New research presented at the Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG) reveals a high protein diet having a positive effect on fertility. Improved egg and embryo quality were seen in those IVF patients who consumed higher levels of protein and lower levels of carbohydrates.
Three-day food logs were taken from 120 patients who underwent IVF treatment. Those patients who consumed 25% of their daily calories from protein and less than 40% from carbohydrates, had four times the pregnancy rate as those who consumed less protein and more carbs. Interestingly, there was no difference in body mass index (BMI) between both groups, further highlighting how diet may be key in improving a woman’s fertility more than overall BMI.
These findings are by no means a reason to start loading up on steak, bacon and butter. But the findings in this study do reveal how dietary modifications during the fertility process may impact the odds of conception. I encourage my patients to consume a source of lean protein at every meal and especially during the afternoon snack. Protein takes longer to digest than carbohydrates, therefore filling you up and keeping you feeling satiated for a longer period of time. Protein is also the building block for your body’s cells and so it is no surprise that it is likely essential for a good reproductive outcome.
The blog posts presented here do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only.
What Couples Need to Know When Attempting to Conceive a Second Child
After the first child, it seems there is a sense of relief, especially if a couple has tried for some time before successfully conceiving. Many couples believe that having that first child proves they are a healthy, fertile couple and that the next child will easily follow. When the time comes to try for that second baby, however, many couples find conception much more difficult than the first time around. This leads to both confusion and frustration, since all the parts worked just fine for baby number one. In fact, it is a common misconception that one baby means another will be easy. A lot can happen between the first and second child in terms of biology, and sometimes that first baby really was a miracle. Secondary infertility, as it is commonly referred to, is encountered by couples facing challenges conceiving a second (and even a third) child. Although, learning about the causes and treatments available can help parents make the changes necessary to increase odds of adding another member to the family.
Causes of Secondary Infertility
Secondary infertility is diagnosed only after a young couple has been trying for more than a year or when a woman over age 35 has been trying for more than six months. The couple may either find themselves unable to get pregnant, or experience multiple miscarriages. There are many biological aspects that can influence fertility, some of which can be controlled and others which simply cannot.
Age
It is common knowledge that age plays a large role in female fertility. As women age, the number of eggs she carries will decrease, as will the quality of the eggs that remain. This is not surprising, since all the eggs she carries have been around since her birth. Miscarriages are often due to diminished egg quality.
Adhesions
In certain instances, the first birth has caused the new infertility issues. Some women develop complications in the form of pelvic or fallopian tube adhesions as a result of rough deliveries, abdominal surgeries, endometriosis, or Asherman’s Syndrome. These adhesions can cause structural complications that prevent the eggs from passing through the tubes or attaching to the uterus.
Sperm Health
As men age, both their sperm quantity and quality degrades as well, albeit at a slower pace. Their sperm may also be negatively affected by health problems or certain medications.
Weight
Being under or overweight can also be detrimental to fertility health. This goes for both men and women. For women, being overweight increases insulin resistance. This causes increased testosterone in the ovaries, which can interfere with normal ovulation. In men, excessive weight impacts them in the opposite way, and instead increases estrogen. Underweight women have a harder time conceiving and tend to have difficulties with ovulation. For both parties, maintaining a healthy diet is crucial for fertility, pregnancy, and health in general.
Addictive Habits
If either partner has any unsavory habits, now would be the perfect time to quit. As with most bad habits, too much of anything causes imbalances in the body, which affect overall health. Tobacco use, for example, adversely affects chances of conceiving and carrying a baby to term, and is strongly advised against for both men and women.
Potential Solutions for Secondary Infertility
Even if an individual has been diagnosed with secondary infertility, it does not mean a second child is impossible. It may simply mean a couple will need to explore options that they did not require for the first child. There are lifestyle changes a couple can make, particularly in the way of diet and exercise, that could significantly increase chances of conception. Additionally, there are many new fertility treatments available that are increasing odds for couples around the world.
Medication
In terms of female infertility, physicians will form an analysis based on the results of a series of diagnostic procedures. This usually starts with strategies to increase available eggs. This can be done through the use of medications like clomiphene citrate, which is taken orally, or gonadotropins, which are injected. Once the medications begin to work, they are expected to stimulate egg production and therefore increase the chances of at least one being fertilized.
In Vitro Fertilization
Once the physician confirms additional eggs are available, a couple may simply resume their usual strategy of intercourse to attempt fertilization. If traditional intercourse is deemed ineffective, the physician might suggest in vitro fertilization. This way, through assisted reproductive technology, the process of fertilization is conducted in a laboratory through medical observation. As with any medical treatment, although costs are involved for performing the procedure and anesthesia, many insurance plans cover a substantial portion of fertility treatment and options exist to lower the costs of IVF.
Egg Donation
If for some reason, the fertilization attempts continue to prove unsuccessful or if a woman has been diagnosed with a severely diminished ovarian reserve, egg donation stands to be an option. Although it does involve using an egg produced by another woman, the egg can still be fertilized by the patient’s spouse’s sperm and carried to term by the patient.
For couples attempting to conceive a second child for an extended period of time without success, it is important for them to be aware of the probable causes of and treatments available for secondary infertility. Gradual changes to lifestyle habits can significantly impact a couple’s fertility health and can be addressed with a fertility specialist. Once the specialist performs a series of tests to determine the root cause of the unsuccessful fertility attempts, he or she can then provide guidance on various options available to the couple to lead them on the path to successful family building.
The blog posts presented here do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only.
Turning to candy and chips during pregnancy is often seen as a right of passage, but a new research study has given us another possible reason for the increased global obesity rates, linking junk food intake during pregnancy with a junk food addiction, later in life, in the child. An Australian researcher and her colleagues from FOODplus Research Center in the School of Agriculture Food and Wine in the University of Adelaide used pregnant and lactating rats in their experiment and split them into a junk food group and a control group that was fed a regular rat diet.
The researchers discovered that the junk food group had changes in their development of opioid signaling pathways in the brains of their unborn children, making the babies less sensitive to opioids, which produce ‘feel good’ chemicals and are released with junk food intake. More simply, the high-fat and high-sugar foods reduced the sensitivity to the opioids, and in turn, the children have an increased tolerance to those foods and end up requiring more junk food in order to have that ‘feel good’ response.
Since this study was performed on rats, future studies still need to be conducted on humans to see if the results are similar. This study, published in the March 2013 issue of The FASEB* Journal, is yet another example of how important a woman’s diet during pregnancy is, and how her food choices can have a lasting effect on her offspring. I’m hoping this study encourages women to make healthier food choices during pregnancy, and causes them to lower their refined sugar and ‘bad-fat’ intake, to help them have healthier children.
*FASEB is the Federation of American Societies for Experimental Biology
The blog posts presented here do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only.
Patients often want to know when they will be most fertile in order to maximize the probability of successful conception and pregnancy. Although there is no single moment that defines maximum fertility, women can take precautions to give themselves the best possible chances of conception. Luckily, human biology helps manage the unpredictability of this moving target. First, it is useful to know that sperm can live in the reproductive tract for several days. On average, sperm can live up to three days, but up to five days is not impossible. As long as viable sperm is present in the reproductive tract, fertilization, conception and pregnancy are possible. This should relieve some anxiety about detecting the “exact” moment of ovulation, which isn’t necessary or even possible, but being aware of ovulation and predicting when it will occur (even a rough prediction) is quite helpful when a woman is trying to conceive.
The best chances for successful conception occur when viable sperm is already present in the reproductive tract prior to the moment of ovulation, because once ovulated, the egg will not survive more than approximately twenty-four hours, unless it is fertilized.
Predicting when ovulation will occur can sometimes be as easy as tracking menstrual cycles, or using a “menstrual calendar” to measure the time that passes from day 1 of one cycle, which is the first day of the period, to day 1 of the next cycle, or the first day of the next period. If the length of each cycle is approximately the same, then it is reasonable to assume that ovulation is occurring approximately 2 weeks before the onset of the period. In future cycles, couples should plan to have intercourse around this anticipated date. Now, sometimes the calculation may be off, because it assumes the future cycle will be similar to past cycles, which is not always the case, but patients having frequent intercourse (every day or at least every other day), leading up to the day of ovulation, are maximizing their chances at successful conception. Since the day of ovulation can be unexpectedly earlier or later from one cycle to the next, it is best for couples to have intercourse frequently beginning a few days before the expected ovulation date and continue for a few days afterward.
Using an ovulation predictor kit can sometimes simplify matters by detecting the hormone surge that triggers ovulation. Luteinzing Hormone (LH) signals the ovary to release an egg. The triggering hormone, however, takes time to cause the egg to actually release, and this biological fact can be used to help time intercourse or insemination. Typically ovulation predictor kits (there are many different kinds available in the drugstore) detect the presence of LH hormone in the urine. LH is not typically present in high amounts throughout the menstrual cycle, but suddenly appears in high concentrations just before ovulation. Since LH hormone is excreted in the urine, when high concentrations are detected in urine, ovulation can be expected to occur soon. (*There are a few special exceptions for when LH kits will not perform as expected, see below.)
The release of LH from the pituitary gland where it is created occurs about 36 hours before ovulation, BUT it takes time for it to circulate around the body, begin the ovulation process in the ovary, get filtered through the kidney and accumulate in the urine, where it is stored until a convenient moment to urinate. Because of this, when the LH surge is detected in the urine, it is safest to assume that ovulation will be occurring within 24 hours, and intercourse or insemination should occur no later than that same day. Since it can be longer than 24 hours from a positive test to ovulation, intercourse should occur the day following as well. Since the egg will not last more than 24 hours (and possibly even less than 24 hours), delaying intercourse can result in a missed opportunity.
*Exceptions – 2 cases when LH kits won’t work: 1. Women who have Polycystic Ovary Syndrome may have “false positive” results when using LH kits. For complicated reasons not important to go into in this blog post, women with PCOS may have higher LH levels than is the norm and these levels may vary, some days in a normal range, some days higher, and can make LH kits turn positive, even when ovulation is not happening. If a period does not occur about two weeks after a positive LH test and if a woman is not pregnant, the LH kit may have been falsely elevated. 2. Women who have ovarian insufficiency (abnormal early onset of menopause either from unexpectedly rapid loss of follicles, damage to ovaries from endometriosis, surgery, or chemotherapy, or unusual genetic conditions that interfere with normal menstrual cycles) and women who are in menopause have high LH levels constantly, regardless of the day tested. This is not a sign of ovulation, but a reflection of the physiology of this situation.
Finally, ANY positive test should be considered positive, and intercourse should be timed accordingly. Some of these tests sometimes don’t look “positive enough” until suddenly the signal disappears and the opportunity is missed. Women who are very well hydrated may dilute the urine test results and sometimes these tests don’t perform quite as expected. Holding back until the “perfect moment” may result in a missed opportunity.
In summary, there is no exact moment of maximum fertility that has been identified. The presence of sperm in the reproductive tract prior to ovulation seems to provide the highest chance of success, and as a result, the best time for the sperm to be present seems to be in the 24-48 hours prior to ovulation. This can be best achieved by the options above, although there can be other signs of impending ovulation, which will be touched upon in future posts, the strategies detailed here seem to be the most reliable and effective.
The blog posts presented here do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only.
The ability to allow embryos to develop outside the human body is the hallmark of in vitro fertilization (IVF). In vitro literally means, “in glass,” which gave rise to the colloquial “test tube baby” image (although now laboratory dishes are typically disposable, medical-grade plastic, which makes the process safer for patients.) Focus on refinement and improvement of the embryo culture process has been the driving factor in IVF success. As culture conditions have improved, greater numbers of eggs have fertilized successfully and completed the necessary cell divisions for proper embryo development.
In the early days of IVF treatment, human embryos could only be successfully incubated for 1 or 2 days, and so all transfers were initially conducted within a 24-48 hour time period following egg retrieval. Eventually, as embryo research continued to advance our understanding of the physiology of early human development, culture techniques improved to permit day 3 embryo transfer.
Embryos transferred on day 3 are referred to as “cleavage” stage embryos, because the individual cell divisions can be observed and accurately counted by microscope examination performed by an embryologist. When day 5 embryo culture, sometimes referred to as “extended culture,” was developed, the improvement in IVF success was a dramatic leap forward.
Initially, many IVF programs were reluctant to include day 5 or “blastocyst transfer” in the standard treatment regimen, because of its complexity and initially sometimes unreliable results, as sometimes accompanies with new biotechnologies that require stringent conditions. As the consistency of the improvement in results became obvious, the adoption of extended culture became increasingly common. Advantages of day 5 culture were immediately apparent: culturing embryos longer allows embryologists to identify more accurately those embryos that are more likely to yield a successful pregnancy, based solely on physical characteristics of the embryo. Increased accuracy at selecting healthy embryos makes it possible to reduce the number of embryos to transfer, which also decreases the likelihood of a multiple pregnancy resulting from treatment, which increases the safety of treatment by reducing the complications related to multiple pregnancy, such as preterm labor and delivery, gestational diabetes, gestational hypertension, preeclampsia, likelihood of surgical delivery, postpartum hemorrhage, transfusion, and the risks of prematurity to the fetuses, which can cause permanent and severe disability.
Embryo selection protocols were developed based on patient outcome results. Because not all patients seemed to benefit from extended culture, a decision tree was established to determine who should have a transfer on day 3, who should be transferred on day 5 and how many embryos should be transferred based on day of transfer, the age of the patient, and the patient’s prior outcomes with IVF treatment. These protocols complicated the process for patients, who needed to be available for embryo transfer on both day 3 and day 5, until they could be informed which day the transfer would take place, and sometimes led to unnecessary disappointment, when patients hoping for day 5 transfer were instead scheduled for day 3 transfer in cycles that would ultimately yield successful live births.
Embryos that fail to develop in culture are obviously not going to yield pregnancies, and extended culture gives additional time for development errors to become apparent. Because not all errors cause an early in-culture failure, increasing the duration of the culture process increases the likelihood of screening out abnormal embryos. As embryos develop, increased complexity means more genes are activated, increasing the probability that an abnormality, previously unexpressed, will be revealed, and as the errors reveal themselves, they frequently result in slower-growing or arrested embryo development.
A useful analogy (and oversimplification) is that of a car with a loose tire: when the car is started, it can be driven as far as until the wheel falls off its axle, but when exactly the wheel will fall off cannot be predicted. The farther that car is driven, the more likely the wheel is to fall off (if it is going to do so), thus allowing us to identify which cars are defective. Extended culture is like “kicking the tires” of a car. While it is still possible to fail to identify an abnormal embryo prior to transfer based solely on physical characteristics of the embryo, extending culture time decreases that likelihood. (For more information on non-invasive embryo assessment see my previous post: Assessing Embryo Development or How to Choose an Embryo for Transfer.)
Unfortunately, some embryo cohorts generated from the egg retrieval will yield no normal embryos. In some cases, this means that all of the embryos will stop growing in the laboratory, and the patient’s treatment cycle will be stopped early, prior to the embryo transfer. Although this situation is disheartening, knowing early that a cycle will fail to yield a pregnancy can avoid the anxiety, cost and, in the case of progesterone injections, physical discomfort, of the nearly two-week wait to get negative results.
We anticipate significant benefits to patients by converting our IVF program to a “blast-only” transfer program. Ease of scheduling, transfer of fewer embryos, improved embryo selection, and decrease in multiple pregnancy are well known benefits and may now be applied universally to all of our patients.
The blog posts presented here do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only.
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