The fact that you know you’re a carrier for hepatitis B is the first step in ensuring that the condition will not harm your baby. Although some children born to some carriers (those with a certain antigen) are at high risk for infection, treating them within 12 hours of birth with hepatitis B vaccine and immune globulin can almost always prevent such an infection.

Be sure to tell your obstetrician that you’re a carrier so that a titer is taken to determine how contagious you are and that your baby is treated as needed. Treatment is repeated at 1 and 6 months, and the child is usually tested at 12 to 15 months to be sure that the treatment has been effective.

Yes it can. Over the past decade more and more studies have shown a link between sleep deprivation and a host of health problems, including obesity, depression, and infertility. Since the immune system is weakened when a person doesn’t get the sleep he or she needs, the body doesn’t work at its full capacity. This makes conception difficult.

South Australian scientists at the University of Adelaide also have recently discovered that “clock genes” that manage daily body rhythms may play a more important role in fertility than previously believed.

In their study of mice, they found that those without a gene that regulated body rhythms were “profoundly infertile.” In an article in the January 2005 issues of the journal Human Reproduction Update, they explain their theory of disrupted circadian rhythms in reproduction.

They plan to conduct further research into the behavior of clock genes and their interaction with the environment to find answers to some of infertility’s most puzzling questions, including why only some embryos grow in the laboratory and why some couples with no known reproductive problem cannot conceive.

The American Association for Reproductive Medicine (ASRM) and SART Practice Committee recently published new guidelines to aid assisted reproductive technologies (ART) programs and their patients. The new guidelines will help to minimize the incidence of multiple pregnancies that carry risks both to the mother and to the children.

The committee recommends that under ordinary circumstances, patients under age 35 should have no more than two cleavage-stage embryos be transferred. Older patients may have more than two transferred, but the number will be determined by the prognosis criteria.

At this point in time you don’t have anything to worry about. Urologists at the State University of New York at Stony Brook conducted the small study to which you refer. Although they found that long-term use of laptops could reduce sperm formation by raising temperatures in the genital area, more studies need to be conducted to determine whether these side effects are short-term or long-term.

The researchers found that keeping a laptop on the lap for an hour can raise scrotal temperatures by more than 2.5 degrees Celsius, enough to affect fertility significantly, according to a report published in the December 9th issue of the European journal Human Reproduction.

The best way to safeguard a man’s fertility while using a laptop is to put it on a desk instead of on the lap, say the researchers.

Yes there are, especially if you have cut back on cereals, crackers, and other foods made with grain fortified with folic acid. According to an article published by Dr. Gideon Koren, professor of Pediatrics, Pharmacology, Pharmacy Medicine, and Medical Genetics at the University of Toronto, with an estimated 10 to 15 percent of American and Canadian women on low-carb diets, a growing number of women are not eating enough folic acid from flour products to prevent neuro tube defects in their offspring.

According to the article before flour and other products were fortified with folic acid, the typical woman consumed slightly less than 200 mg of folic acid from dietary sources alone. This is far less than the daily-recommended 400 mg of folic acid per day for women of childbearing age.

Anyone who is trying to conceive, including those on low-carb diets, should take prenatal vitamins. Remember, as many as half of all pregnancies are unplanned which generally means that women may not know that they’re pregnant until four to six weeks of gestation. Unfortunately the fetus’ neuro tube has already closed by this time if the mother had not been getting her needed supply of folic acid.

Congratulations on deciding to make proper lifestyle changes to be the healthiest you can be when you conceive. Regular exercise has been proven to relieve stress. It also can help protect the cardiovascular and immune systems from the consequences of stressful events.

Tai chi is a good choice for someone who wants low impact exercise. The health advantage of this ancient Chinese system of physicial exercises lies in its breathing method and slow movements. These series of fluid motions are circular, slow, and together form one, larger posture. The deep breathing helps to relieve stress, while the coordination of upper-body moves with the shifting of weight from leg to leg promotes total fitness. Tai chi also has been found to improve flexibility, muscular stamina, and strength. Before beginning any new exercise regime, however, it’s important to consult with your physician.

No, they’re not, according to a recent article published in the August 2004 issue of OB/GYN News. “Many herbal preparations taken during pregnancy are innocuous, but some are ineffective and others are downright dangerous,” Dr. Tieraoana Low Dog of the University of New Mexico in Albuquerque told his colleagues at a meeting on botanical medicine sponsored by Columbia University and the University of Arizona.

Raspberry leaf, often taken to alleviate morning sickness, prevent miscarriage, and aid in childbirth, was found to be safe. A randomized controlled study of 192 women found that women who used raspberry tea from week 32 to delivery had no adverse affects. However, the herb had no perceptible effect on the timing of labor, the length of labor or the need for analgesia.

Ginger also is often taken to alleviate morning sickness. Three clinical trials have confirmed some benefit in this regard without finding harmful effects to the mother or infant. However Dr. Dog told the group, “to be on the safe side, women should limit ginger consumption to one gram per day.” In excessive doses, ginger may affect bleeding tendencies. One study that involved patients taking 10 grams of ginger was associated with significant reduction in agonist induced platelet aggregation.

The British Herbal Medicine Association considers chamomile, which is often ingested in tea made from its flower, safe for consumption during pregnancy. There have been no reports of adverse affects.

Blue cohosh, which is used to stimulate labor, should be wholly avoided in pregnancy, according to the University of New Mexico researchers. Often combined with black cohosh and taken as a uterine tonic or partus preparation during the last six weeks of pregnancy, blue cohosh has been used for these purposes since the 19th century. It is still widely prescribed by lay midwives. In one survey 52 percent of certified nurse midwives said that they recommended labor-stimulating preparations. Of these, 64 percent used blue cohosh and 45 percent used black cohosh. Complications, which were reported by 21 percent of the respondents who used either blue or black cohosh, included transient fetal tachycardia, meconium stained fluid, and nausea.

A study appearing in the June 2004 issue of the Journal of Human Reproduction suggests that it can. The researchers believe that since ultrasound can be used to measure the volume of the ovary, this volume may be able to predict when menopause will set in and how many fertile years a woman has left.

It has long been known that the number of eggs in the female ovary peaks at several million while she is still in the womb about halfway through gestation. From this point on, she experiences a continuous decline in the total number of eggs. At birth approximately one to two million eggs remain. The amount decreases to about 300,000 at the time menstruation begins. At around age 37 a woman has about 25,000 eggs left. In menopause she has only about 1,000 eggs left.

While these researchers have developed a tool to potentially help women plan their reproductive lives, a second study published in the Journal of Human Production warned that women might not want to wait too long before starting a family. Assisted reproductive technology (ART) cannot be relied upon to fully compensate for the lack of natural fertility after age 35. The authors used a computer simulation model to determine that the overall success rate of reproductive technology would be 30 percent for those trying to conceive at age 30, 24 percent at age 35, and 17 percent at age 40.

Even armed with such studies, patients should understand that it is at best difficult to predict at what point in their lives it will become too difficult to conceive.

Symptoms of PCOS include: irregular menstrual cycles (few or no periods) excess facial or body hair acne sudden unexplained weight gain problems maintaining a healthy weight darkened patches of skin on the neck, groin, under the arms, or in the skin folds depression or anxiety elevated cholesterol, especially LDL, and/or triglycerides and a family history of diabetes or heart disease.

According to a recent study conducted by Richard Schacterle, Ph.D., and Dr. Anthony Komaroff of Brigham Women’s Hospital in Boston, that’s usually not the case. They found that the symptoms of chronic fatigue syndrome usually do not worsen during pregnancy.

The study, which was published in the April 1, 2004 edition of OB/GYN News, involved 86 women with the condition who experienced a total of 256 pregnancies, some before and some after the onset of the syndrome. During pregnancy, 41 percent of the women reported no change in symptoms, 30 percent noted an improvement in symptoms, and 29 percent found that their symptoms worsened.

The investigators also found no significant difference in a host of maternal complications and outcomes when they compared pregnancies that occurred before the onset of chronic fatigue syndrome and those that occurred after the onset of the condition. The only exceptions were a higher rate of spontaneous abortions and a correspondingly lower rate of live births by vaginal delivery after the syndrome’s onset. These differences, however, could have been compounded by age or parity as stated by the researchers.

Before trying to conceive, you should consult with your physician.

To help your physicians determine why you and your husband have had trouble conceiving, a semen analysis is usually taken. The analysis is done the same day by a laboratory clinician. The sperm will be examined for a number of factors, including:

• the time for the semen to become liquid

• the semen’s volume, consistency, and pH (measure of its acidity).

• sperm count

• motility (percentage of moving sperm)

• morphology (normality of shape)

• agglutination (“clumping”) of sperm

• the presence of elements other than sperm, such as white blood cells or bacteria.

A normal ejaculate has more than 20 million sperm per ml. More than 40 percent of the sperm should be moving forward, and, using strict criteria, more than 14 percent should have normal shapes.

The sooner you both have the tests needed performed, the sooner you can get the treatment you need to conceive the baby you always wanted.

It’s probably a good idea to have your husband give up his hot tub and steam room visits until after you have conceived. The testes are supposed to be five degrees lower than a man’s body temperature. The sperm can overheat if the testes’ temperature rises too high.

Characterized by disrupted eating habits, unhealthy weight management practices, and distorted perceptions about weight and body shape, eating disorders affect 10 million girls and women in the U.S. The top three eating disorders, anorexia nervosa (selfinduced starvation), bulimia (bingeing and purging), and binge eating disorder (uncontrollable eating) are considered psychological problems, but they have serious health complications and may be life threatening.

Besides damaging the heart, kidneys, electrolye balance, and many bodily functions, eating disorders also can make conceiving and delivering a healthy baby difficult. Infertility often occurs in women with eating disorders because menstrual cycles and hormones are out of kilter. Because they’re not eating or drinking enough of the proper foods, malnutrition and vitamin deficiencies occur. This unhealthy nutritional balance increases the likelihood of high-risk pregnancies and miscarriage. If carried to full-term, the likelihood of birth defects, stillborn babies, and death of chronic illness in newborns rises. Women with eating disorders also are at high risk of developing polycystic ovarian syndrome, a condition that makes it difficult for a woman to conceive and also increases the rate of miscarriage if she does conceive.

If your sister is serious about wanting to have a healthy baby, then she needs to overcome her problem. She should make an appointment with her physician to be referred to a counselor that specializes in helping victims of eating disorders. Once she’s on the road to recovery, then she should visit a fertility specialist.

One of the most common hormonal disorders, hyperthyroidism is a condition where the thyroid gland becomes overactive and secretes too many thyroid hormones, especially the hormone thyroxine. Hyperthyroidism is more common in females and usually occurs between the ages of 20 and 50. About 75 percent of its cases are due to Graves’ disease, an autoimmune disorder in which the immune system produces antibodies that attack the thyroid gland, resulting in excessive secretion of thyroid hormones. Graves’ disease runs in families and may have a genetic basis.

People with vitiligo (a rare skin disorder) and pernicious anemia (a blood disorder) may also develop hyperthyroidism. Thyroid nodules that secrete too many hormones also can cause hyperthyroidism. Thyroiditis (inflammation of the thyroid gland) can cause symptoms of hyperthyroidism to occur temporarily.

Common symptoms of hyperthyroidism include weight loss, persistent tremor, and quick and sometimes irregular heartbeat. Drugs for hyperthyroidism reduce the activity of the thyroid gland. These antithyroid drugs are usually taken for 12 to 18 months until the thyroid gland can produce enough hormones on its own. The drug you are taking propylthiouracil (PTU) is one of the most common and effective antithyroid drugs available.

With expert medical care and guidance, the pregnant woman with hyperthyroidism has just about as good a chance of having a successful pregnancy and healthy baby as any other expectant mother does. Your physician will prescribe levels of the drug for pregnancy use only. The risks of taking the medicine, if any, are quite small compared to the benefits of keeping you well. If you still have to be on the medication after delivery, the levels prescribed may also change.

Answers to your questions depend upon whether or not you had the chicken pox as a child. If you did, then you do not have to get the chicken pox vaccine. However, if you did not get the chicken pox as a child, then you should consider being vaccinated. If you’re not sure, your physician will recommend a blood test to determine whether you’re immune. If you’re not immune and do not have protective antibodies from prior exposure to the virus, you will be given the varicella vaccine (against chicken pox). Couples are then advised to wait at least three months to try to conceive.

A woman who is already pregnant should not receive the vaccine. Besides causing more severe symptoms in adults than in children, chicken pox can cause problems in fetuses. One risk is congenital varicella syndrome, a group of birth defects that can include scars, muscle and bone defects, malformed and paralyzed limbs, a less than normal size head, blindness, seizures, and mental retardation. Congenital varicella syndrome affects only about 2 percent of babies who mothers developed chicken pox during the first 20 weeks of pregnancy. If a mother contracts chicken pox after 20 weeks of pregnancy, the syndrome is extremely rare.

Another risk occurs when the mother is infected with the virus from five days before to two days after delivery. Without preventive treatment, about one-quarter of newborns become infected with a severe chicken pox infection and develop a rash between five and 10 days after birth. According to the March of Dimes, up to 30 percent of infected babies die if not treated.

The good news is that these infections can usually be prevented or the accompanying symptoms greatly lessened if the newborn is treated immediately after birth with a VZIG (varicella-zoster immune globulin) injection. New antiviral drugs also are helpful in managing severe symptoms.

Infertility problems and weight go hand in hand. Research has found that obese women are two times more likely to be infertile than women of healthy weight. They also suffer from irregular menstrual cycles and weakened immune systems, making conception difficult. In addition, obesity can cause men to produce inferior sperm, another reason for infertility in couples.

Many times severely overweight people can develop a relatively common, though not well-known, condition called “Syndrome X. ” This condition is caused by having too much insulin in the body. “Syndrome X” can not only impede a woman’s ability to become pregnant but her ability to carry to term as well.

If you do conceive, being obese also can make your pregnancy more difficult. The risk of hypertension and diabetes in the form of preeclampsia and gestational diabetes rises, and delivery can be complicated because overweight mothers tend to deliver large babies. That’s why it’s so important to be at a healthy weight while trying to conceive.

DVIFG has a nutritionist and expert on Syndrome X on staff to help overweight patients lower their weight and insulin resistance to conceive the children they always wanted.

Yes it can. Women who smoke have consistently been found to have decreased fertility. Researchers believe that smokers have higher rates of certain hormones that can lessen their chances of conceiving. Moreover, women who smoke are more likely to begin menopause at a younger age than average. Studies have also found that even during in vitro fertilization, eggs taken from women who smoke are less likely to be successfully fertilized.

If you want to start a family, you should quit smoking immediately. Besides affecting fertility, smoking during pregnancy can harm the fetus.

As more women delay pregnancy planning until their 30’s and beyond, the importance of studying their ovarian reserve of oocytes (eggs) becomes paramount. Women are born with a full complement of eggs in the ovaries, which reside in a resting pool until they are selected to move into a growing pool. Some of these eggs will become available for ovulation after menarche (a girl’s first menstruation cycle). This cycle of oocytes moving from the resting pool to the growing pool continues throughout the reproductive years until all of the eggs have been used (menopause). Menopause usually occurs around age 51.

An oocyte that leaves the resting pool takes about 220 days to participate in the ovulation process. When a woman’s age is advanced, problems can ensue because there aren’t as many ooctyes available for ovulation in each menstrual cycle. As these numbers decrease, the ovaries’ ability to produce normal eggs to undergo fertilization also is lowered (the ovarian reserve).

There are several tests that measure the ovarian reserve. One of them, the clomiphene citrate challenge test (CCCT) has been standardized and is widely accepted. For five days the patient takes 100 mg of clomiphene citrate (CC). Here FSH serum level is measured both before the test and after the five-day round of medication is completed. A decision about the ovarian reserve is made based on the levels of FSH.

Recently, other tests have been used to determine the ovarian reserve, but they have not become standardized or widely accepted. Measuring inhibin B, a hormone produced from the growing follicle that increases as the follicle and egg mature, for example, can be advantageous in certain cases. Since its levels vary less from cycle to cycle in comparison to FSH, inhibin B can be used to predict the ovarian reserve after stimulating the ovaries with gonadotropins. Ovarian volume and early follicle count are other methods undergoing further evaluation and study.

A major problem may occur if a woman wants to conceive and happens to have high levels of FSH early in any of her cycles. In some cases the problem cannot be resolved with any treatment, while in other cases it can be easily resolved. Therefore, any woman who has a single elevated FSH level should immediately undero further evaluation, and specific studies of treatment should be implemented in order to achieve her desired goal of conception.

Hemachromatosis is an inherited disorder affecting body chemistry in which the level of iron in the blood is too high. If left undetected and untreated, the condition can lead to health problems, such as cirrhosis of the liver, diabetes, and heart disorders.

More common in men than women, hemachromatosis can cause infertility. Common symptoms in men include difficulty in ejaculating, shrinking of the testes, loss of interest in sex, limited facial hair growth, and reduction in their sense of smell. These symptoms usually do not appear until age 40, but excessive alcohol drinkers may experience symptoms earlier because alcohol increases the amount of iron that is absorbed by the intestines. In women, it may cause amenorrhea (the absence or suppression of menstruation).

The condition is usually diagnosed with a blood test, and treatment is targeted at removing some of the excess iron from the body. About 1 pint of blood is removed each week until the iron levels return to normal levels. People with this condition should not drink alcohol or eat iron-rich foods.

Despite its frequency (affecting 3 in 1,000 people in the U.S.) and effect on the endocrine system, hemochromatosis is given little attention in endocrinology and infertility textbooks. This is certainly a disorder that should be considered when taking case histories.

Occurring in about 1 in 100 pregnancies, an ectopic pregnancy is a pregnancy that implants outside the uterus, usually in a fallopian tube. If the condition is not detected and treated early, the pregnancy will continue to grow in the tube and the tube will eventually burst. If this happens, the tube will no longer be able to carry fertilized eggs on their way to the uterus in future conceptions. If the tube ruptures and is not immediately treated, the mother’s life also could be threatened.

Symptoms of an ectopic pregnancy include brown vaginal spotting or light bleeding accompanied by diffuse abdominal pelvic pain on one side or shoulder pain, and lightheadedness or fainting spells.

The good news is that new techniques for early diagnosis and treatment of ectopic (tubal) pregnancy have removed most of the risk for the mother and also have improved her chances of remaining fertile.

Besides high-resolution ultrasound to visualize the uterus and early gestational sac development, detection of the condition also is made through highly sensitive pregnancy tests that track the level of the hCG hormone in the mother’s blood. If the hormone level does not rise appropriately but still rises as the pregnancy progresses, an ectopic pregnancy may be suspected.

Transvaginal sonography is at the forefront for treating patients with a possible ectopic pregnancy. When the BhCG reaches around 2000 in a normal developing pregnancy, a small gestational sac should be visualized within the uterus. Between five to six weeks gestation, a yolk sac (visualized as a small, bright ring) should be seen within the gestational sac. If the BhCG is elevated enough to expect an intrauterine gestational sac, and one is not seen, an ectopic pregnancy is suspected.

Sometimes in the case of ectopic pregnancy, a small collection of fluid accumulates within the endometrial cavity (psuedosac). If the patient experiences pain, it may be due to a ruptured tube and fluid in the free spaces behind the uterus or around the liver and kidneys. Color doppler sonography can add information for further analysis. This technique utilizes color flow mapping to visualize increased blood flow to a suspicious area in the region of the fallopian tubes. A developing pregnancy outside of the uterus will demonstrate an increase in blood flow due to early placental tissue implanting in the fallopian tube. With transvaginal sonography a patient can be diagnosed earlier with an ectopic pregnancy and can be given the proper treatment in order to safeguard her ability to conceive again.

Laparoscopic surgery to remove the abnormal pregnancy is now routinely done. Less invasive than regular surgery, laparoscopic surgery also gives patients shorter hospital stays and quicker recoveries. But surgery is not the only route to take. If an ectopic pregnancy is diagnosed early enough, oral doses of the drug methotrexate can successfully treat the condition without the need for surgery.

If you have any questions regarding transvaginal sonography, please call Laurie Miller, DVIFG’s sonographer, at (856) 988-0072.

Hormonal fluctuations are a normal part of the reproductive cycle in the human female. When you add fertility drugs to the mixture, some, but not all, women may experience strong emotions and mood swings. Should these swings become disabling in their intensity or frequency, medications and/or psychotherapy are available to “cut the edge.” Oftentimes “forewarned is forearmed” and not being taken by surprise can be of great support in going through this period of time. Knowing that it is a temporary phenomenon and oriented toward achieving the goal of having a baby will greatly aid a patient in retaining her perspective. A knowledgeable and supportive partner may also play a critical role.

The Delaware Valley Institute of Fertility & Genetics (DVIFG) can help you cope with the uncertainty of infertility. Through a unique program designed to help you discuss and work through your feelings and concerns, you will learn effective strategies to live each day to its fullest while trying to conceive.

Geoffrey D. Nusbaum, Ph..D., director of DVIFG’s Medical Psychotherapy and BioMedical Ethics Service, is uniquely qualified to help you cope while trying to conceive. A Fellow and Diplomate of the American Board of Medical Psychotherapy and a Fellow of the International Council of Sex Education and Parenthood at American University in Washington,DC. Dr. Nusbaum holds a clinical certificate from The American Association for Marriage and Family Therapy and is a Founding Member of the Mental Health Issues Section of the American Society for Reproductive Medicine. He has over 25 years of experience counseling people on how to deal with the stress associated with a medical condition, including infertility.

To make an appointment with Dr. Nusbaum, please call (856) 988-0072.

Infertility support groups can often be a highly supportive milieu for a couple as they navigate their way through the maze of the infertility workup. It can be very helpful, supportive, and validating for a couple to see, hear, experience, and communicate with other couples that are on the same journey as they are. In some cases, issues may arise during the support group discussion that can then be addressed by the couple with or without professional support.

Like most other things in life, there is no “one-size-fits-all” solution, and each couple must determine if a support group can play a positive role in their infertility workup. Some couples may prefer a support group with only their peers, while others may be helped more by a support group led by a professional counselor.

The Delaware Valley Institute of Fertility & Genetics (DVIFG) can also help you cope with the uncertainty of infertility. Through a unique program designed to help you discuss and work through your feelings and concerns, you will learn effective strategies to live each day to its fullest while trying to conceive.

Geoffrey D. Nusbaum, Ph..D., director of DVIFG’s Medical Psychotherapy and BioMedical Ethics Service, is uniquely qualified to help you cope while trying to conceive. A Fellow and Diplomate of the American Board of Medical Psychotherapy and a Fellow of the International Council of Sex Education and Parenthood at American University in Washington,DC. Dr. Nusbaum holds a clinical certificate from The American Association for Marriage and Family Therapy and is a Founding Member of the Mental Health Issues Section of the American Society for Reproductive Medicine. He has over 25 years of experience counseling people on how to deal with the stress associated with a medical condition, including infertility.

To make an appointment with Dr. Nusbaum, please call (856) 988-0072.

Being on a vegetarian diet, regardless of whether or not you also eat dairy products, is actually healthier than regular diets containing meat products. In answer to your question regarding your ability to conceive, it’s not the vegetarian diet that causes problems but the reasons why you’re on it and how you take it that are more critical.

If a person goes on a vegetarian diet to lose weight and happily stays on it for weight control, then it’s unlikely to affect the reproductive system and fertility. On the other hand, if the vegetarian diet is difficult for her to follow and causes a lot of stress, then it will disrupt the reproductive system and create infertility problems.

From a physical point of view, if a woman loses too much weight while on a vegetarian diet and becomes underweight, then her reproductive system will be compromised or disrupted due to inadequate nutrition. This can lead to ovulatory dysfunction and infertility problems. On the other hand, if a woman consumes excess food, even on a vegetarian diet, and becomes overweight or obese, then she may develop a metabolic disorder such as insulin resistance, leading to ovulatory dysfunction and infertility.

Therefore, one cannot simply say that a vegetarian diet will affect infertility. It is why she is following this diet and where she stands as far as her mental and physical condition that will determine if this situation can affect her fertility.

If you plan to stay on a vegetarian diet, you should know that it lacks omega 3 fatty acids, important fatty acids that are essential to our health. They cannot be synthesized in our bodies, so they have to come from food intake, usually from fish or from some special plant such as flaxseed. Most vegetables do not have enough omega 3 fatty acids. Therefore, you may want to consider taking flaxseed oil capsules for omega 3 fatty acid supplementation, or fish oil. Ask your physician for advice on the proper amounts to take as supplements.

You should wait at least three months after discontinuing the use of birth control pills before trying to conceive. This will give the body sufficient time to clear the estrogens and progestins present in the oral contraceptives and to enable the hypothalamus-hypophyseal-gonal axis to generate a healthy follicle/oocyte for a pregnancy to be achieved. Even in cases where women have unprotected intercourse soon after discontinuing birth control pills, conception has occurred. Studies indicate that oral contraceptive use does not affect the ability to conceive.

Pregnancy, however, does become more difficult to achieve as women age. In general, the later women try to conceive, the harder it is to become pregnant.

The benefits of taking oral contraceptives at an early age is that they may help prevent endometriosis, a common cause of infertility that occurs when tissue fragments of the endometrium (the innermost lining of the uterus) grow outside the uterus, causing scarring on the ovaries and the fallopian tubes. They also may offer some protection against sexually transmitted diseases, and lower a woman’s risk of developing certain types of cancer.

According to Geoffrey D. Nusbaum, Ph.D., director of DVIFG’s Medical Psychotherapy and BioMedical Ethics Service, there are numerous clinical studies indicating that reducing stress and anxiety through supportive intervention, such as counseling or stress management programs, can often prevent or stop preterm labor.

The important thing to remember is that you can control your attitudinal response to the stress of infertility. For help in coping with the stresses involved with infertility, call Dr. Nusbaum at (856) 988-0056.

You’re correct about wanting to lose weight in order to conceive. Infertility problems and weight go hand in hand. Research has found that obese women are two times more likely to be infertile than women of healthy weight.This is due to having too much insulin in the body resulting in a condition called “Syndrome X.”

Syndrome X can not only impede a woman’s ability to become pregnant, but her ability to carry to term as well. The good news is that with the help of a board certified Medical Nutrition Therapist, you can lose the weight and keep it off.

A professional who practices medical nutrition therapy is a crucial part of the infertility treatment team. A medical nutrition therapist can help you and your family understand why eating particular foods are crucial to good health and how to follow a sensible diet/exercise regimen to achieve a healthy weight. A medical nutritional therapist understands that these changes take time and develops gradual plans for changing food intake patterns. The goal of medical nutrition therapy is:

• to help you separate food and weight-related behaviors from psychological issues.

• to develop an action plan for changing food intake patterns.

• to create a life-long sensible diet/exercise program for maintaining a healthy weight.

• to promote overall good health to increase your chance of conceiving, to enhance self-esteem, and to improve metabolic control.

• to help couples make behavioral changes and to utilize support and referral sources to keep them on track.

At DVIFG we offer medical nutrition therapy with a registered dietitian and Certified Diabetes Educator in charge of the service. Melissa Bennett received her B.S. degree in Dietetics from the University of Delaware and has over a decade of experience as a clinical dietitian and educator. Besides individualized counseling, Ms. Bennett can provide you with educational literature on nutrition, personalized meal planning, exercise tips that really work, and easy low-fat cooking tips.

To make an appointment with Ms. Bennett, DVIFG’s Medical Nutrition Therapist, please call (856) 988-0072.

The biomedical ethics community is still divided on both the safety and ethical aspects of this emerging technology. At this point in time the Ethics Committee of the American Society of Reproductive Medicine (ASRM) has stated in its journal, Fertility and Sterility: “As long as the safety of reproductive SCNT [cloning] is uncertain, ethical issues have been insufficiently explored, and infertile couples have alternatives for conception, the use of reproductive SCNT by medical professionals does not meet standards of ethical accredibility.”

The jury is still out on this one, but a recent study conducted by Australian researchers found that the shocks and vibrations from the activity may cause physical damage and compromise men’s fertility. The scientists found that pressure from the bicycle seat can damage blood vessels and nerves in and around the scrotum. Since mountain biking often involves riding over rough terrain, the shocks to the groin only compound any preexisting problem.

More studies need to be conducted to determine whether frequent mountain biking can reduce sperm count. In the meantime, the study researchers suggest that male mountain bikers pad both the bike seat and their shorts and visit a bike shop to ensure that the seat is positioned high enough and at the proper angle.

The study did not mention the impact of mountain biking on female fertility. It did, however, mention that many activities done in excess can damage a man’s fertility, including cigarette smoking and beer drinking. Until more studies are performed, the safest route for men to follow is to mountain bike and exercise in other ways in moderation.

Depending upon your reproductive history and other medical factors, you and your husband may benefit from preconceptional counseling and/or preimplantation genetic testing.

Preconceptional counseling is recommended in cases where couples have suffered early pregnancy loss, preterm labor, or other reproductive problems or where there’s a family history of certain genetic diseases. By screening couples for these genetic diseases before they conceive, it can help them understand the risks and plan accordingly.

Carrier screening can detect certain genetic diseases, including alpha- Thalassemia, beta-Thalassemia (a type of anemia affecting the production of hemoglobin), cystic fibrosis (a condition that affects all of the fluid- and mucus-secreting glands in the body and this leads to thick, abnormal secretions, especially in the lungs and pancreas), Sickle cell disease (a type of anemia usually affecting African Americans in which red blood cells become sickle shaped), Tay-Sachs disease (a fatal childhood disorder in which harmful chemicals accumulate in the brain that is most common in the Ashkenazi Jewish population), and many others.

Preimplantation genetic testing helps couples that choose IVF have a successful pregnancy. This new testing can identify genetic defects at two different stages, in an ovum (unfertilized egg) before fertilization or in an embryo (before implantation). Since approximately 60 percent of all reproductive losses in pregnancy are linked to a chromosomal abnormality, performing this testing may help prevent unsuccessful IVF pregnancies. In fact, a recent study found the pregnancy rate with IVF patients ages 35 to 45 increased from 16 to 30 percent when preimplantation genetic testing was conducted.

Besides screening for the same genetic conditions as preconceptional testing, preimplantation testing can detect certain gender-linked chromosomal disorders, Huntington’s disease (a brain disorder that causes personality changes, involuntary movements, and dementia), Lesch-Nyhan syndrome (a metabolic disease that affects only males, in whom mental retardation, aggressive behavior, self-mutilation, and renal failure are exhibited), muscular dystrophy (a group of genetic conditions in which muscles become weak and wasted), Hemophilia A (a blood disorder), and Retinitis pigmentosa (a progressive disease in which the retina progressively degenerates).

In vitro fertilization (IVF) is a type of assisted conception that involves mixing eggs and sperm outside the body.

IVF offers a chance at parenthood to infertile couples where women have blocked or absent fallopian tubes, where men have low sperm counts, and where other infertility problems occur.

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a petri dish. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman’s uterus. (IVF makes it possible for couples to conceive without the use of the fallopian tubes.) The overall success rate of IVF is approximately 21 percent.

The overall health of both partners has an important effect on fertility. Like you, he should eat a healthy diet, exercise regularly, and find ways to reduce stress. He should also not wear tight underwear, avoid hot baths, saunas, and hot tubs, and limit his exposure to hydrocarbons and other chemicals in the workplace because these factors can affect sperm quality.

He should also reconsider taking the following prescription drugs due to their association with infertility in men: cimetidine (Tagament®), nitrofurantoin (an antibiotic), sulfasalazine (a drug used to reduce inflammation of the intestines), spironolactone (a potassium-sparing diuretic drug), and calcium channel blockers (such as nifedipine®). If he smokes, he should quit immediately. Secondhand smoke can affect your fertility as well.

You should also make sure that your husband is getting enough folic acid in his diet. A recent study conducted by scientists at the University of California, Berkeley and the Western Human Nutrition Research Center (WHNRC) in Davis published in the February 2001 issue of Fertility and Sterility, found that low levels of folic acid in men are associated with decreased sperm count and decreased sperm density. Good dietary sources of folic acid include fortified breakfast cereals, leafy greens, legumes and orange juice.

The researchers now plan to study the effect of too little amounts of other vitamins on male reproductive health. The scientists found in a previous study conducted in 1991 that men with low levels of vitamin C had more genetic damage in their sperm and that smokers were at even greater risk.

Men trying to help their partner conceive may also want to steer clear of St. John’s wort, echinacea, and gingkgo biloba, three popular herbs on the market. According to a preliminary study published in Fertility and Sterility, all three of these herbs affected sperm in some way. The researchers found that the herbs made it more difficult or impossible for the sperm to penetrate eggs and/or changed the sperm’s genetic makeup, making them less viable.

Since heavy alcohol consumption has been found to reduce sperm count, he should drink no more than two alcoholic drinks occasionally. You should also have frequent intercourse (several times per week) to boost your chances of conceiving.

After adopting these healthy lifestyle changes, you should be able to conceive after six months to one year of trying. If you aren’t successful after that period of time, ask your physician for a referral to a physician specializing in infertility. For most couples, it’s only a matter of time before they achieve pregnancy. In fact, 80 percent of couples are successful within six to eight months. Good luck!

Although many women over age 35 have little difficulty conceiving a child, age is a factor in fertility. The older a woman gets, the greater her chance of miscarriage. Fertility problems, however, usually don’t seriously develop until a woman reaches age 40, although women in their mid to late 30s may have problems conceiving due to a natural decline in ovarian function. Although men experience a decrease in sperm production after age 25, some men remain fertile into their 60s and even their 70s. Due to the fact that more and more couples are delaying starting a family until their 30s or beyond, infertility is becoming more common. That’s why in women over 35, a fertility evaluation should be given after six months of unprotected intercourse.

Other factors regarding age and infertility include:

• A decreased ovarian reserve suggests a poor prognosis for fertility.

• Older women hoping to conceive may need aggressive treatment to capitalize on the “window of infertility.”

• Egg donation is usually the best option for women over 40 who have elevated basal FSH (follicle-stimulating hormone) levels.

Yes, there is, and treatment will be based on your diagnosis. If tests have shown that you are not ovulating due to low levels of FSH, drugs will probably be prescribed to stimulate ovulation. These drugs are used when the inability to conceive results from a hormonal imbalance in either the male or the female. Fertility is influenced by hormones produced in the brain by the hypothalamus and the pituitary gland. The hypothalamus produces gonadotropin-releasing hormone, which regulates the release of gonadotropin hormones from the pituitary gland, which are known as follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones control fertility. In women they ripen the eggs and bring about ovulation. In men, FSH and LH manage sperm production. Medications are often used to rectify an imbalance or deficiency of these hormones.

Common drugs for infertility include antiestrogens, such as Clomiphene that work by increasing the production of FSH and LH, and gonadotropins that are used to increase sperm production in men and ovulation in women, respectively. Low testosterone levels in men can be treated with hormone injections, as well.

According to the American Infertility Association, in women who need clomiphene to ovulate, the pregnancy rates are very high, as much as 33 per cycle for the first three cycles. Most patients take the medication for six months to boost their chances of conceiving. Good luck!

You’re not alone in worrying about not meeting your calcium needs because you dislike milk. Many pregnant women share your aversion to milk. The good news is that there are plenty of ways to make sure that both you and baby are getting enough calcium.

Besides helping to make strong bones and teeth, calcium is vital for the fetus’ muscle, heart, and nerve development, blood clotting, and enzyme activity. If you don’t consume four servings per day of calcium, your body will draw upon the calcium in your own bones to help meet its quota, setting you up for osteoporosis later in life. Research also has shown that a diet rich in calcium may help prevent pregnancy-induced hypertension (preeclampsia).

Here are some ways to get four servings of calcium every day (each is one serving):

• Eat a cup of low-fat yogurt.

• Munch on a cup of leafy, green vegetables, such as broccoli.

• Drink an 8-ounce glass of calcium-fortified orange juice.

• Snack on 1/2 cup of low-fat cottage cheese.

Many food manufacturers also have been adding calcium to their products, including cereals, breads, and crackers. Look on the labels for the amount added to each serving. To meet the requirement, each serving should have about 300 mg. of calcium.

According to the American Society of Reproductive Medicine (ASRM), miscarriage soars as women age, from about 15 percent in women ages 25 to 30 to about 40 percent in women over 40. The primary reason for the increase in miscarriage rates is the age of the eggs.

A woman is born with a finite number of eggs, which gradually get ovulated or die off as she ages. These older eggs are less energetic than younger eggs, making it harder for them to even complete the fertilization process. The ones that do are more likely to develop chromosomal abnormalities that often lead to miscarriage. Despite this fact, many women in their late 30s and early 40s give birth to healthy children.

Yes, it can. A 10-year study conducted by John Pennebaker, Ph.D., a professor of psychology at Southern Methodist University in Dallas, found that people who confide their troubling experiences are profoundly and physically relieved of the stress caused by infertility and other stressful events. Whether people talk to a close friend, spouse, or support group, confiding in others can have a powerful effect on health.

But if you’re not comfortable talking about your problems, then Dr. Pennebaker recommends keeping a journal. He writes in his book, Opening Up: The Healing Power of Confiding In Others (William Morrow, 1990): “One reason I recommend writing about upsetting experiences is that it is safe. If you use a journal to explore your deepest thoughts and feelings, you can be completely honest with yourself. No one will judge you, criticize you, or distort your perceptions of the world.”

DVIFG can also help you cope with the uncertainty of infertility. Through a unique program designed to help you work through your feelings and concerns, you will learn effective strategies to live each day to its fullest while trying to conceive.

Geoffrey D. Nusbaum, Ph.D., director of DVIFG’s Medical Psychotherapy and BioMedical Ethics Service, is uniquely qualified to help you cope while trying to conceive. A Fellow and Diplomate of the American Board of Medical Psychotherapy and a Fellow of the International Council of Sex Education and Parenthood at American University in Washington, DC. Dr. Nusbaum holds a clinical certificate from The American Association for Marriage and Family Therapy and is a Founding Member of the Mental Health Issues Section of the American Society for Reproductive Medicine. He has over 25 years of experience counseling people on how to deal with the stress associated with a medical condition, including infertility. To make an appointment with Dr. Nusbaum, please call (856) 988-0072.

As part of a standard infertility work-up, your husband will undergo a semen analysis. This test uses a microscope to examine several samples of semen to investigate male infertility. If there are too few sperm, or many are abnormally formed or dead, fertility will be reduced. A smaller-than-normal volume of semen also indicates that there may be a problem.

Each milliliter of normal semen has at least 50 million sperm, the majority of which are healthy. A low sperm count contains fewer than 20 million sperm.

A low sperm count or the production of abnormal sperm may have various causes. Treatment will be based on the causes. For more on male factor infertility, please check the “News You Can Use” archives.

You’re not alone. A recent study conducted by a Duke University psychologist found that more than one-third of women studied experienced a decline in their sexual relationship and functioning while undergoing infertility treatments.

Eight out of 21 women surveyed reported having intercourse less frequently, engaging in less sexual foreplay, and fewer orgasms. The men surveyed did not experience the same level of problems while undergoing infertility treatments. The women, however, perceived that their spouses were less satisfied and seemed to have difficulty achieving and maintaining an erection.

Trying to conceive can be very difficult for couples. Due to its uncertainty and the stress that accompanies it, the process can make people feel like they’re riding an emotional roller coaster. Not only draining physically but emotionally as well, it’s no wonder many couples experience some sexual difficulties. But a trained professional can help.

DVIF&G can help you cope with the uncertainty of infertility. Through a unique program designed to help you work through your feelings and concerns, you will learn effective strategies to live each day to its fullest while trying to conceive.

Geoffrey D. Nusbaum, Ph.D., director of DVIF&G’s Medical Psychotherapy and BioMedical Ethics Service, is uniquely qualified to help you cope while trying to conceive. A Fellow and Diplomate of the American Board of Medical Psychotherapy and a Fellow of the International Council of Sex Education and Parenthood at American University in Washington, DC. Dr. Nusbaum holds a clinical certificate from The American Association for Marriage and Family Therapy and is a Founding Member of the Mental Health Issues Section of the American Society for Reproductive Medicine. He has over 25 years of experience counseling people on how to deal with the stress associated with a medical condition, including infertility. To make an appointment with Dr. Nusbaum, please call (856) 988-0072.

The jury is still out on the link between dairy and infertility, but a recent study conducted at Harvard University discovered that fertility declined in areas where people drank a lot of milk. The scientists believe that the link may be caused by galactose, a milk sugar that some females have difficulty digesting and that may damage their eggs. Adding further credence to this theory is that studies in mice have found that mothers who eat a diet rich in galactose experience ovarian dysfunction and give birth to daughters with fewer eggs.

Daniel W. Cramer, M.D., professor of obstetrics and gynecology at Harvard Medical School and author of the study, stresses that more research needs to be conducted before advising women hoping to conceive to change their diets. However, Dr. Cramer does advise women who are having difficulty getting pregnant to consider limiting their dairy intake to about one serving per day (1 8 ounce glass or skim milk or 1 cup of low fat yogurt). Since it’s vital to take in enough calcium, make sure you take at least 800 milligrams of a calcium supplement daily if you plan to reduce your dairy consumption.

Once thought to be benign, bacterial vaginosis (BV) can cause complications which can lead to infertility if left untreated. The vaginal infection itself, however, does not cause fertility problems.

The primary symptom of the condition is a fishy smell in the vaginal area. BV can be successfully treated with a 5 to 7 day regimen of antibiotics. No one knows what causes BV, but women at high risk are those who have had sex with multiple partners, engaged in sexual intercourse without a condom, or who have had a sexually transmitted disease (STD). BV alters the beneficial acidic balance in the vagina, allowing harmful germs to enter the area.

If not detected and treated, BV can lead to other sexually transmitted viruses, pelvic inflammatory disease, and pre-term labor. Most physicians now recommend that anyone who is pregnant or with a history of pre-term labor should be screened for the infection.

There has been a lot of discussion and hearsay regarding how often and when intercourse should take place to achieve pregnancy. There's also been much discussion regarding abstinence and its role before intercourse in achieving conception. Several studies have found that prolonged abstinence doesn't seem to provide any benefit and could instead be detrimental.

Frequent intercourse (several times per week) is now recommended. This is good news to couples who hate having their lovemaking be ruled by ovulation cycles. Men and women can go back to enjoying the act instead of viewing it as a necessity.

The reason why frequent lovemaking is recommended lies with the sperm. Sperm, like any other cell in the body, has a limited life. After it dies, it doesn't have a functional value in reproduction. For instance, in the ejaculate, approximately 40 percent of the sperm is dead Sperm is constantly produced and stored in the seminal vessels. During ejaculation, the dead sperm may have a detrimental effect on the remaining live sperm. That's why it's best to have intercourse frequently in order to conceive. Moreover, clinical studies have found that ejaculated sperm survives for approximately five days in the female's genitalia. That's why women can become pregnant after having intercourse several days prior to ovulation.

Another clinical study supports this theory. In couples where the sperm is normal, those who are sexually active prior to ovulation have a higher chance of achieving pregnancy compared to couples who only had intercourse during or after ovulation. This is probably due to an ill-defined function of the sperm called "capacitation" a process that requires the sperm to "mature" prior to being able to fertilize an egg.

Many medications have been linked with erectile dysfunction (ED), and it's possible that your husband's medication could be causing this side effect. A lower cholesterol level, however, has not been associated with ED.

Also known as impotence, ED is an embarrassing medical condition that affects about 30 million men over age 40 in the U.S. Defined as the inability to achieve or sustain an erection, ED is more common in men over age 40.The condition can be caused by a host of factors, both physical and/or psychological. Depression, anxiety disorders, stress, a rocky relationship, and fear of sexual failure can lead to impotence.

The condition also may occur as a side effect of drugs, including antidepressants and antihypertensives. Men who are heavy drinkers, smoke, or don't get enough sleep are at greater risk of developing ED.

The most common physical cause of impotence is atherosclerosis, a disease that lessens the blood supply to the penis. ED can also be caused by chronic diseases, such as multiple sclerosis and diabetes mellitus.

The good news is that most men can be successfully treated for ED. Your husband should consult with his doctor about the problem. Once they determine the cause of ED, they can develop a treatment plan. Many times medications such as Viagra can help. The medication works by increasing blood flow to the penis. Sildenafil, a medication that relaxes the penis' muscles and arteries that carry blood to the penis, has also helped many men achieve an erection.

It could be. According to a recent study published by the Vermont Public Interest Research Group (VPIRG), a consumer advocacy organization, certain polymer modeling clays pose health risk for children, pregnant women, and women who are trying to conceive.

The clay in question can be molded into a shape and then baked at a low temperature in a conventional oven to harden. According to the report, the clay releases phthalate plasticizers, chemical compounds that keep clay soft. Previous studies have linked these compounds to liver damage and infertility.

Yes it does. Aside from all of its other obvious health problems, smoking is a leading risk factor for infertility. Women who smoke inhale more than tar and nicotine. They also take in polycyclic aromatic hydrocarbons (PAHs) that trigger premature cell death in eggs, according to a recent study.

These harmful chemicals trick the eggs into dying early and can lead to early menopause. Smoking also damages the cilia, tiny hairlike structures that move the sperm and eggs through the fallopian tubes.

Yes it can. Although physicians have long linked stress with difficulty in conceiving, no clinical studies had been performed to prove the hypothesis until recently. A study conducted by researchers at the University of California, San Diego found that women suffering from the highest levels of overall life stress (actual stressors and how one copes with them) had 45 percent fewer eggs fertilized and one to two fewer embryos transferred than those with the lowest levels of stress.

The researchers also found that those women with a calm disposition who became pregnant were significantly more likely to successfully carry a baby to term than those women experiencing a lot of stress.

The researchers don’t know exactly why stress affects the biochemical processes involved in conception, but they suspect that it plays a role in the brain’s production of chemicals and hormones responsible for controlling the amount of eggs released for possible fertilization.

No, a diet that is low in carbohydrates is not safe during pregnancy. If the body is too low on resources, it will burn fat for calories. When this occurs, ketones develop which may not be healthy for the growing fetus. Instead of limiting carbohydrates, it’s best to follow a meal plan that includes plenty of vegetables and complex carbohydrates (brown rice, bulgar, whole wheat bread, etc.).

To create healthy meal plans, you may want to consult with Melissa Bennett, R.D., C.D.E., DVIF&G’s Medical Nutrition Therapist. Ms. Bennett can help you and your family understand why eating particular foods are crucial to good health and how to follow a sensible diet/exercise regimen to achieve a healthy weight for a healthy pregnancy. To schedule a consultation with Ms. Bennett, please call (856) 988-0072.

PCOS is a common cause of infertility in women. Traced most often to chronic insulin resistance, PCOS causes women to develop an excess of male hormones (androgens). This overproduction of androgens suppresses egg maturation and can damage the eggs themselves, causing fertility problems. PCOS also increases the rate of miscarriage. PCOS can be controlled with insulin-sensitizing agents and by eating a well-balanced diet, adopting a lowimpact exercise program, and learning to manage stress.

In answer to your question, it has been recognized for years that high glucose levels can have a detrimental effect on the growing fetus. Most doctors will suggest a low-fat diet or insulin injections to control the glucose levels. Recently, there has also been much discussion that high insulin levels may be just as damaging.

Continuing Metformin® in pregnancy is an area of controversy. Some doctors will not prescribe it to women who are trying to conceive. Others tell their patients to discontinue the drug only after a positive pregnancy test. Considered a “pregnancy category B drug,” Metformin® has not been shown to cause birth defects in rats, but there have not been enough clinical studies performed on pregnant women taking the medication to prove its safety.

The choice to continue using Metformin® should be based on whether the patient and doctor feel that the potential benefits outweigh the risks. Most doctors recommend that their patients stop taking Avandia® and Actos® during their pregnancies. These medications have been proven to cause birth defects in rats.

The majority of pregnancy losses (miscarriages) occur during the first trimester. Seventy percent of these first-trimester miscarriages are caused by chromosomal abnormalities. While nothing can prevent these miscarriages from occurring, researchers are focused on preventing the other 30 percent from happening by investigating the following links:

• Work environments. If your job involves heavy physical labor or consistent exposure to heavy metals, radiation, dry-cleaning chemicals or pesticides, research indicates that you may be more likely to miscarry.

• Drinking water. When chlorine is added to drinking water, some 600 by-products are added as well. A few of these by-products have been linked to miscarriage.

• Coffee. According to a Vanderbilt University Medical Center study, pregnant women who experience nausea and who also drink more than three cups of coffee per day are more likely to miscarry. The researchers believe that the caffeine might decrease estrogen levels.

• The body itself. About 5 percent of all recurrent miscarriages (three or more in a row) are due to antiphospholipid antibody syndrome. Women with the condition develop certain antibodies during pregnancy that can cause blood clotting in the placenta and throughout the body. The good news is that the remedy for the condition is simple—low-dose aspirin and heparin, a blood thinner.

• Progesterone. If a woman has a short luteal phase (less than 9 days), her body may not produce enough of the hormone progesterone to sustain the uterine lining. The luteal phase is the time between ovulation and menstruation. Women who have experienced multiple miscarriages are advised to use an ovulation kit to measure their luteal phase and to ask their physician for a blood test to measure progesterone levels. Some physicians prescribe supplements, but their effectiveness is questionable.

Yes, health does have its beginning inside the womb, according to recent research investigating the causes of chronic health problems, including heart disease, high blood pressure, kidney failure, and diabetes. Chronic disease takes 30 to 50 years to develop. To get a clear picture of the disease process it’s important to study what happens to us during fetal development.

Expectant mothers should not only consume enough calories, but also the correct balance of nutrients. A shortage of vitamins and minerals is common and very problematic. Too many vitamins and minerals also can prove to be very detrimental to the developing fetus.

The human kidneys grow most rapidly between 24 and 34 weeks of gestation. If the fetus is malnourished during this time period, the organ’s structure and function may be permanently compromised. Infants whose mothers were severely undernourished in the first two trimesters are more likely than other infants to become obese adults. Moreover, severely underweight newborns are more likely to develop diabetes if they become obese as adults. The reason for this is that babies born to malnourished mothers are prepared for famine. Their bodies are not programmed to handle the conditions of a high calorie/high fat diet.

Recent studies also indicate that infants born to obese mothers and to mothers with Type II diabetes are at high risk of becoming obese and diabetic as adults. This is due to the mother’s inability to regulate blood sugar and insulin levels, which cross the placenta and invade the fetal pancreas. When this happens, the fetal pancreas are less able to recognize and respond to insulin. Unless these mothers adopt a new low fat, high fiber diet, this vicious cycle will continue for generations to come.

Due to these discoveries, scientists now believe that the important development of a child occurs not at conception, but years before. That’s why it’s so important to take excellent care of yourself—for you and for the baby you hope to conceive. Behavior needs to be modified to promote health rather than to just treat disease.

The Polycystic Ovarian Syndrome Association Inc., based in Portland, Oregon, offers information to patients with the condition and can help you find a support group in your area. For more information, please visit the organization’s web site at http://www.pcosupport.org or call (877) 775-PCOS.

Yes, it is true. Smoking has been found to affect the eggs that are growing within the ovaries. For example, numerous reports over the past few years have demonstrated that smoking can affect the ability of an egg to become fertilized. This may explain why patients that smoke and undergo IVF generally have lower fertilization rates and therefore fewer embryos than do nonsmokers who undergo the same procedures.

Although there has not been conclusive evidence to link smoking to poor egg quality, the ability of an egg to become fertilized is often a reflection of quality. The good news is that if a woman quits smoking and makes other healthy lifestyle changes prior to trying to conceive, good egg quality can be restored.

Yes, it can affect his sperm count. A recent study found that men with normal sperm counts experience a drop in sperm retrieval on the days when their partners are undergoing in vitro fertilization (IVF).

The researchers believe that this physiologic response comes from the added anxiety and stress involved in hoping to conceive on these procedural days. Stress management is recommended for couples undergoing fertility treatment to help lower stress levels and to reduce anxiety.

Here at DVIF&G, we offer stress management and other counseling to help our patients cope with the uncertainty of infertility. Debra Ettinger, Ph.D., LPC, serves as Director of Medical and Behavioral Therapy for the Institute. To make an appointment with Dr. Ettinger, please call (856) 988- 0072.

According to a survey of 2,012 women conducted by researchers at the Yale University School of Medicine, those who have frequent orgasms during menstruation are more than twice as likely not to have a buildup of endometrial tissue outside the uterus. The contraction of orgasm helps expel tissue from the uterus during a woman’s period, lowering the chance that the tissue will back up into the pelvis.

As with other menstrual cycle disturbances, skipped periods are often brought on by stress. But sometimes they can signal other problems that can lead to infertility, including hypogonadism.

Hypogonadism in women occurs when the ovaries are underactive, leading to low levels of female sex hormones. Since the female sex hormones control sexual development and the menstrual cycle, lower levels of them may cause menopausal symptoms, including hot flashes, reduced fertility, and reduced or absent menstruation.

Hypogonadism is usually caused by an abnormality of the pituitary gland or hypothalamus in the brain that leads to the underproduction of the hormones that stimulate the ovaries to function. This abnormality may be due to an underlying health disorder, such as a pituitary tumor, or, in rare cases, to damage of the pituitary gland or the hypothalamus as a result of a head injury or an infection such as viral encephalitis. Sometimes hypogonadism can develop from excessive exercise or sudden weight loss.

Treatment depends on the cause of the problem. For example if the condition is caused by excessive weight loss, gaining weight may help. Ask your physician to arrange for you to have blood tests to measure your hormone levels, to have CT scanning of the brain to look for a pituitary problem, and ultrasound scanning of the ovaries. The condition is often treatable.

First of all, don’t worry. Luteal phase defect is a common problem that affects many women, and it’s treatable. It occurs when a woman does not produce normal levels of progesterone during the second half of her menstrual cycle. At the moment of ovulation the follicle, which held the released egg, develops into a structure called the corpus luteum. The corpus luteum serves two important purposes for conception to occur:

1. It releases the hormone estrogen, which helps thicken the uterine lining.

2. It begins to produce the hormone progesterone, which helps soften and thicken the uterine lining for accepting the implantation of a fertilized egg.

Progesterone also is an important hormone in the prevention of miscarriage. When not enough progesterone is produced during the second half of a woman’s menstrual cycle (known as luteal phase defect), the uterine lining stays thin. If conception does occur in women with this defect, they are at increased risk of miscarriage because the weakened state of the uterine lining does not properly promote implantation.

Luteal phase defect can be treated simply with progesterone supplementation after ovulation. It can improve uterine lining quality and increase the likelihood of carrying a successful pregnancy to full-term. Progesterone supplementation is available in pills and vaginal suppositories and by injection. You and your infertility specialist can decide which form is best for your treatment.

Along with a host of other medical problems, including hypotension (low blood pressure), heart attack, and peptic ulcers, eating disorders can make conceiving and delivering a healthy baby difficult.

Infertility often occurs because menstrual cycles and hormones are imbalanced. Malnutrition and vitamin deficiencies can increase the likelihood of high-risk pregnancies and miscarriage. If carried to full–term, the risk of birth defects, stillborn babies, and death in newborns rises.

Women with eating disorders also are at high risk of developing polycystic ovarian syndrome, a condition that makes it difficult to conceive and also increases the rate of miscarriage if she does conceive.

According to a recent study published in the journal Fertility and Sterility, psychological discomfort can lead to sexual dysfunction in men undergoing infertility evaluation.

The researchers studied the sexual function of 412 men and found that 11 percent were unable to collect a semen sample by masturbating during the second infertility workup procedure. Despite being given the option to collect the samples at home by masturbation or by interrupted intercourse, all 46 of these men reported that they experienced severe anxiety while trying to masturbate or have intercourse with their partners. The semen analysis results also were significantly poorer for the men who experienced sexual dysfunction.

Further study is needed, but the researchers speculate that in some men erectile dysfunction is a psychological effect triggered by knowledge of their abnormal semen analysis.

Congratulations on taking folic acid before conception to help prevent the incidence of spina bifida and other neural tube defects. Your daily supplement will not increase the likelihood of giving birth to twins. Results from a recent study of nearly a quarter of a million Chinese women showed that there is no link between increased folic acid consumption and the incidence of giving birth to twins. The study results were published in the February 1st edition of The Lancet.

This large-scale study contradicts the findings of several smaller studies that questioned whether increased folic acid consumption may cause multiple births. This new study is also the first of its kind to follow a large group of women who had accurate records of their folic acid intake both before conception and during the early months of pregnancy.

“DES Update,” a comprehensive information resource about exposure to diethylstilbestrol (DES) recently made its debut on the Internet after three years of preparation. Launched by the Centers for Disease Control (CDC), the site offers health care clinicians and consumers educational tools and resources and contact information for support organizations.

A synthetic estrogen first prescribed in 1938 for women who had miscarriages or premature deliveries, the drug was banned in 1971 by the FDA after research linked DES to a rare vaginal cancer known as clear cell adenocarcinoma in female offspring. Other side effects from its use include:

• Women who took the drug while pregnant have a slightly increased risk of breast cancer.

• Women who were exposed to DES while in the womb are at an increased risk for clear cell adenocarcinoma of the vagina and cervix, reproductive tract structural differences, pregnancy complications, and infertility.

• Men who were exposed to DES have an increased risk for noncancerous epididymal cysts.

• Although there has not yet been a study done of the DES “grandchildren” generation, animal studies have seen adenocarcinomas in this generation.

To visit the site, click on http://www.cdc.gov/DES and follow the prompts to “Consumer Information.”

Diabetes mellitus can sometimes develop during pregnancy. Known as gestational diabetes, the condition is usually treated with insulin to maintain the health of the mother and baby. If the condition is not controlled, the mother’s infant may have low blood sugar levels immediately after birth. The fetus also may gain too much weight making it difficult for a vaginal delivery. Women whose diabetes cannot be controlled also are at greater risk of having an unexplained stillbirth. Gestational diabetes usually goes away after childbirth, but women with the condition are more likely to develop type II diabetes often within five years of the pregnancy.

Many women with gestational diabetes are able to control the condition by following a modified diet that includes less sugar than normal and emphasizes healthy vegetables, low-fat protein sources, and high-fiber complex carbohydrates. Some women, however, do need to take insulin or other medications to increase insulin production.

A landmark study recently conducted at the University of California, San Diego, found that glyburide®, a sulfonylurea drug, is effective in controlling insulin levels in women with gestational diabetes. Sulfonylurea drugs stimulate cells in the pancreas to secrete more insulin to compensate for the reduced sensitivity of the body tissues to insulin.

The researchers also are planning to conduct a randomized trial of women with gestational diabetes using diet and acarbose®, a medication that slows the absorption of glucose to prevent a quick rise in blood glucose levels after meals, to control blood glucose levels. Acarbose® is usually prescribed in mild cases of gestational diabetes. While previous studies have found that acarbose® is not absorbed through the stomach, 35 percent of its breakdown products are passed through the stomach to the fetus. The researchers plan to study whether acarbose® can also control fasting glucose levels.

Another popular medication used to control gestational diabetes, metformin® is usually prescribed to overweight women with gestational diabetes only if diet modification has not controlled the condition. Taken orally twice a day, metformin® boosts body tissue sensitivity to insulin and the absorption of glucose. A recent study found that metformin therapy throughout pregnancy in women with polycystic ovarian syndrome (PCOS) lowered the otherwise high rate of first-trimester spontaneous abortions associated with the condition, apparently without causing abnormal development of the embryo.

In conjunction with regular exercise and stress management techniques, following a healthy diet, including plenty of whole-grain foods and vegetables, can help lower blood pressure. Foods that contain high levels of potassium, including bananas, baked potatoes, avocados, peaches, and prunes, are especially beneficial in regulating blood pressure.

Other foods to include in your diet that may regulate blood pressure include celery garlic fatty fish, including salmon, sardines, and tuna fruits green, leafy vegetables and olive oil.

The role of fibroids and their treatment has long been debated. J.A. Sampson suggested the role of vascular abnormalities in 1912. Although there seems to be agreement that small fibroids are less vascular than the surrounding uterine muscle (myometrium), there is no consensus concerning the vasculature of larger fibroids. Studies implementing ultrasonographic and immunocytochemical techniques provided conflicting results.

A new study from Jagiellonian University in Krakow, Poland seems to offer a convincing explanation to the existing controversy. When the fibroids start developing, the growing tumor compresses pre-existing blood vessels and cuts off the blood supply in certain regions inside the tumor. This leads to hypoxia (an oxygen deficiency) and the secretion of growth factors, such as adrenomedullin (ADM) and basic fibroblast growth factor (bFGF). This pair of growth factors was plentiful in the fibroids. Along with possible other growth factors, ADM and bFGF stimulate the growth of new blood vessels at the periphery of the tumor. These new blood vessels invade the tumor from the periphery, creating a “vascular capsule” seen mostly in larger fibroids.

These findings also explain the particular sensitivity of fibroids to ischemia (a local and temporary deficiency of blood supply). Fibroids have long been treated with hysterectomy or myomectomy. A new approach to fibroid treatment is uterine atrophy embolization (UAE), a procedure that cuts off the blood supply to the uterus by a radiographically guided injection of material inside the vessels that provide blood to the uterus. The same effect can be obtained surgically by ligating the internal iliac arteries and/or the uterine arteries or by causing the blood vessels to clot laparoscopically (LBCUV).

By temporarily cutting off the blood supply to the uterus, these methods reduce the size of fibroids by 75 percent on average. Some fibroids even disappear using these methods. These treatments give women an alternative to hysterectomy and myomectomy and also give them relief from fibroid symptoms, including pressure, pelvic pain, and menorrhagia (heavy bleeding during menstruation).

Although many women around the world have successfully undergone this procedure, their ability to conceive, carry full-term, and delivery healthy babies has not been adequately studied.

So far over 1,000 sexually active patients who wanted to get pregnant have undergone UAE and LBCU. The pregnancy rate in this sampling ranged between 33 percent and 41 percent, with 19 percent to 22 percent of pregnancies proceeding to term.

The vast majority of fibroids do not increase in size during pregnancy following UAE and LBCUV. If they do increase, they will likely return to their pre-pregnancy size. This result concurs with what was found by the Polish researchers.

These patients did, however, suffer a higher percentage of early miscarriage (41 percent) than the general population (26 percent). This does not appear to be caused by cutting off the blood supply to the uterus temporarily since a report in the journal Obstetrics/Gynecologists found that women having these procedures can become pregnant, carry full-term, and deliver healthy infants. Even in cases where the women had remaining fibroids measuring 3 cm or more, they delivered healthy, full-term babies.

Although it’s been proven that fibroids measuring 3 cm or larger are linked to pre-term labor, placenta abruptio, malpresentation, dystocia, and excessive blood loss (all causes of miscarriage), a study in the American Journal of Obstetrics and Gynecology found that the rate of miscarriage in women with fibroids was similar to that of the general population.

The result of increased miscarriage in patients who had undergone these procedures is difficult to interpret since there are so many confounding factors that have to be taken into consideration. Until these issues are completely clarified, UAE and LBCUV should only be given as treatment options to women who do not want any more children.

According to a recent study conducted at the Harvard School of Public Health, mothers who are pregnant with boys need to eat 10 percent more calories than mothers carrying girls. The researchers found that a woman with a male fetus needs to specifically eat the following to gain the same amount of pregnancy weight as a woman with a female fetus: 8 percent more protein, 9 percent more carbohydrates, 11 percent more animal fat, and 15 percent more vegetable fat.

The study authors believe that this increase in calories may have something to do with boys’ secretion of testosterone. To ensure that you eat the right foods to nourish your baby boy-to-be, consult with a medical nutrition therapist. At DVIF&G we offer the Stork’s Nutrition Program® with that goal in mind. For more information, call Melissa Bennett, RD, CDE, DVIF&G Medical Nutrition Therapist, at (856) 988-0072.

The Postcoital Test (PCT), also known as the “after sex” test, examines the ability of the sperm to enter and move into the cervical mucus just before the time of ovulation. A PCT also can show if there’s an adverse reaction between the sperm and cervical mucus that could be causing infertility.

In the case of “mucus hostility,” it may mean that the cervical mucus is more acidic than normal. It also may mean that the mucus is so viscous (sticky or gummy) that it prevents the sperm from penetrating the cervix.

"Mucus hostility” also may occur when the woman has antibodies to sperm. When this happens corticosteroids may be prescribed to suppress the production of antibodies. Another option is to have the semen injected directly into the uterus to avoid contact with the mucus (artificial insemination).

Yes, a new study conducted by doctors at the Oregon Health and Science University found that artificial insemination with donor sperm may be a good option for patients who have not been successful using IVF with intracytoplasmic sperm injection (ICSI).

The physicians reviewed the records of 19 couples who didn’t achieve pregnancy in a total of 32 IVF-ICSI cases from 1994 through 2001 and then agreed to try artificial insemination with donor sperm. The group completed 61 cycles, with 16 couples conceiving within seven cycles of donor insemination. Seventeen pregnancies were achieved, with 15 live births. It took an average of 3.2 inseminations to achieve pregnancy, and the pregnancy rate per cycle was 27.9 percent.

The results of the study were comparable to those achieved by the clinic during the same time period. While the researchers believe that it’s unlikely that pregnancy rates as high as those observed in this small group would continue in further clinical studies, artificial insemination with donor sperm should be viewed as a viable option for couples that aren’t successful using IVF with ICSI.

It’s that season again, and time to decide if you should get the flu shot. Getting a yearly flu shot can prevent a large percentage of flu cases—and even deaths caused by the illness.

But the flu shot should not be given to everyone. The Delaware Valley Institute of Fertility & Genetics (DVIF&G) and the Centers for Disease Control (CDC) recommend that the flu shot not be given to anyone:

• who is actively trying to get pregnant

• who is in the first trimester of pregnancy

• whose health is compromised

People with Guillain-Barre Syndrome, a severe food allergy to eggs, or a previous severe reaction to a flu shot also should not be given the flu shot.

The flu shot can be given to anyone who is over 6-months-old and should be given to anyone:

• who works in fields that deal directly with the public, such as police officers, fire fighters, and medical personnel

• who is at risk of developing a severe case of the flu, including all children between the ages of 6 months and 23 months, children and adults with chronic health conditions, such as diabetes, chronic metabolic diseases, renal dysfunction, abnormal hemoglobin in the blood, or a suppressed immune system, and pregnant women past their first trimester.

The flu season runs from November to April and peaks from December through March. For the flu shot to be most effective in preventing the illness, it should be given in October and November. You can still opt to receive it later, but it won’t be as effective in preventing the illness.

The flu vaccine can be given in two forms. One form, the flu shot, is an inactivated vaccine that contains killed viruses. The second form, a nasal spray known as LAIV-Live Attenuated Influenza Vaccine, contains weakened live influenza viruses and is marketed under the trade name FluMist®. The shot, administered via a needle, can be given to anyone at least six months of age or older. The nasal spray, administered via a spray in the nose, is only approved for use in healthy people ages 5 to 49.

Both vaccines contain a strain of the three common circulation viruses of the season and are given yearly. Since both are grown in eggs, people with severe allergies to eggs cannot receive them.

Common side effects from the LAIV include:

• in children—runny nose, headache, vomiting, muscle aches, and fever

• in adults—runny nose, headache, sore throat, and cough (Fever is not a common side effect in adults receiving the LAIV.)

Don’t think that because you may have had a severe case of the flu, you’re immune. The flu virus changes from year to year, and you can get it more than once in your life. Also the immunity received from a previous case of the flu or the vaccine doesn’t always protect you from a new strain. It’s also good to know that immunity to the flu declines over time, and you may have low protection during the next flu season.

For more information on the flu vaccine, please call Gina Carroll, RNC, BSN, DVIF&G Staff Nurse at (856) 988-0072 or contact your family physician.

Also known as premature ovarian failure, early menopause may be caused by genetic factors, autoimmune disorders, or destruction of the ovaries by radiation therapy, chemotherapy, surgery, or toxins. In about half of the cases, however, no clear cause can be identified. As in regular menopause, early menopause causes a woman’s reserve of eggs to deplete and reduces the amount of estrogen and progesterone production by the ovaries. The levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) also are consistently high.

Many women with early menopause have successfully given birth to healthy babies using the assisted reproductive technology (ART) procedure known as in vitro fertilization (IVF) and donor eggs. For more information on IVF and other ART procedures, please contact the physicians at the Delaware Valley Instititute of Fertility and Genetics (DVIF&G). DVIF&G has three locations: one in Marlton, NJ, one in Vineland, NJ, and one in Lawrenceville, NJ. To make an appointment, please call (856) 988-0072.

It’s important to consult with your obstetrician prior to participation in any exercise program. If your doctor gives you the go-ahead, yoga is a wonderful way to prepare your body and mind for childbirth.

The science of yoga connects the voluntary/involuntary muscles, nervous system, endocrine system, joints and circulatory systems to the mind and beyond. It gives an individual control over physiological and mental changes, which cannot be achieved in any other way.

By doing daily yoga and following a yogic lifestyle, you will embrace the changes pregnancy brings. You will learn to focus your mind and become aware of yourself as a new being, one in harmony with nature and the world. You will achieve great inner strength and faith so that you can face labor and motherhood without any fear.

Common symptoms of pregnancy, including morning sickness, fatigue, mood swings, constipation, anxiety, headache, stiffness, and pain, also are lessened or relieved through yoga. Your energy level will be boosted dramatically. Your body posture will become more balanced and relaxed. Yoga also helps improve flexibility of the joints and muscles, widens the pelvis and pelvic floor, and balances the gravitational center and vertebral pull.

Now that you are pregnant, always stop your posture if you experience shortness of breath. Proceed slowly and cut down on the time spent doing each posture. It’s also not a good idea to do postures while lying on your back. In your third trimester, balancing postures will be difficult to do. Ask your yoga teacher for modifications.

Advances in reproductive technology now make it possible for parents to choose the gender of their children. Although the practice is quite expensive, some parents are paying the steep fees to have the gender of their choice.

Although there are no laws against performing gender selection in the United States, many people believe that the safety and effectiveness of reproductive technologies like preimplantation genetic diagnosis (PGD) should be regulated.

A growing number of infertility specialists, including the Delaware Valley Institute of Fertility & Genetics (DVIF&G), will not perform sex selection services unless it’s medically necessary. They believe that it’s unethical to be biased against gender.

Yes, it could. Chlamydia trachomatis is a bacterial infection that occurs without any specific symptoms and it can often cause infertility if left undetected and untreated. Symptoms in women include abnormal vaginal discharge, a frequent need to urinate, and pain in the lower abdomen. Symptoms in men include pain when urinating and discharge from the penis. Chlamydia can be detected by a blood test. The STD can be treated successfully with antibiotics taken by both partners at the same time.

Chlamydia trachomatis is the most commonly reported bacterial STD in the U.S., with 3 to 4 million cases occurring annually. The fact that both you and your husband were unaware of having the infection is quite common. According to the Centers for Disease Control (CDC) one in five Americans has a sexually transmitted disease (STD), and a whopping 25 percent of new cases are in teens. In a report conducted by the Centers for Disease Control, sexually active teenage girls have a high rate of developing STDs, despite the fact that many only have one sexual partner and practice safe sex. For example, teenage girls may have a greater likelihood of developing the STD chlamydia trachomatis due to increased cervical ectopy and lack of immunity. A recent study published in the American Journal of Obstetrics and Gynecology also found that if the STD is untreated it could lead to an increased risk of cervical cancer in women.

“Some of our patients that come to us with their infertility problems test positive to the chlamydia trachomatis antibody,” says Dr. Chung H. Wu, director of DVIF&G’s Polycytic Ovarian Syndrome (PCOS) Early Detection and Treatment Program. “If left untreated for a long period of time the STD can damage the man’s sperm and the woman’s fallopian tubes.”

Dr. Wu believes that all men and women should receive a blood test for STDs as part of their standard medical workup. “Unfortunately that’s not the case,” he says. “That’s why we ask permission to give the test to all of our patients to increase their chances of conceiving.”

The likelihood of your child being healthy is the same as naturally conceived children or for children born using in vitro fertilization (IVF), according to a recent study conducted by Belgian researchers and published in the December 2003 issue of the journal Fertility and Sterility.

The researchers studied 177 children—66 conceived using ICSI, 52 conceived using IVF, and 59 naturally conceived. The children were evaluated for somatic, psychomotor, and intellectual development at the ages of 9 months, 18 months, three years, and five years.

The ICSI children were found to be healthy with no significant differences from the other children. Their intellectual development was on par with the others, as well.

ICSI is often used to treat male factor infertility. The technique inserts a single sperm into an egg and has been found to be effective in helping couples achieve pregnancy. Because natural fertilization is circumvented using ICSI, there has been some concern that the risk of passing defects on to resulting offspring increases. According to this particular study, this is not the case. Other studies, however, have found a slightly elevated risk of passing on health problems to offspring. If you’re concerned, talk to your doctor before agreeing to the procedure.

While it’s long been known that a woman’s fertility declines with age due to impaired egg quality, new research has found that a man’s fertility also declines with age.

According to research conducted at the University of Seattle in Washington and published in the December 2003 issue of the journal Fertility and Sterility, as men age the percentage of their sperm with highly damaged DNA increases. Apoptosis (programmed cell death) of the tainted sperm becomes much less efficient, contributing to a greater amount of damaged sperm.

The researchers reached this conclusion by studying semen analysis from 66 men, ages 20 to 57. Portions of each semen sample were retained for sperm DNA analysis and apoptosis assessment.

Age, however, is only one factor contributing to DNA damage in sperm. Other environmental factors include cigarette smoking, alcohol and caffeine consumption, and chemical and radiation exposure.

This study is important because both men and women should consider age as a factor in conception. As Anthony Thomas, Jr., MD, president of the Society for Male Reproduction and Urology, told officials at the American Society for Reproductive Medicine (ASRM): “Unfortunately we can’t stop age, but men who are putting off fatherhood might want to consider their lifestyle choices to minimize their risk of infertility or perhaps revise their timetables. It takes healthy sperm to make a healthy baby and with more research, we can perhaps determine how to best protect sperm from DNA damage.”

Congratulations on wanting to be at a healthy weight in order to conceive. Studies show that being overweight can affect your ability to conceive. Fad diets, however, are not the answer to achieving a healthy weight for a long period of time. The answer is to eat a low-fat diet rich in fresh vegetables and fruits, whole grains, and lean sources of protein, such as tofu, chicken, and certain meats, and to exercise regularly.

The World Health Organization (WHO) found that the only way to reduce the risk of obesity is high dietary fiber intake. In 1999, The National Institutes of Health reviewed data from 48 randomized controlled trials on weight loss diets and found that lower fat diets promoted weight loss by spontaneously reducing caloric intake by 20 to 30 percent. Fat has 9 calories per gram, while carbohydrates and protein have only 4 calories per gram. Protein, however, helps make a person feel full. That’s why most weight-reduction programs emphasize lean sources of protein and fewer carbohydrates.

A medical nutrition therapist can help you plan meals to get the nutrients you need. At DVIF&G, we have a staff of highly skilled nutritionists that can help you eat healthy to conceive and to achieve a healthy pregnancy. For more information, please call (856) 988-0072.

Performed during the first trimester of pregnancy, the Ultrascreen involves measuring skin thickness of the fetal neck (known as the nuchal translucency or NT) combined with a blood test. The Ultrascreen assesses the risk of Down Syndrome and other chromosomal abnormalities as compared to the patient’s age-related risk.

In many cases the risk assessment after the Ultrascreen may be lower than the age-related risk. For example, if a woman’s age-related risk is 1 in 300 for Down Syndrome, her risk may be assessed at 1 in 3,000 after the Ultrascreen.

“It’s important to remember that the Ultrascreen does not replace an amniocentesis or CVS, which will give an actual number of chromosomes of the developing fetus,” says Laurie Miller, BS, RDMS a Staff Sonographer with DVIF&G. But according to European researchers, the Ultrascreen is the “most accurate and earliest prenatal screening available. The blood test alone (performed between 9-14 weeks) detects for 68 percent of Down Syndrome cases and 90 percent of Trisomy 18 cases. Combining the blood test with the NT increases detection to 91 percent for Down Syndrome, 97 percent for Trisomy 18, 40 percent of heart defects, and some other birth defects.”

Depending on the performing center’s protocol, test results can usually be obtained in 5 to 7 working days.

The test was developed and is monitored by the Fetal Medicine Foundation (FMF) in cooperation with Genecare Medical Genetics Center. A FMF-certified sonologist or sonographer performs the ultrasound. The certification and re-certification process is very specific and demands excellent technical skills. DVIF&G staff sonographers have been performing the test for the past year. For more information on the Ultrascreen test, please call Laurie Miller at (856) 988-0072.

Yes, incorporating almonds into a healthy diet can help people shed that extra weight, according to recent studies. The researchers believe that almonds help to absorb fat and help people feel full after eating them.

Almonds also are high in monounsaturated fats (the good kind), and are a significant source of antioxidants, calcium, fiber, and phytochemicals known as plant sterols, which also help lower cholesterol levels.

The key is to eat only 1 ounce of almonds per day (about 23 almonds). To achieve this goal, toss a handful in salads, casseroles, rice dishes, or on your morning cereal.

The most difficult moment for a reproductive endocrinologist is to call it quits. It’s very difficult to convey this information to a couple who has invested emotion, resources, time, and effort to achieve pregnancy. However when there are alternative solutions that are more successful than the current treatment, the responsibility weighs on the consulted physician for guidance and support.

According to statistics from a study completed by the Reproductive Science Center in Massachusetts, the success of assisted reproductive technologies (ART), including in vitro fertilization and egg transfer declines precipitously with age. It is 21 percent at age 40, 15 percent at age 41, and 12 percent at age 42. By age 43, the success rate plummets to 2.8 percent. Due to these figures, there’s no question that women age 43 or older should not seek IVT-ET. The success rate of ART for women under age 40 is about 50 percent.

Intrauterine insemination (IUI), however, is equally successful for women over age 38 as it is for younger women, according to a study conducted at Poissy-Saint Germain Hospital in Poissy, France. Out of 82 couples where the female patient was 38 or 39 years old, 29 pregnancies were achieved. This corresponds to a 15 percent per cycle success rate and a 35 percent success rate for couples.

ICSI, an assisted fertilization procedure where a single sperm is mechanically inserted into an egg so that fertilization may take place, is often prescribed in cases where patients have low sperm counts or low sperm morphology (normal shape of the sperm). Recently researchers at the Oregon Health and Science University found that a healthy alternative for couples where ICSI has failed is insemination with donor specimen.

The researchers found that 16 out of 19 couples that were treated with donor insemination after several unsuccessful attempts of IVF with ICSI became pregnant. Pregnancy was achieved after an average of three treatment cycles using artificial insemination with donor specimen. The success rate was 27.9 percent per cycle, well above the average 15 percent rate for pregnancy per cycle using intrauterine insemination (IUI).

The higher success rate may represent the removal of the only responsible factor for infertility, which was the male factor, in these cases. You and your husband should discuss this option with your physician. You also may want to meet with a counselor to help you make the decision to go ahead with the procedure or to forgo it. Some men may be uncomfortable not being the sperm donor for their offspring. A trained professional can help you share your feelings and to reach an agreement with which you’re both comfortable.

Yes, it’s possible, depending on her condition and care. Female circumcision (FC), also known as female genital mutilation, is primarily practiced in predominantly Muslim countries in Africa. As many of these women move to the U.S., American doctors are seeing cases of infertility, obstructed labor, and pelvic pain resulting from FC.

A team of doctors at the Dept. of OB/GYN at the University of Alabama, Birmingham recently helped restore the fertility of a 31-year-old Sudanese woman who had been subjected to FC at age 8. During that procedure her clitoris and part of her labia majora and labia minora were removed. The labia minora had been sewn together leaving two tiny openings for the passage of urine and menstrual blood.

Since the physicians could not perform a pelvic exam, they used ultrasound to confirm that the patient’s uterus and ovaries were normal. After choosing to have surgery to repair her scarred and fused external genitalia, the woman was well enough a month after the procedure was performed to have intercourse without pain. Two months later, she conceived.

While the length of time varies from patient to patient, three to six cycles is a reasonable trial for Clomid, a fertility drug that works by stimulating the pituitary gland to produce the hormones that cause an egg to ripen and be released by the ovary.

Although there?s been concern that long-term use of Clomid or other ovulation-inducing drugs might increase a woman?s risk for ovarian cancer, no clinical studies have proven that link.

You must have been given a Postcoital Test (PCT) also known as the ?after sex? test which examines the ability of the sperm to enter and move into the cervical mucus just before the time of ovulation.  A PCT can also show if there?s an adverse reaction between the sperm and cervical mucus that could be causing infertility.  Either too thick or too thin mucous can make it difficult for the sperm to pass smoothly through the cervix. Unfortunately, there?s nothing that you can physically do to thin it out, but you do have a good option to consider to conceive.

Uterine insemination (IUI) involves placing sperm inside the uterus using a thin catheter inserted through the cervix. IUI is often done in combination with hormone treatments to increase egg production. IUI works in cases such as yours because the procedure bypasses the cervix and the problem of ?too thick? cervical mucous.