IVF - Surrogacy Blog

07Dec/17

15 Ways to Improve your Fertility

While infertility due to medical or hereditary reasons needs medical intervention, the fertility problems arising due to lifestyle factors may be upturned by making some routine chances. If you are worried about having a baby and are wondering how to improve your fertility, you must identify and remove the factors that may be impairing your reproductive system.

Having a baby when we wish to is something most of us take for granted. However, with marriages happening late in life, tensions mounting every day, and lopsided lifestyles, fertility problems are quite common.

Although you cannot stop the biological clock, there are a few things you can do to extend your fertility levels.

Below are some easy ways to improve your fertility naturally:

  1. Eat well: A healthy, nourished body is conducive to the embryo’s growth and it is a good signal to the body and hormones for conception. Include enough protein (foods like eggs, lean meat, fish, low-fat dairy, beans, etc.) in your diet to improve muscle strength.
    Also, make sure you’re having enough fruits and vegetables to provide sufficient amounts of vitamins and minerals to your body, because deficiencies in these can cause longer menstrual cycles and consequently, less frequent ovulation.
    Food may be an overlooked factor but taking care of what you eat can really help boost your fertility.
  2. Watch your weight: Extremely low or high weight can throw off your hormonal balance and mess with your fertility. Some people go into fertility treatments when all they need to do is lose weight. Check your BMI (body mass index) and see if it falls within the normal range of 19-24. Underweight women often cannot carry a pregnancy because their bodies are not strong enough. Being overweight also brings along problems such as high blood pressure, gestational diabetes, etc. which can be bad for pregnancy.Weight problem in women is also sometimes also the reason why IVF fails.
  3. Quit drinking: An occasional glass of red wine is known to have its benefits but alcohol generally alters the levels of estrogen, LH and FSH, causing fertility problems in both men and women. In a study of 430 Danish couples aged 20-35 years, who were all trying to conceive for the first time, it was found that even moderate alcohol intake (five or fewer drinks) caused decreased fecundability in women. Other studies have indicated that the ability to conceive is not affected by upto eight drinks a week. While more research is required to draw conclusions on the effect of alcohol on a woman’s ability to conceive, it is better to proceed with caution and limit alcohol intake for better fertility or to not drink at all.
  4. Cut down the caffeine: It is not just alcohol but also caffeine that can lower your fertility. Excessive consumption of tea or coffee can hinder with conception. A study published in the Lancet found that “women who consumed more than the equivalent of one cup of coffee per day were half as likely to become pregnant, per cycle, as women who drank less.” Caffeine is known to affect female hormone levels, which is why it is recommended to have it in moderation to improve your fertility.
  5. Stop smoking: Cigarette smoking is extremely detrimental to your reproductive health. The toxins take a toll on your entire body, especially your fertility.In women, smoking is associated with cervical cancer, blocked fallopian tubes, adverse changes in lining of the uterus, damage to developing eggs, increased risk of ectopic pregnancy and increased risk of miscarriage.In men, smoking can cause lower sperm count, sperm motility problems, hormonal issues, erectile dysfunction, etc.Smoking is perhaps the most important habit to kick if you want to improve your fertility.
  6. Protect yourself from pesticides: Pesticides and herbicides have toxins which may inhibit ovarian function in women and harmfully affect the sperm in men.
    Occupational exposure of pesticides can certainly cause fertility problems, but recently, a study published in Human Reproduction found that pesticide-treated fruits were also responsible for lower sperm count and reduced sperm motility in men. Stay away from pesticides as much as you can and include organic fruits and vegetables in your groceries.
  7. Have frequent sex: According to the American Society of Reproductive Medicine, the likelihood of conception can be maximized by having sex daily or every other day, during your fertile window. It is challenging to accurately guess the time of ovulation with any method available today, so by increasing the frequency of intercourse after the completion of your period to the expected ovulation time can help raise the chances of pregnancy. Some theories also suggest that frequent sex can help regulate your menstrual cycles and make them more predictable, thus improving your fertility. Also, some reports suggest that weekly sex helps produce more estrogen.
  8. Be careful with the lube: A lot of lubricants are not considered sperm friendly so you must be careful what you choose. Even natural lubricants like saliva and olive oil may be harmful for the sperm. However, baby or mineral oils or just some sperm-friendly lube may be helpful.
  9. Look at your workplace environment: A plenty of workplace chemicals can have negative effects on your reproductive health. Women exposed to organic solvents—toluene, aromatic and aliphatic hydrocarbons, trichloroethylene and tetrachloroethylene (used in dry cleaning)—can have their probability of conceiving reduced to half, according to a study. Even in the healthcare industry certain disinfectants and drugs, and almost all anesthetic gases (nitrous oxide, cyclopropane, methoxyflurane, halothane and ether). So people in industries like printing, dry cleaning, or agriculture (where pesticides are used) must be careful.
  10. Understand your cycle: If your menstrual cycle is highly irregular, your fertility is certainly affected. A normal cycle lasts between 21 and 35 days and if your cycle is longer than that, then you are probably not ovulating enough. 
    It’s best to see your ob-gyn and consider some therapies to improve your periods. Regular periods with normal flow are a good indicator of fertility, but if your periods generally are a sign of trouble, it is advisable that you seek medical intervention to normalize your periods and improve your fertility.
  11. Don’t douche: It is good to be hygienic but excessive douching can disturb the normal environment of your vagina as it can kill the natural bacteria, which is meant for protection. It puts you at a risk of bacterial vaginosis (BV), which has been associated with infertility.
  12. Consider pills: When you finally decide to have a baby, chances are that you’ve already spent 10-15 years trying to avoid a pregnancy. Although general opinion about birth pills varies largely, the pill suppresses your reproductive system for a while and then restores it to where it should be when you stop taking it. Contrary to popular belief, it does not take very long for your periods to restore after you stop taking the pill.

    The pill can actually help to preserve your fertility and enhance it to an extent as it reduces your risk of developing uterine and ovarian cancer.
  13. Exercise within reason: The body of a woman is designed to carry a baby, which is why you have more fat content then men. So if you lose too much fat in pursuit of flat abs, or engage in strenuous exercises, you might be messing with your hormones and jeopardizing your fertility. Moderate exercise is encouraged but periods are known to become lighter and may even stop in women who constantly engage in vigorous exercise.
  14. Get your vitamins: Folic acid is normally advised in women trying to get pregnant but other B vitamin, vitamin A, vitamin C, vitamin D, vitamin E are all important and recommended for both men and women to improve their fertility. Omega-3 fatty acids, iron and zinc are also important nutrients for fertility. You can get all these from a natural diet if you include beans, leafy greens, oranges, flax seed, eggs, spinach, strawberries and fortified cereals.
  15. Manage stress: Any kind of physical or mental stress is bad for fertility as it can throw off your hormonal balance. Numerous researchers have suggested the link between stress and reduced fertility. A study by researchers at the National Institutes of Health and the University of Oxford corroborates the common belief that stress reduces a woman’s chances of conceiving.

    It states that constant long-term stress may cause several failed attempts at pregnancy, which then becomes the reason for added stress and causes further delay in conceiving. Yoga, mindfulness, and meditation are believed to help in improving your fertility levels.

 

You don’t know when you will be ready for pregnancy and what your fertility level will be at that time. To boost your fertility levels look for possible problems in your daily routine and try to make healthier choices as outlined above and hopefully your hormones will cooperate when you most want them to.

19Nov/17

Fertility tests for women—How to test your fertility?

Nobody prepares you for infertility. If you suspect, for any reason, that you might have a problem and are wondering how to test your fertility status, you can get some of these tests to get a better idea of your situation.

Here are some common fertility tests for women:

Basic investigations for infertility

Blood tests for STIs

If you have any history of STIs or lingering infections that can affect your fertility, you must get tested. Residual inflammatory tissue and scarring from previous infections can block your fallopian tubes and cause hindrance to conception.

Hormone tests for infertility

Hormones are a big indicator of the reproductive function in your body as the levels of certain hormones can tell if you have ample ovarian reserve and if you are ovulating easily.

Listed below are the hormones that can help determine your fertility status:

  1. Anti-mullerian hormone (AMH) – This can be checked on any day of your menstrual cycle and the level of AMH will tell you about your ovarian reserve. It tells the doctor about the number of growing follicles you still have, which indicates if you are still producing viable eggs. However, this does not give any idea about the quality of eggs.
  2. Follicle-stimulating hormone (FSH) – FSH is responsible for stimulating growth of your ovarian follicles—the fluid filled cavities in the ovaries that contain eggs. It is responsible for maturing a follicle so an egg is released during ovulation.With rising FSH a number of follicles are stimulated, so they start to grow and produce estrogen. Normally one follicle grows larger than the rest and the ripened egg inside it is released.FSH levels increase until you ovulate and drop after that. It continues to increase in women who don’t ovulate and high levels of FSH are an indication that your body has to work extra hard to help in ovulation and that the ovarian reserve is diminishing.
  3. Luteinizing hormone(LH) – LH works synergistically with FSH. It surges right before ovulation. LH surge only lasts for 24 to 48 hours and it triggers the release of the egg. Raised LH levels at any other stage of the cycle indicate polycystic ovaries or reduced ovarian reserve.Low levels of LH are also bad for your fertility because they indicate problems with your menstrual cycle.
  4. Estradiol – It is a form of estrogen that regulates your menstrual cycle. Increased estradiol levels indicate a lowered ovarian reserve as your body is producing more of this hormone to bring about the ovulation.
    Lowered estradiol can be an indication of PCOS.
  5. Prolactin – Prolactin is associated with your thyroid and pituitary glands. It inhibits FSH and and gonadotropin-releasing hormone (GnRH), prompting them to stop the stimulation of follicles.
    Increased Prolactin levels can indicate PCOS, but this could also be because of Hypothyroidism.The level of Prolactin should be weighed against other clinical findings because if your periods are regular and progesterone levels are normal, an increase in Prolactin could be irrelevant.Extremely high levels of Prolactin could be an indication of pituitary tumor.
  6. Progesterone – After an egg is released, the remaining cells of that follicle stop producing estrogen and start producing progesterone, which prepares the uterine lining to receive the embryo.
    Progesterone levels peak after a week of ovulation and fall sharply before the next period is due, so they can be an indication of positive ovulation.However, if your periods are irregular, the blood test can be mistimed and inaccurate levels of progesterone may be recorded. So this is not considered a very dependable measure of ovulation and fertility.
  7. Thyroid levels (TSH) – Thyroid problems can mess with your fertility because this is the gland that regulates many hormones in your body.  Hypothyroidism or hyperthyroidism may be the reason behind your fertility problems and if you suffer from this, the doctor may decide to correct the levels of Thyroid hormones before offering any fertility treatment.

 

Scans

A pelvic or TVS ultrasound scan can be very helpful to determine your fertility status. The doctor can look at the follicles on your ovaries and get an idea of your ovarian reserve.

Large numbers of primordial follicles indicate you have good ovarian reserve and one growing follicle means ovulation is happening. 

Ultrasounds are also used to check for polycystic ovaries, cysts, uterine fibroids, etc.

These tests are also performed before the doctor starts your IVF treatment

Advanced tests for infertility

  1. Cervical mucus test – A cervical mucus test can help your doctor to see if there are any antagonistic antibodies in there that might be killing the sperm.
    The mucus also should be of the ideal consistency (raw egg white appearance) to create a sperm-friendly environment.
  2. Hysterosalpingogram (HSG) – HSG is a special X-ray that is performed after injecting small amount of a radio-opaque dye in your uterus. It helps the doctor check the patency of your tubes and the inside of your uterus.
  3. Saline hysterogram (SHG) – Also known as the water ultrasound or sono hysterogram, this is done to check for fibroids or polyps inside the uterine wall. It is done by first injecting a saline solution into your uterus to expand its walls and then checking for abnormal growths with the ultrasound.
  4. Hysteroscopy – A hysteroscopy uses a small camera that is inserted into your uterus through the vagina to check for any fibroid or polyp growth or any kind of scarring.
  5. Laparoscopy – This is performed under general anesthesia. A small camera is inserted into your abdominal cavity through small holes made near the pubic hairline. This allows the surgeon to get a clear view of all your reproductive organs—the ovaries, the uterus, the fallopian tubes and also check for endometrial growths over any other organs.
    Scarring in the abdomen or adhesions around other organs can be checked and removed through this laparoscopic surgery.
  6. Endometrial biopsy – Endometrial biopsy involves taking a small piece of the uterine lining to examine under a powerful microscope to check for signs of its proper development as response to progesterone. It is usually done between day 18 and 28 of the cycle.
  7. Magnetic resonance imaging (MRI) – It is an expensive test that can provide useful information about the uterine wall. It can be helpful in cases of adenomyosis—the condition of endometrial growth over the uterus, as well as pelvic cysts, which are suspected in some cases of infertility, IVF failures, and painful periods.
    MRIs are a great diagnostic test because they are non-invasive and unlike the x-rays they are not harmful for the patient, but they are quiet expensive and not often used in cases of infertility.

 

A female, at birth, has over 6 million eggs, but these are reduced to only about 400,000 by the time she reaches puberty. Of these only 300-400 are actually released during the reproductive years.

But it does not mean all females have about 300 perfect chances at conception because fertilization largely depends upon the quality of the eggs. Given a chance, most women I know, would want to get an analysis of their reproductive health and egg quality. However, there is no do-it-yourself kit for that.

Age is a big factor affecting female fertility. At 30 years of age, a woman is believed to have only 12% of her ovarian reserve and at 40 years, she has only 3% of it. Given you have healthy eggs, doctors believe, it is best to try to start your family before 35 or consider egg freezing.
 

To find out more about your fertility and egg health, consult your fertility doctor today or reach out to us via the form on the right.
14Nov/17

What is Invitro Maturation (IVM)? Is it better than IVF?

Have you heard about Invitro maturation or IVM? It is a pioneering new technology that allows women with PCOS to undergo IVF treatment without risking their health.

The process of IVF involves administration of hormonal injections to women for ovarian stimulation, which puts them at risk of Ovarian Hyperstimulation Syndrome (OHSS), especially if they have a history of PCOS.

 

What happens in IVM?

IVM involves collection of immature eggs from the ovaries and then maturing them in the laboratory. The matured eggs are then combined with sperm and the resultant embryos are transferred back to the female uterus.

In a standard IVF procedure large amounts of gonadotropin hormones are administered to the patient to stimulate the ovarian follicles and induce maturation of multiple eggs.

This induction of hormonal injections is an expensive process and may even cause adverse side effects sometimes.

The process of IVM has been available since the 1990s but it hasn’t been extensively used because the results are much better in IVF, because the eggs matured inside the female’s body are considered to be healthier.

 

The old & new IVM procedure

Initially for IVM immature eggs were collected from the follicles and matured in the lab using hormonal drugs.

The new IVM procedure is similar to the old except in one respect—the eggs are matured in the lab using a protein dimer called cumuli (a growth factor) in place of the hormones.

The new method allows for 50% more healthy mature eggs as compared to the old one and that resolves the concern of egg quality which was initially causing IVM to produce poorer results than IVF.

However, not everyone is a candidate for IVM and this treatment in not widely offered still. Only 3,000 babies have been born worldwide with IVM.

 

IVM procedure details

Here are the steps in IVM procedure:

STEP 1 – Investigations

Some blood tests will be performed and a 2D/3D scan will give the doctor an idea about the number of ovarian follicles, and he will be able to decide on the best time to extract the eggs.

STEP 2 – Egg retrieval

After little or no stimulation, the immature eggs are retrieved with an ultrasound guided needle, similar to the IVF process. The needle is inserted through the top of the vagina and this process is performed under anesthesia to reduce patient discomfort.

STEP 3 – Maturation of Eggs

The immature eggs are then stimulated with hormones (old procedure) or cumulin protein and c-AMP (new procedure) to bring about the maturation, which normally requires 1-2 days.

STEP 4 – Fertilization of eggs

Usually ICSI is used to fertilize the mature eggs with sperm, and the resultant embryos are grown under controlled conditions of a laboratory for 3-5 days.

STEP 5 – Embryo transfer

The embryos are then transferred back to the uterus of the patient and pregnancy confirmation comes after two weeks.

 

Is IVM better than IVF?

Invitro maturation clearly has some benefits over the standard IVF procedure:

  • Reduced cost: Hormonal injections make for 30-50% of the total cost of IVF treatment, which is completely eliminated in IVM.
  • Lesser risk: The health risks associated with IVF (over-stimulation of ovaries with hormonal drugs) are not present in IVM cases because those drugs are not used.
  • Less time required: The hormonal injections in IVF take about 10-12 days, which are saved in IVF because none of this hormonal therapy is required.
  • More convenient: No injections are given in IVM and the patient doesn’t have to visit the clinic as frequently as in IVF.

 

Why don’t more doctors offer IVM?

If it is cheaper and safer than IVF, then why is IVM not used in routine? This is because:

  1. IVM results are still not comparable to IVF. Proper stimulation and extraction of good quality mature eggs is critical to IVF success and non-natural maturation of eggs in the lab (as in IVM) can affect the treatment outcome. Some doctors believe that maturation of the eggs inside the woman’s body (as in IVF) is a more natural process and thus gives better outcomes.
    It is also believed that IVM results are usually positive when atleast one naturally mature egg is extracted with the rest of the tiny follicles.
  2. The uterine lining or the endometrium is not sufficiently prepared to receive the embryo because no hormones are given in IVM, and consequently the success rates are lower
  3. Less 1 percent of patients are at risk of severe complications from OHSS in the standard IVF procedure, which is probably another reason why doctors are not pushing for IVM aggressively.

 

Who is IVM for?

IVM is indicated in:

  • Women who have Polycystic Ovarian Syndrome (PCOS)
  • Women who are at a high risk for Ovarian Hyperstimulation Syndrome (OHSS) with the use of hormonal drugs
  • Women who want to preserve their fertility before undergoing chemotherapy for cancer. The stimulation drugs are avoided as they can also trigger the cancer
  • Women who cannot bear elevated levels of estrogen for a long time because of some medical condition
  • Women who have immature eggs collected in the IVF procedure

However, very few clinics offer IVM and the decisions to choose this procedure over IVF is only made after thorough evaluation of the case.
 

IVM costs

The average cost of IVM is between $5,000 and $7,500, which is almost half of what an IVF cycle costs. Fewer tests and little to no hormonal injections help significantly cut the treatment costs.

 

IVM risks and side effects

Most ART procedures are quite safe and in IVF the main risk is about an adverse reaction to the stimulation drugs. Since the drugs are not used, this risk is not present in IVM.

There is also a risk of multiple pregnancies, if more than one embryo is transferred. Besides, as in any medical procedure, there is also a small risk of infection if you are not careful.

 

IVM success rates

The success rates of IVM are said to be around 25%-30%, about half that of IVF. Clinical success rates for the new method of IVM are not yet available.

 

Where can I get IVM?

Very few clinics offer IVM right now because there are not many takers. More research in this direction will hopefully see increased success rate of IVM in due time and make this a more viable option for women.

Doctors are also considering the use of hormone tablets that could improve the endometrial lining and make it more receptive for the embryos.

 

How long has IVM been around?

This science has been around for roughly 20 years and it was ten years ago that a woman first conceived with IVM.

Tina Milkovic, a patient of PCOS, was considering IVF when she was unable to conceive. But just as she was to start with the treatment, her clinic got licensed for IVM and she decided to give it a try. Luckily for her, the first cycle of IVM was successful and she had with her daughter, Isabella, and son, Ilia, who are ten-year-olds, as reported by the Telegraph.


 

Future of IVM

As scientists find ways of improving IVM success rates, the demand for this procedure will increase. Regular improvements in IVF are also making it safer for women, but even if adverse reaction to hormones is not a concern, IVM—being no hormone treatment—is significantly cheaper.

If doctors are able to match IVM’s success rates with those of IVF, the financial benefit in the former will definitely make it the preferred treatment.

However, right now, IVM is scarcely offered and there is not enough data to draw conclusions from. More research is needed to see if this procedure can actually be offered in routine.

 

Do you have any experience with or comments about IVM? Please share in the comments below: