Should I see a doctor first?
Your OBGYN should see you for a preconception visit once you’ve decided you are ready to start trying to conceive. Your OBGYN can review your medical and surgical history, your medications and your vaccination status. It is important to maximize certain medical conditions (hypertension, diabetes, thyroid disease) prior to conceiving. Your doctor will also discuss specific genetic testing that you and your partner may choose to undergo prior to getting pregnant.
You should also start taking prenatal vitamins 3 months prior to becoming pregnant. The folic acid component in prenatal vitamins is important to start before conception. Most women only need 400 mcg daily (the amount in most prenatal vitamins), however, some women need more. Your primary physician should help determine your specific needs.
Diet and Exercise Considerations
If you exercise, continue doing so. Women who participate in moderate amounts of exercise tend to have higher levels of fertility. If you have regular menstrual cycles, there is no specific diet that can help improve your fertility. If you have irregular menstrual cycles, your doctor may recommend a low carbohydrate, high protein diet. For women who are overweight, reaching a healthy weight can help improve your chances of becoming pregnant and staying pregnant. Your doctor can make recommendations for a specific goal weight, as well as diet and exercise strategies to reach your goal weight.
Studies on alcohol use and fertility have produced conflicting data, with some showing lower fertility rates and others showing higher rates of pregnancy. The best data suggest that modest alcohol use is reasonably safe, but keep your use to less than two drinks per day. Once you get a positive pregnancy test, all consumption should stop. Similarly, moderate consumption of caffeine does not impair fertility or pregnancy outcomes. Caffeine use should be limited to one to two cups of coffee per day (less than 300mg of caffeine per day). There is good data that tobacco use negatively impacts ovarian health, and women who smoke go through menopause on average 5 years earlier than those who don’t. For those women who have partners’ who smoke, second and even third-hand smoke can still be detrimental to fertility!
When to See an Infertility Doctor
For women under the age of 35, most will conceive after 12 months of trying. If you haven’t become pregnant after 12 months, you should see your OBGYN or an infertility doctor. Earlier evaluation is indicated for those with irregular periods, pelvic infections, endometriosis, or suspected male infertility. Due to the decline in ovarian function in the late 30s and early 40s, women over the age of 35 should seek evaluation after 6 months. But again, sooner evaluation is recommended if there are concerns about female or male partner health as listed above.
What if I need fertility treatments? Are they safe?
Many patients worry that when they come see the infertility doctor, that IVF will be the only option for treatment. This treatment is actually used for the minority of our patients. Much more commonly we utilize oral medications (pills) to induce ovulation, correct underlying endocrinopathies such as thyroid disease, or perform a laparoscopy to treat scar tissue or endometriosis. For the most part, fertility treatments are safe.
Specific risks that are well known are the risk of multiples—or twins, triplets and more. The octo-mom made this risk very real and very scary to a lot of women. Ultimately, the risk of multiples depends on the type of treatment given. Contrary to what most believe, IVF is the treatment in which we have the most control over the risk of multiples since the physician can transfer one embryo at a time. The movement towards single embryo transfer is one way in which our field has turned the focus onto improving the health of mothers and babies after fertility treatments. The much riskier treatments are those outside of IVF, where we can not control well the number of eggs released. The risk with oral medications (Clomiphene and letrozole) is low, twins are seen in 8-10% of these pregnancies (2-3X higher than in spontaneous conceptions) and triplets in <1%. For gonadotropin treatment cycles, where fertility injections are used, the risk for twins and triplets is much higher.
Over the past few years, there have been studies that have shown improvements in neonatal outcomes after frozen embryo transfer compared to fresh embryo transfer. The mechanism isn’t entirely well understood but is likely due to maternal hormone levels being in the normal range after frozen transfer compared to fresh embryo transfer when they can be 10X higher.
In what other ways can infertility care improve the health of families?
One of the most interesting areas of our field is preimplantation genetic diagnosis—and this technology can be used to improve the health of families. For instance, we have patients that are either affected by a genetic condition themselves, such as cystic fibrosis, or have a child affected by a specific condition, and they are led to pursue PGD to reduce the risk of transmitting that genetic condition to their next child. This is a powerful way that our field has allowed parents to improve the health of their families.
Lastly, we take care of men and women facing treatments for a malignancy or rheumatologic condition that may render them unable to have children. We are able to offer them fertility preservation, or freezing of eggs, sperm or embryos prior to undergoing this treatment. Then, when they are ready to have children, if they are unable to get pregnant, we have sperm, eggs or embryos saved for them to be able to use. Cancer care has turned its focus to healthy survivorship, and being able to pursue parenthood is an important factor in well being for many cancer survivors.