Preparing for A Healthy Pregnancy
It seems like the Monday after Thanksgiving might be a good time for a reminder about what to think about BEFORE you try to become pregnant. It's never too late to start new habits for a healthy pregnancy and make more conscious decisions about your lifestyle.
CT fertility specialist Dr. Mark Leondires, Medical Director of Reproductive Medicine Associates of Connecticut (RMACT), talks about the choices that we can make when we are considering having a baby. As he advises below in the blog that he wrote for the Norwalk Patch, 90 Days Preconception: Habits for Optimal Fertility and a Healthy Pregnancy, better to think ahead. Of course you want to make healthy choices when you are trying to conceive; even better though if you know ahead of time. Ninety days ahead of time, according to Dr. Leondires, can make a real difference.
~ Lisa Rosenthal
CT Fertility Specialist Dr. Mark Leondires On Optimizing Fertility
However, instead of jumping immediately into a treatment plan, I believe in treating the whole patient. My partners and I find that patients are most likely to successfully get pregnant when their physical and mental health is at its best.
Patients should consider their health and lifestyle habits 90 days before conception. This is about more than fertility health. This includes nutrition, mental health, stress management, physical activity… all of it affects a person’s fertility and, upon conception, it affects the health of mother and baby.
Some of our patients are able to get pregnant simply by changing their lifestyle habits – without assisted reproductive technology. As little as a 5 percent reduction in weight can lead to more regular ovulatory cycles, improved insulin sensitivity and an improved chance of pregnancy. Sometimes patients are too lean and their hormonal balance can be restored with weight gain.
Preconception Health Tips - A Checklist
Here are examples of how to improve lifestyle habits (and therefore improve fertility while decreasing the risk of birth defects) from the preconception health checklist that we use with our patients at Reproductive Medicine Associates of Connecticut (RMA of CT).
- Eat a balanced diet that exemplifies the USDA’s balanced plate full of vegetables, fruit, whole grains, lean protein, heart healthy fats
- Test for risk factors: hemoglobin A1c, vitamin D, blood pressure, cholesterol – these are simple tests that can be performed by your family doctor
- Start to take prenatal vitamins (800 mcg of folic acid)
- Drink water (not soda and minimize caffeine).
- Boost important vitamins and minerals: calcium (dairy, leafy greens), folic acid (citric fruit, fortified breads, lentils), iron (spinach, beans), omega-3 (low-mercury fish such as salmon)
- Limit alcohol
- Quit smoking
- Avoid exposure to environmental risk factors (e.g., gardening chemicals, cleaning products)
- Lower caffeine intake to less than 150 mg per day, which is equivalent to two 8 oz cups of coffee
- Try to get to a healthy weight and body mass index (BMI)
- Be physically active with low impact activities such as swimming, walking and restorative yoga
Mental Health & Partner Relationship
- Identify stress management method (e.g., yoga, meditation)
- Communicate with your partner about your dreams of a family
- Identify your network of friends and family – and consider talking to them when you are stressed
- Talk to a professional when going through extreme challenges or making life-changing decisions
- Consider support groups with other fertility patients. RMACT has monthly free support groups for fertility patients
- Check your health insurance. Is family planning covered? Are there restrictions (e.g., age)?
- Schedule a preconception visit with your OB/GYN and be up to date on PAP smear and mammogram
- For women: FSH and/or AMH, which are simple blood tests that help guage ovarian reserve; hysterosalpingogram (HSG), which is a non-invasive test to check the fallopian tubes and uterus
- For men: schedule a semen analysis, limit alcohol, quit smoking, work towards a healthy weight
Simple lifestyle changes have the power to improve fertility and the health of the baby. Sometimes assisted reproductive technologies are still needed for a couple to get pregnant. But improving a couples’ health (yes, the woman and the man) doesn’t have a downside. Best of all, many of my patients like being proactive – this is something within their control.
Male Fertility: Considering Laptops and Sperm
About two years ago now, a publication in the November issue of Fertility and Sterility demonstrated a negative effect of Wi-Fi radio frequency exposure on sperm samples. In other words, the study appeared to show that the computer usage could be contributing to fertility challenges. For this reason, the study was picked up broadly by mainstream media. Perhaps more important than the actual study itself is the attention it brought to male infertility. Many couples do not realize that 30-40% of fertility problems in couples are due to male sub-fertility or infertility.
Can Computer Usage Damage Sperm?
Let's look at this question: does computer usage damage sperm? First, let’s breakdown the study and its findings. Twenty-nine men provided semen samples that were washed and examined for motility and DNA fragmentation. The samples were subsequently placed underneath a laptop receiving a Wi-Fi signal for four hours. There was also a control group of samples that were not exposed to a Wi-Fi signal. Both sperm samples were evaluated; the investigators noted a significant decrease in motility of the sperm and DNA fragmentation in sperm samples. The investigators concluded that: keeping a laptop connected wirelessly to the Internet in the lap or near the testes may result in decreased male fertility. (Avendaño, Conrado, et al; (2011) Use of laptop computers connected to internet through Wi-Fi decreases human sperm motility and increases sperm DNA fragmentation, Fertility and Sterility.)
Here is the weak point of the study: it was conducted in the laboratory only and not on real men. The participants were not tested with laptops on their laps; semen samples were tested 3 cm below a laptop actively receiving Wi-Fi signals. In this artificial environment the laptop computer was continually downloading or uploading information to maximize Wi-Fi exposure. In addition, in real life when a man is using a laptop the sperm are within the body and within the testes; it is difficult to quantify how much radiation exposure the sperm would actually receive.
Regardless, it is plausible that direct exposure to electromagnetic radiation could affect sperm motility and quality. This study should lead to more clinical research about the affect of computer usage on sperm quality and therefore male fertility.
Male Factor Infertility: What to Consider
The most important outcome of this study is the attention it draws to male factor infertility. Beyond computer usage, there are many factors affecting male fertility. These include:
- Prescription drugs
- Environmental toxins
- Vitamin deficiencies
When I meet with patients, we discuss the male partner’s lifestyle choices. A recent large epidemiologic study showed that when men have more than six drinks per week, pregnancy rates in their wives are lower. In addition, a recent large study showed a dramatic decrease in successful pregnancies and increase in miscarriages when a male partner has a body mass index (BMI) of greater than 35. And there are many studies that demonstrate the negative affect of smoking on sperm count - whether the substance is tobacco or marijuana. Certain job situations also put a man's sperm count at risk; for example, exposure to chemical fumes from petroleum products and heavy metals have been shown to negatively affect sperm counts.
How to Optimize Preconception Health
At Reproductive Medicine Associates of Connecticut (RMA of CT) we encourage our patients – both men and women – to optimize their health and their lifestyle choices during the 90 days preconception. This includes:
- drink minimally
- quit smoking
- avoid exposure to environmental risk factors
- try to get to an ideal weight
While the fertility field has made incredible strides to scientifically enhance a couple’s chance of getting pregnant, I believe that a couple’s first step should be to live a healthy lifestyle.
As a closing note: If you spend more than a few hours with your laptop on your lap or your cell phone in your front pocket while connected to WiFi and you are trying to get pregnant you may want to make some simple changes in how you use and where you put your phone.
Just in case…
RMA of CT
Photo: Laptop by Rob Pearce, Flickr Creative Commons
It's not all about us. At least not us women. Men are involved. So here is RMACT's lead infertility doctor, Mark Leondires, MD, sharing his considerable knowledge about what the men go through. He even pulls Carolyn Gundell, RMACT's fertility nutritionist, into this blog for her particular style of wisdom.
Enjoy ~Lisa Rosenthal
The Role of Men During Fertility Treatment
Men sometimes feel powerless during fertility treatment. Even though about a third of my patients are experiencing male infertility and another third are experiencing male and female infertility, most of the “work” throughout assisted reproductive technology (ART) involves the female partner. But men can significantly impact their chances of successfully getting pregnant.
Many of my patients and their partners see fertility treatment as something that they are experiencing together; that emotional support will go a long way during fertility diagnosis and treatment. Besides this, men can take charge of their fertility.
My practice recently held a Fertility Seminar for Couples that included three sessions: Support and Encouragement for You and Your Partner (for couples), Optimizing Male Fertility (for men) and a Fertile Yoga class (for women). During my session with the men, we cleared up some misconceptions about male reproduction and how lifestyle habits – including nutrition, exercise and our vices (e.g., caffeine, alcohol) – impact our reproductive health.
5 Tips for Optimizing Male Fertility
Here are the areas that the attendees were most interested in during our one-hour discussion about optimizing male fertility:
1. Men can improve the health of their sperm and future baby in just three months. Because it takes 80 – 90 days for an immature sperm cell to grow into a mature sperm, men have the opportunity to positively impact the quality of their sperm by improving their health during the three months before fertility treatment. Men can optimize their health and the health of their sperm through improved nutrition, sleep, exercise and stress management. Fertility patients should have regular visits to their primary care physician as well in order to identify and treat other health issues including: hypertension, obesity, and diabetes.
Additionally, these improvements can change the genetics and DNA of the future baby. The study of changes in gene expression, which is called epigenetics, is an area of science with growing interest and clinical data support.
2. Synthetic testosterone actually decreases sperm count. For anyone who took high school biology, it seems counterintuitive that testosterone could lower sperm count. But synthetic testosterone, which can be found in supplements, tricks a man’s body into thinking that it has produced enough testosterone and therefore it slows down sperm production. During fertility treatment men should avoid all supplements and never have a testosterone injection or use testosterone creams or gels before and IVF or IUI cycle.
3. Sleep could be the secret to improving everything from eating habits to endocrine health. While you are sleeping, your body is busy recovering from the day’s physical and emotional wear and tear. Sleep is also instrumental in regulating hormones, including testosterone and other factors for sperm production. Sleep is vital to improving your health. Sleep deprivation, which is typically less than six or seven hours of sleep, can lead to:
- Increased Weight Gain
- Increased Stress
- Increased Hunger
- Increased Cortisol
- Increased Abdominal Fat
- Decreased Muscle Mass
- Decreased Testosterone
- Decreased Fertility
4. Smoking today can affect your children tomorrow. Quitting smoking may be the single greatest change that a patient – male or female – can make for his/her own health and potentially for the health of his/her unborn child. Most people are aware that smoking has far-reaching consequences. Interestingly, smoking tobacco or any other product has a dramatic negative effect on sperm count, quality, motility, and most importantly the genes incorporated in the sperm. There is a great deal of literature available on the dangers of smoking when it comes to issues of reproduction.
It is important that both partners support each other in quitting smoking. This single change will not only improve their fertility, but will also improve their overall health and the health of an unborn child.
5. Caffeine can rob you of energy. We’ve all been there: it’s 4 p.m. and you need one last push before you leave the office. But that one trip to the coffee shop for something frothy, sprinkled with cinnamon, topped with whipped cream, ice cold or piping hot could actually be robbing you of sleep later in the evening. In order to ensure that caffeine does not diminish sleep quality or quantity, avoid caffeine after lunch.
In fact, male and female fertility patients should limit their caffeine intake throughout the day. Carolyn Gundell, the nutritionist with RMACT, and I recommend that our male patients consume no more than 300 mg per day, and ideally that is more like 150 mg. To give you a sense of what this means and how quickly caffeine can add up, consider these amounts:
- Starbucks Grande Coffee (16 oz) 400 mg
- Starbucks House Blend Coffee (16 oz) 259 mg
- Dr. Pepper (12 oz) 37 mg
- 7 Eleven Big Gulp Diet Coke (32 oz) 124 mg
- 7 Eleven Big Gulp Coca-Cola (32 oz) 92 mg
- Ben & Jerry's Coffee Buzz Ice Cream (8 oz) 72 mg
- Baker's chocolate (1 oz) 26 mg
- Green tea (6 oz) 40 mg
- Black tea (6 oz) 45 mg
- Excedrin (per capsule) 65mg
As the medical literature continues to evolve, we’ve learned that these changes not only improve a couple’s chances for pregnancy, but can have effects on the child in pregnancy and throughout his/her life.
~Dr. Mark Ledondires
CT Fertility Center Event Updates
There is a lot happening at RMACT (Reproductive Medicine Associates of Connecticut) this week. Yes, even in a short week.
See about joining us for one or more of our events. We'd love to have you.
A Pre-Conception Wellness Seminar Tools for Fertility Success
Have you ever wondered if you or your partner were eating, sleeping, managing stress, or exercising differently would it improve fertility success? How about the affects of alcohol consumption, smoking, pesticides, plastics, and body composition on sperm and egg quality?
Please join RMA of CT for an interactive discussion on the benefits of preconception with a fertile lifestyle. We will share how to create a fertile lifestyle and The Fertility DietTM tips that will improve conception success and also help to support a healthy pregnancy and a healthy baby. Partners are Welcome.
This one session class is conducted by RMA Nutritionist Carolyn Gundell, MS and RMA Nurse Eloise Downs, RN.
Class Options: SATURDAYS
May 4th or June 1st 11:30am-1:00pm
Free Admission and Open to the Public
Location: RMA Norwalk at 10 Glover Avenue, Norwalk CT RSVP required. Space is limited. Please call Justine to reserve a seat at 203-750-7484. Please visit our website or call to confirm date, time and/or location as they are subject to change.
Pre-natal Yoga Every Thursday
This class was created especially for women who have been through fertility treatment. Class is designed around the special physical and emotional needs former fertility patients may have. Any woman, at any stage of pregnancy, is welcome to attend class (with doctor’s approval).
We will explore how the body changes through the different stages of pregnancy and learn how to continue to feel healthy and strong until labor and birth. Class will be a combination of relaxation, movement and meditation.
Come join us on the next step of your fertility journey.
Thursdays at 20 Glover Avenue (right next door to our main office in Norwalk)
7:15 PM- 8:15 PM
$40 for four classes (do not need to be consecutive sessions)
Please check website for any changes: www.rmact.com
Fertile Yoga Classes Ongoing
Classes will be on-going; come every week or once in a while, whichever suits you. Come alone or bring your spouse, partner, friend or family member. Yoga, meditation and deep relaxation can help men and women experiencing the challenges of infertility. Fertile Yoga helps couples relax and relaxation can help one make more satisfying decisions, communicate more clearly with their doctor, and sustain treatment with a more positive perspective.
What you need:
* comfortable, loose fitting clothing
* a yoga mat
* bottle of water
* two pillows (optional)
* avoid eating one hour before class.
In Norwalk, (classes from 5:45-7:00) we have a peer support group for the first 15-25 minutes where there will be a chance to share experiences, lend support and find comfort from those experiencing similar feelings. You are always welcome to join us at 6:15 if you would prefer only Fertile Yoga. In Brookfield, (Yogaspace- classes from 6-7:15), we wrap up talking by about 6:20.
Fertile Yoga was created and is taught by Lisa Rosenthal RYT -200 (Registered Yoga Teacher). Lisa is a former fertility patient, who has been working for over 2o years as a national patient advocate for couples going through infertility. Lisa is uniquely qualified to understand the specific stresses and challenges that couples trying to conceive encounter. Fertile Yoga is designed with different diagnoses and treatment plans in mind. It is a gentle, restorative class that includes meditation.
Lisa Rosenthal's Google+
Infertility is a Medical Problem
Infertility is a medical problem. While it may be exacerbated by stress, it is not caused by stress. It's also not caused by a bad attitude, bad karma or because you don't deserve to be a parent.
Or, put another way, there is always a medical reason why a pregnancy doesn't occur. Straight from the RMACT website, here is an overview of the problems on the women's side of things: female infertility.
Causes of Female Infertility:
- Defects of the uterus and cervix (fibroids, polyps, birth defects)
- Hormone imbalance or deficiencies, often related to age
- Ovarian cysts and polycystic ovary syndrome (PCOS)
- Pelvic infection or pelvic inflammatory disease (PID)
- Scarring from sexually transmitted disease or endometriosis
- Long-term (chronic) disease, such as diabetes
- Autoimmune disorders
- Clotting disorders
- Excessive exercising, eating disorders or poor nutrition
- Exposure to certain medications or toxins
- Heavy use of alcohol
- Advanced maternal age
"Additionally, there can be egg-related problems, such as egg production in the ovaries, movement of the eggs from the ovary to the uterus, attachment of the eggs to the uterine lining, and survival of the egg or embryo once it has attached to the lining."
Every single one of the problems listed above have solutions and different types of fertility treatment. Not every single person who has infertility problems will end their journey with a baby, but the majority will. Fertility treatment, with a board certified reproductive endocrinologist is your best way to ensure that your path to fertility is swift and easy.
There are also many things that you can do to prepare for being pregnant, with or without fertility treatment.
Assume that you will get pregnant. Regardless of the specific statistics of your prognosis, which give you some chance at becoming pregnant, make the assumption that you will become pregnant. Here are some things that you would do if you knew you were going to become pregnant. Carolyn Gundell, MS, our fertility nutritionist, has shared these well researched thoughts with you.
Pregnancy Diet Planning
"To achieve a healthy pregnancy diet before we create our plate, we must make time for all our meals--breakfast, lunch, dinner, and even snacks. Many women and men skip meals because they are too busy, too tired, or wrongly believe that skipping meals will help them lose weight. Long term meal skipping can cause many unhealthy metabolic changes such as weight gain, elevated fasting glucose, HgbA1c, LDL-cholesterol and triglycerides, and increased insulin resistance. Any one of these symptoms prior to pregnancy can increase a woman’s risk for gestational diabetes."
Having fertility problems does not mean you are infertile. It means you're having infertility or fertility problems; problems that have solutions and treatments.
Often it means that you are sub-fertile, rather than infertile.
Having these problems does not mean you will not become pregnant either. It may take longer, it may take fertility treatment. It may even be as simple as timing ovulation correctly.
If you are 35 or under, take a year of properly timed sexual relations and see if you become pregnant. If you are over 35, six months is long enough to try to conceive before seeing a board certified reproductive endocrinologist.
Having a baby isn't always easy. Sometimes the help that you need is very simple and very non-intrusive. Know how to find help that will support you in the ways that you want and need.
We are here for any questions that you may have. Please know that you can ask and that we will find the answers.
Chemical Exposure in Dads: Show This to Your Partner
A recent study on chemical exposure in dads published in the Journal of Occupational and Environmental Medicine (JOEM) came to my attention. It was the second of two articles on the topic of men, their jobs and the risks of birth defects, and it seemed worthy of mention here.
Occupations Linked to Risks of Birth Defects
14,000 men were enrolled in a study in which job type was linked to increased risk of birth defects in children. It was found that certain jobs held by men in the months before conceiving a child may increase risk of birth defects. Occupations in which workers are exposed to solvents, such as artists, chemical workers, pharmacists, chemical engineers, painters, dry cleaners, printers and plumbers, were associated with eye, heart and intestinal defects as well as oral cleft problems. The chemicals themselves were not studied but should and will be further investigated by researchers.
In another study, a list of the jobs of 10,000 dads who had a child with a birth defect was compiled as well as a list of the jobs of 4,000 dads who had a child without birth defects. Jobs associated with defects included artists, photographers and photo processors, landscapers and groundskeepers. Jobs not associated with birth defects in this study included designers, health care professionals, dentists, firefighters, fishermen, car assembly workers, entertainers, smelters and foundry workers, stonemasons, glass blowers, train drivers, soldiers and drivers.
Among children born in the U.S., the CDC estimates 1 in 33 babies are born with birth defects.
Preventing Birth Defects: What To Do
So what do we do? Can we prevent birth defects or minimize their risk? Having men change careers where they have worked so hard to achieve their goals is not reasonable. I think the lesson here is that it is not only women who need to take care of themselves and their pre-conception health. It is very important that men be aware of their environment and try to limit their exposure to chemicals. Men may not realize that their health and exposures can impact the health of their yet to be conceived child.
Precautions can easily be taken – wearing gloves, keeping areas of chemical use well ventilated, washing hands after exposure, etc. The environment is full of toxins but we have the ability to shield ourselves as best we can by being aware of our surroundings and knowing that these chemicals can cause harm.
If you are a man, hoping to have a child in the future, and are not aware of your risks, please take the time to check. Then follow up with the best precautions possible, for the sake of the health of your child and for you.
~Diana D'Amelio, RPA
Reproductive Medicine Associates of Connecticut (RMACT)
Our resident physicians’ assistant, Diana D’Amelio, RPA-C, serves multiple functions at the Norwalk and Danbury offices of Reproductive Medicine Associates of Connecticut (RMACT). As a clinician, she sees patients and performs physicals and procedures like endometrial biopsies, ultrasounds and saline sonograms. She also oversees the third party reproduction program, which includes donor eggs, gestational carriers and intended parents. Finally, she is the team leader in the Danbury office.
Diana received her undergraduate degree in biology from Cornell University and completed the Surgeon’s Assistant Program at Cornell University Medical College. She has practiced in the field of infertility since 1993.
Pre-Conception Wellness & Cosmetics
If you're trying to be as healthy as possible when trying to conceive, consider your make-up and skin care products as a piece of the puzzle. The 'foundation' of fertility wellness not only starts from the "inside out" (as our Nutristionist Carolyn Gundell, MS, covers in Pre-Conception Wellness), but from the "outside in" as well. Pre-conception health takes research related to environmental and chemical toxins into account, to optimize health before pregnancy.
Knowing more about skin-deep fertility basics can help minimize exposure to chemicals in cosmetics that may cause endocrine disruption, allergies/immunotoxicity and biochemical or cellular level changes.
Environmental Working Group Skin Deep is a nationwide coalition of public health, educational, environmental and consumer groups working to protect the health of consumers and workers by requiring the health and beauty industry to phase out the use of dangerous chemicals and replace them with safer alternatives. More than 1,000 companies joined the effort by signing the Compact for Safe Cosmetics, a pledge to produce safer products and publish safety data.
Environmental Working Group's Skin Deep database provides information and online safety profiles for cosmetics and personal care products. They are one of the founding members of the Campaign for Safe Cosmetics. Their webiste compares ingredients on personal care product labels and Web sites to information in nearly 60 toxicity and regulatory databases. Use the site to review safety ratings for a wide range of products and ingredients on the market - including cosmetics.
Lead in Lipstick - FDA December 2011 Report
Another great site for determining how sound your make-up and skin care products choices are: the U.S. Food and Drug Administration's (FDA) - Cosmetics section. Lead in lipstick was a concern that was raised several years ago and studied in 2009 by FDA scientists who had developed an analytical method for measuring the amount of lead in lipstick.
Their initial findings, as well as their expanded findings on 400 different lipstics, was posted recently in December 2011, and confirms that the amount of lead found in lipstick is very low and does not pose safety concerns. The Campaign for Safe Cosmetics maintains that any amount of lead in cosmetics is too much. Too much lead can affect nearly every system in the body, according to the CDC. Lead poisoning can damage the nervous, muscular and reproductive systems, and has been tied to kidney damage and reduced IQ in kids.
Infertility and fertility basics are sometimes skin deep. Start from there to get healthy before pregnancy . . . it's always good to get back to basics.