperm, and you can sort for different things.

Becca: It’s almost like online dating!

Jean Ann: We wanted someone that hopefully shared a lot of my characteristics. So were able to find someone who was half-Asian, he was getting a graduate degree in chemistry. We could even listen to a 45-minute interview with him where he talked about his favorite books, and he just seemed very thoughtful, quiet, serious, and nice.

Becca: We spent a lot of time looking for sperm – really thinking about these profiles and listening and narrowing it down. I remember we had all these pieces of paper on the kitchen table – we had written down the different donor numbers and which ones we liked – and then we narrowed it down.

And we actually had kind of had a long journey. It was about two and a half years from buying sperm until having Roz. Buying the sperm was step one. I remember, they were having an end-of-year sale, so we had to get it in before the end of 2015!

Were they really? Like, they were really having a sale?

Jean Ann: Yeah, it’s expensive. It’s something that there’s a lot of in the world, but it’s not cheap!

Becca: Well, it wasn’t quite a sale, but they were like, “We’ll throw in an Amazon gift card if you buy today!”

Jean Ann: “And three years of free storage!” But, yeah, we’ve actually spent several thousands of dollars on sperm, if you can believe it.

So, obviously, you found a great deal, but how did you get started with that process?

Becca: Really, we just Googled.

Jean Ann: There’s three or four big sperm cryo websites.

Becca: The one we went with is called California Cryo, one of the largest ones. For us, they felt right— it was a good website experience, and their customer service has been great. We did look at the big ones, some other small ones, and some local ones.

Jean Ann: But I think, for us, wanting a donor who was half-Asian like me was important, and that actually narrowed it down a lot. It went from like 550 to like, eight.

Becca: So then we could spend our time kind of really thinking through those people.

Jean Ann: You can definitely get a situation where there’s a run on the sperm. So we had this total disaster about a year later, where we had used up half the vials that we’d bought, and we were getting really low, and we went online, and they had sold out! And the donor had stopped donating! So we recommend you check what’s in stock a lot.

Becca: Yes, check frequently! And if you can afford it, buy more than you think you need.

Jean Ann: Buy a lot!

Becca: Because you can store it, and you can sell it back if you don’t need it.

Jean Ann: Nothing is worse than the feeling of having decided on someone to be your sperm donor and being very excited about them, and being halfway through the journey, and then realizing that if you want to have more than just one kid that you’re going to run out of sperm.

Becca: You’re going to run out and you may have to use different sperm.

Any other advice about that process for others that are just starting out with sperm donation?

Jean Ann: Just check your sperm stock frequently. And if you’re really excited and settled on someone, I would buy more than you need or just be willing to have a weekly reminder to check that it’s not running out.

Becca: I think the other thing is I would pony up for the extra access to information. Because I think, for us, the interviews with the sperm donors, that was the most impactful. You can only tell so much from a baby picture and some  generic likes and dislikes – which is the basic info you get – but I actually think you can get a pretty good feel for a person from something like an audio interview. It’s like a typical website where it’s like, “Pay to unlock this feature!” but it’s worth it to pay for that premium membership.

So, in December 2015, once you made that decision about your donor, how did things progress from there?

Becca: So that winter when we were back home from the holidays, we started trying to get pregnant, and we were doing IUI.

Jean Ann: You basically have two options, you can do IUI or IVF with donated sperm. IUI is basically artificial insemination.

Becca: Turkey baster!

Jean Ann: The turkey baster method, but at a facility. So we started with IUI.

Becca: I actually got very lucky with the first IUI try in February 2016. I was tracking my ovulation – I was using the Ovia app – and I was peeing on sticks and all of that, and when my ovulation test said I was ovulating we went in for the IUI, we did IUI, and I got pregnant that very first time. And it was amazing! We were so excited! First try!

And then in the spring at about 12 weeks I had a miscarriage. So I got almost through my first trimester, and I had a miscarriage. That sucked, that was a setback and sad, and that was really hard.

So the summer of 2016 was kind of recovering from that, and then it takes a while to get back on track, especially when you have a miscarriage when you’re that far along there’s a lot that your body has a lot to process and then re-regulate. And then we didn’t have a chance to try again until September of that year. So we got back on the horse and started trying again. And we were gonna continue to do IUI at that same facility because it had worked that first time.

And I started tracking my ovulation and going back in monthly, but something was wonky with my cycles. I would think I was ovulating, but I would go in and I wasn’t ovulating. I think one or two times we did get an ovulation, and we tried, but I didn’t get pregnant.

Jean Ann: And that’s when we started running out of sperm. And we realized that there wasn’t more. So that’s when we panicked, realized we couldn’t get anymore, and so we decided to move to IVF. But neither of our insurances, we thought, really covered IVF.  We were both on my insurance, and it wasn’t explicit. It was basically like, “Your IVF is covered, if it’s for a medical reason.”

Becca: “Medically necessary.”

Jean Ann: Yeah, “medically necessary,” that’s the phrase that’s used – and so I went down this whole rabbit hole to figure out if that means coverage if you’re gay. It took forever. But basically, no, being gay was not a “medically neccessary” reason, so it wouldn’t be covered. So I fumed about this for a while.

And then I ended up talking to our company’s head of HR kind of randomly about something else, and I just kind of mentioned this to her and didn’t expect it to go anywhere—I just figured this would sort of take some kind of lawsuit situation to change it— but she was like, “Oh, really? I didn’t know that!” Then two days later somebody that worked for her called and they were like, “Oh, we added it for same-sex couples to our insurance, so it’s covered now!” So I guess some advice would be to know that in terms of your health insurance, you may be able to change the coverage for something like this, depending on your company.

I constantly tell women to ask for those benefits, because they might end up with that exact same story. I was in a meeting recently with a health plan and an employer where we we pointed out in the language of the plan how it was alienating to same-sex couples. And the woman didn’t even realize it and was like, “I’ve gotta change it!” She had just never read the fine print before, but then took action to change it as well. I’m so glad that you asked about it, and I wish more people would!

Becca: Yeah, it was pretty awesome. So, we started IVF in the summer of 2017, and there’s a whole series of tests and all sorts of painful things they need to do to make sure you’re ready for it. And that takes months— you have to wait a few cycles, you have to get on the right timing. So I remember this being such a frustrating time in our lives. It felt like everything was going slowly and like everyday I had to be at the doctor doing some other painful thing. It was a rough period. It is funny now looking back on it, because it all feels like such a blur in retrospect, but at the time it felt really pronounced and painful.

Jean Ann: As someone that has now done IVF three times myself – and Becca has done it once – it’s not as bad as people think it is. It sucks giving yourself the shots, but it’s fast. It’s like a two week period of shots.

Becca: At this point we’ve both done it, because as the journey continues, we ended up having a baby and decided that we wanted to at least give ourselves the option to having another baby in the future with Jean Ann’s eggs.

Can you share more about that experience and what it’s like? Again, I’m sorry to hear about this part of the journey. I just can’t imagine having the 12 week miscarriage, that’s just awful, and the fear of the sperm running out, and then going through the pain of IVF. And I know you say it’s not that bad, but I think maybe you’re just tougher than many – that sounds really hard to me!

Becca: Honestly after being pregnant for nine months, you can barely remember the IVF, it’s like a blip. But I think that the shots – for us at least – I think the shots look scarier than they end up being.

Jean Ann: I feel like the first and second time you’re really just like, am I really going to stab myself in the leg with this needle?

Becca: The thought of it is tough. The first time is the hardest, because you’re just staring at this needle and you’re like looking at your leg, and you’re just like, so I’m really just going to push this in, huh? But it’s a needle, and it’s made to go in. I actually think over the two week period of shots, it gets progressively more painful toward the end. So the last few days are the worst. I think at that point you’re feeling a little bit bloated, you’re not allowed to go to the gym, you’re giving yourself shots every single night. For some reason those last few nights hurt the worst. At that point you’ve shot yourself everywhere on your legs, everywhere on your stomach, and you’re looking for a new spot. So those last few nights, you just want it to be over.

Jean Ann: And then you have the trigger shot, and everybody makes a big deal of the trigger shot. Somebody else gives you that one, and it has to be at an exact time – like, 1:45 in the morning, 10:30 p.m. – so when you go in to have your eggs be retrieved, it’s exactly 36 hours after the trigger shot.

Becca: And then for the egg retrieval process you do go under.

Jean Ann: Under some very temporary anesthesia. You’re all the way under, but it’s very short. And then you’re done!

Becca: And then there’s some anxiety as you wait to hear your egg count. For us we were doing embryos, so right when they retrieved the eggs they fertilized them with our frozen donor sperm. So after that you’re kind of waiting on eggshells – no pun intended – to hear how many of your embryos made it to day 3 or day 5, or just what the status of them is. And we’ve been on both sides of the spectrum. For me, I was really fortunate, I had a pretty high egg count, and with just one retrieval I got enough embryos that we felt comfortable and were able to freeze them. For Jean Ann, on her first and second try she didn’t get that many, and so she’s had to go through the egg retrieval process three times now.

Jean Ann: I will just add that for anybody that’s getting close to age 35, 35, you can get a blood test that will give you your AMH number. It basically tells you how many eggs, roughly, you have left. It’s a very good indicator or whether IVF is going to be a breeze and you’ll just have to do that once, or if your egg yield is going to be low and you’re going to have to do it multiple times like me. It is also a good predictor of if you will have to do IVF at all because the same number is also a good indicator of whether or not you will naturally be able to get pregnant. It’s a very easy first step.

Did you know about this AMH (or Anti-Mullerian Hormone) test before starting the IVF process, or did you learn about that after?

Jean Ann: Actually, someone at work told me about it. Because I was like, “I don’t think I want kids for a few years,” and this very matter of fact 40 year old man was like, “How old are you?” And I said, “35.” And he was like, “Just go get your AMH number. My wife had a low AMH number and it took us 5 years of trying and then we ended up adopting.” I was like, oh, my gosh!

And then I got the test, my AMH number was bad, and, indeed, it took me multiple times to do IVF. So I feel like this AMH blood test is pretty much free information.

A lot of healthcare providers might say no to that sort of testing, but I always suggest that people go to their provider and just insist on it. So, through this process, who was supporting you along the way? Obviously, you had each other. Was there anyone else in your life who was particularly helpful during this time?

Becca: Each other, for sure. I’m not a big oversharer, but it’s been really helpful for me to share, because what I’ve found is that as soon as I start talking about it, everyone has either a similar story themselves, or their friend does, or their sister does. So when I had my miscarriage, it was really helpful for me to tell people about it – even at work – and then people would share these success stories, and that made me feel better. And it was similar when going through IVF. I would talk about it with my friends, and they all had someone they knew who had been through it. At the time, I was really the first of my very good friends who was having a lot of trouble getting pregnant, and I felt a little bit alone, so their IVF success stories were helpful for me.

Jean Ann: But since then, now we know several people who’ve been through this.

Becca: We know people who’ve had miscarriages, been through IVF, and now I’ve been able to help them because we have this success story. So, for me, I would tell anyone who’d listen! And that helped me a lot.

Jean Ann: Then you had a pretty good pregnancy.

Becca: Yeah, and the IVF really worked well for us. We did an egg transfer, and I got pregnant on that first one, and then I had a pretty good pregnancy.

Jean Ann: And you have to give yourself these progesterone shots for the first 12 weeks.

Becca: No one talks about this!

Jean Ann: No one talks about this, but these are actually really terrible shots. And every night for the first 12 weeks that you’re pregnant—

Becca: You give yourself a progesterone shot in the butt.

Jean Ann: That was probably the worst part.

Becca: I think some doctors will allow you to do a suppository instead. So I went, like, running in after three nights of shots and was like, “Give me the suppository!” And they were like, “No, we highly recommend the shots.” They wouldn’t do it. So you’re giving yourself shots for 12 weeks. So much worse that the two weeks of IVF shots! It’s so much longer! So you’re basically so sore in the butt for the entire first trimester. But once we got through that, things were okay.

Jean Ann: Smooth sailing.

Becca: Yeah. I had a lot of heartburn, and that was my main symptom really.

Jean Ann: Then because you were a geriatric pregnancy, they told us that they wouldn’t let you go past one week over your due date. So we got an induction date for almost a week past your due date.

Becca: Yeah, 5 days past my due date they scheduled us for an induction. We went in, I got induced, and like these things do, it took forever to get a room, it took forever for the induction to start.

But then, like, once it started, it really started.I had pretty strong contractions for a long time, for like 15 hours. But I really wasn’t dilating. So, it was kind of sad, I kept having these big contractions and the doctor would go away and then come back a couple hours later to check my cervix and every time I was like, “Oh, I think I’m making progress!” and then she would check and be like, “Nope, still 3 cm. You’ve barely made it to 4 cm.” So I just wasn’t dilating. And then at some point, in about hour 16 or 17 of labor, I got a fever, and they said we’ve got to do a C-section. So we went in on a Thursday night, that Friday night at 11:30 p.m. she was born via C-section. And she was great!

Jean Ann: There’s so much pressure to not have a C-section and to be able to breastfeed right away and all this stuff, and, like, if you walk out with a healthy baby, that’s the goal, that is 100% success. I feel like people shouldn’t put that much pressure on how they want everything to turn out.

I know. There’s so much pressure for birth to be this perfect experience, just as planned. And I remember, too, even with me, I had a C-section, just feeling guilt, feeling like a failure, and realizing that, like, my baby’s awesome, and I really don’t care about how I got her! Do you remember what the first couple of days after Roz was born were like?

Becca: It’s funny, it’s such a blur. And I remember at the time saying to myself, I’m totally lucid and I’m recovering fine and I’m gonna remember all of this. And now I realize I don’t remember much of what those days were like!

I remember stumbling out of bed in the middle of the night and either feeding or pumping, and I remember napping a lot. Because I was recovering from a C-section, I needed a lot of help both during the days and the nights. So luckily I had Jean Ann to help, we had family, we got some help for me during the day when she went back to work. We were fortunate to be able to do that because I couldn’t lift the baby, but it’s all such a blur.

I do remember her being so cute. Like everything she did was so cute. I would feed her, and she’d fall asleep on me right after, and it was the cutest thing I’d ever seen! This weekend, actually, I saw a picture of Roz from her first few weeks. And I remember at the time looking at her and thinking, My newborn is so cute! She doesn’t look like a weird scrunched up newborn like every other one! She’s a perfect baby! And, like, five months later I realize that she definitely looked weird! But you just don’t see it at the time.

You do have an exceptionally cute baby! So what is it like now versus what it was like then?

Becca: I just feel like we’re getting more into what our life will look like for the next few years. Those first few weeks in my maternity leave I just kept thinking about how it was a temporary time – and it was wonderful, and I really enjoyed it – but now we’re trying to figure out what our real life looks like. Like how we manage the jobs and the baby, how we manage finding time for ourselves, how we manage time for the extended family who wants to visit. So, it’s different – I’m much more lucid, I’ve recovered from the C-section, all of that kind of blurriness is gone – but I’m in this, like, this half-place where I feel like, we don’t quite have enough time for everything. And I don’t know if this is just what the new normal is, or if we’re still figuring it out. So that’s kind of the phase we’re in now.

I feel like our journey has taken a lot of different turns. And where we are now – we’re so so happy and so lucky that we have this wonderful healthy baby – but it took a while. And it took a lot of different types of interventions, and along the way there were times when it felt like it wasn’t going to happen, but now she’s here, and she’s perfect, and it makes the last two and a half years feel like a blur, like just a blip. So it was all worth it.

Jean Ann: But at the time, it was tough. It can be very tough.

Becca: Yeah, and I guess some advice we would give is to try to release some of the expectations that you have and some of the perfection that you’re striving for, because you really just don’t know how things will turn out. Like, you might not always be able to hit that exact timing for getting pregnant that you want. Or we thought we wanted a boy, but we obviously love our baby girl! It turns out it doesn’t matter. So just to try to release some of that, to the extent that you can, because the journey is hard enough.

Common questions about the MTHFR gene: Answered

First off, what does the MTHFR gene do exactly? It’s responsible for making the enzyme, methylenetetrahydrofolate reductase (hence the MTHFR acronym and wordy gene name). This, in turn works with the B-vitamin folate to help to reduce the level of homocysteine in the body.

What does it mean to have a MTHFR gene variant?

There are two common gene variants (which is when the DNA sequence of a gene is different in different people) of this gene, and these are called C677T and A1298C. Studies have shown that women with two C677T variants have an increased risk of having children with neural tube defects (though these defects are rare, so the risk is still low). Men and women with the same two variants and elevated homocysteine levels may have an increased risk of blood clots (and people who have elevated homocysteine levels rarely have elevated levels just from the gene variants, so they should be evaluated for other risk factors that are known to cause this). Too much homocysteine in the body can be one risk factor for blood clots and heart disease, however many environmental and genetic factors influence risk for this.

Can the MTHFR gene affect pregnancy?

Associations between these common gene variants and a number of complications have been speculated and evaluated for in different ways, but no association has been found. These gene variants have not proven to be a risk factor for problems that may arise during pregnancy such as blood clots, pregnancy loss, or other negative health outcomes. Because of this, the American Congress of Obstetricians and Gynecologists (ACOG) do not recommend testing for MTHFR gene variants. If genetic testing does show a MTHFR variant, these variants on their own will not impact an individual’s medical treatment. And a medical geneticist will work hard to do a thorough and appropriate evaluation of symptoms to prevent incorrectly attributing medical problems to positive MTHFR status, which is not uncommon.

And what this all means for pregnant individuals is that prenatal care – including recommendations for prenatal vitamins or folate supplementation – will not change in major ways based on the presence of an MTHFR gene variation. Impacts include if, for example, a person has high homocysteine levels, medical providers will seek to identify all possible causes, and pregnant individuals will be advised to take standard folate dosages to reduce the risk of neural tube defects. Or, to use another example, if other symptoms indicate that it’s necessary, an individual may be referred from a medical geneticist to a hematologist or maternal–fetal medicine specialist for further evaluation.

Talk to your healthcare provider if you still have questions or concerns

If you have any questions or concerns about this, talk to your healthcare provider, as they can answer your questions.

Read more

• Genetic testing before pregnancy
• Getting healthy for fertility and pregnancy

Sources

• Scott E. Hickey, Cynthia J. Curry, and Helga V. Toriello. “ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing. Genetics in Medicine. 15(2): 153-156. February 2013. Retrieved August 28 2018. https://www.acmg.net/docs/mthfr_gim2012165a_feb2013.pdf.
• “Basic information about the MTHFR Gene.” Kaiser Permanente. The Permanente Medical Group, Inc., May 2018. Retrieved August 28 2018. https://mydoctor.kaiserpermanente.org/ncal/Images/GEN_MTHFR_tcm63-938252.pdf.
• “MTHFR gene variant.” U.S. Department of Health & Human Services, National Institutes of Health, National Center for Advancing Translational Services. Genetic and Rare Diseases Information Center, April 18 2018. Retrieved August 28 2018. https://rarediseases.info.nih.gov/diseases/10953/mthfr-gene-mutation.

The differences between an IVF and an ICSI

Articles and websites are known to use the two names (IVF and ICSI) interchangeably, without explanation, or definition. How are people supposed to know what these treatments are and how they’re different? Wait, are they different? Let’s start from the beginning.

In Vitro Fertilization (IVF)

You may already know a little about IVF because it’s probably the most popular form of assisted reproductive technology (ART) out there. It’s also the most expensive. One IVF cycle can cost anywhere from $8,000 to $30,000 depending on factors like age, health, or if you plan on using donor sperm or eggs. However, if IVF turns out to be the right choice for you, it may very well be worth the hefty price tag.

Many people who seek out IVF treatment do so because they have issues with fertility. These could include endometriosis, polycystic ovary syndrome (PCOS), problems with sperm function, and unexplained infertility. For people over 35, IVF may also offer a better chance of conceiving than traditional intercourse, ICI, or IUI. It’s always a good idea to speak to your healthcare provider when you are thinking about moving forward with any ART or other fertility treatments.

How IVF works

The IVF process can take up to two weeks, and there are several different ways to prepare the body for treatment based on individual health. These preparations include taking hormone-encouraging drugs to boost ovulation and improve chances of producing a high number of mature eggs. There are also medications to help prepare the uterine lining for fertilized embryos. Specialists work closely with patients to help develop a game plan.

When a healthcare provider gives the green light, mature eggs will be carefully retrieved from the ovaries. These eggs (or donor eggs) are taken to a lab where they will then be put in a petri dish with fresh sperm (collected shortly before the procedure), or sperm that has been thawed and prepared beforehand. These close living quarters will allow sperm to mingle with eggs in a way that is isn’t really possible during traditional intercourse. Aside from the setting of the petri dish, the fertilization process is much the same as during intercourse. In the end, one sperm should match up with one egg. Then it’s a bit of a waiting game. If the procedure is successful, after a period of two to six days, the fertilized embryo or embryos will finally be transferred to the uterus, where, hopefully, implantation will be successful and result in pregnancy! With IVF and ICSI, it’s sometimes possible to find out if it worked by taking a pregnancy test as soon as two weeks after implantation.

Intracytoplasmic sperm injection (ICSI)

This treatment is also used when people are having trouble getting pregnant, or by people using donor eggs or sperm. The name “intracytoplasmic sperm injection” makes ICSI sound like a very complicated treatment, but when you break it down, the concept is pretty straightforward. In truth, the term is just a really formal way of saying that during the ICSI process, sperm will be directly injected into an egg to fertilize it. But, what exactly does that mean, and how is it possible?

How ICSI works

ICSI is a form of IVF treatment, often referred to as “IVF with ICSI,” so both processes take place in a IVF lab. As for preparation, traditional IVF and ICSI are very similar, if not identical in some cases. The real difference between the two happens after the sperm and eggs have already been taken to the lab. Unlike traditional IVF, ICSI samples are not mixed together in a petri dish and left to match up on their own. Through the ICSI process, you are able to make the connection for them. A single egg is delicately held in a specialized pipette, while a very small and hollow needle carefully selects a single sperm and immobilizes it by picking it up. Once both parties are secured, the needle is slowly brought through the shell of the egg (zona) before reaching its goal at the center of the egg (cytoplasm). The needle then places the sperm within the cytoplasm. After injecting the sperm, the process is complete, and the needle is removed. Eggs are checked after a day or so to see if the process of “normal fertilization” has begun. Just like traditional IVF, the successfully fertilized eggs are then implanted in the uterine lining once they are mature enough.

Other things to consider

In the end, there really isn’t a “qualifying factor” that can say for sure whether you should use traditional IVF or ICSI treatment (though ICSI may be more effective in cases of severely low sperm count and unexplained male infertility). The process of egg retrieval and insertion of embryos into the uterus are the same between both options. Both are mostly painless, and have mild side effects. In fact, because ICSI has become more popular over the last decade with a 70% to 85% fertilization rate, many clinics have begun to use the two procedures interchangeably, and some have even begun using ICSI for every treatment!

We all know that it’s sometimes difficult to get a straight answer from the internet. We’ve covered the basics, but nothing can replace your healthcare provider’s knowledge and advice. Asking them detailed questions may be the first step in beginning your IVF journey!

Read more

• Sperm donation 101
• Egg donation: thinking it through

Sources

• Mayo Clinic Staff. “In Vitro Fertilization (IVF)”. Mayo Clinic. Mayo Clinic. March 22, 2018. https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716
• “Intracytoplasmic Sperm Injection- ICSI and IVF. Advanced Fertility Center of Chicago. Advanced Fertility Center of Chicago. 2017. https://www.advancedfertility.com/icsi.htm
• “Egg Donation Cost at the Advanced Fertility Center of Chicago”. Advanced Fertility Center of Chicago. Advanced Fertility Center of Chicago. 2017. https://www.advancedfertility.com/eggdonationcost.htm

Jennifer Heinen, MS, RDN, LDN Founder, Nourish for Life

As couples begin their journey toward pregnancy, they may consider making changes to their lifestyle. Many are aware that a nutritious diet, exercise, stress reduction, and improving sleep habits are keys to preparing the body for reproduction. However, after 6 months to a year of trying without becoming pregnant, it’s time to start looking at what each partner can do to improve their chances of conceiving. As information directed at women and fertility is abundant and readily-available, we are going to focus instead on what male partners can do on their own.

If you’re looking to boost male fertility, consider these diet changes

According to research, male factor infertility is the cause of infertility about 40% of the time, and yet less than 15% of people in this category seek independent medical advice for infertility. Considering that it takes both partners to make a baby, male lifestyle and diet also play a role in TTC. The good news is that men can take some control over their reproductive health by making simple changes to daily habits.

Maintaining a healthy weight is one way to improve fertility for men. Obesity and being overweight are acknowledged risk factors that can impact male fertility, as they can lead to lower testosterone levels and reduced semen quality. According to one study, the chances of infertility increase by 10% for every 20 pounds a man is overweight. Following a healthy eating plan and getting regular exercise to help manage weight can be a first step towards improving a couple’s chances of getting pregnant.

But not all men struggling with infertility are overweight. Even those at a healthy weight can practice unhealthy behaviors. For instance, smoking, drug use, and excessive alcohol intake can negatively affect chances of conception. Men at a normal BMI that do not eat a well-balanced diet may not reap the benefits that good nutrition could have on their fertility.

Add more produce to the mix

So what is a fertility-friendly meal plan for men? Begin by eating more fresh produce. This can easily be done by getting at least one serving at each meal and snack, or filling half the plate with fruits or vegetables. Focus on the most colorful veggies, which are packed with antioxidants like Vitamin E, Vitamin C, and beta carotene. Also, enjoy fatty fish, like salmon, sardines, and mackerel on a regular basis. They are high in DHA, a fatty acid that is found in sperm. Other healthy foods to focus on are chicken, low-fat dairy, and whole grains.

Reduce consumption of processed meats

Some research suggests that certain foods have a negative effect on fertility in men. These include processed meats (like hot dogs, deli meats, bacon, and canned meats), sweets, fatty foods (especially trans-fats and saturated fats), and other highly processed foods. Replacing these with healthier options may increase sperm motility and quality.

Although the research around male fertility and diet is limited, following a healthy eating pattern and managing weight is a solid recommendation – not only to benefit conception, but the overall health for the father-to-be. Men play an important role in baby-making, so discuss ways you can help make changes and support each other in your journey towards starting a family.

Reviewed by the Ovia Health Clinical Team

Read more

• Finding a fertility specialist
• What you need to know about fertility and perimenopause

Sources

• Myriam C. Afeiche, et al. “Meat intake and reproductive parameters in young men.” Epidemiology. 2014 Oct. 1. 25(3): 323-330. Retrieved September 19 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4180710/.
• Phil Berardelli. “Sugar and Sperm Don’t Mix.” Science. American Association for the Advancement of Science, May 3 2007. Retrieved September 19 2017. http://www.sciencemag.org/news/2007/05/sugar-and-sperm-dont-mix.
• Giahi L, et al. “Nutritional modifications in male infertility: a systematic review covering 2 decades.” Nutr Rev. 2016 Feb;74(2):118-30. https://www.ncbi.nlm.nih.gov/pubmed/26705308.
• Katib, A. “Mechanisms linking obesity to make infertility.” Cent European J Urol. 2015; 68(1): 79–85. Retrieved September 19 2017. https://www.ncbi.nlm.nih.gov/pubmed/25914843.
• Sallmén M, et al. “Reduced fertility among overweight and obese men.” Epidemiology. 2006; 17: 520–523. Retrieved September 19 2017. https://www.ncbi.nlm.nih.gov/pubmed/16837825.
• Nancy Shute. “Fatty Foods Bad for Sperm.” NPR. NPR, March 14 2012. Retrieved September 19 2017. http://www.npr.org/sections/health-shots/2012/03/13/148540108/fatty-foods-bad-for-sperm.
• “Infertility FAQs.” Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, March 30 2017. Retrieved June 7 2017. https://www.cdc.gov/reproductivehealth/infertility/index.htm.
• “Less processed meat, more fish and exercise may boost sperm count, quality.” Harvard School of Public Health. The President and Fellows of Harvard College. Retrieved September 19 2017. https://www.hsph.harvard.edu/news/hsph-in-the-news/less-processed-meat-more-fish-and-exercise-may-boost-sperm-count-quality/.
• De Jonge CJ, Gellatly SA, Vazquez-Levin MH, Barratt CLR, Rautakallio-Hokkanen S. Male Attitudes towards Infertility: Results from a Global Questionnaire. World J Mens Health. 2023 Jan;41(1):204-214. doi: 10.5534/wjmh.220099. Epub 2022 Aug 16. PMID: 36047077; PMCID: PMC9826912.

Is it unsafe to use? Learn about common household products

Depending on what your routine is, you may end up needing to make a few changes to make sure you’re keeping yourself and your future baby as safe as possible.

Hair dye

Many hair dyes are vegetable-based, and so there’s not much concern about harmful chemicals being absorbed by your scalp, and aiming for vegetable-based dyes can help to limit any risk. You can also take additional precautions by wearing gloves, coloring in a space with good ventilation, and following package instructions. If you have your hair colored professionally, you can still check in about the ingredients in the dye they use. 

Nail polish

During pregnancy, many experts recommend sticking to non-acetone based products when you can – including nail polish and nail polish remover. Since new moms don’t know they’re pregnant during the earliest part of pregnancy, some choose to get started avoiding acetone-based products early on. Some of the ingredients in these products – like phthalates – can affect fertility, too, if you’re exposed to them often in the long-term. Acetone-free products and good ventilation can help limit exposure to potentially troublesome chemicals while TTC. Products that are labeled “three-free,” “five-free” and even “seven-,” “eight-,” and “nine-free” mark a commitment not to use potentially harmful ingredients, and the number corresponds to just how many of those ingredients are left out. Here, it’s what’s missing that counts.

Face and body products

Products like face lotion or facial scrubs that contain retinoids, salicylic acid, or benzoyl peroxide, which are used to treat and prevent wrinkles and acne can be harmful in large doses during pregnancy, so many doctors suggest erring on the side of caution and cutting them out early. Some alternatives that have the green light are ingredients like glycolic acid, alpha-hydroxy acid, and vitamin C.

You may also want to skip products containing parabens and phthalates – found in everything from body lotion to shampoo to perfumes. Because parabens can take on the characteristics of estrogen, there’s some evidence that exposure to too much of this can throw hormones out of whack and affect fertility. Beyond that, exposure to a lot of phthalates has been linked to preterm birth and impaired neurodevelopment. Fortunately, there are more and more products available today that are paraben- and phthalate-free, so you should have a wealth of other options.

Bug spray

You may have heard about potentially adverse side effects of certain ingredients found in insect repellents, such as DEET, but depending on where you live, what’s even more concerning is the risk of being exposed to serious mosquito and tick borne illnesses, including the Zika virus. There are DEET-free repellents on the market, but for the best protection, many experts recommend products that do contain DEET, and there are now formulations on the market that use lower concentrations of DEET that you may simply need to apply more often. Recent studies show that DEET and some of the other popular ingredients in insect repellants do not cause adverse health issues when used as recommended. The Centers for Disease Prevention and Control actually recommend ingredients like DEET, picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol products.

House paint

Steering clear of oil-based paints, paint thinner, and any painting supplies that contain mercury or lead is recommended during pregnancy, and women trying to conceive may also choose to avoid exposure. Latex based paints with ethylene glycol ethers and biocides, which includes most indoor paints, aren’t known to be dangerous, but they also haven’t been studied much for the effect they may have on early fetal development. Organic solvents like benzene, toluene, and perchloroethylene could increase the risk of preterm birth, stillbirth, or birth defects. This is also a great time to ask for help from friends or family if there are any painting projects on the horizon in your home.

Cleaning products and detergents

Most cleaning products are safe to use when TTC as long as you use them as advised, wear gloves when necessary, and work in a well-ventilated area. However, some products with fragrance contain phthalates, some oven and glass cleaners contain glycol ethers, and some mildew cleaners contain phenols. There isn’t clear evidence of what effect each of these chemicals might have, but there have been studies that suggest that a negative effect is possible, and that more research is needed. Parents-to-be who find themselves needing to use these products may choose to use products that omit these substances when possible, or they may choose to ask a partner to take over tasks that involve these chemicals for a little while.

Flame-retardant products

Flame-repellant chemicals are meant to do just what they sound like – prevent products like building insulation, furniture foam, and upholstery from catching on fire – but they can have unexpected effects as well. The chemicals used in flame-retardants don’t just stay in products, and can make their way into dust which can then be ingested. This is significant when TTC or pregnant because flame-retardants can reduce the chances of becoming pregnant using assisted reproductive technology, and, in women who are pregnant, can hurt the chances of live birth. When buying new products, it can be helpful to look for those that are marked flame-retardent-free, and with materials that are already a part of your life, just making sure to wash your hands before meals can help to prevent the ingestion of any questionable dust.  

Pesticides

Eating organic is the most common strategy people use to avoid pesticides, but it can be more helpful to limit direct exposure to organophosphate pesticides in other ways, like the use of these pesticides in your yard or on your family pets.

It isn’t always clear where the danger in pesticides lies – what ingredients, in what form, and at what dosage? If you find yourself stressing that you can’t possibly limit your exposure to all proven and potentially harmful chemicals, do keep in mind that when it comes to exposure to many of these substances, the dose makes the poison. If you occasionally use acetone-based nail polish before finding out you’re pregnant, you probably don’t need to worry. But if you work in a nail salon without great ventilation and are exposed to these sort of ingredients every day, the chance of an adverse effect may start to grow. Your healthcare provider is a great resource for guidance about specific products you’re using or are being exposed to.

Read more:

• Why do I keep hearing about toxins?
• Household items that could affect fertility

Sources:

• DB Barr et al. “Pesticide concentrations in maternal and umbilical cord sera and their relation to birth outcomes in a population of pregnant women and newborns in New Jersey.” Science of the Total Environment. 408(4): 790-5. January 2010. Retrieved August 28 2017. https://www.ncbi.nlm.nih.gov/pubmed/19900697.
• Yvonne Butler Tobah. “Is it OK to use hair dye during pregnancy?” Mayo Clinic. Mayo Foundation for Medical Education and Research, July 13 2017. Retrieved August 28 2017. http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hair-dye-and-pregnancy/faq-20058484.
• Jeneen Interlandi. “How safe is DEET?” Consumer Reports. Consumer Reports, August 20 2017. Retrieved August 28 2017. https://www.consumerreports.org/insect-repellent/how-safe-is-deet-insect-repellent-safety/.
• R McGready et al. “Safety of the insect repellent N,N-diethyl-M-toluamide (DEET) in pregnancy.” The American Journal of Tropical Medicine and Hygiene. 65(4): 285-9. October 2001. Retrieved August 28 2017. https://www.ncbi.nlm.nih.gov/pubmed/11693870.
• The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women, American Society for Reproductive Medicine Practice Committee, the University of California, San Fransisco Program on Reproductive Health and the Environment.  “Exposure to toxic environmental agents.” Obstetrics & Gynecology. 122(4): 931-5. October 2013. Retrieved August 28 2017. https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Exposure-to-Toxic-Environmental-Agents.
• “Common flame-retardant chemicals may reduce likelihood of clinical pregnancy, live birth among women undergoing fertility treatments.” Harvard School of Public Health, The President and Fellows of Harvard College, August 25 2017. Retrieved September 25 2017. https://www.hsph.harvard.edu/news/press-releases/chemicals-flame-retardants-pregnancy/.
• “DEET.” United States Environmental Protection Agency. United States Environmental Protection Agency. Retrieved August 28 2017. https://www.epa.gov/insect-repellents/deet.
• “Household products database.” U.S. Department of Health & Human Services. National Institutes of Health: Health & Human Services, September 2016. Retrieved August 28 2017. https://householdproducts.nlm.nih.gov.
• “Insect repellent use & safety” Centers for Disease Control and Prevention. U.S. Department of Health & Human Services,  March 31 2015. Retrieved August 28 2017. https://www.cdc.gov/westnile/faq/repellent.html.
• “Zika virus.” World Health Organization. World Health Organization, September 6 2016. Retrieved August 28 2017. http://www.who.int/mediacentre/factsheets/zika/en/.

Healthy snack alternatives to help with fertility

Whether your getting ready to eat for two, or eating just for you, you’ll want to keep your snacking healthy and part of a regular nutritious diet. But, of course, sometimes it’s easier to reach for something that’s a little less than healthy. Having healthy snack alternatives in mind to swap in can help you satisfy your not-so-healthy cravings while giving you a fertility boost.

When you’re craving something savory, try:

• Popcorn: Certainly if it’s covered in butter and salt, the nutrition can be questionable, but popcorn can actually be very healthy! Popcorn is a whole grain that provides a wealth of fiber, which helps to increase fullness, reduce blood sugar spikes, decrease constipation, and improve digestive health and mobility. It also includes a ton of vitamins and minerals – like various B vitamins, iron, magnesium, potassium, zinc, and manganese – and polyphenol antioxidants. And you can spring for healthy toppings like a drizzle of olive oil, a pinch of salt, herbs, or grated parmesan cheese.
• Nuts: These snack all-stars provide fiber, protein, and a ton of healthy, unsaturated fats – including omega-3 and omega-6 fatty acids – which are an important source of energy, help you metabolize a number of important vitamins, and can help lower cholesterol.
• Whole wheat pretzels with flax: The complex carbs found in whole grains provide not only fiber, but also long lasting energy. Whole grains can also provide nutrients like the antioxidant vitamin E and the mineral selenium. And the addition of flax can provides good unsaturated fat.
• Baked sweet potato fries: These might take some prep, but sweet potatoes are more than tasty – they also provide fiber, folate, vitamin-C, and beta-carotene, which converts to vitamin A in the body.
• Whole grain toast with hummus, plain Greek yogurt, nut butter, or avocado: Again, there are lots of goodies to be found in those whole grains, and all of these creamy options you can spread on top provide even more of a nutritional boost. The garbanzo beans in the hummus, much like other all beans, provide you with protein, which helps provide amino acids, fiber, and a number of other nutrients, like large amounts of folate (B9), iron, calcium, and zinc. The yogurt provides calcium, phosphorus, various B-vitamins, magnesium, and zinc. It also provides probiotic bacteria, which supports digestive health. Nut butters have all the health benefits of nuts, and the avocado contains unsaturated fats, folate, potassium, vitamin C and vitamin B6.
• Hard boiled eggs: Eggs are a powerhouse, providing you with protein, healthy fats and amino acids, and vitamins and minerals like choline, potassium, magnesium. Eaten with a pinch of salt, herbs, or hot sauce, they’re a tasty snack option any time of day.
• Edamame: Soy beans provide all the goodies mentioned when talking about hummus, as well as a ton of antioxidants, and vitamins C and A.
• Hummus or guacamole with vegetables or whole grain crackers: Again, you’ve already heard about the wonders of hummus, guac, and whole grains, but veggies are real stars, too. They provide not just great flavor and satisfying crunch, but a wealth of vitamins and minerals. Aim for a variety of color – green, red, orange, yellow, and purple!
• Cheese: Is packed with calcium, protein, and vitamin D. (Just skip soft, unpasteurized cheese because of the risk of Listeria if you’re TTC.)

All of these options will help you bypass the large amount of trans fats and high amounts of sodium that can be found in chips and dip.

When you’re craving sweets, try:

• Fresh fruit: From bananas and apples to cherries and grapes, fruit provides fiber along with vitamins and minerals like folate, vitamin C, potassium, and beta carotene.
• Dried fruit: These provide all the same nutrients as the fresh stuff, but sometimes can travel more easily. Mango, apricots, and dates are all great choices!
• Dark chocolate: If you really want a chocolate fix, go for a small piece of dark chocolate, which is typically lower in fat and sugar than other kinds of chocolate, contains some good fats, provides antioxidants, which improve immunity, and also contains nutrients like iron and magnesium.

When you’re craving sugary drinks, try:

• Ice water with fruit: You already know that staying hydrated is a healthy part of any diet, but the addition of fruit can add a touch of flavor and sweetness to jazz up your usual H2O.
• Iced tea with honey: Whether you opt for caffeinated or caffeine-free, tea sweetened with a touch of honey, which provides some vitamins and minerals – can be a real sweet treat and a far healthier option that the amount of sugar in soda. (As above, if you’re TTC, just make sure your honey is pasteurized.)

When you’re craving something cold, sweet, and creamy, instead of ice cream, try:

• Fruit with yogurt and honey
• A blended fruit and Greek yogurt smoothie
• Pureed frozen fruit with yogurt: You’ve already heard about all the good in yogurt and fruit, but a chilled treat like this will provide you with a tasty bowl or glass full of fiber, calcium, and vitamins.

When you’re craving a sugary breakfast cereal, try:

• Oatmeal with fruit and honey: The fruit and honey? Yummy and nutritious. The oatmeal? It provides you with more of those same goodies in whole grains, plus the oat bran can help lower cholesterol levels.

Eating healthy isn’t all-or-nothing, it exists on a scale, and the more nutrients, and the less empty calories, you can fit into every snack, the further towards the “healthy” end of the scale you’re going to move.

Sources

• Mayo Clinic Staff. “Pregnancy nutrition: Healthy-eating basics.” Mayo Clinic. Mayo Foundation for Medical Education and Research, February 15 2015. Retrieved August 28 2017. http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20046955.
• Mayo Clinic Staff. “Pregnancy diet: Focus on these essential nutrients.” Mayo Clinic. Mayo Foundation for Medical Education and Research, February 15 2015. Retrieved August 28 2017. http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20045082?pg=1.
• Mayo Clinic Staff. “Prenatal vitamins: Why they matter, how to choose.” Mayo Clinic. Mayo Foundation for Medical Education and Research, September 13 2016. Retrieved August 28 2017. http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20045082?pg=1.
• “Good Nutrition During Pregnancy for You and Your Baby.” Cleveland Clinic. The Cleveland Clinic Foundation, June 15 2015. Retrieved August 28 2017. https://my.clevelandclinic.org/health/articles/good-nutrition-during-pregnancy-for-you-and-your-baby.
• “Nutrition During Pregnancy.” The American College of Obstetricians and Gynecologists. American Congress of Obstetricians and Gynecologists, April 2015. Retrieved August 28 2017. https://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy.