Obesity Impacts Your Reproductive Health Goals

The topic of weight and fertility is a sensitive one: Years ago, I mentioned patient's concerns about “fat phobic” doctors in a newsletter on “Weight & Fertility”, in which I gave a quick description of how a woman's weight impacts her ability to get pregnant. Now, The Endocrine Society has made available a free, downloadable booklet with more information on the topic.

“Obesity, fertility, and contraception: Disparities Among Women – 3 Perspectives” covers the entire fertility spectrum, explaining how body weight is not just an issue for women trying to get pregnant. Those who are trying to avoid pregnancy are also at risk – for weight-related contraceptive failures.

The booklet is complex and thorough, and offers the professional opinions of a basic researcher, a clinical practitioner perspective, and a clinical researcher. A few interesting points in the publication:

• Higher prevalence of obesity in African American and Latina women is an important factor in racial and ethnic disparities in reproductive outcomes. 

• Obesity adversely alters egg quality, in addition to the endocrine system, and is associated with ovulatory dysfunction and higher risk of miscarriage.

• Donor egg recipients who are obese do not appear to have lowered IVF pregnancy rates.

• Hormonal contraception may fail more frequently in obese women.

Body weight is not merely a matter of fashion, and reproductive endocrinologists are specifically trained and experienced in applying the latest research-based knowledge to the related fertility needs of patients in the clinic.

The staff of Houston Fertility Center and I offer all fertility patients the opportunity to access helpful nutrition counseling, whether it is for weight-loss, maintenance, or weight-gain – whatever is healthiest for their situation and will promote the greatest fertility treatment success.

Lyme Disease – Do you need to worry?

A recent post by Dr. Beth Hartog on Fertility Authority talks about something we don't think of often here on the Gulf Coast: Lyme disease. In the post, Dr. Hartog describes a fertility patient who finds a tick after a hike in the woods and is worried about lyme disease.

Lyme disease is an inflammatory disease that impacts multiple systems in the body. Its cause is infection by a bacterium spread via deer ticks. Humans and other animals are susceptible to lyme disease if bitten by a deer tick. The disease can result in long-term symptoms which can become severe if untreated. Fortunately, treatment with antibiotics upon early detection almost results in a cure. You can find out more about Lyme disease at the American Lyme Disease Foundation website.

What does Lyme disease have to to with infertility or getting pregnant?

As Dr. Hartog explains, treatment of the disease during pregnancy or when trying to get pregnant can be tricky. Some of the medications typically used for Lyme disease are contraindicated – unsafe – during pregnancy.

Lyme disease has spread predominantly from the northeast U.S. and into the Midwest. So do we Texans need to worry about Lyme disease? Not really, according to this prevalence map from the American Lyme Disease Foundation. But there are other tick-borne diseases that are less well-known, some of which are discussed on the Foundation's website. And of course, if you travel to areas of high prevalence and spend time outdoors, you could be at increased risk for Lyme disease. Like some of our staff at Houston Fertility Center, you may find yourself wandering in the beautiful woods just north of the city, and ticks are definitely a possibility.

To prevent contact with or to deal with removing ticks, the Foundation site offers very helpful and specific tips. 

Is IUI All You Need?

Did you know that many fertility patients don't need IVF? With all of the information about in vitro fertilization that goes around the Internet, it might seem otherwise. But the truth is that many people need a far simpler boost in fertility than IVF affords.

Intrauterine insemination, sometimes simply called “artificial insemination”, is very often a first step for fertility patients who have no structural infertility conditions, like blocked fallopian tubes. The insemination itself is conducted in less than a day within the clinic, and patients are able to return immediately to work and other daily activities. Prior to the actual insemination procedure, the woman may or may not use fertility medications – oral or injectable, depending on her body's needs – to optimize the number of eggs she ovulates during that treatment cycle. Then when tests indicate that she is near ovulation, semen (from either a partner or a donor) is introduced to the uterus via a tiny catheter threaded through the cervix.

Placement of the sperm cells directly into the uterus via IUI allows us to bypass what's sometimes called “hostile” cervical mucus, a condition in which the woman's naturally-occurring mucus has properties that prevent sperm from reaching their destination. IUI also works well for women who have timing issues that prevent intercourse from being the optimal route; for example, some active military couples have frozen semen prior to deployment, for use with IUI at a future date. IUI enables even fertile women without male partners to use donor sperm in a clinically safe manner. Women with PCOS (polycystic ovarian syndrome) also are often quite successful in getting pregnant with medicated IUI.

There are cases in which trying IUI might be more wasteful of the patient's time, money, and effort, including patients with:

• Tubal factor infertility
• Ovarian failure, or elevated Day 3 FSH levels
• Severe male-factor infertility
• Woman's age over mid- to late-30's

It is recommended that patients in such cases consider using IVF, in vitro fertilization.

~Dr. Sonja Kristiansen MD

Another Infertility Cause: Fear Of the Unknown

One of the most distressing comments I hear regularly in my office: “Dr. Kristiansen, I cannot believe I waited so long to seek help getting pregnant. Now that so much time has passed, I hope I can still get pregnant!”

Why am I writing about this? Because we know from studies that a big percentage of men and women avoid seeking fertility treatment because they're afraid. If you've already taken that big first step of scheduling a fertility consultation, you know exactly what I mean. People who are starting to worry about why they haven't gotten pregnant scour the Internet for reasons and solutions, and what they see can scare them away from the very thing that could result in pregnancy.

Image(s): FreeDigitalPhotos.net

Here's what I want them to know: An initial consultation with a fertility specialist does not equate to treatment, but it can often add up to more informed women and men who go on to “get it right,” with or without treatment.

What are they afraid of?

Intimacy issues – Who wants an audience to be in on your private dreams of building a family? It's hard enough to discuss with loved ones, but talking to a professional can make you feel even more uncomfortable. Fortunately, I can tell you that my staff at Houston Fertility Center are all long-timers in this medical arena. We understand, in some cases from personal experience, the emotional discomfort that you're going through. Your concerns are treated with utmost dignity and discretion.

Medical procedures – Most fertility patients are of average health and have never gone through any kind of treatment process beyond an occasional round of antibiotics for infection. It's understandable that virtually any medical tests or treatments might seem scary. Many are under the mistaken impression that IVF is the only kind of treatment. Again, simply talking with a fertility specialist does not necessarily include any tests or procedures. That said, a lot of first-time patients do agree that scheduling their initial consultation on Day 3 of the woman's cycle, and undergoing a simple blood draw to determine levels of reproductive hormones, can save time and money in the getting-pregnant process. It's your choice.

Financial costs – It's true that once you decide to become a fertility patient, there will be some costs involved. The financial expenses will vary from patient to patient, depending on health care coverage (or not) and on the causes that are determined to be your own fertility obstacle. Treatment costs vary widely and, actually, most patients do not need IVF to get pregnant. The majority of patients can become pregnant with less costly forms of treatment, like IUI (intrauterine insemination). (I'll address the differences in an upcoming blogpost.) But no one can tell you what your costs will be until thorough diagnostics have been implemented, and you have had a chance to discuss the options.

The important point: There's no way that your research alone or even any online-only consultations can adequately review and assess your fertility status and sum up whatever issues might need to be addressed for you to get pregnant.

Don't let fear of the unknown be your own major obstacle to getting pregnant.

Saving Your Nest Eggs For A Rainy Day

Chances are good you've heard of oocyte cryopreservation – in plain language, egg freezing – as a way for women with cancer to preserve their fertility just prior to undergoing chemotherapy or radiation treatments. But did you know that women without cancer can also choose to freeze their egg cells?

It's becoming more common for women – who are now far more savvy about fertility than past generations – to make use of their highly-informed foresight in family planning and opt for freezing their eggs, well in advance of when they plan to conceive.

Image:FreeDigitalPhotos.net

The technology used to freeze and thaw oocytes has rapidly advanced to be more reliable and effective, resulting in greater success rates. So more fertility centers are offering this option to women whose goals are simply to “freeze in place” their fertility. For example, women in their 20's who are super-busy with academic and career goal tasks might envision motherhood for their 30's. These same well-informed women also know that their chances at natural conception decrease with age. So far, it appears that freezing an egg cell now – in its healthiest condition – can result in thaw, conception, and pregnancy success several years down the road.

Many specialists -- including my own lab staff at Houston Fertility Center -- see the greater possibilities for use of egg freezing in this way, to preserve the family-building options for fertile women. I can't tell you how many times I've heard in my office, “Dr. Kristiansen, I cannot believe I spent all those years using contraceptives and trying NOT to get pregnant – and now when I want to, I can't!” For some of these patients, if egg freezing had been available, they could've continued with their contraceptive efforts until the time was right – as late as their 30's or 40's – and their eggs, frozen while still young, would be ready and waiting to be used to create embryos.

Perhaps egg freezing will eventually become just part of the normal course of reproductive health care management that young women learn about and use for wise family-planning.


~Dr. Sonja Kristiansen MD

Summertime Blues Or Time To Get Pregnant?

Summer on the Gulf Coast can be tough on the psyche! First, there's the heat, which adds up to physical discomfort (and a lot of bad hair days!) and your year's highest electric bills. Then, there's the feeling that everything has slowed to a crawl (might be that sweltering heat!) – and that could feel like a burden or a relief. Many of my patients have chosen summer as their go-to time for getting pregnant, for all of these reasons.

photo: Tracy Morris

If your plan to get pregnant includes the use of assisted reproduction, you can also plan for the process to take up your time in ways that are different from the “old fashioned” path to pregnancy. Even if you're not seeing a fertility specialist because of infertility, the various kinds of techniques – from the simplest to the most complex – require at least a little bit of time and attention before and after the actual “conception event”.

And that “lazy hazy feeling” of summer could be just what some women need to boost their body's natural fertility. I know you've heard “Just relax!” and feel yourself do exactly the opposite! No, just relaxing is not the key to pregnancy, especially for a lot of women with particular infertility-causing disorders. But it is true that your body's so-important endocrine system functions best when you're not feeling keyed up, tense, and on-the-go. When your hormones are flowing in the right order and level, your chances at getting pregnant are boosted with and without fertility treatment.

So for a lot of people, taking summer vacation time to get pregnant makes the most sense.

And for those who are feeling the brunt of the electric bills right now, Houston Fertility Center always offer summer discounts on several fertility services.

When you add up the possibilities – with treatment discounts and a little more downtime on your hands – it could be that a Spring-time baby is in your future.

Speaking of Infertility Awareness: The Question of Age + Pregnancy = Never-Ending Confusion?

Advanced maternal age and how it gets in the way of pregnancy is in the news again. This time, the focus is on how so many women have the misunderstanding that assisted reproductive technology can defeat age as a barrier to conception.

How many times have I heard, "Dr. Kristiansen -- I hate that term! Can't we use something different to refer to my age?" Sorry -- it's a rather tacky-sounding medical terminology shortcut that means "chronologically older than average for optimal fertility".

Here's a message that needs to be heard during this National Infertility Awareness Week:

The fact: Without intervention, most women in their 40's (and many in their 30's) would not get pregnant.

Another fact: Yes, IVF is incredible technology worth marveling at, and one of the reasons is its ability to facilitate conception in women who otherwise would not get pregnant.

The Big Myth: IVF is so effective, you can wait until you're of "advanced maternal age" to try and get pregnant -- and have a high likelihood of succeeding by way of fertility treatment.

That myth IS a fact for some women. But only for some women. Are you one of them? There's a good chance that a thorough diagnostic workup by a reproductive endocrinologist can provide clues to answer that question. Can we guarantee it? No.

I don't think either the media or fertility experts intend to confuse women about the question of age and pregnancy. But the confusion among women is apparently prevalent and ongoing.

Just as it would be overkill to suggest that all women in their teens or early 20's run out and get fertility testing to prepare for the future, it is unreasonable to recommend women put all their eggs into that future basket by expecting ART to be their surefire answer to pregnancy. (There is the option of freezing your eggs, a different but related story...)

So, the simple truth: If you're delaying conception until your late 30's or older with the intention of simply walking into any fertility center and getting pregnant easily on the first try, you're automatically decreasing your odds.

If you're like many of my patients and have delayed pregnancy for lifestyle reasons like not finding Mr. Right, wanting to give your all to your career before parenthood, or because your finances aren't in order yet, you can take heart in knowing that virtually any safe and effective technique will be made available to you here at Houston Fertility Center. Not only that, but the treatment will be delivered by a team of experienced, compassionate women.

We know how much you want a baby. We applaud your courage and tenacity in the pursuit of parenthood. We'll educate you about every treatment option. We'll be your cheerleaders in the journey. And we'll be honest with you, too.

~ Dr. Sonja Kristiansen M.D.




[Image: photostock | FreeDigitalPhotos.net]