Get Your OB On Board: Regular Menstruation Does NOT Equal Fertility

"Getting your period" is a big event for girls. And many a parent or counselor has tried to console young women's related worries by offering comments that equate menstruation with motherhood. It's understandable that so many of my patients at Houston Fertility Center grew up with the message that if you're menstruating, you can get pregnant.

Your OB/Gyn may even tell you something similar. After all, it's basically true for the average woman with average fertility. But if you're one of the many women who has regular menstrual periods but can't seem to get pregnant, you might be feeling dismissed by your primary care doctor's casually hopeful remarks.

Once you have reason to understand more than the average woman about menstruation, you'll find that the connection between periods and fertility is a bit more complicated. Your OB/Gyn might do a great job of providing you with that in-depth education about the reproductive details of menstruation -- but you'll probably first have to request more explanation. And never hesitate to ask! You definitely won't be the first patient in my office to say with great frustration, "But, Dr. Kristiansen, I have a period every month!"

Your body's menstrual and ovulatory cycles are absolutely linked, but they are also separate. Both cycles are the result of communication between several organs and glands which emit different levels of various hormones, producing a cascade effect that's supposed to be ongoing. There are so many different points along the path where something can go wrong. A small, seemingly insignificant glitch in one spot -- whether it's a gland that produces too much or too little of a hormone, or an organ that isn't responding to its cues -- winds up disrupting the whole fertility process.

Simply put, and as many Houston Fertility Center patients will attest, women can have regular periods and still be infertile, for many reasons -- some structural (as in blocked fallopian tubes), some hormonal (sometimes resulting in anovulatory bleeding, in which no eggs are being released).

It's pretty complicated. And if your OB/Gyn is more OB than Gyn (they're really not all the same!), then their focus in both training and, more importantly, experience may be on helping women manage their pregnancies and deliver their babies -- not on the many things that can go wrong when you're trying to get pregnant.

So if you've heard "If you're having a period, you have nothing to worry about" from your doctor, he or she may not be putting you off or ignoring your worries. It might just not be their area of expertise.

This is the 3rd post in a series called Is Your OB On Board With Baby-Making?
Also see: Get Your OB On Board: Time Is (Almost) Everything

~ Dr. Sonja Kristiansen M.D.

Fertility Treatment & Wellness Go Hand in Hand

A recent article on Fertility Authority reminds fertility patients to get their flu shots (and be sure you get the shot, not the nasal spray!) The article reminded me about all the preventive health measures that might get back-burnered by patients.

Many new patients at Houston Fertility Center enter fertility treatment territory in great physical shape and feeling emotionally hopeful. Some arrive at their first consultation already dragged out, physically and mentally, by their months or even years of trying to conceive. Naturally, their first question is, "Dr. Kristiansen, what can we do to finally get pregnant?" My first recommendation for all of them is to optimize their fertility at baseline by getting or staying healthy, whatever that means for them.

Once you enter fertility treatment, you could find your calendar newly crowded by the required exams and office consults, by scheduled at-home injections and tests, even by scheduled intimate time with your partner. It's easy to lose track of all the good things you've learned to make a regular part of your day-to-day experience to keep yourself feeling fit and well.

Fertility treatment and preventive health measures are different yet interactive. Many facets of your fertility in general can change, for better or worse, as your overall health changes. So you could say your efforts at maintaining wellness -- balanced, healthy diet, moderate and regular exercise, relaxation activities, managing exposure to toxins -- are even more important during this point in your life.

So do remember your flu shot and all the other good things you do to stay healthy. And if you haven't yet instituted preventive health activities into your life, now's the time. It's an investment not only in your wellness, but your fertility, too.

~ Dr. Sonja Kristiansen M.D.

IVF Myths: You'll Wind Up With a Football Team

More debunking of myths about IVF, referring to a recent blogpost I found by Dr. Kathy D.


Myth #2. “IVF produces twins, triplets and more”


Bearing in mind that this is a quick blogpost and not a full-on journal article on the subject, Dr. Kathy D. is right about the age of a woman's eggs. But I want to interject that there are many more facets to consider when trying to institute how many embryos should be transferred in an IVF cycle. So in fact, the decision to use single embryo transfer (or SET) is not as clear cut as it sounds.

Age of the hopeful mother is a huge factor, as is her overall health. Possibly the even greater factor we take into account is the grade of the embryo.

Embryos are graded by observing several parameters. For a detailed but patient-friendly description of the embryo grading process, check out this Healthline article.

At this week's annual gathering of the American Society for Reproductive Medicine, the question of how many embryos to transfer was addressed again. It is, indeed, still an unanswered question -- but we're getting closer!

One poster presentation, titled simply "Optimum Number of Embryos to Transfer on Day 3 to Achieve High Pregnancy Rates and Low Multiples Rates Based on Patient Age and Embryo Quality," looked at 717 ART cycles at one IVF center with Day 3 (post-fertilization) transfers and their outcomes. Their conclusions:

Patients < 35 yrs; transfer of 1 Top quality embryo is recommended. Addition of a second embryo for transfer increases twin rate without significantly increasing pregnancy rate. Patients 35-37 yrs; transfer of 2 embryos is recommended to achieve desired pregnancy rate, however, risk of multiples needs to be addressed particularly if Top quality embryos are transferred. (L. Hill, S. LaBrie, P. St. Marie, K. Lynch, E. Tougias, M. Arny Baystate Reproductive Medicine, Baystate Health, Springfield, MA)

Researchers are continually trying to determine the best culture medium, the best time period, the best tools for helping fertilized eggs grow into the healthiest possible embryos, but there are many things out of even the best embryologist's control. Still, conscientious fertility specialists, like the staff of Houston Fertility Center, stay on top of the latest findings and apply them in their labs and clinics.

Whether your specialist is in Houston or New York or any other location, we're all interested in how to make pregnancy a reality for our patients. So success -- a healthy singleton baby -- becomes more quickly achievable all the time.

IVF Myths: It's "Last-Ditch" Fertility Treatment

When it comes to fertility treatment, IVF (in vitro fertilization) is indeed the most costly and invasive technique available. But it's also very successful -- in many cases, the only thing that works -- for helping men and women who might otherwise not have a chance at having biologically related children.

I recently ran across this blogpost that nicely sums up a few of the myths about IVF. The author, a physiologist and reproductive endocrinology researcher, also has personal experience with using IVF to build her family.

I'm going to write my own responses to Dr. Kathy D's debunking of the myths she calls "most common" through the next few posts.

Myth #1. IVF is a last-ditch effort to become pregnant

She's correct in her responses to this myth! But I'll add that for many patients, IVF is definitely "a last-ditch effort."

For some infertile patients, like those described by Dr. Kathy D., IVF is the only way conception is going to happen. In those cases, heading straight for IVF first is sensible. But for most fertility patients, making the choice to use IVF instead of, say, intrauterine insemination (IUI) is definitely a step that feels like the "final straw" in a series of attempts. In fact, this patient page on "Preparing for IVF: Emotional Considerations" puts it succinctly, saying that for most people, IVF is "the last, best option for having a child."

No experienced, qualified fertility specialist will tell you that IVF (or any other treatment) will definitely result in pregnancy. But it is true that IVF, in particular, helps us get around the greatest number of obstacles and barriers of the most severe nature. So it's no wonder everyone thinks of it as "last-ditch"!

When to recommend IVF for a fertility patient is part of the art (and I don't mean Assisted Reproductive Technology here) of medicine. Some of my colleagues will recommend IVF a little too soon in a patient's fertility treatment journey, while others might wait until it's only going to work with a third-party involved (most often, an egg donor). It takes years of experience on top of specialized training, plus an excellent laboratory team (like the staff I'm grateful to have with me at Houston Fertility Center) to know when a patient's family-building needs will be best served by IVF versus other techniques.

So this myth is actually reality for some patients. And while your attitude and feelings toward whatever medical treatment you choose is important, and timing is a crucial factor in fertility treatment success, in the end, whether it's "last-ditch" or not -- IVF works.

If You're Trying to Conceive, Skip the Triathlon. Try Yoga.

Along the same lines as there being no magic to getting pregnant, whether with IVF or without treatment, there's also no perfect exercise that will lead to conception.


But... yoga comes close.


Conception (and pregnancy) have much to do with balance. Not too much of this, and just the right amount of that. Your fitness factors, including your weight and body mass index, flexibility and strength, all play roles in keeping your endocrine system humming along.


Choice of exercise is a very personal thing. You should take several things into consideration when choosing the type, level, and frequency of physical exertion you engage in, whether you're trying to conceive or not. For example, running isn't the safest idea for everyone, but for some, it's perfect. Swimming is great, but not everyone has regular, easy access to a pool. The same could be said of biking.


As this article in The Windsor Star describes, yoga is about more than stretching and posing. If done well, yoga can both strengthen and relax your body, which is a state of being that facilitates hormone health.


You may want to avoid the most rigorous forms of yoga (there are many different versions), including the forms that are taught in studios heated above 90 degrees. And if you can find a yoga instructor who knows specific poses that are good for your reproductive organs, that's a bonus. (Here at Houston Fertility Center, we'll help you find one...)


Remember, you're looking for balance through activity.
Put your dreams of being a triathlete on hold until after the baby comes, but don't shelve your body's need to move and breathe.


~Dr. Sonja Kristiansen MD

Building a Family In Tough Times

The country's economy is struggling so much that women are quite possibly having fewer children as a result. A report published last month by the Centers for Disease Control likens the trend to the Great Depression's fertility rates.

My patients feel the pain. If getting pregnant the old fashioned way is harder now, imagine what it's like to need special fertility treatment in order to have a baby.

In that light, I'm currently offering a big discount on IVF: $7995 through November 30th.

Because Houston Fertility Center has its own state-of-the-art laboratory, I'm able to provide the highest quality reproductive medicine services at more affordable prices. And since this is the time of year when people living in the Houston area are caught between high electric bills (for air conditioning!) and impending holiday season expenses -- it seems like the best time of year to make family-building a reality for so many.

Hang in there!

~Dr. Sonja Kristiansen MD

When Egg & Sperm Don't Hook Up

It's pretty amazing what is still being learned about the most basic points along the conception trail. The big news recently is about a molecule that helps sperm cells bind to egg cells.

Researchers are calling it SLeX, short for sialyl-LewisX. Their study found SLeX on 70% of the 195 unfertilised eggs tested. If your egg cells don't have SLeX, sperm cells won't connect to it for the mating game. The best news: the authors of the study, who came from Britain, Taiwan, and the U.S., believe this discovery might lead to related infertility treatments in only about two years.

But what about in the meantime? While clinical diagnosis of this condition may be a couple of years away, the treatment for women with missing SLex is already available.

Intractytoplasmic sperm injection, or ICSI, is available for patients whose infertility is caused by lack of SLeX, as well as other causes. ICSI is one of assisted reproduction's most fascinating treatments -- a single sperm cell actually being injected into an egg cell. And while it may sound like science fiction, ICSI is no longer experimental. In fact, ICSI's been around for decades now and used with great success in conjunction with IVF. In 2008, staff of Houston Fertility Center had a related poster presentation accepted for that year's meeting of the American Society for Reproductive Medicine. Our study concluded that patients using ICSI had higher implantation rates.

One of the most incredible uses of ICSI is to treat even the most severe forms of male factor infertility. Since IVF with ICSI requires only one good sperm cell, the treatment has made biological dads out of men who previously had nearly no chance of having offspring.

Developments from our greater understanding of how SLeX can make or break conception attempts might lead to quicker, more direct diagnosis for couples with unexplained infertility. Every little detail makes a difference.

~Dr. Sonja Kristiansen, MD