Mikio A. Nihira, MD
For some couples, getting pregnant is quick and easy. For others, things are not as easy.
Sometimes, problems are linked to such specific physiological issues as blocked fallopian tubes in the woman or low to no sperm count in the man -- problems that can be addressed by a fertility specialist and subsequent treatments like in vitro fertilization (IVF) or insemination.
For many others, however, reasons behind their infertility are much harder to define.
"Often, problems are subclinical -- meaning we know something is wrong, it's just not showing up on the radar," says Staci Pollack, MD, a reproductive endocrinologist at the Montefiore Medical Center's Institute of Reproductive Medicine and Health.
Pollack says standard fertility treatments can usually help, but in some cases, so can a host of other, less costly techniques -- some of which couples can try on their own.
The key to success: Knowing when to try -- and when it's time for more serious medical treatment. The good news: Doctors say both options can be clearly mapped out with the help of a medical fertility workup. Designed to rule out specific causes that require medical care, test results can also help you decide if any of these low-tech treatments are worth a try.
And what if you aren't anticipating a problem but just want to give your fertility a boost? Some of these low-tech methods can work for you as well. Just keep in mind that the American Society for Reproductive Medicine says if you don't get pregnant after 12 months of regular unprotected intercourse -- or six months if you are a woman over 35 -- it's time to seek help from a fertility specialist.
Among the most common causes of unexplained infertility in women is "ovulatory dysfunction" -- an umbrella term encompassing problems with ovulation.
Though a number of factors can be responsible, many doctors now believe diet is one of the keys. In a study of some 17,000 women conducted by the Harvard School of Public Health, researchers were able to define a group of "fertility foods" able to improve conception odds.
Which dietary tenets were significant for increasing fertility?
Jorge Chavarro, MD, a study researcher, believes diet made a difference because the majority of women experiencing ovulatory dysfunction were also suffering from undiagnosed or subclinical PCOS (polycystic ovary syndrome), a condition related to insulin resistance that also affects ovulation.
"It responds well to diet, so that could be one of the reasons these foods were so helpful," says Chavarro, who translated his medical study findings into a book called The Fertility Diet.
Pollack believes it's worth giving the diet a try but says, "You should not depend on it alone -- make it just one part of your overall efforts to conceive."
Whether or not you eat the so-called "fertility foods," maintaining a healthy weight is another way to enhance your fertility.
Studies show that having either a very low or very high BMI (body mass index) disrupts ovulation and may also affect production of important reproductive hormones.
"One of the first things I counsel women about is the role of their weight in influencing their fertility," says Janet Choi, MD, a reproductive endocrinologist at the Columbia Presbyterian Medical Center in New York City.
For many women -- particularly those who are overweight -- problems are traced to ovulatory dysfunction, often caused by PCOS. That said, a recent Dutch study of some 3,000 women found excess weight could also interfere with fertility even if a woman is ovulating normally.
Reporting in the journal Human Reproduction, researchers documented a 4% decrease in conception odds for every point in BMI above 30. For women whose BMI was higher than 35, there was up to a 43% overall decrease in the ability to conceive.
The good news: Losing those extra pounds may preclude the need for pricey fertility treatments.
In fact, the British Fertility Society in 2007 issued new guidelines urging members to defer fertility treatments in very obese women (BMI over 35) until they gave weight loss a try.
At the same time, being too thin can also keep you from conceiving. "Women who are extremely lean often have a problem getting pregnant because they are not able to sustain a regular menstrual cycle -- for these women, it is more beneficial to gain weight," Chavarro says.
Although links between stress and infertility have been long debated, evidence continues to mount that the two are intertwined.
In studies conducted by Alice Domar, PhD, at Harvard's Mind-Body Institute, women who underwent stress reduction therapy saw dramatic increases in their ability to get pregnant. In fact, even women who were already undergoing fertility treatments had more successful outcomes when stress was kept under control.
More recently, research conducted at Magee Women's Hospital in Pittsburgh by Sarah Burga, MD, linked stress to a condition known as functional hypothalamic amenorrhea (FHA). Affecting some 5% of women in their reproductive years, it causes irregular or absent menstrual cycles.
Choi says, "I don't advocate quitting your job just to get rid of stress, but if you can try to get better day-to-day management of your anxieties, I believe it can work in conjunction with other methods to encourage fertility."
What can you do to reduce fertility-related stresses? Experts say anything that makes you feel relaxed can help -- be it listening to music, doing yoga, getting regular massages, writing in a journal, reading, gardening -- even chatting on the phone with friends.
You can also think outside the box for some unique ways to reduce stress. One recent study published in the journal Psychological Science found the simple act of holding hands with your spouse can drop stress levels dramatically. Or you might try renting a stack of romantic comedy videos.
If you're tempted to handle your stress by smoking or drinking alcohol, experts say don't. Numerous studies have shown that smoking contributes to both male and female infertility and can even impair the outcome of fertility treatments. Excessive alcohol consumption can impair ovulation in women and sperm production in men.
Studies linking acupuncture to conception have by and large been conducted on women undergoing fertility treatments. Still, many experts are quick to point out that this ancient Chinese medical art may also work to help encourage fertility overall -- even for those couples trying to conceive naturally.
"I sometimes recommend acupuncture, in conjunction with stress reduction activities such as yoga, to help encourage pregnancy," Pollack says.
"I wouldn't advise a couple to rely only on acupuncture, or to try it without first getting a fertility workup, but if everything checks out OK, acupuncture can be helpful," she says.
While being intimate during the "right time of the month" won't do anything to increase your fertility, it can increase your chances of getting pregnant -- simply by ensuring you and your partner connect during the time conception is possible.
Timing is crucial, says Pollack, because "an egg only lives for 24 to 36 hours." But sperm can live in the lower portion of a woman's reproductive tract a lot longer -- often up to five days. So to increase your chances of conceiving you should be intimate with your partner beginning three to four days prior to ovulation, and continuing up to 24 hours after ovulation.
But how do you know when you're about to ovulate? Experts say there are several methods you can use to approximate.
A kit that helps predict ovulation may tell you when it's the best time to have intercourse, but most did little else to foster fertility -- until now.
A new kit developed by Conceivex not only offers ovulation prediction, but it also contains a small latex-free cervical cap to actually help you conceive. The idea here is to concentrate an ejaculate into the cap and insert it into a woman's body directly at the opening of the cervix. In a kind of do-it-yourself mini-insemination, it does away with the need for sperm to swim through a sometimes chemically "hostile" vaginal canal, placing them instead right at the palace gates.
Shari Brasner, MD, who has recommended the kit to patients, says it's most useful for women with previous cervical issues or for men with low sperm volume or performance anxiety.
"Short of diagnosing a cervical infection, we don't really have a test for cervical factor infertility -- and it is my belief that this could be the problem for many women with a past history of treatment for an abnormal Pap smear," Brasner says.
Though she says Conceivex won't repair any defects, it is a way around them. "It's also an important aid for men with sperm concentration problems," she says.
Although Conceivex requires a prescription, it can be purchased online after completing a questionnaire reviewed by their medical doctors. The cost is $300.
A second new kit is called Fertell. While the female version is simply an ovulation predictor kit, the male version is an at-home test able to measure sperm motility -- the ability of sperm to reach a woman's fallopian tubes. It sells for $99 and does not require a prescription. Other do-it-yourself sperm motility tests are available.
"There is no harm in trying these kits, or any of the other methods to encourage fertility. But if you don't get pregnant within the suggested time frame, then don't wait -- see a fertility specialist," Pollack says.
Colette Bouchez is the author of Getting Pregnant: What Couples Need to Know.
SOURCES:Staci Pollack, MD, assistant professor of reproductive medicine, Einstein College of Medicine; reproductive endocrinologist, Montefiore Medical Center's Institute of Reproductive Medicine and Health, New York City.Jorge Chavarro, MD, department of nutrition, Harvard School of Public Health, Boston.Janet Choi, MD, reproductive endocrinologist, Columbia Presbyterian Medical Center, New York City.Shari Brasner, MD, assistant professor of obstetrics and gynecology, Mount Sinai School of Medicine, New York City.Chavarro, J, Obstetrics and Gynecology, November 2007; vol 110, No. 5.Van Der Steeg, J.W. Human Reproduction, December 2007; online edition.Scolaro, K. American Journal of Health-System Pharmacy, Feb. 15, 2008; vol 65: pp 299-314.FDA: "Home-Use Tests - Ovulation (Saliva Test.)"American Pregnancy Association: "Ovulation Kits & Fertility Monitors."American Fertility Association: "Trying to Get Pregnant? New Advances in Technology for Ovulation and Induction and Treatment."
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